Great provoker
Anthony Storr
The Myth of Psychotherapy; The Theology of Medicine; Schizophrenia Thomas Szasz (Oxford £5.95, £5.75, £5.95)
The vital thing to understand about the controversial Thomas Szasz is his system of values. In Schizophrenia he writes: 'Life is an arduous and tragic struggle; what we call "sanity" — what we mean by "not being schizophrenic" — has a great deal to do with competence, earned by struggling for excellence; with compassion, hard won by confronting conflict; and with modesty and patience, acquired through silence and suffering. This image, not so much of some sort of idealistic sanity or mental health, [is] simply of being able to endure life with decency and dignity . .' It follows from this that he regards psychotic and neurotic people not as 'ill', as conventional psychiatry would have us think of them, nor as the victims of the family and society as the 'anti-psychiatrists' Laing and Cooper regard them, but as persons who have failed in life's major task, 'the obligation to transfer oneself from infant into child, adolescent, and adult (into whatever we think we ought to be)'.
In Szasz's view, 'Childhood is a prison sentence of 21 years. To the child, control means care and love; to the adult, disdain and repression.' Autonomy, therefore, is highest in Szasz's hierarchy of values; and anyone who diminishes adult autonomy, even though he may seem to be doing this from the best of motives as in caring for the 'mentally ill' or protecting them in 'their own best interests' is a malignant persecutor who conceals his desire for power and his need for scapegoats as reassurance by masquerading as a psychiatrist or 'doctor of the mind'.
Szasz is nothing if not consistent. If people want to commit suicide, it is no part of a psychiatrist's duty forcibly to prevent them. If people want to make use of harmful substances like heroin, alcohol, tobacco, or marijuana, there Should be no legal controls to prevent them doing so (provided that they are legally adult). Life is essentially a tragic business. If adults are too weak or too unfortunate to be able to endure life and wish either to stupefy themselves or make an end of themselves, they must be allowed to do so rather than be put in the humiliating position of being labelled 'mental patients' and put under the control of white-coated gaolers.
Psychotherapy (in which Szasz still believes, in spite of appearances to the contrary), is not a technique for making people happy or freeing them from guilt or responsibility, but a means for enabling them to gain a better understanding of themselves and others, and thus, essentially, for facilitating their achievement of greater autonomy by freeing themselves from whatever in themselves they feel to be alien, compulsive, or out of control. This is why psychotherapy must be a contract which is freely negotiated between client and analyst. Any other form of so-called 'psychiatric treatment' is not only liable to be paternalistic and therefore demeaning, but also a fraud in that, by labelling the subject as 'mentally ill', and by treating him as less than autonomous, it is encouraging him to persist in the role of patient rather than enabling him to become an increasingly free agent. Moreover, those who exercise power over patients cut themselves off from understanding them. 'In human affairs, power and understanding are antithetical to each other.'
This, in summary, is what Szasz has been saying, over and over again for over 20 years, in book after book (I have ten on my shelves, but there are others). I admire Szasz, and I think so highly of his book The Ethics of Psycho-Analysis that I warmly recommend it to students who are studying psychotherapy. In spite of this, I profoundly disagree with Szasz in certain respects, and I also deplore the intemperate, polemical tone which disfigures so many of his writings, and which seems to have become more strident with the years. If ever a man damaged his omit case by overstatement, that man is Szasz.
I disagree first with his conception of schizophrenia. I and the majority of my colleagues believe that schizophrenia is a genuine illness, in spite of the fact that, to date, no organic lesion or chemical imbalance has been proved to account for it. As J. K. Wing points out in his recent book Reasoning About Madness, many genuine illnesses have been recognized and described before their physical pathology was understood. Secondly, I don't think that every psychiatrist who goes along with some degree of legal coercion of 'mentally people is a malignant persecutor. A man who is threatening to kill others because hallucinatory voices tell him to do so is, I believe, better looked after in a mental hospital than in prison, which is Szasz's only alternative for those who, in any society, have to be restrained. Szasz is, of course, basing his views on mental hospitals in the United States in which a far greater proportion of patients are involuntarily confined than in Great Britain.
Szasz is much too inclined to abuse anyone who disagrees with him as dishonest or in search of self-aggrandisement. This is especially true of his strictures on Freud. Nor do I agree that mental patients are necessarily, or even very often, the scapegoats of society in the same way in which witches, Jews, and negroes have been made into scapegoats. Szasz seems almost to have abandoned any concept of unconscious mental functioning and to treat everyone as if their symptoms were a matter of will.
1 think that the distinction between malingering and neurosis and psychosis is a real one, however difficult it may be to make it in specific instances. People do not choose to perform obsessional rituals, to be claustrophobic, to prefer small boys to women sexually, or to experience hallucinations. Szasz of course knows this; but he often writes as if he did not, In spite of these and many other areas of disagreement, Szasz is a valuable critic and agent provocateur. I agree that psychotherapy is not .a medical treatment and should probably be removed from the sphere of the medical model. I too deplore the misuse of language employed by psychiatrists, of which Szasz gives many examples. Szasz has much to say which requires answering. But I wish he would conduct his arguments in a reasoned, dignified manner. So much of what he writes is couched in that 'base rhetoric' which he so freely accuses others of employing.
THIS WEEK'S CONTRIBUTORS Tim Garton Ash lives in Berlin where he is writing a book on East Germany.
Dr Anthony Storr is clinical lecturer In psychology at Oxford university and the author of Human Aggression and The Dynamics of Creation.
Richard Ritchie has edited A Nation or No Nation, a critical study of Powell's speeches. Alex de Jonge's latest book was The Weimar Years.
Finns Keller's next book is on Criticism.
Peter Jenkins is the political colum. nist of the Guardian and the author of The Battle of Downing Street.
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