#11 "Psychiatry: A Branch of the Law," The Freeman, 56: 18-20 (December), 2006.

#10 The Pretense of Psychology as Science: The Myth of Mental Illness in Statu Nascendi

#9 Keynote Address, "Controversies in End of Life Care: Terri Schiavo's Lessons"

# 8 FEAR AND FOLLY: Bertrand Russell, C. S. Lewis, and the Existential Identity Thief

# 7 "A bogus Benjamin Rush quote: contribution to the history of pharmacracy"

# 6 "Idiots, infants, and the insane": mental illness and legal incompetence.

# 5 Malpractice vs. "Malresult". A new form of insurance for an eternal problem.

# 4 Caveat Emptor (Let the Buyer Beware).

# 3 Self-Ownership or Suicide Prevention?

# 2 Psychiatrist who changed the view of homosexuality as a mental disorder.

# 1 The psychiatric protection order for the "battered mental patient".

Essay by Thomas Szasz on the massacre at Virginia Tech: Dangerousness Is Not a Disease

 

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Earlier this year, I stood with Presidents Sarkozy and Obama to honour the service and the sacrifice of the heroes who stormed the beaches of Normandy 65 years ago. And just last week, we marked the 70 years which have passed since the British government declared its willingness to take up arms against fascism and declared the outbreak of the Second World War. So I am both pleased and proud that, thanks to a coalition of computer scientists, historians and LGBT [lesbian, gay, bisexual, and transgender] activists, we have this year a chance to mark and celebrate another contribution to Britain’s fight against the darkness of dictatorship: that of code-breaker Alan Turing.

We apologize. We erred when we declared homosexuality a disease and the forcible injection of female sex hormones an effective treatment for it. We committed evil when, instead of joining the defenders of liberty and endorsing the abolition of anti-homosexual legislation, we eagerly supported the coercive apparatus of the State and prostituted ourselves in the service of the social control of society’s unwanted.

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The Shame of Medicine:
The Case of General Edwin Walker

by Thomas Szasz
The Freeman, Volume: 59 • Issue: 8 • 10/09

In 1962 James Meredith, an African-American student, tried to enroll at the University of Mississippi. His admission was opposed by Ross Barnett, the Democratic governor of the state, former Major General Edwin A. Walker (1909–1993), a decorated hero of World War II and prominent “right-winger,” and a group of segregationist white students. To ensure Meredith’s enrollment and maintain order, President John F. Kennedy sent 400 federal marshals and 3,000 troops to Oxford, Mississippi.

On September 29, 1962, Walker issued a public statement: “This is Edwin A. Walker. I am in Mississippi beside Governor Ross Barnett. I call for a national protest against the conspiracy from within. Rally to the cause of freedom in righteous indignation, violent vocal protest, and bitter silence under the flag of Mississippi at the use of Federal troops. . . .”

The campus demonstration led to a riot in which two people were killed and six federal marshals were injured. Importantly, according to a United Press report, “During a lull in the rioting, General Walker mounted a Confederate statue on the campus and begged the students to cease their violence. . . . His plea was greeted with one massive jeer.”

Unnoticed at the time and forgotten today is the fact that while the federal government used the military to guarantee Meredith’s constitutional right to equal protection of the laws, it used psychiatry to deprive Walker of his constitutional right to trial. This was another example of my long-held view that we are replacing social controls justified by race with social controls justified by psychiatric diagnosis.

Guilt by Diagnosis

Arrested on four federal charges, including “inciting, assisting, and engaging in an insurrection against the authority of the United States,” Walker was taken before a U.S. commissioner and held pending the posting of $100,000 bond. While he was making arrangements to post bail, Attorney General Robert Kennedy ordered Walker flown, on a government aircraft, to Springfield, Missouri, to be incarcerated in the U.S. Medical Center for Prisoners for “psychiatric observation” on suspicion that he was mentally unfit to stand trial.

Walker’s entry in Wikipedia mentions neither this nor the ensuing confrontation between Walker’s legal team and the government’s psychiatric team. The reader is told only that Walker “posted bond and returned home to Dallas, where he was greeted by a crowd of 200 supporters. After a federal grand jury adjourned in January 1963 without indicting him, the charges were dropped.”

How could this happen? Was it legal? It was legal, and in Psychiatric Justice (1965) I presented a detailed, documented account of how it happened. Here I wish to add a few personal details not previously reported.

News of Walker’s psychiatric incarceration had barely hit the newspapers when I received a telephone call from Robert Morris, then president of the University of Dallas, formerly chief counsel to the Senate Judiciary Subcommittee on Internal Security. He identified himself as one of Walker’s attorneys, explained he had been given my name by William F. Buckley, Jr., and asked me to help his team to free Walker from psychiatric imprisonment.

I flew to Dallas and spent a long afternoon and evening with Morris and his team of lawyers. They believed it was obvious that Walker was sane. They wanted me to examine him and say so in court. It was not easy to disabuse them of their conventional beliefs about mental illness as a medical disease and psychiatry as a medical specialty. I summarized the evidence for my view that psychiatry is a threat to civil liberties, especially to the liberties of individuals stigmatized as “right-wingers,” illustrated by the famous case of Ezra Pound, who was locked up for 13 years while the government ostensibly waited for his “doctors” to restore his competence to stand trial. Now the Kennedys and their psychiatrists were in the process of doing the same thing to Walker.

I reminded the attorneys that a courtroom confrontation concerning his “sanity” would not be a search for truth or justice (which they well understood), and noted that they were on the losing side of the civil rights battle (which they well knew). I urged them to avoid unnecessary dramatics and focus on freeing Walker from psychiatric detention as their sole goal. Finally, I persuaded them that in a Mississippi courtroom, I–with a foreign name and a foreign accent–would not be the best possible expert for Walker and talked them out of their plan to have me examine him and engage in a contest of “expert opinions” about the predictably dire diagnoses of the government’s psychiatric experts. Instead, I proposed that they “nominate” a prominent Dallas university psychiatrist as their defense expert–that is, a local, publicly employed physician who could ill afford to declare Walker insane on the basis of his “racist” views. (Before the Civil War, proslavery physicians in the South diagnosed black slaves who tried to escape to the North as mentally ill, “suffering from drapetomania.” In the Walker case, pro-integration psychiatrists in the North diagnosed white segregationists as mentally ill, “suffering from racism.”) Next morning I flew back to Syracuse.

For Whose Own Good?

A competency hearing was scheduled. Dr. Robert L. Stubblefield, chief psychiatrist at the Southwest Medical Center in Dallas, was to examine Walker and testify in his defense. The prosecution’s expert was Dr. Manfred Guttmacher, long-time chief medical officer at Baltimore City’s Supreme Court. Walker’s attorneys had no trouble exposing Guttmacher for the evil quack he was. Guttmacher kept referring to Walker as if Walker were his patient and supported the prosecution’s request that Walker be incarcerated (“hospitalized”) for up to three months, testifying under oath that doing so would be “for Mr. Walker’s own good from a medical point of view.”

In the end, the government’s psychiatric plot failed. Walker was declared mentally fit to stand trial, a federal grand jury refused to indict him, and the charges against him were dropped.

Less than two years later, my view that organized American psychiatry was becoming overtly political, seeking the existential invalidation and psychiatric destruction of individuals who do not share the psychiatric establishment’s left-liberal “progressive” views, received further dramatic support. In 1964, when Senator Barry Goldwater was the Republican candidate for president, 1,189 psychiatrists publicly declared–without benefit of examination–that Goldwater was “psychologically unfit to be President of the United States.” Many offered a diagnosis of “paranoid schizophrenia” as the basis for their judgment.

Psychiatry is despotism in the service of the Therapeutic State, rationalized as “progressive” science and “compassionate” medical care. In the past, racial stigmatization and segregation were indispensable for the political class and the State. Today, psychiatric stigmatization and segregation are indispensable for the political class and the State. This is why no exposure of brutal psychiatric injustices makes a dent in the mental health system’s lofty social status as a benevolent, ethical, scientific medical discipline.

The Freeman, Volume: 59 • Issue: 8 • 10/09

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#16

Psychiatry: The Shame of Medicine

by Thomas Szasz
The Freeman, 59: 12-13 (March), 2009

The practice of medicine rests on cooperation and the ethical-legal premise that treatment is justified by the patient’s consent, not his illness. In contrast, the practice of psychiatry rests on coercion and the ethical-legal premise that treatment is justified by the mental illness attributed to the patient and must be “provided” regardless of whether the patient consents or not. How do physicians, medical ethicists, and the legal system reconcile the routine use of involuntary psychiatric interventions with the basic moral rule of medicine, “Primum non nocere,” a Latin phrase meaning “First do no harm”?

The answer is: by the medicalization of conflict as disease, and coercion as treatment. Carl Wernicke (1848-1905), one of founders of modern neuropathology, observed, “The medical treatment of [mental] patients began with the infringement of their personal freedom.” Today, it is psychiatric heresy to note, much less emphasize, that psychiatry-as-coercion is an arm of the punitive apparatus of the state. Absent the coercive promise and power of mental health laws, psychiatry as we know it would disappear.

Ever since its beginning approximately 300 years ago, psychiatry’s basic function has been the restraint and punishment of troublesome individuals justified as hospitalization and medical care. For two centuries, all psychiatry was involuntary psychiatry. A little more than 100 years ago individuals began to seek psychiatric help for their own problems. As a result, the psychiatrist became a full-fledged double agent and psychiatry a trap. The film “Changeling”--written by J. Michael Straczynski and directed by Clint Eastwood--is a current example.

The story, set in Los Angeles in 1928, is said to be the “true story” of a woman, Christine Collins, whose son, Walter, is kidnapped. The police are corrupt, and little effort is made to find Walter. Months pass. To repair its damaged image, the police decide to stage a reunion between an abandoned youngster pretending to be Walter and his mother, played by Angelina Jolie. Unsurprisingly, she realizes that the fake Walter is not her son. After confronting the police and city authorities, she is vilified as an unfit mother, branded delusional, and incarcerated in a “psychopathic ward,” where she is subjected to the brutalities of sadistic psychiatrists and nurses, and watches fellow victims being punished by electric shock treatment--ten years before its invention. So much for the truth of the story.

Clueless about the true nature of the psychiatric terrorization to which the Jolie character is subjected, film critic Kirk Honeycutt praises Clint Eastwood who “again brilliantly portrays the struggle of the outsider against a fraudulent system. . . . ‘Changeling’ brushes away the romantic notion of a more innocent time to reveal a Los Angeles circa 1928 awash in corruption and steeped in a culture that treats women as hysterical and unreliable beings when they challenge male wisdom.’”

The Jolie character does not simply challenge “male wisdom.” Instead, her actions illustrate the insight of the Hungarian proverb, “It is dangerous to be wrong but fatal to be right.” The psychiatrist as brutal agent of the state enters the story only after the mother proves--by securing the testimony of her son’s teacher and dentist--that “Walter” is an impostor. The psychiatrically incarcerated individual’s greatest crime--for which psychiatrists cannot forgive her--is that she is innocent of lawbreaking and objects to being deprived of liberty.

Medicalized Terrorism
Psychiatric coercion is medicalized terrorism. So-called critics of psychiatry--who often fail or refuse to distinguish coerced from contractual psychiatry--are unable or unwilling to acknowledge this disturbing truth. As a result, the more things change in psychiatry, the more they remain the same, as the following conveniently forgotten example illustrates.

On May 21, 1839, Elizabeth Parsons Ware (1816-1897) married the Reverend Theophilus Packard. The couple and their six children resided in Kankakee County, Illinois. After years of marriage, Mrs. Packard began to question her husband's religious and pro-slavery beliefs and express opinions contrary to his. In 1860 Mr. Packard decided that his wife was insane and proceeded to have her committed. She learned of this decision on June 18, 1860, when the county sheriff arrived at the Packard home to take her into custody. The law at the time stated that married women “may be entered or detained in the hospital [the Jacksonville State Insane Asylum] at the request of the husband of the woman or the guardian . . . without the evidence of insanity required in other cases.”

Mrs. Packard spent the next three years in the Asylum. In 1863, due largely to pressure from her children who wished her released, the doctors declared her incurable and released her. Mrs. Packard stayed close to her children, retained their support, founded the Anti-Insane Asylum Society, and published several books, including Marital Power Exemplified, or Three Years Imprisonment for Religious Belief (1864) and The Prisoners’ Hidden Life, Or Insane Asylums Unveiled (1868).

The Beginning, Not the End
Little did Mrs. Packard realize that she was living at the beginning, not the end, of the Psychiatric Inquisition. Today, “inquiry” into the minds of unwanted others is a pseudoscientific racket supported by the therapeutic state. Millions of school children, old people in nursing homes, and persons detained in prisons are persecuted with psychiatric diagnoses and punished with psychiatric treatments. Nor is that all. Untold numbers of Americans are now psychiatric parolees, sentenced by judges--playing doctors--to submit to psychiatric treatment as so-called outpatients, or face incarceration and forced treatment as inpatients.

The subtext of films such as “Changeling” is always subtle psychiatric propaganda seeking to make people believe they are witnessing past “psychiatric abuses.” The truth is that every new psychiatric policy or practice labeled an “advance” is a step toward making psychiatric deception and brutalization more legal and more difficult for the victim to resist.

As I write this column, I learn from an “antipsychiatry” website that a man named Ray Sandford is being subjected to court-ordered outpatient electroshock treatment.

“Each and every Wednesday, early in the morning, staff shows up at Ray’s sheltered living home called Victory House in Columbia Heights, Minnesota, adjacent to Minneapolis. Staff escorts Ray the 15 miles to Mercy Hospital. There, Ray is given another of his weekly electroconvulsive therapy (ECT) treatments, also known as electroshock. All against his will. On an outpatient basis. And it’s been going on for months.”

As the forced psychiatric treatment of competent adults living in their own homes becomes the “standard of medical practice,” the failure to provide such betrayal and brutality becomes medical malpractice. In a democracy people are said to get the kind of government they deserve. In a pharmacracy they get the kind of psychiatry they deserve.

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#15

Questioning One’s Insanity

by Thomas Szasz
Liberty, 23: 27-28 (March), 2009.

"The Changeling," the recent Clint Eastwood movie, “reveals the perversity of a system in which it is virtually impossible to prove one’s sanity,” writes Jo Ann Skousen (Liberty, Jan.-Feb. 2009). This statement completely misses or avoids the point about the problem psychiatric incarceration poses for many libertarians.

To begin, the term “insanity” refers to a judgement, not a phenomenon or illness or fact. In “The Changeling,” the Angelina Jolie character, has no trouble proving to her son’s dentist and teacher that the boy impersonating the child is not her son. She has trouble proving it to the police and the psychiatric system. Why? Because they are corrupt and destructive, each having its own fish to fry. The police’s fish is staging a publicity stunt to enhance its soiled image. Psychiatry’s fish is convincing the world and itself that the lie that insanity is an objectively identifiable illness “like any other” is true.

