An Interview with Jeffrey Schaler, author of Addiction Is A Choice

IN 2000, psychologist Jeffrey A. Schaler published a book that shook the foundation of the powerful addiction industry. His thesis was simple: people consume drugs and alcohol because they want to, not because they have a disease. The addiction industry, with annual revenues in the tens of billions of dollars, fought back ferociously against Schaler. Some former heavy drug users and drinkers also attacked Schaler for challenging the belief that their drug use was a biological compulsion, not an act of free will. Many in medicine and criminal justice — institutions wedded to the addiction theory, came not to praise Schaler but to bury him. But 20 years after its publication, Addiction is a Choice is still in print and stimulating discussion. In a review, Steven Slate, a researcher fellow with the Baldwin Research Institute, calls the book “a brilliant work, and…a serious must-read for anyone seeking the truth about this behavior we call addiction.” Dr. Schaler consented to an interview by Nicolas S. Martin on the 20th anniversary of the publication of his classic book.

NM: Addiction is now commonly understood to be a biologically-based compulsion, but you disagree. Could you summarize your view of addiction.

JS: As I’ve asserted for over 20 years, addiction is a choice. I’ve asserted, based on the core meaning of the word, that “addiction” means to say “yes” to something, to move towards it. And in my book I cite hundreds of years of usage in this sense. it just means you want to do something; it has nothing to do with compulsion, disease, or involuntariness. All of that was never considered — especially applied to drugs.

It was only in the early part of the 20th Century, in the movement that lead to the temperance era, that the meanings of addiction or alcoholism changed. People said that addiction meant loss of control, or involuntariness, as if a behavior could be done involuntarily, the way a person has an epileptic seizure. They also asserted that alcohol was an addicting substance like other drugs. With the federal narcotics act of 1914, all of these were asserted to be addictions caused by the substance itself. So, the remedy for preventing problems associated with abusive use was to make it illegal to possess and use the substance.

We must speak about the terms behavior and disease because they are also key to refuting the ideas that alcoholism and addiction are diseases. What does the word disease mean? It means a cellular abnormality, something in the physical structure of the body. A behavior is deportment, or the way one carries oneself, and is necessarily voluntary. Your behavior is what you choose. So, right off the bat, based on these operational terms and definitions, a disease cannot be a behavior. If we think about smoking, for example; smoking cigarettes is a behavior, but some of the possible consequences may be lung disease or chronic obstructive pulmonary disease. Those are diseases because they are abnormal changes in the cells of the body. They are certainly not choices.

Another thing to keep in mind as we go along with this discussion is that giving up destructive drug use is a matter of choice. When somebody decides to stop, they choose to stop. It’s the only way to stop. So, you have to think back to how a person began drinking or using drugs. They began by choosing to use drugs, which may have been a very irrational or self-destructive decision. There’s no doubt about that. And there also are many people who continue to use illegal drugs in meaningful ways to them. This use is a choice, not a disease. If it was a disease you couldn’t control yourself, and that’s what people are saying drug users can’t do. But as we talk I’ll elaborate on the research that shows that people have always been able to choose to stop or moderate their use of drugs for reasons that are important to them.

NM: You refer to the early part of the 20th century, which corresponds roughly to the Progressive Era, when there was a profound reversal of American opinion. It had previously been autonomy-based and transformed into paternalism. That change, which is one of the most important in American history, opened the door to the redefinition of drug use as addiction.

JS: I agree. And I think it is important to understand the context within which that emerged and developed. People were very unhappy. There was a lot of poverty, and the disparity between the haves and the have-nots was striking. There were terrible problems with the quality of food that was sold throughout the 19th and early part of the 20th century, particularly dairy and meat products. The incredible scientific work by Harvey Wiley, and the birth of the Poison Squad, met these problems head on. It you study some of the problems arising from food consumption, from the 1900s well into the 20th century, people were dying all over from tainted food. It was horrendous. Upton Sinclair’s book, The Jungle, documented this and shocked the public. You have to look at the whole environmental context within which people viewed food and drugs, and how their attitudes about drugs and alcohol were shaped. It was easy for them to find a scapegoat and say, “the drug made you sick.” Food made thousands of people sick. Also, many men were drinking very heavily and beating up their wives, breaking up their families, losing their jobs, and this was a terrible problem, after the Civil War and just prior to the temperance movement The Women’s Christian Temperance Union and similar groups, along with many ministers, were out to change the world. I can’t say that I blame them because they were upset. What they came up with is the idea that if you cut off the drugs or the alcohol, you would stop the problem. But they couldn’t do that: Prohibition was a complete failure. Tied to the idea that the substance caused the problem, was that the substance would make anyone who used it diseased. So, this idea of involuntariness associated with the alleged addictive quality of the substance became key to the new ideas about alcoholism and addiction that developed throughout the early 1920s and 1930s, leading to attitudes today.

