Randall C.

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. You've been well-known for the phrase, "the myth of mental illness." In less
than 1000 words, what does it mean?
Thomas 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 abnormality 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 organ like the bones, liver, kidney, and so on and of course can be diseased.
That's 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 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." Let's 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.
RW: Let's 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.
Let's say people who have hallucinations or are delusional have some biological deficits. What
does that make of your ideas?
TS: Such a development would validate my views, not invalidate them, as my critics think.
Obviously, I don't 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 diseases
and 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.RW: It's interesting, because a lot of students of mine, and colleagues, who have
read your work or heard of your ideas, think that when condition previously thought to be mental
is to be a brain disease, as noted, your ideas become moot.
TS: That's because they are not familiar with the history of psychiatry, don't really understand
what a metaphor is, and don't 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 conceived crimes but that when a person composes a great
symphony, that's due to his talent and free will so 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, neurological
seizures and 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 it's 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 prove objectively, not by making a "clinical diagnosis" that 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 post traumatic 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."
RW: Psychiatrists, of course, don't 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?
TS: I hardly know what to say about this silliness. Unless a person understands the history of
psychiatry and something about semantics, it's very difficult to deal with this. Diagnoses are
NOT diseases. Period.
Psychiatrists have had some very famous diseases for which they have never apologized, the two
most obvious ones being masturbation and homosexuality.
Psychiatrists have had some very famous diseases for which they have never apologized, the two
most obvious ones being masturbation and homosexuality. 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 psychiatrists prostitutes of the dominant ethic
invent new diseases, like the ones you mentioned. The war on drugs is the current psychiatricjudicial pogrom. And so is the war on children called "hyperactive," poisoned in schools with the
illegal street drug called "speed," which, when called "Ritalin," is a miracle cure for them.
Let me mention another, closely related characteristic of psychiatry, as distinct from the rest of
medicine. Only in psychiatry are there "patients" who don't 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, don't have any patients who don't want to be
their patients. But the psychiatrists' patients are paradigmatically involuntarily.
Dermatologists, ophthalmologists, gynecologists, don't have any patients who don't want to be
their patients. But the psychiatrists' patients are paradigmatically involuntarily.
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. Back to Top

Slavery, Witchcraft, and Psychiatry

RW: In terms of involuntary hospitalization and coercive psychiatry, which you've critiqued in
your works.
TS: Excuse me, all psychiatry is coercive, actually or potentially because once a person
walks into a psychiatrist's 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.
RW: The symbolic nature of psychiatry and the sociology of psychiatry are coercive. Yet, every
act isn't literally coercive. Somebody comes to a doctor and says, "I can't sleep. I'm depressed.
Can you give me something to help me go to sleep, help wake me up?" That's a free exchange.
TS: That's 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
pseudo-medical 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 didn't have to do that, you could go to a drug store, or to Sears Roebuck, and buy all the
drugs you wanted opium, 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.
RW: On a side note, isn't it interesting, and troubling, that most 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 non-minority, and they get to be heroes in society for essentially selling what is sometimes
the same merchandise, albeit legally, of course?
TS: 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; it's a medicalized version of drug distribution. Physicians did
the same thing with liquor during Prohibition, which was quite lucrative
.RW: And now psychiatry and pharmacology can be a lucrative business. TS:
Psychiatry is a lucrative business only insofar as it partakes of these two medical-psychiatric
privileges or monopolies prescribing drugs, which only licensed physicians can do; and
creating their own patients, that is, transforming people into patients against their will, which
only psychiatrists can do.
Psychiatry is a lucrative business only insofar as it partakes of these two medical-psychiatric
privileges or monopolies prescribing drugs, which only licensed physicians can do; and
creating their own patients, that is, transforming people into patients against their will, which
only psychiatrists can do. Back to Top

The Right to Use Drugs

RW: 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 "intra-psychic
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
things? TS: I am smiling because I know you know my views! However, I wouldn't 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 doesn't 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.RW: That brings up the issue of drug and prescription laws, which you have written about
extensively. TS: 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 ails, assuming they want to do 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 don't have any laboratory tests for neuroses and psychoses.
As for insomnia, typically that's a complaint, an indirect communication, to obtain sleeping pills.
A person can't 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 can't sleep."
How could the doctor know if that's true?RW: You ask him how many hours he sleeps, he says
two hours a night. TS: How would the doctor know if that's true? The term "insomnia" can
function as a strategic lie that the patient has to utter to get the prescription he wants. Back to
Top

