More on Szasz

Acute, honest, fearless, and funny. After they made Tom Szasz, they broke the mold.

Lowry’s lovely obit for Thomas Szasz brings back fond memories. Talking to him was an education, and arguing with him a delight. We didn’t get to spend much time together, but I enjoyed every minute.

Tom was utterly clear-headed and completely forthright. His position on drug policy came from such deep principle – that interfering with someone else’s autonomy for that person’s own good is always and everywhere unjustified – that he could frankly acknowledge some of the likely practical disadvantages of the courses of action he endorsed without feeling that he was conceding anything.

And Tom was quite willing to believe that more interventionist policy preferences followed logically if you were willing – as he emphatically was not – to count as a benefit sparing someone the consequences of his own bad habits. (By the same token, Szasz appreciated my willingness to confront, and try to reduce, the costs of prohibition. He once said to me in private that if he thought that drug prohibition could be run on my principles, rather than on drug-warrior principles, he wouldn’t have been so firmly anti-prohibitionist.)

The first time we met was on a TV talk show, the Morton Downey, Jr. Program. I think Szasz knew what he was getting into, but I certainly didn’t. Downey was a reasonably smart and sensible person in the green room, but the character he played on camera was a dime-store Rush Limbaugh. The set-up for our joint appearance – again, unknown to me – was that I was going to be the practical policy guy and Szasz the ridiculous egghead.

So after a little bit of friendly jousting with me, Downey turned to – or, rather, turned on – Szasz. He started out the introduction by deliberately mispronouncing his name, twice, and referring to him as “a shrink – I mean, a psychiatrist – at SUNY Albany.” The goal was clearly to bait Szasz into an intemperate reaction.

It would have worked on me, but Tom had a thicker skin. Mildly, in the Hungarian accent that seemed to make whatever he said both more friendly and more convincing, he replied, “Meester Towney, I am not uf your country or uf your generation, and I cannot match your manners.” Downey was tame for the rest of the broadcast.

Szasz’s impact on psychiatry was far more profound than his impact on drug policy; it’s hard now to remember that when he started to write involuntary commitment, physical confinement, lobotomy, and the brutal form of electro-shock were all accepted practice. Even his denial that there is an illness called schizophrenia – based, again, on his bedrock principle of autonomy, and fear of the consequences of limiting people’s rights due to their departure from consensus reality – seems less absurd when it is recalled that the same diagnostic manual that described schizophrenia also treated homosexuality as a disease.

Acute, honest, fearless, and funny. After they made Tom Szasz,they broke the mold.

Update And in the wish-I’d-said-that department, how about: “Addictive drugs stand in the same relation to
ordinary or non-addictive drugs as holy water stands in relation to ordinary or non-holy water.”

Obviously false, to my eye: it’s simply a fact that very few people complain that they have an amoxicillin habit they can’t break, while many make the analogous complaint about nicotine or oxycodone.  Whether you want to call those bad habits “additions” or not, whether y0u think that having one is a “disease” or not, I don’t see how you can pretend that the difference is merely one of convention. (If Szasz had limited himself to drugs people enjoy taking, then it would be true that all have some risk of habituation, but still false that hey all have the same risk.)

But simply considered as a sentence in an argument, I’d give an eye for Szasz’s capacity to come up with such sentences.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

10 thoughts on “More on Szasz”

  1. I knew Szasz and feel I have the right to take significant issue with AT LEAST one thing that you
    say! His denial “that there is an illness called schizophrenia” is NOT based as you say
    upon his “bedrock principle of autonomy.” Rather it is based upon his insistance that we not have
    the temerity to conclude that we have the right to say that we see reality more accurately than
    the schizophrenic. What you are missing is his deep respect for other human beings. What I believe that many people have missed in trying to understand him is that he saw himself very
    much as an educator.

    1. You’re right, of course, that Szasz rejected the idea that a physician ought to be able to impose his version of reality on a patient. In my view, that came from his respect for the patient’s autonomy, not from any actual doubt about whether the patient in question was in fact the King of Siam.