NM: They focused more intensely on alcohol than on drugs because alcohol was much more detrimental socially.

JS: Right.

NM: What were the consequences of unregulated drug use prior to the 20th Century? Was there social decadence and crime?

JS: I don’t think there was much drug-related crime because crime associated with drug and alcohol use was and is a product of prohibition. Make something illegal and you create a criminal class. In the 19th century, especially during the Civil War, people were miserable, and if they could make themselves feel better by drinking, of course they would do that. Alcohol use was considered a sin before it was widely considered a disease. That hardly stopped people from drinking heavily. The Civil War brought terrible misery to the lives of people from the North and South, during the war and its aftermath.

The idea that alcoholism is a disease originally came from Benjamin Rush, a prominent physician in the 18th century and signer of the Declaration of Independence, who proclaimed that drinking alcohol was a disease. But he also called any number of socially abnormal and problematic behaviors diseases. For example, he said that lying was a disease. One of his most famous proclamations was that having black skin was the result of a disease that he claimed was a congenital form of leprosy. A Black slave by the name of Henry Moss, who had white spots appear on his skin, was brought to Rush for examination. A physician today would call that vitiligo, which is a genetic disease, but Rush proclaimed that Moss was experiencing the spontaneous cure of his blackness. He said that all healthy, natural skin was white, and Black people had a disease that he named “negritude.” That diagnosis was used by Rush to advance the idea that Blacks and Whites should not intermarry because the disease would be spread. It was medicalized racism. We know that Rush’s ideas were nonsense, but it’s important to realize that this was the sort of thinking at the time. Benjamin Rush was a very influential speaker and rhetorician, especially in Philadelphia. He was taken seriously, even by Thomas Jefferson, but he was absolutely wrong. Rush had no scientific basis for his pronouncement. Thomas Trotter, a physician who attended the same medical school as Rush in England, also said alcoholism was a disease. But again there was no scientific evidence for the pronouncements by Rush and Trotter.

NM: Rush is known as the Father of American Psychiatry.

JS: That’s right. His portrait is still on the official literature of the American Psychiatric Association. This tells us something about who the people are who consider someone like this a hero today. Rush was a complete quack, and despite his claims — that he loved Black people and even the name “Africa” — he was a racist.

NM: I was reading historian Will Durant’s book, The Life of Greece, and came across this quote; “No civilization has found life tolerable without narcotics or stimulants.” Do you share Durant’s view?

JS: Yes. I’m not saying that life is tragic, but there certainly is a world of suffering that we’re all living in, and people find different ways of coping with that suffering. Religious belief, alcohol and drug consumption are ways of dealing with existential angst and suffering.

NM: James Madison, often called “the father of the constitution,” said that there hasn’t been any society in which people did not indulge in intoxicating substances like alcohol and opium.

JS: I agree. I think there are lot of myths about the Chinese opium war, for example. I don’t think it caused the disaster that some people have claimed. But why did and do people turn to opium and narcotics? To make their lives more bearable. Frankly, the rule, not the exception, is that most people have always been able to moderate their use of drugs like opium, heroin, cocaine, alcohol, and marijuana. Obviously, there are people who self-destruct using drugs and do too much, but there are also people who self-destruct and do too much in all walks of life. As you know, Nicolas, I have long argued for the complete repeal of drug prohibition. I personally would not think it such a bad idea to return to opium dens here in the country, the way it was in New York in the early part of the 20th Century, where people could go to relax.

Again, I don’t think people are hooked uncontrollably and biologically to opium or narcotics; people can and do quit when it is important enough for them to do so. I’ve proven that for myself. Not that I used narcotics for pleasure, but I was prescribed methadone for 15 years because of a serious back problem that I had. I had tried everything after a failed back surgery, and I couldn’t walk. I was a professor. At times I could not stand before my class, I couldn’t walk from class to class; the pain was absolutely horrendous. I had cortisone injections and every kind of pain drug you can imagine. Finally, a very good pain doctor prescribed methadone. I was on very high doses of methadone for 15 years because everybody develops tolerance. Over time it just doesn’t work as well is it used to, and I was up to 14 milligrams of methadone a day. Some people are on up to 100 milligrams of methadone a day. Then, this past December I said, “this is enough, I’m going to stop using this,” and some of my doctors said, “be careful, methadone is one of the worst drugs to get off of.” Many former heavy heroin users given methadone to try and wean off of heroin have said that giving up methadone was far, far worse than giving up heroin. I weaned myself off the drug in the course of about three months, and I quit completely. I had and have absolutely no craving, no desire for methadone, and it was easy to stop. However, I did have severe withdrawal symptoms, which I did not anticipate. Symptoms seem to vary from person to person. But I went through those. One of the worst was an inability to sleep for several weeks. I had crying episodes and severe gastrointestinal problems. My blood testosterone level went very low and I had to go on testosterone supplements, which have helped to restore needed muscle strength and stamina. I made it through and I’m glad I’m off it. One of the things I’ve learned is that methadone inhibits the healing of wounds, and my doctors confirmed this. I had a non-healing wound on my shin for 10 years. The top dermatopathology experts at Hopkins and everywhere were useless — nobody could help me. We confirmed it was not cancer, but they couldn’t understand why it was happening. Since I stopped the methadone this wound has been healing remarkably fast.

