In Memory of Thomas Szasz, MD (1920-2012)

     In Memoriam:

Thomas S. Szasz, MD    

                                 1920 - 2012

                                                                 

                                               Patrick B. Kavanaugh, Ph.D.

Dr. Thomas S. Szasz, MD passed away suddenly on Saturday, September 8^th, 2012 after falling at his home in Manlius, N.Y. A long time member of the Academy for the Study of the Psychoanalytic Arts, his voice and presence in the professional community will be greatly missed.

Born in Budapest, Hungary on April 15^th, 1920, he and his family emigrated to the United States in 1938. He earned an undergraduate degree in physics and a Bachelor of Arts in medicine from the University of Cincinnati in 1941, and he graduated from the university’s medical school three years later as class valedictorian. He received his diploma from the Chicago Institute for Psychoanalysis in 1950. After teaching at the Chicago Institute and serving at the United States Naval Medical Center in Bethesda, Maryland for several years, he joined the faculty of the psychiatry department of SUNY Upstate Medical University in Syracuse in 1956.  During his years at SUNY, he authored hundreds of articles and more than 30 books. Since 1990, he had been Professor Emeritus of Psychiatry at the SUNY Health Science Center.

A psychiatrist, academic, scholar, and speaker, Dr. Szasz held an unwavering commitment to the rights of the individual over the interests of the collective. His views on the inseparability of power, knowledge(s), rhetoric, and ethics in the mental health professions and their political and educational institutions were quite similar to those of the Canadian sociologist Erving Goffman and the French philosopher Michel Foucault.

         A controversial and celebrated psychoanalytic thinker, Szasz was known for his critique of the mental health professions’ pseudo-scientific foundations, medicine’s unholy alliance with the state, and the overlapping ideologies of social control shared by medicine and the state. Throughout his life, he argued vigorously against the myth of mental illness (1961/1974), the secularization of the mental health professions (1978/1988), and the subsequent evolution of the therapeutic state in modern society (Szasz, 1963; 1984).

             "Mental illness," Szasz maintained, is a metaphor for behaviors that are particularly offensive, disturbing, shocking, or perplexing to others. Such behaviors, he believed, were better thought of as “problems in living” as opposed to “mental illnesses” or “mental diseases, disorders, or disturbances.” And, to the extent that psychiatry, psychology, and psychoanalysis represent these “problems in living” as "medical diseases", their methods as "medical treatments," and their clients as “medically ill patients,” they reify the metaphor of “mental illness,” sanction the medicalization of the human condition, and contribute to the growth of The Therapeutic State, a fundamental threat to the freedoms and dignity of people in a democratic society.

         As the theological state swallows up everything human on the rational grounds that nothing falls outside the province of God and religion, the Therapeutic State swallows up everything human on the seemingly rational grounds that nothing falls outside the province of health and medicine (Szasz, 1963; 1978/1988). The therapeutic state compels everyone, without exception, to be dependent on the state in the essential medical and pharmacological aspects of his or her life (Szasz, 2001). And in the therapeutic state, such human behaviors as suicide, unconventional religious beliefs, racial bigotry, unhappiness, anxiety, shyness, sexual promiscuity, domestic violence, shoplifting, gambling, temper tantrums, addictions, overeating, smoking, and illegal drug use are all considered symptoms or illnesses that need to be treated and cured. A more thorough listing -and ever expanding codification- of such behaviors can be found in the DSM-IV, or the more recently approved DSM-V.

         In the therapeutic state, the idea of “mental illness” functions as a euphemism for “problems in living,” as a legally sanctioned excuse for crime, and encourages the abrogation of personal responsibility for one’s conduct in society. And, the ideas of “mental health” and “mental illness” have shaped, in large measure, our current culture of victimization, and the formation of our social, legal, and educational theories and policies (Szasz, 1963;1987/1997).