The Therapeutic State and the Medica Model

RW: You seem to have a different view of the medical model of medicine, than the medical
model of psychiatry. TS: Yes, very much so. We don't speak of the medical model of medicine in
medicine or the medical model of pneumonia. There is no other model. We don't 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 model" treating 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.RW: If you were to use mental
illness as a metaphor, or pseudonym... disease meaning "dis-ease," people are personally
distressed, the psychosocial model of mental illness. If you substitute "emotional troubles". TS:
No. That won't do. Almost anything can be the cause of emotional trouble being 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 don't. Instead we medicalize what used to be called melancholia, and
sloth, and self-murder, and racism, and sexism.RW: To shift gears. TS: Let's 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."
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."RW:
Certainly everything used to be viewed religiously, and now so much is seen as medical. The
transformation is almost pure. TS: Exactly! And it's 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 problem sickness, poverty, suicide, war. Now they
are all seen as medical problems as psychiatric problems, as caused by genes and curable with
"therapy." In the past, the criminal law was imbued with theology; now, it's imbued with
psychiatry.RW: 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 issue the religious model. He went to a minister. TS: That's a good
point. But note that Clinton didn't go to a real minister. He went to a politician Jesse Jackson.
His job was to make Clinton look good again. And he did it. Clinton hand-picked him as he did
the others, much as a medieval emperor might have hand picked a bishop to make him look
good.RW: Can I shift gears now? TS: Sure. Back to Top

Liberty and the Practice of Psychotherapy

RW: You're known as a libertarian.
TS: Yes, I am a libertarian.

RW: It's a philosophical view, an economic and political view. What does that mean in terms of
practicing psychotherapy? TS: I'll 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. Non-coercive 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 it's sometimes also called "classical liberalism." It's 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 from doctors or the state because they need it; it's 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." It's dangerous to depart too far from this
principle.RW: Why does money necessarily have to come into it? If people have less money,
they can't afford as much as others who have more money. A poor person can benefit from
therapy. TS: 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 epidemiologist 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 people's political liberty and economic well being were systematically undermined by the
state where they enjoyed "equal misery for all" life 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. It's primarily a matter of life style of what used to be called good
habits versus bad habits. And of good public health, in the sense of having a safe physical
environment. Back to Top

Psychotherapy, Szasz Style

RW: You wrote, "The Ethics of Psychoanalysis" in 1965. That was your diving into
psychotherapy, psychoanalysis. What do you have to say about what is useful in psychotherapy?
What theories do you hold to or do you find valuable? When you're in a free relationship of
psychotherapy simply put, one person helping another with their personal issues what have
you found to be helpful, and what theories have you used in your own work? TS: 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 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.
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 doctor's personality. It's 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 life
style works for them, that's all there is to it. So, first I say that I believe that any kind of so-called
"therapy" any 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 fraud any and all of that is, by definition, helpful. If it were not helpful, the client
wouldn't 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, I'm 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 wouldn't be going to church if they didn't find it helpful,
assuming they're not just going for purely social reasons, in which case they still find it useful,
though not for strictly theological reasons.RW: What was your initial interest in becoming a
psychiatrist? TS: 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 premise - and
promise, which, unfortunately, never materialized as a professional code. Freud and Jung and
Adler had a very good idea that is, that two people, a professional and a client get 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.
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.RW: How does this play out in term of the therapeutic relationship? TS: 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 patient's agent. This doesn't mean that he
must agree with everything the patient believes or wants; far from it. But it means that the
therapist is prohibited by his own moral code from doing anything against the patient's
interest, as the patient defines his interest. That is part of my idea of the contract with the patient.
That's 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 wasn't 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 isn't 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 therapist's job is to help him
change in the direction in which the patient wants to change, provided that's acceptable to the
therapist. If it's not acceptable, then it is therapist's job to discuss that with the patient and end the
relationship.RW: What are the expectations of the patient then? TS: The patient doesn't have to
do anything except pay. This sounds like a selfish joke. It is not. It is important. It's 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 don't learn
something, that's your business. It's your loss.RW: You mentioned that change isn't a prerequisite,
yet most people want some change. TS: It's not that simple. People want to change and they also
don't want to change. The behavior that the patient wants to change must, in some way this is
very Freudian be also functional for the patient, or else he would already have changed it,
without formal therapy. People can and do change themselves.RW: Adaptive? TS: 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 it's adaptive in this or other similar pathological situation only. It's 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.RW: Your goal for psychotherapy, that is, the
fully-functioning human, is to increase their autonomy. You did have that as a goal. TS: 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
freedom in 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
one's own life.
The goal is to assume more responsibility and therefore gain more liberty and more control over
one's own life. The issues or questions for the patient become to what extent is he willing to

