Thomas S. Szasz


It is really quite simple! I will go through a list of the standard objections that are made against the argument that there is no mental illness and that involuntary psychiatric interventions are necessary.

Now the first one is that mental illnesses are brain diseases under the analogy of brain syphilis or epilepsy; that is to say that medical science has not yet advanced far enough to demonstrate the precise biological causation or nature of the various things which are now called mental illnesses, which has a very good historical basis in something like neuro-syphilis. I will just list them, then I will present my counter-argument.

It is quite possible that there are brain diseases which medical science has not yet discovered. Obviously, not everything that exists in the world has been discovered already. The brain is a quite complicated organ; it is quite possible that there are brain diseases. The second one is essentially a public health argument. Foucault alluded to this but this has actually very little to do with Foucault or with anybody else. It is well known that there are diseases which on the analogy of crimes, after all, what is it that we want protection from by the state? We want protection from the state from being attacked on the street and being stabbed and injured by another human being. Another human being can injure us simply by coughing, if what he coughs out is tuberculosis. If he has infectious tuberculosis and he is coughing, you don´t want this person to be working in the cafeteria and giving breakfast or lunch to you or anybody else. Now, that´s a public health measure of controlling infectious diseases, which is well established and I have no objection to that.
The third one would be a derivative of the second one. Namely, that this is not public health in terms of tuberculosis or syphilis or AIDS but it is dangerousness of behaviour. In english/american this would be called "preventive detention". Now I might mention that preventive detention does not exist in english and american law, it exists in continental law. It typically exists in totalitarian countries. An example of that would be that if there are so-called dissidents, political dissidents, then when a visiting statesman comes, the dissidents are rounded up and arrested for a week, to make sure they don´t demonstrate. You can´t do this in the U.S. You can´t deprive someone of liberty because he might do something; but in the case of psychiatry this is done because of the "dangerousness" of the person to himself or others. As you know, this formula forms the basis of involuntary mental hospitalisation in all civilized countries; that the person is mentallly ill and dangerous to himself or others.

The false argument is that with bodily illness, unlike mental illness - let´s say if you have melanoma or if you have cancer of the breast or cancer of the prostate - you are considered to be rational. In other words, you can decide whether or not you want treatment. If you have schizophrenia, you are irrational, then you are like a child and therfore the state / the doctors take care of you. Again, there is a name for this in political philosophy (it is very important that you keep this in mind, because this is the bottom line): this is called "paternalism".

Paternalism is a very enchanting idea. Keep in mind that when I was born, half the population of the U.S. did not have the vote. Blacks could vote but women could not vote. Women traditionally could not vote - we are back to this. Now why? Because they were considered to be children, to be cared for by their fathers and when they got married, then by their husbands (handed over) or if they were not married then they had brothers or some other male member. This was right up to the 20th century. But this is the way mental patients are treated now. Paternalism! This is a very enchanting idea. The very idea of colonialism, of slavery, John Stuart [Will] himself endorsed slavery and [admitted] that these people were like children in the Congo. There is something to be said for this in the sense that these people were like children in the Congo and that a lot of people behave very stupidly.

The question is: what do we do about it? A lot of people are very childish. In fact both Freud and Jung maintained - and they have a point, a rather obvious point - that a great deal of what we call "mental illness" is a kind of childishness, in the sense of: you are excessively afraid. What does it mean when a 40 year old woman or man says: "I am afraid to get into an elevator."? Obviously, that´s how children behave. I´m afraid of this, I´m afraid of that. Life is scary and a lot of adult people are afraid of it.

What did Marx say? "Religion is the opiate of the people!" People are afraid to grow up, so they believe in this man in heaven, who is going to take care of everything. So, the fact that paternalism operates in psychiatry shouldn´t surprise us - it operates in other parts of life but does not justify involuntary interventions today outside of psychiatry.
So these are the 4 standard arguments.

To summarize: the argument that mental illness is bodily illness - as I said: I have no problem in granting that for the sake of the argument - in other words, I don´t believe it. So let´s assume it´s a bodily illness. Well, then we are back to square one! If it´s a bodily illness, then it belongs to the patient, then it´s exactly like needing glasses or needing any other medical intervention. It´s up to you whether you want it or not. It in no way justifies any intervention by the state or by doctors. That simply reverts into a medical illness and in a way it is a most powerful argument against psychiatry because if its a bodily illness then it´s a brain disease and then it belongs to neurology. So again, its a backwards argument, so what do we need psychiatry for?

As I indicated, I also have no problem with [this]. I think its a good idea for people to be protected from other people, who by virtue of being sick, can contaminate them. This is the principle of contagion. Of course, this does not apply to what we call "mental illlness", because there are no bacteria; nothing is transmitted. So the public health danger is entirely metaphorical and non-existant. There is a second argument against this argument, namely that public health measures - and let me give you a typical example - the T.B. person who is prevented from working in a cafeteria, or the other classic example thats given is a person who is a typhoid carrier. Now as you know, typhoid fever can be a disease which is very severe but you can also have typhoid baccilli in your body, typically in your gall-bladder (you get it from dirty water). You can be a carrier of that disease, you can have it in your body and excrete it in your faeces and not be sick.

