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Dr. Thomas Szasz discusses his book "The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement"

BROADCAST: 1970 | DURATION: 00:57:22

Synopsis

Dr. Thomas Szasz discusses his book "The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement" and the ways that mental illness has been used to control and maintain the status quo, scapegoat certain kinds of people, and label people as "other." Szasz asserts his belief that mental illness and mental health cannot be defined, that depression and schizophrenia are not diseases, and the distinction between individuals seeking mental health treatment and those who are institutionalized against their will.

Transcript

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Studs Terkel "Thomas Szasz is unique among psychiatrists in the United States in the depth of his commitments to human freedom and the precision with which he perceives that psychiatry, which should have become a major liberating force, has instead created highly effective forms of human bondage, in "The Manufacture of Madness"." This is the book that my guest, Dr. Szasz, will talk about, as well as his other writings and approaches to psychiatry, "advances his continuing inquiry into the myth of mental illness, the myth of mental illness and the sinister social uses to which that myth increasingly contributes." Edgar Friedenberg, who writes very often with "The Saturday"--"The New York Review of Books" and who is a member of the faculty of the University of New York at Buffalo, writes of Dr. Szasz. Dr. Szasz's book is called "The Manufacture of Madness", Harper & Row the publishers, and I would say conventional psychiatrists probably are furious with you, aren't they, Dr. Szasz?

Thomas Szasz I think so, by and large. They don't like this kind of criticism.

Studs Terkel Suppose we start at the very beginning, your theme, your theme is that in this book you're saying, in a sense, the inquisition of witches in medieval days has a modern counterpart in what you call a therapeutic state and institutionalized psychiatry.

Thomas Szasz Exactly. I see a tremendous parallel between voluntary religion, for example, Christianity as an ideology, as a religion with voluntarily practiced on the one hand, and the Inquisition on the other. I compare these two phenomena with voluntary psychiatry, which is like psychoanalysis, which is fine, and then its counterpart, which is analogous to the Inquisition, which is involuntary psychiatry, institutional psychiatry, in which people who either don't want help are caught up, or people who may seek help, they get caught up and instead of getting help are stigmatized, persecuted, generally mistreated, often incarcerated for years or for life.

Studs Terkel Let's keep this very free, Dr. Szasz, not so much question/answer as our, you know, talking. Institutional psychiatry, where someone is committed at the behest of a physician or someone else, and you cite cases throughout history, there are the startling ones, and compare it with today. If a person is a mental patient, you're saying that he has far less, far less rights than, say, a criminal would have.

Thomas Szasz That is correct. A criminal has all the rights guaranteed to him by the Constitution. I should really say, first of all, an accused criminal has rights to protect himself from being criminalized, by the protections of the Constitution, so that he has a right to trial in which he may have, he has a chance of being acquitted. And then after conviction, he has all kinds of rights in prison. For example, he has a right to certain privacy, he has a right to write a book, and of course he has a right to get out of prison following, serving, after serving his time, which is a finite limited sentence. Now in contrast, the involuntary mental patient, when he's accused of mental illness, he has really no, there is no due process by which he can prove that he's not mentally ill. Because if he agrees that he's mentally ill, of course, he gets hospitalized; if he disagrees with the psychiatrist's contention that he's mentally ill, then he's considered even more severely mentally ill, then he is considered paranoid. And then once--and then, of course, after he's placed in the mental hospital, that's for an indefinite period and there is no finite, legally set time after which he must be released.

Studs Terkel And a physician can do it so that someone who is called mentally ill can be sent up 15 days, isn't there, isn't there some?

Thomas Szasz That varies from state to state, but in most states a person can be sent to a hospital without a hearing anywhere from 15 days to 90 days, often merely on the signature of one physician or two physicians without any court proceeding, which really means imprisonment for a period of anywhere from two weeks to three months.

Studs Terkel Dr. Szasz, your theme, the theme that recurs throughout your book is this parallel of the witch hunt, witches, the Inquisition [in? and?] a theological state, and the person called mentally ill in what we call a therapeutic state, and generally you find that it's the person who does not conform to what the dominant ethic is, easy way to dispose of him. Someone who is different from whatever the norm is established by the powers, whoever may be at the time.

Thomas Szasz Yes. The crucial concept is deviance or nonconformity, and perhaps this is best illustrated by taking a very obvious kind of case in our modern American civilization: there's a great deal of emphasis placed on getting along and not rejecting life, so that if a person is depressed, is sad, is kind of fed up with life, that's a kind of psychiatric nonconformity which is, in my terms, punished by commitment to a mental hospital. Now, a psychiatrist calls this treatment, I call it punishment. But an example of a case would be Ernest Hemingway, who was depressed. I am simply referring to material published in biographies of him, who was hospitalized at the Mayo Clinic for depression, which, of course, psychiatrists have no way of treating, because I don't consider it a disease. And after a while, he got electric shock treatment, which is a kind of brutality in my terms. And after many months he was released and committed suicide anyway.

Studs Terkel Another case in point I suppose could be the homosexual. That's in our dominantly heterosexual society, we call the homosexual ill.

Thomas Szasz Exactly. That would be, it's excellent example, and I discuss it at length in my book of how the define call human differences, disagreements, diseases, which I think is absurd.

Studs Terkel You know, it's interesting, from time to time on this point you're quoting Sartre, Sartre's point is that the scapegoat, whoever it is, that person, the other, the scapegoat, he is never able to define himself at all, somebody defines it for him.

