Prof Thomas Szasz's attitude to mental illness may be extreme but it does raise questions about coercion and state intervention. Sylvia Thompsonreports
World-renowned psychiatrist Prof Thomas Szasz will give the keynote lecture at a mental health conference in Dublin City University (DCU) next week. The Hungarian-born and US-based psychiatrist will share his controversial views on mental illness with health professionals, users of the mental health services and their families at a conference entitled Thinking, Feeling, Being: Critical Perspectives in Psychosocial Health.
Szasz is the author of many papers and books which question the very authority of psychiatry. He is perhaps most famous for his book, The Myth of Mental Illness(1961), which examines the social and historical roots of psychiatry. Now, more than 25 years later, the 87-year old Professor Emeritus of Psychiatry at the State University of New York Health Science Center, Syracuse, New York, remains as convinced as ever of his views.
"The concept of mental illness is a fashionable error that psychiatrists are locked into believing," he says.
"Most mental patients are unwanted by their families or society and, in the United States at least, most of them are poor. You practically can't be mentally ill and rich in the United States," he adds.
Often dubbed a proponent of the anti-psychiatry movement, Szasz says he is unhappy with the term anti-psychiatry. "Basically, I'm against the use of force as a way of helping people and the idea that it is okay to lock someone up because he is depressed."
A long-time opponent of laws permitting the involuntary hospitalisation of psychiatric patients, Szasz also disagrees with insanity laws which give psychiatrists the authority to testify whether someone was sane/insane when they committed a crime.
Szasz argues that psychiatry is a pseudo-science because firstly it medicalises problems of living and then goes on to use a moral/ethical framework in its analysis of what is good or bad behaviour.
"Many contemporary psychiatrists hold the view that some neurological defect, perhaps a very subtle one, will ultimately be found for all the disorders of thinking and behaviour," he writes.
According to Szasz, psychiatrists are but "soul doctors", the successors of priests, who deal with the spiritual "problems in living" that have troubled people forever.
He argues that the hardship for modern man derives not so much from a struggle for biological survival as from the stresses and strains inherent in the social intercourse of complex human personalities. He also suggests that a fundamental belief that such social intercourse should be harmonious is in itself part of the problem.
He says, "It seems to me that - at least in our scientific theories of behaviour - we have failed to accept the simple fact that human relations are inherently fraught with difficulties and that to make them even relatively harmonious requires much patience and hard work."
While teaching at the State University of New York, Szasz offered private psychotherapy to individuals with "problems of living" consistent with his belief that mental illness is a myth and that drugs do not solve emotional conflicts. He did not apply psychiatric disease labels to his patients because he believes that such diseases are fictional.
Rickard Lakeman, lecturer in the School of Nursing at DCU, says there is quite a lot of sympathy for Szasz's stance on mental illness and the pathologising of everyday problems of living.
"Many health professionals hold personal libertarian attitudes but, as professionals, they have to take a moralistic stance which is at odds with their personal viewpoint," he says.
"In practice, very few health professionals will take as extreme a stance as Prof Szasz," says Lakeman. "But he raises a lot of questions about the practise of mental health services in relation to coercion and state intervention in mental health through Mental Health Acts. These questions remain unanswered and are rarely discussed."
While many people might agree with Szasz's view that some mental health professionals are medicalising "the moral conflicts in human relations", there will be fewer who support his more controversial views on suicide, drug addiction and obesity.
"I believe in freedom," he says, "and this includes the freedom to end your own life." Szasz also argues that people have the right to take drugs and overeat because, as adults, they should understand the consequences of their behaviour.
"I believe we should treat children as children and adults as adults and that is the beginning of all wisdom," he says.
"As adults, we have the right to inform ourselves about what we do or be punished by natural law. The problem is that society has abdicated us from our personal responsibilities," he adds.
But, isn't that rather harsh? "Twenty or 30 years ago, I was called a communist and then later I was called a fascist. But, really I just believe in freedom and with freedom comes personal responsibility," he says.
See also www.szasz.com