Before this was clearly understood, this was very often spread by people, who were perfectly healthy but had this bug in them, working typically in an ice-cream factory. The ice-cream preserves the bacterium and then you eat the ice-cream and then you get typhoid fever. When people like this are isolated of prevented from working there, no-one claims that this is for the benefit of the isolated person - this is for the benefit of everybody else. But this is not what is claimed for mental patients. No-one claims: "We are locking them up to protect their parents, who want them locked up." The argument is: they are locked up because they need treatment, they are ill, its for their benefit.

So the hypocrisy and the lie is quite obvious. If we would say: "Lock them up! Let´s lock up the schizophrenics because they are unpleasant", then it would be out in the open and then we could say: "Why lock them up? A lot of people are unpleasant!" So you see, the public health analogy is used in a dishonest way.

Now we come to the danger of this idea. In a way, thats a very interesting argument in the modern world. But a very stupid argument! Because dangerousness (socialogically, politically) is clearly identifiable statistically in terms of certain groups; but this is extremely politically incorrect and dangerous. This is essentially the totalitarian argument.

After all, if you go to America - a fairly dangerous country - say, to New York, who are you afraid of? Are you afraid of 5 year-old children? Are you afraid of 65 year-old men or women? Are you afraid of 20 year-old women? No! You are afraid of young men, especially if they are black and especially if they are poor! O.K.? The inner-city is full of black people. Are you going to lock them all up? You know, the argument in english and american law is that it is better to let a thousand guilty people go free than to lock up one innocent person. So you can´t lock up a thousand people because maybe 500 or 50 of them might commit crimes.
But this is the argument with people who are called schizophrenic. Now, many people who are called schizophrenic commit crimes. Many people who are not called schizophrenic commit crimes. Whether or not there is some statistical correlation is stupid, because many people who commit crimes are given psychiatric diagnoses. So naturally, it then looks like they commit crimes. That´s because instead of being treated as being criminals, they are given diagnoses. So this is all mixed up!

There are two more points on the side of my argument against the argument of involuntary psychiatric interventions. But then again, they cut both ways. This is pivotal to understanding psychiatry; namely, suicide. One of the most common reasons why families where people get [...] is where someone tries to commit suicide and the idea is that this has to be prevented and that this is the job of psychiatrists. Well, as long as people believe that, we are going to have involuntary psychiatry.

This, to my mind, is like believing in God. If you believe in God, you have a religion. If you don´t believe in God, then you don´t need religion. If you believe that suicide should be prevented by the state, then obviously you have to have laws which allow people to lock you up, because you might kill yourself.

This job was an interest to psychiatrists 300 years ago and this is a fundamental aspect of psychiatry. The people might be dangerous to themselves, specifically: kill themselves. This cuts both ways. If you say: "People should be allowed to kill themselves, there´s nothing to discuss. Like they said in ancient Greece: "If you want to kill yourself, you kill yourself! What´s the problem?" Then you have eliminated this issue.

Finally, we come to the other side of the phenomenon, which I called paternalism: namely that people should be protected from themselves because they are like children. That argument works both ways. Can you argue that somebody in childhood, after all, is in an objective category. It´s not subjective, it´s not like schizophrenia. Childhood is a subjective criterion. Legally, philosophically defined by chronology.

In the bible, in Judaism, it´s defined as ending at 13. In modern societies it ends at 18 or 21. When you get the vote, when you get drafted into the army, when you can get married, you can do all kinds of things without parental consent. Capitalism is based on that. If you are 10 years old, you cannot - no matter how much money your grandfather left you - go and buy a thousand shares of "Daimler Benz" stock. But if you are 18 years old, you can buy and sell "Daimler-Benz" stock. The stock-broker doesn´t ask you "Are you sane, are you insane?" You are presumed competent.

Keep in mind, life in all societies - going back to the ancient times - is considered to be a "bi-phasic" game. First you learn how to live: that´s called "childhood" and then you live. If you screw up, if you don´t know how to live, that´s tough! Because you are supposed to learn how to live. Like learning how to play tennis; if you learn very well, you go to Wimbledon and if somebody beats you, you are out! That´s life! You can´t say: "I didn´t mean it!" when you hit an "out" in tennis. You can´t say: "Excuse me, I didn´t mean that!" That´s what psychiatry is about; you do something wrong and you say: "I didn´t mean that!" Who cares what you meant!? The question is what you did.

So the argument of paternalism cuts both ways. There is no paternalism when you are 18, if you take people seriously. If somebody says: "Life is too tough for me. I need protection", society has always provided refuge for people like that. You can become a nun. You can be doing some scholarly activity. You don´t have to get married, if that´s too dangerous. You don´t have to engage in some competitive activity, you can become something which is relatively non-threatening. There are various occupations and choices. You don´t have to become a politician and get shot at - like in America, let´s say - if you want to avoid that. Like the Kennedys; that´s dangerous! If you want to avoid that, you don´t have to do it.

So these would then be the various alternatives of looking at this risk of competitiveness. These would be the pros and cons, but as you can see - to sum up - the attractions of psychiatric control in modern society are very great. Therefore I am not at all optimistic. There must be some interest in this issue in the media, in the public, to reject psychiatric controls on the analogy on which religious controls were rejected during the enlightenment.

Until such time, modern society will use psychiatric controls. In fact, they are using them more and more at the moment. Drip-controls would be an example of psychiatric controls. It´s a kind of "protect me from the dangers of life". It´s an issue like collective neurosis, in freudian terms.