Insanity Defense

...She was attractive, intelligent, energetic, and funny...

...Courts of law, however, do incarcerate people...

...In her 58th year, she lost interest in work, became consumed with guilt over imaginary misdeeds, and progressively lost the ability to eat or sleep...

...The laws of the state in which she lived, informed by the principles of Thomas Szasz, insisted on what was, for her, a lethal dose of autonomy...

...Yet civilization requires that certain actions must be encouraged and others must be prevented...

...They are motivated by hubris, venality, folly—or perhaps simply malice...

...The book’s introduction gives us a clue...

...they are the only values...

...Occasionally, they consider psychiatric opinion in their decision...

...I doubt that the worst psychiatrist, on his worst day, would deny him the means to express himself thus...

...Thomas Szasz is an enormously erudite and energetic man who has wasted his life on a silly fi ction...

...Jane, my friend of 30 years, died recently by her own hand...

...This is dishonest...

...Genetics, brain imagery, neurophysiology, psychology, chemistry, and pharmacology together show this mounting evidence: The brain, like every other organ, may suffer from a wide spectrum of disorders...

...Its practitioners are the shock troops of societal oppression...

...Thus, the third sentence of Chapter One: Incarcerating people is what psychiatrists do...

...Omitting the facts of the case, Szasz describes this episode as an example of oppression of a man who had “annoyed the city’s mental health authorities...

...While not fully understood, these disorders are nevertheless real and can, in many cases, be ameliorated...

...Since the publication of The Myth of Mental Illness (1961), he has tilted at the windmill of psychiatry, and not without a measure of success...

...William Anderson, M.D., is a lecturer at Harvard and retired psychopharmacologist...

...But perhaps this is now in danger of being overdone...

...No, it isn’t...

...Psychiatry, no doubt, has its complement of knaves, fools, and mountebanks, but that is not the whole story...

...Courts also make errors, and yet we mostly agree that we need them...

...The central conceptual error of Szasz’s metaphysical perspective is his failure to recognize that the brain and the mind are related, as are structure and function...

...For Szasz, professor emeritus of psychiatry, individual freedom and autonomy are not the most important values...

...Results are often less than satisfactory...

...There is also no room for brotherly love, charity, or assistance to those who may be impaired...

...In doing so, he has brought quite a lot of misinformation into the world, and enhanced the misery of a lot of troubled people...

...This current incarnation of the polemic contains many familiar elements, but is organized around what he purports to be a “critical” history...

...Szasz informs us that “long before medical school, I suspected that mental illness was a medical fi ction...

...He seems not to have looked carefully in the evidential archives...

...This cornerstone supports a moral universe of elegant simplicity: No one should have the right or capacity to coerce anyone else...

...A similar familiar example is that of Dr...

...Given a highly imperfect understanding of how the brain works, this is not an easy thing to do...

...Yet deny it he does...

...Since then there has been a societal trajectory toward recognition of individual rights...

...How, then, can we make sense of this half-century jihad for unfettered individual expression and autonomy...

...It is perverse to deny it...

...He may certainly express his autonomy with a lifelong rage against practices of which he disapproves...

...And in a way, it is—if, by history, one means a catalogue of every ugly, stupid, evil thing that a profession may have allowed for the past 300 years, and which omits any activity that might have had some positive value...

...He’s a crank...

...This concept generates a morality with curious properties: There is no room for the possibility that autonomy may be compromised by illness, that such illness may be treated, and autonomy thus restored...

...This is accomplished, all else failing, by coercion...

...Since the publication of his fi rst book, 46 years ago, there has been an explosion of understanding in the neurosciences...

...But I can express my ideas, too...

...This is an example of an overvalued idea, a notion that is neither a delusion nor obsession, and not necessarily wrong in itself but that, for some personal reason, crystallizes as an all-consuming illumination, pushing aside all other considerations and becoming the ruling passion of one’s life...

...He goes on to say that, by graduation, he had no doubt of it...

...If one accepts his obviously fl awed premise, his argument is as resilient and impermeable as a steel ball...

...There were cases in which families, psychiatrists, and judges colluded to rusticate an embarrassing wayward scion, sometimes with tragic results...

...By my count, this is the 30th book by Szasz that argues this central theme...

...He had a proclivity toward the use of alcohol and cocaine as well as other eccentricities of brain function...

...Fifteen years ago, Larry Hogue was a well-known citizen who inhabited the streets of Manhattan...

...She was unhurt...

...It would be odd indeed if the brain were the only bodily organ that has malfunctions which are fully understood...

...To deny this is idle dreaming, an adolescent fantasy of anarchic Arcadia...

...He sees himself as a modern Voltaire, seeking to erase the infamy of coercion, as best enabled by psychiatry...

...He insists, over and over, that mental illness doesn’t exist because he sees no evidence of brain dysfunction in common psychiatric diagnoses such as psychosis or depression...

...This sweeping agnosia is unworthy of a man who holds himself out as a professor...

...Psychiatrists try to apply scientifi c medicine in the service of ameliorating disturbances of thinking, feeling, and action brought about by disturbances of brain function...

...Not if Thomas Szasz can help it...

...Courts do this not to indulge a malicious desire to suppress autonomy, but to protect the public order and provide an alternative to tribal warfare...

...Szasz insists we should live...

...Yet that is Szasz’s position...

...Early in the 20th century, it should be noted, his concern about coercion was not entirely wrong...

...These may impair the cognitive and emotional functions upon which autonomy depends...

...But her illness was such that she declined to continue her treatment...

...There exists no mind, and hence no free will, in the absence of an adequately functioning brain...

...Jack Kevorkian’s advocacy of euthanasia...

...Yet the alternative is to do nothing, and that is often worse...

...Yet that is the world in which Dr...

...She accepted hospital admission, and a fi rst-rate psychiatrist began to treat her...

...That is a fact...

...BY WILLIAM ANDERSON Coercion as Cure A Critical History of Psychiatry by Thomas Szasz Transaction, 336 pp., $34.95 "No man is an island . . . any man’s death diminishes me, because I am involved in mankind,” said John Donne...

...This is, of course, the author’s right...

...He expressed his autonomy by breaking windows, assaulting passersby, and, most notoriously, by pushing a young girl in front of moving truck...

...The practice of psychiatry, he insists, represents the chief obstruction to the realization of his goal...

...The underlying premise of his life’s work is that all of us are, or ought to be, islands of individual autonomy and responsible only to our inner lights...

...After seemingly endless wrangling, he was fi nally hospitalized involuntarily for psychiatric evaluation...

...She was a graduate of an Ivy college and medical school, with training in two specialties from teaching hospitals of the fi rst rank...