Medications & Psychiatry
Resources

 email page    print page

All Topic Reviews
Psychiatry Under the InfluenceAlternatives Beyond PsychiatryAmerican MadnessAmerican PsychosisAn Unquiet MindAntipsychiatryBad PharmaBefore ProzacBetter Than ProzacBiological PsychiatryBlack Man in a White CoatBlaming the BrainBrain Science and Psychological DisordersBrainwashedClinical Psychopharmacology Made Ridiculously SimpleComfortably NumbCompassion and Healing in Medicine and SocietyComplete Mental HealthConcise Guide to PsychopharmacologyCrackedCultural FormulationDeconstructing PsychosisDemystifying PsychiatryDiagnosing the Diagnostic and Statistical Manual of Mental DisordersDiagnosis: SchizophreniaDiagnostic Issues in Depression and Generalized Anxiety DisorderDimensional Models of Personality DisordersDisordered Personalities and CrimeDoctoring the MindDoctors of DeceptionDruggedDrugs for LifeEmpirical Ethics in PsychiatryEssential PsychopharmacologyEssential Psychopharmacology of Depression and Bipolar DisorderEssentials of Psychiatric DiagnosisEsssential Philosophy of PsychiatryEthics in PsychiatryEvidence-Based Treatment of Personality DysfunctionFinding the Right Psychiatrist:Forces of HabitHandbook of Clinical Psychopharmacology for TherapistsHappy Pills in AmericaHealing the Soul in the Age of the BrainHelping Parents, Youth, and Teachers Understand Medications for Behavioral and Emotional ProblemsHerbs for the MindHigh PriceHippocrates CriedHistory of Psychiatry and Medical PsychologyHookedHuman TrialsInfectious MadnessInspired SleepIntoxicating MindsIs It Me or My Meds?Let Them Eat ProzacLife-Threatening Effects of Antipsychotic DrugsLitLiving with Bipolar DisorderMad in AmericaMad ScienceMalignant SadnessMedicating ChildrenMedicating Modern AmericaMoments of EngagementMommy I'm Still in HereNatural Healing for DepressionNot CrazyOrdinarily WellOur Daily MedsOverdosed AmericaPathologist of the MindPediatric PsychopharmacologyPediatric PsychopharmacologyPediatric PsychopharmacologyPharmacracyPharmageddonPharmageddonPoets on ProzacPower HerbsPowerful MedicinesPrescriptions for the MindProfits Before People?Prozac and the New AntidepressantsProzac As a Way of LifeProzac BacklashProzac DiaryProzac on the CouchPsychiatric DiagnosisPsychiatric HegemonyPsychiatrists and Traditional HealersPsychiatry and EmpirePsychiatry and the Business of MadnessPsychiatry as Cognitive NeurosciencePsychiatry at a GlancePsychiatry in PrisonsPsychiatry ReconsideredPsychopathyPsychopharmacology Problem SolvingPsychotropic Drug Prescriber's Survival GuidePsychotropic Drugs And Popular CulturePsychotropic Drugs: Fast FactsRaising Generation RxRe-Visioning PsychiatryRecovery from SchizophreniaReligious and Spiritual Issues in Psychiatric DiagnosisRitalin NationRunning on RitalinRutter's Child and Adolescent PsychiatrySaving NormalSchizophreniaShock TherapyShock TherapyShould I Medicate My Child?ShrinksSide EffectsStraight Talk about Psychiatric Medications for KidsSuccessful PsychopharmacologySuffer the ChildrenTaking America Off DrugsTalking Back to ProzacTextbook of Cultural PsychiatryThe $800 Million PillThe Age of AnxietyThe Anti-Depressant Fact BookThe Antidepressant EraThe Antidepressant SolutionThe Antidepressant Survival ProgramThe Big FixThe Book of WoeThe Complete Guide to Herbal MedicinesThe Conceptual Evolution of DSM-5The CorrectionsThe Creation of PsychopharmacologyThe Cult of PharmacologyThe Dream DrugstoreThe Emperor's New DrugsThe Essential Guide to Prescription Drugs 2005The Essential Guide to Prescription Drugs 2006The Making of DSM-III®The Medicated ChildThe Medication QuestionThe Merck DruggernautThe Mind/Mood Pill BookThe Natural Pharmacist : Natural Health Bible from the Most Trusted Alternative Health Site in the World The Pill BookThe Pill Book Guide to Natural MedicinesThe PlaceboThe Rise and Fall of the Biopsychosocial ModelThe Therapist's Guide to PsychopharmacologyThe Therapist's Guide to Psychopharmacology, Revised EditionThe Truth About the Drug CompaniesThe Use and Misuse of Psychiatric DrugsThe World of CaffeineToxic PsychiatryTrouble in MindTry to RememberTry to RememberUnderstanding Physician-Pharmaceutical Industry InteractionsUnhingedVoluntary MadnessWarning: Psychiatry Can Be Hazardous to Your Mental HealthWhat Is Mental Illness?What Psychiatry Left Out of the DSM-5What Works for Whom?Will@epicqwest.comWomen, Madness and MedicineYour Drug May Be Your Problem

