how the system workslast verified 2026-09-28

who was thomas szasz?

four words of his have outlived him: mental illness is a myth. they get used as a weapon by people who have not read the next paragraph. six pages into the 1960 article that made him famous, Szasz wrote that the suffering people bring to psychiatrists is “real enough,” and that what he was arguing about was the label and what gets done to people once it is applied. he was a physician and psychiatrist in private practice who saw patients for decades. he also wrote that all involuntary psychiatric hospitalization should be abolished and called it a crime against humanity, and in 1969 he co-founded an organisation with the Church of Scientology. here is the record, in his own words and his critics’, with the parts that are inconvenient for everybody left in.

the sentence almost nobody quotes

“While I have argued that mental illnesses do not exist, I obviously did not imply that the social and psychological occurrences to which this label is currently being attached also do not exist. Like the personal and social troubles which people had in the Middle Ages, they are real enough. It is the labels we give them that concerns us and, having labelled them, what we do about them.”

Thomas Szasz, “The myth of mental illness,” American Psychologist 1960;15(2), p. 118[1]

that is on the last page of the article whose title people fire at each other. it is the fifth paragraph from the end. he is not saying you are making it up. he is saying the thing you are going through is real and the word being used for it is doing work that a word for a disease should not be doing — and that the interesting question is not what to call it but what gets done to you once it has been called that. everything else on this page follows from that distinction, including the parts where he is wrong.

the record, in order

1920

Thomas Stephen Szasz is born in Budapest on 15 April, the second child of Julius Szasz, a lawyer, and the former Lily Wellisch.[15]

1938

the family, who were Jewish, emigrate to the United States and settle in Cincinnati. he is eighteen.[13][15]

1944

a degree in physics from the University of Cincinnati, then a medical degree from the same university.[13][15]

1950

diploma from the Chicago Institute for Psychoanalysis. he is, and remains, a trained analyst; the criticism that he did not understand what he was attacking has to get past that first.[15]

1954 to 1956

two years in the US Navy, between Chicago and Syracuse.[13][15]

1956

he joins the psychiatry faculty in Syracuse, at what is now SUNY Upstate Medical University — not Syracuse University, which is a different institution in the same city — and remains there, latterly as emeritus professor, until his death. alongside it he runs a private practice, “always less than half time,” for decades.[7][14]

1960

the article. “The myth of mental illness,” American Psychologist 15(2):113-118. six pages. it is not in PubMed and it has no PMID, which is part of why it is quoted so much more often than it is read.[1]

1961

the book, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, Hoeber-Harper. a different and much longer work from the article of the same name, published a year later. people cite one and mean the other constantly.[2]

1963

Law, Liberty, and Psychiatry sets out the reform programme: abolish involuntary hospitalization, abolish the insanity plea, restrict psychiatric hospitals to “consenting, voluntary, adult patients.”[4]

1965

two books in one year: Psychiatric Justice, on psychiatry in the courts, and The Ethics of Psychoanalysis: The Theory and Method of Autonomous Psychotherapy — the positive programme, the therapy he thought was legitimate.[5][6]

the 1960s

New York state mental health officials, according to two former colleagues quoted by the New York Times, block him from teaching at a state hospital where residents trained. his teaching is curtailed. he has little recourse.[15]

1969

he co-founds the Citizens Commission on Human Rights with the Church of Scientology. the Lancet: critics “felt their suspicions confirmed.” he was not a Scientologist and later distanced himself from the church. he never explicitly repudiated the organisation.[13][14][15]

1973

“Mental illness as a metaphor” appears in Nature. this is where the word that everyone now attributes to the 1960 article actually enters. the 1974 edition’s own footnote points at it.[2][3]

1974

the revised edition of the book adds a ten-point Summary, the clearest statement of the whole position he ever wrote. point 1: disease can affect only the body. point 2: “mental illness” is a metaphor. point 10: involuntary psychiatric interventions “are crimes against humanity.”[2]

1986

“The case against suicide prevention,” American Psychologist 41(7):806-812. the title is the argument.[8]

1999 and 2001

Fatal Freedom, on the ethics and politics of suicide; then a newspaper commentary opposing physician-assisted suicide, on the ground that it hands the decision back to a doctor. “Suicide ought to be a basic human right… killing oneself with illegal drugs prescribed specifically for that purpose is not legitimate medical practice. It is bootlegging suicide.”[9][10]

2010

at ninety, and on the fiftieth anniversary of the article, the Royal College of Psychiatrists invites him to give a plenary address at its International Congress in Edinburgh. the body he had spent fifty years attacking puts him on its main stage.[12][14]

2012

he dies at his home in Manlius, New York, on 8 September, after a fall. he is 92. he leaves two daughters, more than 30 books, and an argument nobody has finished having.[13][15]

seven questions, answered from his own pages

did he say that mental suffering is not real?[1]

no, and he said so in the same article, in a paragraph headed “Choice, responsibility, and psychiatry.” verbatim: “While I have argued that mental illnesses do not exist, I obviously did not imply that the social and psychological occurrences to which this label is currently being attached also do not exist… they are real enough. It is the labels we give them that concerns us and, having labelled them, what we do about them.” he called those occurrences “problems in living.” that phrase is often quoted as a dismissal; in the article it is the name for the thing he thinks is real, as against the diagnosis he thinks is not. if you take one sentence off this page, take that one, because it is the opposite of how he is usually used.