When psychiatrists categorize (“diagnose”) an unwanted individual as “mentally ill” or “insane,” they do not describe or identify a disease, they delegitimize a person or behavior--formerly homosexuality, now substance abuse. However, our culture and laws authenticate psychiatrists as bona fide medical doctors and define the “conditions” they call “mental illnesses” as diseases on a par with cancer and diabetes. At the same time, psychiatrists continue to incarcerate “mentally sick” persons and possess the power to compel “patients” to submit to unwanted invasions of their bodies with toxic chemicals and electrically induced grand mal seizures.

How do friends of freedom deal with the conflict between elementary libertarian principles and prevailing psychiatric practices? This is the question I addressed and answered in my book "Faith in Freedom: Libertarian Principles and Psychiatric Practices" (2004). The distinguishing feature of the libertarian philosophy of freedom is the belief that self-ownership is a basic right and initiating violence is a fundamental wrong. In contrast, psychiatric practice is based on the belief that self-ownership-- epitomized by suicide--is a medical wrong and that initiating violence against persons called “mental patients” is a medical right.

Are self-medication and self-determined death exercises of rightful self-ownership, or manifestations of mental diseases requiring deprivation of liberty? Does deprivation of liberty under psychiatric auspices constitute odious preventive detention, or is it beneficial, therapeutically justified hospitalization? Should forced psychiatric drugging be interpreted as assault and battery or medical treatment?

These questions point to delicate, embarrassing, uncomfortable human dilemmas that most people prefer to avoid. Although "Faith in Freedom" received glowing prepublication endorsements from several prominent libertarian scholars, neither Liberty nor Reason reviewed it.

Skousen describes the Jolie characte’s psychiatric imprisonment as follows: “When she complains to the police and begs them to continue the search [for her kidnapped son], the police chief has her committed.” Skousen realizes that there is a problem here that stares us in the face and yet we do not want to look at:
It’s a frightening issue, one that hasn’t gone away: many states have the equivalent of Florida’s Baker Act, under which a person can be committed to 30 days in a mental institution without recourse, if a psychologist [sic, not psychiatrist] deems the person dangerous to himself or others. (And when the psychologist is employed by the police department, it’s pretty easy to predict whether the detainee will be so deemed. My own daughter came frighteningly close to being Bakered when she was 17, so I know how quickly it can happen.)

Nevertheless, Skousen avoids a more serious moral engagement with the routine use of psychiatric coercions (and excuses) in the United States. She is not alone.

Deirdre McCloskey--the Tinbergen Distinguished Professor at Erasmus University in Rotterdam--is an internationally recognized economic historian, teacher, and writer. In addition to numerous works on economics, she is the author of "Crossing: A Memoir" (1999), an autobiographical account of her journey from Donald to Deirdre McCloskey. What makes McCloskey’s "Memoir" of particular interest and importance is that she is, to my knowledge, the only prominent libertarian who has been personally violated by psychiatrists: she was “hospitalized”--twice--because she “suffered” from a dread disease called “transsexualism.” If not for her professional and social status, good attorney, and financial ability to fight the Chicago psychiatric machine, McCloskey might still be languishing in some Illinois state mental hospital. And she, too, probably wisely, chose to not engage the psychiatric Leviathan.

In a review of "Crossing" in the New York Times, the poet and writer Maxine Kumin attributes McCloskey’s ordeal in part to mistakes by poor psychiatrists:

His sister and one of her academic colleagues played a sinister role in trying to thwart him. They conspired to have him committed as mentally incompetent--unfit to sign papers for optional surgical procedures. . . . Twice during his determined journey into womanhood, they managed to have him incarcerated--handcuffed, locked away where he could not harm himself, at first in the University of Iowa Hospital's mental ward and later in the University of Chicago Hospital--to await evaluations by psychiatrists whose knowledge of his situation was less than rudimentary. The shrinks he had the misfortune to encounter seemed still to be operating at a pre60's level.

The truth is that the psychiatrists McCloskey encountered were among the leaders of the profession. In Iowa, McCloskey’s psychiatrists were Raymond Crowe, Professor of Psychiatry, an expert on Genetics and Developmental Neurobiology, a “seasoned, well-funded researcher”; and Robert Robinson, Professor and Chairman of the Department of Psychiatry, a recognized researcher in neuropsychiatry, and former Chairman of the Neurosciences Review Committee, National Institute of Mental Health. In Chicago, McCloskey’s psychiatrist was Fred Ovsiew, a Member of the American Psychoanalytic Association, Associate Professor of Clinical Psychiatry at the University of Chicago, and director of its Inpatient Psychiatric Unit. These men cannot be dismissed in the way Kumin dismisses them. The fact that she assumes the doctors who abused McCloskey were bungling psychiatric troglodytes speaks for itself.

Revealing her inability to see past the psychiatric rhetoric to the psychiatric slavery it conceals, Kumin remarks, “Gender crossers are still waiting for the gender identity disorder to be removed from the list of mental illnesses.” After their experiences with the mental health system, I would expect at least some gender crossers to scoff at psychiatric diagnoses and not care what unpopular behaviors psychiatrists classify as diseases. During my own lifetime, psychiatrists have removed masturbation, fellatio, cunnilingus, and homosexuality from the list of mental illnesses, yet managed to triple and quadruple the number of disorders listed in the American Psychiatric Association=s (APA) "Diagnostic and Statistical Manual," adding, for example, caffeinism, nicotinism, dysmorphobia, and pathological gambling.

The legitimacy of psychiatry rests entirely on its being a branch of medicine. It has no legitimacy as a quasi-theological system allied with the state for the forcible resolution of family conflicts and social problems. Sadly, there is, in modern society, no legitimate space for thinking and speaking clearly about psychiatry. Even emphasizing the differences between consensual psychiatric practices helping patients and coercive psychiatric practices harming them is now anathema.

The practices of psychiatric slavery are deeply embedded in our society. Even an account as fine as "Crossing," written by so eminent a witness as Deirdre McCloskey, makes no impact on the unquestioning approval of this peculiar institution by bioethicists, journalists, writers--and many libertarians.

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#14

The Therapeutic State ~
Mendacity by Metaphor

by Thomas Szasz
The Freeman, Vol. 58 No. 8  (Oct., 2008)

Once upon a time, law-abiding citizens acknowledged that they wanted lawbreakers punished. They did not say the offenders “needed” punishment. When they used the term “need” metaphorically—as when an outlaw in a bar told his buddies that one of their adversaries “needed” killing—they knew what they were talking about. They did not lie to themselves, nor did they deceive others. This is no longer true. In our society soaked in psychiatry, we systematically use the term “need” metaphorically, to lie to ourselves and to deceive others. Here is an example.

In February 2008 David Tarloff—a career “schizophrenic”—is released from a type of prison we call “hospital.” Ten days later he kills a psychologist who shares offices with a psychiatrist whom Tarloff holds responsible for depriving him of liberty. In June the New York Times reports: “A lawyer for a schizophrenic man accused of killing an Upper East Side psychotherapist tried three times on Tuesday morning to persuade his client to leave his holding cell for a hearing.” The lawyer was unsuccessful. Tarloff was not interested in being cooperative. He was interested in his life situation as he saw (constructed) it. Of course there is nothing new about defendants—especially defendants charged with a capital crime—not cooperating with the judicial system. What is new about it is the way the medical-judicial system now deals with such a person. According to the Times,

    The hearing, held in a small courtroom at Bellevue, was held to decide whether doctors could force Mr. Tarloff to take his medication. . . . Justice John E. H. Stackhouse of State Supreme Court in Manhattan granted the hospital’s request. . . . Ronald L. Kuby, a defense lawyer, said medication was too often used to create a false sense of sanity. “When the jury sees your client sitting there calmly, peacefully, sort of blankly staring, that person then looks sane,” Mr. Kuby said. “But that’s a chemically induced stability designed to make the judicial railroad function.” . . . “When somebody is in need of medication,” Mr. Konoski [Tarloff’s principal attorney] said, “forcing them not to have it, forcing them to deal with their demons instead of being able to suppress them through the medication, that’s almost like torture.” [Emphasis added.]

Voilà: The defendant who refuses to ingest a chemical straitjacket has a medical need for the drug. Acceding to the defendant’s wish to not be chemically restrained is torturing him. Only in the age of psychiatry could people believe such brazen lies.

I was a trained physician and psychoanalyst before the advent of the class of chemicals we call “psychiatric drugs.” I well remember watching—1954 or 1955, when I was serving my required military tour of duty at the National Naval Medical Center in Bethesda, Maryland—what must have been one of the first films promoting chlorpromazine, patented in the United States as Thorazine. The film showed monkeys, rendered irritable and aggressive by starvation and crowding, being injected with the drug and becoming “tranquilized.” The term was new then. This, we were told, was the new cure for schizophrenia. I did not like what I saw and immediately wrote the following: “The widespread acceptance and use of the so-called tranquilizing drugs constitutes one of the most noteworthy events in the recent history of psychiatry. . . . These drugs, in essence, function as chemical straitjackets. . . . When patients had to be restrained by the use of force—for example, by a straitjacket—it was difficult for those in charge of their care to convince themselves that they were acting altogether on behalf of the patient. . . . Restraint by chemical means does not make [the psychiatrist] feel guilty; herein lies the danger to the patient.”

This, then, was the glorious—but unacknowledged and unacknowledgeable—psychopharmacological breakthrough: Restraint could be put in the patient instead of on him and be defined as “drug treatment” (of and for the patient). It was obvious from the start that neuroleptic drugs benefit psychiatrists, not patients. Psychiatrists deal with this predictable result by attributing it to a newly invented mental¬-brain disease they call “anosognosia.”

In 1931 Robert Frost (1874–1963) delivered a lecture at Amherst College with the unexciting title “Education by Poetry.” It is a profound meditation on, and warning about, uses and abuses of metaphor. Long before I “discovered” the vast errors hidden from us by the metaphor of mental illness, Frost wrote:

    Health is another good word. And that is the metaphor Freudianism trades on, mental health. And the first thing we know, it has us all in up to the top knot. . . . What I am pointing out is that unless you are at home in the metaphor, unless you have had your proper poetical education in the metaphor, you are not safe anywhere. Because you are not at ease with figurative values: you don’t know the metaphor in its strength and its weakness. You don’t know how far you may expect to ride it and when it may break down with you. You are not safe with science; you are not safe in history. . . . They don’t know what they may safely like in the libraries and galleries. They don’t know how to judge an editorial when they see one. They don’t know how to judge a political campaign. They don’t know when they are being fooled by a metaphor, an analogy, a parable. And metaphor is, of course, what we are talking about. Education by poetry is education by metaphor.

Paraphrasing that phrase, I suggest that education by psychiatry is education by and with mendacity, a thesis I have maintained for more than half a century.

Recent reports in the press exposed Dr. Joseph Biederman, professor of psychiatry at Harvard Medical School, and his collaborators of failing to report “at least $3.2 million dollars they had received from drug companies between 2000 and 2007,” violating federal and university research rules designed to police potential conflicts of interest.

Biederman is said to be “one of the most influential researchers in child psychiatry, whose work has helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children.”

He is confident that the children whose behavior displeases their mothers suffer from a brain disease that requires pharmacological treatment. But is drugging children allegedly suffering from “pediatric bipolar disease” analogous to vaccinating them against smallpox, as Biederman suggests? Never mind that antipsychotic drugs are promoted as therapeutic agents, not as prophylactics. Never mind that press reports routinely refer to antipsychotic drugs as subduing involuntary subjects. And never mind that the modern psychiatrists’ favorite “patients” are persons who are powerless to resist being cast in that role: children, prisoners, and old people in nursing homes.

If you are ignorant of metaphor, warned Frost, “You are not safe with science; you are not safe in history . . . in the libraries and galleries.” You are certainly not safe if you believe that psychiatrists care for and cure sick people, when in fact they coerce and control persons helpless to resist their violence.

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#13

Anti-Coercion Is Not Anti-Psychiatry
by Thomas Szasz
The Freeman, 58: 26-27 (May, 2008)

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#12

Book review by Andrew Scull:
"Untruly Madly Deeply"
in The TLS, January 19, 2007

of

"MY MADNESS SAVED ME".
The madness and marriage of Virginia Woolf.
By Thomas Szasz

Many might be tempted to call Thomas Szasz the enfant terrible of modern psychiatry, save for the fact that he is now eighty-six years of age: obviously, enfant no longer applies. For years, Szasz was a Professor of Psychiatry at the State University of New York Upstate Medical Center at Syracuse. And yet, from 1961 onwards, he consistently proclaimed that mental illness, the presumed object of the psychiatrist's attentions, was a myth -a myth created and nurtured by self-interested professionals acting as agents of social control, either on behalf of families or, more sinisterly, the leviathan State. Disease was a predicate of bodies, and "mental illness", having no demonstrable biological cause, could only be metaphorically and mendaciously classified as a medical matter. So far from being disinterested therapists seeking to assist and cure their patients, psychiatrists were bad-faith con artists in the business of oppressing their patients, stigmatizing them, damaging them with drugs and electric shocks, depriving them of their liberty and their basic human rights. Such false experts, who were no better than concentration-camp guards, served routinely as agents of dehumanization and destruction. .

Mental patients were generally their victims, but the patients themselves might also appear in different guises: as actors consciously or unconsciously playing a role they had created for themselves, exploiting the category of mental illness to obtain absolution from punishment for their crimes and delinquencies; or using their mythical madness as a weapon with which to disrupt and confuse those around them, all the while escaping responsibility for their actions.

In "My Madness Saved Me", Thomas Szasz now takes his ideas in a literary direction. He seeks to recast the accepted view of the life and death of Virginia Woolf. He acknowledges that "Virginia's family, friends, colleagues, and psychiatrists regarded her as having been mad all of her life", and that this was "a view that, for the most part, she shared". Succeeding generations have largely echoed these judgements (though some critics have embraced a variant position, holding that Virginia was a disturbed woman further victimized by her male psychiatrists, her husband, or both). It is a consensus Szasz rejects: "My aim in this study is radically different. I propose to examine how Virginia Woolf, as well as her husband Leonard, used the concept of madness and the profession of psychiatry to manage and manipulate their own and each other's lives". Virginia was, he insists, no victim, but "an active, goal-directed . . . intelligent and self-assertive person, a moral agent who used mental illness, psychiatry, and her husband to fashion for herself a life of her own choosing". It was not a life or a set of choices that Szasz always finds particularly edifying or worthy of praise, but he insists that it was her life, one for which she should be held responsible.

Leonard, too, "used madness and psychiatry like an expert. He used it to deny and cover up the phoniness of his marriage, to control Virginia, and to avoid military service in World War ...". Virginia first became depressed at the age of thirteen, following the death of her mother. Her nephew, Quentin Bell, called this a "(nervous) breakdown".

Szasz denounces such an interpretation as "obtuse", but acknowledges that it was one Virginia "never made a serious attempt to (reject). On the contrary, she embraced the role (of mental patient) and made playing it an integral part of her life strategy -to her profit as well as her peril". Nine years later, her father, Leslie Stephen, the great man of letters, to whom she was deeply attached, died of cancer after a long illness, and once more she was grief-stricken, on one occasion jumping from a window so close to the ground that she sustained no injury -an action her family interpreted as a suicide attempt and as new evidence of her susceptibility to insanity. Szasz insists that it was nothing of the sort.

