10.

1177/0022167803261611
Thomas
Randall
Szasz
C. Wyatt
Interview

ARTICLE

THOMAS SZASZ: LIBERTY AND THE

PRACTICE OF PSYCHOTHERAPY
RANDALL C. WYATT, Ph.D., is an adjunct professor
at the California School of Professional Psychology,
San Francisco Bay campus at Alliant International
University. He practices in psychotherapy, in Oakland, California, and is director of counseling at
CrossWinds Counseling in Dublin, California. He is
also editor-in-chief of Psychotherapy.net, an online
magazine for psychotherapists.

Summary
The foremost psychiatric critic of our times, Thomas Szasz, M.D.,
engages in an in-depth dialogue of his lifes work. He is author of
more than 600 articles and 26 books, including the controversial The
Myth of Mental Illness, The Ethics of Psychoanalysis, and his most
recent work, Pharmacracy: Medicine and Politics in America.
Szaszs steadfast commitment to individual freedom and liberty permeate his commentaries on drug laws, managed care, involuntary
hospitalization, and the fragile state of psychotherapy. This interview also explores the nuances of his work on the myth of mental illness in light of recent discoveries in neuroscience. Szasz shares personal reflections of his long career, revealing his tenacity in the face
of personal and professional attacks, and his genuine passion for
humanistic values and social justice.
Keywords:

Szasz; mental illness; psychotherapy; freedom

Prolific writer and psychiatric critic, Thomas

Szasz, M.D., has never paused long enough
between his 26 books, hundreds of articles, and
speaking engagements to take stock of the substantial breadth of his career. Although his critics vilify him for challenging the psychiatric status quo, others view Szasz as a brilliant social
Journal of Humanistic Psychology, Vol. 44 No. 1, Winter 2004 71-85
DOI: 10.1177/0022167803261611
2004 Sage Publications

71

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Thomas Szasz Interview

commentator and as a man of courage for continuously speaking

his truth, even when his ideas were unpopular and threatening to
his career. He is as admired as he is critiqued, and even when he is
ignored, it is with great emotion. In person, he is a passionate orator, second to none in debating, and always entertaining with great
wit and satire. In this interview, Szasz is queried and cajoled into
dissecting his major contributions in light of current trends in psychiatry, psychotherapy, and the sociopolitical landscape.
Szaszs critique of the psychiatric and therapeutic establishment is more relevant now than ever as he confronts the contradictions inherent in combining managed care and psychotherapy. In
revisiting the myth of mental illness he refutes the argument
that recent discoveries in the neurosciences have rendered his thesis no longer relevant. Szaszs unflinching commitment to human
freedom is evident from his views on the dangers of drug laws,
involuntary hospitalization, and the medicalization of social
problems. He sheds light on the intertwining nature of civil
and psychotherapeutic liberty, and the necessity of both, if selfunderstanding is to be openly and effectively pursued. Szasz also
shows the human aspect of these issues by demonstrating how
day-to-day decisions and choices of those in power in our institutions, governments, and the helping professions can support or
undermine the values of freedom and responsibility.
Throughout this dialogue, Szasz follows a methodical approach
to each topic, his voice measured yet impassioned. He shares personal reflections and recollections of his long career, revealing his
tenacity, caring, and genuine passion for humanistic values and
social justice. Dr. Szasz is currently Professor Emeritus at SUNY
Health Science Center in Syracuse, New York, where he has taught
since 1958.
THE MYTH OF MENTAL ILLNESS 101
Wyatt: I am going to ask you a wide variety of questions, given the diversity of your interests, and I want to make sure to also focus on your work
as a psychotherapist. A little background first. Youve been well-known
for the phrase, the myth of mental illness. In less than 1,000 words,
what does it mean?
Szasz: The phrase the myth of mental illness means that mental illness
qua illness does not exist. The scientific concept of illness refers to a
bodily lesion, that is, to a material, structural, or functional abnormal-