My point again is that users can get off of drugs that other people say are so addicting that it isn’t possible to stop or moderate. But remember, there are many things in life that are challenging and difficult. I’d never go back to my adolescence, it was too difficult. Going to school, going to graduate school, getting married, going through divorce, raising children — life is full of challenge, dealing with serious illness, and that’s when everything is going well. So, we should not say or believe that giving up a drug is too hard because it’s uncomfortable to do so. We go through all kinds of uncomfortable things, and we accept this as life.

Read the rest of the interview at: https://medium.com/@smartnic/addiction-is-a-choice-51b615797452

Kanye West on dancing to the beat of a different drummer

In short, where psychiatric historians see stories about terrible illnesses and heroic treatments, I see stories about people marching to the beats of different drummers or perhaps failing to march at all, and the terrible injustices committed against them, rationalized by hollow “therapeutic” justifications. Faced with vexing personal problems, the “truth” people crave is a simple, fashionable falsehood. That is an important, albeit bitter, lesson the history of psychiatry teaches us.

Thomas Szasz, Preface to Coercion as Cure

We call coercing a woman to submit to a sexual act “rape.” We call coercing a person to submit to psychiatric defamation and confinement “diagnosis” and “treatment.”

Szasz, Thomas. Words to the Wise (p. 67). Taylor and Francis. Kindle Edition.

Mental illness is the name of a category of alleged “conditions” that has no members. There is no mental illness. There is a diversity of human behaviors, some socially approved, others socially disapproved. In modern societies, many people prefer to view some disapproved behaviors as diseases and call them “mental illnesses.”

Szasz, Thomas. Words to the Wise (p. 106). Taylor and Francis. Kindle Edition.

Advice to Therapists from Thomas Szasz

From the Epilogue to, The Ethics of Psychoanalysis: The Theory and Practice of Autonomous Psychotherapy.

Learning to Practice Psychoanalysis

I have argued that the analytic relationship is like a game, with analyst and analysand its players. This view of the analytic procedure has implications, not only for its theory and practice but also for teaching it and learning it.

How do we learn to play games of skill and strategy? It is important that we be clear about the answer to this question, for what is true of games of this sort is also true of psychoanalysis. There are some things about games that can be taught and learned through the printed word and through didactic instruction; there are other things, however, that cannot and that must be acquired through practice.

What can be taught and learned formally are the rules of the game and the principles underlying the aim and structure of the game. I have tried to lay bare these two aspects of psychoanalysis. What cannot be taught and learned formally is how to play a particular game, in this case, how to be an analyst or an analysand. Indeed, it should be obvious that there are serious Limitations to doing anything of this sort. After all, one cannot tell players how to play a game; that is their business. It is the very essence of games that the players are free to play or not and, within the rules of the game, to play as they see fit. If a person is coerced-either to play against his will or to play in a certain fashion-then he is no longer a game-player (in the ordinary sense ); although such a player may appear to others as though he were playing a game, he will actually be “working,” not ‘playing.”

None of this is intended to deny that some ways of playing games are more effective than others. I merely wish to call attention to the crucial role of freedom in game-playing; a person whose moves in a game are regulated by others is considered a puppet or a robot. Players are ordinarily expected to be entirely free within the rules of the game. In keeping with this, a good player of almost any game will develop his distinctive style. How does this apply to the analytic situation?

Clearly, both analyst and analysand must be left free to conduct themselves as they see fit, as Iong as they keep within the rules of the analytic game. The competent analyst will thus develop his distinctive style of analyzing; this style is likely to vary somewhat from patient to patient and may also change as the analyst ages and is subjected to various experiences. The patient must, of course, be even freer to play the role of analysand as he sees fit than is the therapist to play the role of analyst. After all, the aim of the therapy is to observe and analyze the patient’s game-playing strategies; if the analyst tells him how to behave, what is there to analyze? The value of the psychoanalytic situation lies in constraining the patient only slightly and in a general way, that is, by certain game rules only, rather than by demands for specific acts of compliance.

In addition to learning the rules and principles of autonomous psychotherapy, the therapist who wishes to become proficient in this activity must practice it. The beginning therapist may profit from “supervision” of his work if the relationship between him and his supervisor is also autonomous, that is if the supervisor is the therapist’s agent.

What about the therapist’s personal analysis? Does it not help him to learn how to be an analyst? I have deliberately omitted discussion of this subject in earlier parts of this book and will not say much about it here.

