Radical psychiatrist tilted at windmills

PSYCHIATRIST

15-4-1920 8-9-2012

DR THOMAS Szasz, the New York psychiatrist whose Don Quixote-like attacks on the psychiatric profession in the 1960s and '70s led him to a position of prominence and influence before his radical ideas fell into disrepute and he faded into obscurity, has died at his home in New York following complications from a fall. He was 92.

He came to prominence with his 1961 book, The Myth of Mental Illness, in which he argued that mental illness was not a disease but simply "problems in living". In that and a series of later tomes, he argued against using drugs to treat mental disorders, using insanity as a defence against criminal acts and committing people to mental institutions against their will. He called the latter act "a crime against humanity".

Szasz published his critique at a particularly vulnerable moment for psychiatry. With Freudian theorising just beginning to fall out of favour, the field was trying to become more medically oriented and empirically based. Fresh from Freudian training himself, Szasz saw psychiatry's medical foundation as shaky at best.

In 1992, he boldly stated: "I am probably the only psychiatrist in the world whose hands are clean. I have never committed anyone. I have never given electric shock. I have never, ever given drugs to a mental patient."

Perhaps his most controversial act was allying himself with the Church of Scientology to found the Citizens Commission on Human Rights, a group that sharply opposed psychiatry and its methods of treatment. Although Szasz was not a Scientologist, his co-operation lent a veneer of credibility to an organisation inspired not by science but by a science-fiction writer, according to his critics.

He later distanced himself from the church, but his association with the commission and his other views led New York mental health authorities to block him from teaching at a state hospital where residents with the State University of New York trained.

The crusader emerged at a time when many critics were questioning some tenets of psychiatry, particularly such actions as diagnosing women as "hysterical" when they refused to bow to the dominance of men or claiming that homosexuality was a mental illness. Some critics even agreed that too many "mentally ill" people were being locked away without proper justification.

But Szasz, in effect, threw the baby out with the bathwater, arguing that the vast majority of psychiatric diagnoses were ill-conceived and scientifically baseless.

To those sceptical of modern psychiatry, he was a foundational figure.

"We did not agree on everything, like his view that there is no such thing as mental illness," said Vera Hassner Sharav, president and founder of the Alliance for Human Research Protection, a patient advocacy group, and a long-time critic of the field. "But his message that people get designated as ill, labelled and then shafted out of society and preyed on by an industry dominated by drugs that's where he was very valuable."

Dr Robert Daly, a psychiatrist at SUNY Upstate Medical Centre, said Szasz was responsible for introducing new ideas. "The discussion of the use of coercion and forced treatment and all that, I think he had a real impact on the discussion of those matters within the profession and within the law itself," he said. "He helped sensitise everybody to what, in fact, they were doing."

In a 2006 profile in The New Atlantis, Szasz almost conceded that he had been tilting at windmills. "I really don't think I am falsifying it when I say I never had much hope of having an impact on psychiatry. I viewed psychiatry all along as more like the Catholic Church. What impact did Voltaire make on it? If you think about what happened since then, nothing! No, I didn't expect to make any difference."

Szasz was widely sought after as a speaker and presented with dozens of national and international awards. Until the end of his life he continued to discuss psychotherapy, the practice he was trained to perform and of which he became so sceptical.

"The goal is to assume more responsibility and therefore gain more liberty and more control over one's own life," he said of talk therapy in an interview in 2000. "The issues or questions for the patient become to what extent is he willing to recognise his evasions of responsibility, often expressed as 'symptoms'."

Szasz was born in Budapest, Hungary. After his family immigrated to the United States in 1938, he received a bachelor's degree in physics from the Cincinnati University in 1941. When he earned a medical degree there, he was valedictorian of his class in 1944.

He studied psychoanalysis at Chicago University and, except for two years in the Naval Reserve, worked at the university before joining in 1955 what is now SUNY Upstate. He remained on the faculty until he retired in 1990 but continued writing and researching until his death.

Two years after his retirement, he was sued for malpractice by the widow of a man who committed suicide six months after Szasz told him to stop taking lithium for his depression. The case was settled out of court, and Szasz eventually gave up private practice.

Szasz published 35 books and hundreds of articles during his career that spanned more than 50 years.

His wife, Rosine, died in 1971. He is survived by two daughters, a grandson, and a brother.