Virginia was "an uneducated, unhappy, confused adolescent (actually she was by now twenty-two years of age) . . . faced with an empty and useless life, terrified by the challenges of sex and adulthood", and her behaviour was nothing more or less than "a non-verbal dramatization of her dilemma and despair".

But if, in these years, mental illness was a label imposed on young Virginia, then, as she grew to maturity, Szasz alleges, she came to use it as both an excuse and a weapon. "Woolf students assume that Virginia had no part in being identified as mad. This is not true. She played an important part in being identified as a mental patient and she deliberately exploited that role for her own purposes." Indeed, the more accurate way to describe what happened is that she became "a user of madness-and-psychiatry and a victimizer of her husband and those close to her. Hence the legend of Virginia Woolf the mad genius".

Biographers notoriously fall under the spell of their subjects. Not Szasz. It becomes clear in the course of his brief survey that he finds little to like in both Virginia and Leonard Woolf, and much to loathe. About Virginia's fiction, he has little of substance to say; about the lives and attitudes of the couple, he is scathing and unsparing. Leonard is presented as a snob and a social climber, a physically unattractive man consumed with hatred and fury, who sought to marry up into the Stephen family, only settling on Virginia when his first choice, her sister, Vanessa, refused to have him. Autocratic and self-centred, and incapable of understanding another human being, let alone someone as psychologically complex as Virginia, he was a man of neither wealth nor personal distinction. Besides, he was Jewish -a seemingly fatal flaw given that the spouse he sought was an anti-Semite who viewed his Jewishness as "alien, alienating, and abhorrent".

He was -and for the arch-individualist and libertarian Szasz, it is hard to conceive of a worse term of abuse -"at heart a social worker". Like his wife, he was a twentieth- century Mrs Jellyby, "full of love for mankind in the abstract . . . domineering, nasty, and snobbish (in daily behaviour)".

Virginia, despite her attractive appearance, is portrayed as an equally unattractive human being. Desperate to occupy the social role of married woman, she chose a social inferior so she could marry on her own terms. Those terms included a bar to physical intimacy, since intimacy of all sorts, and heterosexual intimacy in particular, repelled her. Her future husband revolted her, and she spent her married life chronically angry with him. Her anger spilled out in vitriolic abuse that was explained away by all sides as another symptom of her madness. Mad she was, Szasz would have it, but mad in the sense of furious -furious with the choices she had made for herself and with the dysfunctional relationship she had entered into. Her subliminal anger was, he judges, the reason that "the theme of Virginia's 'giving pain'" to Leonard recurs throughout her marriage". On Szasz's account, Virginia was a coward, a conformist, self-deceitful, gutless, inauthentic, and lacking in moral seriousness, to say nothing of "disdainful and nasty . . . toward hired help" in a fashion worthy of the way -another revealing Szaszian comparison -"Soviet apparatchiks related to members of the expendable lower orders".

Together, Szasz argues, Virginia and Leonard were "masters at deception and selfdeception". Their marriage was a sham, but each gladly occupied roles that obscured this reality from self and others: "one as madwoman-wife-writer; the other as nurse-husband-manager". And as for Virginia's suicide, stones in pockets, wading into the river to drown, "I surmise that she killed herself, and killed herself as she did, to enhance her fame . . . a lonely, aging woman . . . she feared for her future and escaped it".

"My Madness Saved Me" is a thorough demolition job. The unattractive features Szasz discerns are so many and varied that one can only wonder at the continuing fascination Virginia and Leonard seem to hold for readers and authors alike. Vile creatures both, by now they ought surely to have been cast into oblivion. Except that adherents of the Bloomsbury cult (and admirers of Virginia in particular) seem oblivious to the mismatch between their idealized image of their heroine and her actual behaviour and beliefs -it is enough, for them, that she was intermittently a fine writer; that she can be claimed for the feminist cause; that she came from a privileged background (and exploited that privilege for all it was worth, while criticizing others who did the same); and that she was a martyr, for martyrdom insulates from criticism and creates acolytes, as the life and death of the late Princess of Wales vividly remind us -and except that so much of Szasz's version of the Woolfs' lives depends on one's acceptance of his view of mental illness as myth, and on one's willingness to follow him in relentlessly interpreting the pair's words and actions in the worst possible light.

Nuance is not one of the good doctor's strengths. Nor is subtlety. The contrast between mental and physical illness is, for Szasz, stark and complete. There is black; and there is white. There is real and wholly unambiguous physical illness, which is bereft of any contamination by the social and the cultural; and there is a mere simulacrum invented by a demonic profession and swallowed by the credulous and muddled masses. That neither physical nor mental disease matches his crude representations wholly escapes him.

As his portrait of the Woolfs and their marriage reveals, Szasz is no better at capturing the complexities of individuals and their relationships. The people and intimate relationships with which I am familiar -all of them -are a mix of kindness and cruelty, honesty and illusion, truth and deception, altruism and self-interest, happiness and misery, and that remains the case even when the men and women one is considering are comparatively sane. Individuals, even mad or thoroughly unpleasant ones, cannot plausibly be reduced to one-dimensional caricatures, as Szasz so readily renders the Woolfs here.

When Virginia claims that she is happy with Leonard, except when mentally ill, Szasz insists that her words "ring hollow". On the brink of suicide, she "may have sensed that Leonard . . . was getting tired of her. Perhaps she was getting tired of writing". No evidence is offered for either claim.) She chooses to die by drowning as a means "of dramatizing herself to the end", and as a way of inflicting yet more pain on the odious Leonard. If she acknowledges her madness, she is deceiving herself, her husband and us, or manipulating her audience for nefarious reasons that the omniscient Dr Szasz can reveal to us. He knows better because "in my view" (a phrase that recurs throughout) . . . well, because he simply knows better.

====================================

TLS Online, 7 Feb. 2007, Letters: 'My Madness'

Sir, - In his review of "My Madness Saved Me" by Thomas Szasz (January 19), Andrew Scull suggests that Szasz compared psychiatrists to "concentration camp guards". Szasz's favoured analogy has always been with slave owners, who believed their charges to be incapable of independent lives, thus providing the perfect excuse for their "cruel compassion". This telling analogy explains why Szasz, in his ninth decade, remains a radical figure, feted by "survivors" of psychiatric slavery worldwide.However indirectly, Szasz has helped these supposedly "mad" people to find their own voice. Woolf appeared to have little difficulty in making her voice heard. "My Madness Saved Me" offers an intriguing reading of what Virginia might have been "saying" during her periods of "madness". Scull also neglected to acknowledge that a quarter of Szasz's book is devoted to two appendices, which unpack the feminists' adulation of Woolf and also the "myth" of the "mad genius": the book is worth reading for these challenging pages alone. As a historian of the asylum trades, one might have expected Scull to applaud Szasz as the arch "deconstructor" of psychiatric slavery, and its insinuation into literary appreciation. Rather than judging the Woolfs, Szasz respects them as persons; acknowledging their agency, something which psychiatric apologists (and many feminists) have denied, by genuflecting at the altar of the "myth of mental illness".

PHIL BARKER,
Trinity College Dublin, D'Olier Street, Dublin.

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#11

"Psychiatry: A Branch of the Law,"
The Freeman, 56: 18-20 (December), 2006.

Medicine and law are independent but intimately interacting social institutions. Medicine guards its autonomy jealously and relates to the legal system as an equal partner. Psychiatry, in contrast, submits slavishly to being dominated by the law and obediently meets its demands. Herewith some examples.

On July 3, 2006, Orin Guidry, M.D., president of the American Society of Anesthesiologists, appealed to his colleagues to refuse to assist the states in carrying out a death sentence by means of lethal injections. "Lethal injection," Guidry reminded anesthesiologists, "was not anesthesiology's idea. American society decided to have capital punishment as part of our legal system and to carry it out with lethal injection. The fact that problems are surfacing is not our dilemma. The legal system has painted itself into this corner and it is not our obligation to get it out."

The American Medical Association's code of ethics, Guidry continued, declares: "A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution." Guidry urged the Association's 37,000 members "not to attend executions of death sentences by lethal injection, even if called to do so by a court. The court cannot modify physicians ethical principles to meet its needs".

Evidently, many, perhaps most, American anesthesiologists reject rescuing the criminal justice system from the consequences of its decision to deprive certain persons of life. Depriving persons of liberty is only one rung down the ladder of harms that the state may legally inflict on certain individuals. Nevertheless, most American psychiatrists feel it is their professional privilege to assist the justice system in depriving certain individuals of liberty; indeed, they insist that loss of liberty under psychiatric auspices constitutes a form of medical treatment for the imprisoned individuals. In fact, the assertion of this claim -- as medical "fact" -- was the very first resolution enacted in 1844 by the newly formed American Psychiatric Association (APA; then more descriptively named the Association of Medical Superintendents of American Institutions for the Insane): "Resolved, that it is the unanimous sense of this convention that the attempt to abandon entirely the use of all means of personal restraint is not sanctioned by the true interests of the insane."

Ever since, psychiatrists have clung to their privilege to imprison innocent persons like drowning men cling to life-preservers.

Indeed, psychiatrists never tire of asserting and reasserting their right to deprive people of liberty. In 2005 Steven S. Sharfstein, president of the APA, reiterated his and his profession's commitment to coercion: "We must balance individual rights and freedom with policies aimed at caring coercion." The term "caring coercion" would have fitted perfectly into the Nazi lexicon, along with Arbeit macht frei ( "labor liberates") and Gnadentot ("mercy death").
Because the ideas about psychiatry I have been presenting in these columns differ radically from what people read in the newspapers or see on television, I always present the evidence for my view. The reader is free to judge the information and come to his own conclusion. In support of my contention that psychiatrists have an unappeasable appetite for assisting the legal system in imprisoning individuals who irritate and upset society, I offer the following evidence:
The history of mental health laws and of standard psychiatric practices illustrates that psychiatric confinement has nothing to do with psychiatric treatment. In 1851, the State of Illinois statute specified that "married women ...may be received and detained at the hospital on the request of the husband of the woman ... without the evidence of insanity or distraction required in other cases."

Today, the desire to psychiatrically incarcerate persons who are not committable by the lawyers' and psychiatrists' own criteria looms large in connection with the popular pressure and political need to keep so-called sex offenders confined after they have served their sentences. In 1997 the U. S. Supreme Court declared this practice to be constitutional. In Kansas v. Leroy Hendricks, the Court declared: "States have a right to use psychiatric hospitals to confine certain sex offenders once they have completed their prison terms, even if those offenders do not meet mental illness commitment criteria."

In November 2005, New York Governor George Pataki made the headlines when he initiated "an administrative program to commit sexual predators to public psychiatric hospitals indefinitely." Pataki's order pulls back the curtain. The state's mental health system is like an army. The Governor is the general. The foot soldiers, the psychiatrist -are expected to follow the orders of their superiors. "As citizens, most of us would be comfortable seeing people properly incarcerated if these are considered crimes," said Barry Perlman, M.D., president of the New York State Psychiatric Association (NYSPA). "What we are concerned about is using the mental health system to solve a problem that seems to spill over to it because the criminal justice system cannot adequately handle it."

Perlman acts as if he had just discovered that the mental-health system is an arm of the criminal justice system. But even after discovering it, he does not suggest that psychiatrists, individually or as a group, defy the Governor's orders.

Politicians have no illusions about psychiatry; they know that it is an extension of the state's law enforcement apparatus and use it as such. According to one report, "The governor [Pataki] directed the Office of Mental Health and the Department of Correctional Services to push the envelope of the state's existing involuntary commitment law because he couldn't wait any longer for the Assembly leadership to bring his legislation to the floor for a vote... The state has begun to identify ‘appropriate models for treatment' and to hire staff to treat these patients. ... To date, 16 states and the District of Columbia have enacted laws to allow authorities to confine violent sexual offenders in psychiatric hospitals after their prison terms."

Mental Hospitals as Prisons
It is important to note here that as far back as in 1988 the APA's Council of Psychiatry and Law explicitly approved the use of mental hospitals as prisons. In a document dated November 11-13, 1988, the Council declared: "Psychiatric patients who no longer require active psychiatric treatment or who are untreatable can still be best managed in a psychiatric setting. ... Acquittees who are unable to be discharged to outpatient status should remain under psychiatric care in a hospital environment." Note that the psychiatric prisoner longing for freedom is treated as if he has power over his own discharge but is "unable to be discharged." Not surprisingly, psychiatrists resent being considered jailers. Confronted with the reality that the mental hospital is a prison and that the psychiatrist who works there is a jailer, they deceive themselves, no less than they deceive the public, with a rhetoric of "care."
It is obvious that as long as law, psychiatry, and society define destructive and self-destructive behaviors as mental diseases, assign the duty to control persons who display such behaviors to psychiatrists, who eagerly embrace that responsibility, "seclusion and restraint" -- in plain English, psychiatric coercion -- will remain a characteristic feature of psychiatric practice.

The definition of psychiatry as a medical specialty concerned with the diagnosis and treatment of mental diseases is a monumental falsehood. Psychiatry is a branch of the law, combining features of criminal, civil, and family law: its primary function is to promote and ensure domestic tranquility.

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R.G. Collingwood
(1889-1943; 1978: 93, 95, 149)

1

In the Age of Faith, religion pretended to be a science, offering allegedly empirical observations about God and his works. In the Age of Science, psychology and psychiatry pretend to be sciences, offering allegedly empirical observations about the functions and malfunctions of the human mind. Much modern intellectual and political mischief rests upon this false and pretentious claim. The epistemologically misleading character of the two principal "mental sciences" is inherent in their respective definitions. Wikipedia Encyclopedia identifies psychology as "an academic and applied field involving the study of the human mind, brain, and behavior. Psychology also refers to the application of such knowledge to various spheres of human activity, including problems of individuals' daily lives and the treatment of mental illness." Interestingly, Wikipedia then describes how "Psychology differs from anthropology, economics, political science, and sociology. . . ." and from "biology and neuroscience," but is silent about how psychology differs from psychiatry.

Psychiatry, Wikipedia tells us, "refers to the practice of medicine relating to the mind and behavior. . . . It is a subspecialty of medical practice. . . . While all clinicians encounter patients with mental illnesses and any of them may treat it, psychiatrists specialize in these areas." Missing from these definitions is acknowledgment that the most constant and most characteristic element of so-called mental treatments is and has always been the coercion of the "patient" by the "doctor."

To be sure, many psychologists pursue work unrelated to mental illnesses and mental treatments, and some psychiatrists deal with voluntary mental patients. In this essay, however, I shall use the terms "psychologist" and "psychiatrist" to refer to persons whose professional roles are defined or shaped by mental health laws, that is, coercion. Why do I emphasize the central role of coercion in psychology and psychiatry? Because in my view voluntary mental health relations differ from involuntary mental health interventions the same way as, say, sexual relations between consenting adults differ from the sexual assaults we call "rape." I maintain that it is essential - morally and politically - not merely to distinguish between coerced and consensual"therapeutic" relations, but to contrast them. The terms "psychology" and "psychiatry" ought to be applied to one or the other, but not both.

