 

HOME » MENTAL HEALTH AND THE LAW

Recycling Thomas Szasz

Create PDF in your applications with the Pdfcrowd HTML to PDF API PDFCROWD
 By The Editors
August 30, 2012

 Tweet  Like  Submit  Plus

E
ditors’ Note: Rael Jean Isaac is co-author (with Virginia Armat) of Madness in the
Streets: How Psychiatry and the Law Abandoned the Mentally Ill, Free Press, 1990.
We are pleased to publish her letter here.

For decades Cato has remained attached to the ideas of Thomas Szasz, most recently
recycled in the essay by Szasz acolyte Jeffrey Schaler in Cato Unbound. The notion that
there is no such thing as mental illness is not a “big picture” or a profound idea but a
foolish one, and Cato discredits itself by clinging to it. It is deeply ironic that it should be left
to D.J. Jaffe, whose politically liberal beliefs are diametrically opposed to those of Cato (and
to my own), to explain to Cato what a libertarian approach to mental illness should be,
given libertarian principles and the realities of mental illness. Indeed Jacob Sullum
concedes as much: were these diseases, Sullum agrees, Jaffe’s suggestions would make
sense for libertarians.

On what do Szasz and followers like Schaler and Sullum base their claim that mental illness
does not exist? It’s on rhetorical sleight of hand. To quote Szasz (and Schaler echoes him to
such an extent that it makes sense to go to the source): “Mental illnesses do not exist; indeed
they cannot exist, because the mind is not a bodily part or bodily organ.”[1] As one of his

Create PDF in your applications with the Pdfcrowd HTML to PDF API PDFCROWD
 critics has aptly observed, Szasz seems to think words can create and destroy, a belief in
“word magic” that one usually loses at the age of two.[2] For of course what is diseased in
“mental illness” is the brain, which is as susceptible to malfunction as any other
bodily organ.

Schaler, echoing Szasz, tries to dispose of mental illness as brain diseases by arguing that
they do not appear in pathology textbooks. Ronald Pies has torn apart this argument in his
letter to Cato Unbound, so there is no need to repeat what he says here. In his letter, D.J.
Jaffe reports on the advances in brain imagery that have shown differences in the brain
between mentally ill and normal individuals, such as enlarged ventricles and decreased
functioning of the prefrontal area.

The notion that mental illness does not exist, which Szasz first advanced in the 1950s,
would normally have remained a fringe curiosity. The reason it didn’t–and this should give
Cato pause—is that the idea was taken up by the counter-culture and political radicals of
the 1960s. The mentally ill became a group to be “liberated” along with blacks, Hispanics
and Third World peoples. The mentally ill were an especially attractive cause because they
were imprisoned, not in the invisible institutional complexes of law and custom, but in the
concrete brick and mortar of the asylum. While many have noted the radical egalitarianism
of the adversary culture, what escaped notice is the way that denial of mental illness
dissolved the most fundamental distinction of all: that between sanity and madness. For the
most radical claim of the left was that all realities were equal. Indeed some countercultural
intellectuals went so far as to invert the consensual order. The mad were sane, the sane
mad. After all the mad rejected the unacceptable, irrational reality of a rotten social system,
while those called sane conformed to the sick values of the culture.[3]

Create PDF in your applications with the Pdfcrowd HTML to PDF API PDFCROWD
 The upshot was that a literally mad idea—the bizarre conceit that the ancient, ongoing and
universal scourge of mental illness did not in fact exist—became the foundation of public
policy. Legislators and lawyers emptied state mental hospitals. As readers of Amanda
Pustilnik’s contribution already know, their role has been taken over by jails and prisons.
Involuntary commitment became contingent on imminent dangerousness and even then
treatment was uncertain because the law instituted a right to refuse treatment, which could
be exercised even after commitment.

These developments have wreaked untold havoc on the lives of the mentally ill, who have
been left, in psychiatrist Darrold Treffert’s famous phrase, to die with their rights on. It has
devastated families who have been forced to watch those they love deteriorate and are
helpless to obtain treatment for them. Szasz recognized what the impact on families would
be and, with typical hard-heartedness, shrugged it off. Families, says Szasz, have three
options: they can beg the individual to change his behavior, sever the relationship, or enlist
psychiatric help to obtain involuntary commitment. This last, says Szasz, “ensures the
maintenance of family relationships, loyalties, and responsibilities as positive
moral values.”[4]

Szasz’s first option is (to use his favorite word) a myth. A mentally ill person cannot alter
his behavior on command for he is a prisoner of his aberrant mental processes. The third
option has largely been taken away. That leaves the second option and in many cases the
family does indeed eventually withdraw, even flee from their mentally ill relative, whom
they may physically fear. It is often these people, untreated and without family anchor,
who engage in the random violence that makes headlines. More frequently, families
reluctantly pursue what has become a fourth option, becoming a mini-institution. Only this

Create PDF in your applications with the Pdfcrowd HTML to PDF API PDFCROWD
 staff is without shifts, without backup, without the ability to enforce daily routines or
medication compliance.

Szasz asks: “Which should we prefer, the integrity of the family or the autonomy of the
individual?” (Italics in original)[5] For Szasz the choice is easy. He declares “Autonomy is my
religion.”[6] This emphasis on human autonomy is doubtless the source of the appeal of his
ideas for Cato. But however ideologically inconvenient, the fact is that the mentally ill do
not possess autonomy as Szasz himself defines it: “[Autonomy is] freedom to develop one’s
self—to increase one’s knowledge, improve one’s skills, and achieve responsibility for one’s
conduct. And it is freedom to lead one’s own life, to choose among alternative courses of
action so long as no injury to others results.” But the mentally ill possess none of these
freedoms as long as they are confined in the terrible prison of psychosis. The irony is that it
is medications that can restore the individual’s autonomy, his ability to make choices in any
meaningful sense.

