A few years back I read Thomas Szasz’s Ceremonial Chemistry and The Myth of Mental Illness, and found them both to be brilliant and enlightening books. Yet he’s dealing in nuanced issues, and sometimes it’s easy to miss the point. When there’s an army of people threatened by his discussions of these nuances, they want you to miss the point, and so they obliterate the nuances. For example, even though I read those two works of his, I had accepted and repeated the title others have given Szasz as “the anti-psychiatry psychiatrist.” It turns out this label is dreadfully wrong, and it matters. Szasz was absolutely in favor of voluntary psychiatric arrangements and did not wish to do away with such help. I’m sure it was there in the books I read, yet it was lost to me as I read critics of Szasz. What he was “anti” was psychiatry as a tool of coercion. This is but one of the things I learned in the highly illuminating new volume Thomas S Szasz The Man and His Ideas, a collection of essays about his life, ideas, impact, and legacy, edited by his close associates Jeffrey A Schaler, Henry Zvi Lothane, and Richard E Vatz.
The book is a scholarly work, meant for readers who already have some background with Szasz and his ideas. It brings together several authors (most of whom I think knew him in some capacity) who both pay great respect to him and his work, and yet respectfully disagree with and criticize him at times. Addiction being my pet topic, I learned this lesson quickly because I jumped straight to chapter six on addiction by Bruce Alexander. It showed me this wasn’t a fawning book that simply cheerleaded Szasz’s ideas. It challenges many of them. My initial reaction was that it was an odd editorial choice to include in this piece, but then again it isn’t. Bruce Alexander’s (of the famous “Rat Park” experiments) ideas have gone mainstream with the help of Johann Hari’s recent hit book on addiction, Chasing The Scream, as well as many derivative videos and thinkpieces (people are constantly sending me this stuff). Alexander is a relevant voice today, but he seems to disagree with much of Szasz’s take on addiction, while walking the line of praising it’s relevance. I’ll use his chapter to demonstrate some of the dynamics and big points I found threaded through the book (because addiction is my favorite topic, and this forum is focused exclusively on it).
All the authors make it abundantly clear that Szasz’s main concern was that psychiatry is used as a tool of coercion, and that this coercion is justified and thus publicly accepted on the basis of the myth that “mental illness” is literal illness. That is, as in an uncontroversial illness such as cancer, the term “mental illness” suggests there is some problem on a physiological level that causes all of these ways of thought, feeling, and behavior that we call mental illnesses. Szasz maintains that this is not necessarily the case, and that for example in the case of the mental illness known as addiction, there is no such pathology. “Drug addicts” then, are not literally ill by Szasz’s account. They are simply engaging in an unpopular behavior, and the myth of addiction as a literal illness/disease allows those who want to stop others from using drugs heavily to do so under the guise of compassionately providing the treatment they need for their disease.
Alexander portrays Szasz’s view as somewhat naive:
Whereas Szasz’s critique of the medicalization of severe addiction has proven correct, his alternative explanations for the lifestyles that are being medically diagnosed as addiction have not held up as well. It is not enough to say, as Szasz did in various places, that drug addicted people just “like to use drugs” or that addiction is “a problem in living”; a “ceremonial practice”; a “self medication” for physical disease; a yielding to temptation; or a useful habit that people pursue of their “own free will” and abandon if it becomes counterproductive. Although these formulations do describe many drug users and mildly addicted people, they do not address the misery and hopelessness that grows from severe addictions.
Alexander holds that Szasz is right to say the medicalization of this problem is misguided, but that his view of it as an individual problem is wrong. In Alexander’s view, the locus of addiction is societal – caused by the evils of capitalism and other big cultural and systemic forces.
Szasz was born in Hungary, and came to America fleeing Hitler. Like many escaping tyranny, he became very libertarian in his views, both politically and culturally. It comes across crystal clear in his work that he believes each individual should be free to determine his own life. This background and it’s relation to his fight against the coercive use of psychiatry was mentioned by many contributors to the book, including Alexander, who seems to think it caused a bit of a blind spot for Szasz:
But what will follow the recession of the War on Drugs, Institutional Psychiatry, and the Therapeutic State? I believe that the vision of the future that Szasz idealized in the final chapter of Ceremonial Chemistry is too simple.