Thomas Szasz It seemed to me that the whole subject matter of psychiatry really centers around the point that you have just made, the struggle for the power to define, and psychiatrists in the last 40 or 50 years have gone to great pains in defining what kinds of behavior are normal and which are abnormal. Actually, Freud himself, who in many way was a great man, contributed to this mischief in a very significant way. One example of which, some of which I quote in the book, but a striking example of which is around female sexuality. Now, Freud insisted that a woman is normal only if she has an orgasm through the vagina, but in fact biologically it appears that it's perfectly biologically normal for women to have a clitoral orgasm. Freud insisted that this was a sign of mental illness. You see, this is, this would be an example simply of the power to define.

Studs Terkel He is setting the standard then, for this other person, the other, the woman.

Thomas Szasz And the purpose of setting the standard is always to demean, to debase, to control.

Studs Terkel Well, this is interesting, since we're on the subject of women, you cite a case that's very interesting. In the 1930's, Mrs. Packard. Mrs. Packwood was a married woman who disagreed with her clergyman husband and he had her committed because she disagreed with him.

Thomas Szasz Correct. Now actually, it's rather interesting that in Illinois in 1851 the commitment laws stated that a married woman could be committed to a mental hospital even if she was not ill, simply at the request of her husband. We chose to what an extent psychiatrists went along as really policemen to perpetuate the status quo or in the name of health, medicine, mental health.

Studs Terkel This husband, in a sense, had the power, let's say, of the judge, or you would say, of the psychiatrist. This husband, by virtue as being the man.

Thomas Szasz Right. Had the power not only of a psychiatrist, but, really, psychiatrist, judge, jailer rolled into one.

Studs Terkel This is interesting on this case, Mrs. Packard's case that was in 1860, and she is saying in her defense, this is interesting, this woman who was put away as mentally ill, is saying, "Had I lived in the 16th instead of 19th century," wrote Mrs. Packard, my husband would have used the laws of the day to punish me as a heretic for this departure from the established creed, while under the influence some intolerant spirit he now uses this autocratic institution as a means of torture to bring about the same result, namely a recantation of my faith." I take it she had a religious argument with him. "In other words, instead of calling me by the obsolete title of heretic, he modernized this phrase by substituting insanity instead of heresy as the crime for which I am now sentenced to endless imprisonment in one of our modern inquisitions." And, thus, she resets it, doesn't

Thomas Szasz she? Actually, this is no mere analogy. There are endless, countless people whom in this country and in other countries have been placed in mental hospitals for political deviance. The Russians, of course, do this now routinely. But in this country Ezra Pound was confined in a mental hospital for 14 years without ever having been tried. There was a Black lady who stabbed Martin Luther King many years ago who was never tried, who is still in a mental hospital. And more recently, a dramatic case would be that of Sirhan Sirhan, who committed what he obviously thought and wanted to define as a political assassination, but here you see the struggle for definition is very obvious. He wanted to define as a political assassination, but the psychiatrists wanted to define it as completely non-political, that he was simply a psychiatric heretic, a madman, in other words, that he was nuts, because after all, what sane man would want to kill a Kennedy?

Studs Terkel May I cite a case even more pertinent at this particular moment. There's a case in the Midwest of four people who have burned draft cards, one a young minister, four Catholic people, and they're pleading insanity ironically, it's an ironic plea, because they say, in fact it was Vice President Agnew who spoke of the criminally insane people. He said this, you see. And they wanted to subpoena him as a witness, as a defense witness. Yes, we are insane, because we are different than the norm which believes that the burning of women and children in Vietnam is quite normal. Then we must be insane, which would be even more to the point of your book, it seems to me.

Thomas Szasz Yes, that's an ironic dramatization of this point, and sooner or later there will have to be many more such confrontations of this view that normality is social conformity, is a kind of statistical frequency and deviance from that is abnormality. Of course there was. Let me cite a political analogue of that. There was a great deal of discussion of this years ago in the days of the Nazis when the question arose, "What is a normal German like?" when Hitler was in power. Is a normal German one who agrees with Nazi policies and thinks that Jews should be killed, or is he one who disagrees with this? Of course, we know that, actually, in those days also, the Nazis used mental hospitalization to punish deviants. There is another interesting story that I might tell in connection with that, a very dramatic one. Towards the end of the war, the chief of the German secret service whose name I can't recall, who subsequently became an important man in West German espionage afterward, for a year or two or three before the end of the war, when the push against Russia really began and when Hitler, thought he would have a blitzkrieg against him, this man rendered the detailed report to Hitler about his estimate of Russian strength. And this contradicted Hitler's view so much, his estimate was that the Russians are much stronger than Hitler wanted to believe it, that he relieved him of his job and committed him to a mental hospital. That's where he spent the rest of the war.

Studs Terkel Hitler then was defining.

Thomas Szasz Hitler was defining.

Studs Terkel And, so, we come to so many aspects of who defines what is normal. You point out cases of sometimes welfare mothers who object too much, and so they are subjected to psychiatric examination. Interesting you point this out, because in a book I was involved with, I came across this lady I call Lucy Jefferson, and I thought of your book when I recall this phrase, she said she had--her son had problems and there was no father in the house and she said she went to the hospital, and the psychiatrist--"I asked for help. I realized," the social worker said--"I realized all the voices Melvin her son heard were female voices, my voice, sister's voice, his grandmother's, his teachers'. I was frightened. I went down to this institute. I talked and they decided I was the one needed the psychoanalyzing. They had me in a conference and there were 12 psychiatrists all around. Somebody was taking notes and what have you." Of course, she wasn't given any help at all about her son, but she, then they said that she must be crazy.