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73

ity of the body, as a machine. This is the classic, Victorian, pathological definition of disease, and it is still the definition of disease used
by pathologists and physicians as scientific healers.
The brain is an organlike the bones, liver, kidney, and so onand of
course can be diseased. Thats the domain of neurology. Since a mind
is not a bodily organ, it cannot be diseased, except in a metaphorical
sense in the sense in which we also say that a joke is sick or the economy is sick. Those are metaphorical ways of saying that some behavior or condition is bad, disapproved, causing unhappiness, etc. In
other words, talking about sick minds is analogous to talking about
sick jokes or sick economies. In the case of mental illness, we are
dealing with a metaphorical way of expressing the view that the
speaker thinks there is something wrong about the behavior of the
person to whom he attributes the illness.
In short, just as there were no witches, only women disapproved and
called witches, so there are no mental diseases, only behaviors of
which psychiatrists disapprove and call them mental illnesses.
Lets say a person has a fear of going out into the open. Psychiatrists
call that agoraphobia and claim it is an illness. Or if a person has odd
ideas or perceptions, psychiatrists say he has delusions or hallucinations. Or he uses illegal drugs or commits mass murder. These are all
instances of behaviors, not diseases. Nearly everything I say about
psychiatry follows from that.
Wyatt: Lets say that modern science, with all the advances in genetics
and biochemistry, finds out that there are some behavioral correlates of biological deficits or imbalances, or genetic defects. Lets say
people who have hallucinations or are delusional have some biological deficits. What does that make of your ideas?
Szasz: Such a development would validate my views, not invalidate
them, as my critics think. Obviously, I dont deny the existence of
brain diseases; on the contrary, my point is that if mental illnesses
are brain diseases, we ought to call them brain diseases and treat
them as brain diseasesand not call them mental illnesses and
treat them as such. In the 19th century, madhouses were full of people who were crazy; more than half of them, as it turned out, had
brain diseases, mainly neurosyphilis, or brain injuries, intoxications, or infections. Once that was understood, neurosyphilis ceased
to be a mental illness and became a brain disease. The same thing
happened with epilepsy.
Wyatt: Its interesting, because a lot of students of mine, and colleagues,
who have read your work or heard of your ideas, think that when a
condition previously thought to be mental is found to be a brain disease, as noted, your ideas become moot.
Szasz: Thats because they are not familiar with the history of psychiatry, dont really understand what a metaphor is, and dont want to
see how and why psychiatric diagnoses are attached to people. Ted
Kaczynski, the so-called Unabomber, was diagnosed as schizophrenic by government psychiatrists. If people want to believe that a
genetic defect causes a person to commit such a series of brilliantly

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conceived crimesbut that when a person composes a great symphony,

thats due to his talent and free willso be it.
Objective, medical diagnostic tests measure chemical and physical
changes in tissues; they do not evaluate or judge ideas or behaviors. Before there were sophisticated diagnostic tests, physicians had a hard
time distinguishing between real epilepsy, that is to say, neurologiccal
seizuresand what we call hysterical seizures, which is simply faking epilepsy, pretending to have a seizure. When epilepsy became understood as due to an increased excitability of some area of the brain,
then it ceased to be psychopathology or mental illness and became
neuropathology or brain disease. It then becomes a part of neurology.
Epilepsy still exists. Neurosyphilis, though very rare, still exists and is
not treated by psychiatrists; it is treated by specialists in infectious
diseases, because its an infection of the brain.
The discovery that all mental diseases are brain diseases would mean the
disappearance of psychiatry into neurology. But that would mean that
a condition would be a mental disease only if it could be demonstrated,
by objective tests, that a person has got it, or has not got it. You can
proveobjectively, not by making a clinical diagnosisthat X has
neurosyphilis or does not have it; but you cannot prove, objectively, that
X has or does not have schizophrenia or clinical depression or posttraumatic stress disorder. Like most nouns and verbs, the word disease
will always be used both literally and metaphorically. As long as psychiatrists are unwilling to fix the literal meaning of mental illness to an
objective standard, there will remain no way of distinguishing between
literal and metaphorical mental diseases.
Wyatt: Psychiatrists, of course, dont want to be pushed out of the picture.
They want to hold on to schizophrenia as long as they can, and now depression and gambling, and drug abuse, and so on, are proposed as biological or genetically determined. Everything is thought to have a genetic marker, perhaps even normality. What do you make of this?
Szasz: Psychiatrists have created some very famous diseases for which
they never apologized, the two most recent ones being masturbation
and homosexuality. I hardly know what to say about this silliness. Unless a person understands the history of psychiatry and something
about semantics, its very difficult to deal with this. Diagnoses are NOT
diseases. Period. People with these so-called diseases were tortured by
psychiatrists for hundreds of years. Children were tortured by
antimasturbation treatments. Homosexuals were incarcerated and
tortured by psychiatrists. Now all that is conveniently forgotten, while
psychiatristsprostitutes of the dominant ethicinvent new diseases,
like the ones you mentioned.
The war on drugs is the current psychiatric-judicial pogrom. And so is the
war on children called hyperactive, where children are poisoned in
schools with the schedule II dangerous drug methylphenidate, which,
when called Ritalin, is a miracle cure for them. The Drug Enforcement Administration classifies Ritalin as among the most dangerous
and most addictive drugs that can be legally prescribed, such as opiates, methadone, barbiturates, and amphetamines. (Dexedrine, an am-