Having criticized Szasz’s focus on free will as the solution to addiction, he now moves on to criticizing his libertarian vision of granting freedom back to the people in regard to their own substance use. Alexander sees both of these positions of Szasz as ignoring the reality that people are still, at the end of the day, pawns being helplessly pushed around by societal forces. He sees the solution in some sort of organization of society that makes people feel included and well adjusted, as well as imposing some undescribed cultural controls as part of belonging in society. Again, the implication is that Szasz would’ve seen this too, if only he hadn’t been so blinded by his hatred of the state – if only his past hadn’t made him hostile to people organizing to exercise controls against one another. Szasz’s personal history of fleeing tyranny then, is supposedly a handicap to his own clear thinking on addiction. I’ll say I disagree, but won’t delve any further since this is a review.
In the course of the chapter, Alexander does pay great respect to Szasz while criticizing his stance on addiction. He shows that Szasz’s views are a worthy advance in our thinking about addiction, and can become compatible with a radically different view shifting addiction away from the individual and onto society. He praises him for laying the groundwork for rejecting the medicalization of addiction, and thus opening the way for other views such as his/Karl Polanyi’s view that addiction grows from a fragmentation of cultures and disconnection caused by freedom of markets/industrialization and modernization.
So what is Szasz’s ultimate impact now that he’s gone? It’s clear that he’s had an impact on Bruce Alexander’s work, which means he’s had an impact on Johann Hari’s work in an indirect way. When Hari says “the opposite of addiction isn’t sobriety – it’s connection,” or “It’s not you—it’s the cage you live in,” he is moving us away from the medicalization of addiction. He’s moving us toward seeing it as more of a “problem of living” as Szasz would say, rather than a matter of brain disorder. And trust me, Hari is moving us; I know that his book, TED Talk, and various media appearances have been extremely influential to the current discourse on addiction. Again, people send me this stuff constantly. They know there’s some commonality between our views, even if they don’t realize what I see as massive important differences. The dial has been significantly moved, and in some way I think it might credibly be traced back to Szasz and Ceremonial Chemistry.
I’ve obviously strayed from review of the book into my own analysis of what Szasz’s impact might be at least in the world of addiction. But I don’t think it’s a stretch, given that the book taught me that Szasz did in fact have an impact on Bruce Alexander. What his chapter showed, and what the whole book demonstrates, is that Szasz’s views aren’t the ravings of a lunatic as many of his detractors would have us believe; they aren’t accurately summed up as being blindly “anti-psychiatry” as many would have us believe. They contain important insights and nuances that can and have become part of serious discussions taking place in the world today. They can be taken seriously by deep thinking academics who will lead tomorrow’s thinkers. The only rub is that people seem to have a stylistic issue with Szasz. They bristle at his presentation. Some seem to think his libertarianism detracts and just doesn’t fit into today’s world and ideas.
This is present in Alexander’s discussion. He doesn’t like Szasz’s focus on the individual and free will. Yet, in the course of describing the individual as being crushed by society, he describes an individual freely reacting to those societal forces:
I believe that, whereas Szasz was right about the folly of medicalizing addictions of all sorts, he was wrong to put free will at the center of his analysis. Severely addicted people have not lost their will power and do not need medical treatment; they are dislocated people who have desperate needs for belonging, identity, meaning, and purpose. Addiction is the best way they have been able to find to meet these powerful needs. It can be argued legalistically that severely addicted people adopt addictive lifestyles literally “by their own free will,” but it is more useful to leave free will out of the conversation entirely, because the remediable cause of addiction is not free will, but mass dislocation in a fragmented society that makes any alternative to addiction feel insufficient for growing numbers of desperate people.