Thomas Szasz That's a beautiful example of the kind of thing which I also talk about in my book. It touches again on the issue of the power to define and it touches more broadly, it illustrates more broadly the issue that in any kind of human helping situation, when there is a helper and the helped, one of these people is going to be in control of the situation, and I emphasize this throughout. In ordinary private practice of medicine, we don't often think of it this way, but in the ordinary private practice of medicine, the patient is in charge. He decides whether to go to a doctor and which doctor, he decides how he likes the treatment and if he doesn't like it, he can quit. Now this is also true in the ordinary good practice of psychoanalysis, but in the all of rest of psychiatry which I call institutional psychiatry, it's exactly the other way around. The patient doesn't, the so-called patient doesn't decide whether or not to go, doesn't decide who to go to, has no control over who his doctor is, which hospital he's in, how long he's in, when he gets out, when he can--you know, what his diagnosis is, and so forth. The whole procedure is under the control of the expert, and this is where the analogy to the Inquisition comes in. The Inquisition was a quasi-religious kind of an undertaking in which the whole procedure was under the control of inquisitors.

Studs Terkel And, so, the inquisitors are defining who is normal or who is the decent person, and so the witch or during the Spanish Inquisition the Jew was the scapegoat. And in a way you're also implying throughout in the book you're saying that the power, those in power at a certain time always need the scapegoat to hold the power.

Thomas Szasz That is underlying theoretical basis of my work, that every society seems to need a scapegoat upon which to vent its troubles, its aggressions. I call this the moral metabolism of society, for which a scapegoat seems to be necessary, and it seemed to me that, strange as this may sound, and this is one of the reasons why my views are sometimes considered or often considered controversial, I hold that the scapegoating profession has actually become medicine and more particularly psychiatry, and the modern scapegoats of our society are the people whom we ostensibly help as mental patients. Now, the hundreds of thousands of people locked up in mental hospitals are not there to be treated, but are there to be persecuted. They are our scapegoats. They are our Jews, if you like the Nazi analogy.

Studs Terkel And is it true, I suppose in institutionalized psychiatry those held involuntarily, to a great extent they would be the poor and the outcasts, are they not?

Thomas Szasz Well, there are many, many statistical sociologic studies on this and we know that there is a direct, a highly direct and a highly accurate correlation between poverty, lack of education, and so forth, and mental hospitalization, that mental hospitals are by and large filled with lower-class, poorly educated people, and the more money you have, the more education you have, the smaller your chances of being caught up in this inquisitorial psychiatric system are.

Studs Terkel Because this leads to so many thoughts, the big question to ask you, Dr. Szasz, and I'm sure many of psychiatrists as you know, may be listening to the program somewhere, they'd say, "Ask him, ask him," do you believe there is such a thing as madness?

Thomas Szasz There is such a thing as madness in precisely the same sense in which there was such a thing as witchcraft. It is the nature of human societies, of human beings, that when an idea, a belief receives a great deal of social support and it is socially defined and supported, then it becomes real. Now, when people believed in witchcraft, then witchcraft was real. When people believe in mental illness, then, to that extent, mental illness is real. So that--and this reality is then supported institutionally, so that we have such a thing as a National Institute of Mental Health, which disposes over millions and tens of millions of dollars, so how can one say there is no such thing as mental health when there is this institution? But, of course, my view is, and I don't mean to insult anyone's religious sensibilities, that this would be a little bit like going to Rome and standing before St. Peter's and looking at the beautiful building and concluding that, since there is this beautiful building, there must be a god!

Studs Terkel So you mean--

Thomas Szasz It's a kind of a circular reasoning.

Studs Terkel But then we come to the question, your point is, the institution is set up, Parkinson's Law is at work here. It must justify its existence is what you're saying.

Thomas Szasz That's beautiful. This is a kind of professionalized version of Parkinson's Law, but going it one better, this Parkinson's Law built upon a non-existent entity, of a mythological entity, because Parkinson's Law operates even in relation to such things as automobiles or soap, which are real things, the merchandising of these things, but when we merchandise mental health, actually we go, we do it one better because we are merchandising something which doesn't exist, which is undefinable, and, therefore, the possibilities for applying Parkinson's Law are really limitless. A limitless amount of money can be siphoned off in these directions and in this way, one group of the population can gain control over another part, which is a tradition of political struggle in society.

Studs Terkel We're in a--were there--now, let me be the gadfly, since you are the gadfly to institutional psychiatrists, you know, to conventional ones. Let me be gadfly to you, Dr. Szasz, for a moment. Would there not be mental illness, you know, would there not be something called madness, whatever that may mean, were there no Institute for Mental Health? Were there no psychiatrists?

Thomas Szasz Well, of course there would be no madness. After all, we know historically that until institutional psychiatry became a socially acceptable phenomenon, until that time madness was simply a concept which was applied to some kinds of behavior, but there was no epidemic mental illness. Let me illustrate this. Hamlet, the Prince of Denmark, is described in Shakespeare as having been considered mad by his mother and uncle. That's a beautiful play, and I think people today should re-study from a psychiatric point of view. Now, if Hamlet were living today, his mother and uncle, who were guilty of murder, premeditated murder, would have locked up Hamlet, who would be rotting away in a mental hospital because in fact he was smart enough to smell that there was something rotten in Denmark. But they couldn't lock him up, so what did they do? They tried to hire some killers, but in fact, Shakespeare plays out, really, the concept of madness in its classic humane sense. Madness is, in my terms, conflict. Simply conflict. Now, in the case of Hamlet it was a conflict between the culprits of the King's murder, and Hamlet, who suspected it, and then the play plays out the resolution of this conflict.

Studs Terkel So in what today you call a therapeutic state, King Claudius would not have hired killers, but psychiatrists.

Thomas Szasz And in fact we know that this is what people do. A modern example of this, lest people think that I'm theorizing and there is no, not solid data behind this, the last King of Bavaria, Ludwig the II, was not assassinated like other political leaders, was not simply deposed, but Bismarck hired psychiatrists who declared him mad and tried to lock him up. Now, it's a very interesting story, I don't want to go into details of it, but in this case a psychiatrist, who himself, many of these psychiatrists of course, and many psychiatrists today sincerely believe that there is a mental illness, this psychiatrist, who in fact was a king killer, who deposed the King, was himself killed by Ludwig, who subsequently committed suicide. Now this is a piece of real-life history.