I believe that it is generally helpful for the therapist to have a personal analysis, but let me add some qualifications. I have serious reservations about the value of coerced “training analyses,” practiced in conformity with the requirements of the various psychoanalytic organizations. Though such an “analysis” may help the therapist gain accre&tation, it is unlikely to help him become liberated from his inner constraints. Personal analysis, undertaken outside the juris&ction of an organized training system, is more likely to be personally helpful to the therapist. But here, too, we ought to be sober about what to expect. Having a “good analysis” does not make one a good analyst, nor does knowing one’s “blind spots” ensure him against analytic ineptitude.

In other words, I do not consider a personal analysis indispensable for competence in analyzing. lndeed, if the therapist’s analysis is autonomous, it can have only one effect: to set him personally free to do what he wishes. Some analyzed therapists may want to practice autonomous psychotherapy; others may prefer to practice differently. The notion that the psycho- therapist’s personal analysis is bound to make him a better analyst than he would be without it is illogical and probably untrue.

What the analyst needs more than anything else is genuine interest in doing analytic work and a readiness to enter into a relationship with his client on the basis of well-considered principles, rather than with an amorphous therapeutic intent. If such a person has also had a period of analytic work and is thus familiar with the analytic game from the point of view of the analysand as well, so much the better.

There is one more type of instruction that can be useful to prospective game-players, namely, advice about some aspects of the game-in our case, about certain recurrent types of the analytic situation. In conclusion, I shall offer some suggestions of this kind for those interested in practicing autonomous psychotherapy.

Forget That You Are a Physician

If you are a psychiatrist, do not let your medical training get in your way. If you are not medically trained, do not secretly aspire to be a doctor. If the service you propose to sell is analysis, you owe it to your clients and to yourself to be a competent analyst. Competence in another discipline for example, in medicine-is not an excuse for incompetence in the theory and practice of psychoanalysis.

You Are “Helpful” and. “Therapeutic” if Yar Fulfill Your Contract

Do not feel that you must comply with the patient’s requests for nonanalytic services. You are not responsible for the patient’s bodily health; he is. You need not show that you are humane, that you care for him, or that you are reliable by worrying about his physical health, his marriage, or his financial affairs. your sole responsibility to the patient is to analyze him. If you do that competently, you are “humane” and “therapeutic”; if you do not, you have failed him, regardless of how great a .trumani- tarian” you might be in other respects.

You Must Get to Know Your Patient

You must see the patient often enough and over a long enough period to get to know him well. There must be continuity in your relationship. To understand and master a new game, some players require more exposure to it than others. If you are a beginning therapist, you would do well to charge less and see your patient more often than you might otherwise. With your first few patients, have at least four weekly sessions and, if possible, five or six. If you see patients only three times a week, you may have difficulty following the moves in the game, and, if only twice a week, your chances of becoming a skilled autonomous psychotherapist are slim.

Do Not Let Yourself Be Coerced by “Emergencies”

If you have conducted yourself autonomously at the beginning of the treatment and have progressed satisfactorily to the contractual phase of the relationship, one of the major threats to the therapy is an ’emergency’. Remember your contract, and do not be coerced by an emergency to abandon it. It is unimportant whether the emergency is real or whether the patient is testing you to see whether you will maintain your analytic role. ( In any case, you will not be able to find out unless you do). Here is an example. The patient, a homosexual, is arrested by the police. Do you intervene? No; this is a problem for the patient and his attorney.

If you intervene in an emergency, you engage the patient in another game and vitiate your usefulness as analyst. For instance, your patient may be depressed; you may want to hospitalize him and treat him with electroshock. In my view, this is like interrupting a bridge game to advise your partner on managing his business or getting a divorce. The advice may be good, bad, or indifferent, but it is not part of the game of bridge. In the analytic game, once you step out of it, you may find it difficult or impossible to get back in again. This is an important characteristic of contractual psychotherapy, and both you and your patient must recognize it.

Do Not Misconstrue the Patient’s Feelings and, ldeas about You

What the patient feels and thinks about you is as ‘real” as what anyone else feels and thinks. Though it may be reasonable to label some of his feelings and thoughts “transference,” remember that, in doing so, conduct is being judged, not described. As a working hypothesis, assume that, in proportion as the patient is preoccupied with you as a person and as a source of approval and love, he is avoiding the responsibility for deciding what he wants to do with himself. He thus tries to solve the problem of having to give meaning to his life by attaching himself to the meaning you have given yours. You betray him if you encourage his doing so.

Your Life and. Work Situation Must Be Compatible with the Practice of Autonomous Psychotherapy

If you practice autonomous psychotherapy, you will have to exhibit an attitude of “live and let live” toward your patients. It will be difficult for you to do this if you are coerced and harassed by others or if, outside your analytic practice, you engage in activities that require you to coerce and harass others. For example, if you are a resident in a state hospital or a candidate in an analytic institute, how will you be able to leave your patients alone when your superiors do not leave you alone? Will you be able to let your patients become freer than you are yourself?