Related Topics
PharmacracyReview - Pharmacracy
Medicine and Politics in America
by Thomas Szasz
Praeger, 2001
Review by Gordon Fisher, Ph.D.
Feb 28th 2002 (Volume 6, Issue 9)

            The indefatigable Thomas Szasz is at it again.  Dr. Szasz is now about 82 years old, and it is a little more than 40 years since his hit book of the 1960s was published, The Myth of Mental Illness (1961, rev. 1974).  He is at present Professor Emeritus of Psychiatry at the State University of New York Upstate Medical University at Syracuse.  In this work, Dr. Szasz pursues some of his familiar themes, with updated examples and events.

            The first chapter establishes his view that “only the pathologist’s concept of disease is relevant to the scientific view of disease as a departure from normal bodily structure and function.  Lest one misinterpret the referent of function, he adds:  “ ‘All illnesses,’ writes Stanley L. Robbins, the author of a standard textbook of pathology, ‘are expressions of cellular derangements.’ ” (p. 11, his italics)  “In this connection,” Szasz says, “it cannot be overemphasized that while a particular pattern of behavior may be the cause or the consequence of a disease, the behavior, per se cannot, as matter of definition, be a disease.” (p 12)

            Thus it appears that paranoia, for example, is not a disease, insofar as no cellular pathology of the sort detected and described by pathologists, using chemical, microscopic and other such techniques peculiar to them, can be associated with paranoia in any direct way.  Thus, it seems that according to Szasz’s definition of disease, a patient who exhibits paranoid behavior after, but not before, a brain injury should not be classified as being ill on account of his paranoid behavior, but rather on account of an injury, in case a pathologist certifies that something has changed in the patient’s cellular structure in an adverse way, but otherwise not.  If nothing is changed in the cellular structure, then the paranoid behavior should be judged by the legal system, not the medical system, as to whether or not the patient is a danger to a community, and if the patient is so judged, should be taken out of circulation by the legal system, presumably by putting the patient in jail.

            Similar judgments can be made about substance abuse, depression, and a host of other diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).  Szasz says:  “Medical bureaucrats confuse not only diagnoses with diseases, but also diagnostic disease entities with peoples’ subjective judgments regarding the need for and value of their treatment.  In the case of psychiatric diagnoses – for example, 312.33 Pyromania, 312.31 Pathological Gambling, 313.81 Oppositional Defiant Disorder, 300.7 Body Dysmorphic Disorder, and 307.42 Primary Insomnia – it is plainly false that the diagnostic terms name objectively identifiable diseases.  Actually, the DRGs [diagnosis-related groups on which medical disbursements are based] and DSMs are parasitic on one another; the Diagnostic and Statistical Manuals feed the diagnosis-related groups with diagnoses, authenticated as diseases by the medical profession and the government, and the DRGs in turn revalidate the diagnoses in the DSMs as the names of bona fide diseases.  The authors of DSM-IV deny this, declaring: ‘DSM-IV is a classification of mental disorders that was developed for use in clinical, educational, and research settings.’ Not true.  The diagnoses of most mental diseases are used to justify the psychiatrist’s obligation to commit patients or his need to prescribe drugs and other so-called treatments for them, collecting third-party payments for their treatments for them, and assisting lawyers engaged in civil and criminal litigation making use of psychiatric concepts and interventions.” (p 44)

            As the foregoing suggests, Dr. Szasz has political axes to grind (or spin around).  He is often described as a libertarian, as believing in the preservation of liberties of individuals in the face of governments who are bent on restricting individual liberties to the extent that the governing individuals can get away with.  One could discuss Szasz’s views on this topic at length, but to keep this review from getting too long, I will quote a summary statement of his from his Epilogue: 

