Insanity: The Idea and Its Consequences

by Thomas Szasz

From one of the most renowned and controversial thinkers in behavioral science, here is a critical examination of the way both science and society define insanity. Attacking the universally accepted psychiatric doctrines that blur the distinction between literal and metaphoric diseases, Szasz argues that insanity is not an objectively definable or identifiable condition and presents a more fully-rounded account of the insanity concept, showing how it relates to and differs from three closely allied ideas--social deviance, bodily illness and the sick role. Reveals why it is truly impossible to understand psychiatric problems without first distinguishing an abnormal biological condition--like diabetes--from the sick role. Destined to become a classic, this is an important addition to the author's already impressive body of work.

Genres: Psychology, Philosophy, Nonfiction, History, Book Club, Psychiatry

414 pages, Paperback

First published November 1, 1986

About the author

Thomas Stephen Szasz (pronounced /sas/; born April 15, 1920 in Budapest, Hungary) was a psychiatrist and academic. He was Professor Emeritus of Psychiatry at the State University of New York Health Science Center in Syracuse, New York. He was a prominent figure in the antipsychiatry movement, a well-known social critic of the moral and scientific foundations of psychiatry, and of the social control aims of medicine in modern society, as well as of scientism. He is well known for his books, The Myth of Mental Illness (1960) and The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement which set out some of the arguments with which he is most associated.

Reviews

[David M · Rating 5 out of 5]

When I was a young feller this book helped me self-diagnose my way out of the psychiatric system. I remain grateful.

[Dave · Rating 5 out of 5]

I was right! psycho-babble really is psycho-babble.

What an amazing case-study into the mysteries of the so-called mind. Motives for coercion & compulsion are examined as well. It is definitely more quasi-religion tan any sort of quantifiable science.

[Paul Sand · Rating 4 out of 5]

In a Substack post, Bryan Caplan shared mail from an anonymous reader, who called this Thomas Szasz book "his best book overall". I noted that it was owned by the University Near Here Library, and they haven't revoked my borrowing privileges yet, so I grabbed it.

It is Szasz's full-throated explication and defense of his view that mental illness is a metaphor. Excepting certain obvious brain malfunctions, like Alzheimer's, there are no physical "lesions" associated with mental illness.

Metaphors are fine, as far as they go. But the mainstream psychiatric community takes this one way too far, using it to absolve evildoers of responsibility for their misdeeds, and to coerce people with unusual beliefs and behavior. (And also, not coincidentally, to make a lot of money off the misguided concept.)

I'm not totally convinced by Szasz, but he makes some excellent points, and he dragged my skepticism meter about "mental illness" up by more than a few notches.

One of his more telling arguments: it's alleged that when mentally ill people perform crimes (murder, arson, assault, theft, etc.) thay are acting under the compulsion of their illness; they aren't responsible, and don't deserve criminal punishment. Szasz notes that the actions that mental illness supposedly compels are uniformly bad; nobody ever claims that mental illness compelled people to perform acts of saintliness, generosity, tolerance, etc.

And that's darn peculiar. Does "mental illness" have some sort of built-in compass about human morality, causing it to work in only one direction? That seems incoherent and unlikely on its face. Actual physical illnesses seem to be morally neutral.

Szasz doesn't mention so-called "hate crimes", but this related observation kept coming to my mind while reading: If you've misbehaved illegally, and the authorities think you did so because you had "hatred" as an underlying motive, that's not considered "mental illness": that's your fault, your responsibility, and it may bring you more years in prison.

Does that seem conveniently arbitrary to you, as it does me?

Another drive-by point: is pregnancy per se an illness? Of course not! Ah, unless it's an unwanted pregnancy: then it's a mental illness, and the only cure is abortion, always euphemized as "reproductive care".

This book is, in part, just one side in a slow-motion decades-long debate between Szasz and his critics. Caution is warranted when reading only one side. Szasz is occasionally strident, occasionally sarcastic, and that may be understandable, but my own tastes are for something more measured.

I will point out one place where I think he badly stumbles: in drawing his own parallel between psychiatry and slavery, he makes much of the Constitution's famed three-fifths compromise, calling it "a remarkable legal fiction created to legitimize a peculiar human institution".

And (sorry Tom) it just wasn't that simple: it was the southern slaveholding states that wanted to count their (non-voting) enslaved populations as much as possible for purposes of increased Congressional representation. (And also, to neglect them if it came to "direct taxation".)

[Courtney Skelton · Rating 3 out of 5]

Thomas's book shows a great deal of research and intelligence on the subject of insanity. He looks at it from every angle, from the outside in, and the inside out. It shows where physicians have come from as far as how barbaric they used to be and how much society has grown on the subject, and it also hints as we still have room to grow. Parts of it he talked down upon others and cast references that intimated he knew more than others, and put himself on a pedestal. Other than that, it was a thick, yet educational read.

[William Nist · Rating 4 out of 5]

If you are worried that Attention Deficit Disorder, and various addictions are now classified as mental illnesses; That the 'Insanity Defense' is no more than a legal trick; The the DSM-IV has exploded the number of mental illness astronomically: then you might find the volume by Dr Thomas Szasz fascinating.

This renegade psychiatrist lampoons his own profession, challenging the vary existence of 'mental illness' and the paternalistic, coercive therapy that it actually is! Psychiatry is the new religion minus demons and hellfire. Psychiatrists are the new priests.

Since science has not found the 'lesions' that at the root of mental illness, or maybe the chemistry associated with mental illness is the result not the cause of the malady, Szasz does cast a question mark over the very definition of mental illness. And once the ideological thesis's are considered, the definition further erodes.

The author has written over 18 books on this topic. He challenges our mainstream paradigms.

[Nicolas S Martin · Rating 5 out of 5]

If you want understand Szasz on psychiatry, this is the book with which to start, not The Myth of Mental Illness. By this time Szasz had fully flushed out his beliefs and was a brilliant and elegant polemicist. MoMI is an historically important document, but it is not a great read. Insanity is.