Thomas Szasz

The pressure to reduce health care costs is aimed only at the treatment of real diseases. There is no pressure to reduce the costs of treating fictitious diseases. On the contrary, there is pressure to define ever more types of undesirable behaviors as mental disorders or addictions and to spend ever more tax dollars on developing new psychiatric diagnoses and facilities for storing and treating the victims of such diseases, whose members now include alcoholics, drug abusers, smokers, overeaters, self-starvers, gamblers, etc.

When and why do we attribute a person's behavior to brain disease, and when and why do we not do so? Briefly, the answer is that we often attribute bad behavior to disease (to excuse the agent);never attribute good behavior to disease (lest we deprive the agent of credit); and typically attribute good behavior to free will and insist bad behavior called mental illness is a "no fault" act of nature.

The principal differences between law and science are as follows:1. In the administration of the law, facts are necessary to enable the umpire (jury, judge) to decide whether rules have been broken and, if so, the type of penalty to apply. In science, facts are necessary to form new or better theories and to develop novel applications (for example, drugs, machines). Novelty is not a positive value in law. Instead, the lawyer looks for precedent. For the scientist, however, novelty is a value; new facts and theories are sought, whether or not they will prove useful. 2. If we endeavor to change objects or persons, the distinction between law (both as law making and law enforcing) and applied science disappears. In applying scientific knowledge, one seeks to change objects, or persons, into new forms. The scientific technologist may thus wish to shape a plastic material into the form of a chair, or a delinquent youth into a law-abiding adult. The aims of the legislator and the judge are often the same. Thus, legislators may wish to change people from drinkers into nondrinkers; or judges many want to change fathers who fail to support their dependent wives and children into fathers who do. This [is a] "therapeutic" function of law.

In a secular democracy, a person is supposed to be punished only when he breaks the law; never because he is evil. That is, after all, what distinguishes a democracy from a theocracy.

If a man loses his money through unwise market speculation or by playing the horses, he has been punished in a manner which we may call passive. By this I mean that another person has not taken special, socially overt steps to harm the "offender." This phenomenon has not received the attention it deserves.

It is mainly by resisting authority that the individual defines himself. This is why authorities--whether parental, priestly, political, or psychiatric--must be careful how and where they assert themselves; for while it is true that the more they assert themselves the more they govern, it is also true that the more they assert themselves the more opportunities they offer for being successfully denied.

Malcolm X and Edmund Burke shared an appreciation of this important insight, this painful truth--that the state wants men to be weak and timid, not strong and proud.

Modern Western democracies no longer engage in such despotic assaults on freedom, Instead, they deprive people of liberty indirectly, by relieving them of responsibility for their own (allegedly self-injurious) actions and calling the intervention "treatment.

If we regard the state as the father, and the citizens as children, there are three alternatives. First, the father may be bad and despotic:this, most people will agree, was the case in Czarist Russia. Second, the father may be good, but somewhat tyrannical; this is the way the Communist governments in Russia and China picture themselves. Third, the father may not act as a father at all, for the children have grown up, and there is mutual respect among them. All are now governed by the same rules of behavior (laws): this is the Anglo-American concept of nonpaternalistic humanism and liberty under law.

Honoring the value of competence and steadfastness requires a generosity of spirit and a curbing of the passion for envy, traits that few people value and fewer still cultivate and acquire. Not until there is more of Smith and less of Hobbes in the human heart, will the majority of people prefer peaceful and boring market relations to the violent and exciting relations between coercer and coerced, predator and victim

The medical profession's classic prescription for coping with such predicaments, Primum non nocere (First, do no harm), sounds better than it is. In fact, it fails to tell us precisely what we need to know: What is harm and what is help? However, two things about the challenge of helping the helpless are clear. One is that, like beauty and ugliness, help and harm often lie in the eyes of the beholder--in our case, in the often divergently directed eyes of the benefactor and his beneficiary. The other is that harming people in the name of helping them is one of mankind's favorite pastimes.

The ethics of psychiatric therapy is the very negation of the ethics of political liberty. The former embraces absolute power, provided it is used to protect and promote the patient's mental health. The latter rejects absolute power, regardless of its aim or use.

Our legal system does not grant adults a right to liberty, because they already possess that right; it only revokes the right to liberty (for certain offenses) or restores it (if the deprivation did not conform to due process).

Men love liberty because it protects them from control and humiliation from others, and thus affords them the possibility of dignity. They loathe liberty because it throws them back on their own abilities and resources, and thus confronts them with the possibility of insignificance.

Although both home and mental illness are complex, modern ideas, we have fallen into the habit of using phrases such as "housing the homeless" and "treating the mentally ill" as if we knew what counts as housing a homeless person or what it means to treat mental illness. But we do not. We have deceived ourselves that having a home and being mentally healthy are our natural conditions, and that we become homeless or mentally ill as a result of "losing" our homes or our minds. The opposite is the case. We are born without a home and without reason, and have to exert ourselves and are fortunate if we succeed in building a secure home and a sound mind.

There are two kinds of 'disabled' persons: Those who dwell on what they have lost and those who concentrate on what they have left.

The concept of disease is fast replacing the concept of responsibility. With increasing zeal Americans use and interpret the assertion "I am sick" as equivalent to the assertion "I am not responsible": Smokers say they are not responsible for smoking, drinkers that they are not responsible for drinking, gamblers that they are not responsible for gambling, and mothers who murder their infants that they are not responsible for killing. To prove their point _ and to capitalize on their self-destructive and destructive behavior _ smokers, drinkers, gamblers, and insanity acquitees are suing tobacco companies, liquor companies, gambling casinos, and physicians.

Is psychiatry a medical enterprise concerned with treating diseases, or a humanistic enterprise concerned with helping persons with their personal problems? Psychiatry could be one or the other, but it cannot--despite the pretensions and protestations of psichiatrists--be both.