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phetamine, and a close chemical cousin of Ritalin, is also widely

prescribed for hyperactive children.)
Let me mention another, closely related characteristic of psychiatry, as
distinct from the rest of medicine. Only in psychiatry are there patients who dont want to be patients. This is crucial because my critique of psychiatry is two pronged. One of my criticisms is conceptual: that is, that mental illness is not a real illness. The other one is
political: that is, that mental illness is a piece of justificatory rhetoric, legitimizing civil commitment and the insanity defense. Dermatologists, ophthalmologists, gynecologists, dont have any patients
who dont want to be their patients. But the psychiatrists patients
are paradigmatically involuntary.
Originally, all mental patients were involuntary, state hospital patients. That concept, that phenomenon, still forms the nucleus of
psychiatry. And that is what is basically wrong with psychiatry. In
my view, involuntary hospitalization and the insanity defense ought
to be abolished, exactly as slavery was abolished, or the disfranchisement of women was abolished, or the persecution of homosexuals
was abolished. Only then could we begin to examine so-called mental illnesses as forms of behavior, like other behaviors.

SLAVERY, WITCHCRAFT, AND PSYCHIATRY

Wyatt: In terms of involuntary hospitalization and coercive psychiatry,
which youve critiqued in your works . . .
Szasz: Excuse me, all psychiatry is coercive, actually or potentially
because once a person walks into a psychiatrists office, under certain conditions, that psychiatrist has the legal right and the legal
duty to commit that person. The psychiatrist has the duty to prevent
suicide and murder. The priest hearing confession has no such duty.
The lawyer and the judge have no such duties. No other person in society has the kind of power the psychiatrist has. And that is the
power of which psychiatrists must be deprived, just as White men
had to be deprived of the power to enslave Black men. Priests used to
have involuntary clients. Now we call that forcible religious conversion and religious persecution; it used to be called practicing the
true faith or loving God. Now we have forcible psychiatric conversion and psychiatric persecution and we call that mental health
and therapy. It would be funny if it were not so serious.
Wyatt: The symbolic nature of psychiatry and the sociology of psychiatry are coercive, certainly. Yet, every act isnt literally coercive.
Somebody comes to a doctor and says, I cant sleep. Im depressed.
can you give me something to help me go to sleep, help wake me up?
Thats a free exchange.
Szasz: Thats correct. There are voluntary psychiatric exchanges, at
least in principle. As I like to say, I wholeheartedly approve of psychiatric acts between consenting adults. But such acts are pseudomedi-

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cal in nature, because the problem at hand is not medical, and also because the transaction often rests on taking advantage of the
criminalization of the free market in drugs. Why do you have to go to a
doctor to get a sleeping pill or a tranquilizer? A hundred years ago you
didnt have to do that, you could go to a drug store, or to Sears Roebuck,
and buy all the drugs you wantedopium, heroin, chloral hydrate. In
certain ways, the psychiatric profession lives off the fact that only physicians can prescribe drugs, and the government has made most drugs
that people want prescription drugs.
Wyatt: On a side note, isnt it interesting, and troubling, that a higher percentage of people who go to jail for drug abuse, or drug selling, are Black
and minority, and those that have the license to prescribe are often
nonminority, and they get to be heroes in society for essentially selling
what is sometimes the same merchandise, albeit legally, of course?
Szasz: Indeed. I discuss that new form of Black enslavement in detail in
my book, Our Right to Drugs. Because of the kinds of laws we have, physicians prescribe mood-altering drugs, which patients often want and
demand; its a medicalized version of drug distribution. Physicians did
the same thing with liquor during Prohibition, which was quite
lucrative.
Wyatt: And now psychiatry and pharmacology can be a lucrative business.
Szasz: Psychiatry is a lucrative business only insofar as it partakes of
these two medica-psychiatric privileges or monopolies prescribing psychoactive drugs, which mostly only licensed physicians can do; and creating their own patients, that is, transforming people into patients
against their will, which only psychiatrists can do.

