Psychiatry and Its Free Market Champion

This week is a big one in the psychiatry world. The American Psychiatric Association released the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). What is now a massive 1,000-page tome doesn’t come out very often, but when it does, as Johns Hopkins distinguished professor Paul McHugh writes, the book “shape[s] what psychiatrists say and do with their patients.”

Back in the old days, say, in 1952, when the DSM-1 was a spiral-bound pamphlet, people were shy; now they have social anxiety disorder. People who were once referred to as nervous Nellies now are afflicted with general anxiety disorder.

But after just a few precious minutes spent with a psychiatrist, the troubled are sent off to their friendly pharmacist for the modern version of “mother’s little helper.”

Thomas Szasz, who died at age 92 last fall, believed the psychiatric community was — dare I say it — nuts.

Szasz wrote in his book The Second Sin, “If you talk to God, you are praying; if God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; if you talk to the dead, you are a schizophrenic.”

Imagine a book full of witty common-sense quips similar to the above, listed from A-Z. That is Szasz’s Words to the Wise: A Medical-Philosophical Dictionary.

In this age of Obamacare, Big Pharma, and the therapeutic state, the wisdom of Szasz, arguably the medical profession’s biggest classical liberal, will reassure you that you’re not the one’s that’s crazy.

Szasz believed that each person owns his or her body and mind and has the right to be free from the violence of others. The government, in his view, has no business interfering with the practice of medicine, suicide, the use and sale of drugs, and sexual relations.

He argued that the definitions contained in books like the DSM-5 were simply names attached to sets of behavioral criteria. He opposed involuntary psychiatric treatment while at the same time condemning the insanity defense.

The scare tactics used by the drug prohibitionists were vigorously disputed by Szasz. In an interview with Reason magazine in 1974, he said, “The idea that a single experience with a drug — say, heroin — makes one a ‘slave’ to it, makes one unable to exist without it, is simply not true. It’s what I call ‘pharmacomythology’ — in contrast to pharmacology, which has to do with the real chemical effects of drugs.”

Szasz believed in a free market in all things, including heroin. As he put it, it should be sold like baby food. Giving yourself pleasure shouldn’t be a crime, even if it kills you. In fact, killing yourself shouldn’t be illegal either.

Szasz believed the term “mental illness” is simply a metaphor. His view was that psychiatrists can’t really treat anyone. Szasz believed the subject matter of psychiatry is, the same as religion, “what used to be called moral philosophy, of what the great dramatists and novelists of all ages have written about.”

When pressed, he called psychiatry a religion, or several religions. Szasz, the great libertarian, was essentially the atheist of psychiatry. Psychiatry is the misuse of language, he said. Patients aren’t sick, and psychiatrists aren’t treating any sort of illness.

Szasz told Reason that he liked to think up short statements or aphorisms. Words to the Wise compiles 240 pages of the brilliant fruit from Szasz. It is the perfect book, not necessarily to read cover to cover, but to poke through for pleasure and reference.

There are extensive entries for “language,” “drugs,” “psychoanalysis,” “suicide,” and “therapeutic state,” among others.

Szasz had a way of looking at the world that will turn you around and make you think. He does this not with long-winded monologues, but with sentences and paragraphs that are both pithy and memorable.

Remembering the country’s founding, Szasz explains that the United States government “was established on the principle that there are certain things it must not do to people. These injunctions are properly called the Bill of Rights.” Today’s government, however, believes “that there are certain things it must do for or to the people. These prescriptions ought properly to be called the Bill of Wrongs.”

  • “Giving oneself a controlled substance is a crime. Accepting it from a physician is a treatment”
  • “Treating addiction to heroin with methadone is like treating addiction to scotch with bourbon”
  • “Some parents want their children to have it better; others want them to do better. The former are likely to have incompetent and unhappy children, the latter, competent and happy ones.”

“Statist medicine turns adults into children,” Szasz writes. “Popular acceptance of this paternalistic substitution of needs for wants — of medicalized permissions for personal decisions — is emblematic of how readily the American people have embraced medical statism, and rejected individual liberty and personal responsibility.”

More than once, the author will make you chuckle. For instance: “The four categories of persons who can be relied on not to keep promises: politicians, psychiatrists, psychopaths, and psychotics.”

Speaking of the DSM-5, Szasz writes: “What the sharia is to the Islamic state, the Diagnostic and Statistical Manual of the American Psychiatric Association is to the therapeutic state.”

Unquestionably, Szasz displays his wisdom throughout:

“Most people want liberty and self-determination for themselves and subjection for others. Some want subjection for everyone. Few want liberty and self-determination for everyone.”

Thomas Szasz was one of the few who wanted liberty for everyone and is considered (rightly) one of the heroes of the freedom movement. Words to the Wise is great way to build a common-sense vocabulary in freedom, psychiatry, medicine, and so much more.


Doug French

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