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First, he admits that "the social and psychological occurrences so labeled " as mental illness do indeed exist Second, he acknowledges that, like mental illness, "bodily" illness is a normative notion, implying deviation from some favored standard, although in the case of bodily but not mental illness the favored standard and the deviation from it "can be stated in anatomical and physiological terms" Third, he concedes that finding oneself labeled as mentally ill, precisely because one deviates from a non-anatomical, non-physiological norm can have enormous implications for how one sees oneself, how one is seen by others, how one will be treated in the legal system, and so on.

Surely, Szasz is operating with an unnecessarily impoverished notion of existence here. He could certainly claim, as one might nowadays put it, that mental illnesses are "socially constructed" in ways that the bodily illnesses addressed by what Szasz calls "medicine proper" are not. This claim would be easier to defend, and would not require Szasz to retreat from his ambitious political project of denying psychiatry access to the credibility and authority it derives from its "essentially misleading association with the practice of medicine" of the usual, non-psychiatric sort In any case, this is a line of thinking that Szasz did not pursue.

Nietzsche points out that a society ruled by priests needs sin, because sin is the "handle" and foothold for power. Szasz makes similar points about the function of mental illness for psychiatry.

ISBN 13: 9781258233952

The application of the "mental illness" label has the function of authorizing intrusions and coercions of various kinds, but in this book Szasz is primarily interested in one kind of intervention: involuntary commitment of the mentally ill to hospitals. According to Szasz, the fact that this phenomenon is widely thought to be tolerable, even in countries with liberal legal systems, arises out of two unquestioned but plainly mistaken presuppositions.

First, there is the assumption that many people labeled as "mentally ill" are not responsible for their actions. The first assumption often necessitates finding a proxy decision-maker; the second assumption makes it natural that the physician should be invited to assume that role, alone or in concert with others. Szasz tries to challenge both assumptions. By contrast, his case for dropping the assumption that psychiatrists are primarily advocates for the best interests of their patients, as opposed to advocates for the maintenance of social order embodied in moral opinions about what kinds of behavior are "healthy" , seems essentially airtight.

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Above all, the notion that commitment, when demanded by a psychiatrist, should be presumptively taken to be in the patient's best interests, is here subjected to a withering and utterly convincing critique. The Therapeutic State. For many readers, the least appealing aspect of Law, Liberty, and Psychiatry will be the association of Szasz's critical insights about psychiatry as a mode of social control which often anticipate Michel Foucault's nominalist genealogies of "subjection" through identification with a specifically "libertarian" approach to questions of political morality.

Libertarians most famously, Robert Nozick and Milton Friedman tend to reduce political questions to questions about what should be done with property, whether property in one's person or one's resources, and then to assume that questions of that kind should generally be referred to the private preferences of the relevant property-holders taken individually.

For Szasz, accordingly, the basic moral objection to psychiatry in particular, and to the therapeutic state in general, is that it usurps the function of self-ownership from individuals. Szasz draws attention to the plain fact that the demands made on the state, or made by the state, have expanded into previously private realms, such as helping citizens reach their full potential, relieving their suffering, and protecting them from misfortunes.


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In the face of this development, Szasz, like other libertarians, worries about the price that will have to be paid in personal liberty for every advance in social welfare. This is bound to lead to the parentification of the government, and the infantilization of the governed" Of course, obvious objections will arise from other locations on the political spectrum.

How beneficial is liberty from state paternalism to a person whose behavioral idiosyncrasies for lack of a better word make sustained gainful employment unlikely indeed? To be sure, infantilization at the hands of the state is not an appealing solution, but neither is abandonment to a libertarian labor market. Convert currency.

Psychiatry, Mental Illness, and the State

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