Studs Terkel So we're talking again, throughout, too, there appears a matter of haves and have-nots. That is the church, the physician, the priest, serving those who have, whereas the have-nots, the poor had to go to another kind of therapy, another kind of help: the white witch. The herb doctor, whom it was. And, therefore, that person was considered outside the respectable. That person was considered the menace and had to be tried.

Thomas Szasz And that person, of course, was also and continues now to be his equivalent, continues now to be a competitor to these socially accredited and accepted so-called therapists. Here's a parallel, would be in the Middle Ages, the white witch, would be a, the good witch would be a competitor to the priest. The inquisitor as accredited healer and manipulator of the individual, and analogous situation today is that psychiatrists spend a good deal of time and effort and often money in opposing nonmedical healers who try to help people with what I call problems in living, whether these be psychologists or social workers or bartenders or just friends, and psychiatrists professionally maintain that all these problems are medical problems and no one without a medical degree should be allowed to minister for these things.

Studs Terkel It's interesting. I think that in China today, I'd read somewhere there are two kinds of hospitals they have there. There's the modern hospital but also for the older people, and this is China today, older people they have herb doctors, still aware, apparently, with whatever medical advance there is, still aware that other is terribly important for this other person.

Thomas Szasz That there is, of course, nothing like that here. There is a term which has gained some currency in the last few years in America called the "indigenous healer." But this is really a term of pejoration here. Indigenous healers are people who are really not effective, that poor benighted stupid people go to instead of going to scientifically accredited doctors.

Studs Terkel Again, I suppose, I don't think you would defend that which we call faith healing. I don't know. I'm thinking about certain evangelists who make a fast buck. You know, at the big evangelical tent meetings where I have seen and the placing of the hand over the head and a child dies, you know.

Thomas Szasz Well, this gets us into a subject which is very important. Of course I would not defend it scientifically or rationally, so to speak. I believe that it's a good idea that if, let's say a person has pneumonia, that he go to a doctor and have treatment by penicillin and other proper medical means. But the matter is not so simple because we touch here on the fundamental issue of human rights, of civil rights, of which the medical example, the simplest medical example, is Christian Science. Does a person have a right to be Christian Scientist? Now, Christian Scientists reject medical treatment, and they have this right in America under the First Amendment, because this is a religious right. But more broadly, this is just a tip of the iceberg. More broadly what we deal with here is the alliance between the state, the government, and certain other functions. In this case, medicine today, and religion in the past. And I see in this alliance between the state and medicine a tremendous danger for social suppression, the curtailment of individual rights for what I call the therapeutic state, for Big Brother-ism, for totalitarianism, which doesn't look like communism, which doesn't look like fascism, which doesn't look like anti-Semitism, but which is just as destructive, because it destroys all opposition, because it can label it as sickness or mental sickness and can then destroys (sic) a person, can put him out of commission by hospitalization or often even by destructive so-called treatments.

Studs Terkel Would you call these social controls?

Thomas Szasz Social controls through medical interventions. Now, this is completely analogous to the Inquisition. The Inquisition, after all, in a nutshell was social control through religious interventions.

Studs Terkel So if we can return to this whole, well, we are touching on all the way through, that person who is considered other, and toward the end of the book, in your epilogue you quote from the remarkable novel by Kosinski, "The Painted Bird", the other, so it's a question of that person who is considered different therefore must be wrong, and must be done away with or put away.

Thomas Szasz Or transformed.

Studs Terkel Or transformed.

Thomas Szasz And conversely, once we look upon the problem in such light as you have described and as I try to support in my work and certainly Sartre, Kosinski, [Orville? Oliver?], many people have written on this. Once we take this perspective, it follows that we must carefully balance the value of, in this case, scientific medicine or scientific treatment or whatever we so consider against the right of the individual to be the determiner or the definer of his own fate, even if that seems to conflict with the tenets of scientific medicine. And there can be no weaseling out of this conflict. Either one or the other must take precedence. And I come out squarely for the view that individual self-determination must be a higher value than psychiatric dogma. And dramatic example of that is, does a person have a right to commit suicide? Now, suicide is defined now in medicine, in psychiatry, as a symptom of mental illness. I say, "Nonsense!" Suicide is simply in the last analysis a manifestation of the person's taking his life in his own hand and destroying it, saying, "It is mine, and I will destroy it."

Studs Terkel This is interesting. I know that in Scandinavian countries, here suicide is hidden by the family, a sense of shame is there, I remember being in Copenhagen not too long ago, "Oh, my father committed suicide." "Oh, yes," so and so. It's not hidden. Is it because, perhaps, this being a non-Catholic country, that suicide itself among Jews and among Catholics considered in the past theologically sinful, you see.

Thomas Szasz That may be a part of it. Of course, suicide was just as sinful among Protestant, I suspect, I really don't know, but that I suspect that the Scandinavians have in some ways emancipated themselves from some prejudices that we have with respect to mental health. This would be the explanation of this particular situation.

Studs Terkel But it's autonomy you're talking about, we come back of the matter of a subject that comes up in so many forms, autonomy.

Thomas Szasz Autonomy, self-determination.

Studs Terkel And, yet I suppose, if we have to talk about the matter of murder or the matter of crimes, as such, do you believe in insanity as a defense ever in a law case?

