On Religious and Psychiatric Atheism: The Success of Epicurus, the Failure of Thomas Szasz

[rug]

I presented the following comparison of the philosophic psychiatry of Thomas Szasz to the psychiatric philosophy of Epicurus in May 2014 at the 167th annual meeting of the American Psychiatric Association in New York City. Because Szasz had died late in 2012 I assumed it would be merely one of several retrospectives of his thought and influence. In the event, mine was the only paper to mention him, and the circumstances afforded me for presenting it proved challenging. I was assigned to the last slot on the last of the five-day conference, to a session titled “Topics of Interest Rarely Presented.” (The first presentation discussed psychiatric patients’ self-assessments of body weight, while the third dealt with psychiatric morbidity among Bangladeshi women in rural and slum populations.) The audience was predictably small, but the paper was quite a hit among them. It has continued to garner favorable remarks in private circulation. Since the second anniversary of Szasz’ death on September 8 is now approaching, it seems a suitable occasion to publish it to a wider audience.

Michael Fontaine is Associate Professor of Classics and Associate Dean of the Faculty at Cornell University. He publishes mostly on Latin literature and ancient Roman society. He is the author of Funny Words in Plautine Comedy and co-editor of the Oxford Handbook of Greek and Roman Comedy, both published by Oxford University Press (2010 and 2014), and the editor and translator of Joannes Burmeister’s Neo-Latin comedy Aulularia (Leuven University Press, 2014). His 2013 paper ‘On Being Sane in an Insane Place—the Rosenhan Experiment in the Laboratory of Plautus’ Epidamnus’ was published in Current Psychology and reposted, with commentary by Jeffrey Schaler, at Szasz.com).



August 26, 2014
By Michael Fontaine

When the American psychiatrist Thomas Szasz killed himself a year and a half ago at the age of 92, I thought there would be a global outpouring in psychiatric circles of sympathy or scorn. Instead, his death was largely met with silence, a silence as deafening as the one that attended the second half of his long, prolific, and polemical career. Szasz’ name didn’t show up at all in the APA program last year, and this presentation of mine is apparently the only one to mention him this year. This silent treatment has, ironically enough, and surely against his will, forced him to fulfill the ancient Epicurean ambition to live and die unnoticed (in Greek, lathe biosas, ‘shun the limelight as you pass through life’).

Who Was Thomas Szasz?

I am not sure I need to tell you, but perhaps I do.

From the 1960s through the 1980s, Dr. Thomas Szasz (1920-2012) was the most famous psychiatrist on earth. Born in Budapest, he emigrated to the United States with his family as a teenager and graduated as valedictorian of his class at the University of Cincinnati Medical school. In 1961 he published The Myth of Mental Illness. It was an international bestseller. In it he argued the simple proposition that personal distress and behavioral eccentricity were being wrongly interpreted as medical illnesses, and that attempts to treat such behaviors by medical or surgical means were forever doomed to fail.

Szasz was fond of comparing psychiatry to the Inquisition, psychiatrists to witches, the mental hospital to the Church, and the medieval Age of Faith to what he called the modern Age of Madness. He saw psychiatry as the secular successor to the medieval practice of persecuting witches and heretics: it was, he argued, merely a change of name and rationale, rather than a change of substance, in man’s eternal quest to dominate man.

http://www.madinamerica.com/2014/08/religious-psychiatric-atheism-success-epicurus-failure-thomas-szasz/

[Starboard Tack]

1. Very interesting reading.

I'd love to see the full documentary on Szasz.

[rug]

2. This is the documentary's website.

http://witnessfilms.com/documentary/

[Starboard Tack]

3. Thanks! I'll check it out.

[intaglio]

4. Reading the article in full

very promising

[cbayer]

5. He turns my stomach to the point that I don't even want to read this.

I might be interested in the documentary at some point, but I think he was a horrible man who did a lot of damage.

[rug]

7. The author recounts his failure.

[cbayer]

8. I may take a look at it when I am in the right mood.

[rug]

10. Take personal responsibility!

Don't blame it on dysthymia. There's no such thing!

[cbayer]

12. I just read the two paragraphs you excerpted and now think I will probably never

read this.

It appears that the author actually agrees with him and thinks he only failed because people in general, and psychiatrists in particular, just don't want to accept what he said.

What a cruel position to take.

[rug]

13. I don't think he agrees. But it is a pointed critique, not a diatribe.

[cbayer]

14. I'm not so sure about that.

In short, Szasz failed not because he was wrong but because he championed an ideal, personal responsibility, that few want to accept. As he knew and said, responsibility is something man is forever hoping to avoid and displace onto another; hence his attribution to Satan or illness as the agent “really” responsible for his poor choices. It is more pleasant to blame his failings on demons, witches, his genes, or his metabolism for his gaining weight—anything but himself. The fact that bariatric surgeries, and the unending quest for a weight-loss pill, are on the rise suggests that in the short term, Szaszianism will never succeed.

The other reason Szaszianism has failed is because—on my evidence— psychiatrists do not know what philosophers have to say about the mind or soul. They are committed to the Hippocratic, reductionist-materialist view that it’s just the brain. They aren’t taught that other views are out there. Perhaps they should be.