THE RIGHT TO USE DRUGS

Wyatt: So what is your view on psychiatric medication for people suffering
from schizophrenia or problems in living as you call it, or interpersonal difficulties, or intrapsychic difficulties? Whatever you call it, people suffer or are troubled internally or interpersonally. What is your
view on the use of either legal or illegal drugs to help people cope with
these struggles?
Szasz: I wouldnt phrase the question this way. In my opinion, using drugs
is a fundamental human right, similar to using books or prayer. Hence,
it comes down to the question of what does a person want and how can
he get what he wants? If a person wants a book, he can go to a store and
get it or get it on the Internet. He ought to be able to get a drug the same
way. If he doesnt know what to take, then he could go to a doctor or a
pharmacist and ask them. And then he should be able to go and buy it.
Wyatt: That brings up the issue of drug and prescription laws, which you
have written about extensively.
Szasz: Indeed. Prescription drug laws are a footnote to drug prohibition.
Prescription laws should be repealed. All drug laws should be repealed.
Then, people could decide for themselves what helps them best to relieve their existential and personal struggles, assuming they want to do

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it with a drug: opium or marijuana or cigarettes or Haldol or Valium.

After all, the only arbiter of what ails a person mentally and what
makes him feel or function better, as he defines better, is the patient.
We dont have any laboratory tests for neuroses and psychoses.
As for insomnia, typically thats a complaint, an indirect communication, to obtain sleeping pills. A person cant go to a physician and tell
him: Please write me a prescription for a barbiturate. If he did that,
he would be diagnosed and denounced as an addict. So he must say:
I cant sleep. How could the doctor know if thats true?
Wyatt: You ask him how many hours he sleeps, he says 2 hours a night.
Szasz: How would the doctor know if thats true? The term insomnia
can function as a strategic lie that the patient has to utter to get the
prescription he wants.

THE THERAPEUTIC STATE AND THE MEDICAL MODEL

Wyatt: You seem to have a different view of the medical model of medicine, than the medical model of psychiatry.
Szasz: Yes, very much so. We dont speak of the medical model of medicine in medicine or the medical model of pneumonia. There is no
other model. We dont speak of the electrical model of why a light
bulb emits light. Language is very important. If a person says: I am
against the medical model of mental illness, that implies that mental illness exists and that there is some other model of it. But there is
no mental illness. There is no need for any model of it. The important
issue is not the medical model, a badly abused term; the issue is the
pediatric model, the irresponsibility modeltreating people labeled
as mentally ill as if they were little children and as if the psychiatrist was their parent. The pillars of psychiatry are medically rationalized and judicially legitimized coercions and excuses.
Wyatt: If you were to use mental illness as a metaphor, or pseudonym
for disease meaning dis-ease, people are personally distressed, the
psychosocial model of mental illness. Or, if you substitute emotional
troubles?
Szasz: No. That wont do. Almost anything can be the cause of emotional
troublebeing Black or being poor or being rich, for that matter. Innumerable human conditions can create human distress. Which
ones are we going to medicalize, and which ones are we not? We used
to medicalize, psychiatrize, Blacks running away from slavery, masturbation, homosexuality, contraception. Now we dont. Instead we
medicalize what used to be called melancholia, and sloth, and selfmurder, and racism, and sexism.
Wyatt: To shift gears . . .
Szasz: Lets not yet. Because I want to add that it is this tendency to call
more and more human problems diseases and then try to remedy
them, or attack them, as if they were diseases is what I call the
therapeutic state.

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Wyatt: Certainly everything used to be viewed religiously, and now so

much is seen as medical. The transformation is almost complete.
Szasz: Exactly! And its perfectly obvious. It requires the systematic, educational, and political dumbing down of people not to see it. Three hundred years ago, every human predicament was seen as a religious
sickness, poverty, suicide, war. Now they are all seen as medical problemsas psychiatric problems, as caused by genes and curable with
therapy. In the past, the criminal law was imbued with theology; now,
its imbued with psychiatry.
Wyatt: President Bill Clinton is a prime example of how we use different
models to describe the same problem. His wife said his problems were
due to emotional problems in his childhood. His brother said he was a
sex addict, because he was a drug addict, himself. And Bill Clinton said
it was a sin issuethe religious model. He went to a minister.
Szasz: Thats a good point. But note that Clinton didnt go to a real minister. He went to a politicianJesse Jackson. His job was to make Clinton
look good again. And he did it. Clinton handpicked him as he did the
others, much as a medieval emperor might have handpicked a bishop to
make him look good.
Wyatt: Can I shift gears now?
Szasz: Sure.

