interview with thomas szasz

8/18/2019 Interview With Thomas Szasz

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Randall C. Wyatt: I am going to ask you a wide variety of questions, given the diversity of your

interests, and I want to make sure to also focus on your work as a psychotherapist. A little

ackground first. !ou"ve een well#known for the phrase, $the myth of mental illness.$ In lessthan %&&& words, what does it mean'

(homas )*as*: (he phrase $the myth of mental illness$ means that mental illness qua illness

does not e+ist. (he scientific concept of illness refers to a odily lesion, that is, to a material structural or functional anormality of the ody, as a machine. (his is the classic, -ictorian,

pathological definition of disease and it is still the definition of disease used y pathologists and

physicians as scientific healers.

(he rain is an organ like the ones, liver, kidney, and so on and of course can e diseased.

(hat"s the domain of neurology. )ince a mind is not a odily organ, it cannot e diseased, e+cept

in a metaphorical sense in the sense in which we also say that a oke is sick or the economy issick. (hose are metaphorical ways of saying that some ehavior or condition is ad, disapproved,

causing unhappiness, etc.

In other words, talking aout $sick minds$ is analogous to talking aout $sick okes$ or $sick

economies.$In other words, talking aout $sick minds$ is analogous to talking aout $sick okes$ or $sick

economies.$ In the case of mental illness, we are dealing with a metaphorical way of e+pressingthe view that the speaker thinks there is something wrong aout the ehavior of the person to

whom he attriutes the $illness.$

In short, ust as there were no witches, only women disapproved and called $witches,$ so there

are no mental diseases, only ehaviors of which psychiatrists disapprove and call them $mental

illnesses.$ /et"s say a person has a fear of going out into the open. 0sychiatrists call that

$agoraphoia$ and claim it is an illness. 1r if a person has odd ideas or perceptions, psychiatristssay he has $delusions$ or $hallucinations.$ 1r he uses illegal drugs or commits mass murder.

(hese are all instances of ehaviors, not diseases. 2early everything I say aout psychiatryfollows from that.RW: /et"s say that modern science, with all the advances in genetics and iochemistry, finds out

that there are some ehavioral correlates of iological deficits or imalances, or genetic defects.

/et"s say people who have hallucinations or are delusional have some iological deficits. Whatdoes that make of your ideas'

(): )uch a development would validate my views, not invalidate them, as my critics think.

1viously, I don"t deny the e+istence of rain diseases3 on the contrary, my point is that if mental

illnesses are rain diseases, we ought to call them rain diseases and treat them as rain diseases and not call them mental illnesses and treat them as such. In the %4th century, madhouses

were full of people who were $cra*y$3 more than half of them, as it turned out, had rain diseases

mainly neurosyphilis, or rain inuries, into+ications, or infections. 1nce that was understood,neurosyphilis ceased to e a mental illness and ecame a rain disease. (he same thing happened

with epilepsy.RW: It"s interesting, ecause a lot of students of mine, and colleagues, who have

read your work or heard of your ideas, think that when condition previously thought to e mentalis to e a rain disease, as noted, your ideas ecome moot.

(): (hat"s ecause they are not familiar with the history of psychiatry, don"t really understand

what a metaphor is, and don"t want to see how and why psychiatric diagnoses are attached to

people. (ed 5ac*ynski, the so#called 6naomer, was diagnosed as schi*ophrenic y


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ermatologists, ophthalmologists, gynecologists, don"t have any patients who don"t want to e

their patients. 7ut the psychiatrists" patients are paradigmatically involuntarily.

ermatologists, ophthalmologists, gynecologists, don"t have any patients who don"t want to etheir patients. 7ut the psychiatrists" patients are paradigmatically involuntarily.

