The following letter to the editor was published in the June 6, 1995 issue of The Medical Post, (Vol.. 31, No. 22), page 12. It is reproduced here by permission.
"Why single out Dr. Szasz for his views?"
To the Editor: Morton Rapp attacks Thomas Szasz's character, not his ideas, in his opinion piece, "Has Dr. Szasz learned anything over the years?" (The Medical Post, March 21).
Argument ad hominem appeals to feelings rather than intellect and, according to [Eugene] Ehrlich, "is considered a logical fallacy, in that such an argument fails to prove a point by failing to address it."
Dr. Rapp refuses to address the matter at hand -- the myth of mental illness and its relation to civil commitment.
That aside, Dr. Rapp claims "a landmark case of alleged psychiatric negligence has recently been settled in the United States." How can "alleged" negligence be a "landmark case?"
Surely Dr. Rapp knows that an accusation of wrongdoing does not constitute guilt. There was no finding of negligence in the civil lawsuit filed against Dr. Szasz.
Cynically, Dr. Rapp asks why Dr. Szasz continues to practise psychiatry since he "has been preaching...the doctrine that there is no such thing as mental illness": Practising psychiatry is not contingent upon believing in the existence of mental illness.
Is there an oath regarding belief in "mental illness" that one must now take to belong in the church of psychiatry? Many psychiatrists practice psychotherapy. Their clients find the conversation called psychotherapy useful. Believing in "mental illness" has nothing to do with it!
Moreover, if Dr. Rapp would take time to read Dr. Szasz's voluminous works he'd discover that Szasz has always differentiated between institutional and contractual psychiatry.
Dr. Rapp states that the psychiatrist who engaged in a contractual relationship with Dr. Szasz and later committed suicide was "suffering from bipolar affective disorder ('manic-depressive psychosis')." That diagnosis is based on a newspaper account of the deceased. That's an unethical way to present an allegedly definitive diagnosis.
Finally, Dr. Rapp confuses explanations for behavioral events with the events themselves, a common mistake.
Schizophrenia is a label used to explain abnormal behavior, usually characterized by false claims and self- reported imaginings, e.g., hallucination.
Schizophrenia is not an event -- it is one explanation for an event. Biological explanations for abnormal behavior are not the events Dr. Rapp claims as "mental illness." That's why mental illness is not listed in standard textbooks on pathology.
Descriptions of an explanation for mental illness do not meet the nosological criteria for disease classification.
Why does Dr. Rapp rail against Dr. Szasz when pathologists, clearly experts on disease, do not consider mental illness a real disease too?
Dr. Rapp's vituperation notwithstanding, Dr. Szasz is clearly one of the most important writers and thinkers of this century. His ideas will continue to be a thorn in the side of the "therapeutic state" until the power of government no longer fuels the Inquisition of Institutional Psychiatry.
Based on the excitement my students consistently express about Dr. Szasz's work, I suspect that day is not far off. -- Jeffrey A. Schaler[, Ph.D.], adjunct professor, department of justice, law and society, American University, Washington, D.C.
In reply to
From The Medical Post, a publication for the Canadian medical profession, March 21, 1995, page 12, opinion column entitled "I say, I say":
"Has Dr. Szasz learned anything over the years?" by MORTON S. RAPP
A LANDMARK CASE of alleged psychiatric negligence has recently been settled in the United States, and considering that it contains all those elements which make for a media spectacle, it is amazing this case has been neglected by the press.
The defendant was Dr. Thomas Szasz, 74, psychiatric renegade, who has been preaching for the last 40 years, in books, lectures and public forums, the doctrine that there is no such thing as mental illness. (Why he then continued to practise psychiatry is something for him to explain.)
The plaintiff was the estate of a psychiatrist-patient suffering from bipolar affective disorder ("manic- depressive psychosis") who consulted Dr. Szasz after being first treated by a more traditional physician.
The issue is that the patient wasn't taking his lithium during treatment with Dr. Szasz, presumably became depressed, and committed suicide.