LIBERTY AND THE PRACTICE OF PSYCHOTHERAPY

Wyatt: Youre known as a libertarian.
Szasz: Yes, I am a libertarian.
Wyatt: Its a philosophical view, an economic and political view. What does
that mean in terms of practicing psychotherapy?
Szasz: Ill start at the end, so to speak. If you use language carefully and
are serious about libertarianism and psychiatry, then the term libertarian psychiatrist is, quite simply, an oxymoron. Libertarianism means
that individual liberty is a more important value than mental health,
however defined. Liberty is certainly more important than having psychiatrists lock you up to protect you from yourself. Psychiatry stands or
falls with coercion, with civil commitment. Noncoercive psychiatry is
also an oxymoron. This is one of the main reasons why I never considered myself a psychiatrist because I always rejected psychiatric
coercions.
Now, in term of political philosophy, libertarianism is what, in the 19th
century, was called liberalism. Nowadays its sometimes also called
classical liberalism. Its a political ideology that views the state as an
apparatus with a monopoly on the legitimate use of force and hence a
danger to individual liberty. Contrariwise, the modern liberal view regards the state as a protector, a benevolent parent who provides security for its citizens as quasi-children. To me, being a libertarian means
regarding people as adults, responsible for their behavior; expecting
them to support themselves, instead of being supported by the government; expecting them to pay for what they want, instead of getting it

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from doctors or the state because they need it; its the old Jeffersonian idea that he who governs least, governs best. The law should
protect people in their rights to life, liberty, and property from other
people who want to deprive them of these goods. The law should not
protect people from themselves.
This means that, as far as possible, medical care ought to be distributed, economically speaking, as a personal service in the free market. There is much wisdom in the adage, People pay for what they
value, and value what they pay for. Its dangerous to depart too far
from this principle.
Wyatt: Why does money necessarily have to come into it? If people have
less money, they cant afford as much as others who have more
money. A poor person can benefit from therapy.
Szasz: Of course. The issue you raise confuses the quest for egalitarianism with the concepts of health or psychotherapy and also with the
quest for health. Why should psychotherapy be dispensed in a more
egalitarian manner than anything else? Also, people often value
things other than health more highly than they value health, such
as adventure, danger, excitement, smoking.
Let me elaborate on this. Economists and epidemiologists have shown,
beyond a shadow of a doubt, that the two variables that correlate
most closely with good health are the right to property and individual liberty, the free market. The people who enjoy the best health today are people in the Western capitalist countries and in Japan; and
those in the poorest health are the people who enjoyed the blessings
of 80 years of paternalistic statist, communism. In the Soviet Union,
where peoples political liberty and economic well-being were systematically undermined by the statewhere they enjoyed equal
misery for alllife expectancy dropped from more than 70 years to
about 55 years. During the same period, in advanced countries, it increased steadily and is now almost 80. And medical care has little to
do with it, since Russia had access to medical science and technology.
Its primarily a matter of lifestyleof what used to be called good
habits versus bad habits. And of good public health, in the sense of
having a safe physical environment.

PSYCHOTHERAPY, SZASZ STYLE

Wyatt: You wrote, The Ethics of Psychoanalysis in 1965. That was your
diving into psychotherapy, psychoanalysis, autonomy, the role of the
therapist. What do you have to say about what is useful in psychotherapy? What theories do you hold to or do you find valuable? When
youre in a free relationship of psychotherapysimply put, one person helping another with their personal issueswhat have you
found to be helpful, and what theories have you used in your own
work?
Szasz: You are asking two questions: what did I find useful or interesting and what theories did I use. The kind of therapy one does, if one

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does it well, in my opinion, is selected and depends primarily on the