In the first paragraph he is saying that the idea of personal responsibility has failed because people desperately want to avoid taking it, and points to easy fixes for obesity as an example.

In the second, he makes a blanket and incorrect statement about psychiatrists. It is critical for psychiatrists to be able to distinguish what is most likely biologically driven from that which is most likely situational/personality/family dynamic driven. His proposal about their "commitment" to believing that everything is just the brain is untrue and there is clearly a place for calling on "personal responsibility" with some patients.

[rug]

18. That first paragraph is referring to the three preceding paragraphs.

One possibility is that Szasz’ opponents reinterpreted his ideal, autonomy, to mean selfishness, just as Epicurus’ opponents twisted his ideal, pleasure, to mean hedonism. No one wants to be called a glutton or selfish; but I don’t think this explains his failure.

Rather, it seems Epicureanism spread because its endpoint was popular. People wanted to believe there was no (horrible) life after death because its physicalist-atheist underpinnings made sense to them and because believing in it freed them to pursue pleasure, however they defined that word for themselves.

Szaszianism also preached freedom—not from the fear of death, but from coercion. His highest aim, autonomy, sounds pleasant, but it is not. Framed as freedom, autonomy sounds grand. Framed as personal responsibility—accountability, answerability, paying the price, failing—it is exceedingly unpleasant. Therein lies the difference. Pleasure and personal responsibility are not merely different; they are often polar opposites, as we can see when manifested in the case of, say, obesity or alcoholism, and the various treatments of them.

The second paragraph is broad brush rhetoric used, I think, to make a point. by contrast.

[cbayer]

19. I really should read this before I make more comments.

I am doing what I sometimes accuse others of, and I'm wrong for that.

[rug]

21. Meh, people pop off all the time and you're not doing that.

But it is a nuanced issue especially in light of the wiki spew on delusions last week.

[cbayer]

23. Someone actually quoted Szasz as an authority on psychiatric illness during

that debate. Disgusting.

http://www.democraticunderground.com/?com=view_post&forum=1218&pid=147170

[rug]

24. That was an immoderate thing to do.

[cbayer]

25. Lol. I don't know if he is actually a Szasz supporter or whether he just found that

quote to be convenient.

Of all the prejudices there are, those against people with psychiatric illnesses are some of the worst, imo. Completely defenseless and undefended by others for the most part.

[Jim__]

6. Just based on that article, I doubt that Szasz failed because he advocated personal responsibility.

My understanding is that he is correct in saying that no one can really identify a chemical imbalance in the brain. However, for clinically depressed people or schizophrenics, I don't think telling them to shape up and accept responsibility for themselves is any kind of an answer - from the article, I take that to be something like Szasz's message. In cases of severe depression or schizophrenia, drugs do seem to make a real difference and to bring about a positive change in a large number of people.

Of course, Szasz's understanding is probably a lot more complicated than the take I am getting from the article. But, no matter what his real understanding is, it would take a lot to convince me that there is no such thing as mental illness. It may well be that a lot of what we call mental illness is misdiagnosed. But, some people genuinely seem to both need and get help from psychiatry.

[rug]

9. What do you think of his conclusion?

In short, Szasz failed not because he was wrong but because he championed an ideal, personal responsibility, that few want to accept. As he knew and said, responsibility is something man is forever hoping to avoid and displace onto another; hence his attribution to Satan or illness as the agent “really” responsible for his poor choices. It is more pleasant to blame his failings on demons, witches, his genes, or his metabolism for his gaining weight—anything but himself. The fact that bariatric surgeries, and the unending quest for a weight-loss pill, are on the rise suggests that in the short term, Szaszianism will never succeed.

The other reason Szaszianism has failed is because—on my evidence— psychiatrists do not know what philosophers have to say about the mind or soul. They are committed to the Hippocratic, reductionist-materialist view that it’s just the brain. They aren’t taught that other views are out there. Perhaps they should be.

[AtheistCrusader]

16. I find the bariatric surgery analogy particularly revealing.

There is a food industry, in this country, that thrives on using cheap high-carb fillers in our food, that actually are addictive.

One can hardly attribute rising obesity/bariatric lap sleeve/etc procedures to simple bad personal choices. Some people are already locked in this struggle before they have even reached the age of majority.

[Jim__]

26. I can't speak to what psychiatrists know.

I would be surprised if none of them knew what philosophers have to say about the mind or soul, though not overly surprised to learn that many of them did not know.

My guess as to what psychiatrists are committed to is to treat the patient to the best of their ability, and largely in line with the treatments preferred by the profession. I would think that they consider environmental issues in treating people. His summary seems to be an over-simplified characterization of a profession. Again, the reality is probably a lot more complex than he suspects.

[rug]

27. I'm sure it is. He's setting up a dichotomy.

The issue is how accurate it is.

[Jim__]

28. A dichotomy - do you mean between the mental and the physical?

When philosophers talk about the mind or the soul, I think most of them are talking about consciousness. I'm not sure that there's any conflict between philosophy's concern with the nature of consciousness and psychiatry's concern with mental illness - but, I may be missing your point.

