Thomas Szasz (see also here) is unquestionably the most prolific and outspoken critic of coercive psychiatry. In addition to Psychiatry: The Science of Lies and Antipsychiatry: Quackery Squared, one of the last books that Szasz wrote was Coercion as Cure: A Critical History of Psychiatry. All of Szasz’s books are meritorious, but Coercion as Cure is uniquely praiseworthy because of its concise and accurate depiction of the underlying motive and the moving force of psychiatry: coercion.
In Coercion as Cure, Szasz demonstrates with dexterity how psychiatry is distinguished from the healing arts by its direct opposition to the established mantra of medicine: primum non nocere (first do no harm). His thesis is simple, and true. Although most historians of psychiatry write apologetically, hagiographically and panegyrically, Szasz writes truthfully:
“Contrary to Arieti’s and Kraepelin’s assertions, it is easy to define psychiatry. The problem is that defining it truthfully – acknowledging its self-evident ends and the means used to achieve them – is socially unacceptable and professionally suicidal. Psychiatric tradition, social expectation, and the law – both criminal and civil – identify coercion as the profession’s determining characteristic.” (Coercion as Cure, p. xi)
Psychiatry, Szasz rightly argues, is “the theory and practice of coercion, rationalized as the diagnosis of mental illness, and justified as medical treatment aimed at protecting the patient from himself and society from the patient.” (p. xi)
Szasz sees in psychiatry the rudiments of a false religion, one in which force and fraud combine with cunning euphemisms to produce “coercion as cure.” Szasz identifies three main erroneous premises that former historians of psychiatry have embraced: 1. “That so-called mental diseases exist.” 2. “That they are diseases of the brain.” and 3. “That the incarceration of ‘dangerous’ mental patients is medically rational and morally just.” (p. xii) To correct these errors, Szasz asserts that “mental disease is fictitious disease,” “psychiatric diagnosis is disguised disdain,” and “psychiatric treatment is coercion disguised as care, typically carried out in prisons called ‘hospitals.’” (p. xii) These are bold claims, but with characteristic acumen, Szasz bolsters his claims with incontrovertible historical evidence and scintillating literary and philosophical support.
Szasz is as ardent a defender of liberty and responsibility as he is an opponent of coercion and irresponsibility. But his opponent is not just psychiatry per se. As shown in Coercion as Cure, the creation and the rise of psychiatry is couched within a post-enlightenment, secular culture that defines psychiatric coercion as a virtuous endeavor to “care for” and to “benefit” the “patient.” (p. 1) For example, Szasz decries the coercive paternalism in John Locke’s Second Treatise on Government. In his Second Treatise, Locke categorizes so-called “madmen” as persons lacking reason who are justifiably deprived of liberty. (p. 3) In contrast, and in defense of the coerced against the coercer, Szasz later cites C.S. Lewis:
“We know that one school of psychology already regards religion as a neurosis. When this particular neurosis becomes inconvenient to government, what is to hinder government from proceeding to ‘cure’ it? Such ‘cure’ will, of course, be compulsory; but under the Humanitarian theory it will not be called by the shocking name of Persecution. No one will blame us for being Christians, no one will hate us, no one will revile us. The new Nero will approach us with the silky manners of a doctor, and though all will be in fact as compulsory as the tunica molesta or Smithfield or Tyburn, all will go on within the unemotional therapeutic sphere where words like ‘right’ and ‘wrong’ or ‘freedom’ and ‘slavery’ are never heard. And thus when the command is given, every prominent Christian in the land may vanish overnight into Institutions for the Treatment of the Ideologically Unsound, and it will rest with the expert gaolers to say when (if ever) they are to re-emerge. But it will not be persecution. Even if the treatment is painful, even if it is life-long, even if it is fatal, that will be only a regrettable accident; the intention was purely therapeutic. In ordinary medicine there were painful operations and fatal operations; so in this. But because they are ‘treatment’, not punishment, they can be criticized only by fellow-experts and on technical grounds, never by men as men and on grounds of justice.” (C.S. Lewis, The Humanitarian Theory of Punishment, in Coercion as Cure, p. 89)
This is indeed a sound defense, and a sobering warning.