Mental healing, qua psychology or psychiatry, resembles religion, not medicine or science. Asserting that a respected social institution-such as religion, psychology, or psychiatry-rests on a farrago of fables is disrespectful of received opinion and dangerous. It took us, in the West, a long time before we rejected coercion in the name of religion and punished instead of praised the person who embraced violence in the name of God (Seager, 1933). I believe we ought also to reject coercion in the name of mental health and condemn instead of commend the person who embraces violence in the name of mental healing.

2

The humoral theory of disease, let us remember, was alive and well a mere 150 years ago. As long as that theory prevailed, there was only one kind of disease, humoral. The idea of two kinds of diseases-one bodily, the other mental-is a product of the scientific revolution; more specifically, of nineteenth century empirical-scientific medicine, based on anatomical and physiological observation and measurement. I coined the term "myth of mental illness" in 1960 to suggest that the distinction between bodily illness and mental illness rests on a misuse of the term "illness." If we restrict the use of the term "illness" (or "disease") to observable biological-anatomical and physiological-phenomena, then, by definition, the term "mental illness" is a misnomer or metaphor. Mind is not matter, hence mental illness is a figure of speech.

The great nineteenth-century neuropsychiatrists regarded this view as a given:

Emil Kraepelin (1856-1927): "The subject of the following course of lectures will be the Science of Psychiatry, which, as its name [Seelenheilkunde] implies, is that of the treatment of mental disease. It is true that, in the strictest terms, we cannot speak of the mind as becoming diseased [Allerdings kann mann, streng genommen, nicht von Erkrankungen der Seele sprechen]" (Kraepelin, 1901/1968: 1).

In short, the proposition that there is no mental illness is not new. What is new are the practical, political-economic consequences of affirming or denying its existence.
Until the 1970s, the idea that mental illness is a nondisease-a medical name for unwanted personal conduct-was accorded a measure of professional and public recognition. Since then, the debate about the disease-status of mental illness has been brought to a halt. Leaders in politics, jurisprudence, medicine, neuroscience, psychology, and psychiatry allied with business leaders, insurance executives, and journalists, declared that brain and mind, bodily illness and mental illness are identical and must-as a matter of law and justice-be treated as if they were the same.

In practice, none of this is true. Medicine and law continue to distinguish between neurology and psychiatry, between laws regulating the rights and duties of persons suffering from neurological diseases such as syringomyelia, and the rights and duties of persons suffering from psychiatric diseases such as schizophrenia. What accounts for this disjunction between academic-political declarations about mental illness and the legal-social realities of mental health practices? Answering that question fully requires a reprising of the history of psychiatry. Here I limit myself to showing that the idea of mental illness qua medical disease is a product of modern materialist-reductionist psychology/psychiatry.

3

The modern history of the mind is a tapestry woven with two different strands, one concerned with "mental healing," another with "mental illness." At the dawn of the age of mental healing, the practice was called "Mesmerism." Freud named it "psychoanalysis." Stefan Zweig aptly dubbed it Heilung durch den Geist, "healing by means of the spirit" (Zweig, 1962). We call it "psychotherapy" or "talk therapy." The subject is important because controversy regarding the nature and scientific status of mental healing antedates and prefigures the controversy regarding the nature and scientific status of mental illness, psychiatry, and psychology.

Noted psychiatric historians, such as Henri Ellenberger and Gregory Zilboorg, trace the origin of modern psychotherapy to the work of Franz Anton Mesmer (1733-1815) (Ellenberger, 1970: 53; Zilboorg, 1941: 347). They do so because he had established-or so Ellenberger and Zilboorg believe-that suggestion ("hypnosis") is a genuine medical method of treating bodily ailments. In my view, Mesmer's so-called therapeutic successes prove the power of human gullibility, resting on man's ultimate helplessness and quasi-religious need for dependence on benevolent (theological or medical) authority. The power and universality of this need is aptly expressed in the adage, "There are no atheists in foxholes." Mutatis mutandis, there are no medical skeptics in operating rooms.

Mesmer's work must be situated in the context of his age. The eighteenth century was a period of revolutions-political and scientific. Although the phenomenon physicists call "magnetism" had been known since antiquity, the fabrication and sale of magnets, mainly to scientific investigators and terrestrial navigators, began only around 1740. The famous Leyden Jar-a simple electrical capacitor that could be used to give a person a sudden, albeit weak, shock and which quickly became a show-business prop and sensation-was invented about 1745, by a Dutch physicist at the University of Leyden. In 1752, Benjamin Franklin (1706-1790), invented the lightning rod, a feat that made him the first modern "scientific celebrity." Finally, in 1780, the Italian scientist Luigi Galvani (1737-1798) discovered the electric current and what he mistakenly thought was "animal electricity." It was in this atmosphere of scientific discovery along with medical quackery and popular showmanship that Mesmer, an Austrian physician, "discovered" what he thought was "animal magnetism," a mysterious "force" and substance (fluidum) to which he attributed vast therapeutic powers (Szasz, 1978/1988: 43-66).

4

The twentieth century, too, has been a revolutionary period, in politics, science, and medical quackery. In medicine, many important discoveries and new treatments rested on novel uses of electricity and magnetism, such as the x-ray, computerized axial tomography (CT scan), positron emission tomography (PET scan), and magnetic resonance imaging (MRI), not to mention radio, television, computers, and the Internet. It is in this atmosphere that modern-day Mesmers discover near-miraculous cures for mental illnesses making use of electrical-magnetic devices, such as electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), deep brain stimulation (DBS), and transcranial magnetic stimulation (TMS). Other "therapeutic breakthroughs" make use of pharmacotherapies modeled after antibiotics, called "antipsychotic medications." I am not concerned here with whether these interventions are considered by some to be "effective." I list them only to set the stage for my subsequent remarks about the alleged illnesses they supposedly treat.

Although we live in an age of far greater scientific and technological sophistication than did people in the eighteenth century, human gullibility remains undiminished. Perhaps it is a kind of existential constant, drawing its force from people's seemingly unappeasable need to believe in, and submit to, authority. Today, people are especially credulous concerning matters having to do with the "mind"-its alleged material (anatomical, chemical, electrical) basis, its functions and malfunctions, and, most pressingly, the supposed diseases to which it is subject and the appropriate treatments for them. Social historians are familiar with the roles that the great nineteenth-century psychiatrists and the pioneer psychoanalysts played in exploiting this credulity. Less familiar is the role in this story of William James (1842-1910), whose boundless naïveté about mental matters is hidden by his stature as America's greatest psychologist, one of the founders of the modern science of psychology and of the American Psychological Association.

5

James's obituary in The New York Times was entitled, "William James Dies; Great Psychologist, Brother of Novelist and Foremost American Philosopher Was 68 Years Old." It summarized his work in these words: "Virtual Founder of Modern American Psychology, and Exponent of Pragmatism and Dabbled in Spooks. Long Harvard Professor" (James, 1910). James's essay on religious belief, tellingly titled "The Will to Believe"; his famous book, Varieties of Religious Experience; and his credulous participation in "spiritualism" all testify to his own deeply-felt need "to believe," if necessary, in the sense of credo quia absurdum est. ("I believe because it is absurd."

Usually attributed to Tertullian, c. 160-220.) Less well-known, but of greater interest to the subject of mental illness and psychiatric treatment, is James's 1892 essay, "A plea for psychology as a natural science" (pp. 146-153). His words are clear and need no extended exegesis. My comments about them will be brief.

James (1892) begins with a puerile statement:

Assuming the posture of "doctor knows best," James charges ahead:

By 1892, William James had come out of the spiritualist closet. Here he lists "biologists, nerve-doctors, and [or] psychical researchers" as scientists of the same kind, all engaged in a quest for the material cure of "chronic insane delusions" and not giving a whit about "seraphic insight into the soul."
James was shockingly indifferent to the great controversies in psychology and psychiatry raging around him. It was then even more obvious than it is now that what sets psychiatry apart from medicine is coercion. The incarceration of the insane was, and is, the proverbial 800-pound gorilla in the room. Everyone knows it is there.

Now, it is impolite to notice its presence. Not so in the 1890s. The following is a brief excerpt from an address by Silas Weir Mitchell (1829-1914)-the great American neurologist and founder of the American Neurological Association-presented at the 1894 annual meeting of the American Medico-Psychological Association (now the American Psychiatric Association): "You quietly submit to having hospitals called asylums; you are labeled as medical superintendents . . . I presume that you have, through habit, lost the sense of jail and jailor which troubles me when I walk behind one of you and he unlocks door after door. . . . You have for too long maintained the fiction that there is some mysterious therapeutic influence to be found behind your walls and locked doors. We hold the reverse opinion . . . Your hospitals are not our hospitals; your ways are not our ways" (Mitchell, 1894, pp. 414, 427, emphasis added).

James and the psychologists and psychiatrists who joined his quest for the material cure of "chronic insane delusions" without giving a whit about "seraphic insight into the soul" got what they wished for-and more: a "science of the mind" without soul or ensouled.

Szasz, T., "The Pretense of Psychology as Science: The Myth of Mental Illness in Statu Nascendi," Current Psychology, 25: 42-49 (Spring), 2006.

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REFERENCES

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#9
Keynote Address, "Controversies in End of Life Care:
Terri Schiavo's Lessons"

"I kept my promise" (Schiavo, 2005a).
Theresa Schiavo's grave marker, June 20, 2005.

''I laid a red rose in her hand and said goodbye'' (Schiavo, 2005b).
Michael Schiavo, September 24, 2005.

1

In 1992, during a deposition in his malpractice suit against the physicians who treated Terri Schiavo for infertility, Michael was asked how he saw his future with his wife.

He replied:
A: I see myself hopefully finishing school and taking care of my wife.
Q: Where do you want to take care of your wife?
A: I want to bring her home.
Q: If you had the resources available to you, if you had the equipment and the people, would you do that?
A: Yes. I would, in a heartbeat.
Q: How do you feel about being married to Terri now?
A: I feel wonderful. She's my life and I wouldn't trade her for the world. I believe in my marriage vows.
Q: You believe in your wedding vows, what do you mean by that?
A: I believe in the vows I took with my wife, through sickness, in health, for richer or poor. I married my wife because I love her and I want to spend the rest of my life with her (Schiavo, 2005c).

Michael Schiavo made those statements, under oath, in 1992. In 2005, he had inscribed on Terri's grave marker "February 25, 1990" as the date she had "Departed this Earth."
Does Michael Schiavo's self-aggrandizing memorial to refer to his promise of marital fidelity? For more than a decade he has lived with another woman, to whom he refers as his fiancee and with whom he has two children.

Does his statement, "I kept my promise," refer to his promise to Terri's parents, Mary and Robert Schindler, that Terri ‘s body would not be cremated and her remains would be buried at a Schindler family plot in Pennsylvania? Two days after she died, Terri was cremated and her ashes were buried at Sylvan Abbey Memorial Park in Clearwater. The Schindlers were notified only after the event.

To what promise-keeping, then, does Michael Schiavo refer on his wife's tombstone? Ghoulishly, he brags about his alleged pledge to kill her, in her own best interest. The removal of Terri's feeding tube was, as Joan Didion points out, "repeatedly described as ‘honoring her directive.' This, again, was inaccurate: there was no directive. Any expressed wish in this matter existed only in the belated telling of her husband and two of his relatives" (Didion, 2005).

The conflict between the Schindlers and Michael Schiavo was clear. The Schindlers preferred a half-dead daughter above ground to a dead daughter in the grave. Michael preferred a dead ex-wife in the grave to a half-dead wife in a hospice. The Schindlers acknowledged that they wanted Terri alive. Michael denied that he wanted his wife dead and instead attributed the death-wish to Terri's desire to have her life terminated if she were as disabled as she was. This is the fiction the courts upheld.
And this is the fiction Michael memorialized -- naively and narcissistically -- with the inscription he chose to have engraved on Terri's grave marker. "I kept my promise": Sartre could hardly have found a more dramatic example of a husband's bad faith following his wife to her grave.

The Schiavo drama was a classic battle of words: he who controlled the vocabulary, controlled the debate and was assured of victory. Apparently, the Schindlers did not recognize this. They failed to emphasize that what Theresa Schiavo allegedly wanted was unconfirmable, based totally on hearsay evidence, and that, in doubtful cases, the long tradition of English and American law and the Christian religion favors the preservation of life and liberty over their forfeiture. (Michael Schiavo and the Schindlers are Catholics.) The moral default position in the case of Terri Schiavo was clear: she was not dead and killing her was an act of medical killing, a type of heterohomicide.

Was it morally justified? In my opinion, it was not: 1) Terri had no living will and there was no credible evidence about what she might have wanted to happen to her half-alive body; 2) Terri's parents wanted to keep her alive, while her husband, living with another woman, wanted her dead; 3) Michael Schiavo's representations lacked credibility and hence the courts erred in appointing him as Terri's guardian; and 4) assuming that Terri Schiavo would have wanted her life ended, she would not have wanted it ended by being alternately starved and fed, by having her feeding tube repeatedly removed and reinserted over a period of months.

Led by medical ethicists, the mainstream media nevertheless defined the case as a battle between "humanists" and "religious zealots," "rationalists" and "irrationalists." Didion observes: "Yet there remained, on the ‘rational' side of the argument, very little acknowledgment that there could be large numbers of people, not all of whom could be categorized as ‘fundamentalists' or ‘evangelicals,' who were genuinely troubled by the ramifications of viewing a life as inadequate and so deciding to end it. There remained little acknowledgment even that the case was being badly handled..." (Didion, 2005).

2

Medicine and science change and, in our day, change rapidly. Fundamental ethical principles are enduring. Probably the most enduring principle is the injunction against killing human beings, especially when the justification for doing so is morally feeble.
Religion and law decree certain human bonds to be unbreakable, and many people experience them as such. The paradigm of such a bond is that between the pious Jew and his God. Christianity decreed the marriage bond to be similarly unbreakable. This rule, long enshrined in civil law, was repudiated only in recent times.
The principal issue in the Schiavo case -- besides the economics of Terri's care -- was the conflict between two parties both claiming undying love and loyalty to her: her husband who wanted her dead, and her parents who wanted to keep her alive.

In this circumstance, the commandment against killing should alone have been enough to tilt the balance in the parents' favor.
Few moral dilemmas present us with truly novel conundrums. The Schiavo case is not among them. To the contrary, the conflict between the Schindlers and their son-in-law calls to mind the legendary case of the disputed baby in the Old Testament. Two women live together and give birth to babies at about the same time. One baby dies during the night. His mother switches him with the other baby.

