Thomas Szasz, M.D. died on September 8, 2012 at the ripe old age of 92. He was a pioneer in the field of making us rethink what we mean when we say someone is “mentally ill.” Is it really a purely physical disease, or is it part physical, part social construct?
And if it’s partly a social construct (and, to be honest, it is), it must be subjective. We’ve all simply agreed that this set of symptoms = mental illness. Keep in mind that his theories were based with our knowledge of mental illness in the 1950s and 1960s — a time when our understanding of mental illness was truly in its infancy. At that time, mental disorders truly were quite arbitrarily defined.
While many associate Szasz with the anti-psychiatry movement, that’s a label he never was comfortable with. It also over-simplifies his complex and nuanced views about mental illness as one of the most vocal critics of psychiatry.
Szasz’s views about psychiatry stemmed from his understanding and perception of how mental illness was defined (in the 1960s). If mental illness is just a set of arbitrary symptoms defined not by scientific data, but by doctors, then committing people to state psychiatric hospitals was unconscionable.
As a libertarian, Szasz believed that government should limit its interference in a person’s pursuit of happiness and their own lives. Psychiatry is the only specialty in medicine that had the power to take away a person’s freedom and used it with regularity.
Ironically, some of Szasz’s ideas were eventually embraced — but not for the reasons he thought. We saw the deinstitutionalization movement pick up steam in the 1980s, with the shuttering of many state hospitals. But this was due more to budget cuts than for philosophical reasons, with many deinstitutionalized patients ending up on the streets, homeless. Free, indeed. But often penniless with little social support or prospects for their future.
States toughened up their commitment laws as well, making it harder to “lock people up” indefinitely. Most states now have only a 72 hour hold period for someone with psychiatric issues. Longer periods of involuntary commitment need to be regularly reviewed by judges and other doctors.
Szasz often found himself as a lone voice in a profession where the power differential was emphasized between doctor and patient. He eschewed that relationship, recognizing that such power could be corrupting and ultimately harmful to the patient.
He argued that what are called mental illnesses are often better described as “problems in living,” and he opposed involuntary psychiatric interventions. His reputation in defense of these principles was launched in 1961 with The Myth of Mental Illness. He published 35 books, translated into numerous languages, and hundreds of articles in the subsequent 50 years.
Recognized worldwide as one of the most important critics of psychiatric coercion and a defender of individual responsibility and freedom, Dr. Szasz was the recipient of several honorary degrees and many awards, including the Humanist of the Year, Jefferson Award from the American Institute of Public Service, Mencken Award from the Free Press Association, establishment of “The Thomas S. Szasz Award for Outstanding Contributions to the Cause of Civil Liberties” by the Center for Independent Thought, and the George Washington Award from the American Hungarian Foundation.
Szasz was a true pioneer in every sense of the word, and his contributions to the discussion about mental illness were invaluable. He should be required reading for not just all psychiatrists and psychologists, but all doctors and patients too.
Because while we have a much greater scientific understanding of mental illness today, our knowledge about how the brain works — and therefore, also sometimes doesn’t work (in the case of mental illness) — is still in its infancy.
Read his full obituary: Thomas Stephen Szasz Obituary – Manlius, New York