Thomas Szasz (1920–2012) was a Hungarian-American psychiatrist who argued, most famously in The Myth of Mental Illness (1961), that psychiatric diagnoses are not genuine medical diseases because they lack the tissue damage that defines physical pathology. For Szasz, calling emotional suffering or unconventional behavior a “mental illness” was not a scientific discovery but a rhetorical move — a way of using medical authority to enforce social norms. His critique was inseparable from a civil-libertarian politics: he spent fifty years arguing that involuntary psychiatric commitment is an act of oppression, not treatment, and that psychiatry functions as a hidden arm of the state.
Intellectual Formation
Szasz was born in Budapest in 1920 and trained as a physician and psychoanalyst before settling in the United States, where he became professor of psychiatry at the State University of New York Upstate Medical University — a post he held for most of his career. His formation was classical Freudian: he was analyzed and supervised in the standard psychoanalytic tradition. But Szasz turned psychoanalytic ideas against the medical model of psychiatry itself. Where Freud had retained the disease metaphor while building a psychological account of suffering, Szasz argued the metaphor was the source of the problem.
The intellectual context of The Myth of Mental Illness was a psychiatry that had recently declared itself a biological science. The 1950s had seen the introduction of chlorpromazine and imipramine, and the profession’s self-understanding was shifting toward the claim that mental disorders were brain diseases amenable to drug correction. Szasz found this claim philosophically confused and politically dangerous in equal measure.
The Myth of Mental Illness
The central argument of The Myth of Mental Illness is that disease, properly understood, is a lesion or pathological process in the body identifiable by objective physical criteria.(Unknown, unknown) Szasz argued that behaviors and experiences psychiatry calls mental illness involve no demonstrated tissue pathology.(Unknown, unknown) He consequently maintained that ‘mental diseases’ are a myth and that mental illness is a prescriptive concept masquerading as a descriptive one.(Unknown, unknown)
Szasz framed his project as an effort “at demolishing the major false substantives of contemporary psychiatric thought” — entities like “illness,” “neurosis,” and “treatment” — and replacing them with a process-oriented theory of personal conduct.(Szasz, Thomas, 1960) What psychiatrists actually do, he observed, is “communicate with other persons (often called ‘patients’) by means of language, nonverbal signs, and rules,” but they describe this work in the language of physiology and biology: “sick patients” and “treatments,” “instincts” and “endocrine functions,” “libido” and “psychic energies.” All this, Szasz wrote, “is fakery and pretense whose purpose is to ‘medicalize’ certain aspects of the study and control of human behavior.”(Szasz, Thomas, 1960)
What psychiatry calls mental illness, Szasz proposed, are better understood as “problems in living” — difficulties in navigating social roles, relationships, and the pressures of modern life.(Unknown, unknown) He called for a “rapprochement between psychiatry on the one hand, and ethics and philosophy on the other,” noting that until the late nineteenth century psychology had been allied with moral philosophy, not natural science, and that “psychologists and psychiatrists deal with moral problems which, I believe, they cannot solve by medical methods.”(Szasz, Thomas, 1960)
This was not an argument that people do not suffer. Szasz was explicit that the suffering addressed by psychiatry is real. His claim was that the medical framing of that suffering does epistemic and political harm: it naturalizes what are really moral and political judgments, and it licenses coercive intervention in the name of treatment.
Szasz chose hysteria as his central case study because it “captured the attention of the pioneer neuropsychiatrists Charcot, Janet, and Freud, and paved the way to the differentiation between neurology and psychiatry.” More fundamentally, hysteria forced a confrontation with “the task of distinguishing ‘real’ or genuine illness from ‘imaginary’ or faked illness. This distinction — between fact and facsimile, object and sign, physics and psychology, medicine and morals — remains the core problem of contemporary psychiatric epistemology.”(Szasz, Thomas, 1960) His reframing was radical: hysteria was “a form of nonverbal communication, making use of a special set of signs,” “a system of rule-following behavior, making use of the rules of illness, helplessness, and coercion,” and “an interpersonal game characterized by, among other things, strategies of deceit to achieve the goal of domination and control.”(Szasz, Thomas, 1960)
The dehumanizing dimension of this diagnostic history was not lost on Szasz. Freud’s 1893 obituary of Charcot compared him to Cuvier (the great taxonomist of animal life) and to the biblical Adam naming the creatures of Paradise, a comparison Szasz read as an inadvertent self-indictment: “To Charcot and Freud, these patients are mere objects or things to be classified and manipulated. It is an utterly dehumanized view of the sick person.”(Szasz, Thomas, 1960) The historical record of how Charcot’s successors responded to “counterfeit illness” was equally instructive. Szasz identified three distinct physician postures: punishment (treating the hysterical patient as a malingerer and deceiver), refusal to treat, and what Charcot and Freud actually chose: rewriting the rules of medicine itself. “This is what Charcot began and Freud perfected. Under the new rules … persons disabled by phenomena that resembled bodily diseases — in particular so-called hysterics — were also classified as ill — that is, ‘mentally ill.’”(Szasz, Thomas, 1960) The category of mental illness was not discovered; it was legislated into being by a change in the rules of the diagnostic game.