The living child's mother discovers the deception and brings the dispute to Solomon for arbitration. The Bible tells what happened this way: Then came there two women... And the one woman said, O my lord, I and this woman dwell in one house; and I was delivered of a child with her in the house. ... And this woman's child died in the night; because she overlaid it. And she arose at midnight, and took my son from beside me .... and laid it in her bosom, and laid her dead child in my bosom .... And the other woman said, Nay; but the living son is my son. ... Thus they spake before the king. ... And the king said, Bring me a sword. ... And the king said, Divide the living child in two, and give half to the one, and half to the other. Then spake the woman whose living child was unto the king ... O my lord, give her the living child, and in no wise slay it. But the other said, Let it be neither mine nor thine, but divide it. ... And then the king answered and said, Give her the living child, and in no wise slay it: she is the mother thereof (1 Kings 3: 16-27; King James Version).

Today's Solomon would order both women to undergo psychiatric examination to determine who would make a better mother and would then rule in accordance with the psychiatric "findings," ratified by committees of bioethicists. Herein lies the difference between the language of love and life, and the language of envy and death; between the philosophy of individualism and libertarianism, and the philosophy of collectivism and statism; and between the ethics of justice and the sanctity of life, and the ethics of bioethics and the justification for medical killing.

Solomon, we might be tempted to glibly observe, had it easy because of the second mother's gratuitous comment. Suppose she had said the same thing the first mother said. How would Solomon have decided? We don't know. It would have been a different case, both contending parties choosing life over death. Ironically, Michael Schiavo's conduct reinforces the analogy with the biblical case. In 1993, when he was ostensibly still trying to keep Terri alive, Michael was asked what he had done with her jewelry. He replied: "Um, I think I took her engagement ring and her... what do they call it... diamond wedding band and made a ring for myself" (Schiavo, 2003).

After Terri died, he defined the date of her death as February 25, 1990, and placed that date on his wife's tombstone. If that is when, in Michael Schiavo's view, his wife died, then, after that date, he considered himself wifeless, a widower who had no morally valid claim to Terri's living body, and no legally valid ground for objecting to the Schindlers' desire to assume caring for their daughter who was, de facto and de jure, still alive. I shall abstain here from considering his financial and other possible reasons for not divorcing Terri and fighting the Schindlers' efforts to be her legal guardians.

3

The Schiavo case has generated a vast literature, some in print, much of it on the Internet. Most of this literature analyzes the case from the point of view of the supposed "rights" of the main dramatis personae. What would Terri have wanted had she anticipated her half-alive state? Did feeding and hydration constitute "artificial life support"? Who ought to be her legal guardian? Although the Schindlers's efforts to keep Terri alive received much popular and professional support, most of the debate was straitjacketed into medical terminology and dealt with concepts and issues such as the patient's ability to feel pain, recognize persons, respond to stimuli, permanent vegetative state, brain death, prognosis, rehabilitation, and so forth.

All this was shadowboxing. After more than a decade of being half-dead, it required no sophisticated medical knowledge or technology to conclude that, as a person, Terri Schiavo existed no longer, but that, as a human being, she was still alive. That, after all, is why there had been a long battle about the legitimacy of killing her. She had to be put to death before she could be legally declared dead and her corpse buried or cremated.

Most people who are not religious prefer to be completely dead rather than half-dead. They usually assume that their closest relatives, the persons who truly deserve the awkward appellation "loved ones," share this choice. If they assume otherwise, they are likely to execute a living will expressing their desire to be kept alive as long as possible, regardless of circumstances or costs. The Schindlers themselves wished to keep their daughter alive and believed, with good reason -- they were all practicing Catholics -- that that is what Terri would have wanted. I shall now briefly examine the Schiavo affair from what I imagine was the Schindlers' point of view, and do so by reference to a justly celebrated short story by William Faulkner.

"A Rose for Emily" is a Gothic tale set in a small town in the Old South (Faulkner, 1935). Emily Grierson is the only daughter of one of the small town's leading citizens. "The Griersons held themselves a little too high for what they really were. None of the young men were quite good enough for Miss Emily." Mr. Grierson dies, leaving Miss Emily in genteel poverty, living alone in the big house. She becomes a shadowy figure who, however, manages to dominate the town authorities. Afraid to collect the taxes she owes on her home, they are one day confronted with complaints by neighbors about a foul odor emanating from it. "That was two years after her father's death and a short time after her sweetheart -- the one we believed would marry her -- had deserted her. ... 'But what will you have me do about it, madam?'," wailed the mayor. "After a week or two the smell went away."

Having set the stage, Faulkner dispels the mystery. A few years after the death of Miss Emily's father, a construction company comes to town, "with riggers and mules and machinery, and a foreman named Homer Barron, a Yankee -- a big, dark, ready man, with a big voice and eyes lighter than his face. ... Presently we began to see him and Miss Emily on Sunday afternoons driving in the yellow-wheeled buggy and the matched team of bays from the livery stable." The construction company leaves and Homer Barron is seen no more. The townsfolk assume that he left with the company.

In fact, Homer Barron rejected Miss Emily, and she poisoned him with arsenic. The years pass. "Each December we sent her a tax notice, which would be returned by the post office a week later, unclaimed. Now and then we would see her in one of the downstairs windows --she had evidently shut up the top floor of the house ... Thus she passed from generation to generation -- dear, inescapable, impervious, tranquil, and perverse. And so she died."

Distant relatives come to bury her:
Already we knew that there was one room in that region above stairs which no one had seen in forty years, and which would have to be forced. They waited until Miss Emily was decently in the ground before they opened it. The violence of breaking down the door seemed to fill this room with pervading dust. A thin, acrid pall as of the tomb seemed to lie everywhere upon this room decked and furnished as for a bridal: upon the valance curtains of faded rose color, upon the rose-shaded lights, upon the dressing table, upon the delicate array of crystal and the man's toilet things backed with tarnished silver, silver so tarnished that the monogram was obscured.

Among them lay a collar and tie, as if they had just been removed, which, lifted, left upon the surface a pale crescent in the dust. Upon a chair hung the suit, carefully folded; beneath it the two mute shoes and the discarded socks. The man himself lay in the bed. ... The body had apparently once lain in the attitude of an embrace, but now the long sleep that outlasts love, that conquers even the grimace of love, had cuckolded him. What was left of him, rotted beneath what was left of the nightshirt, had become inextricable from the bed in which he lay; and upon him and upon the pillow beside him lay that even coating of the patient and biding dust. Then we noticed that in the second pillow was the indentation of a head. One of us lifted something from it, and leaning forward, that faint and invisible dust dry and acrid in the nostrils, we saw a long strand of iron-gray hair.

Miss Emily preferred the simulacrum of a husband to no husband at all. The Schindlers preferred the simulacrum of a daughter to no daughter at all. I believe their argument was fatally flawed by their failure to acknowledge this and engaging instead in an ill-considered debate about Terri's medical condition and "prognosis." Their claims that Terri was responsive, that she was not in a vegetative state, that her prognosis was not hopeless were counterproductive. Watching the case unfold, my impression was that the Schindlers wanted their daughter to be kept alive regardless of how badly damaged and hopeless her condition was. They preferred a daughter half-dead or four-fifths dead to no daughter at all. But they never said so. Nor did they offer to foot the bill for caring for Terri.

4

Exploring the economic aspects of the cost of caring indefinitely for persons in Terri's condition would require another essay or, rather, a substantial monograph. Let me say only that I am not aware that the Schindlers ever offered to pay for Terri's care or, for that matter, would have been able to afford doing so. I assume (and I believe it is reasonable to assume) that had the Schindlers been billionaires, they would have mounted a very different kind of legal challenge against their alienated and antagonistic son-in-law. They could have petitioned the courts -- in a type of habeas corpus plea -- for the opportunity to care for Terri, indefinitely and at no cost to the public, supported by appropriate medical, nursing, and other help. In the absence of an advance medical directive by Terri, I believe the courts would have found such a request impossible to reject.

I agree with Nat Hentoff that, since the law lets people execute advance medical directives refusing life support should they become profoundly incapacitated, they have the responsibility to prepare such directives. "Absent that, the law should require the courts in contested cases to give every reasonable benefit of the doubt to sustaining life and not causing death by dehydration."

Importantly, Hentoff adds:
Having reported on the Terri Schiavo case for the past two and a half years -- and having read all of the transcripts of court hearings -- I am certain of one dimension of this case: Terri Schiavo was fatally denied due process because all the appellate courts, state and federal, relied wholly on the rigid misunderstanding of the central facts of the case by one Florida Circuit judge, George Greer. If this had been a case of a prisoner on death row with an execution date, the ACLU and a good many liberals would have demanded habeas review, from the beginning, of all the facts in the case (Hentoff, 2005).

Not only does the problem of so-called "fruitless care" for the terminally ill or severely disabled require serious consideration of its economic implications, it requires also attention to the moral dilemmas attending medical killing, with special reference to the legal-psychiatric prohibition of drugs and suicide. I have written extensively about these subjects and a few observations must suffice here. The Schiavo case touches on many of the difficult economic, moral, legal, and social dilemmas presented by the combination of advances in modern medical technology, the national-socialization of heath care services, and the war on autonomy and personal responsibility and autonomy disguised by a preoccupation with so-called "medical ethics." I use the term "national socialism" here in its precise descriptive sense, to refer to state control of important sectors of the nation's economy, not to the German National Socialist regime.

Medical ethics, as I see it, must be one of two things -- the justification and ratification of prevailing medical principles and political practices or a critique and condemnation of such principles and practices. Since the medical ethics industry is ideologically and economically parasitic on -- is, indeed, a part of -- the same therapeutic state that supports and justifies the medical and pharmaceutical industries, it functions, in effect, as the propaganda arm of the therapeutic state. Hence, it is both unable and unwilling to play the role of moral critic. Supported by co-opted authorities on medical ethics, the Florida courts sidestepped all the complex moral and political problems and chose to pretend that the conflict between husband and parents in the Schiavo case ought to be resolved on the basis of a fictitious autonomy plus a fictitious advance medical directive that they attributed to Terri.

Autonomy is self-government. It can be curtailed only by the self and the state. We limit our own autonomy every time we make a promise or enter into a contract, for example by marrying. The state limits our autonomy every time it prohibits an act, especially the type of act which John Stuart Mill aptly called "self-regarding," such as self-medication. Our autonomy is now strictly limited by a political system I call the therapeutic state (Szasz, 1963 / 1989).

Paradoxically, when I was growing up in a not-very democratic Hungary and the world was on the verge of a totalitarian nightmare, personal autonomy was less limited than it is today in the United States. No one tried to prevent individuals -- not even school children -- from killing themselves. Opiates and sleeping pills were widely available and their possession was not prohibited. Although traditionally a Roman Catholic country, Hungary has long had, and still has, one of the highest suicide rates in the world.

"The free man owns himself. He can damage himself with either eating or drinking; he can ruin himself with gambling. If he does he is certainly a damn fool, and he might possibly be a damned soul; but if he may not, he is not a free man any more than a dog" (Chesterton, 1935). The words are Gilbert K. Chesterton's. He was a devout Catholic and a passionate conservative, not a liberal, much less a libertarian. Today, with the whole "civilized" world waging wars on drugs and suicide, few people agree with this statement.

Physicians, especially psychiatrists, have been waging war on autonomy for more than 200 years. As medical professionals acquired more knowledge about the human body and its diseases, they sought increasing control over it. Physicians attacked autonomy along three fronts, corresponding to three basic human urges -- sex, drugs, and death. Supported by pseudoscience and the state, they declared self-abuse, self-medication, and self-killing diseases and punished them as offenses against the public health and hence the public good. The free man owns himself. The therapeutic state prohibits self-ownership.

Terri Schiavo had no right to kill herself when she was fully alive. "Suicidality," defined as a "symptom of depression," is the main justification for civil commitment -- an act of depriving a person not only of autonomy but of liberty. Nevertheless, so the story goes, Terri Schiavo had a right to have her life terminated when she was only half-alive, because, allegedly, that is what she would have wanted had she been able to express her wants. We often believe X not because X is true, but because believing X helps us to achieve our selfish purposes. We have no right to suicide, yet we insist that respect for "patient autonomy" requires that we have a right to physician-assisted suicide (Szasz, 1999 / 2001).

Reconsider the basic facts of the case. For fifteen years Terri Schiavo's half-alive body lay in bed. Ostensibly, during all this time, both her husband and her parents wanted to "help" her. Initially, they helped her to stay alive. No one then spoke of Terri's wish to be killed. Then came a sudden reversal, when Michael "remembered" Terri's alleged verbal living will. Michael now sought to help Terri by ending her life as soon as possible, while the Schindlers helped her by preserving her life as long as possible.

At the same time -- characteristically for the times we live in -- neither party was willing to assume real obligation to care for her; both parties wanted to use the power and purse of the state to implement their wishes. Michael wanted the state to end Terri's life. The Schindlers wanted the state to keep Terri alive and pay for her care. (Only a small, initial part of Terri's care was paid by the malpractice insurance money awarded to Michael. By the end, the taxpayer was paying the bills.)

5

The truth is that the Schiavo case had nothing whatever to do with what we fatuously call "patient autonomy." Instead, it had to do with property rights and money -- specifically, with deciding, first, who was the rightful "owner" of Terri's half-alive body, and second, who was to pay for keeping her alive till she was pronounced legally dead.

Regardless of the medical-technical term we choose to describe Terri's state -- coma, permanent vegetative state, severe and irreversible brain damage -- two things are clear: that before her feeding tube was removed, she was not dead; and that she was helpless and dependent on others for survival in much the same way that a newborn baby is: she could breathe and metabolize food, but needed to be fed, and hydrated, and cared for. The difference between Terri and a baby was that Terri was destined to remain totally disabled and dependent until she died.

There is nothing unusual or uncommon about this sort of situation. On the contrary, the problem is pervasive and perennial. But we must be clear about whose problem it is, and what the true nature of the problem is. The problem is not the patient's, just as the problem of abortion is not the fetus's. Terri had no problem. She was the problem. For whom? For her husband, for her parents, and for the agents of society charged with protecting certain classes of dependents. Under the age-old legal principle of parens patriae, incompetent human beings needing and deserving care and protection were, in John Locke's words, "idiots, infants, and the insane." Today, in addition to "idiots, infants, and the insane," the category of such incompetents includes the aged, the unconscious, and persons, like Terri, in a chronic vegetative state.

If relations among family members are harmonious and some are willing to care for a disabled person, they do so, and that is the end of the matter. Many parents care for their severely handicapped children, and many adult children care for their demented parents. If the persons responsible for the dependent are wealthy, they typically delegate the task to others. That is the way Joseph Kennedy, Sr. cared for his daughter Rosemary who, after the lobotomy to which he had subjected her rendered her, too, only half a person. Severely brain-damaged, Rosemary was sent to a Catholic convent home in Wisconsin, lavishly endowed by Kennedy to conceal his embarrassing deed and care for his damaged daughter. Out of sight and out of mind, Rosemary "lived" there for more than 60 years, until her death in 2005, at the age 86.

Family members may also agree on the opposite course, which they often do in the kind of hopeless situation with which Terri's husband and parents were faced. They then instruct medical personnel to desist from heroic measures to prolong the dying process. This is one of the functions of hospice care. It is worth noting in this connection that Terri Schiavo did not qualify for such care.