Thomas Szasz Never, for the same reasons for which I don't believe that insanity is a legitimate weapon for injuring other people, namely commitment. I don't believe that mental illness is ever a justification for hospitalizing someone. In other words, for depriving him of his liberty. Now the other side of this coin is I also don't believe that mental illness should ever be a justification for getting something for nothing, for getting an excuse. And, so, an insanity defense is in effect getting excused for a criminal act which a person committed but about which he says, "Well, you know, don't punish me because I didn't know what I was doing," An extension of this would be, I also don't believe in our present practices with respect to abortion. In many states now, you can't get an abortion, you cannot get an abortion if you walk into a gynecologist's office and say, "Dr., I want an abortion." But if you go to two psychiatrists and assure them that you are feeling very nervous and you'll probably kill yourself and you are very mentally disturbed and then they fill out a piece of paper which says yes, you're mentally disturbed and you should have an abortion, then you can get an abortion. This is all, to me, gimmickry. This is psychiatric gimmickry like the Inquisition was religious gimmickry. It can work both ways. Usually it works against a person. Sometimes it can work for his benefit and the detriment of society.

Studs Terkel But as far as abortion, you believe that a woman has a right to the use of her body, a woman does. I assume that you are--

Thomas Szasz I certainly do.

Studs Terkel I assume that you are for the legalizing of abortion laws.

Thomas Szasz I am not only for the legalizing of the abortion laws, I go much, much further. I believe that the very concept of legalizing abortion laws is a misnomer. I believe that the state is a criminal when it illegalizes something about which it has no business. So that the very word "legalizing" is much too mild. I think that abortion is none of the state's business. I think homosexuality is none of the state's business. I think mental illness is none of the state's business. I think the state's business is a prevention and punishment of criminality.

Studs Terkel But suppose coming back to insanity defense in case of Richard Speck I'm thinking of, quite obviously, and murder of the eight student nurses. The defense is, would you say that Speck was sane at the time that he killed--allegedly--well, he was convicted of it, of the eight student nurses.

Thomas Szasz That's a good case. Leopold and Loeb case, of course, is a famous earlier one. Every case is a good case. I would, my own view is really very simple. I can't answer your question directly, whether I would say that he was sane, because I reject these qualifications. I reject the qualifications of sane and insane in a courtroom. After all, we don't talk about Jewish criminals and Christian criminals, we don't talk about fat criminals and thin criminals. We don't talk about rich criminals and poor criminals. So by the same token, I say we should not talk about sane and insane criminals. These are completely irrelevant distinctions for the criminal law. The criminal, all should be concerned is whether or not the person committed the act and whether he committed it within the definition of what constitutes a criminal act.

Studs Terkel We come again to--

Thomas Szasz So self-defense, for example, to me makes sense. But insanity is absolutely an illegitimate category and I would not place anyone into that category.

Studs Terkel We come again to, there's so many aspects to, by the way, you may agree or disagree with Dr. Szasz's work, we're talking to Dr. Thomas Szasz, who is certainly a most provocative psychiatrist, the most unconventional one, "The Manufacture of Madness", is the book we're talking about, published by Harper & Row, he's written hundreds of articles and pieces, all very provocative, provoking, certainly, to very many psychiatrists, and some of his previous books have been the "Law, Liberty, and Psychiatry", and "The Myth of Mental Illness". It's--you're talking about the question of who decides what is normal, or who decides what is moral and immoral, just as it was the church militant during the time of the Inquisition, you're saying now it is the state and their sidekicks.

Thomas Szasz The state militant, I like that. It is the state psychiatric. And again, in opposition to this view, I have no--I'm not anti-psychiatric or anti-medical, I am simply insisting that it should be the prerogative of the individual citizen to say whether or not he feels well. Now, if a person, let's say if a person has fears, let's say a young woman is afraid to cross the street, or is afraid to have a baby, or is afraid to have sexual relations. These are real problems, I call this problems in living. And I think it is a very intelligent thing for such a person to go to a good, competent psychotherapist. But this would be an example, an instance in which the person defines his own behavior as abnormal, as undesirable. This is good. I don't think the state, I don't think the medical profession or the psychiatric profession should have the power to do this to the person.

Studs Terkel This is the difference between contractual psychiatry as against--

Thomas Szasz Against institutional. And this is a difference between a person who feels depressed or who has a medical problem going to an analyst and the person who is a homosexual being stigmatized by the psychiatric profession as sick.

Studs Terkel Again, somebody defining for him what his state is, you're coming back to that again.

Thomas Szasz Yeah, coming back which is a fundamental issue.

Studs Terkel This is the question, then, that when a person is physically ill, he feels it, as you say. When a person is called, I said deliberately called mentally ill, he is told he is so.

Thomas Szasz And statistically speaking, most people who are called mentally ill do not feel ill and do not want to be so defined.

Studs Terkel But suppose, this will lead to the question of crime and law again, but suppose this person does an act that injures another, then you say it is a crime.

Thomas Szasz There is no problem. That is what the criminal law is for. I am not at all, my view is often by unfair critics interpreted as somehow endangering society, I think that's a complete misreading. I am very much in favor of intelligent and humane criminal laws intelligently and humanely administered and enforced. We cannot have a society in which harmful behavior against others is not restricted, restrained and punished. That is what the criminal law is for. But it is precisely through the psychiatrization of the criminal law that our society has become more endangered because in fact we have confused and mystified what is crime and what is illness. Crime is injury against others. Illness is a very complicated concept of not feeling well and wanting some sort of help for it.

Studs Terkel This crime, of course, can be institutional as well as personal.

Thomas Szasz Yes, indeed.

Studs Terkel Of course.

Thomas Szasz And in fact, it is no mere play on words. I consider involuntary mental hospitalization, the commitment of mental patients, a crime against humanity. That is a crime.

Studs Terkel So we come to the defense of what you call the defense of the dominant ethic and here you describe auto da fes, the pomp and circumstance of a trial, you know, a trial of the dissenter, whoever he might be, of a nonconformist. And there's a great ceremony attached to it, isn't there? That is, the rationale of something real and fairness and justice is being done. But you know it's a setup to begin with.