so what exactly was he claiming?[2][7]

that the word “disease” has a definition, and that mental illnesses do not meet it. his standard, stated plainly in 1997: “Like the traditional pathologist, I regard histopathology and other physico-chemical (e.g. radiological, etc.) evidence of a lesion as the Gold Standard of disease.” the 1974 summary compresses it to a syllogism — “Strictly speaking, disease or illness can affect only the body; hence, there can be no mental illness” — and adds the consequence: “‘Mental illness’ is a metaphor. Minds can be ‘sick’ only in the sense that jokes are ‘sick’ or economies are ‘sick.’” the second half of the claim is about what the metaphor is used for: psychiatric diagnoses, he wrote, are “stigmatizing labels, phrased to resemble medical diagnoses and applied to persons whose behavior annoys or offends others.”

was the word “myth” or “metaphor”?[1][2][3]

in 1960 it was myth, and only myth. the word “metaphor” appears zero times in the American Psychologist article; “myth” appears eight. metaphor arrives thirteen years later, in a 1973 Nature paper titled “Mental illness as a metaphor,” and becomes the load-bearing word in the 1974 revised edition, whose own footnote cites that Nature paper. this is not pedantry. “myth” reads as “does not exist and you are lying”; “metaphor” reads as “the word is being used figuratively and then cashed as if it were literal.” the second is a much better argument, and it is the later one. people who quote the 1960 article for the metaphor claim are quoting a paper that does not contain it.

what did he want done about commitment and the insanity plea?[2][4]

abolition of both, and he wrote the words. 1963: “All provisions for involuntary mental hospitalization should be abolished. Like the institution of slavery, the institution of hospital psychiatry, as we know it, must go.” and: “The Insanity Plea Should Be Abolished.” the 1974 summary escalates the language: “There is no medical, moral, or legal justification for involuntary psychiatric interventions. They are crimes against humanity.” two precisions his critics and his fans both skip. first, in 1963 he filed abolition under long-range goals and said so: “As a short-range goal, this is impractical. However, as a long-range goal it is not.” second, he did not say nothing should happen in a crisis: “Legal provisions for so-called psychiatric emergencies are, of course, necessary” — he wanted them handled under the ordinary law of medical emergency and of crime, not under a separate psychiatric power. on fitness to stand trial he kept the test and threw out the diagnosis: “the reason for not trying such a person is that he is unable to assist in his own defense — not that he is schizophrenic.”

was he against therapy?[1][6][7][11][12]

no. he trained as a psychoanalyst, taught individual psychotherapy to residents, published a book on how he thought it should be done, and saw private patients for decades on terms he described exactly: “Anyone who wanted to see me as a patient had to make his own appointment and had to pay me, directly. This excluded persons who did not really want to see a psychiatrist but were forced to do so by others, especially by legal coercion.” he called it contractual psychiatry, or “listening and talking.” in 1960 he wrote that he did not intend “to offer a new conception of ‘psychiatric illness’ nor a new form of ‘therapy.’” in 2011 he described what he thought did help: people said to have mental diseases “may be benefited by persons who respect them, understand their predicament and help them to help themselves overcome the obstacles they face.” the line he drew was not medicine versus talk. it was consent versus force, and payment was his test of it.

was he an antipsychiatrist?[11][13][14]

others called him that; he rejected it, repeatedly, to the end. the Lancet obituary says he “vigorously denied being part of the anti-psychiatry movement… it still claimed him as one of its own.” Haldipur, who shared an office with him: “He was labelled as being an anti-psychiatrist, yet distanced himself from other anti-psychiatrists, such as R. D. Laing.” and in 2010, replying in print to two authors who had grouped him with Foucault, Szasz wrote the correction himself: “Szasz has made it clear that he is anti-coercion, not anti-psychiatry. In fact, for almost 50 years he has practiced what he calls ‘contractual psychiatry’ or ‘listening and talking.’” whether the label fits is a fair argument. that he accepted it is simply false.

what did he say about suicide?[4][8][9][10]

that it is a moral and legal question and not a medical one, and he took that to both ends. against prevention: “In a free society, a person must have the right to injure or kill himself”; a 1986 paper in American Psychologist titled “The case against suicide prevention”; a 1999 book, Fatal Freedom. and then, in 2001, against physician-assisted suicide too, because a prescription puts a doctor back in charge of the decision: “Suicide ought to be a basic human right. I believe that killing oneself with illegal drugs prescribed specifically for that purpose is not legitimate medical practice. It is bootlegging suicide.” people who cite him on one of those two positions and are surprised by the other have not understood the position, which is not about death. it is about who decides.

