Szasz is a critic of the influence of modern
medicine on society, which he considers to be the
secularisation of religion's hold on human kind. Criticizing
scientism, he targets in particular psychiatry, underscoring its campaigns against
masturbation at the end of the 19th century or the use of
lobotomy to treat
schizophrenia. To sum up his conception of medicine, he declared:
Since theocracy is the rule of God or its priests, and democracy the rule of the people or of the majority, pharmacracy is therefore the rule of medicine or of doctors.
He considers that:
"The struggle for definition is veritably the struggle for life itself. In the typical Western two men fight desperately for the possession of a gun that has been thrown to the ground: whoever reaches the weapon first shoots and lives; his adversary is shot and dies. In ordinary life, the struggle is not for guns but for words; whoever first defines the situation is the victor; his adversary, the victim. For example, in the family, husband and wife, mother and child do not get along; who defines whom as troublesome or mentally sick?...[the one] who first seizes the word imposes reality on the other; [the one] who defines thus dominates and lives; and [the one] who is defined is subjugated and may be killed."
His main arguments can be summarised as follows:
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The myth of mental illness: It is a medical metaphor to describe a behavioral disorder, such as
schizophrenia, as an "illness" or "disease". Szasz wrote: "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." While people behave and think in ways that are very disturbing, this does not mean they have a disease. To Szasz, people with mental illness have a "fake disease," and these "scientific categories" are in fact used for power controls. Schizophrenia is "the sacred symbol of psychiatry". To be a true disease, the entity must somehow be capable of being approached, measured, or tested in scientific fashion. According to Szasz, disease must be found on the autopsy table and meet pathological definition instead of being voted into existence by members of the
American Psychiatric Association. Mental illnesses are "like a" disease, argues Szasz, putting mental illness in a semantic metaphorical language arts category. Psychiatry is a
pseudo-science that parodies medicine by using medical sounding words invented over the last 100 years. To be clear,
heart break and
heart attack belong to two completely different categories. Psychiatrists are but "soul doctors", the successors of
priests, who deal with the spiritual "problems in living" that have troubled people forever. Psychiatry, through various Mental Health Acts has become the secular
state religion according to Thomas Szasz. It is a social control system, which disguises itself under the claims of scientificity. The notion that biological psychiatry is a real science or a genuine branch of medicine has been challenged by other critics as well, such as
Michel Foucault in
Madness and Civilization (1961).
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Separation of psychiatry and the state: If we accept that "
mental illness" is a euphemism for behaviours that are disapproved of, then the state has no right to force psychiatric "treatment" on these individuals. Similarly, the state should not be able to interfere in mental health practices between consenting adults (for example, by legally controlling the supply of
psychotropic drugs or psychiatric medication). The medicalization of government produces a "therapeutic state," designating someone as "insane" or as a "drug addict". In
Ceremonial Chemistry (1973), he argued that the same
persecution which has targeted
witches, Jews, Gypsies or
homosexuals now targets "drug addicts" and "insane" people. Szasz argued that all these categories of people were taken as
scapegoats of the community in
ritual ceremonies. To underscore this continuation of religion through medicine, he even takes as example
obesity: instead of concentrating on
junk food (ill-nutrition), physicians denounced hypernutrition. According to Szasz, despite their scientific appearance, the
diets imposed were a moral substitute to the former
fasts, and the social injunction
not to be overweight is to be considered as a moral order, not as a scientific advice as it claims to be. "Health" is a moral concept, argues Szasz. As with those thought bad (insane people), those who took the wrong drugs (drug-addicts), medicine created a category for those who had the wrong weight (obeses). Szasz argued that psychiatrics was created in the
17th century to study and control those who erred from the medical norms of social behavior; a new specialisation, "drogophobia", was created in the
20th century to study and control those who erred from the medical norms of drug consumption; and then, in the 1960s, another specialization, "
bariatrics", was created to deal with those who erred from the medical norms concerning the weight which the body should have. Thus, he underscores that in 1970, the American Society of Bariatic Physicians (from the Greek
baros, weight) had 30 members, and already 450 two years later.