         Szasz viewed psychiatry, psychology, and psychoanalysis as the secularization of religion in modern society wherein medicine and its chemical controls substitute for the influences of religious morality and legal controls on behavior. Sanctioned and endorsed by the State through various licensing laws and mental health legislation, psychiatrists, psychologists, and psychoanalysts are the high priests and priestesses of the secular state religion: Mental Health. Premised on unscientific foundations, certain unethical practices flow from and sustain, at once, the mental health professions and the therapeutic state: coercive treatments, involuntary hospitalizations, and the various uses of psychiatric diagnoses in the courts, schools, and insurance and governmental entities (1977).

         Amongst the many honors and awards received during his lifetime, Dr. Szasz received the Hans W. Loewald Memorial Award in 2002 from the International Forum (Federation) for Psychoanalytic Education. In his Loewald Address, The Cure of Souls in the Therapeutic State, he asserts that psychoanalysis, in the affirmative, is a modern reincarnation of the age-old cure of souls as a secular-existential dialogue (Szasz, 1978/1988; 2002). And he articulates what he regards as the moral and political-economic core of, and the social conditions necessary for the psychoanalytic situation:  

         …the inviolable privacy of the professional-client relationship; the client's

         willingness to assume responsibility for his behavior and pay for the service

he receives; the analyst's willingness to eschew coercion justified by the legal-psychiatric principle of the ‘duty to protect’ (the client from himself and the community from the client); the legal system's willingness to exempt the analyst from this principle (at present an integral part of the mental health professional's legal and social mandate); and the public's willingness to accept that a secure guarantee of privacy and confidentiality, similar to that granted the priest, as an indispensable condition for the proper conduct of psychoanalysis as a secular ‘cure of souls.’ These conditions are absent in the therapeutic state. The result is a tragic loss of liberty for client, "therapist," and society.                     (Szasz, 2002, VI)

         For Szasz, psychoanalysis is a moral dialogue having absolutely nothing to do with illness or health, medicine or treatment, or any other idea that places “professional listening and talking” within the purview of the state’s licensing authority as a “medical treatment” (1965/1988; 2002). As a secular-moral “cure of souls,” psychoanalysis is initiated by the client on a wholly voluntary basis, consists of two consenting adults meeting by contractual agreement for the purpose of listening and talking with each other in the context of strict confidentiality (emphasis added).

          Throughout his life, Szasz’s controversial ideas profoundly impacted various citizens’ and professionals’ groups concerned with the medicalization of the human condition and the erosion of civil liberties. His ideas have prompted some professionals to rethink the conceptual foundations of psychoanalysis, to call their received identity, purpose and ethics as healthcare professionals into question, and to form such psychoanalytic interest, educational, and practice groups as the Academy for the Study of the Psychoanalytic Arts. Died at the age of 92: R.I.P. And may his spirit live on…

REFERENCES

Szasz, T. (1961/1974). The Myth of Mental Illness: Foundations of a Theory of Personal

         Conduct. Harper & Rowe, Publishers, New York.

Szasz, T. (1963). Law, Liberty, and Psychiatry: An Inquiry Into The Social uses of

         Mental Health Practices. The Macmillan Company, New York, NY.

Szasz, T. (1965/1988). The Ethics of Psychoanalysis: The Theory and Method of

         Autonomous Psychotherapy. Syracuse: Syracuse University Press.

Szasz, T. (1974). The Age of Madness: The History of Involuntary Mental

         Hospitalization. Jason Aronson, New York.

Szasz, T. (1977). Psychiatric Slavery: When Confinement and Coercion Masquerade as

         Cure. The Free Press, Macmillan Co. Inc., New York.

Szasz, T. (1978/1988). The Myth of Psychotherapy: Mental Healing as Religion,

         Rhetoric, and Repression. Syracuse: Syracuse University Press.

Szasz, T.(1984). The Therapeutic State: Psychiatry in the Mirror of Current Events.

         Buffalo: Prometheus Books.

Szasz, T. (1987/1997). Insanity: The Idea and Its Consequences. Syracuse: Syracuse

         University Press.

Szasz, T. (2001/2003). Pharmacracy: Medicine and Politics in America. Syracuse:

         Syracuse University Press.

Szasz, T. (2002). The Cure of Souls in the Therapeutic State. The Loewald Memorial

         Address; 13^th Annual Interdisciplinary Conference of the International Federation

         for Psychoanalytic Education. Fort Lauderdale, FL.