therapist. Different people have different temperaments about how to
relate to other people. Because the therapeutic relationship is an intimate, human relationship with another human being, the kind of psychotherapy that makes sense to therapists reflects the kind of person
they are. In this respect, psychotherapy could not be more different
from physical therapies in medicine. The proper treatment of diabetes
does not depend, and ought not to depend, on the doctors personality.
Its a matter of medical science. On the other hand, the proper treatment of a person in distress seeking help is a matter of values and
personal styles, on the parts of both therapist and patient.
The proper analogies to psychotherapy are not medical treatment but
marriage or raising children. How should a man relate to his wife, and
vice versa? How do you raise your child? Different people relate differently to their wives or husbands or children. As long as their lifestyle
works for them, thats all there is to it. So, first I say that I believe that
any kind of so-called therapyany kind of human-helping situation
that makes sense to both participants and that can be entered and exited and conducted wholly consensually, voluntary, and that is devoid of
force and fraudany and all of that is, by definition, helpful. If it were
not helpful, the client wouldnt come and pay for it. The fact that a client
returns and pays for what he gets from a therapist is prima facie
evidence for me, that he finds it helpful.
I would compare it, once again, to religion, to going to church. Personally,
Im not religious. But I respect religions and people who find solace in
their faith. Millions of persons the world over continue to go to church.
They wouldnt be going to church if they didnt find it helpful, assuming
theyre not just going for purely social reasons, in which case they still
find it useful, though not for strictly theological reasons.
Wyatt: What was your initial interest in becoming a psychiatrist?
Szasz: I was never interested in becoming a psychiatrist and never considered myself a psychiatrist. Psychiatry was a category I had to operate
in, given the society in which we live. I was interested in psychotherapy,
in what seemed to me the core of the Freudian premiseand promise,
which, unfortunately, never materialized as a professional code. Freud
and Jung and Adler had a very good ideathat is, that two people, a
professional and a clientget together, in a confidential relationship,
and the one tries to help the other live his life better. Each of these pioneers emphasized a different aspect of how best to go about this business. There are three aspects to life: the past, the present, and the future. Freud dwelled on the past, Jung dwelled on the future, and Adler
(and Rank) dwelled on the present. All of these make sense. But all this
has to be tailored to whether or not it makes sense to the patient.
Wyatt: How does this play out in terms of the therapeutic relationship?
Szasz: The relationship has to be wholly cooperative. The two people may
meet only a few times, or they meet many times over many years. The
therapist is the patients agent. This doesnt mean that he must agree
with everything the patient believes or wants; far from it. But it means
that the therapist is prohibitedby his own moral codefrom doing

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anything against the patients interest, as the patient defines his interest. That is part of my idea of the contract with the patient. Thats
why I titled my book, The Ethics of Psychoanalysis. Therapy is a
matter of ethics, not technique.
It was crucial that my patients selected themselves. They came when
they wanted; they came to see me, because they wanted to see me,
not someone else. And there wasnt any of this business about being
ready to end therapy. Just as the patient decided when or whether
to begin therapy, so he decided when or whether to end therapy.
There isnt any of this business that the therapist has to change the
patient, or make him better, or control his behavior, or protect him
from himself, and so forth. It is up to the patient to change himself.
The therapists job is to help him change in the direction in which the
patient wants to change, provided thats acceptable to the therapist.
If its not acceptable, then it is therapists job to discuss that with the
patient and end the relationship.
Wyatt: What are the expectations of the patient then?
Szasz: The patient doesnt have to do anything except pay. This sounds
like a selfish joke. It is not. It is important. Its up to the patient what
he or she takes away from the situation. The situation is similar to
what happens in school, especially at the university level. If you go to
school and have to pay for it, the idea is that you should learn something. But there is no coercion. At the end of it, if you dont learn
something, thats your business. Its your loss.
Wyatt: You mentioned that change isnt a prerequisite, yet most people
want some change.
Szasz: Its not that simple. People want to change and they also dont
want to change. The behavior that the patient wants to change must,
in some waythis is very Freudianbe also functional for the patient, or else he would already have changed it, without formal therapy. People can and do change themselves.
Wyatt: Adaptive?
Szasz: Adaptive. Exactly. So-called mental symptoms are rather unlike
medical symptoms. A cough, say, if you have pneumonia, is adaptive:
it rids the body of mucus and infectious material and tissue debris as
sputum. But its adaptive in this or other similar pathological situation only. Its not adaptive to you as a human being. But a phobia,
anxiety, depression, etc. maybe adaptive as some kind of a life strategy, economic or interpersonal strategy.
Wyatt: Your goal for psychotherapy, that is, the fully functioning human, is to increase their autonomy. You did have that as a goal.
Szasz: That was my underlying goal, which I communicated [to my clients] as the ethical principle. My premise is that responsibility is,
morally speaking, anterior to liberty. So if a person wants to gain
more freedomin relation to his fears, his wife, his work, etc.he
must first assume more responsibility (than he has been) toward
them; then he will gain more liberty in relation to them. The goal is
to assume more responsibility and therefore gain more liberty and
more control over ones own life. The issues or questions for the pa-

