The Reality-Based Community

Tom Szasz died on September 8, 2012. I met him in the early 1990s, when he was in Cambridge to participate in a symposium on drug policy. Keep in mind, please, that what I know about public policy, psychiatry and the War on Drugs could fit into a teaspoon. Mark asked me to help him host a post-forum dinner for the panelists solely because of his faith in my social skills. Two of the men at the party were known to square off against each other based on a difference of ideology, and Mark wished to avoid unpleasantness. I was touched by his groundless belief that good manners could prevent a food fight, and I resolved to do my best.

As things turned out, there was no need for oil on troubled waters. The dinner guests kept it civil, and I got to meet Tom, who was seated across from me. I don’t want to sound melodramatic, but it was a life-changing experience for me. True to form, Mark had not thought it necessary to mention Tom’s prominence or suggest that I read his books, so I chatted up this kindly professor of psychiatry without knowing anything about him.

Until that evening, I had never witnessed an actual example of academic debate without ad hominem unpleasantness. I understood the concept, but it was a vague ideal, not anything real.

At one point Mark asked Tom about something specifically because he knew Tom’s view on a related issue and thought he might take the opposite position. He was right. I saw the twinkle in Tom’s eye first, and then I got the most marvelous lesson in civil debate. Tom said things like, “I do not think it is true that [whatever],” and then he explained his reasons, with emphasis on the data. He never said, “That’s nonsense,” even when it was. His word choice was phenomenal. Every sentence was constructed to avoid casting aspersions. He made no effort to persuade anyone.

The effect hit me hard. By eliminating all the tropes of debate, only the ideas were left for our attention. This was powerful stuff. I drank it in and I have never forgotten. Faced with difficult interactions, I still try to channel Tom Szasz.

Mark reminded me that Tom used to say, “Var on drogs? Var on drogs? Vat is zees var on drogs? You cannot make a var on a drog! A drog is a chemical, inert until you swallow it. You can only make var on human beeinks, and zat is what we are doink.”

Professor Szasz hated tyranny so much that it caused him to turn against his own expertise. He rejected the idea that a man marching to a different drummer was failing to keep step because of some hearing disability that need to be corrected. If the patient wanted to keep thinking that he was the King of Siam, Szasz would try to help him live as happy as possible a life- measured against the patient’s values, not Szasz’s- while holding onto that belief. If the patient found that the belief was making him unhappy and wanted to change it, Szasz would help the patient with that task. I do not believe that his rejection of schizophrenia as a disease stemmed from anything other than an understanding that diagnosis should never be a weapon exclusive to those possessed of a license to practice psychiatry. In the heyday of involuntary commitments and the use of psychiatric patients as guinea pigs, Tom must have envisioned the looming presence of a psychiatrist-in-chief silencing critics with the velvet glove of treatment and he wanted no part of it.

Dr. Szasz never wavered in his belief that people are accountable for their choices and their conduct. There can be no compromise between rights and responsibilities. Just as tyranny removes rights, it confers a freedom from responsibility, and this, I think, is why Tom feared allowing psychiatry to alter the landscape of human culpability. He wrote about the difference between behavior and disease, deftly identifying the tension that bedevils lawyers seeking to incorporate science into justice.

Saying that a priest who takes sexual advantage of a child entrusted to his care “suffers from pedophilia” implies that there is something wrong with his sexual functioning, just as saying that he suffers from pernicious anemia implies that there something wrong with the functioning of his hematopoietic system. If that were the issue, it would be his problem, not ours. Our problem is that there is something wrong with him as a moral agent. We ought to focus on his immorality, and forget about his sexuality. A priest who has sex with a child commits a grave moral wrong and also violates the criminal law. He does not treat himself as if he has a disease before he is apprehended, and we ought not to treat him that way afterward.

Sins of the Fathers: Is child molestation a sickness or a crime?  August/September 2002 issue of “Reason.”

It may be human nature to push reason over the edge, to create sickness from overindulgence in what would otherwise be a good thing. Tom’s work on mental illness and human rights spoke directly to that point. There are few pure heroes and villains in life; by demonizing wrongdoers we absolve them from their responsibility as human beings, and by forcibly helping those we deem to be sick, we diminish them as people. The moral courage of Tom Szasz is apparent in his ability to recognize the danger inherent in a power that he already had, one which was reserved to a very few. He so valued his fellow man that he was willing to disarm psychiatry rather than see it misused. As the Greek philosophers said: μη δ’εν αγαν.

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Posted: Saturday, September 15th, 2012 at 1:23 pm
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