What is up with Dr. Thomas Szasz?

I know Szasz is the name to drop when I want to rile up a debate about the state of psychiatry in America. As a proponent of the Anti-Psychiatry movement in the 60’s, Szasz ticked off – and continues to tick off – mainstream psychiatry with his belief that mental illness is a metaphor for bad and bizarre behavior and that the pharmaceutical industry and mainstream medical community have perverted treatment for these problems.

But Szasz went way over the top with an article in the Wall Street Journal on July 15. I have a problem Szasz’ comparison of car repairs to health “repairs.” Bizarre. ┬áBig difference between a humane society’s responsibility to pay for my car repairs versus my body “repairs.”

“The concept of reimbursable health-care service rests on the premise that the medical problem in need of servicing is the result of involuntary, unwanted happening, not the result of voluntary, goal-directed behavior. Leukemia, lupus, prostate cancer, and many infectious diseased are unwanted happenings. Are we going to county obesity, smoking, depression and schizophrenia as the same kinds of diseases?”

I don’t know where he gets that idea. I have never categorized medical problems “in need of servicing” under reimbursable health care as either voluntary or involuntary maladies. Carry Szasz’ logic a few steps further and you have to ask – who gets to decide whether a medical problem is voluntary or involuntary? I hope it is not Szasz.

Why wouldn’t we lump depression and schizophrenia in with “involuntary, unwanted happenings” such as leukemia and lupus? It has been nearly 50 years since Szasz began making his argument that mental illness should not be classified as a disease. Maybe back then, before the invention of CAT, PET and other technologies used in neuroimaging, Szasz’ theory kinda made sense. ┬áBut come on. In 1961, the year Szasz published his controversial book, The Myth of Mental Illness, IBM introduced the Selectric typewriter. That is how advanced technology was.

How much science do we need before we stop classifying mental illnesses as character defects or bad behavior? And let’s not use the argument that if you can’t find it during an autopsy it must not be a disease. Fifty years ago there were diseases that could not detected during an autopsy but that doesn’t mean these diseases were not real. It just means we did not have the knowledge and technology to detect them.

“Many American would willingly pay for insurance to protect them against exorbitant cost of treating their own leukemia,” Szasz wrote. “But how many Americans would willingly pay for insurance to protect them from the expenses of treating their own depression?”

He’s joking, right?

“Everyone with health insurance is compelled to protect himself from risks, such as alcoholism and erectile dysfunction, that he would willingly shoulder in exchange for a lower premium.”

Is Szasz saying that alcoholism and erectile dysfunction are “risks?” Really. The promise of lower insurance premiums would not have prevented my alcoholism.

I get upset about the beliefs of Szasz and others like him because they fuel the stigma that mental illness is not real. I have a lot of character defects. But my alcoholism, depression and bipolar are not among them. These I treat as illnesses. The way I behave when I am drunk, depressed or manic ARE my responsibility, but I am not responsible for acquiring these illnesses.