Thomas Szasz And I compare that to the ceremonial structure of our mental health and commitment hearings. For example, if somebody now is accused of mental illness and is apprehended and taken to hospital he's then held by court order for 30 days or 60 days or 90 days, and then the doctors and psychologists submit all kinds of papers which is all a ritual purporting to show how he suffers from this or that kind of mental illness to justify what is already a foregone conclusion that he should be locked up.

Studs Terkel You know, if I could extend this, Dr. Szasz, and I think logically, see if you agree, this could also be done politically, too, some would say the conspiracy trial in Chicago was a ritual; there was pomp, there was ceremony, and yet it was a setup to begin with. Some might say that, following out your theories.

Thomas Szasz Well, this has of course, Mr. Terkel, this has often been said and this has been the distinction. There is actually a vocabulary for this in English. This is a difference between a real trial and the so-called political trial. The term "political trial," for example, the trial in Nazi Germany after the burning of the Reichstag is a ceremonial circus, the purpose of which is to whip up public feeling against certain individuals or groups to show whether they are criminal elements. There's a great deal of this now against young people, against hippies, yippies, people who take drugs, a kind of a ceremonial liturgical quasi-religious whipping up of sentiment against these people as malefactors.

Studs Terkel On the subject--

Thomas Szasz The others.

Studs Terkel Yes. On the subject the young you're talking about, the juvenile court, the nature of the juvenile court itself. The young has no, he has no protection at all.

Thomas Szasz Doesn't--

Studs Terkel Much like a person called mentally ill, in a sense.

Thomas Szasz He used to be. A few years ago the Supreme Court actually abolished many of these quasi-therapeutic measures prevailing in juvenile courts but it's an excellent example. Children have traditionally been treated by the law very much like mental patients and mental patients are now treated like children, namely we are doing it all for their good, like the inquisitors did for the heretics, and once we accept that authorities act for the good of the subjects, then we have taken away all rights from the subjects because after all how can one be opposed to benevolent authorities?

Studs Terkel So again, there's a phrase here that you use called "thought crime," rather than "act crime," of thought crime being that person whose thoughts are considered strange. Either he's nutty, dangerous, or whatever, see, in contrast to the actual physical crime so in the way it's physical illness, too, as against that which is called mental illness.

Thomas Szasz An example of that would be what psychiatrists call schizophrenia. I in this book categorize in part as a thought crime. Let me illustrate it. When a person believes that he is Jesus. Now, that's pretty nutty. I don't think that's--that's okay. But in effect, that's a thought crime. He's not harming anyone. He is thinking something or he's asserting something which does not happen to be true, but there is no law against making such lies. Now, when a person says, and I'm thinking this because it's a very dramatic illustration of how I differ from traditional psychiatry, when a person says that he's Jesus, he's in effect lying, because he's not Jesus, he's John Doe. But this lie, this misstatement, is interpreted in psychiatry as a symptom of the disease called schizophrenia, which then justifies a most far-reaching brutalities against this person, the least of which is locking him up and the most of which is cutting out half his brain called lobotomy, which is a kind of murder. It ranks on par with gassing of Jews. It's a medical crime and I hope that one day, obviously, as a matter of history, the doctors who have engaged in such acts will be viewed exactly in the same way in which the Nazis are now viewed who gassed Jews. They are simply killing scapegoats.

Studs Terkel So, on the subject of schizophrenia, though, you don't believe there is schizophrenia, schizophrenic conditions?

Thomas Szasz No, I don't believe that the thing which psychiatrists now call schizophrenia is a condition. There is no such thing. This is simply another nasty term which is being applied to people who behave in ways that we disapprove of, who deviate, who are others with a capital O, who are heretics. These are people who behave in such eccentric ways that we simply will not tolerate in our society: people who refuse to eat or people who refuse to dress properly, or engage in certain sexual acts in public, or who maintain false identities, who insist, let's say, that they are Jesus or that they are being persecuted by communists, these kind of beliefs, these are so offensive to ordinary beliefs, and of course, needless to say, I'm not defending these beliefs as accurate. I am defending, I think Voltaire said, "I disagree with you passionately, but I will defend to death your right to have your views." Now this view, interestingly, is very well-accepted in the political realm, in the religious realm, I simply want to extend it to the psychiatric realm.

Studs Terkel No, I wasn't thinking so much of someone who thinks he is Jesus or, for that matter, this man is articulating what so many of us fantasize anyway. We, all of us have fantasies, of course. Now if we articulated our fantasies, we would, in a sense, be saying, "We are Jesus" or "We are Don Juan" or whatever the case may be, you see. I'm talking about something, I'm talking about a person, let's say, who has not delusions of grandeur, but suppose he feels he is persecuted to such an extent and he's thinking about a certain person, or group of persons, that he will take out after them physically. Do you see what I mean?

Thomas Szasz Yes. That gets us back into the connection which, of course, is a time-honored one and complicates matters unless it's very carefully thought out and talked out, which I don't think we can do fully. It gets us into the connection between mental illness and psychiatry on the one hand, and criminality and law on the other hand. People will commit criminal acts for all kinds of reasons. One of them is perhaps, pure greed. You know, the kind of Mafia-type thing. It's an easy way to make money, take it away from other people. Okay. We understand that. That's not mental illness. Another kind of criminal behavior, illegal, antisocial, violent behavior may come from certain false beliefs, that people believe that other people have some malevolent intentions toward them. I think that's criminal behavior also!

Studs Terkel Would you say--

Thomas Szasz I would make no distinction between those.

Studs Terkel To extend that a step further, some have this feeling that other people have these feelings toward them, that some might say that we think, somebody might think a man thousands of miles away or little brown people thousands of miles away and therefore we burn them.