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tient become to what extent is he willing to recognize his evasions of

responsibility, often expressed as symptoms.
Wyatt: Thats a dialogue.
Szasz: Yes, that is likely to be a focus of the therapeutic dialogue. Actually,
some people say they want to do this or thatsay stop smoking or be a
better parentbut they dont really want to do it, dont want to forego
the pleasures of smoking or experience the burdens of caring for a dependent. A person comes to see a therapist and says that he wants to
kill himself. Obviously, thats not all he wants. He also wants psychotherapy. In short, people are often ambivalent about basic choices. Ambivalence is not a pathological symptom; it a normal, appropriate mental state of many people, in many situations.
Wyatt: Coming back to therapy, again, youre not practicing any more?
Szasz: No, but I did for 45 years.
Wyatt: What was the most difficult and what was the most satisfying aspects for you in working with people one-to-one?
Szasz: I found practicing therapy very satisfying and not at all arduous. I
left Chicago for Syracuse mainly to escape having to fully support myself from doing therapy, which can create financial temptations to make
the client dependent on therapy. Of course, everyone who does therapy
is likely to say it, but I think a lot of people benefited from having a
conversation with me.
Wyatt: With all your work in politics and philosophy, your work on psychotherapy is overlooked. That you were in the trenches, helping people,
conversing with them.
Szasz: And many of the people I saw would have been diagnosed as very
sick by other people. Some of them would have been diagnosed as psychotic and put on psychiatric drugs.
Wyatt: You never prescribed?
Szasz: No. Never when practicing psychiatrypsychotherapyI never
prescribed a drug. I never gave insulin shock or electric shock. I never
committed anyone. I never testified in court that a criminal was not responsible for his crimes. I never saw, as a patient, anyone who did not
want to see me. I went into psychiatry with my eyes wide open. I never
viewed psychiatry or psychotherapy as a part of medicine. Perhaps I
should add, though it should be obvious, that I had no objections to the
patient taking drugs or doing anything else he wanted. As far as I was
concerned, things outside the consulting room were not my business
in the sense that if the patient wanted to take drugs, he had to go to a
doctor and get them, just as if he wanted a divorce, he had to go to a
lawyer.
Wyatt: With the laws today, its very hard for a therapist or a psychiatrist
to practice psychotherapy. You can shy away from involuntary hospitalization, or other state mandates, or insurance demands, but when push
comes to shove, you are pressured to break confidences or end up in
trouble.
Szasz: Thats putting it mildly. For all practical purposes, its impossible. It
is the hallmark of totalitarianism that there can be no personal secrets
from the state. Thats why I call our present political system a thera-

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83

peutic state. Such a state is your friend, your benefactor, your doctor. Why should you want to hide anything from it? Keep in mind
that it was impossible to do real psychotherapy in Soviet Russia, too,
or in Nazi Germany. Suppose someone came to you in Nazi Germany
and said, Im harboring Jews in my cellar. If you did not report that,
you ran the risk of being put in a concentration camp and gassed. Today, if you dont report that the patient is suicidal, or homicidal, or a
child abuser, among other mandates, you are asking for trouble. So
confidential psychotherapy is kaput, finished. Therapists and
patients kid themselves that it isnt.
What can you do? Nothing. We have managed to make the free practice
of psychotherapy de facto illegal! The psychotherapist has been
transformed into a reporting agent, an agent of the state whose job is
to betray his patient. Child abuse, drug abuse, violence, suicidethe
therapist must stop, must prevent, all these things. The therapist
must be a policeman pretending to be therapist. Increasingly, people
complain about one or another of these problems of confidentiality,
but they dont see the larger picture. They dont see that this has to
do with the alliance of psychiatry and psychotherapy with the state,
replicating the alliance of church and state and all its implications.
Wyatt: Even more so, when people go to a therapist who is working under managed care, they have to have enough problems to get in the
door to see the therapist and talk, or get drugs, but not too many
problems. If they have too many problems theyre seen as chronic,
and they cant get help. Do you think a therapist working under
managed care is able to freely practice psychotherapy? Is the client
free to work in psychotherapy?
Szasz: Psychotherapy under managed care is a bad joke. Its like religion under managed care, or education under managed care. Even
medical care gets complicated and contaminated if the direct relationship between doctor and patient is disrupted by the input of
third parties, if the patient doesnt, in some form, pay for what he
gets, and if he cant get what he wants with the money he pays.
Modern psychotherapy is based on psychoanalysis, and the psychoanalytic relationship was based on the relationship between priest
and penitent in the confessional. The crux of the confessional is selfaccusation on the part of the penitent, and the secure promise, by the
priest, that the confession he hears will and can have no consequences for the self-accuser in this world (but only in the next). A
priest hearing confession and working as a spy for the state would be
a moral obscenity. Not in the darkest days of totalitarianism did
such a thing occur.
What is truly ugly about psychotherapy today is that many patients labor under the false belief that what they say to the therapist is confidential. The same thing is true for psychotherapy based on confidentiality and on the premise that the patient accuses himself in the
hope that, by so doing and with the help of the therapist, he might be
able to change himself. Yet if the patient utters certain thoughts and
words, the therapist will report them to the appropriate authorities,