“Although we have little to fear from the traditional foes of freedom, commentators across the political spectrum lament the creeping loss of our liberties.  How can this be?  Our foreign policies have not failed:  America is more secure than ever from foreign aggression.  Our religious policies have not failed:  The clergy has no power to deprive anyone of liberty.  Our economic policies have not failed:  More Americans are working and are economically more secure than ever before.  How, then, have we failed to protect our liberties?  By entrusting the care of our health to the state …”  (p. 161-2)

            A major theme of this book is the claim that our health care has become dominated by the state.  Szasz says in his Epilogue:  “After vanquishing the two great twentieth-century statisms – National Socialism and Communism – we are sacrificing our freedom on the altar of the most catholic and democratic of all modern statisms, the ideology of pharmacracy embodies in the therapeutic state guaranteeing every man, woman, and child a ‘right to health care.’ “  (p. 162)

            Szasz is what I will call a binary thinker, a devotee of views that are either/or and not both.  Szasz says: “Every American recognizes that when the government controls religion, all religion becomes state religion.  But few Americans are willing to accept that when the government controls health, all health becomes public health and all privacy is lost.”  (p. 163)  And Szasz takes a dim view indeed of public health.  For example, he says:  “It took centuries of terrible wars before people began to recognize that because the state is, par excellence, an instrument of violence, while the church ought to be, par excellence, an instrument of non-violence, the two should get a divorce or at least a legal separation.  Medicine and the state ought also to get a divorce, with primary custody of the citizens (as potential patients) granted to themselves, medicine having visitation rights.” He then speaks of “certain public health measures as legitimate instruments of state coercion.” “However,” he says, “this reasoning does not justify state coercion as a morally legitimate instrument for protecting people from themselves.”  He goes on to ask (expecting an affirmative answer):  “Should protecting one’s health be the responsibility of the individual, just as it is his responsibility to feed and house himself and provide for his spiritual health?”  (p. 131).

            The dichotomous, or binary, thinking by Szasz that I spoke of is exhibited early on:  “Before there was science,” Szasz says, “there was religion, and before there was scientific medicine, there was magical medicine.”  My experience as an historian of science leads me to object that we have had both science and religion simultaneously for a long, long time, and still have them, although to be sure both of these human endeavors have changed over time, and the relations between them have long been uneasy in some respects.  And the same for scientific and magical medicine. I find the history of medicine sketched in the first couple of chapters oversimplified to the point of caricature.

            It can be said, however, that the binary style of Szasz is stimulating, if only because it arouses one to an examination of some of the problems he discusses, and to see to what extent one may agree with him or not, or with some modification of his views.  In a biographical article posted online, “Thomas Szasz, M.D.: Philosopher, Psychiatrist, Libertarian”, the author, Eric V. D. Luft, Curator of Historical Collections, Health Science Library at Szasz’s university says that “Szasz was the most exciting teacher in the psychiatry department from the 1950s to the 1970s, and very popular with residents.  About 25 per cent of Upstate’s psychiatric residents at that time came to Syracuse specifically to study under him.”

In conclusion, I note that Luft begins his article with an encomium to Szasz’s The Myth of Mental Illness written in a letter to Szasz from Timothy Leary on July 17, 1961, when Leary was still a member of the Harvard psychology faculty.  The quotation from the letter begins:  The Myth of Mental Illness is the most important book in the history of psychology.”  Time has shown that this evaluation was, to put it mildly, hyperbolic.  My memory is that the charm of Szasz’s book during the 1960s was related to its apparent justification of “dropping out” (as it was called – dropping out of any sort of conventional society) as not being evidence of mental aberration of a certifiable sort, and indeed a kind of exercise of the freedom of individuals to reject morals and ambitions of one’s elders, even if one used some illegal drugs (possible addictive) in the practice of this freedom.  For those who may be too young to remember, Leary recommended the use of such drugs, and got into trouble for it.

 

© 2002 Gordon Fisher

 

Gordon Fisher, Professor Emeritus, Mathematics and Computer Science, one-time Senior Lecturer in Mathematics, and History and Philosophy of Science


Share

Welcome to MHN's unique book review site Metapsychology. We feature over 7700 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than thirty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Can't remember our URL? Access our reviews directly via 'metapsychology.net'


Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from Amazon.com for purchases through this site, which helps us send review copies to reviewers. Please support us by making your Amazon.com purchases through our Amazon links. We thank you for your support!


Join our e-mail list!: Metapsychology New Review Announcements: Sent out monthly, these announcements list our recent reviews. To subscribe, click here.

Interested in becoming a book reviewer for Metapsychology? Currently, we especially need thoughtful reviewers for books in fiction, self-help and popular psychology. To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716