In the Schiavo controversy, the courts upheld the fiction that Terri's autonomy required that she be medically killed, in her own best interest. In view of the fact that we live in a country whose laws prohibit suicide and often deny patients with terminal illnesses the pain-killers they need, the doctors' and courts' sensitivities to patient autonomy were, in this case, touching to say the least. Michael requested the court to attribute to Terri the de facto right to physician-assisted suicide. That this decision favored Michael's personal and financial interests, and the taxpayers' economic interests, was purely coincidental.

The Schiavo case -- like Shakespeare's Lear or Hamlet -- was and remains great drama. It holds up a mirror, as it were, that reflects our selfishness, our moral uncertainties and vanities, and, above all else, our boundless hypocrisies about drugs, dying, medical care, and money.

Enlisting physicians in the task of killing people, whether patients or enemies of the state, is not a new idea. The fact that the Hippocratic Oath prohibits medical killing suggests that physicians and their superiors must have found it a temptation. The practice seems to have started in Rome under Nero, who would send "doctors to those who hesitated to execute his order to commit suicide, ... instruct[ing] them to 'treat' (curare) the victims, for thus the lethal incision was called" (Hoof, 1990). The guillotine and the gas chamber were developed by medical doctors. The Nazi medical Holocaust was an unabashed euthanasia program planned and carried out by physicians.

In English literature, the earliest reference to death as treatment appears in Sir Thomas More's Utopia. He wrote: "Should life become unbearable for these incurables, the magistrates and priests do not hesitate to prescribe euthanasia. ... When the sick have been persuaded of this, they end their lives willingly either by starvation or drugs" (More, 1516).

The practice of routinely referring to the ostensible beneficiary of physician-assisted suicide (PAS) as a "patient," albeit seemingly harmless, prejudges the act as medical and legitimizes it as beneficial ("therapeutic"). To be sure, a person dying of a terminal illness is, ipso facto, considered a patient. However, dying is not a disease; it may, inter alia, be a consequence of disease (or other causes, such as accident or violence). More importantly, killing (oneself or someone else) is not, and by definition cannot be, a treatment.

Strictly speaking, the phrase "assisted suicide" is an oxymoron. Suicide is killing oneself. We ought to call it autohomicide, to distinguish it from heterohomicide, which is the correct name of the act by which Terri Schiavo's life was terminated. Neither autohomicide nor heterohomicide is a medical matter. Both are legal, moral, economic, and political matters (Szasz, 1999 / 2001).
A person has no need for another to perform a service that he could perform for himself, provided, of course, that he wants to and is allowed to perform the service. If a person knows how to drive but prefers to be driven by someone else, he has no need for a chauffeur, he wants a chauffeur. Such a person is not receiving "chauffeur-assisted driving." The same is true for killing oneself.

Let us not forget that physicians have always been partly agents of the state and are now in the process of becoming de facto government employees. Hence, unless a person kills himself, we cannot be certain that his death is voluntary; under no circumstances should such a death be called "suicide." If a person is physically unable to kill himself and someone else kills him, then we are dealing with a clear case of heterohomicide (euthanasia, mercy killing, or medical murder, as the case may be).

Moreover, if a physician carries out the act, which is what happened in the Schiavo case, then we cannot be sure that the patient did not want to change his mind in the last moment, but could not or was not allowed to do so. We know that many persons who prepare advance directives requesting that physicians abstain from "heroic measures" to prolong their dying change their minds when the time comes to honor their own prior requests.

In short, conjoining the terms "assisted" and "suicide" is cognitively misleading and politically mischievous. The term "physician-assisted suicide" is a euphemism, similar to terms like "pro-choice" (for abortion) and "right to life" (for prohibiting abortion). We ought to reject PAS not only as social policy but also as a conventionally used phrase, especially so long as suicide remains, de facto, illegal, prohibited by mental health law and punished by psychiatric agents of the state.

Words are important. We must be careful about what we call the persons who receive and deliver suicide assistance services. If we call the persons who receive the services "patients" and those who deliver them "physicians," then dying by means of such a service is, ipso facto, a "treatment," and PAS becomes an approved cause of death, like dying from a disease. In short, the legal definition of PAS as a procedure that only a physician can perform expands the medicalization of everyday life, extends medical control over personal conduct, especially at the end of life, and diminishes patient autonomy.

6

Let us call a spade a spade. Terri Schiavo was killed: to be precise, she was executed, in accordance with a legally valid court order, by starvation and dehydration. Why? Because no one -- not her husband, not her parents, not any philanthropist, not the American taxpayer -- was willing to pay to keep her alive. The elephant in the room no one wanted to see was money. Had Terri's parents been Melinda and Bill Gates, and had they wanted to keep Terri alive, there would have been no "case." If we believe that executing innocent people is wrong, then the Schiavo case presents no ethical problem. It presents economic, political, and social problems.

Millions of persons all over the world -- infants, old people, severely disabled persons -- would die if they were not given food and water by others. Tens of thousands of persons, whose quality of life is not measurably better than Terri Schiavo's was, languish in nursing homes, tied to wheelchairs and drugged with Haldol. Looking after them for seven years, how many of their relatives could "remember" that the "patients" chose to die when they fell into such a state? How many could produce "credible witnesses" from among siblings or close friends to testify that they heard the patients say that? Would this be sufficient legal ground to starve them to death?

The problem is obvious: dependency. Formerly, this was a problem for the family and the church. Now, it is a problem for the state. Why? Because the modern national-socialist state has assumed the social-economic functions of the church, and is assuming more and more of the social-economic functions of the family.

Sir William Osler (1849-1919), perhaps the most celebrated physician in the history of American medicine, foresaw the problem of mass dependency in mass society and boldly offered a notorious recommendation. In 1905, Osler resigned from John Hopkins Medical School, of which he had been a founder, to accept the even more prestigious position of Regius Professor of Medicine at Oxford.

Nearly fifty-six years old, contemplating his own aging, he delivered an address titled The Fixed Period, declaring that "men over the age of sixty were useless," that "the history of the world shows that a very large proportion of the evils may be traced to sexagenarians," and that "peaceful departure by chloroform might lead to incalculable benefits," for them as well as for society (Osler, 1905 / 1943). Subsequently, Osler said, not very persuasively, that his proposal was "whimsical." However, many people took it seriously. His supposed spoof had temporarily enriched the language, generating the verb "Oslerize" (meaning "euthanize"), used both in jest and in earnest.

When Osler delivered his speech, he was a revered figure in American medicine. Nevertheless, the press -- then still vigilant about protecting personal freedom from medical statism -- was alarmed. An editorial in the New York Times castigated his remarks and compared his proposal to the practices of "savage tribes ... whose custom it is to knock their elders on the head whenever the juniors find their elders in their own way" (Johnson, 1996).

Two days after the address was denounced in the papers, a Civil War veteran shot himself to death. A clipping of Osler's address was found on his desk. The story was front-page news in a report entitled "Suicide Had Osler Speech." Undaunted, Osler angrily retorted: "I meant just what I said, but it's disgraceful, this fuss that the newspapers are making about it." In his hagiography of Osler, Harvey Cushing, the famed Harvard neurosurgeon, stated: "Efforts were made in vain to get him to refute his statement; and though there can be no question that he was sorely hurt, he went on his way with a smile" (Cushing, 1925).

His later disclaimers notwithstanding, Osler was serious. This conclusion is supported by his favorable reference to John Donne's now forgotten defense of suicide in Biathanatos (1646 / 1930), and also by the fact that Osler's essay and title were inspired by Anthony Trollope's (1815-1882) novel, also titled The Fixed Period (1882 / 1963). Trollope's tale, cast in the mold of a futuristic utopia/dystopia, takes place on the imaginary island, "Britanulla," where the human life span is fixed at sixty-five years. At the end of their sixty-sixth year, men and women are admitted to a college for a twelve-month period of preparation for euthanasia by chloroform. Trollope was sixty-seven when he wrote the novel. A year later he died, without benefit of chloroform. Despite his stature as the giant of American medicine, Osler never lived down his flirtation with medical killing.

7

On September 24, 2005, Michael Schiavo traveled to the Twin Cities to speak at a conference on medical ethics at the Hyatt Regency hotel honoring Dr. Ronald Cranford, a Minneapolis neurologist who was one of his medical advisors. "I never, in my entire life, thought I would be thrown into such a national debate," said Michael. "All I wanted to do was carry out my wife's wishes. ... Terri didn't die an awful death. I laid a red rose in her hand and said goodbye." His address was met by a standing ovation from the more than 200 people in attendance (Lerner, 2005).

Writing from Singapore after hurricane Katrina, New York Times columnist Thomas Friedman, an expert on medical ethics and everything else, opines: "There is something troublingly self-indulgent and slothful about America today -- something that Katrina highlighted and that people who live in countries where the laws of gravity still apply really noticed. ... We let the families of the victims of 9/11 redesign our intelligence organizations, and our president and Congress held a midnight session about the health care of one woman, Terri Schiavo, while ignoring the health crisis of 40 million uninsured" (Friedman, 2005).

As befits the true Jacobin, Friedman self-righteously dismisses the rights of the individual in the name of compassion for the masses. More than two hundred years ago, Edmund Burke (1729-1797) -- alluding to Rousseau -- delivered this priceless satirical portrait of the modern "humanist"-collectivist. Wrote Burke:
Benevolence to the whole species, and want of feeling for every individual with whom the professors come in contact, form the character of the new philosophy. ... He melts with tenderness for those only who touch him by the remotest relation, and then, without one natural pang, casts away, as a sort offal and excrement, the spawn of his own disgustful amours, and sends his children to the hospital of foundlings.

The bear loves, licks, and forms her young; but bears are not philosophers. Vanity, however, finds its account in reversing the train of our natural feelings. Thousands admire the sentimental writer; the affectionate father is hardly known in his parish. ... As the relation between parents and children is the first among the elements of vulgar, natural morality, they erect statues to a wild, ferocious, low-minded, hard-hearted father, of fine general feelings -- a lover of his kind, but a hater of his kindred (Burke 1791 / 1961).

Vanity, indeed. In 1993, while ostensibly trying to keep his wife, Terri, alive, Michael Schiavo converts her engagement ring and wedding band into a ring for himself; in June 2005, after Terri is cremated and her ashes are buried, he defines the date of her death as February 25, 1990 and uses her gravestone as a placard for congratulating himself on his self-proclaimed moral fidelity to her; and now, while continuing to loudly disclaim interest in publicity, he lectures on medical ethics.

Michael Schiavo had a choice to relinquish the care of his half-dead wife to her parents, who were begging him to let them assume that role and could have avoided the ensuing publicity which he claims he abhorred. He refused to do so. Cui bono?

---

References

- Burke, E. (1791 / 1961). Letter to a Member of the National Assembly. In The Philosophy of Edmund Burke: A Selection from His Speeches and Writings. Edited with an Introduction by Louis I. Bredvold and Ralph G. Ross. Ann Arbor: University of Michigan Press, p. 249.
- Chesterton, G. K. (1935). Broadcast talk, 6-11-35. Quotations of G. K. Chesterton. Http://www.chesterton.org/discover/quotations.html
- Cushing, H. (1925). The Life of Sir William Osler. London: Oxford University Press, vol. 1, p. 669.
- Didion, J. (2005). The Case of Theresa Schiavo." New York Review of Books, Volume 52, Number 10, June 9.
Donne, J. (1646 / 1930). Biathanatos. New York: Facsimile Text Society.
- Faulkner, W. (1935). A Rose for Emily. Http://xroads.virginia.edu/~drbr/wf_rose.html
- Friedman, T. (2005). Singapore and Katrina. New York Times, September 14. http://www.nytimes.com/2005/09/14/opinion/14friedman.html?hp
- Hentoff, N. (2005). "he legacy of Terri Schiavo for the Nonreligious: The disabled sound the alarm. Free Inquiry. 25: 33-35 (August/September).
- Hooff, A. J., van. (1990). From Autothanasia to Suicide: Self-Killing in Classical Antiquity. London: Routledge, p. 51.
- Johnson, H. A. (1996). Osler recommends chloroform at sixty. The Pharos. 59: 24-26.
- More, T. (1516 / 1984). Utopia and Other Writings. New York: New American Library, p. 18.
- Lerner, M. (2005). Michael Schiavo speaks at local medical ethics conference. Minneapolis Star Tribune. February 24. Http://www.startribune.com/stories/
1556/5631487.html
- Osler, W. (1905 / 1943). The Fixed Period. In Osler, W., Aequanimitas: With Other Addresses to Medical Students, Nurses and Practitioners of Medicine, 3rd edition. Philadelphia: Blakiston, pp. 375-393.
- Schiavo, M. (2003). Quoted in http://www.sptimes.com/2003/webspecials03/schiavo/
- Schiavo, M. (2005a). Quoted in http://msnbc.msn.com/id/8299372/, June 21, 2005 (a).
- Schiavo, M (2005b). Quoted in Lerner, M., Michael Schiavo speaks at local medical ethics conference. Minneapolis Star Tribune, September 24. http://www.startribune.com/stories/1556/5631487.html
- Schiavo, M., (2005c). Quoted in Didion, J.. The Case of Theresa Schiavo. New York Review of Books, Volume 52, Number 10, June 9, 2005.
- Szasz, T. (1963 / 1989). Law, Liberty, and Psychiatry: An Inquiry Into the Social Uses of Mental Health Practices. Syracuse: Syracuse University Press, 1989, pp. 212-222.
- Szasz, T. (1999 / 2001). Fatal Freedom: The Ethics and Politics of Suicide. Syracuse: Syracuse University Press.
- Trollope, A. (1882 / 1993). The Fixed Period. London: Penguin.

---

"‘A Rose for Emily,' a rose for Terri: The lifeless body as love object and the case of
Theresa Marie Schindler Schiavo," Palliative and Supportive Care, 4: 159-167 (June), 2006.

"A Rose for Emily," a rose for Terri: The lifeless body as love object and the case of
Theresa Marie Schindler Schiavo

Thomas Szasz, M.D., Department of Psychiatry, Upstate Medical University, State University of New York, Syracuse, New York.
Mailing address: 4739 Limberlost Lane, Manlius, NY 13104. Tel. 315-637-8918. E-mail: tszasz@aol.com

Keynote Address, "Controversies in End of Life Care: Terri Schiavo's Lessons,"
Baystate Medical Center, Department of Psychiatry; Smith College School of Social Work; Baystate Health Systems, Office of Continuing Education. Smith College, Northampton, Massachusetts, October 10 and 11, 2005.

---

#8 FEAR AND FOLLY
Bertrand Russell, C. S. Lewis, and the Existential Identity Thief
Thomas Szasz

Falsehood flies and the truth comes limping after; so that when men come to be undeceived it is too late: the jest is over and the tale has had its effect.
Jonathan Swift (1667-1745)

One of the basic functions of living organisms is avoiding danger. In human beings, the emotion of fear serves that function. Because feeling fear is unpleasant, we try to escape it by seeking protection from danger, typically by looking to a Protector to protect us. Tragically, this longing -- be it for a deity, demagogue, dictator, or doctor -- is, itself, a source of danger. "Necessity," William Pitt (1759-1806) famously remarked, "is the plea for every infringement of human freedom.