the argument he was actually making

strip the polemic and the 1960 article makes three moves. first: where there is a demonstrable lesion, say so and call it neurology — “a disease of the brain, analogous to a disease of the skin or bone, is a neurological defect, and not a problem in living.”[1] second: a mental symptom is a judgement about the content of what someone says, not an observation of their tissue. his example is a man who says he is Napoleon or that the Communists are persecuting him: “These would be considered mental symptoms only if the observer believed that the patient was not Napoleon or that he was not being persecuted.” the judgement is therefore made against a psychosocial, ethical and legal norm, not an anatomical one, while the remedy is dressed as medical — and, he wrote, “the definition of the disorder and the terms in which its remedy are sought are therefore at serious odds with one another.”[1] third, and this is the question the whole career hangs on: “Whose agent is the psychiatrist?” the psychiatrist may be working for the patient, or for the relatives, the school, the military, an employer, or a court — and the answer changes what the encounter is.[1]

he never retreated from the first move, and in 2011 he pushed it to its logical end: if a brain lesion is found, the diagnosis was simply wrong. “The physician who concludes that a person diagnosed with a mental illness suffers from a brain disease discovers that the person was misdiagnosed: he did not have a mental illness, he had an undiagnosed bodily illness.”[12] that is airtight and it is also the problem, which he conceded in the same paper, in print, at ninety. see below.

what people get wrong about him

eight claims that circulate in both directions — from people defending him and people attacking him — with what the record says instead.

“he was a Scientologist.”

he was not. the Lancet: “Szasz maintained that while he shared the Scientologists’ view of psychiatry, he was not himself a member of the organisation.” the New York Times: “Dr. Szasz was not a Scientologist himself.” he did co-found the Citizens Commission on Human Rights with the Church of Scientology in 1969, which is a separate and real fact, set out in full below.[13][15]

“he denied that mental suffering is real.”

he wrote the opposite, in the 1960 article: the occurrences the label is attached to “are real enough.” his quarrel was with the label and with what is done to people once it is applied.[1]

“in 1960 he called mental illness a metaphor.”

the word “metaphor” appears nowhere in the 1960 article. its word is “myth,” eight times. “metaphor” comes from a 1973 Nature paper and the 1974 revised edition of the book.[1][2][3]

“he called himself an antipsychiatrist.”

he refused the label for fifty years and corrected it in print as late as 2010: “anti-coercion, not anti-psychiatry.” the movement claimed him; he did not join it.[11][13][14]

“he opposed psychotherapy.”

he was a trained analyst who taught psychotherapy to residents and saw private patients for decades, on the condition that they booked and paid him themselves. he opposed coerced treatment, not talk.[6][7][11]

“the 1960 article and the 1961 book are the same thing.”

they are not. the article is six pages in American Psychologist, 1960. the book is a book, published by Hoeber-Harper in 1961 and revised in 1974, and the ten-point summary people quote from “the 1961 book” was actually added in 1974.[1][2]

“he taught at Syracuse University.”

he was at what is now SUNY Upstate Medical University in Syracuse — a state medical school, a different institution from Syracuse University. the 1960 article’s own byline reads “State University of New York, Upstate Medical Center, Syracuse.”[1][14]

“O’Connor v. Donaldson established a right to a hearing before you can be committed.”

it did not. O’Connor is a substantive limit on who may be confined, not a rule about process, and the Court said so in terms: “We need not decide whether, when, or by what procedures, a mentally ill person may be confined by the State.” the procedural case is Addington, four years later, and it is about the standard of proof, not about who must hear it.[16][17]

the Scientology problem, stated plainly

in 1969 Szasz co-founded the Citizens Commission on Human Rights with the Church of Scientology. that is not an allegation; it is in both obituaries. the Lancet puts it at the centre of how he was received: “Critics who had already questioned Szasz’s judgment felt their suspicions confirmed when, in 1969, he collaborated with the Church of Scientology in setting up a Citizens Commission on Human Rights.”[13] the New York Times calls it “a move that damaged his credibility even among allies.”[15]

the defence, such as it is, is that he was not a member. the Lancet: “Szasz maintained that while he shared the Scientologists’ view of psychiatry, he was not himself a member of the organisation.”[13] the Times: “Dr. Szasz was not a Scientologist himself, and he later distanced himself from the church.”[15] the counterweight comes from a colleague who shared his office for a decade and admired him, which is why it lands harder than an enemy’s version would. Haldipur, in the Royal College of Psychiatrists’ own journal: “It is also well known that Scientologists often cited his work, and much to the chagrin of his admirers he did not explicitly repudiated [sic] Scientologists’ claims.”[14]

those two things are both true and they are not the same size. denying membership is cheap. declining for forty-three years to disown what an organisation you helped start was saying in your name is a choice, and it is a fair reason to be careful with him. it is not a reason to misquote him, which is what mostly happens instead. this page cites nothing that organisation has published, in either direction — not its claims, and not the rebuttals of its claims — because a body founded to attack a field is not a source about that field, and neither is its mirror image. the argument stands or falls on the journals, the courts and the man’s own books.

what his critics say, including the one he made himself

the sharpest objection is his own. in 2011, in the Royal College of Psychiatrists’ journal, Szasz wrote: “My claim that mental illnesses are fictitious illnesses is also not based on scientific research; rather, it rests on the pathologist’s materialist–scientific definition of illness… If we accept this definition of disease, then it follows that mental illness is a metaphor — asserting that view is stating an analytic truth, not subject to empirical falsification.”[12] read that twice. he is saying his central claim is true by definition and cannot be tested. a claim that no possible finding could disturb is not a scientific claim about the world; it is a rule about how to use a word. much of the heat of the last sixty years comes from people arguing about evidence with a man who had already said evidence was not what his argument ran on.