Thomas Szasz Or wage war against them.

Studs Terkel Yes.

Thomas Szasz Well, we go--we come into here into the whole area of what is truth. You know, what are the facts in a case. Who in fact is for or against one. And then we get into such areas as whole nations being or not being dangerous to all other nations. Are a certain people in Asia dangerous to America, or is capitalism a danger to communism? These are such global, such fuzzy concepts that it's possible to believe anything and it's impossible to prove whether it's right or wrong. This would be my view on it.

Studs Terkel Impossible to prove right or wrong, let us say, about what, of what is being done right now, say in Vietnam?

Thomas Szasz No, not about what is being done. But it is impossible to prove whether or not the Vietcong is a real political danger to the security of the United States. I think that that is not a statement like one can make about, let's say, it is possible to prove that excessive X-ray radiation is harmful to the human body, causes cancer. Well, you can prove this, this is yes or no. Or taking arsenic is not good for the human body. You can prove this. Or that taking large doses of Vitamin C is harmless to the human body. I do not see how it is possible to prove whether or not certain political beliefs are or certain large groups are in fact a danger or not a danger to another large group. These are too fuzzy for proof. These are political things.

Studs Terkel Perhaps not as fuzzy as you may think, but we'll go on further, Dr. Szasz, I know, because we're wandering from this theme. Not really, I think it's all related, because you do believe in institutional violence.

Thomas Szasz Yes.

Studs Terkel You do subscribe to that, you know, that there is institutional violence to human lives. So we'll let that one lay. But let's come back to the idea of heresy to mental illness. This is what you're talking about, the product conversion, you call your chapter, from how the natural--by the way, you point certain times that in the 13th century or so, you know, the trials for heresy came into flower or into weed and then mental illness what, 17th century--

Thomas Szasz Seventeenth century.

Studs Terkel And there were certain moments when ethics, when certain dominant ethics were being threatened, too.

Thomas Szasz Right. It was with the decline of religious ethic and with the decline of the power of the churches, the power vacuum was created into which stepped science and the modern state. And it was at this time that psychiatry originated, it was at this time that mental hospital movement. There were no mental hospitals in the world as we now know them before approximately 1650, the middle of the 17th century, which I think is a very, very important thing for people to remember, because there were many, many large urban areas in the ancient world. There were two million people in ancient Rome, at the height of Rome, you know, in whatever it was, 100, 200 A.D. There were no metal hospitals. Well, we now think that, you know, no civilized society can exist without mental hospitals because that's where you have to put the people, you know, who don't get along, but that's simply not true. The whole idea of mental illness as we now know it, in mental hospitals, is a modern scientific idea, is a modern scientific way of categorizing and disposing of social deviants.

Studs Terkel You know, before the Europeans came to this country, to this land, America, United States, the Indians, many Indians say there were never were mental hospitals among the Indians in America, you know.

Thomas Szasz And, of course, there are still no mental hospitals, curiously, in the, what we call underdeveloped countries. In primitive countries there are no mental hospitals.

Studs Terkel That's interesting. In the materially underdeveloped countries.

Thomas Szasz In the materially underdeveloped countries because, well, of course there are several reasons for this, but the main one being that the kind of social control that we use psychiatry for, they use the family and the tribe for. The family takes care of, after all, again let's be very practical. In New York state, and I imagine Illinois is not all that different, in New York state 40% of all the patients committed against their will to mental hospitals are 65 years and over. So we are dealing here with roughly half of the patient population whose quote illness unquote is obviously simply being old, decrepit, poor, and not having a family that's willing to take care of it. If tomorrow all American families would become more conscientious and more humane towards their old mothers and fathers, then half of the mental patients in the country would simply disappear from being mental patients, could leave the hospital and could go home.

Studs Terkel Of course, here you are-- Here you

Thomas Szasz

Studs Terkel course, here you are-- Because they would be taken care of. Here you are describing the difference between the underdeveloped countries so--that is, not spiritually but materially underdeveloped countries who take care of the grandfathers and grand--who are part of the family, the tribal family, extended family, whereas here to dispose of the older people, something has to be found wrong with them.

Thomas Szasz And we are, of course, now we are also doing this with younger people, it's a very popular idea that the children have a great deal of mental illness. Now this simply means that there are a lot of children who cause trouble to their families, to their mothers and fathers, and one way to get rid of these children is for the mother and the father to take him to a psychiatrist, and then they can get locked up in the mental hospital.

Studs Terkel Because, in a way, another theme of Dr. Szasz's very, I think, profound, provocative book though I may disagree and you may with some aspects of it, "The Manufacture of Madness", is what you call the struggle for self-esteem near the end, and basically this is what it's all about, isn't it, in a way, the diversity in all human life that you consider sacred.

Thomas Szasz Yes. This is really very, very basic, a very, very basic issue. Again, a very simple issue in its elementary components. After all, the most important thing for every human being is to stay alive, to get enough food and get enough sleep so that one doesn't die. But once one has gone beyond the survival stage, then every human being once he becomes more than two or three years old, and the older one gets in some ways the more important this becomes, must feel that his life has some meaning, has some significance. This is why I think that religion and the spiritual realm is so important. Not that I am personally, formally religious, but I'm using religion now in the sense of life not simply being a material, physical act of existence, of consumption, of taking things in and excreting things and producing something for society. But it has to do with, it pertains to the dimension of significance. What am I here for? What am I good for, and what does somebody else think of what I am good for? Does the other person think I am good? And obviously one way in which one can increase one's own self-esteem, and I emphasize this, this is a philosophical part of my book, one way, the cheapest--I use cheap in the existential sense. The cheapest, really, the most despicable way in which a person can feel that he is important is by declaring that somebody else is no good.

