Szasz is a critic of the influence of modern medicine on society, which he considers to be the secularisation of religion's hold on humankind. Criticizing scientism, he targets in particular psychiatry, underscoring its campaigns against masturbation at the end of the 19th century, its use of medical imagery and language to describe misbehavior, its reliance on involuntary mental hospitalization to protect society, or the use of lobotomy and other interventions to treat psychosis. To sum up his description of the political influence of medicine in modern societies imbued by faith in science, 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.
Szasz consistently pays attention to the power of language in the establishment and maintenance of the social order, both in small interpersonal as well as wider socio-political spheres:
"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:
- The myth of mental illness: "Mental illness" is an expression, a metaphor that describes an offending, disturbing, shocking, or vexing conduct, action, or pattern of behavior, 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, and that may resemble a disease process (pain, deterioration, response to various interventions), this does not mean they actually have a disease. To Szasz, disease can only mean something people "have," while behavior is what people "do". Diseases are "malfunctions of the human body, of the heart, the liver, the kidney, the brain" while "no behavior or misbehavior is a disease or can be a disease. That's not what diseases are" Szasz cites drapetomania as an example behavior which many in society did not approve of, being labeled and widely cited as a 'disease' and likewise with women who did not bow to men's will as having "hysteria" Psychiatry actively obscures the difference between (mis)behavior and disease, in its quest to help or harm parties to conflicts. By calling certain people "diseased", psychiatry attempts to deny them responsibility as moral agents, in order to better control them.
People who are said (by themselves or others) to "have" a mental illness can only have, at best, a "fake disease." Diagnoses of "mental illness" or "mental disorder" (the latter expression called by Szasz a "weasel term" for mental illness) are passed off as "scientific categories" but they remain merely judgments (judgments of disdain) to support certain uses of power by psychiatric authorities. In that line of thinking, schizophrenia is not the name of a disease entity but a judgment of extreme psychiatric and social reprobation. Szasz calls schizophrenia "the sacred symbol of psychiatry" because those so labeled have long provided and continue to provide justification for psychiatric theories, treatments, abuses, and reforms. The figure of the psychotic or schizophrenic person to psychiatric experts and authorities, according to Szasz, is analogous with the figure of the heretic or blasphemer to theological experts and authorities. According to Szasz, to understand the metaphorical nature of the term "disease" in psychiatry, one must first understand its literal meaning in the rest of medicine. To be a true disease, the entity must first, somehow be capable of being approached, measured, or tested in scientific fashion. Second, to be confirmed as a disease, a condition must demonstrate pathology at the cellular or molecular level.
A genuine disease must also be found on the autopsy table (not merely in the living person) and meet pathological definition instead of being voted into existence by members of the American Psychiatric Association. "Mental illnesses" are really problems in living. They are often "like a" disease, argues Szasz, which makes the medical metaphor understandable, but in no way validates it as an accurate description or explanation. Psychiatry is a pseudo-science that parodies medicine by using medical sounding words invented especially over the last 100 years. To be clear, heart break and heart attack, or spring fever and typhoid fever belong to two completely different logical categories, and treating one as the other constitutes a category error, that is, a myth. Psychiatrists are the successors of "soul doctors", priests who dealt and deal with the spiritual conundrums, dilemmas, and vexations ... the "problems in living" ... that have troubled people forever.
Psychiatry's main methods are those of conversation or rhetoric, repression, and religion. To the extent that psychiatry presents these problems as "medical diseases," its methods as "medical treatments," and its clients ... especially involuntary ... as medically ill patients, it embodies a lie and therefore constitutes a fundamental threat to freedom and dignity. Psychiatry, supported by the State through various Mental Health Acts, has become a modern secular state religion according to Thomas Szasz. It is a vastly elaborate social control system, using both brute force and subtle indoctrination, 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), and Erving Goffman in
Asylums (1961).
- Separation of psychiatry and the state: State government by enforcing the use of shock therapy has abused Psychiatry with impunity. If we accept that "mental illness" is a euphemism for behaviors 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 diet 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. 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 were created in the 17th century to study and control those who erred from the medical norms of social behavior; a new specialization, 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.
- 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.
- 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. My Madness Saved Me: The Madness And Marriage of Virginia Woolf
- Abolition of the insanity defense: Szasz believes that testimony about the mental competence of a defendant should not be admissible in trials. Psychiatrists 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.
- 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.
- 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 morphine, which in turn was created as 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 leads 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 wrongly associated with the anti-psychiatry movement of the 1960s and 1970s. 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. In a 2006 documentary film called
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.