What will it take for Cato to wake up from its own delusions regarding mental illness? In
mental illness rational arguments are helpless to change distorted thinking. Let’s hope that
does not prove to be the case with Cato, whose positions on so many issues are a model of
intelligence and clarity.

Notes

[1] Thomas Szasz, The Therapeutic State, Buffalo: Prometheus Books, 1984, p. 15.

[2] Richard E. Vatz and Lee S. Weinberg, eds., Thomas Szasz: Primary Values and Major
Contentions, Buffalo: Prometheus Books, 1983, p. 199.

Create PDF in your applications with the Pdfcrowd HTML to PDF API PDFCROWD
 [3] Rael Jean Isaac and Virginia Armat, Madness in the Streets: How Psychiatry and the Law
Abandoned the Mentally Ill New York, The Free Press, 1980, pp. 25-26.

[4] Thomas Szasz, Law, Liberty and Psychiatry, New York: Macmillan, 1963, pp. 153-4.

[5] Ibid., p. 154.

[6] Ibid.

ALSO FROM THIS ISSUE

Lead Essay

Strategies of Psychiatric Coercion by Jeffrey A. Schaler

Professor Schaler notes that mental illness differs in several important ways from physical
illness, and these ways make a mockery of conventional diagnosis. Nonetheless mental
illness plays an important role in our legal system; it permits psychiatrists to exercise a
significant degree of coercion. Schaler challenges this arrangement and argues that those
whom we may classify as mentally ill are still deserving of their liberties, including the
liberty to refuse treatment. Schaler also questions whether “insanity” is an appropriate
legal fiction at all.

Response Essays

A Clinical Reality Check by Allen Frances

Professor Frances agrees that mental disorders are not diseases properly speaking, but he
maintains that they are nonetheless useful analytic constructs. As to coercive psychiatric
treatment, he argues it can indeed be a horrific abuse. Still, in some especially desperate

Create PDF in your applications with the Pdfcrowd HTML to PDF API PDFCROWD
 cases it will be necessary to save lives and to prevent even greater harms. He recommends
several practices designed to minimize the frequency and risks of coercive treatments.

Psychiatrists Create Their Own Reality by Jacob Sullum

Jacob Sullum asks the mental health establishment for consistency: If mental disorders are
not diseases, what justifies involuntary treatment? Evidence of criminal conduct is a matter
for law enforcement, not mental health. And how is it that we punish sexual predators (on
the theory that they are responsible) — then treat them afterward (on the theory that they
aren’t)? Psychiatric diagnoses are ultimately arbitrary, Sullum argues, and they lead to the
arbitrary exercise of power.

Calling Mental Illness “Myth” Leads to State Coercion by Amanda Pustilnik

Amanda Pustilnik argues that the most profound violations of liberty in this area don’t
come from coercive psychiatry, but from the warehousing of the mentally ill in our criminal
justice system. Such people aren’t more likely to commit crimes, but they fare badly in the
criminal justice system, where unusual behavior leads to convictions, longer sentences,
parole violations, and reincarceration.

The Conversation

In Search of a Middle Ground by Allen Frances

Reply to Allen Frances by Jeffrey A. Schaler

A Way Forward? Or, Libertarianism Is Not Equal to Indifference by Amanda Pustilnik

Mental Disorders Are Not a Myth by Allen Frances

Finding a Place for the Mentally Ill by Jacob Sullum

Reply to Amanda Pustilnik by Jeffrey A. Schaler

Create PDF in your applications with the Pdfcrowd HTML to PDF API PDFCROWD
 One Last Try at Synthesis by Allen Frances

The Legal and Moral Problems of Involuntary Commitment by Jacob Sullum

Access to Voluntary Treatment by Amanda Pustilnik

A Summation, but Not a Middle Ground by Jeffrey A. Schaler

Letters: A Libertarian’s Proposal to Reform Involuntary Commitment by The Editors

Letters: The Pathology and Reality of Schizophrenia by The Editors

Diagnosis Isn’t the Problem. Coercion Is. by The Editors

Recycling Thomas Szasz by The Editors

 Tweet  Like  Submit  Plus

DISCLAIMER

Cato Unbound is a forum for the discussion of diverse and often controversial ideas and opinions. The views expressed on the website belong to their authors alone and
do not necessarily reflect the views of the staff or supporters of the Cato Institute.

ALSO FROM CATO SOCIAL MEDIA

CATO.ORG  FACEBOOK

Create PDF in your applications with the Pdfcrowd HTML to PDF API PDFCROWD
 STUDENT PROGRAMS  TWITTER

DOWNSIZINGGOVERNMENT.ORG  RSS

LIBERTARIANISM.ORG

SIGN UP
HUMANPROGRESS.ORG

Receive the latest posts from Cato Unbound:

UNLAWFUL SHIELD

Email SUBSCRIBE
OVERLAWYERED

ELCATO.ORG

ALT-M

Cato Institute
1000 Massachusetts Ave, NW
Washington, DC 20001-5403
Phone (202) 842 0200
Fax (202) 842 3490

Create PDF in your applications with the Pdfcrowd HTML to PDF API PDFCROWD