But if psychiatry promotes coercion as cure, how does it accomplish this terrible injustice? In the introduction to Coercion as Cure, Szasz explains:
“‘You cannot judge a book by its cover’ says the proverb. Nor can you judge what psychiatrists do by what they say they do. What psychiatrists in fact do is self-evident: they stigmatize people, deprive them of liberty, injure their bodies and minds by means of forcibly imposed physical and chemical agents and interventions, and call their actions the ‘diagnosis and treatment of disease.’ They do not, of course, do this all by themselves. In the ordinary course of events, the ‘prepatients’ – to use Erving Goffman’s felicitous term – are first stigmatized by their families or peers. The psychiatrist makes the unofficial stigma official by pinning a psychiatric diagnosis on the subject. The diagnosis is a double stigma, identifying the subject as both deranged and dangerous.” (p. 7)
Szasz knew intuitively, long before he began his medical training, that mental illness was a medical fiction. (p. 9) But he became credentialed as a psychiatrist in order to critique state-sponsored psychiatric violence and the justification and legitimization of the use of force. In the course of his critique, Szasz formulated one of his keenest insights: that psychiatry has become an ersatz religion:
“[The Founders] did not anticipate, nor could they have anticipated, that the idea of mental health and the alliance of psychiatry and the state might one day replace the idea of salvation and the alliance of church and state, in short, that the therapeutic state might supplant the theological state.” (p. 9)
In fact, later on in the introduction to Coercion as Cure, Szasz defines psychiatry as a “pseudoscientific statist religion, the study and teaching of psychiatric fictions authoritatively acclaimed as scientific truths, and the enforcement of social controls rationalized by pseudo-medical diagnoses and defined as treatments.” (p. 10)
Nevertheless, Szasz is careful to separate Freud from Kraepelin, or psychoanalysis from psychiatry proper, because the former contains elements of contract, while the later rests entirely on coercion. But his caution ends there. “I have never harbored any patriotic sentiments toward psychiatry,” Szasz writes. “My aim has been to abolish psychiatric slavery, not reform it.” (p. 12)
Szasz is unflinching and unrelenting in his denouncement of the evils of psychiatry:
“Many people recognize that psychiatrists deal with human problems, not diseases of the brain, which fall in the domain of neurologists and neurosurgeons. However, it is one thing privately to recognize a ‘forbidden fact,’ another to accept its moral and social implications, and still another to proclaim publicly that the psychiatrist-emperor is not merely naked but a liar and an abuser of his fellow man, unworthy of being considered a member of a healing profession.” (p. 13)
After this compelling introduction, Szasz proceeds to expose the nefarious history of psychiatry in all its horror, excoriating practices such as mental hospitalization as “therapeutic imprisonment,” shock and commotion as “terror therapy,” and moral treatment as “renaming coercion.” In subsequent chapters he lambastes coercive psychiatric practices such as sleep deprivation “therapy,” iatrogenic epilepsy, lobotomy or “cerebral spaying,” and psychopharmacology. Without doubt, other authors of the critical history of psychiatry such as Robert Whitaker (see here, here, here, and here), Peter Breggin (see here, here, here, and here), and James Davies (see here and here), are indebted to Szasz for his courage, his comprehensive scholarship and his meticulous research.
I cannot commend Thomas Szasz’s Coercion as Cure more highly, but I can recommend it to anyone who has ever been puzzled by the myth of mental illness. In contrast to the coercion inherent in psychiatry, Thomas Szasz offers his insights by way of persuasion, and I recommend Szasz’s book by way of invitation.
Dr. Thomas Szasz
(For more works by Dr. Thomas Szasz, see here, here, here, here, here, and here.)
Psychiatric Survivors 