[rug]

29. I should've said trichotomy. He frames it here:

From time immemorial, popular thought in Greece and Rome attributed mental abnormality, as inferred from behavioral deviance, to divine intervention. People believed in possession by supernatural forces, such as gods or demons, and sought to expiate it through the shamanistic sacrifice of animals. Jesus himself was a firm believer in demons and regularly cast them out of people. Amid the Ecclesiastical State of the European middle ages and early modern period, this belief reemerged and prevailed. According to it, the Church held that witches, possession by Satan, and Jews and heretics were responsible for mental abnormality as inferred from behavioral deviance. The sacred symbol of this view is its emblematic treatment, exorcism, or shamanic ritual.

In 5th-century BC Greece, Hippocrates introduced a new explanation—the medical model, which attributed mental abnormality, again as inferred from behavioral deviance, exclusively to natural bodily causes. Hippocratic healers believed in humoral imbalances in the brain, and sought to correct them through the use of neuroleptic drugs, forcibly administered if need be, and confinement in the clinic.5 With the dawn of the Scientific state of the European Enlightenment, this belief reemerged and has come to prevail. Because few people today really believe in demons, witches, or Satanic possession, they, and their governments, hold that chemical imbalances in the brain are responsible for mental abnormality or personal distress as inferred from behavioral deviance. The sacred symbol of this view is its emblematic treatment, excision, of parts of the brain through surgery, electroshock, or neuroleptic chemicals.

The opposition of these two approaches is well known, and figures in every history of psychiatry. What is less familiar today is that in 4th-century BC Greece, yet another view was on offer—the Epicurean model, which attributed mental abnormality, as inferred from behavioral deviance or self-report, to spiritual anguish. The Epicurean model held that man’s universal fear of death was responsible for his mental anguish, which caused and resulted from his poor choices and failure to understand the relationship between his appetites and his responsibility. The sacred symbol of the Epicurean view is its emblematic treatment, talk therapy or exercise, both mental and physical.

Supernatural causes versus natural causes versus, ironically, Epicurus' "spiritual anguish" from the universal knowledge of death.

What I find interesting about this paper is that the man is a classicist, not a mental health practitioner, and he examines it from that perspective. But then, both Epicurus and Hippocrates were steeped in the classics themselves and worked forward from that framework.

It's an unusual way to evaluate Szasz and by extension, the intersection between modern psychiatry and religious thought/

It is the Epicurean model, I suggest, that Szasz himself hit upon and developed independently—though he was apparently unaware that he was reactivating a view that was not only ancient, but that had once been massively influential on civilized man, and for seven centuries.

[cbayer]

11. Neuropsychiatry has come a very long way since he was at his peak.

While there are no specific blood tests, some psychiatric illnesses are associated with patterns on a PET scan and many, many are now known to be corrected by medications that address specific neurochemical imbalances.

Psychiatric patients are severely marginalized and the notion that they are somehow personally responsible for their illnesses is reprehensible to me.

[AtheistCrusader]

15. "The fact that bariatric surgeries, and the unending quest for a weight-loss pill, are on the rise"

Well, fuck that dude. Completely ignorant of the nature of addiction, as one issue out of many, to attribute it to 'personal responsibility'.


In this context, I now understand the kerfuffle between cbayer and myself over 'failings' in relation to psychiatric issues. (I was not actually attempting to use it in that context. But I understand why it could elicit strong feelings, if interpreted this way)

[cbayer]

17. Yes it is one of the things that really pushes my buttons,

and this guy is the king of persecution when it comes to psychiatric patients, imo.

I am not opposed to people being expected to take personal responsibility, but I am strongly opposed to insisting the people take responsibility for things that are entirely out of their control.

[AtheistCrusader]

20. That was part of why I was outraged at the implication.

I've always taken a strong stand against that. Over in the Gungeon, I have repeatedly taken slings and arrows for adamantly opposing the association of 'mental health issue' and the knee-jerk disqualification for access to firearms that is always advocated for after any public shooting.

'Mental health issue' does not automatically imply danger to self or others, and the only useful thing it can be used to predict, is that people in that category are FAR more likely to be, themselves, victims of violence, rather than perpetrators of it.

It's a surprisingly unpopular position to take, given this audience's otherwise strong adherence to the idea of due process, which does allow for the removal of weapons from individuals adjudicated to be a danger to self or others, rather than some blanket, 'oh you talked to a therapist? DANGER' reaction that we too often see smeared against people who need help, not derision or fear.

Too easy to fear 'the other' these days...

[cbayer]

22. Good for you for taking a stand on this issue in the gungeon.

It is really hurtful to those who have psychiatric illnesses when this issue about who should have access to guns come up.

And you are exactly right about their being more risk of being a victim than a perpetrator.

In the gun debate, I think the psychiatrically ill are used as bogey men by both sides. The RBKA people think that it's an easy out for reducing gun violence to just blame it on "crazy" people. The gun control advocates point out that there is no really good way to keep guns out of the hands of "crazy" people.

But, I'm going to back out of this. There are reasons I don't frequent the gungeon.