Szasz and Social Control
The most politically charged dimension of Szasz’s work was his account of psychiatry as an instrument of social control. Here he drew on a long historical record. In the nineteenth century, Samuel Cartwright had diagnosed enslaved Africans who fled bondage with “drapetomania” — the disease of running away — as if resistance to slavery were a symptom requiring cure.(James Aho, Kevin Aho, 2009) Benjamin Rush, the father of American psychiatry, had classified “negritude” (dark skin pigmentation) as a variety of leprosy and “anarchia” (excessive passion for liberty) as a distinct disorder requiring medical management.(James Aho, Kevin Aho, 2009) In the Soviet Union, political dissidents were diagnosed with “sluggish schizophrenia” and committed to psychiatric hospitals as a substitute for criminal prosecution.(Stegenga, 2018)
Thomas Szasz suggests that Anna O was essentially an oppressed, unpaid sick-nurse, coerced into the role by her father’s helplessness and her own relationship to him, and that the progression of her symptoms after her relief from caregiving duties was a somatization of guilt over her father’s illness.(James Aho, Kevin Aho, 2009)
Szasz extended this analysis to contemporary welfare-state institutions as well as to overtly authoritarian ones. He drew an explicit structural parallel between Soviet medicine and American social work, arguing that both are “fundamentally, systems of social care and control” that meet genuine personal needs while simultaneously serving as instruments for “gently keeping ‘in line’ the discontented and dissenting members or groups of society.”(Szasz, Thomas, 1960) This was not a counsel of nihilism: Szasz acknowledged that people need care. His point was that care delivered through institutions with dual loyalties (to both patient and state) cannot be fully distinguished from coercion.
Dowbiggin’s historical analysis independently confirms that an analogous antipsychiatric critique emerged in France in the 1860s, when a coalition of liberal and clerical critics attacked the 1838 asylum law on grounds that alienists were arbitrarily imprisoning citizens as political opponents.(Ian Dowbiggin, 1991) Szasz’s twentieth-century argument had nineteenth-century precedents. Dowbiggin’s formulation — that both the 1860s French movement and the 1960s Szasz/Laing/Goffman movement shared a “psychodynamic” emphasis on the psychological rather than somatic nature of madness, and both involved clerical interests — points to a recurring structure in anti-psychiatric critique that is not reducible to any single intellectual genealogy.(Ian Dowbiggin, 1991)
The 1961 Conjuncture
In 1961, the same year The Myth of Mental Illness appeared, the sociologist Erving Goffman published Asylums, a detailed empirical study of mental hospital life arguing that the institution itself manufactured and perpetuated the “mental illness” it claimed to treat.(Andrew Scull, 2015) Scull notes that the two publications constituted the most influential simultaneous critique of psychiatry of the twentieth century.(Andrew Scull, 2015) Goffman attacked the institution; Szasz attacked the diagnosis.(Andrew Scull, 2015)
Scull’s own assessment is unsparing: he regards Szasz’s position — that mental illness is a myth, a matter of social construction and labels — as “romantic nonsense, or a useless tautology,” correctly noting that massive and lasting disturbances of reason, intellect, and emotion are a phenomenon found in all known societies that pose profound challenges regardless of how they are classified.(Andrew Scull, 2015) This is the strongest version of the mainstream objection to Szasz. But it partly misses his target: Szasz did not deny that people suffer profoundly or behave in disturbing ways; he denied that this suffering constitutes a disease in the medical sense and objected to the state power that the disease label licenses.