Edward Shorter, historian of psychiatry, in the Lancet obituary: “I don’t think he was committing any acts of fraud, but his views were colossally ill-guided.” Shorter’s specific charge is harm — that Szasz made patients fearful of the whole mental health enterprise and so less likely to seek treatment — and his verdict on the legacy is flat: “I don’t think he’s had any lasting influence.”[13] E. Fuller Torrey, who founded the Treatment Advocacy Center and has spent his career arguing that schizophrenia is a brain disease and that involuntary treatment is sometimes necessary, wrote a chapter in the 2019 Oxford appraisal of Szasz’s legacy making exactly that case against him.[20] and Haldipur makes the cleanest structural criticism of the lot, in two parts: the book “should have been The Myth of Mental Disease,” because the distinction that actually does the work is between disease (a demonstrable lesion) and illness (subjective distress); and the two halves of Szasz’s position do not need each other — “one could take a libertarian position, as he does, without questioning the concept of mental disease.”[14] if that is right, the metaphysics was never load-bearing, and he spent fifty years defending the wrong half.

what his critics concede

Allen Frances chaired the DSM-IV task force — as establishment as this field gets — and wrote, in the same 2019 Oxford volume: “He performed great service, exposing the risks of coercive psychiatry, fighting for patient empowerment, freedom, and dignity… he helped to free them from hospitals.”[21] Torrey, to the New York Times: “For the record, I will say that I admired him, even though I think he was dead wrong about the nature of schizophrenia… But he made a major contribution to the issue of the misuse of psychiatry. His message is important today.”[15] Haldipur credits him with a measurable change in the law and, notably, does not treat it as a compliment: commitment statutes in many US states and elsewhere became more stringent over three decades, so that “it has become more difficult to treat involuntarily patients with even severe chronic psychiatric disorders, largely owing to his influence.”[14] Joanna Moncrieff says he “articulated some of the conceptual and philosophical problems of psychiatry better than anyone else,” while doubting he ever produced a workable alternative; David Healy says that unlike other critics of that generation, “he endured.”[13] and in 2010 the Royal College of Psychiatrists invited him to give a plenary address at its International Congress on the fiftieth anniversary of the article.[12]

the fair summary is that the profession rejected his philosophy and absorbed a fair amount of his politics. nobody teaches that mental illness is a myth. a great many people now take for granted that locking someone up requires a legal justification and not just a clinical opinion, and that is at least partly his doing.

what the law actually requires, which is less than most people assume

this is where the argument stops being philosophy. Szasz wanted involuntary hospitalization abolished; it was not abolished; what it got instead was a constitutional floor, built in two decisions, four years apart, that do two different jobs. they are constantly confused with each other.

O’Connor v. Donaldson, 422 U.S. 563 (1975) — a limit on who[16]

Kenneth Donaldson was confined for almost fifteen years in a Florida state hospital. the Court held that “a State cannot constitutionally confine without more a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.” that is a substantive limit: it says something about who may be held, not about what process is owed. the Court said so itself, in the opinion: “We need not decide whether, when, or by what procedures, a mentally ill person may be confined by the State on any of the grounds which, under contemporary statutes, are generally advanced to justify involuntary confinement of such a person.” if you have read anywhere that O’Connor guarantees you a hearing, that is wrong, and it is wrong in a way that matters to anyone relying on it.

Addington v. Texas, 441 U.S. 418 (1979) — a limit on how sure[17]

decided 30 April 1979 — some secondary sources, including an otherwise useful 2010 review, date it to 1978, which is when it was argued.[19] the holding: “A ‘clear and convincing’ standard of proof is required by the Fourteenth Amendment in a civil proceeding brought under state law to commit an individual involuntarily for an indefinite period to a state mental hospital.” more than a coin flip, less than a criminal trial. and then the sentence that explains why the picture on the ground is so uneven: “As the substantive standards for civil commitment may vary from state to state, procedures must be allowed to vary so long as they meet the constitutional minimum.” the Court set a floor and handed the building back to fifty legislatures.

so what did the fifty legislatures build? a 2016 study in Psychiatric Services coded the emergency-hold law of every state and the District of Columbia. every state has one. beyond that they diverge on duration, on who can start a hold, on what rights the person keeps, and above all on whether a judge is involved at all: only 22 states require some form of judicial review of the emergency hold process, and only nine require a judge to certify the commitment before a person is hospitalized. five states do not guarantee assessment by a qualified mental health professional during the hold.[18] that is the answer to the question people actually have when they read Szasz. the short-term deprivation of liberty that starts most psychiatric confinements in the United States is, in most states, not a court proceeding, and in five states it is not guaranteed to include an examination by a specialist either. you do not have to accept a word of his metaphysics to find that number worth knowing.