Perhaps you will conclude that the only way you can be your own master is to be in full-time private practice. There is much to be said for this. Unfortunately, however, it is difficult to spend all one’s time practicing analysis. If you see eight or ten patients day in and day out, the chances are that the level of your work may not be consistently high. A good solution to this dilemma is to combine analytic work with other activities compatible with it, for example, with teaching, research, or writing.

Do Not Take Notes

The psychoanalytic relationship is a personal encounter. You are not doing anything to the patient-at least no more than he is doing to you. You are not the observer and he the observed. Both of you play dual roles as participants in a relationship and as observers of it. What effect would note-taking have on your relationship with your mother, wife, or friend? Thus, do not be oblivious to the metacommunicative implications for the patient of your act of note-taking.

In any case, ask yourself why you want to take notes. To help you remember what the patient tells you? It will not do that, but not taking notes might. To record a case history? What will you do with it? To record material for research purposes? You can jot down what you think you will need after the interview or at the end of the day. If you are uncertain about the sort of thing you will need, notes will serve no purpose; a detailed account of the patient’s “productions” is a useless document.

You Are Responsible for Your Conduct, Not for the Patient’s

This is the central principle of autonomous psychotherapy. You are not responsible for the patient, his health (mental or physical), or his conduct; for all this, the patient is responsible. But you are responsible for your conduct. You must be truthful; never deceive or mislead the patient by misinforming him or withholding information he needs. Do not communicate about him with third parties, whether or not you have his consent to do so. Make every effort to understand the patient by trying to feel and think as he does. Finally, be honest with yourself and critical of your own standards of conduct and of those of your society.

In sum, you must be an analyst.

– Thomas Szasz, 1965

Originally posted at: https://www.upstate.edu/psych/pdf/szasz/epilogue-advice-to-therapists.pdf

Electroshock (ECT): True Story of Kenny

Psych Survivor YYC

Here’s a link to a testimonial of someone that underwent electroshock treatment.  He is a friend of a friend of mine.  At 21, he had 30 rounds of shock. (He’s 28 in this video.)  If you are uncomfortable clicking links, google “Kenny electroshock video”.  Although the doctor kept insisting that the shock would help, he says he would never wish it on his worse enemy.

 

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The Method of Autonomous Psychotherapy

From The Ethics of Psychoanalysis by Thomas Szasz:

Psychoanalysis is not a medical treatment, but an education. It is not like getting cure of a disease, but rather like getting to know another person well or learning a foreign language or a new game. How long does each of these take? It is with this kind of human experience that analysis must be compared. Thus, it can be understood why the analytic enterprise , by its very nature, precludes speed. This does not mean, however, that, to be useful, every analysis must last three, four, or more years. There is another fundamental misunderstanding in the expectation that, with greater knowledge and skill, analysts ought to be able to increase the speed of analyses. It lies in not realizing that the duration of a particular analysis depends, neither on the nature of the patient “mental illness” nor on the efficiency or inefficiency of the “treatment” used (though this plays a part), but rather on the patient’s needs and wishes to continue to receive “analytic education.”

Perpetual graduate students do not necessarily make the best scientists nor always the worst. Conversely, students who drop out of school early or who complete their education rapidly may do much or little with what they have learned; some may continue a process of self-education, whereas others may soon forget whatever they have learned. The situation is similar in psychoanalysis. Some analyses last long and ought to last long because of the sort of person the patient is; others are and ought to be relatively short. It is a grave mistake to link the effective- ness of analysis with its duration. In fact, the two are nearly unrelated. Some persons learn more rapidly than others, whether in school or in analysis. The same is true for analysts; some work more quickly than others.

In sum, the duration of a particular analysis reflects two things: the needs of the patient and the personal styles of the analyst and analysand as analytic game-players. We should expect this and not superimpose on analysis concepts and values alien to it. Only under such conditions can psychoanalytic treatment be an authentic and autonomous encounter between analyst and analysand.

Discovering Thomas Szasz with Scott McLain

I had a chance to ask a fan of Thomas Szasz, Scott McLain a few questions about Szasz. Scott is author of a recent review of the movie, Joker, which he writes about from a Szaszian perspective. You can listen to an interview with Scott on the podcast Stories We Live By.

How did you discover Thomas Szasz’s ideas?

I first heard about Thomas Szasz and his ideas through Bryan Caplan on his blog, EconLog.

What did you think when you first learned about Szasz’s ideas on mental illness?

Shock and disbelief. In our culture experts, scientists, spiritual leaders, celebrities and laymen have all taken for granted that phenomena like depression, anxiety, schizophrenia and the like are “diseases just like physical diseases”. The phrase “the myth of mental illness” sounded to me like “the myth of the round earth”.