1riginally, all mental patients were involuntary, state hospital patients. (hat concept, that phenomenon, still forms the nucleus of psychiatry. And that is what is asically wrong with

psychiatry. In my view, involuntary hospitali*ation and the insanity defense ought to e

aolished, e+actly as slavery was aolished, or the disfranchisement of women was aolished, orthe persecution of homose+uals was aolished. 1nly then could we egin to e+amine so#called

$mental illnesses$ as forms of ehavior, like other ehaviors. 7ack to (op

Slavery, Witchcraft, and Psychiatry

RW: In terms of involuntary hospitali*ation and coercive psychiatry, which you"ve critiqued in

your works. (): 8+cuse me, all psychiatry is coercive, actually or potentially ecause once a person

walks into a psychiatrist"s office, under certain conditions, that psychiatrist has the legal right and

the legal duty to commit that person. (he psychiatrist has the duty to prevent suicide and murder.(he priest hearing confession has no such duty. (he lawyer and the udge have no such duties.

2o other person in society has the kind of power the psychiatrist has. And that is the power of

which psychiatrists must e deprived, ust as white men had to e deprived of the power toenslave lack men. 0riests used to have involuntary clients. 2ow we call that forcile religious

conversion and religious persecution3 it used to e called $practicing the true faith$ or $loving


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patients often want and demand3 it"s a medicali*ed version of drug distriution. 0hysicians did

the same thing with liquor during 0rohiition, which was quite lucrative

.RW: And now psychiatry and pharmacology can e a lucrative usiness. ():0sychiatry is a lucrative usiness only insofar as it partakes of these two medical#psychiatric

privileges or monopolies prescriing drugs, which only licensed physicians can do3 and

creating their own patients, that is, transforming people into patients against their will, whichonly psychiatrists can do.

0sychiatry is a lucrative usiness only insofar as it partakes of these two medical#psychiatric

privileges or monopolies prescriing drugs, which only licensed physicians can do3 andcreating their own patients, that is, transforming people into patients against their will, which

only psychiatrists can do. 7ack to (op

The Right to Use Drugs

RW: )o what is your view on psychiatric medication for people suffering from $schi*ophrenia$

or $prolems in living$ as you call it, or $interpersonal difficulties,$ or $intra#psychicdifficulties.$ Whatever you call it, people suffer or are trouled internally or interpersonally.

What is your view on the use of either legal or illegal drugs to help people cope with these

things' (): I am smiling ecause I know you know my views= ;owever, I wouldn"t phrase thequestion this way. In my opinion, using drugs is a fundamental human right, similar to using

ooks or prayer. ;ence, it comes down to the question of what does a person want and how can

he get what he wants' If a person wants a ook, he can go to a store and get it or get it on theInternet. ;e ought to e ale to get a drug the same way. If he doesn"t know what to take, then he

could go to a doctor or a pharmacist and ask them. And then he should e ale to go and uy

it.RW: (hat rings up the issue of drug and prescription laws, which you have written aout

e+tensively. (): Indeed. 0rescription drug laws are a footnote to drug prohiition. 0rescription

laws should e repealed. All drug laws should e repealed. (hen, people could decide forthemselves what helps them est to relieve their e+istential ails, assuming they want to do it with

a drug: opium or mariuana or cigarettes or ;aldol or -alium. After all, the only ariter of whatails a person $mentally$ and what makes him feel or function etter, as he defines etter, is the

patient. We don"t have any laoratory tests for neuroses and psychoses.

As for insomnia, typically that"s a complaint, an indirect communication, to otain sleeping pills.

A person can"t go to a physician and tell him: 0lease write me a prescription for a ariturate. If

he did that, he would e diagnosed and denounced as an addict. )o he must say: $I can"t sleep.$

;ow could the doctor know if that"s true'RW: !ou ask him how many hours he sleeps, he saystwo hours a night. (): ;ow would the doctor know if that"s true' (he term $insomnia$ can

function as a strategic lie that the patient has to utter to get the prescription he wants. 7ack to(op

The Therapeutic State and the Medica Model

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RW: !ou seem to have a different view of the medical model of medicine, than the medical

model of psychiatry. (): !es, very much so. We don"t speak of the medical model of medicine in

medicine or the medical model of pneumonia. (here is no other model. We don"t speak of theelectrical model of why a light ul emits light. /anguage is very important. If a person says: $I

am against the medical model of mental illness,$ that implies that mental illness e+ists and that

there is some other model of it. 7ut there is no mental illness. (here is no need for any model ofit.