what this page will not do is tell you what to do with it. commitment law is state law, it varies on exactly the axes the 2016 study measured, and the person to ask is a lawyer licensed where you are — not a website, and not this one.

what this page does not say

it does not say whether he was right. it does not say anything about starting, stopping or changing a medication; that question is not in any of these sources and nothing here is a reason to alter a treatment. it does not tell anyone what to do about a hold or a commitment, theirs or a family member’s. it does not cite or reproduce anything published by the organisation he co-founded in 1969, in either direction. and it leaves out several things that circulate about him which could not be checked against a primary source in the time available, including a frequently repeated claim about an award he was given in 1994 — if a fact is not in the source list, it is not on the page. for the diagnostic manual his argument was aimed at, see what the DSM is for and the DSM: the book, the money, the count. for a case where a diagnosis was voted out of that manual within his lifetime, on grounds close to the ones he was arguing, see how homosexuality left the DSM.

questions people ask

Who was Thomas Szasz?

Thomas Stephen Szasz (Budapest, 15 April 1920 — Manlius, New York, 8 September 2012) was a psychiatrist and psychoanalyst who spent his career on the psychiatry faculty at what is now SUNY Upstate Medical University in Syracuse, New York, while running a small private practice. He published more than 30 books. His 1960 article "The myth of mental illness" in American Psychologist, and the 1961 book of the same name, argued that because disease requires demonstrable bodily pathology, "mental illness" is a metaphor rather than a literal disease, and that involuntary psychiatric hospitalization and the insanity plea should be abolished.

Did Szasz say mental illness does not exist?

He said the category is not a disease in the pathologist’s sense. He explicitly did not say the suffering is unreal. In the 1960 article he wrote: "While I have argued that mental illnesses do not exist, I obviously did not imply that the social and psychological occurrences to which this label is currently being attached also do not exist… they are real enough. It is the labels we give them that concerns us and, having labelled them, what we do about them."

Was Thomas Szasz a Scientologist?

No. Both The Lancet and The New York Times state that he was not a member of the Church of Scientology, and the Times reports that he later distanced himself from the church. He did, in 1969, co-found the Citizens Commission on Human Rights together with the Church of Scientology, which damaged his credibility with allies at the time and remains the most common objection to him. His colleague C.V. Haldipur wrote in 2013 that "much to the chagrin of his admirers he did not explicitly repudiated [sic] Scientologists’ claims" — denying membership is not the same as repudiating the organisation.

Did Szasz call mental illness a metaphor in 1960?

No. The word "metaphor" does not appear in the 1960 American Psychologist article at all; its word is "myth". "Metaphor" comes from his 1973 Nature paper "Mental illness as a metaphor" and from the 1974 revised edition of the book, which cites that Nature paper in its own notes.

What did Szasz want to happen to involuntary commitment?

Abolition, as a long-range goal. In Law, Liberty, and Psychiatry (1963) he wrote: "All provisions for involuntary mental hospitalization should be abolished." In the 1974 summary: "There is no medical, moral, or legal justification for involuntary psychiatric interventions. They are crimes against humanity." He also wrote in the same 1963 chapter that abolition was impractical as a short-range goal, and that "legal provisions for so-called psychiatric emergencies are, of course, necessary" — handled, he argued, under the ordinary law of medical emergency and of crime rather than a separate psychiatric power.

What does US law actually require before someone can be held?

Two Supreme Court decisions set the floor. O’Connor v. Donaldson (1975) held that a state "cannot constitutionally confine, without more, a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends" — a limit on who may be confined, not a rule about court process, which the Court expressly declined to decide. Addington v. Texas (1979) held that the Fourteenth Amendment requires "clear and convincing" proof before indefinite involuntary commitment to a state mental hospital, while saying that procedures "must be allowed to vary so long as they meet the constitutional minimum". Below that floor, practice differs sharply by state: a 50-state review published in Psychiatric Services in 2016 found that only 22 states require some form of judicial review of the emergency hold process, and only nine require a judge to certify the commitment before a person is hospitalized.

Does this page give medical or legal advice?

