Interviewer: Randall Wyatt, PhD

Selected Questions and Responses

RW: I am going to ask you a wide variety of questions, given the diversity of your interests, and I want to make sure to also focus on your work as a psychotherapist. A little background first. You've been well-known for the phrase, "the myth of mental illness." In less than 1000 words, what does it mean?

Thomas Szasz: The phrase "the myth of mental illness" means that mental illness qua illness does not exist. The scientific concept of illness refers to a bodily lesion, that is, to a material — structural or functional — abnormality of the body, as a machine. This is the classic, Virchowian, pathological definition of disease and it is still the definition of disease used by pathologists and physicians as scientific healers.

The brain is an organ — like the bones, liver, kidney, and so on — and of course can be diseased. That's the domain of neurology. Since a mind is not a bodily organ, it cannot be diseased, except in a metaphorical sense — in the sense in which we also say that a joke is sick or the economy is sick. Those are metaphorical ways of saying that some behavior or condition is bad, disapproved, causing unhappiness, etc. In other words, talking about "sick minds" is analogous to talking about "sick jokes" or "sick economies. In the case of mental illness, we are dealing with a metaphorical way of expressing the view that the speaker thinks there is something wrong about the behavior of the person to whom he attributes the "illness."

In short, just as there were no witches, only women disapproved and called "witches," so there are no mental diseases, only behaviors of which psychiatrists disapprove and call them "mental illnesses." Let's say a person has a fear of going out into the open. Psychiatrists call that "agoraphobia" and claim it is an illness. Or if a person has odd ideas or perceptions, psychiatrists say he has "delusions" or "hallucinations." Or he uses illegal drugs or commits mass murder. These are all instances of behaviors, not diseases. Nearly everything I say about psychiatry follows from that.

RW: Let's say that modern science, with all the advances in genetics and biochemistry, finds out that there are some behavioral correlates of biological deficits or imbalances, or genetic defects. Let's say people who have hallucinations or are delusional have some biological deficits. What does that make of your ideas?

Thomas Szasz: Such a development would validate my views, not invalidate them, as my critics think. Obviously, I don't deny the existence of brain diseases; on the contrary, my point is that if mental illnesses are brain diseases, we ought to call them brain diseases and treat them as brain diseases — and not call them mental illnesses and treat them as such. In the 19th century, madhouses were full of people who were "crazy"; more than half of them, as it turned out, had brain diseases — mainly neurosyphilis, or brain injuries, intoxications, or infections. Once that was understood, neurosyphilis ceased to be a mental illness and became a brain disease. The same thing happened with epilepsy.

RW: It's interesting, because a lot of students of mine, and colleagues, who have read your work or heard of your ideas, think that when conditions previously thought to be mental is to be a brain disease, as noted, your ideas become moot.

Thomas Szasz: That's because they are not familiar with the history of psychiatry, don't really understand what a metaphor is, and don't want to see how and why psychiatric diagnoses are attached to people. Ted Kaczynski, the so-called Unabomber, was diagnosed as schizophrenic by government psychiatrists. If people want to believe that a "genetic defect" causes a person to commit such a series of brilliantly conceived crimes — but that when a person composes a great symphony, that's due to his talent and free will — so be it.

Objective, medical diagnostic tests measure chemical and physical changes in tissues; they do not evaluate or judge ideas or behaviors. Before there were sophisticated diagnostic tests, physicians had a hard time distinguishing between real epilepsy — that is to say, neurological seizures — and what we call "hysterical seizures," which is simply faking epilepsy, pretending to have a seizure. When epilepsy became understood as due to an increased excitability of some area of the brain, then it ceased to be psychopathology or mental illness, and became neuropathology or brain disease. It then becomes a part of neurology. Epilepsy still exists. Neurosyphilis, though very rare, still exists, and is not treated by psychiatrists; it is treated by specialists in infectious diseases, because it's an infection of the brain.

The discovery that all mental diseases are brain diseases would mean the disappearance of psychiatry into neurology. But that would mean that a condition would be a "mental disease" only if it could be demonstrated, by objective tests, that a person has got it, or has not got it. You can prove — objectively, not by making a "clinical diagnosis" — that X has neurosyphilis or does not have it; but you cannot prove, objectively, that X has or does not have schizophrenia or "clinical depression" or post traumatic stress disorder. Like most nouns and verbs, the word "disease" will always be used both literally and metaphorically. As long as psychiatrists are unwilling to fix the literal meaning of mental illness to an objective standard, there will remain no way of distinguishing between literal and metaphorical "mental diseases."

