Until recent years, “bad” and “immoral” were the terms used to describe people who are now referred to as “sick” and “in need of treatment.” Moral and religious perspective has been replaced by medical and therapeutic rhetoric. It is little wonder why the world is plagued by legions of rapists, drug users, murderers, thieves, and child abusers, all of whom are now referred to as having one form or another of “addiction” and are thus either “sick” or suffering from “mental illness.” Accordingly, modern psychotherapists claim that these are in need of specialized “therapy” or “treatment” to help them “cope with their disease.” Moral relativism, bolstered by psychotherapy, has prevailed over the traditional ideas of self-control, individual responsibility, and moral culpability. Thomas Szasz moves to demythologize psychotherapy itself in a most provocative manner.
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The mind is my métier, my most absorbing intellectual occupation. An ambition to understand the mind of Man (and mine own) motivated my initial interest in Medicine. Upon entering medical school “under the influence” of such Neuro-Psychiatrists as Dr. Richard Restak and Nobel Laureate Dr. Eric Kandel, I reasoned that Neurology, Neurosurgery, or Psychiatry would place me in a prime position to purse my explorations of the mind and the mental maladies of mankind. Settling upon Psychiatry as most suitable, I soon came to appreciate the degree to which matters of the mind were marginalized by modern Psychiatry, molecules and medicine being the basis of most discourse in the discipline. I knew that I had made an error which would require rectification. After immersing myself for several years in independent study and self-reflection I became intrigued with Existentialism and Thanatology (the study of death) and took a Master’s degree in the latter discipline. In addition to being an author and researcher, I am an existentially-oriented Analyst in private practice. The purpose of this pronouncement and the preceding personalized preamble is to declare my distaste for Psychiatry owing to its domination by drugs, its defense of dubious diagnoses, and its overarching inclination to “over-medicalize” or “pathologize” innumerable aspects of the ordinary human condition. In short, I am inclined to agree with the central critique of Psychotherapy to which Dr. Szasz subscribes. This inclination is incomplete albeit. Dr. Szasz makes several important points in his highly informative opus. Piteously, the positive attributes of his exposition are not entirely original. Sympathetic souls can certainly appreciate his candid chronicling of the horrendous history of Psychiatry. [However, Investigative Journalist Robert Whitaker does a far better job of this in his “Mad in America”, available in audiobook.] He castigates the character of Freud and condemns the credulity of our entire culture for collectively countenancing such obvious inanity for so long. [I echoed this argument in my analysis of Freud’s “Interpretation of Dreams”; see previous book review kindly posted on Audible’s site.]
Now for the not-so-positive points. Dr. Szasz restates his argument (expostulated in his classic “The Myth of Mental Illness”) that an ‘illness of the mind’ is a misnomer, a mere metaphor that is objectively untrue. Only physical illness is actual illness. He laments that language and its misuse leads to dangerous deceptions and duplicity and that this is true of the psychotherapeutic professions. He argues that Psychotherapy is not scientific but essentially spiritual in essence and that Therapists should accept this semantic signifier instead of purely pretending to practice Medicine or purporting to provide healing therapies. So, Szasz maintains that it is impossible to heal a mind; it is only possible to change a mind. While such conceptions may seem conservative to Szasz, they seem rather radical and overwrought in the estimation of this auditor. Is it absurd to accept that suffering can be as severe when psychological in origin as when afflicting an area of the body? Is pain more profound when palpable, when its nature is physical rather than psychological? Is it absurd to suppose that the psyche is subject physical, experiential, and ideational influences alike? Do not molecules manifestly modulate our moods? Do not deleterious drugs damage our minds, our memories, our very sense of self and reality? Cannot words, whether wise, warm, or weighty, often attenuate or eradicate emotional anguish? Is this not what some “Psychotherapists” earnestly endeavor to do? And when such Psychotherapists succeeded in assuaging another individual’s inner anguish, anxiety, depression, or grief—as clients commonly confess that we do—is it erroneous to regard such transactions as “therapeutic”, as “healing”? If the principles upon which such healing rests are rationally refined, systematically studied, diligently practiced and perfected, is it preposterous to pronounce such professionals “Therapists”?
Something must also be said for Philosophy. Dr. Szasz is a very learned scholar, steeped in history, literature, and the philosophy of science and ideas. The vehemence with which he rejects the notion of psychogenic suffering and psychological “treatment” suggests that he subscribes to radical dualism. If this be so, he should state it explicitly instead of (ostensibly) assuming that his audience assents to this view. Many modern men and women of learning are monistic, I imagine, considering mind to be a manifestation of matter (or vice versa). Conceptually constricting therapy to encompass only the physical realm, declaring suffering to be solely somatic and qualitatively distinct from disorders of the mind is arbitrary and conflicts with abundant empirical evidence and scientific studies too numerous to name. Finally, Dr. Szasz recommends that Psychotherapy be regarded as rhetoric. While I do not reject this denomination of our discipline, it is not irrational to regard it as (ideally) something more—something salubrious, something soterial, something scientific and, sometimes, sagacious. Is our society too lax in what it labels “therapeutic”? Yes. Are there demonstrable differences in the efficacy of diverse therapies and in the effectiveness of differentially skilled therapists? Of course. These are societal and professional problems that call for continual improvement in the provisioning of mental health care; they do not call for the dismantling of Psychotherapy as such.
Ironically, at the extreme end of his exposition, the enlightened Anti-Psychotherapist offers us an alternative appellation to employ in place of our ‘nonsensical nomenclature’. His suggested neologism is “Iatrology”. For someone who stresses the singular importance of semantics, of conceptual coherence and clarity of communication, this coinage is almost comical. I wonder if he realizes that the root ‘iatro’ originates etymologically from a Greek word signifying “physician”—or synonymously, “therapist”. Is this not the notion that he finds so noxious? The brain damage that certain psychotropic drugs and psychosurgical treatments have been documented to induce is defensibly described by some as “iatrogenic” in origin. [See Dr. Breggin’s bold and brilliant book, “Toxic Psychiatry”.] Dr. Szasz’s most recent audiobook is on this very topic. I wonder if he appreciates the irony. I do.
Dr. Nun Sava-Siva Amen-Ra, Ascetic Analyst Damascus, Maryland USA August MMXIV