How long did it take for you to understand what Szasz was saying?

Once I started reading Szasz’s books and listening to lectures and debates I gradually came to a greater understanding of his views. I then spent a year reading dozens of his books and articles as well as listening to every lecture he gave and debate he had with opponents and it was really in this period when I came to fully agree with him. Disease is an abnormality or malfunction of the human body. The mind is not an organ of the body and as such cannot be diseased except in a metaphorical sense. It’s not really that difficult to grasp.

What do you see as Szasz’s main idea?

Human suffering of the inner/emotional/existential/spiritual/religious kind as well as deeply disturbing behaviors are very real phenomena, but they are not properly located in the domain of medicine, and in medicalizing human problems in living we sacrifice not only our political freedoms but also our personal dignity

What do you find most compelling about Szasz’s ideas?

The idea that clear thinking requires courage, not intelligence. So intellectually easy to understand, yet so emotionally difficult in a society predicated on ignoring the elephant in the room.

Do Szasz’s ideas help you in everyday life? 

Absolutely. Szasz emphasized personal responsibility, the equal dignity and worth of all persons, and their ability and duty to courageously cope with their problems in living. These simple yet powerful ideas have provided a unique and necessary existential succor in a society constantly trying to find newer and more sophisticated ways to convince each other that they are victims and that their plight is due to forces completely outside their control.

What resources would you recommend to someone trying to understand Szasz? Books, Podcasts, or video?

Of his books, the one that best explains his position is Insanity: the Idea and its Consequences but for those with less time I would recommend the below interview with his longtime colleague Jeffrey Schaler, followed by the book The Medicalization of Everyday Life which is a compendium of some of Szasz’s greatest essays and articles intended for popular audiences (affiliate links).

CRAZYWISE Film shows alternative narrative of mental illness

What can we learn from those who have turned their psychological crisis into a positive transformative experience?

During a quarter-century documenting indigenous cultures, human-rights photographer and filmmaker Phil Borges often saw these cultures identify “psychotic” symptoms as an indicator of shamanic potential. He was intrigued by how differently psychosis is defined and treated in the West.

Through interviews with renowned mental health professionals including Gabor Mate, MD, Robert Whitaker, and Roshi Joan Halifax, PhD, Phil explores the growing severity of the mental health crisis in America dominated by biomedical psychiatry. He discovers a growing movement of professionals and psychiatric survivors who demand alternative treatments that focus on recovery, nurturing social connections, and finding meaning.

CRAZYWISE follows two young Americans diagnosed with “mental illness.” Adam, 27, suffers devastating side effects from medications before embracing meditation in hopes of recovery. Ekhaya, 32, survives childhood molestation and several suicide attempts before spiritual training to become a traditional South African healer gives her suffering meaning and brings a deeper purpose to her life.

CRAZYWISE doesn’t aim to over-romanticize indigenous wisdom, or completely condemn Western treatment. Not enery indigenous person who has a crisis becomes a shaman. And many individuals benefit from Western medications.

However, indigenous peoples’ acceptance of non-ordinary states of consciousness, along with rituals and metaphors that form deep connections to nature, to each other, and to ancestors, is something we can learn from.

CRAZYWISE adds a voice to the growing conversation that believes a psychological crisis can be an opportunity for growth and potentially transformational, not a disease with no cure.

https://crazywisefilm.com/

Madness, myth and medicine; the continuing relevance of Thomas Szasz

By Ron Roberts

Only after we abandon the pretence that mind is brain and that mental disease is brain disease can we begin the honest study of human behaviour and the means people use to help themselves and others cope with the demands of living 

(Szasz, 2007a, p.149).

Fifty years ago American Psychologist published a seminal article by the Hungarian-born psychoanalyst and psychiatrist Thomas Szasz, “The myth of mental illness” (Szasz, 1960). The thesis was elaborated at length in a book of the same name a year later (Szasz, 1961).

As the decade got into full swing, Szasz’s critique of psychiatric theory and practice was herded into the same conceptual basket as the musings of Scottish psychiatrist R.D. Laing, and his erstwhile friend and collaborator David Cooper. The quite different ideas of these men came to be bracketed inappropriately under the rubric of “anti-psychiatry”—an expression coined by Cooper though disclaimed by Laing and rejected outright by Szasz.

Since then biological psychiatry has developed a stranglehold on research, teaching and practice in the field of “mental health,” and Szasz’s opposition to psychiatry and the basis for it has been mislocated in the art and culture of the day, its relevance for today denied. Szasz’s view has become viewed by many as a supposed child of its time—a component in the social manufacture of the so-called anti-establishment Swinging Sixties. To let such misapprehension pass unchallenged into the history of the behavioural sciences would be a serious error, and Szasz for his part has constantly endeavoured to set the record straight.