Szasz made the point that human behavior has reasons rather than causes, a point that editor Jeffrey Schaler has repeated often, and with which I agree wholeheartedly. Alexander is listing reasons for addiction here, but continues to think in terms of causes. This is the main difficulty Szasz’s views face in the public, as I see it. Many people have a hard time seeing people as freely thinking, and freely coming up with reasons that support various course of action. They see people as caused with no recourse, like billiard balls, to go where they go, by forces outside their volitional control. Yet Szasz and Alexander seem to be saying the same thing, but with a dramatic difference, in that Alexander seems to have to hold on to the view that people are helpless victims in this interaction between the person and the conditions they face.
He’s not alone. Other contributors to the volume have described the tendency in our world to bitterly hang onto the view of troubled people as helpless, especially as victims of mental illness. For example in chapter 3 Richard Vatz concludes that:
Thomas Szasz’s prolific writings and media work explicating why mental illness is a myth should be seen as indisputable truth. Regardless, the responsibility-denying rhetoric of mental illness, steeped in mystification and self-serving explanations of the difficult-to-explain, will perhaps forever successfully endure.
Throughout the chapter he explains that people hang onto mental illness as an explanation because they “want to make sense of atrocities that are unpreventable” such as terrorist attacks, murders, other gruesome crimes, and suicides. He states the plain truth that when family is involved, the grasp on mental illness as explanation is strongest, responding to a Times article about suicide and psychiatric treatment:
The op-ed article described the apoplexy a man has when his beloved son killed himself, perhaps accidentally, due to the lack of judgment of someone suffering from mental illness who does not receive sufficient treatment… There are no words that would convince a loving parent that his deceased son or daughter did not suffer from psychiatric illness or something that could have been cured or fixed by professional counseling. [emphasis added]
The myth of mental illness then, fills a void we have when we just can’t handle the idea that people do irrational things, and that this is maybe just part of the difficulties of living and being human. When high emotions are involved, the myth is comforting, and there’s almost an instinct to grasp onto it. At least on contributor recounted having a highly emotional reaction to initially hearing Szasz’s message that mental illness is a myth.
Szasz acknowledges there are brain problems that might cause some wild behavior. He draws a distinction between the brain and the mind though, seeing the brain as physical and the mind as some sort of construct, and thus incapable of being literally ill or diseased. Every contributor seems to see great value in this nuanced distinction and point. Each has shown with their contributions to the volume that Szasz’s views offer a great seed for further thinking and understanding of the problems of living – that is what I see as the great value of this book. We get to see others taking Szasz and his ideas very seriously, without derision, but with considered criticism. The outlook is grim in some ways; the myth will probably live on; but the value of his work is clear in all the thinking that it sparked among these authors. Inherent in all of the attacks on Szasz out there and the mischaracterization of his views is the fact that they struck a chord and must hold some truth; that they are influential and will continue to be. This book gives some perspective to how and why.
I learned something from every chapter in this book, although two or three of them were very hard for me to get through, which could be due to the writing or to my own lack of background on those particular subjects. With that said, there were also a few brilliant and highly readable chapters that I could not put down and which I want to recommend to countless others to read. I’ll talk about those now.
Chapter 4: Szasz’s Distinction between Physical and Mental Illness by Joanna Moncrieff is a tour de force of all the issues affecting the debate about addiction’s status as a brain disease (even if it doesn’t explicitly mention addiction – I forget whether it does). The writing and thinking is so clear and consistent here, and it breaks down all the big issues. I highlighted so much that I almost don’t know what to quote.
Moncrieff repeats Szasz’s key point that some conditions that were considered mental illnesses lost that moniker once we found that there was a credible pathology for them in the brain, such as epilepsy. Then she discusses ways that we understand behaviors to be volitional:
The other way we attempt to discriminate between situations that arise from a brain disease and those that do not is by asking whether the behavior is understandable. If we can fathom a motive for the behavior, or understand it as a meaningful response to external events, then we would be less inclined to view it as arising from a bodily disease.
She builds on this:
No one has suggested, to my knowledge, that cognitive decline might be an understandable reaction to life events, or a complex but meaningful response to perceived threats or difficulties, for example
The fact that cognitive impairment, in later life at least, is progressive may account for some of our intuition that it arises from a brain disorder…
It seems to be something about [cognitive impairment’s] depleting nature: something about the fact that there is loss or lack without gain; a narrowing and restriction of human capacities, a lowering of the qualities that we associate with full human mental functioning, with no compensation in terms of the creation of alternative ways of seeing or responding to the world.