No. It is an account of what one writer argued, with his critics quoted at equal length, plus the text of two Supreme Court decisions and one peer-reviewed survey of state law. It says nothing about whether anyone should start, stop or change a medication, and nothing about what anyone should do about a commitment — that is a question for a lawyer in your state, not a web page.

sources

  1. Szasz TS. The myth of mental illness. American Psychologist 1960;15(2):113-118. DOI 10.1037/h0046535. Not indexed in PubMed; there is no PMID. The full scanned article was read for this page. Verbatim, p. 118: “While I have argued that mental illnesses do not exist, I obviously did not imply that the social and psychological occurrences to which this label is currently being attached also do not exist. Like the personal and social troubles which people had in the Middle Ages, they are real enough. It is the labels we give them that concerns us and, having labelled them, what we do about them.” Also: “a disease of the brain, analogous to a disease of the skin or bone, is a neurological defect, and not a problem in living”; “Mental illness exists or is ‘real’ in exactly the same sense in which witches existed or were ‘real’”; “Whose agent is the psychiatrist?”; “I do not intend to offer a new conception of ‘psychiatric illness’ nor a new form of ‘therapy.’” The word “metaphor” does not appear anywhere in this article; “myth” appears eight times. The scan carries OCR damage (“Ali” for “All”, “zot” for “not”, “Vet” for “Yet”, “perseucted” for “persecuted”); quotations here are corrected to the obvious reading. https://doi.org/10.1037/h0046535
  2. Szasz TS. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New York: Hoeber-Harper, 1961. Revised edition, Harper & Row (Perennial Library), 1974. The book is a separate and later work from the 1960 article of the same title. The digitised 1974 revised edition was read for this page. From the Preface to the Second Edition: “Strictly speaking, then, disease or illness can affect only the body. Hence, there can be no such thing as mental illness. The term ‘mental illness’ is a metaphor”; “bodily illness stands in the same relation to mental illness as a defective television set stands to a bad television program.” From the ten-point Summary the 1974 edition added, pp. 267-268 — 1: “Strictly speaking, disease or illness can affect only the body; hence, there can be no mental illness.” 2: “‘Mental illness’ is a metaphor. Minds can be ‘sick’ only in the sense that jokes are ‘sick’ or economies are ‘sick.’” 3: “Psychiatric diagnoses are stigmatizing labels, phrased to resemble medical diagnoses and applied to persons whose behavior annoys or offends others.” 5: “Mental illness is not something a person has, but is something he does or is.” 9: “In most types of voluntary psychotherapy, the therapist tries to elucidate the inexplicit game rules by which the client conducts himself.” 10: “There is no medical, moral, or legal justification for involuntary psychiatric interventions. They are crimes against humanity.” https://archive.org/details/szasz_myth
  3. Szasz TS. Mental illness as a metaphor. Nature 1973;242(5396):305-307. PMID 4699048. DOI 10.1038/242305a0. PubMed record checked; the paper itself was not read for this page. It is cited only for the date at which “metaphor” becomes the operative word, which the 1974 edition’s own reference note confirms: “See Thomas S. Szasz, Mental illness as a metaphor, Nature, 242: 305, 1973.” https://doi.org/10.1038/242305a0
  4. Szasz TS. Law, Liberty, and Psychiatry: An Inquiry into the Social Uses of Mental Health Practices. New York: Macmillan, 1963. Digitised copy read, pp. 225-229. “All provisions for involuntary mental hospitalization should be abolished. Like the institution of slavery, the institution of hospital psychiatry, as we know it, must go.” “The Insanity Plea Should Be Abolished.” “Every person should be considered mentally healthy (innocent) until he is proved mentally sick (guilty).” On staging, in his own words: “I have divided my suggestions into two groups — long-range and short-range objectives… one of my suggestions is to eliminate involuntary mental hospitalization. As a short-range goal, this is impractical. However, as a long-range goal it is not.” On emergencies: “Legal provisions for so-called psychiatric emergencies are, of course, necessary.” On competence: “the reason for not trying such a person is that he is unable to assist in his own defense — not that he is schizophrenic.” On suicide: “In a free society, a person must have the right to injure or kill himself.” https://archive.org/details/lawlibertypsychi00szas
  5. Szasz TS. Psychiatric Justice. New York: Macmillan, 1965. Cited for its existence only; the text was not read for this page and nothing is attributed to it.
  6. Szasz TS. The Ethics of Psychoanalysis: The Theory and Method of Autonomous Psychotherapy. New York: Basic Books, 1965. Cited for its existence and title only; the text was not read for this page and nothing is attributed to it. The title is the point: this is the book in which he set out how he thought psychotherapy should be conducted.
  7. Thomas Szasz in conversation with Alan Kerr. Psychiatric Bulletin 1997;21(1):39-44. DOI 10.1192/pb.21.1.39. Full interview read. On what he means by disease: “Like the traditional pathologist, I regard histopathology and other physico-chemical (e.g. radiological, etc.) evidence of a lesion as the Gold Standard of disease.” On his own practice: “After I came to Syracuse in 1956, my private practice was always less than half time… Anyone who wanted to see me as a patient had to make his own appointment and had to pay me, directly. This excluded persons who did not really want to see a psychiatrist but were forced to do so by others, especially by legal coercion.” Note: the journal’s own biographical note to this interview prints “From 1956 to 1970 he was Professor of psychiatry”; both obituaries in this list state that he remained at the university, latterly as emeritus professor, until his death, which is what this page says. https://doi.org/10.1192/pb.21.1.39