RW: Psychiatrists, of course, don't want to be pushed out of the picture. They want to hold on to schizophrenia as long as they can, and now depression and gambling, and drug abuse, and so on, are proposed as biological or genetically determined. Everything is thought to have a genetic marker, perhaps even normality. What do you make of this?

Thomas Szasz: I hardly know what to say about this silliness. Unless a person understands the history of psychiatry and something about semantics, it's very difficult to deal with this. Diagnoses are NOT diseases. Period. Psychiatrists have had some very famous diseases for which they have never apologized, the two most obvious ones being masturbation and homosexuality. People with these so-called "diseases" were tortured by psychiatrists — for hundreds of years. Children were tortured by antimasturbation treatments. Homosexuals were incarcerated and tortured by psychiatrists. Now all that is conveniently forgotten, while psychiatrists — prostitutes of the dominant ethic — invent new diseases, like the ones you mentioned. The war on drugs is the current psychiatric-judicial pogrom. And so is the war on children called "hyperactive," poisoned in schools with the illegal street drug called "speed," which, when called "Ritalin," is a miracle cure for them.

Let me mention another, closely related characteristic of psychiatry, as distinct from the rest of medicine. Only in psychiatry are there "patients" who don't want to be patients. This is crucial because my critique of psychiatry is two-pronged. One of my criticisms is conceptual: that is, that mental illness is not a real illness. The other one is political: that is, that mental illness is a piece of justificatory rhetoric, legitimizing civil commitment and the insanity defense. Dermatologists, ophthalmologists, gynecologists, don't have any patients who don't want to be their patients. But the psychiatrists' patients are paradigmatically involuntarily.

Originally, all mental patients were involuntary, state hospital patients. That concept, that phenomenon, still forms the nucleus of psychiatry. And that is what is basically wrong with psychiatry. In my view, involuntary hospitalization and the insanity defense ought to be abolished, exactly as slavery was abolished, or the disfranchisement of women was abolished, or the persecution of homosexuals was abolished. Only then could we begin to examine so-called "mental illnesses" as forms of behavior, like other behaviors.

RW: In terms of involuntary hospitalization and coercive psychiatry, which you've critiqued in your works.

Thomas Szasz: Excuse me, all psychiatry is coercive, actually or potentially — because once a person walks into a psychiatrist's office, under certain conditions, that psychiatrist has the legal right and the legal duty to commit that person. The psychiatrist has the duty to prevent suicide and murder. The priest hearing confession has no such duty. The lawyer and the judge have no such duties. No other person in society has the kind of power the psychiatrist has. And that is the power of which psychiatrists must be deprived, just as white men had to be deprived of the power to enslave black men. Priests used to have involuntary clients. Now we call that forcible religious conversion and religious persecution; it used to be called "practicing the true faith" or "loving God." Now we have forcible psychiatric conversion and psychiatric persecution — and we call that "mental health" and "therapy." It would be funny if it were not so serious.

RW: The symbolic nature of psychiatry and the sociology of psychiatry are coercive. Yet, every act isn't literally coercive. Somebody comes to a doctor and says, "I can't sleep. I'm depressed. Can you give me something to help me go to sleep, help wake me up?" That's a free exchange.

Thomas Szasz: That's correct. There are voluntary psychiatric exchanges, at least in principle. As I like to say, I wholeheartedly approve of psychiatric acts between consenting adults. But such acts are pseudo-medical in nature, because the problem at hand is not medical, and also because the transaction often rests on taking advantage of the criminalization of the free market in drugs. Why do you have to go to a doctor to get a sleeping pill or a tranquilizer? A hundred years ago you didn't have to do that, you could go to a drug store, or to Sears Roebuck, and buy all the drugs you wanted — opium, heroin, chloral hydrate. In certain ways, the psychiatric profession lives off the fact that only physicians can prescribe drugs, and the government has made most drugs that people want prescription drugs.

RW: On a side note, isn't it interesting, and troubling, that most people who go to jail for drug abuse, or drug selling, are black and minority, and those that have the license to prescribe are often non-minority, and they get to be heroes in society for essentially selling what is sometimes the same merchandise, albeit legally, of course?

Thomas Szasz: Indeed. I discuss that new form of black enslavement in detail in my book, "Our Right to Drugs." Because of the kinds of laws we have, physicians prescribe mood-altering drugs, which patients often want and demand; it's a medicalized version of drug distribution. Physicians did the same thing with liquor during Prohibition, which was quite lucrative.

RW: And now psychiatry and pharmacology can be a lucrative business.

Thomas Szasz: Psychiatry is a lucrative business only insofar as it partakes of these two medical-psychiatric privileges or monopolies — prescribing drugs, which only licensed physicians can do; and creating their own patients, that is, transforming people into patients against their will, which only psychiatrists can do.Psychiatry is a lucrative business only insofar as it partakes of these two medical-psychiatric privileges or monopolies — prescribing drugs, which only licensed physicians can do; and creating their own patients, that is, transforming people into patients against their will, which only psychiatrists can do.