It is the argument of tyrants; it is the creed of slaves." (Pitt was British Prime Minister, 1783-1801 and 1804-1806.) Fear of the insane and the psychiatrist's role as society's protector from the risk he allegedly poses is what has made the mere ascription of the label "insane" a justification for depriving the bearer of liberty.

Although the idea of "the dangerous madman" is a bugaboo or a tautology (because we redefine bad as mad, deviant as deranged), it has captivated the contemporary mind -- secular and religious alike -- and has entrapped some of the most admired modern intellectuals.

In A History of Western Philosophy, Bertrand Russell (1872-1970), the great atheist skeptic, tried to refute David Hume's sceptical empiricism and concluded that he was unequal to the task:

It is therefore important to discover whether there is any answer to Hume within the framework of a philosophy that is wholly or mainly empirical. If not, there is no intellectual difference between sanity and insanity. The lunatic who believes that he is a poached egg is to be condemned solely on the ground that he is in a minority, or rather -- since we must not assume democracy -- on the ground that the government does not agree with him. This is a desperate point of view, and it must be hoped that there is some way of escaping from it (Russell, 1945: 673).

Russell's "desperation" was inconsistent with his scepticism, expressed earlier in his Sceptical Essays, where he had stated: "I wish to propose
for the reader's favourable consideration a doctrine ... that it is undesirable to believe a proposition when there is no ground whatever for supposing it true" (Russell, 1928: 1). Russell was sceptical about religion, but not about psychiatry. Positing the existence of a lunatic who believes that he is a poached egg is a perfect example of believing "a proposition when there is no ground whatever for supposing it to be true."

Clive Staples Lewis (1898-1963), the celebrated Christian apologist, believed in religion but disbelieved in psychiatry. Nevertheless, in
his famous "trilemma," he too used the imaginary poached-egg man to support his reason for believing in the divinity of Jesus:

I am trying here to prevent anyone saying the really foolish thing that people often say about Him: "I'm ready to accept Jesus as a great moral
teacher, but I don't accept His claim to be God." That is the one thing we must not say. A man who was merely a man and said the sort of things Jesus said would not be a great moral teacher. He would be either a lunatic -- on a level with the man who says he is a poached egg -- or else he would be the Devil of Hell.

You must make your choice. Either this man was, and is, the Son of God: or else a madman or something worse. You can shut Him up for a fool, you can spit at Him and kill Him as a demon; or you can fall at His feet and call Him Lord and God. But let us not come with any patronising nonsense about His being a great human teacher. He has not left that open to us (Lewis, 1952: 40-41).

The model lunatic as a person who believes himself to be a poached egg evidently was fashionable among twentieth-century English academics, at least at Cambridge. Let us scrutinize this modern psychiatric miracle.

In a debate unrelated to matters psychiatric, Russell, the hard-headed empiricist, would emphasize that we have no way of knowing what a person believes himself to be. We can know only what he tells us about who or what he is and have no grounds for treating his claim as, a priori, true.

In ordinary English as well as in the idiom of psychiatry, we call a person's claim that he is a poached egg a "delusion." I have seen many
persons with so-called delusions and have read about many more, but have never seen or read of a poached-egg-man. In nineteenth-century European asylums, the most popular delusion was being Napoleon. In modern American mental hospitals, it is being Jesus. Whether or not the speaker believes his delusion to be true is irrelevant. The simplest, most parsimonious explanation for his speech act is that he is lying. In his Sceptical Essays, Russell himself suggested this interpretation. He wrote:

A man who has suffered some humiliation invents a theory that he is King of England, and develops all kinds of ingenious explanations of the fact that he is not treated with that respect which his exalted position demands. In this case, his delusion is one with which his neighbors do not sympathize, so they lock him up. But if, instead of asserting only his own greatness, he asserts the greatness of his nation or his class or his creed, he wins hosts of adherents, and becomes a political or religious leader (Russell, 1928: 1).

People often claim or pretend to be someone they are not. When a person does this on the stage, we call his behavior "acting." When he impersonates another for economic gain, defrauding others in the process, we call his behavior "identity theft." We treat him as a criminal, guilty of committing fraud, not as a lunatic harboring false beliefs. When, however, an individual impersonates say, Jesus, we refuse to see the self-evident method in his madness, the desire to gain existential rather economic advantage, and dismiss his conduct as "meaningless delusion."

I submit that we ought to view such behavior as a type of "existential identity theft," a phenomenon that presents no particular challenge to either philosophy or theology. Yet, Russell and Lewis both regarded the existential identity thief as presenting the grandest of philosophical and theological problems. Russell spoke of it "a desperate point of view, and it must be hoped that there is some way of escaping from it." There is, as I just showed. Lewis declared, "Either this man was, and is, the Son of God: or else a madman or something worse." There is an obvious third choice.

The man who says he is a poached egg is a liar, and that ought to be the end of the matter, for theology, philosophy, and psychiatry alike.
If we prefer to cast Lewis's riddle in softer terms, we might say that the man in Nazareth 2000 years ago who said he is the Son of God was a god-obsessed Jew, using a figurative language fashionable at the time, expressing and conveying a meaning to himself and others the exact signification of which we have no way of recapturing.

Much as I admire Lewis the man and his many memorable books, his assertion that -- "You can shut Him up for a fool, you can spit at Him and kill Him as a demon; or you can fall at His feet and call Him Lord and God. But let us not come with any patronising nonsense about His being a great human teacher. He has not left that open to us" -- is simplistic and foolish.

Lewis said that his aim was to show us why we ought to believe in the divinity of Jesus. Accepting his own postulate, he asserted that this hypothetical man-god had forbidden us to say "patronising nonsense" about him and that we must obey his prohibition. In short, Lewis treated his premise as proof of itself.

For the man who says he is Jesus, his identity thievery is an existential coup. For psychiatry, such as man -- Jesus or poached egg -- is an existential and economic gold mine. The fact that modern societies choose to value the products of this "salted mine" more highly than gold, indeed that they revere it as the science and practice of psychiatry, is another issue.

Finally, both Russell and Lewis compounded their mistaken reasoning about the nature of Existential Identity Theft by assuming that individuals or society need to sanction the Thief. Russell declared:
"The lunatic who believes that he is a poached egg is to be condemned solely on the ground that he is in a minority, ... etc."

Lewis agreed:
"You can shut Him [Jesus as liar] up for a fool... " These are non sequiturs. There is no need for individuals or society to condemn and punish the Existential Identity Thief. Severing relations with him suffices for our self-protection.

===============

Thomas Szasz, M.D., Professor of Psychiatry Emeritus, Upstate Medical
University, State University of New York, Syracuse, New York. Home address: 4739 Limberlost Lane, Manlius, NY 13104-1405. Tel.: 315-637-8918.
E-mail: TSZASZ@aol.com

***

I thank Professor Robert Spillane, Graduate School of Management, Macquarie University, Sydney, Australia, for calling my attention to this passage.

***

References
Lewis, C. S. (1952) Mere Christianity (New York: Macmillan).
Russell, B. (1928) Skeptical Essays (London: Allen & Unwin).
Russell, B. (1945) A History of Western Philosophy: And Its Connection with Political and Social Circumstances from the Earliest Times to the Present Day (New York: Simon and Schuster).

---

# 7
"A bogus Benjamin Rush quote:
contribution to the history of pharmacracy"

Benjamin Rush (1746–1813), the ‘father' of American psychiatry, is perhaps best known as the inventor of the ‘tranquilizing chair'. In recent decades, political and psychiatric activists have attributed a quotation to him in which he allegedly warned: ‘To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science.' The source of this quotation cannot be found, and Rush's remarks about ‘medical despotism' are inconsistent with the body of his work. Other examples are cited to illustrate the thesis that false attributions, used to support and advance particular ideological causes, are remarkably resistant to efforts at correction.
Keywords: Benjamin Rush; interest groups and their agenda; ‘medical freedom'; truth-falsehood

------------------------------------------------------

I

Benjamin Rush (1746–1813) was a Professor of Physic and Dean of the University of Pennsylvania medical school, physician general of the Continental Army, and a signatory to the Declaration of Independence. In 1812 he published Medical Inquiries and Observations upon the Diseases of the Mind, the first American textbook of psychiatry (Rush, 1812/1962). Appropriately, he is considered the father of American psychiatry: his portrait adorns the official seal of the American Psychiatric Association.

It is the fate of such men that activists and writers with an axe to grind often falsely attribute statements to them in their quest to bolster their own arguments. Such misattributions readily assume a life of their own, in accord with the psychological law discovered by Mark Twain. He wrote (Twain, 1882):
[The …] maxim that ‘Truth is mighty and will prevail' [is] the most majestic compound fracture of fact which any of woman born has yet achieved. For the history of our race, and each individual's experience, are sewn thick with evidences that a truth is not hard to kill, and that a lie well told is immortal. [...] How easy it is to make people believe a lie, and how hard it is to undo that work again!'

Examples abound. One of the most successful fabrications is H. L. Mencken's hilarious hoax about the history of the introduction of the bathtub into the United States. Written during the war-time Prohibition of 1917, the piece ostensibly memorialized the fictitious seventy-fifth anniversary of this momentous event. Fifty years later, Mencken (1917/1967: 592) commented:
The success of this idle hoax, done in time of war, when more serious writing was impossible, vastly astonished me. It was taken gravely by a great many other newspapers, and presently made its way into medical literature and into standard reference books. It had, of course, no truth in it whatsoever, and I more than once confessed publicly that it was only a jocosity [...] Moreover, it was exposed and denounced by various other men, for example, Vilhjalmur Stefansson, the arctic explorer (and great connoisseur of human credulity) [...] But it went on prospering and in fact is still prospering. Scarcely a month goes by that I do not find the substance of it reprinted, not as foolishness but as fact, and not only in newspapers but in official documents and other works of the highest pretensions.

The following bogus quotation attributed to Benjamin Rush is a recent example of foolishness masquerading as fact and mistaken for it. This is, we are told, what Rush said about the relations between medicine and the state:

Unless we put medical freedoms into the Constitution, the time will come when medicine will organize into an undercover dictatorship [...] To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un?American and despotic and have no place in a republic [...] The Constitution of this republic should make special privilege for medical freedom as well as religious freedom. (Grinspoon; 2003: 63; Lord,2 1994)

This bogus quotation – without a scintilla of evidence to support it, and with a plethora of evidence against it – has become a ‘fact.' A search of the World Wide Web (Internet) with the search engine Google reveals dozens of entries to it. But not a single author supplies a verifiable source for it. Hence, I believe this false attribution, depicting Rush as a medical libertarian, needs to be exposed as bogus.

It is important to remember that this is not the first time ‘humanitarian' hagiographers of psychiatry have repainted ugliness as beauty. Famed psychoanalyst and historian of psychiatry Gregory Zilboorg recast Johannes Weyer (1515–88) from medieval demonologist into a proto-psychiatrist who allegedly ‘recognized' that witches were ‘mentally ill.' According to Zilboorg (1941: 216), ‘He [Weyer] leaves no doubt but that one conclusion is warranted: the witches are mentally sick people'. With similar disregard for the truth, psychiatrists have created the legend of Philip Pinel (1745–1826) as a ‘reformer' who ‘struck the chains off the insane.' In fact, what Pinel had done is to medicalize the justification for incarcerating innocent persons in insane asylums (Szasz, 1970/1997: 203–4).

II

In my book, The Manufacture of Madness, I presented a review of Rush's psychiatric principles and practices and showed that he was a zealous advocate of the medicalization of personal and social problems and their coercive control by means of ‘therapeutic' sanctions. In short, he was a pioneer champion of pharmacracy and the therapeutic state (Szasz, 1970/1997, 2001/2003). Anyone familiar with the history of psychiatry ought to recognize that the quotation in question is a fabrication.
In Rush's day, psychiatry was a newborn infant. Most mad?house keepers were still clergymen, not physicians. Madness, as the term continues to imply, was associated with anger, lack of self?control, murder and suicide (‘self?murder'), in short, with behaviour regarded as sinful (Szasz, 1999/2002: 1–28). In 1774, when Rush was only twenty?eight?years old, he revealingly declared: ‘Perhaps hereafter it may be as much the business of a physician as it is now of a divine to reclaim mankind from vice' (Rush, 1774/1967).

To distinguish himself from the doctor of divinity, the doctor of medicine could not simply claim that he was protecting people from sin or, as Rush put it, from vice.
Badness was still, after all, a moral concept. As medical scientist, the physician had to represent badness as madness, and madness as a bona fide medical malady. He had to demonstrate, by his language and actions, that his object of study was not the immaterial soul, but a material object, a bodily disease. That is precisely what Rush did. In a letter to his friend, John Adams, he wrote: ‘The subjects [mental diseases] have hitherto been enveloped in mystery. I have endeavored to bring them down to the level of all other diseases of the human body, and to show that the mind and the body are moved by the same causes and subject to the same laws' (quoted in Binger, 1966: 281).

Rush did not discover that certain behaviours are diseases, he decreed that they are: ‘Lying is a corporeal disease. / Suicide is madness. / Chagrin, shame, fear, terror, anger, unfit for legal acts, are transient madness' (Rush, 1810/1948: 350). Today, some of these and many other unwanted human behaviours are widely accepted as real diseases, their existence ostensibly supported by the modern science of neurobiology.
In addition to deploying the idea of insanity to rationalize the widespread use of ‘therapeutic' coercion, Rush (1812/1962: 263–70) also championed the insanity defence. He defined crimes as ‘derangements of the will,' explaining: ‘I have selected those two symptoms [murder and theft] of this disease (for they are not vices) from its other morbid effects, in order to rescue persons affected with them from the arm of the law, and render them the subjects of the kind and lenient hand of medicine' (Rush, 1810/1948: 264).

For example, Lester Grinspoon – a Professor of Psychiatry at Harvard and a prominent advocate of so-called ‘medical marijuana' – believes, and would have us believe – that Rush stated: ‘To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science' (Grinspoon, 2003: 63). In fact, Rush is on record stating the exact opposite.

Among the many mental illnesses Rush invented was the disease he named ‘derangement in the principle of faith or the believing faculty'. Instead of defining this ailment, he illustrated it with examples of two types of ‘patients': ‘[P]ersons who deny their belief in the utility of medicine, as practiced by regular bred [trained] physicians, believing implicitly in quacks; [and] persons who refuse to admit human testimony in favor of the truths of the Christian religion' (Rush, 1812/1962: 273–4).

As noted, Rush defined his own ‘medical' methods as ‘kindly.' In fact, his ‘treatments' consisted of inflicting pain on the patient and depriving him of liberty. The following passage illustrates his mind-set: ‘Lying, as a vice, is said to be incurable. The same thing may be said of it as a disease [...] Its only remedy is, bodily pain, inflicted by the rod, or confinement, or abstinence from food' (Rush, 1812/1962: 265–6). For good measure, he added: ‘Terror acts powerfully upon the body, through the medium of the mind, and should be employed in the cure of madness' (p. 211). Rush went so far as to invent a new ‘therapeutic' device – actually, an instrument of terror and torture – which he presciently called the ‘tranquilizing chair.' It was but a short ideological step from the tranquilizing chair to the tranquilizing drug, each ‘administered' against the will of the patient.

