(If you want to skip my comments, the quotations are at the end of this post.)
I came across Thomas Szasz’s The Myth of Mental Illness many years ago, after I had spent several years with the New York State Narcotic Control Commission, which operated under the jurisdiction of the Department of Mental Health. His premise, as stated in the title of the book, was startling. But I had already developed my own attitudes toward psychiatry based on personal experiences–it seemed I could never talk to anyone at a party or even in a one-on-one conversation without the person, sometimes a total stranger, saying, “My therapist says…” or in some other way introducing their therapy into the conversation as if it were as relevant as the weather–as well as a result of my years with the NACC.
For one thing, the psychiatrist at the facility where I worked ranked above and could overrule the director, held a higher grade, in civil service terminology. As well, I sometimes sat in on case reviews at which the psychiatrist ruled with as iron a will as anything I had seen in my days as a Catholic school student. I recall asking about the reasoning for an interpretation of a particular addict’s drawing (drawings of houses were used as indicators of personality disorders). The psychiatrist’s response was hostile and dismissive, more or less telling me that as a layman I should keep quiet and defer to the judgment of professionals like himself. I wasn’t, of course, denying the validity of his interpretation, just asking for the reasoning behind it.
Also, the agency operated with a flagrant disregard for the Constitution and eventually was brought to court on that account, though not until many years of functioning outside its bounds. I kept, for instance, a stack of warrants in my desk drawer. If I wanted someone arrested and brought to our facility–usually for failure to keep his weekly or bi-weekly appointments with me or because he had given a “dirty” urine–I had only to pull one out and sign it. Legally, I was doing so under the authority of the facility director, but practically I was more or less on my own. And constitutionally, I was behaving like King George.
There were plenty of other problematic issues with the way the agency operated, but they became moot when the state legislature stopped funding it and it began farming out its patients to private drug programs.
Meanwhile, many if not most of the staff I worked with had therapists. It was, again, very reminiscent of the religious environment in which I had been raised and educated, though I didn’t make a lot of conscious connections at the time. It wasn’t until much later, especially after I became involved with someone who had two family members diagnosed as schizophrenic that my thoughts began to take a more conscious, coherent shape.
I discovered Szasz’s book after the great discharge of mental patients from institutions to aftercare in the late 1960s and early 1970s, but it was and still is a radical point of view. My more recent readings about the more recent psycho-pharmacological treatment of so-called mental patients has convinced me that nothing has changed except the means of confinement. For this you might want to look into Robert Whitaker’s Mad in America: Bad Medicine and the Enduring Mistreatment of the Mentally Ill. And, of course, Michel Foucault’s Madness and Civilization. Foucault, like Szasz, was a fierce opponent of social control masquerading as medicine.
For the full Szasz interview you can go to: http://www.psychotherapy.net/interview/thomas-szasz
My premise is that responsibility is, morally speaking, anterior to liberty. So if a person wants to gain more freedom — in relation to his fears, his wife, his work, etc. — he must first assume more responsibility (than he has been) toward them; then he will gain more liberty in relation to them.... The goal is to assume more responsibility and therefore gain more liberty and more control over one's own life. The issues or questions for the patient become to what extent is he willing to recognize his evasions of responsibility, often expressed as "symptoms."... It is the hallmark of totalitarianism that there can be no personal secrets from the state. That's why I call our present political system a "therapeutic state." Such a state is your friend, your benefactor, your doctor. Why should you want to hide anything from it?... Modern psychotherapy is based on psychoanalysis, and the psychoanalytic relationship was based on the relationship between priest and penitent in the confessional. The crux of the confessional is self-accusation on the part of the penitent, and the secure promise, by the priest, that the confession he hears will and can have no consequences for the self-accuser in this world (but only in the next). A priest hearing confession and working as a spy for the state would be a moral obscenity. Not in the darkest days of totalitarianism did such a thing occur.... The same thing is true for psychotherapy based on confidentiality and on the premise that the patient "accuses" himself in the hope that, by so doing and with the help of the therapist, he might be able to change himself.... What is truly ugly about psychotherapy today is that many patients labor under the false belief that what they say to the therapist is confidential, and that therapists do not tell patients, up front, that if they utter certain thought and words, the therapist will report them to the appropriate authorities, they may be deprived of liberty, of their job, of their good names, and so forth.... Of course it [hostility to his ideas] did [concern him], especially when people actually wanted to injure me — personally, professionally, legally. No need to get into that. I tried to protect myself and escaped, luckily enough. I found boundless support in literature, in the great writers. Ibsen said, among other things, that "the compact majority is always wrong."... Where should I start, there are many? Shakespeare, Goethe, Adam Smith, Jefferson, Madison, John Stuart Mill, Mark Twain, Mencken. Tolstoy, Dostoyevski, Chekhov. Orwell, C.S. Lewis. Ludwig von Mises, F.A. Hayek. Camus and Sartre, though personally and politically, he is rather despicable. He was a Communist sympathizer. He was willing to overlook the Gulag. But he was very insightful into the human condition. His autobiography is superb. His book on anti-Semitism is important.... Yes, Camus broke with him, mainly about politics. Camus was a much better person, a much more admirable human being. He was also a terrific writer.