recognize his evasions of responsibility, often expressed as "symptoms."RW: That's a dialogue.

TS: Yes, that is likely to be a focus of the therapeutic dialogue. Actually, some people say they
want to do this or that say stop smoking or be a better parent but they don't really want to
do it, don't 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,
that's 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.RW: Come back home to therapy, again, you're not practicing
any more? TS: No, but I did for 45 years.RW: What was the most difficult and what was the most
satisfying for you in working with people one-to-one? TS: 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.RW: 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. TS: 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.RW: You never prescribed? TS: No. Never when practicing
psychiatry psychotherapy
I 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 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.RW: With the laws today, it's 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. TS: That's putting it mildly. For all
practical purposes, it's impossible. It is the hallmark of totalitarianism that there can be no
personal secrets from the state. That's why I call our present political system a "therapeutic
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 psychotherapy in Soviet Russia, too,
or in Nazi Germany. Suppose someone came to you in Nazi Germany and said, "I'm 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 don't 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 isn't.
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, suicide the 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 don't see the larger picture. They don't 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.RW: Even more so, when people go to a therapist who's 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 they're seen
as "chronic" and they can't 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? TS: Psychotherapy
under managed care is a bad joke. It's 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 doesn't, in
some form, pay for what he gets, and if he can't 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 self-accusation 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.
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.
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
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, and that therapists do not tell patients, up front,
that if they utter certain thought and words, the therapist will report them to the appropriate
authorities, 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 state that's 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 it's spiritual. It's
not physical.RW: We only have a couple of minutes left. I want to ask you one or two more
questions. It was a pleasure to talk about your therapy, because you get very little chance to talk
about that work given the vitriol surrounding many of your views. TS: Thank you. Back to Top

Critics and Heroes

RW: You've had a lot of critics in your career. TS: You can say that again!RW: Maybe an
enormous amount! In your book, Insanity, you point out all the critics. TS: Not all of them!RW:
You couldn't mention all of them? TS: No. Just a few (laughter).RW: How do you deal with this?

You're one of the most criticized psychiatrists in history, perhaps. I don't know anybody else
who's as criticized as you are. TS: 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 at lot that I felt there were many people who agreed with me that what I'm simply
saying is simply 2 + 2 = 4 but that many people are afraid to say this when it is personally and
politically improvident to do so. I haven't made any scientific discoveries. I'm simply saying that
if you are white and don't like blacks, or vice versa, that's not a disease, it's a prejudice.
If you're in a building that you can't get out of, that's not a hospital, it's a prison.
If you're in a building that you can't get out of, that's not a hospital, it's a prison. I don't care how
many people call racism an illness or involuntary mental hospitalization a treatment.RW: Did the
criticism ever get you down? TS: Of course it did, especially when people actually wanted to
injure me personally, 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."RW: My last question. In
addition to being criticized a great deal, you are also somewhat of a hero to a lot of people, in
what you've fought for, liberty, individual rights, and increased freedoms with responsibility.
Who are the your heroes, since childhood and now? TS: 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, he is rather despicable. He was a Communist
sympathizer. He was willing to overlook the Gulag. But he was very insightful into the human
condition. His autobiography is superb. His book on anti-Semitism is important.RW: Camus
challenged him. TS: 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.RW: 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 our readers will appreciate your candor. TS: Thank
you.