(he important issue is not the $medical model,$ a adly aused term3 the issue is the $pediatricmodel,$ the $irresponsiility model$ treating people laeled as mentally ill as if they were

little children and as if the psychiatrist was their parent. (he pillars of psychiatry are medically

rationali*ed and udicially legitimi*ed coercions and e+cuses.RW: If you were to use mental

illness as a metaphor, or pseudonym... disease meaning $dis#ease,$ people are personallydistressed, the psychosocial model of mental illness. If you sustitute $emotional troules$. ():

2o. (hat won"t do. Almost anything can e the cause of emotional troule eing lack or

eing poor or eing rich, for that matter. Innumerale human conditions can create human

distress. Which ones are we going to medicali*e, and which ones are we not' We used tomedicali*e, psychiatri*e, lacks running away from slavery, masturation, homose+uality,

contraception. 2ow we don"t. Instead we medicali*e what used to e called melancholia, andsloth, and self#murder, and racism, and se+ism.RW: (o shift gears. (): /et"s not yet. 7ecause I

want to add that

it is this tendency to call more and more human prolems $diseases$ and then try to remedythem, or $attack$ them, as if they were diseases is what I call $the therapeutic state.$

it is this tendency to call more and more human prolems $diseases$ and then try to remedy

them, or $attack$ them, as if they were diseases is what I call $the therapeutic state.$RW:

Certainly everything used to e viewed religiously, and now so much is seen as medical. (hetransformation is almost pure. (): 8+actly= And it"s perfectly ovious. It requires the systematic

educational and political duming down of people not to see it. (hree hundred years ago, every

human predicament was seen as a religious prolem sickness, poverty, suicide, war. 2ow theyare all seen as medical prolems as psychiatric prolems, as caused y genes and curale with

$therapy.$ In the past, the criminal law was imued with theology3 now, it"s imued with

psychiatry.RW: 0resident 7ill Clinton is a prime e+ample of how we use different models todescrie the same prolem. ;is wife said his prolems were due to $emotional prolems$ in his

childhood. ;is rother said he was a se+ addict, ecause he was a drug addict, himself. And 7ill

Clinton said it was a sin issue the religious model. ;e went to a minister. (): (hat"s a good

point. 7ut note that Clinton didn"t go to a real minister. ;e went to a politician >esse >ackson.;is o was to make Clinton look good again. And he did it. Clinton hand#picked him as he did

the others, much as a medieval emperor might have hand picked a ishop to make him look

good.RW: Can I shift gears now' (): )ure. 7ack to (op

Liberty and the Practice of Psychotherapy

RW: !ou"re known as a liertarian.

(): !es, I am a liertarian.

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RW: It"s a philosophical view, an economic and political view. What does that mean in terms of

practicing psychotherapy' (): I"ll start at the end, so to speak. If you use language carefully and

are serious aout liertarianism and psychiatry, then the term $liertarian psychiatrist$ is, quitesimply, an o+ymoron. /iertarianism means that individual lierty is a more important value

than mental health, however defined. /ierty is certainly more important than having

psychiatrists lock you up to protect you from yourself. 0sychiatry stands or falls with coercion,with civil commitment. 2on#coercive psychiatry is also an o+ymoron. (his is one of the main

reasons why I never considered myself a psychiatrist ecause I always reected psychiatric

coercions.

2ow, in term of political philosophy, liertarianism is what, in the %4th century, was called

lieralism. 2owadays it"s sometimes also called $classical lieralism.$ It"s a political ideology

that views the state as an apparatus with a monopoly on the legitimate use of force and hence adanger to individual lierty. Contrariwise, the modern $/ieral$ view regards the state as a

protector, a enevolent parent who provides security for its citi*ens as quasi#children. (o me,

eing a liertarian means regarding people as adults, responsile for their ehavior3 e+pecting

them to support themselves, instead of eing supported y the government3 e+pecting them to pay for what they want, instead of getting it from doctors or the state ecause they need it3 it"s the

old >effersonian idea that he who governs least, governs est. (he law should protect people intheir rights to life, lierty, and property from other people who want to deprive them of these

goods. (he law should not protect people from themselves.