First it must be said that Szasz’s insights into the shortcomings of conventional psychiatry pre-date the 1960s by some considerable margin. In a brief autobiographical sketch Szasz makes clear that the absurdity of psychiatric fictions had dawned on him long before Fellini’s masterpiece was highlighting the shallowness of La Dolce Vita: “Everything I had learned and thought about mental illness, psychiatry, and psychoanalysis—from my teenage years, through medical school, and my psychiatric and psychoanalytic training—confirmed my view that mental illness is a fiction; that psychiatry, resting on force and fraud is social control, and that psychoanalysis—properly conceived—has nothing to do with illness or medicine or treatment.” (2004, p.22)

Szasz graduated in medicine in 1944, having migrated to the US from his native Hungary in 1938, a fugitive from the looming menace of Nazism. He undertook a psychiatric residency and trained in psychoanalysis. The appeal of psychoanalysis, besides its intellectual and interpersonal attractions, lay in its ostensibly consensual and contractual nature. Less well known than his other works, his dissection of power in psychoanalytic relationships—published as The Ethics of Psychoanalysis (Szasz, 1965)—is central to his thinking and stands complementary to the assertions that mental illness is a myth. In this Szasz effectively provides a practical guide on how to ensure a level playing field in psychotherapeutic relationships, to the benefit of both parties. He is honest and open enough to explicitly explore the role that money may play in distorting therapeutic means and ends. As such, it not only stands the test of time but stands squarely against the numerous vested interests, both pharmaceutical-financial and professional, which dominate the mental health industry past and present

Anti-psychiatry or pro-consent?

Szasz is not “anti”-psychiatry. He advocates the right to agree consensual contractual relations of any kind, including consensual psychiatry if that is what suitably informed people want. He has proposed, for example, the use of advanced psychiatric directives whereby people could agree to accept or refuse specific interventions to be made “on their behalf” in the event of their becoming extremely distressed and “irrational” in future. Such ideas have unfortunately been rejected outright by leading figures in both psychiatry and medical ethics, and accordingly Szasz sees little possibility of any kind of consensual psychiatry until the use of coercion, whether explicit or tacit, is relinquished.

As psychiatry continues to function for the most part as an extension of the criminal justice system, Szasz asserts that psychiatry in its current form must be abolished. This would require a concerted challenge to its support structures, premised as they are on the notions of behaviour as disease, the fear of dangerousness and the necessity for medical treatment under the guise of protecting the individual from his or herself. The championing of the latter notion in particular owes much to an ignorance of its origins. A careful reading of Szasz’s historical analysis of the origins of the insanity defence in 17th-century England goes some way to clarifying where behavioural scientists got the idea from that people of “unsound mind” were not responsible for their actions and could not be held accountable for them. In Coercion as Cure, he writes

With suicide defined as a species of murder, the persons sitting in judgment of self killers had the duty to punish them. Since punishing suicide required doing injustice to innocent parties… the wives and minor children of the deceased—eventually the task proved to be an intolerable burden. In the seventeenth century, men sitting on coroners’ juries began to recoil against desecrating the corpse and dispossessing the suicide’s dependants of their means of support. However, their religious beliefs precluded repeal of the laws punishing the crime. Their only recourse was to evade the laws; The doctrine that the self-slayer is non compos mentis and hence not responsible for his act accomplished this task (Szasz, 2007a, p.99)

And so a social practice became reified into an imaginary biological disease process ravaging through the brains of its unfortunate victims, necessitating psychiatric intervention!

The label of “anti-psychiatry” that continues to be attached to Szasz is one which he has been at pains to condemn (Szasz, 2009), used as it is to stultify and nullify any criticism of contemporary psychiatry. While Laing saw himself as “essentially on the same side” as Szasz (Mullan, 1995, p.202), Szasz sees considerable distance between them, for a number of reasons. Perhaps at the forefront of these Laing was known to have forcibly drugged one of his patients (Szasz, 2008) and for all his eloquence and insight into human misery his writings do not in principle condemn the forced treatment or incarceration of people against their will on psychiatric grounds. Finally whilst The Divided Self (Laing, 1960) and Sanity Madness and the Family (Laing & Esterson, 1964) amongst other outpourings proclaimed the intelligibility of going mad within a human rather than biological framework, Laing did not reject outright the notion of mental illness, which in Szasz’s view remains at best a metaphor.

Szasz has throughout his career stood firmly to his principles and steadfastly eschewed psychiatric practice in an environment where people have been deprived of their liberty. He has on occasion appeared in court both to represent individuals deprived of their liberty and to uphold the principle of criminal responsibility in murder cases where those accused have sought to evade it through the insanity defence (see Szasz, 2007b, chapter 13 in particular). Such consistent challenges to institutional psychiatry have been made at some professional cost. Szasz has not simply been the recipient of fierce criticism from the psychiatric fraternity, who feel betrayed by his actions, but has also endured attempts to limit his academic freedom. In the aftermath of the publication of The Myth of Mental Illness, for example, attempts were made to ban him from teaching at the state hospital medical school—citing his beliefs as “proof” of his “incompetence as a psychiatrist” (Schaler, 2004, p.xix).