  2. First off – you were on Morton Downey? For this, and this only, I genuflect in your general direction. Szasz was more than brilliant, I think. The post seems to intimate his actual effect – to generate awareness and thought outside the box of accepted discourse, especially the soft discourse of behavioral science. “The Myth of Mental Illness” guides my practice foundationally in every way; his Chomsky-esque questioning of what is ‘known’ in the practice of psychology and psychotherapy, even when he seems to be running on the fumes of ideology, still triggers an essential re-re-examination of habit and self absorption. For me, anyways. Szasz fundamentally shaped my thinking not only as a therapist, but as a companion traveler through this demanding vortex we call reality. I see his influence across the field; reminiscent of Foucault, the telltale signs of a foundational shift in thinking about ‘settled’ issues. I have no doubt that his basic ideas will be vindicated over time; he got it, like very few of those settled in and constrained by convention can or will.

  3. I loved “The Myth of Mental Illness” as a teen, who was also enamored with anarchist and libertarian principles. But when I began to see and try to talk with people who were mentally ill, i.e. schizophrenic, I began to doubt the absolute autonomy principle and his idea that a schizophrenic was merely seeing a different reality. His thinking still guides me to some extent, but I blanch at any extreme including his. Sazsz was an amazing mind and analyst and he has been missed because there are few who had his command of knowledge, language and understanding.

  4. The concept of individual autonomy is a preposterous theoretical and philosophical luxury, unconnected with the dynamics of any real society.

    We do not interfere with an addict’s autonomy for that person’s own good, but to improve the quality of life for everyone else.

    Ideally (no, we do not live there), constraints upon individual autonomy would be candid rather than dissembled, deliberate rather than fortutious, consistent rather than capricious, and founded upon the greater good of the greaest number rather than upon pure sadism. But constrained it must be.

  5. A question for all (not just Mark and Lowry) regarding Thomas Szasz and Kendra Webdale:

    The only Szasz comment I could find regarding the Kendra Webdale case was at and focused on the history of the insanity defense for suicide, later extended to homicide. It seems that this case presents a test of Szasz’ approach to insanity which is not addressed in this comment. He presents a good case for holding Andrew Goldstein responsible for his actions, but says nothing about whether his crime could have been prevented by the criminal justice system.

    Andrew Goldstein pushed Kendra Webdale to her death in the New York subway in January of 1999. He had been in and out of mental hospitals and had been on and off medications. He had refused treatment numerous times and had subsequent hallucinations resulting in re-admissions to different hospitals and treatment programs. Soon before attacking Ms. Webdale, he had shown aggressive behavior towards others, mostly in minor incidents like altercations in supermarkets, things for which he could have been held criminally liable but for which any incarceration would have been short and may not have kept him behind bars when Ms. Webdale stood on that subway platform on the day of her death.

    So my question is this: do you happen to know what Szasz thought should be done with individuals like Andrew Goldstein? We cannot contemplate a system of laws which provide for preventive incarceration. Is the only alternative to be one in which the Goldsteins among us are allowed to run around loose until they commit murder? Is the occasional Kendra Webdale murder to be regarded as the price we pay for freedom? Or is it possible that the reforms under “Kendra’s Law” offer us another societal choice? The law’s defenders argue that there are provisions in the law which protect individuals from arbitrary or abusive treatment; they also present data showing reductions in homelessness and harmful behaviors.

    I am willing to agree with arguments against Kendra’s Law which object to the provisions regarding “harm to self,” but the provisions about harm to others do appear reasonable to me. Inform me, please, if I am misunderstanding Szasz, but it soes seem as if his only alternative would be incarceration, requiring that the standards of the criminal law be met; my problem with this, as stated above, is that the warning behaviors of Andrew Goldstein were misdemeanors and would not be likely to have kept him off the streets long enough to keep him away from his final victim.