RW: So what is your view on psychiatric medication for people suffering from "schizophrenia" or "problems in living" as you call it, or "interpersonal difficulties," or "intra-psychic difficulties." Whatever you call it, people suffer or are troubled internally or interpersonally. What is your view on the use of either legal or illegal drugs to help people cope with these things?

Thomas Szasz: I am smiling because I know you know my views! However, I wouldn't phrase the question this way. In my opinion, using drugs is a fundamental human right, similar to using books or prayer. Hence, it comes down to the question of what does a person want and how can he get what he wants? If a person wants a book, he can go to a store and get it or get it on the Internet. He ought to be able to get a drug the same way. If he doesn't know what to take, then he could go to a doctor or a pharmacist and ask them. And then he should be able to go and buy it.

RW: That brings up the issue of drug and prescription laws, which you have written about extensively.

Thomas Szasz: Indeed. Prescription drug laws are a footnote to drug prohibition. Prescription laws should be repealed. All drug laws should be repealed. Then, people could decide for themselves what helps them best to relieve their existential ails, assuming they want to do it with a drug: opium or marijuana or cigarettes or Haldol or Valium. After all, the only arbiter of what ails a person "mentally" and what makes him feel or function better, as he defines better, is the patient. We don't have any laboratory tests for neuroses and psychoses.

As for insomnia, typically that's a complaint, an indirect communication, to obtain sleeping pills. A person can't go to a physician and tell him: Please write me a prescription for a barbiturate. If he did that, he would be diagnosed and denounced as an addict. So he must say: "I can't sleep." How could the doctor know if that's true?

RW: You ask him how many hours he sleeps, he says two hours a night.

Thomas Szasz: How would the doctor know if that's true? The term "insomnia" can function as a strategic lie that the patient has to utter to get the prescription he wants.

RW: You seem to have a different view of the medical model of medicine, than the medical model of psychiatry.

Thomas Szasz: Yes, very much so. We don't speak of the medical model of medicine in medicine or the medical model of pneumonia. There is no other model. We don't speak of the electrical model of why a light bulb emits light. Language is very important. If a person says: "I am against the medical model of mental illness," that implies that mental illness exists and that there is some other model of it. But there is no mental illness. There is no need for any model of it.

The important issue is not the "medical model," a badly abused term; the issue is the "pediatric model," the "irresponsibility model" — treating people labeled as mentally ill as if they were little children and as if the psychiatrist was their parent. The pillars of psychiatry are medically rationalized and judicially legitimized coercions and excuses.

RW: If you were to use mental illness as a metaphor, or pseudonym... disease meaning "dis-ease," people are personally distressed, the psychosocial model of mental illness. If you substitute "emotional troubles".

Thomas Szasz: No. That won't do. Almost anything can be the cause of emotional trouble — being black or being poor or being rich, for that matter. Innumerable human conditions can create human distress. Which ones are we going to medicalize, and which ones are we not? We used to medicalize, psychiatrize, blacks running away from slavery, masturbation, homosexuality, contraception. Now we don't. Instead we medicalize what used to be called melancholia, and sloth, and self-murder, and racism, and sexism.

RW: To shift gears.

Thomas Szasz: Let's not yet. Because I want to add that it is this tendency to call more and more human problems "diseases" and then try to remedy them, or "attack" them, as if they were diseases is what I call "the therapeutic state.

RW: Certainly everything used to be viewed religiously, and now so much is seen as medical. The transformation is almost pure.

Thomas Szasz: Exactly! And it's perfectly obvious. It requires the systematic educational and political dumbing down of people not to see it. Three hundred years ago, every human predicament was seen as a religious problem — sickness, poverty, suicide, war. Now they are all seen as medical problems — as psychiatric problems, as caused by genes and curable with "therapy." In the past, the criminal law was imbued with theology; now, it's imbued with psychiatry.

RW: President Bill Clinton is a prime example of how we use different models to describe the same problem. His wife said his problems were due to "emotional problems" in his childhood. His brother said he was a sex addict, because he was a drug addict, himself. And Bill Clinton said it was a sin issue — the religious model. He went to a minister.

Thomas Szasz: That's a good point. But note that Clinton didn't go to a real minister. He went to a politician — Jesse Jackson. His job was to make Clinton look good again. And he did it. Clinton hand-picked him as he did the others, much as a medieval emperor might have hand picked a bishop to make him look good.

RW: Can I shift gears now?

Thomas Szasz: Sure.