In contrast, the individual in the grip of a paranoid psychosis can be extraordinarily creative in constructing a delusional system or interpreting their own thoughts as alien occurrences… And depression too, despite the reduced functioning that it often entails, involves a productive state of self-blaming, catastrophizing, and pessimistic interpretations of the world.
And then here’s the part that really got me as a brilliant insight:
Here I am not simply making the point that states of madness or emotional extremis are not simply states of deficiency, as the state of cognitive decline or impairment can be understood to be. Unlike someone with dementia, people with psychosis or severe depression have not lost the tools of mental activity. They are merely employing those tools in unusual ways. [emphasis added]
That chapter really built on Szasz’s thinking, and keeps to the “reasons, not causes” theme in his work. Creativity is alive and well in people with many problems called mental illnesses. She mentions how much effortful action a depressed patient puts into acquiring and using marijuana, and that really brings things to a head. Voluntary human behavior is purposeful, it’s always aimed toward some end the individual is trying to achieve. It’s always self-serving in some way. It always has reasons.
Chapter 7: Szaszian Reflections on Cults, by Jeffrey A Schaler, is a thorough exploration of everything we think we know about cults. We think that people are somehow involuntarily involved in cults, as they are involuntarily using drugs, or engaging in any behavior we think wrong and irrational. Schaler breaks this down from every angle, and along the way, shows that there are personal reasons at play, not causes. He relates cult involvement to a protective herd mentality – people gather as groups to protect themselves. He relates it to an attempt to absolve oneself of responsibility. The number one rule of cults, according to Schaler, is thou shalt not question the cult, and it makes sense as he shows this tendency in Alcoholics Anonymous, the cult of psychiatry, and others. By agreeing not to question, you evade responsibility for your own choices in some way, and this can be attractive and self-serving. He also mentions that cults can seem to take the place of a religion or a family in your life, and offer an identity of sorts, even if their is a giving up of one’s identity as an individual.
There are many other points along the way, but the idea of brainwashing is thoroughly disposed of in this chapter. People have reasons they join and stay in cults. They also have reasons for agreeing to the idea that they were brainwashed when they leave – it absolves them of personal responsibility for their choice to be involved in the cult in the first place.
Perhaps may favorite thing about this chapter was how he broke down the defensive measures of cult members with a thorough description of the tactics used by AA members against those who are critical of their tenets. They were:
- Accusations of murder (you’re killing people by saying that addiction isn’t a disease)
- You’re only in it for the money
- Diagnosis of mental illness (“You’re in denial of your own disease”, “You have narcissistic personality disorder and just want to prove everyone wrong”)
- It takes one to know one (“You’re not a real addict, so you don’t know what it’s like”)
- Invoking authority (“AMA says it’s a disease”, “what are your credentials?”)
- Shaming (“you’re so mean to addicts” – tone policing)
The comments section of almost any post on my site serve as abundant proof of all of these tactics. Personally, it was a joy reading this section of the chapter, because it spoke directly to me as a target of such attacks.
I’ve now indulged in retelling my favorite parts of the book, but it’s time to wrap up. Here’s the overall point – this volume gives much depth, criticism, and further explanation of Szasz’s life and ideas, as the title promises. Again, nuances that I had missed when I originally read two of his books were made abundantly clear to me. I can’t recommend this book enough as a companion to reading anything by Szasz himself.
Thomas S. Szasz: The Man and His Ideas – Jeffrey A. Schaler, Henry Zvi Lothane and Richard E. Vatz, editors – available on Amazon
Jeffrey Schaler’s personal website is also a wealth of this same kind of thinking applied in many ways.
Here is one of my favorite articles by Schaler, well ahead of it’s time: Internet Addiction – To Diagnose or Disregard
And as always, check out Schaler’s brilliant Addiction Is A Choice, a book that introduced me to much important research. It is a must read for anyone interested in critical works on addiction.