In his persona, Rush displayed all of the manifestations of psychiatric megalomania that characterize modern psychiatric thought and practice (Binger, 1966: 200). Not only did he oppose the kind of ‘medical freedoms' the bogus quote attributes to him, he ‘diagnosed' the ‘excess of the passion for liberty' as a form of mental illness. Lamenting this passion, ‘inflamed by the successful issue of the [Revolutionary] war', he explained: ‘The extensive influence which these opinions had upon the understandings, passions, and morals of many of the citizens of the United States, constituted a form of insanity, which I shall take the liberty of distinguishing by the name of anarchia' (quoted in Boorstin, 1948: 182). Disappointed with his political efforts, he declared: ‘Were we to live our lives over again and engage in the same benevolent enterprise, our means should not be reasoning but bleeding, purging, low diet, and the tranquilizing chair' (Rush, 1951: letter dated xxxx, in Butterfield, 1951: 1092).

To ascertain further the fabricated provenance of the quotation that is the subject of this essay, I sought the help of the Library of Congress. On 17 October 2003, I received the following reply, which requires no further comment.

Subj: Benjamin Rush quotation
Date: 10/17/03 3:40:42 PM Eastern Daylight Time
From: HSSref@loc.gov
To: tszasz@aol.com

Dear Dr. Szasz:
This is in reply to your letter of September 24, addressed to the Reference Referral Service, Library of Congress. We have not found the quotation, attributed to Benjamin Rush, which you are seeking. Your suspicion that it is bogus is supported by a look at some of its words in the Oxford English Dictionary. The Dictionary records no use of ‘un?American' until a few years after Rush's death. ‘Under?cover' as an adjective meaning ‘operating in secret' does not appear until 1920.

III

Rush's stature in the history of American medicine alone justifies calling attention to the bogus nature of the quotation in question. It is further justified by the fact that many of the persons who cite it are academics, politicians and psychiatrists who ought to know better. The following list is merely a sampling of the individuals and organizations who make use of this bogus quote.

The American Association for Health Freedom and the Access To Medical Treatment Act (AMTA)
We strongly support the American Association for Health Freedom (web site www.apma.net) in their effort to pass the Access To Medical Treatment Act. This is a Federal bill that has been introduced in the House by Representatives Peter DeFazio, Joe Barton, and Ron Paul [...] As things stand now, those who hold one view of health care expect to be allowed to decide what constitutes legal methods of healing. It is just this kind of despotism that our Founding Fathers intended to prevent. Benjamin Rush, MD, a signer of the Declaration of Independence and personal physician to George Washington said: ‘Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship to restrict the art of healing to one class of men and deny equal privileges to others; the Constitution of the Republic should make a special privilege for medical freedoms as well as religious freedom' (American Association for Health Freedom, 2003).
Congressman Ron Paul is trained as a physician. He also supports legislation for ‘medical marijuana' and physician-assisted suicide. The reference to Washington is lamentably shameless. Bloodletting – Rush's panacea – has often, probably rightly, been blamed for Washington's premature death from what may have the flu.
***
[...] So many massage therapists with so many kinds of training have massaged so many people with so many contraindications so many times for so many years with so many benefits reported in so many publications, but with so few, if any, well?documented cases of harm. [...] Dr. Benjamin Rush, one of the Signers of the Declaration of Independence and Surgeon General of the Continental Army of the United States, believed: ‘The Constitution of the Republic should make special provision for Medical Freedom as well as Religious Freedom. To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un?American and despotic. They are fragments of monarchy and have no place in a republic'. (Schatz and Brewster, 1999)
***
Demand Healthcare Freedom [...] Read the reports on our links and proposed Health Care Freedom Bill with an open mind. [...] ‘Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an underground dictatorship [...] To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un?American and despotic and have no place in a republic [...] The Constitution of this republic should make special privilege for medical freedom as well as religious freedom.' Dr Benjamin Rush, signer of the Declaration of Independence. (Citizens for Health Care Freedom, 2003)
***
‘The Constitution of this republic should make special provisions for medical freedom as well as religious freedom. To restrict the art of healing to one class of man and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un?American and despotic.' Benjamin Rush, M.D., Leading Allopath During the Founding of America. (OKHealthfreedom, 2001)
***
Thomas Jefferson and Dr. Benjamin Rush (who was George Washington's personal physician and a signer of the Declaration of Independence) both foresaw that the federal government might someday attempt to control medicine. Dr. Rush gave this diagnosis: ‘Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an underground dictatorship [...] To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un?American and despotic and have no place in a republic [...] The Constitution of this republic should make special privilege for medical freedom as well as religious freedom'. (Un Sacco di Canapa, n.d.)
***
Our Mission is the advancement of Hyperbaric Oxygen Therapy used in traditional circumstances as well as the prevention and enhancement aspects of your health. [...] ‘Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship […] To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un?American and despotic and have no place in a republic […] The Constitution of this republic should make special privilege for medical freedom as well as religious freedom.' Benjamin Rush, M.D., Signer of Declaration of Independence, Physician to President George Washington (Rapid Recovery Hyperbarics, 2003).
***
A World Without Cancer
[...] In order to abolish the FDA, or at least to restrict its operation, we will need either legislation or a constitutional amendment. We should pursue both. The possibility of a constitutional revision is not as extreme as it may sound. In fact, Dr. Benjamin Rush of Philadelphia – one of the signers of the Declaration of Independence, a member of the Continental Congress, Surgeon?General of Washington's armies, and probably the foremost American physician of his day – had urged his colleagues to include ‘medical liberty' in the First Amendment at the time it was drafted. He wrote: ‘Unless we put medical freedom into the Constitution, [...]'. As quoted by Dr Dean Burk in The Cancer News Journal, May/June, 1973: 4. (Griffin, 2003)1.
The reference is bogus as well. This author embellishes the quote by claiming that Rush had ‘urged his colleagues to include "medical liberty" in the First Amendment at the time it was drafted' (Griffin, 2003).

IV

The use by various ‘therapeutic' interest groups of the bogus quotation by Rush illustrates that falsehood can serve expediency, but it cannot serve liberty. The advocacy of so-called ‘medical marijuana' – in plain English, marijuana by medical prescription – is a dramatic case in point. It is a bad cause, argued with bad evidence and in bad faith.

For my part, I have long agreed with Gilbert K. Chesterton, the celebrated Christian humanist-humorist-philosopher, who stated: ‘The free man owns himself. He can damage himself with either eating or drinking; he can ruin himself with gambling. If he does he is certainly a damn fool, and he might possibly be a damned soul; but if he may not, he is not a free man any more than a dog' (Chesterton, 1909: 32). Either we have the right to poison and kill ourselves with food, alcohol and drugs, or we do not. For nearly half a century I have opposed drug prohibition, the growing power of the therapeutic state, and mistaken efforts of ‘reformers' to deal with drug prohibition by multiplying instead of repealing regulations that treat drug use as a crime (and mental illness).

In one of his recent essays, Lester Grinspoon reprises the medicinal value, as defined by the consumers, of smoking marijuana, and the objections of the government against permitting physicians to dispense it by prescription. His argument is paternalistic both in content and tone. He laments that we are not moving towards a ‘regulatory system that would allow responsible use of marijuana' (Grinspoon, 2003: 81). No totalitarian authority objects to the ‘responsible use' of the press, sex, alcohol or anything else. In Grinspoon's scheme, who – if not agents of the government – would have the authority to define ‘responsible use'? Grinspoon not only begins his essay with a strategic misattribution to Rush, he also ends it by repeating Rush's non-existing opposition to ‘medical fascism' – precisely the type of pharmacracy Rush supported and Grinspoon (2003: 81) now supports:

If the cynical attitude of the federal government toward patients who use medical marijuana, its attempt to intimidate physicians [the intimidation is a fact, not an attempt] [...] lends credence to Benjamin Rush's concern about medical fascism, then the patients and the people who help them in a variety of ways constitute a resistance movement against medical dictatorship.

This is not a plea for medical liberty. It is the self-congratulation of one medical statist seeking to replace the authority and power of his opponent, defining his coercive regulations ‘to responsibly use this plant' as helpful, and those of his opponent to do the same thing as harmful (Szasz, 2003; also Szasz, 1992/1996).

The facts, let me repeat, contradict the contents of Rush's bogus quote and refute the arguments and claims of those who use them. Rush was, quite literally, a prohibitionist. In a letter to Jeremy Belknap (1744–98), a Congregational minister and amateur American historian in Boston, Rush wrote: ‘In the year 1915, a drunkard I hope will be as infamous in society as a liar or thief, and the use of spirits as uncommon in families as a drink made of a solution of arsenic or a decoction of hemlock' (quoted in Binger, 996: 201).

Sadly, the individuals and organizations who make use of the bogus Rush quote have no interest in separating medicine and the state. If they had such an interest, they could use a genuine quote to support their cause – not by Rush but by Jefferson, who, not by coincidence, considered Rush to be a quack and a medical menace (mainly on account of his enthusiasm for bloodletting). Alluding to the crucial importance of bodily self-ownership as a political issue, Jefferson (1781/1944: 275) mocked would-be statist meddlers into our diets and drugs by reminding his readers that ‘in France the emetic was once forbidden as a medicine, the potato as an article of food. [...] Was the government to prescribe to us our medicine and diet, our bodies would be in such keeping as our souls are now'.

---

History of Psychiatry (UK), 16: 89-98 (March), 2005.
THOMAS SZASZ*
State University of New York

Notes
1. For additional web sites citing the quote, see:
http://www.drbrodie.com/beliefs.shtml; http://www.quackcenter.com/questiondoc.html
Quotes http://www.city?net.com/~davekle/newqt.html
David Wallace Croft Compilation. http://www.alumni.caltech.edu/~croft/quotes.txt. Copyright released to the Public Domain by the author, 2003?03?19.
2. Dr Nancy Lord Johnson is both a lawyer and physician. In 1992, she was the vice presidential candidate of the Libertarian Party.
References
The American Association for Health Freedom (2003) TITLE?? [PO Box 458, Great Falls, VA 22066, USA]. Retrieved from www.apma.net; http://www.citizenshealth.org/amta.htm
Binger, C. (1966) Revolutionary Doctor: Benjamin Rush, 1746–1813 (New York: Norton).
Chesterton, G. K. (1909) Orthodoxy (London: John Lane).
Citizens for Health Care Freedom (2003) Philosophy of Health Freedom [PO Box 62282, Durham, NC, 2771–2282, USA]. Retrieved from CHF@nc.rr.com;http://www. citizensforhealthcarefreedom.org/vision.html
Griffin, G. E. (2003) A World without Cancer [Worldwithoutcancer.org.uk, PO Box 2038, Leigh?on?Sea, SS9 2ZB, UK]. Retrieved from http://www.worldwithoutcancer.org.uk/aworldwithoutcancer.html
Grinspoon, L. (2003) The medical marijuana problem. Journal of Cognitive Liberties, 4, 63–81.
Jefferson, T. (1781/1944) Notes on the State of Virginia [1781]. In A. Koch and W. Peden (eds) (1944), The Life and Selected Writings of Thomas Jefferson (New York: Modern Library).
Lord, N. (1994). Excerpts from closing argument in the trial of Alternative Health Care Provider Rodger Sless versus The United States Food And Drug Administration, Albuquerque, NM, USA. Retrieved from http://gos.sbc.edu/l/lord.html
Mencken, H. L. (1917/1967) A neglected hoax [1917]. In Mencken, H. L. (ed.) (1967), A Mencken Chrestomathy (New York: Knopf).
OKHealthfreedom (2003). Religious and cultural issues impede attempts to license natural healing arts in Oklahoma. 2001. Retrieved from http://okhealthfreedom.homestead.
com/files/page17.html
Rapid Recovery Hyperbarics (2003) TITLE. Retrieved from http://www.hbot4u.com/introduction.html
Rush, B. (1774/1967) Letter to Granville Sharp (1774). Quoted by J. A. Woods (1967) The correspondence of Benjamin Rush and Granville Sharp, 1773–1809. Journal of American Studies, 1, 8.
Rush, B. (1810/1948). Lectures on the medical jurisprudence of the mind (1810). In G. W. Corner (ed.) (1948), The Autobiography of Benjamin Rush: His ‘Travels through life' together with his ‘Commonplace book for 1789–1812' (Princeton: Princeton University Press).
Rush, B. (1812/1962) Medical Inquiries and Observations upon the Diseases of the Mind (Reprinted 1962, New York: Macmillan – Hafner Press).
Rush, B. (1951) TITLE. In L. H. Butterfield (ed.), Letters of Benjamin Rush (Princeton: Princeton University Press).
Schatz, A. and Brewster, M. (1999) A declaration of independence for massage therapists. Massage Law Newsletter, 7 (4), PAGES. Electronic version, retrieved from http://www.healingandlaw.com/
Massage_Law_Newsletter/MLN_Vol.7/MLN_Vol.7.No.4/mln_vol.7.no.4.html
Szasz, T. (1970/1997) The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement (Syracuse, NY: Syracuse University Press).
Szasz, T. (1992/1996) Our Right to Drugs: The Case for a Free Market (Syracuse, NY: Syracuse University Press).
Szasz, T. (1999/2002) Fatal Freedom: The Ethics and Politics of Suicide (Syracuse, NY: Syracuse University Press).
Szasz, T. (2001/2003) Pharmacracy: Medicine and Politics in America (Syracuse, NY: Syracuse University Press).
Szasz, T. (2003) Marijuana medicalization: bad cause, bad faith. Journal of Cognitive Liberties, 4: 83–5.
Twain, M. (1882) Advice to youth. Retrieved from http://www.twainquotes.com/lies.html
Un Sacco di Canapa (date). TITLE. Retrieved from http://www.unsaccodicanapa.com/htmlpages/jdi.html
Zilboorg, G. (1941) A History of Medical Psychology (New York: Norton).

© 2005 Thomas Szasz

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# 6
"Idiots, infants, and the insane":
mental illness and legal incompetence

Prior to the second world war, most persons confined in insane asylums were regarded as legally incompetent and had guardians appointed for them. Today, most persons confined in mental hospitals (or treated involuntarily, committed to outpatient treatment) are, in law, competent; nevertheless, in fact, they are treated as if they were incompetent. Should the goal of mental health policy be providing better psychiatric services to more and more people, or the reduction and ultimate elimination of the number of persons in the population treated as mentally ill?

# 1
The psychiatric protection order
for the "battered mental patient"

Thomas Szasz (tszasz@aol.com) was professor of psychiatry emeritus at SUNY Upstate Medical University in Syracuse. His latest books, both from Syracuse University Press, are The Medicalization of Everyday Life: Selected Essays and Psychiatry: The Science of Lies.

Dr. Szasz latest book: Antipsychiatry: Quackery Squared (Syracuse University Press) 2 Reviews at amazon.com

The 50th anniversary edition of the epochal book by Thomas Szasz "The Myth of Mental Illness" is launched in February 2010. Read the new foreword by Thomas Szasz here.