  8. Szasz T. The case against suicide prevention. American Psychologist 1986;41(7):806-812. PMID 3740640. DOI 10.1037/0003-066X.41.7.806. PubMed carries no abstract for this paper and the paper was not read for this page; it is cited for its existence and title, which state the position. https://doi.org/10.1037/0003-066X.41.7.806
  9. Szasz T. Fatal Freedom: The Ethics and Politics of Suicide. Westport, CT: Praeger, 1999. Cited for its existence only; not read for this page.
  10. Szasz T. Assisted suicide is bootleg suicide. Commentary, Los Angeles Times, 23 November 2001. Text of the commentary read. “Suicide ought to be a basic human right. I believe that killing oneself with illegal drugs prescribed specifically for that purpose is not legitimate medical practice. It is bootlegging suicide.” This is the source for his opposition to physician-assisted suicide, which is the same position as his opposition to coercive prevention: keep the doctor out of it in both directions.
  11. Szasz T. Psychiatry, anti-psychiatry, critical psychiatry: what do these terms mean? Philosophy, Psychiatry, & Psychology 2010;17(3):229-232. Johns Hopkins University Press. Full text read; no stable DOI found, so no link is given. Replying to Bracken and Thomas, who had grouped him with Foucault as “anti-psychiatry”, Szasz writes that they could have remedied the confusion “by adding something like, ‘Szasz has made it clear that he is anti-coercion, not anti-psychiatry. In fact, for almost 50 years he has practiced what he calls “contractual psychiatry” or “listening and talking.”’”
  12. Szasz T. The myth of mental illness: 50 years later. The Psychiatrist 2011;35:179-182. DOI 10.1192/pb.bp.110.031310. Delivered as a plenary address at the International Congress of the Royal College of Psychiatrists, Edinburgh, 24 June 2010. Full text read. “My claim that mental illnesses are fictitious illnesses is also not based on scientific research; rather, it rests on the pathologist’s materialist–scientific definition of illness as the structural or functional alteration of cells, tissues and organs. If we accept this definition of disease, then it follows that mental illness is a metaphor — asserting that view is stating an analytic truth, not subject to empirical falsification.” “The physician who concludes that a person diagnosed with a mental illness suffers from a brain disease discovers that the person was misdiagnosed: he did not have a mental illness, he had an undiagnosed bodily illness.” “Fifty years ago, it made sense to assert that mental illnesses are not diseases. It makes no sense to do so today.” On what he thought does help: persons said to have mental diseases “cannot be treated or cured by drugs or other medical interventions, but may be benefited by persons who respect them, understand their predicament and help them to help themselves overcome the obstacles they face.” https://doi.org/10.1192/pb.bp.110.031310
  13. Watts G. Thomas Stephen Szasz [obituary]. The Lancet 2012;380(9851):1380. DOI 10.1016/S0140-6736(12)61790-5. Read in full. Biography, and: “In a fusillade of more than 30 books penned over almost 40 years, Szasz poured scorn on the concept of psychiatric illness.” On Scientology: “Critics who had already questioned Szasz’s judgment felt their suspicions confirmed when, in 1969, he collaborated with the Church of Scientology in setting up a Citizens Commission on Human Rights… Szasz maintained that while he shared the Scientologists’ view of psychiatry, he was not himself a member of the organisation.” Edward Shorter, quoted: “I don’t think he was committing any acts of fraud, but his views were colossally ill-guided”; the obituary reports that “Shorter thinks Szasz did harm by making patients fearful of the entire mental health enterprise, and so less likely to seek treatment”, and that Shorter says “I don’t think he’s had any lasting influence.” Also quoted: David Healy (“Unlike other critics such as R D Laing, who’ve come and gone, he endured”) and Joanna Moncrieff (“He articulated some of the conceptual and philosophical problems of psychiatry better than anyone else”, though she “is not sure he came up with any realistic solutions”). https://doi.org/10.1016/S0140-6736(12)61790-5
  14. Haldipur CV. Thomas Szasz [obituary]. The Psychiatrist 2013;37(2):79. DOI 10.1192/pb.bp.112.042358. Open access; read in full. Haldipur was his colleague at Syracuse and shared an office with him for a decade. “He joined the faculty at what is now the Upstate Medical University at Syracuse, New York, and remained there, eventually as an emeritus professor, until his death.” “The title of his book should have been The Myth of Mental Disease, given the distinction made nowadays between disease, with demonstrable pathological lesions, and illness, largely determined by psychosocial factors giving rise to subjective distress.” “One need not couple the two strands in his work: one could take a libertarian position, as he does, without questioning the concept of mental disease.” “In the past three decades laws in various states in the USA and elsewhere have been made more stringent and it has become more difficult to treat involuntarily patients with even severe chronic psychiatric disorders, largely owing to his influence.” “He was labelled as being an anti-psychiatrist, yet distanced himself from other anti-psychiatrists, such as R. D. Laing.” On Scientology: “It is also well known that Scientologists often cited his work, and much to the chagrin of his admirers he did not explicitly repudiated [sic] Scientologists’ claims.” And: “his true legacy may well be to caution us against rushing to medicalise all human follies and to give indiscriminate power to psychiatrists in courts of law.” https://doi.org/10.1192/pb.bp.112.042358