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Presumption of competence: Just as legal systems work on the presumption that a person is innocent until proven guilty, individuals accused of crimes should not be presumed incompetent simply because a doctor or psychiatrist labels them as such. Mental incompetence should be assessed like any other form of incompetence, i.e., by purely legal and judicial means with the right of representation and appeal by the accused.
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Death control: In an analogy to
birth control, Szasz argues that individuals should be able to choose when to die without interference from medicine or the state, just as they are able to choose when to conceive without outside interference. He considers
suicide to be among the most fundamental rights, but he opposes state-sanctioned
euthanasia. In his 2006 book about
Virginia Woolf he stated that she put an end to her life by a conscious and deliberate act, her suicide being an expression of her freedom of choice.
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Abolition of the insanity defense: Szasz believes that testimony about the mental competence of a defendant should not be admissible in trials. Psychiatrist testifying about the mental state of an accused person's mind have about as much business as a priest testifying about the religious state of a person's soul in our courts. Insanity was a legal tactic invented to circumvent the punishments of the Church, which, at the time included confiscation of the property of those who committed suicide, which often left widows and orphans destitute. Only an insane person would do such a thing to his widow and children, it was successfully argued. Legal mercy masquerading as medicine, said Szasz.
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Abolition of involuntary hospitalization: No one should be deprived of liberty unless he is found guilty of a criminal offense. Depriving a person of liberty for what is said to be his own good is immoral. Just as a person suffering from terminal cancer may refuse treatment, so should a person be able to refuse psychiatric treatment.
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Our right to drugs:
Drug addiction is not a "disease" to be cured through legal drugs (
Methadone instead of
heroin; which forgets that heroin was created in the first place to be a substitute to
opium), but a social "
habit". Szasz also argues in favor of a drugs free-market. He criticized the "
war on drugs", arguing that using drugs was in fact a
victimless crime. Prohibition itself constituted the crime. He shows how the "war on drugs" lead states to do things that would have never been considered half a century before, such as prohibiting a person from ingesting certain substances or interfering in other countries to impede the production of certain plants (e.g.
coca eradication plans, or the campaigns against
opium; both are traditional plants opposed by the
Western world). Although Szasz is skeptical about the merits of psychotropic medications, he favors the repeal of
drug prohibition. "Because we have a free market in food, we can buy all the bacon, eggs, and ice cream we want and can afford. If we had a free market in drugs, we could similarly buy all the barbiturates, chloral hydrate, and morphine we want and could afford." Szasz argued that the
prohibition and other legal restrictions on drugs are enforced not because of their lethality, but in a
ritualistic aim (he quotes
Mary Douglas's studies of rituals). He also recalls that
pharmakos, the Greek root of
pharmacology, originally meant "scapegoat". Szasz dubbed pharmacology "pharmacomythology" because of its inclusion of social practices in its studies, in particular through the inclusion of the category of "
addictiveness" in its programs. "Addictiveness" is a social category, argued Szasz, and the use of drugs should be apprehended as a social ritual rather than exclusively as the act of ingesting a chemical substance. There are many ways of ingesting a chemical substance, or "drug" (which comes from
pharmakos), just as there are many different cultural ways of eating or drinking. Thus, some cultures prohibit certain types of substances, which they call "
taboo", while they make use of others in various types of ceremonies.
Szasz has been associated with the
anti-psychiatry movement of the
1960s and
1970s, although he has resisted being identified as an anti-psychiatrist. He is not opposed to the practice of psychiatry if it is non-coercive. He maintains that psychiatry should be a contractual service between consenting adults with no state involvement. He favors the abolition of involuntary hospitalization for mental illness. In a 2006 documentary film called
Psychiatry: An Industry of Death released on DVD Szasz stated that involuntary mental hospitalization is a crime against humanity. Szasz also believes that, if unopposed, involuntary hospitalization will expand into "pharmacratic" dictatorship.
Szasz's work has influenced thinkers as diverse as
Karl Popper, Milton Friedman, and
Michel Foucault.
