This book doesn't require a long review. It can be summed up in a single sentence: it's Szasz's response to misinformation about his position on psychiatry. In trying to set the record straight he quotes numerous works by his critics, and then forcefully rebuts them.
I have to admit, I believed Szasz identified himself with antipsychiatry. But he doesn't for the simple reason that the so-called antipsychiatrists still uphold the two central tenets of psychiatry which he is against: forced treatment, and mental disorder as a legal defence in criminal cases. He states that "Psychiatrists and antipsychiatrists alike accept the medical, moral, and legal legitimacy of involuntary mental hospitalization and treatment" (21). In short, he sees psychiatry and antipsychiatry as "two sides of the same coin" (40). Added to this is his well-known, and properly understood, position that mental illness is not a medical condition. He argues that the antipsychiatry movement still implicitly holds that mental illness is in fact medical in nature. Szasz defends the classical approach to psychiatry which can be defined in a few words as a form of talk therapy, for the simple reason that when a mental disorder's origin is biological (a problem with the brain) it is automatically a medical issue and not a psychiatric one. He argues that, while antipsychiatrists purport to believe this as well, their actions prove otherwise, such as, for example in their willingness to prescribe psychotropic medications that alter brain chemistry, and, what's worse, coerce their consumption even in the absence of the patient's consent.
Szasz's criticism of psychiatrists for their efforts to be recognized as medical practitioners and expert consultants to the legal system brought the wrath of the psychiatric establishment down on him. He explains that this is why he has been labeled as antipsychiatry. This labeling has in turn resulted in numerous publications by authors in many fields attributing to him a position he doesn't hold: that psychiatry per se is bogus and useless. He makes it clear that he believes strongly in the efficacy of psychiatry in the form of a cognitive therapy, and that he still considers himself a psychiatrist in every respect. In effect his efforts have been in an attempt to return mainstream psychiatry to its former non-medicalized roots, and not to simply destroy it.
He goes into painstaking detail, naming the names of the famous in the field of psychiatry and carefully explaining who said what to whom, but I found much of this was tedious reading. His central point is quite obvious and easy to grasp. The angry lashing out at his critics is understandable but only marginally informative, and not at all enjoyable to read.
In the end it seemed to me this book was written from a deep sense of frustration. The repetition and forceful statements in it felt to me like Szasz is not only (justifiably) angry with the misinformation that has been published about his own position on psychiatry, but also very frustrated that this misinformation has been so persistent in both professional and lay circles.
This thin volume, consisting of 6 chapters, an Epilogue and an Afterword, spans just 159 pages. It's easy to read in that there's little technical jargon; but it's also a difficult read because it's like listening to only one side of an argument: interesting for a while, but eventually somewhat tiresome. This is not a book for practitioners or students of psychiatry. I think it fits best into the category of autobiography and the history of psychiatry.
© 2010 Peter B. Raabe
Peter B. Raabe teaches philosophy and has a private practice in philosophical counseling in North Vancouver, Canada. He is the author of the books Philosophical Counseling: Theory and Practice (Praeger, 2001), Issues in Philosophical Counseling (Praeger, 2002), and Philosophical Counselling and the Unconscious (Trivium, 2006).
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