  15. Carey B. Dr. Thomas Szasz, psychiatrist who led movement against his field, dies at 92. The New York Times, published 11 September 2012 (in print 12 September 2012, p. A29). Read in full. Biography: born in Budapest 15 April 1920, second child of Julius Szasz, a lawyer, and the former Lily Wellisch; the family moved to Cincinnati in 1938; physics degree and medical degree, University of Cincinnati, 1944; diploma, Chicago Institute for Psychoanalysis, 1950; died at his home in Manlius, New York, after a fall. “In 1969, in a move that damaged his credibility even among allies, he joined with the Church of Scientology to found the Citizens Commission on Human Rights… Dr. Szasz was not a Scientologist himself, and he later distanced himself from the church, but he shared the religion’s critical view of psychiatry.” Also reported: in the 1960s New York state mental health officials blocked him from teaching at a state hospital where residents trained, according to two former colleagues. E. Fuller Torrey, quoted: “For the record, I will say that I admired him, even though I think he was dead wrong about the nature of schizophrenia… But he made a major contribution to the issue of the misuse of psychiatry. His message is important today.” Szasz on talk therapy, in a 2000 interview quoted by the paper: “The goal is to assume more responsibility and therefore gain more liberty and more control over one’s own life.” https://www.nytimes.com/2012/09/12/health/dr-thomas-szasz-psychiatrist-who-led-movement-against-his-field-dies-at-92.html
  16. O’Connor v. Donaldson, 422 U.S. 563 (1975). Decided 26 June 1975. Official United States Reports text read. Held: “a State cannot constitutionally confine without more a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.” The Court expressly declined to go further: “We need not decide whether, when, or by what procedures, a mentally ill person may be confined by the State on any of the grounds which, under contemporary statutes, are generally advanced to justify involuntary confinement of such a person.” Donaldson had been confined almost 15 years. https://tile.loc.gov/storage-services/service/ll/usrep/usrep422/usrep422563/usrep422563.pdf
  17. Addington v. Texas, 441 U.S. 418 (1979). Argued 28 November 1978, decided 30 April 1979. Official United States Reports text read. Held: “A ‘clear and convincing’ standard of proof is required by the Fourteenth Amendment in a civil proceeding brought under state law to commit an individual involuntarily for an indefinite period to a state mental hospital.” The Court refused to require the criminal standard, and said what it was leaving to the states: “As the substantive standards for civil commitment may vary from state to state, procedures must be allowed to vary so long as they meet the constitutional minimum.” It also left “determination of the precise burden equal to or greater than the ‘clear and convincing’ standard” to state law. https://tile.loc.gov/storage-services/service/ll/usrep/usrep441/usrep441418/usrep441418.pdf
  18. Hedman LC, Petrila J, Fisher WH, Swanson JW, Dingman DA, Burris S. State laws on emergency holds for mental health stabilization. Psychiatric Services 2016;67(5):529-535. PMID 26927575. DOI 10.1176/appi.ps.201500205. Abstract read verbatim: a 50-state open-source data set of the laws governing emergency holds. “Although every state and the District of Columbia have emergency hold laws, state law varies on the duration of emergency holds, who can initiate an emergency hold, the extent of judicial oversight, and the rights of patients during the hold… Only 22 states require some form of judicial review of the emergency hold process, and only nine require a judge to certify the commitment before a person is hospitalized. Five states do not guarantee assessment by a qualified mental health professional during the emergency hold.” https://doi.org/10.1176/appi.ps.201500205
  19. Testa M, West SG. Civil commitment in the United States. Psychiatry (Edgmont) 2010;7(10):30-40. PMCID PMC3392176. Open access; read. Background on the standards of proof and on O’Connor v. Donaldson. One caution, checked against the Reports: this paper calls Addington v. Texas “an important Supreme Court case in 1978”. It was argued in November 1978 and decided 30 April 1979, and is reported at 441 U.S. 418 (1979). That error is not repeated on this page. https://pmc.ncbi.nlm.nih.gov/articles/PMC3392176/
  20. Torrey EF. Schizophrenia: sacred symbol or Achilles heel? In: Haldipur CV, Knoll JL IV, Luft E v.d., eds. Thomas Szasz: An Appraisal of His Legacy. Oxford: Oxford University Press, 2019:98-103. DOI 10.1093/med/9780198813491.003.0009. Torrey’s position across his work and in this chapter is that schizophrenia is a brain disease and that involuntary treatment is often necessary — the direct contradiction of Szasz’s central claim, argued by someone who admired him (see source 15). https://doi.org/10.1093/med/9780198813491.003.0009
  21. Frances A. The myth and reality of mental illness. In: Haldipur CV, Knoll JL IV, Luft E v.d., eds. Thomas Szasz: An Appraisal of His Legacy. Oxford: Oxford University Press, 2019:169-176. DOI 10.1093/med/9780198813491.003.0014. Frances chaired the DSM-IV task force. “He performed great service, exposing the risks of coercive psychiatry, fighting for patient empowerment, freedom, and dignity… he helped to free them from hospitals.” https://doi.org/10.1093/med/9780198813491.003.0014

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