Studs Terkel So we come, of course--

Thomas Szasz We come full circle around to this. This is, of course, what religious wars were about. After all, I mean, again, certainly no offense to my co-religionist. I was raised Jewish, but there is something about Judaism which is very illustrative in this. It is the original belief of Judaism that the Jews are "the chosen people." Now, doesn't this mean that all the other people are God's stepchildren? In this belief, in this early belief I see a kind of a nuclear example, a very early historical example of this, what I call the struggle for self-esteem, to the extent to which the Jews believed, and continue to believe, that they are God's chosen people, this gives them an enormous charge of self-esteem. This makes one special. This gives one a feeling of self-esteem very much like in a large family if there is a child who is preferred, where in the old days, in a large family, let's say, where there were three or four girls and one boy, this was a traditional family in the 17th, 18th century, or even more recently, then the boy was, of course, preferred, you know. He didn't really have to do anything to get self-esteem. The very fact that he was a male--

Studs Terkel You

Thomas Szasz know, this is rather interesting-- Gave him self-esteem.

Studs Terkel If a people are pushed around and oppressed, this could be any people, have a rough life, somewhere along the line to survive they must find someone less. The poor Southern white I'm thinking of.

Thomas Szasz Exactly.

Studs Terkel Who says, if I aim to use his phrase, "If I ain't better than a nigger, who am I better than?" So, in a sense, you're really saying this is what it's about, really.

Thomas Szasz This is what it's about. And what I am saying, I'm going further, I'm saying that life is becoming very complicated. There is a population explosion, there are lots of people around, and if we keep doing this, we are going to do terrible things to each other, and I think we should stop. We should try to find ways of securing self-esteem without debasing the other person. In some other way, for example, by creative effort.

Studs Terkel You're really--

Thomas Szasz By doing something worthwhile.

Studs Terkel You're really speaking of a society in which a creativity comes into play without the need for competition; that is, beating someone else.

Thomas Szasz Exactly. I think that it is, this is the reason why, there must be a reason why creative people, artists, writers, people who create something new, scientists, discoverers of new treatments, why people like this have been held in high esteem for hundreds and thousands of years, and I think the reason for this is that it is this small group, relatively small band of people historically, who have managed to show mankind that it is possible to give one's life significance without in the process pushing somebody else down. I sort of like to think of life, of a good deal of life as a teeter-totter, which is unfortunate, that the only way in which you can go up is if the other person on the other end of the teeter-totter goes down.

Studs Terkel Whereas don't you find many of the young, many of the young, of our concerned young, are thinking precisely as you do, that is, they are less competitive than their parents are, many of these very young, and they're not putting someone else down.

Thomas Szasz This is a very, very good point. The youth movement, some of the best things in the youth movement are their awareness and their objection to this organized, institutionalized really, historically confirmed and approved method of putting other people down through religious supremacy, national supremacy, and now, of course, as I bring out, medical, psychiatric supremacy.

Studs Terkel So it's the other capital O, there's always been the putting down of the other, and that person who is the other, therefore has to become "the painted bird." We'll, perhaps I can read that last part of your book, the epilogue, a piece from the novel by Jerzy Kosinski, "The Painted Bird", the other has always been put down, and you're saying that one must feel for the other as one must for himself if we're to survive.

Thomas Szasz That's very, very nicely put. Or if I can put it another way also, one must feel for the other, but ultimately one must strive towards the situation where there is no other. Perhaps I could--where there is no other, where everyone, where there is really a true appreciation that every human life is sacred.

Studs Terkel Sacred. And disparate, too. I mean, with the differences.

Thomas Szasz With the differences, but sacred, not inferior because of any difference, and not necessarily superior, either.

Studs Terkel You know, Dr. Thomas Szasz is our guest and it's a, it's a book that is obviously going to provoke you into thinking, and you may find many aspects of this, oh, maddening to you, if I can use the word maddening, but it'll make you think. "The Manufacture of Madness", Harper & Row the publishers. Thomas Szasz, S-Z-A-S-Z, by the way, you were here at the Institute of Psychoanalysis for a while, too.

Thomas Szasz Yes, I was, trained here and I was on the staff and I still practice psychoanalysis. I think psychoanalysis is a fine thing if it is practiced in the spirit of the old Freudian tradition, perhaps I should leave this program by reminding the listeners of the fact that Freud's contribution was not just to psychiatric theory, but it is not, what I like to remind listeners of, is the fact that Freud practiced psychiatry for 45 years and he never treated, he never saw anyone who didn't want to be seen by him, that he only dealt with voluntary patients. And what I am really urging is abolition of involuntary psychiatry and the strengthening of good, pluralistic, diverse kind of humane, voluntary psychiatry.

Studs Terkel Yes. Thank you very much, Dr. Szasz, I was about to read that part from "The Painted Bird", but there's no need because of what you said. This is just as, quickly, the case of a young boy in the forest is protected by a hunter, and the hunter finds a certain bird, and he paints that bird differently from the other birds who are part of his flock. And the scene is beautifully written, and they destroy this bird because this bird seems so different. Isn't that it?

Thomas Szasz Yes, the birds don't recognize a member of their own species once its wings are painted different colors, and as soon as they recognize him as another species, they destroy him. And, of course, this is what we do in wartime--we always say that enemy is inhuman, is sub-human, is non-human, and there are all kinds of semantic ways of doing this.

Studs Terkel And this bird, this flock of birds, or these ravens, others, in destroying this one who is part of themselves, the one they call the other because simply the paint on him by someone else is different, are really destroying themselves.

Thomas Szasz Yes. Thank you very much.

Studs Terkel Dr. Thomas Szasz. Thank you very much. And the book is "The Manufacture of Madness", Harper & Row the publishers.