84

Thomas Szasz Interview

and they may be deprived of liberty, of their job, of their good names,
and so forth.
Now, it should be clear that to place psychotherapy under the control of an
insurance company or the statethats just heaping nonsense upon
nonsense. We can still call it psychotherapy, and we can treat it as if doing psychotherapy, curing souls, were in principle no different from
doing orthopedic surgery, setting a fractured bone. But, psychotherapy
is like going to church. You go there voluntarily for a certain kind of service from a certain person. And its spiritual. Its not physical.

CRITICS AND HEROES

Wyatt: Youve had a lot of critics in your career.
Szasz: You can say that again!
Wyatt: Maybe an enormous amount! In your book, Insanity, you point out
all the critics.
Szasz: Not all of them!
Wyatt: You couldnt mention all of them?
Szasz: No. Just a few (laughter).
Wyatt: How do you deal with this? Youre one of the most criticized psychiatrists in history. I dont know of anyone who is as criticized as you are.
Szasz: I was very fortunate. I had very good parents, a very good brother, a
very good education as a child in Budapest. I have very fine children,
good friends, good health, good habits, a fair amount of intelligence. Really, I have always felt blessed. It also helped a lot that I felt there were
many people who agreed with methat what Im simply saying is simply 2 + 2 = 4but that many people are afraid to say this when it is personally and politically improvident to do so. I havent made any scientific discoveries. Im simply saying that if you are White and dont like
Blacks, or vice versa, thats not a disease, its a prejudice. If youre in a
building that you cant get out of, thats not a hospital, its a prison. I
dont care how many people call racism an illness or involuntary
mental hospitalization a treatment.
Wyatt: Did the criticism ever get you down?
Szasz: Of course it did, especially when people actually wanted to injure
mepersonally, professionally, legally. No need to get into that. I tried
to protect myself and escaped, luckily enough. I found boundless support in literature, in the great writers. Ibsen said, among other things,
that the compact majority is always wrong.
Wyatt: My last question. In addition to being criticized a great deal, you
are also somewhat of a hero to others, in what youve fought for: liberty,
individual rights, and increased freedoms with responsibility. Who are
the your heroes, since childhood and now?
Szasz: Where should I start? There are many: Shakespeare, Goethe, Adam
Smith, Jefferson, Madison, John Stuart Mill, Mark Twain, Mencken.
Tolstoy, Dostoyevski, Chekhov. Orwell, C. S. Lewis. Ludwig von Mises,
F. A. Hayek,. Camus, and Sartre, though personally and politically,
Sartre is rather despicable. He was a communist sympathizer. He was

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85

willing to overlook the Gulag. But he was very insightful into the human condition. His autobiography is superb. His book on antiSemitism is important.
Wyatt: Camus challenged Sartre.
Szasz: Yes, Camus broke with him, mainly about politics. Camus was a
much better person, a much more admirable human being. He was
also a terrific writer.
Wyatt: We could go on about how each of them influenced you, I am sure
of it, another day perhaps. I want to thank you for being with us today. I am sure readers will appreciate your candor.

SELECTED WORKS BY AND ABOUT THOMAS SZASZ

Szasz, T. S. (1965). The ethics of psychoanalysis: The theory and method of
autonomous psychotherapy. New York: Dell Publishing.
Szasz, T. S. (1984). The myth of mental Illness: Foundations of a theory of
personal conduct (Rev. ed.). New York: Quill.
Szasz, T. S. (1988). The myth of psychotherapy: Mental healing as religion,
rhetoric, and repression. New York: Syracuse University Press.
Szasz, T. S. (1987). Insanity: The idea and its consequences. New York: John
Wiley.
Szasz, T. S. (1996). Our right to drugs: The case for a free market. New York:
Syracuse University Press.
Szasz, T. S. (2001). Pharmacracy: Medicine and politics in America. New
York: Praeger.
The Thomas S. Szasz Cybercenter for Liberty and Responsibility: www.
szasz.com
Weinberg, L. S., Szasz, T. S., & Vatz, R. E. (1983). Thomas Szasz: Primary
values and major content. New York: Prometheus Books.
Reprint requests: Randall C. Wyatt, Alliant International University, CSPP, San
Francisco Bay Campus, 1005 Atlantic Avenue, Alameda, CA, 94501; e-mail:
rcwyatt@LMi.net.