50 years ago Thomas Szasz rocked the world of psychiatry: The difference between a disease and a disorder

By Dr. Jeffrey Schaler
Assistant Professor of Justice, Law & Society

The Myth of Mental Illness by Thomas SzaszIt is fifty years now since Thomas Szasz rocked the world of psychiatry by writing The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. His work continues to have a profound impact on how we think about disease, behavior, liberty, justice, responsibility, and most important of all, what it means to be human.  Szasz has shown us how the idea of mental illness is used by the state to deprive innocent people of freedom, and guilty persons of justice.  Without the state involved, the medicalization of behavior means nothing.

He has shown us how the idea of mental illness functions as legal fiction within our legal system. In this sense, the idea of mental illness has been used much as the idea that African American slaves were considered three-fifths of a person. Persons labeled as mentally ill are now considered three-fifths of a person. It is as if there was a postscript at the bottom of the Bill of Rights that reads: “PS: For mentally healthy people only.”

The courts will not allow the idea of mental illness to be disproved, in much the same way that the idea that slaves could be three-fifths person was not allowed to be disproved. Today, mental illness as legal fiction maintains the institution of psychiatric slavery.

The Theraputic State by Thomas SzaszMental illness diagnoses have more to do with politics and science fiction, than medicine and science. Take for example the idea that people with a homosexual orientation are mentally ill. The category was excluded from the Diagnostic and Statistical Manual of Mental Disorders – our contemporary “Malleus Maleficorum,” or “Hammer of Witches” – the same way it was included, for political reasons, not scientific reasons. No one discovered that homosexuality was a disease, and no one discovered that it isn't a disease. They pronounced it as such, in each case, because of political pressure.

About two years after The Myth of Mental Illness was first published, Szasz published another book that has had an equally profound impact on freedom and responsibility. In Law, Liberty and Psychiatry he predicted the following:

“Although we may not know it, we have, in our day, witnessed the birth of the Therapeutic State. This is perhaps the major implication of psychiatry as an institution of social control.”

Thomas Szasz wrote that in 1963.

We live in a Therapeutic State today. Moral management now masquerades as medicine. The state dictates a “duty to be healthy.”

Seventy years ago another state, Nazi Germany, dictated a “duty to be healthy.” Back then, murder masqueraded as medicine. I think you all know what I'm referring to. We don't need a weatherman to know which way the wind blows.

Today, good health practices have become a social responsibility. Bad health practices are viewed as socially irresponsible behavior. When health and illness are applied to the mind and behavior, this means that people must think and speak and act the right way. Otherwise, they may end up in a prison called a mental hospital.

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