Some confusion about Szasz’s work has arisen through the quite different political cultures within which it is interpreted, even by those who oppose institutional psychiatry in its current incarnation. His work has been claimed and repudiated by those on both the “left” and “right”—deemed a liberal in some quarters and a fascist in others—with the claims and counterclaims rooted in the predilections of the critics for different configurations of state power. European intellectual tradition on the left, for example, clings to a belief and a desire that state power can be harnessed for the good. This means that while Szasz’s attacks on psychiatric authority are applauded, his admonitions against the “therapeutic state” (Szasz, 2001, 2002), with its merging of psychiatric and state power on the one hand and private and public health on the other, are glossed over. In truth, if such a thing can be said, Szasz’s ideas belong to neither the right nor the left. His work challenges and questions all operations of organised power from the state downwards, as long as they are used to crush and oppress human freedom. His work implies unanswered questions concerning theforms of community and social organisation which people can harness for the individual and common good in order to enable them to deal elegantly with the insatiable demands of living.

Addendum

While preparing this article I encountered Philippe Petit’s (2002) wondrous account of his high-wire walk across the twin towers of the World Trade Center in 1974. Immediately after performing his “artistic crime of the century” Petit was arrested and subject to psychiatric examination. Petit was judged to be sane, but the outcome of the psychiatric interview is less revealing than the fact that psychiatrists were willing to play their part in a pseudo-medical intervention provoked by nothing more than social rule breaking of the highest imaginative order. It struck me that Petit—an imaginative, unusual and beguiling figure—exemplifies much that modern psychiatry stands in antipathy to. Petit cares not for the rules and regulations that structure and govern the lives of citizens and lives, in his terms, only to dream “projects that ripen in the clouds”(Petit, 2002, p.6). There can be little doubt that psychiatry is an enterprise that is engineered to destroy these—that it cannot tolerate idiosyncrasies of thought, whether grandiose or mundane. Petit succeeded in his outlandish and highly improbable quest—but why should one have to achieve outlandish success to be embraced by society and enjoy the right to pop one’s head in the clouds or spend the “afternoons in treetops”? Szasz’s efforts over the years can be seen in many lights, but without doubt he has toiled on behalf of the dream of human accountability and responsibility, for the freedom to be different and to take charge of one’s life, free from the machinations of state sponsored psychiatric interference.

Ron Roberts is a Senior Lecturer in Psychology at Kingston University.

References

Laing, R.D. (1960). The divided self. London: Tavistock.

Laing, R.D. & Esterson, A.E. (1964). Sanity madness and the family. London:Tavistock.

Mullan, B. (1995). Mad to be normal: Conversations with R.D.Laing. London:Free Association.

Petit, P. (2002). To reach the clouds. London: Faber and Faber.Schaler, J. (Ed.) (2004). Szasz under fire: The psychiatric abolitionist faces hiscritics. Chicago: Open Court.

Szasz, T. (1960). The myth of mental illness. American Psychologist, 15,13-118.

Szasz, T. (1961). The myth of mental illness. New York: Harper & Row.

Szasz, T. (1965). The ethics of psychoanalysis. Syracuse, NY: Syracuse University Press.

Szasz, T. (2001). Pharmacracy: Medicine and politics in America. London: Praeger.

Szasz, T. (2002). Liberation by oppression: A comparative study of slavery and psychiatry. New Brunswick, NJ: Transaction.

Szasz, T. (2004). An autobiographical sketch. In J. Schaler (Ed.) Szasz under fire. Chicago: Open Court.

Szasz, T. (2007a). Coercion as cure: A critical history of psychiatry. New Brunswick, NJ: Transaction.

Szasz, T. (2007b). The medicalization of everyday life: Selected essays. Syracuse: Syracuse University Press.

Szasz, T. (2008). Debunking antipsychiatry: Laing, law, and Largactil. Current Psychology, 27, 79-101.

Szasz, T. (2009). Antipsychiatry: Quackery squared. Syracuse: Syracuse University Press.

Originally posted at: http://www.centerforindependentthought.org/Psychologist_article.html

Addiction is a choice with Jeffrey Schaler and Dangerfield

Dr. Jeffrey Schaler PhD is a bad-boy of American psychology, with a particular focus on the fields of Psychiatry and Addiction. Jeffrey says Psychiatry is a pseudo-science and addiction – rather than being a disease – is simply a choice. Winner of The Ninth Annual Thomas S. Szasz Award for Outstanding Contributions to the Cause of Civil Liberties, Schaler has proven himself a force to be reckoned with against institutions, individuals, and corporations, who have a lot to lose if the challenges laid out by Schaler continue to become more and more accepted as legitimate.