(his means that, as far as possile, medical care ought to e distriuted, economically speaking,

as a personal service in the free market. (here is much wisdom in the adage, $0eople pay for

what they value, and value what they pay for.$ It"s dangerous to depart too far from this

principle.RW: Why does money necessarily have to come into it' If people have less money,they can"t afford as much as others who have more money. A poor person can enefit from

therapy. (): 1f course. (he issue you raise confuses the quest for egalitarianism with the

concepts of health or psychotherapy and also with the quest for health. Why should psychotherapy e dispensed in a more egalitarian manner than anything else' Also, people often

value things other than health more highly than they value health such as adventure, danger,

e+citement, smoking.

/et me elaorate on this. 8conomists and epidemiologist have shown, eyond a shadow of a

dout, that the two variales that correlate most closely with good health are the right to property

and individual lierty the free market. (he people who enoy the est health today are peoplein the Western capitalist countries and in >apan3 and those in the poorest health are the people

who enoyed the lessings of ?& years of paternalistic statist, Communism. In the )oviet 6nion,

where people"s political lierty and economic well eing were systematically undermined y thestate where they enoyed $equal misery for all$ life e+pectancy dropped from more than @&

years to aout years. uring the same period, in advanced countries, it increased steadily and

is now almost ?&. And medical care has little to do with it, since Russia had access to medicalscience and technology. It"s primarily a matter of life style of what used to e called good

haits versus ad haits. And of good pulic health, in the sense of having a safe physical

environment. 7ack to (op

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Psychotherapy, Szasz Style

RW: !ou wrote, $(he 8thics of 0sychoanalysis$ in %4B. (hat was your diving into psychotherapy, psychoanalysis. What do you have to say aout what is useful in psychotherapy'

What theories do you hold to or do you find valuale' When you"re in a free relationship of

psychotherapy simply put, one person helping another with their personal issues what haveyou found to e helpful, and what theories have you used in your own work' (): !ou are asking

two questions: what did I find useful or interesting and what theories did I use. (he kind of

therapy one does, if one does it well, in my opinion, is selected and depends primarily on thetherapist.

ifferent people have different temperaments aout how to relate to other people. 7ecause the

therapeutic relationship is an intimate, human relationship with another human eing, the kind of

psychotherapy that makes sense to therapists reflects the kind of person they are.ifferent people have different temperaments aout how to relate to other people. 7ecause the

therapeutic relationship is an intimate, human relationship with another human eing, the kind of

psychotherapy that makes sense to therapists reflects the kind of person they are. In this respect,

psychotherapy could not e more different from physical therapies in medicine. (he propertreatment of diaetes does not depend, and ought not to depend, on the doctor"s personality. It"s a

matter of medical science. 1n the other hand, the proper treatment of a person in distress seekinghelp is a matter of values and personal styles on the parts of oth therapist and patient.

(he proper analogies to psychotherapy are not medical treatment ut marriage or raisingchildren. ;ow should a man relate to his wife, and vice versa' ;ow do you raise your child'

ifferent people relate differently to their wives or husands or children. As long as their life

style works for them, that"s all there is to it. )o, first I say that I elieve that any kind of so#called

$therapy$ any kind of human helping situation that makes sense to oth participants and thatcan e entered and e+ited and conducted wholly consensually, voluntary, and that is devoid of

force and fraud any and all of that is, y definition, helpful. If it were not helpful, the clientwouldn"t come and pay for it. (he fact that a client returns and pays for what he gets from atherapist is, prima facie evidence for me, that he finds it helpful.

I would compare it, once again, to religion, to going to church. 0ersonally, I"m not religious. 7utI respect religions and people who find solace in their faith. illions of persons the world over

continue to go to church. (hey wouldn"t e going to church if they didn"t find it helpful,

assuming they"re not ust going for purely social reasons, in which case they still find it useful,

though not for strictly theological reasons.RW: What was your initial interest in ecoming a psychiatrist' (): I was never interested in ecoming a psychiatrist and never considered myself a

psychiatrist. 0sychiatry was a category I had to operate in, given the society in which we live. I

was interested in psychotherapy, in what seemed to me the core of the Dreudian premise # and promise, which, unfortunately, never materiali*ed as a professional code. Dreud and >ung and

Adler had a very good idea that is, that two people, a professional and a client get together,

in a confidential relationship, and the one tries to help the other live his life etter. 8ach of these pioneers emphasi*ed a different aspect of how est to go aout this usiness. (here are three

aspects to life: the past, the present, and the future.