The legal settlement included an agreement that neither side would "voluntarily seek publicity" in the matter, so it is difficult to determine, for example, whether the patient stopped his lithium and then sought out Dr. Szasz's help or whether Dr. Szasz encouraged the patient.
The only thing that's clear is Dr. Szasz paid $650,000 US to the family of the deceased in settlement.
Dr. Szasz did not begin his professional career as an iconoclast. Some of his early work dealt with, for example, some very sophisticated theoretical considerations about pain.
However, few people have paid much attention to his early work. Dr. Szasz became widely known as a result of publishing a series of books which described a way of looking at psychiatry, psychiatric patients, and psychiatric treatment and practice in a manner which can only be called conspiratorial and paranoid.
To Dr. Szasz, the entire psychiatric apparatus served the function of isolating dissidents from mainstream society, using "mental health laws" to strip patients of their right, and employing instruments of torture (e.g. electroconvulsive therapy) disguised as "helpful treatments."
He even claimed the entire concept of mental illness was a convenient fiction enabling white-coated agents of society to carry out this function.
His conception of American psychiatry in the 1950s did not differ radically from the historically proven abusive system then existing in the Soviet Union, where 5% of psychiatric facilities were indeed used for the purpose of containing, discrediting and often destroying political opponents.
Of course, if the concept of "mental illness" is to be denied, then the actions of "patients" somehow have to be explained in terms other than their suffering from "schizophrenia" or "bipolar disorder."
It became a little difficult to explain why the "oppressed dissidents" occupying the psychiatric asylums of the U.S. didn't stop acting that way when released, or why they so closely resembled their untreated and neglected brethren in other countries. But somehow Dr. Szasz was able to convince himself of the continued rightness of his beliefs.
It is often say by critics with more forgiveness than this writer that while Dr. Szasz's essential ideas were disastrously wrong (or, in words attributed to Nobel winner Edelman, "so bad they are not even wrong"), he nevertheless uncovered and helped to curtail certain specific excesses and injustices in the system.
I don't think this is true. Dr. Szasz was against electroconvulsive therapy for the usual reasons, but ECT disappeared not because of his rhetoric, but because it could be replaced by antidepressant and antipsychotic drugs, so it was no longer the only psychiatric modality that actually worked.
Similarly, the much more narrow definition of which psychiatric patients could be detained against their will resulted from two factors unrelated to Dr. Szasz's pronouncements.
First, human rights were in ascendancy. Second, the newer drug treatments were producing a larger population of mentally ill who could safely reside outside hospitals.
Having said all this, however, an admission must be made that in the 1960s, when Dr. Szasz' books were getting close attention both from fellow anti-psychiatrists and also from bewildered and defensive members of "the establishment," there was one fact that made his ideas sustainable.
That was that we knew absolutely nothing about brain pathology, neurohormones or the biological relationships among thinking, feeling and behavior.
But this has changed. We have overwhelming evidence of the genetic transmission of at least the propensity to become mentally ill. We have machines that can register metabolic differences in the brains of people with schizophrenia and people without it.
We have machines that can differentiate when one is thinking about a tomato, and when one is thinking about slicing a tomato. And we have drugs which take advantage of our still primitive, but at least extant, knowledge of brain chemistry, to effect symptomatic cures of diseases once thought incurable, including resistant schizophrenia.
Not all anti-psychiatrists of the past clung so tenaciously to their ideas.
For example, Dr. R. D. Laing, a British psychiatrist and darling of the '60s counterculture, originally declared that schizophrenia was not a disease, but a response of a sane person to an insane set of social controls, administered by the patient's parents.
However, in response to the growing biological science of mental disorders, he recanted this belief shortly before his death, though not in time to undo so much human misery he caused with his mistaken pronouncements.
Dr. Thomas Szasz, as far as one can tell at a distance, seems not to have incorporated the enormous knowledge base about the brain and behavior accumulating at an exponential rate since at least the '70s. Like the Bourbons, he seems to have learned nothing and forgotten nothing.
_Morton Rapp is a psychiatrist in Willowdale, Ont._
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