  6. The thing is that Wilhoit knows he’s right, so what else is there to say. Szasz believed that there are other things, like people and individuals for example, that are more important than being
    right and being in control. Wilhoit obviously does not believe this, so what else is there to say?

    A similar reply to Whitney. Is what we are here about is making this society effective, in control, safe and secure. After you have control, safety and security, but you don’t have
    individuals, what do you really have??!!

    Incidentally, I have been trying ad infinitum to be recognized as someone qualified, but these
    “individuals” with their degrees obviously surpass me since they are “credentialed.”

    1. Paul,

      There are of course such things as individuals. There is also such a thing as society. The question is, how shall their interaction be structured — or even thought about? Have you (as I gather and as I hope) something to say about how that circle is to be squared? — a topic that everyone else has been engaging, off and on, for the past several millenia, to no noticeable effect.

      I have no suggestions of my own; I consider the subject utterly intractable. The only thing I consider myself “right” about is the entirely subjective observation that society is my only bulwark against individuals, without which bulwark I would have been long since dead. Your mileage may vary, but it is safe to assume that you have benefited largely and pervasively from the existence of society and that many of those benefits have flowed from constraints upon some individual or group. Set the slider where you will, but do tell us why: that would be of general interest.

      Parenthetically, a Master’s degree in music does not, by any construction, “qualify” me to participate in this forum. It is a pure — and, arguably, heedless — courtesy extended to me by Prof. Kleiman, which I presume would be immediately revoked were I to abuse it. (I actually seem to recall that he banned me once before, about five or six years ago, but only briefly. Perhaps I flatter myself.)

      Thanks much,

    2. Szasz built a powerful view of psychiatry by noticing the noxious effects of its coercive powers: the involuntary commitment of individuals who did not share society’s consensus of what constitutes reality. His arguments took into consideration a massive amount of data on the adverse effects of neuroleptic drugs and other interventions which in one way or another exert an ablative effect on the range of activity of the human brain.

      Wide though his range of data was, I remain uncertain whether it was wide enough to include people like Kendra Webdale, or whether she was left outside the spectrum of reality which he took account of. I appreciate his view that “interfering with someone else’s autonomy for that person’s own good is always and everywhere unjustified.” The issue is whether it is always unjustified to interfere with someone else’s autonomy for the good of a third person.

      Kendra Webdale was also an individual. Did she have the right not to be shoved to her death while waiting for the subway train to arrive? If she had that right, by what means does she have a claim on society to secure that right to her?

      Suppose that person A is walking down the street minding her business. Suppose that person B sees A as a menacing and destructive she-devil, against whom physical force is justified as a matter of self-defense. Suppose further that if B is taking antipsychotic medication, he will see A as a harmless fellow human being. I take it as self-evident that A has a right to expect that B will not harm her. Does A have a right to expect that B will take the medication which will make that harmful action less likely?

      This particular thread appears to be slowing down to the point that only the three of us are left. Please note that asking a question is different from knowing one is right and insisting on being in control. The frame of reference for this discussion needs to be broad enough to include the Kendra Webdales of the world in its scope. It is easier to contract the scope of the discussion to exclude her and people like her. But this is not an easy issue.

  7. As to Wilhoit, I will say this. No sir, you assume that there must be an anteraction. No sir!
    There is an irreconcilable conflict. It is obvious which way you have taken. Interesting that
    you have a Master’s Degree in Music. My mother was a classical pianist and I heard her play from
    birth until l8, day in and day out. Without the individual there is nothing. Society is, at best,
    an adjunct or an aid!
    Frankly, I think I am agruing the same thing with Whitney. You’ve got to give up this idea of what
    the individual is going to DO to society. Society has never had trouble surviving (sometime
    unfortunately,–look at the political situation we are in-choosing tyranny over liberty-I never
    thought I would see the day!!)(That’s the reason Szasz never commented much about that sort of thing)

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