Schizophrenia as Sacred Symbol
Szasz’s 1976 book Schizophrenia: The Sacred Symbol of Psychiatry sharpened the political argument. Schizophrenia, he contended, was the diagnostic pivot on which psychiatric authority rested — the category that most fully justified involuntary hospitalization and compulsory treatment. Without schizophrenia as a clearly defined entity, the medical legitimacy of compulsory psychiatry would become difficult to sustain.(German E. Berrios & Roy Porter (eds.), 1995) This argument connected his philosophical critique of disease concepts to his civil-libertarian objections to involuntary treatment: the two positions were not separable.
The critique was contested on several grounds. Phenomenologists working in Szasz’s era and after argued that his position committed precisely the Cartesian mind-body split he accused others of maintaining: by insisting that real diseases must involve tissue damage while mental illness involves only problems of living, he preserved a sharp line between body and mind that phenomenological medicine had been trying to dissolve.(James Aho, Kevin Aho, 2009) The philosophical objection is well-taken. Szasz’s account of disease is narrowly somatic in a way that most philosophy of medicine would not endorse, and it struggles to accommodate conditions like epilepsy, migraine, and chronic fatigue syndrome, which have organic substrates but are experienced primarily as disruptions of mental life.
Philosophical Position
The Stanford Encyclopedia of Philosophy situates Szasz within the normativist tradition in philosophy of medicine: the view that disease concepts are not value-neutral biological descriptions but require normative judgments about what counts as harmful deviation.(Unknown, unknown) This places him alongside Tristram Engelhardt, H.L. Sedgwick, and others who challenged Christopher Boorse’s influential naturalist account. His position is more radical than most normativists: where many normativists argue that values are embedded in disease concepts alongside biological facts, Szasz argued that what psychiatry calls mental illness involves no biological facts at all — only values.
Jerome Wakefield’s “harmful dysfunction” hybrid theory holds that a condition counts as a mental disorder only when it both causes harm to the person and results from an internal mechanism failing to perform its evolutionarily natural function, thus distinguishing genuine disorder from normal distress.(Unknown, unknown) [GAP: The original paragraph claimed that much depression would fail to qualify as a disorder under Wakefield’s account and that this connects to Szasz’s concerns about diagnostic overreach; no supporting evidence in the cited card.]
Szasz’s own constructive vision, spelled out in the Epilogue to The Myth of Mental Illness, was modest by comparison. The ideal psychotherapeutic relationship, he argued, was not psychoanalysis in the technical sense but something simpler: “the notion of being a student of human living.” What this enterprise requires, above all, is “the sincere desire to learn and to change,” an incentive stimulated by hope of success.(Szasz, Thomas, 1960) This framing placed responsibility squarely on the individual and on the clarity of those who teach, a direct corollary of his critique of obscurantism. Psychiatric theories, Szasz warned in the same section, had joined religious cosmologies and nationalistic myths as “obscurantist teachers misleading the student than as genuine clarifiers helping him to help himself. Bad teachers are, of course, worse than no teachers at all. Against them, skepticism is our sole weapon.”(Szasz, Thomas, 1960)
Legacy
Szasz’s influence spread in several directions simultaneously. He was taken up by libertarians as a theorist of state overreach. He was appropriated by survivors of psychiatric hospitalization as a validator of their experiences of coercion. He was cited by conservative critics of the therapeutic state, by left-wing critics of medicalization, and by lawyers challenging involuntary commitment. The breadth of his influence reflects both the genuine power of his civil-libertarian argument and the instability of an anti-psychiatry position that could be claimed by almost any politics.
He spent his last decades as a consistent thorn in the profession’s side, insisting as the DSM expanded to include ever more conditions that the expansion confirmed his original argument: that psychiatric diagnosis follows social interest rather than biological fact.(Andrew Scull, 2015) He died in 2012, having never substantially modified the core position he had staked out in 1961.
Human Notes
See Also
- anti-psychiatry
- myth-of-mental-illness
- medicalization
- erving-goffman
- r-d-laing
- dsm
- involuntary-hospitalization
- drapetomania
- social-control-in-psychiatry
Sources
Evidence cited from: szasz-mythmentalillness-1960, scull-madnesscivilization-2015, sep-philosophy-medicine, berrios-porter-historyclinicalpsychiatry-1995, stegenga-care-and-cure-2018, aho-aho-body-matters-2009, dowbiggin-inheritingmadness-1991