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recogni*e his evasions of responsiility, often e+pressed as $symptoms.$RW: (hat"s a dialogue.

(): !es, that is likely to e a focus of the therapeutic dialogue. Actually, some people say they

want to do this or that say stop smoking or e a etter parent ut they don"t really want todo it, don"t want to forego the pleasures of smoking or e+perience the urdens of caring for a

dependent. A person comes to see a therapist and says that he wants to kill himself. 1viously,

that"s not all he wants. ;e also wants psychotherapy. In short, people are often amivalent aout asic choices. Amivalence is not a pathological symptom3 it a normal, appropriate mental state

of many people, in many situations.RW: Come ack home to therapy, again, you"re not practicing

any more' (): 2o, ut I did for years.RW: What was the most difficult and what was the mostsatisfying for you in working with people one#to#one' (): I found practicing therapy very

satisfying and not at all arduous. I left Chicago for )yracuse mainly to escape having to fully

support myself from doing therapy, which can create financial temptations to make the client

dependent on therapy. 1f course, everyone who does therapy is likely to say it, ut I think a lotof people enefited from having a $conversation$ with me.RW: With all your work in politics

and philosophy, your work on psychotherapy is overlooked. (hat you were in the trenches,

helping people, conversing with them. (): And many of the people I saw would have een

diagnosed as very sick y other people. )ome of them would have een diagnosed as psychoticand put on psychiatric drugs.RW: !ou never prescried' (): 2o. 2ever when practicing

psychiatry psychotherapy I never prescried a drug. I never gave insulin shock or electric shock. I never committed

anyone. I never testified in court that a criminal was not responsile for his crimes. I never saw,

as a patient, anyone who did not want to see me.I never prescried a drug. I never gave insulin shock or electric shock. I never committed

anyone. I never testified in court that a criminal was not responsile for his crimes. I never saw,

as a patient, anyone who did not want to see me. I went into psychiatry with my eyes wide open.

I never viewed psychiatry or psychotherapy as a part of medicine. 0erhaps I should add, thoughit should e ovious, that I had no oections to the patient taking drugs or doing anything else

he wanted. As far as I was concerned, things outside the consulting room were not my usiness

in the sense that if the patient wanted to take drugs, he had to go to a doctor and get them, ustas if he wanted a divorce, he had to go to a lawyer.RW: With the laws today, it"s very hard for a

therapist or a psychiatrist to practice psychotherapy. !ou can shy away from involuntary

hospitali*ation, or other state mandates, or insurance demands, ut when push comes to shove,you are pressured to reak confidences or end up in troule. (): (hat"s putting it mildly. Dor all

practical purposes, it"s impossile. It is the hallmark of totalitarianism that there can e no

personal secrets from the state. (hat"s why I call our present political system a $therapeutic

state.$ )uch a state is your friend, your enefactor, your doctor. Why should you want to hideanything from it' 5eep in mind that it was impossile to do psychotherapy in )oviet Russia, too,

or in 2a*i


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must stop, must prevent, all these things. (he therapist must e a policeman pretending to e

therapist. Increasingly, people complain aout one or another of these $prolems of

confidentiality,$ ut they don"t see the larger picture. (hey don"t see that this has to do with thealliance of psychiatry and psychotherapy with the state, replicating the alliance of church and

state and all its implications.RW: 8ven more so, when people go to a therapist who"s working

under managed care, they have to have enough prolems to get in the door to see the therapistand talk, or get drugs, ut not too many prolems. If they have too many prolems they"re seen

as $chronic$ and they can"t get help. o you think a therapist working under managed care is ale

to freely practice psychotherapy' Is the client free to work in psychotherapy' (): 0sychotherapyunder managed care is a ad oke. It"s like religion under managed care, or education under

managed care. 8ven medical care gets complicated and contaminated if the direct relationship

etween doctor and patient is disrupted y the input of third parties, if the patient doesn"t, in

some form, pay for what he gets, and if he can"t get what he wants with the money he pays.

