According to Nietzsche (1965), Szasz's approach is nearly genealogical. He looks at compassion, the so-called virtue which motivates the infamous treatment of those we diagnose as mentally ill, through its historical, economical and political expressions. Historically Szasz shows how we have striven to 'store the unwanted' i.e. those unable to support themselves because they cannot work (the indigent) or because they're homeless, those unable to pay debts, children whose parents are unable or unwilling to bring up, and relatives who constitute an embarrassment, merely because they are different. In all cases, the disposal and slavish treatment of the unwanted cover-ups as compassion, and the real motive, which is the embarrassment they cause to others, is unspoken.
Szasz' analysis is intriguing - even if some of his pronouncements and conclusions are somewhat unsavoury, for instance, his claim that schizophrenics who break the law should be treated as criminals. People diagnosed as mentally ill are stripped of their liberty. They also loose something, which for Szasz is equally important: their responsibility. People diagnosed as mentally ill cannot be held responsible, and therefore should not be punished for the crimes they commit against other people's person or property. Yet, oddly enough, they often are punished even more than they would be if society judged them sane. They are condemned to a life long dependency on institutions and drugs the result of which is that it is nearly impossible for them to become well adjusted independent adults. Therefore, they would be better off, and society's treatment of them would be less hypocritical, Szasz says, if they were treated as common criminals. Szasz does not take it into consideration that if psychiatric institutions make people mad, the prison systems in many countries; including the US, make them criminals. It is said that it is a myth that one comes out of prison with a just sense of retribution, and cured of the criminal impulse which put us there in the first place. Moreover, why not address the issue of psychiatric 'help', and ask whether mentally ill people who break the law could not be offered drugs, counselling, or even temporary hospitalization?
One does not need to share Szasz' philosophical and political views in order to share his indignation at the treatment meted out to those diagnosed as mentally ill, nor to recognize our tendency to 'store' away those we cannot interact with. This leads to the question whether the political and philosophical views in question do form an important part of Szasz' arguments. In particular, his claim that there is no such thing as mental illness (undefended in this book) is not needed to conclude that schizophrenia (the condition he focuses on) is an unauthentic category, or that being diagnosed as mentally ill does not justify having one's liberty taken away.
Szasz believes that giving some people power over others is commonly justified in the name of "compassion." In the article ‘The Inhumanity of "Compassionate" Compulsion’ (Reviewed by Jim Powell, J. November 1995), it is demonstrated by Szasz that "compassion" is a cover for oppression. He provides shocking historical perspective on the inhumanity of compulsion. He tells how 18th century English "reformers" like Jeremy Bentham promoted rounding up indigent people in "poor houses," so they would be out of sight and under control. Szasz talks about supposedly benevolent 19th century psychiatrists who urged that epileptics be forced into "therapeutic communities." Although 20th century psychiatrists never had objective criteria for diagnosing schizophrenia, Szasz explains, they forcibly inflicted
dangerous treatments on people labelled schizophrenic. He reveals how psychiatrists, backed by the federal government, promote "homelessness" now and also expresses outrage at the long history of "compassionate" compulsion applied to children. He covers madhouses of the past. He explains why, during the 1980s, the number of teenagers locked in madhouses soared almost 50%. He shows why hundreds of thousands of children are incarcerated unnecessarily—and how even the New York State Commission on Quality Care for the Mentally Disabled reports that three-quarters of children in the state's psychiatric facilities don't show any psychotic symptoms.
Szasz makes clear how psychiatrists possess more power than ever to subvert individual rights, with adults kept against their will in state mental hospitals, Veterans Administration hospitals, community hospitals, general hospitals, private mental hospitals, children's psychiatric units, nursing homes, alcohol and drug rehabilitation centers, forensic psychiatric facilities, jails and prisons, among other places.
Szasz’s most famous book is ‘The Myth of Mental Illness’. By ‘myth’ he does not mean that psychological disorders are not real experiences. He means that to call them illnesses is misleading because they share little in common with physical illness. Szasz says that psychological disorders have only one significant characteristic in common with bodily diseases. This is that the sufferer is to some extent disabled from performing some activities.
He states in 1972 that psychological and bodily disorders differ, he says, in that psychological disorders can only be understood if they are viewed as things that do not just happen to a person, but are brought about by him: `Mental illness' is not something a person has, it is something he does or is. Psychological disorders are actions rather than events and they are of some value to the patient. The patient, however, is not malingering. He is not fully aware of what he is doing and it is the psychiatrist's job to help him find out. Physical illnesses, on the other hand, just happen to a patient, and cannot be cured by self-knowledge. You have to kill the bug and / or set the bone.
Szasz has attempted to replace the illness model of mental disturbances with an analysis in terms of meaningful (but perhaps unconscious) communication. Hysteria, for example, is a psychological disorder that manifests itself as physical illness. He describes it as a dramatised representation of the message ‘My body is not functioning well’. The mental illness called depression is a dramatisation of the proposition ‘I am unhappy’.
Szasz regards the medical model of mental illness as an ideological justification for coercion. It is a way of excusing violence against mental patients by representing it as treatment. Szasz says that compulsory psychiatry cannot be justified medically or morally. It is a crime against humanity (Szasz 1972), and it undermines a free society.
It has been mentioned earlier that there are two established reasons for the use of compulsion, one of which is to help the patient. Szasz insists that one should not force help on anyone. In support of his case he quotes the philosopher, John Stuart Mill, who wrote:
(Mill 1859, quoted in Szasz 1971, pp 349-340).
Mill made an exception for those without the full use of their reason but Szasz does not do likewise. According to Szasz (1978), it is a precondition of a free society that we do not force help on one another. We must be free to make our own choices and decide what is in our own best interest. In a society pledged to the advancement of individual freedom and responsibility, the State, the family and the medical profession must restrict themselves to offering help. He goes on to say that the law should prevent them forcing help on unwilling people. However, he does not say that compulsory psychiatry is always harmful to the patient. His basic case is that it is unable to coexist with a free society. He says, in fact, that some increase in liberty gained by outlawing compulsion, might be at the cost of the impaired health or even death of some people who, he says, make themselves ill, or who want to kill themselves. He says that freedom, to a certain extent, entails the right to make the 'wrong' choice.
William Blackstone (1723-1780) in his Commentaries on the Laws of England, wrote that:
There are two long established reasons for the legitimate use of compulsion against mad people:
- the protection of society
- compassion for the mad person.
References
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Clare, A.W (1980) Psychiatry in Dissent. Controversial Issues in Thought and Practice, 2nd Edition, London: Tavistock Publications.
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Banton et al (1985) Teaching about prejudice / edited by Ben Whitaker and Michael Banton , New Edition , Report No.59 ,London : Minority Rights Group, 1985
- Diagnostic and Statistical Manual of Mental Disorders (1968)
- Mental Health Foundation, (1999)
- Mental Health Foundation (March 2000).
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Nietzsche, F. (1965) The philosophy of Nietzsche / edited, and with an introduction by Geoffrey Clive, New York: New American Library, 1965
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Szasz, T. S. (1994) Cruel Compassion: Psychiatric control of society's unwanted /, New York; Chichester: Wiley.
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Szasz, T. S. (1961) The myth of mental illness, HarperCollins.
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Szasz, T. (1963) Law, Liberty and Psychiatry.
- The Department of Health (November 1999)