odern psychotherapy is ased on psychoanalysis, and the psychoanalytic relationship was

ased on the relationship etween priest and penitent in the confessional. (he cru+ of the

confessional is self#accusation on the part of the penitent, and the secure promise, y the priest,that the confession he hears will and can have no consequences for the self#accuser in this world

Eut only in the ne+tF. A priest hearing confession and working as a spy for the state would e amoral oscenity. 2ot in the darkest days of totalitarianism did such a thing occur.

(he same thing is true for psychotherapy ased on confidentiality and on the premise that the patient $accuses$ himself in the hope that, y so doing and with the help of the therapist, he

might e ale to change himself.

What is truly ugly aout psychotherapy today is that many patients laor under the false elief

that what they say to the therapist is confidentialWhat is truly ugly aout psychotherapy today is that many patients laor under the false elief

that what they say to the therapist is confidential, and that therapists do not tell patients, up front,

that if they utter certain thought and words, the therapist will report them to the appropriateauthorities, they may e deprived of lierty, of their o, of their good names, and so forth.

2ow, it should e clear that to place psychotherapy under the control of an insurance company or the state that"s ust heaping nonsense upon nonsense. We can still call it psychotherapy, and

we can treat it as if doing psychotherapy, $curing souls,$ were in principle no different from

doing orthopedic surgery, setting a fractured one. 7ut, psychotherapy is like going to church.

!ou go there voluntarily for a certain kind of service from a certain person. And it"s spiritual. It"snot physical.RW: We only have a couple of minutes left. I want to ask you one or two more

questions. It was a pleasure to talk aout your therapy, ecause you get very little chance to talk

aout that work given the vitriol surrounding many of your views. (): (hank you. 7ack to (op

ritics and !eroes

RW: !ou"ve had a lot of critics in your career. (): !ou can say that again=RW: aye anenormous amount= In your ook, Insanity, you point out all the critics. (): 2ot all of them=RW:

!ou couldn"t mention all of them' (): 2o. >ust a few ElaughterF.RW: ;ow do you deal with this'

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!ou"re one of the most critici*ed psychiatrists in history, perhaps. I don"t know anyody else

who"s as critici*ed as you are. (): I was very fortunate. I had very good parents, a very good

rother, a very good education as a child in 7udapest. I have very fine children, good friends,good health, good haits, a fair amount of intelligence. Really, I have always felt lessed. It also

helped at lot that I felt there were many people who agreed with me that what I"m simply

saying is simply J K J L ut that many people are afraid to say this when it is personally and politically improvident to do so. I haven"t made any scientific discoveries. I"m simply saying that

if you are white and don"t like lacks, or vice versa, that"s not a disease, it"s a preudice.

If you"re in a uilding that you can"t get out of, that"s not a hospital, it"s a prison.If you"re in a uilding that you can"t get out of, that"s not a hospital, it"s a prison. I don"t care how

many people call racism an illness or involuntary mental hospitali*ation a treatment.RW: id the

criticism ever get you down' (): 1f course it did, especially when people actually wanted to

inure me personally, professionally, legally. 2o need to get into that. I tried to protect myself

and escaped, luckily enough. I found oundless support in literature, in the great writers. Isen

said, among other things, that $the compact maority is always wrong.$RW: y last question. In

addition to eing critici*ed a great deal, you are also somewhat of a hero to a lot of people, in

what you"ve fought for, lierty, individual rights, and increased freedoms with responsiility.

Who are the your heroes, since childhood and now' (): Where should I start, there are many'

)hakespeare, efferson, adison, >ohn )tuart ill, ark (wain, encken.

(olstoy, ostoyevski, Chekhov. 1rwell, C.). /ewis. /udwig von ises, D.A. ;ayek. Camus and

)artre, though personally and politically, he is rather despicale. ;e was a Communist

sympathi*er. ;e was willing to overlook the

interview with thomas szasz

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