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Cruel Compassion: Psychiatric Control of Society's Unwanted
Cruel Compassion is the capstone of Thomas Szasz's critique of psychiatric practices. Reexamining psychiatric interventions from a cultural-historical and political-economic perspective, Szasz demonstrates that the main problem that faces mental health policy makers today is adult dependency. Millions of Americans, diagnosed as mentally ill, are drugged and confined by doctors for noncriminal conduct, go legally unpunished for the crimes they commit, and are supported by the state—not because they are sick, but because they are unproductive and unwanted. Obsessed with the twin beliefs that misbehavior is a medical disorder and that the duty of the state is to protect adults from themselves, we have replaced criminal-punitive sentences with civil-therapeutic 'programs.' The result is the relentless loss of individual liberty, erosion of personal responsibility, and destruction of the security of persons and property—symptoms of the transformation of a Constitutional Republic into a Therapeutic State, unconstrained by the rule of law. Szasz shows convincingly that not until we separate therapy from coercion—much as the founders separated theology from coercion—shall we be able to get a handle on our seemingly intractable psychiatric and social problems. No contemporary thinker has done more than Thomas Szasz to expose the myths and misconceptions surrounding insanity and the practice of psychiatry. Now, in Cruel Compassion, he gives us a sobering look at some of our most cherished notions about our humane treatment of society's unwanted, and perhaps more importantly, about ourselves as a compassionate and democratic people.
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First published January 1, 1994
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About the author
Thomas Szasz
97 books318 followersThomas 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.
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April 12, 2023
Szasz's first book was The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. The title of that first work adumbrates the main points of Szasz's later work. He believes that mental patients should not face coercive treatment, involuntary commitment, or involuntary medication unless and until they have committed a criminal offense. Let me rephrase that--his beef is even bigger. Coercive psychiatry is a contradiction in terms to Szasz, and those criminal issues are best dealt with through the criminal law system. "Replacing the practice of committing persons as mental patients with the practice of treating them as responsible persons would require a ... metamorphosis of professional and popular opinion. People would have to accept that involuntary mental hospitalization is counterproductive, because it deprives the subject of dignity and and liberty, excuses him from responsibility for his behavior, and prevents him from learning by suffering the consequences of his selfish or unwise actions; and they would have to conclude that the relationship between sane family members and their insane relatives--or between the state and certain violators--could be better regulated by means of regular criminal and civil law sanctions than by special mental health law procedures."
Szasz in this book sketches the history of mental illness and the social rules governing the unwanted or inconvenient members of society and shows how in fact the two have converged. Also notable is the way that psychiatry got things wrong--really wrong--in the not-so-distant past. The low point might be the assumptions about and isolation of epileptics until the 1950s. Or, Szasz might argue, it might be the present.
While there have been many changes in mental health policy since Szasz began to speak out in the 1950s, he argues those changes really haven't been improvements, because they still don't deal with the core flaws in our philosophy--the trampling of the twin virtues of personal liberty and personal responsibility in our dealings with the so-called mentally ill.
A brilliant rhetorician, Szasz often explores the semantics behind the world views we take for granted. He conducts in this book a profound and probing discussion, for instance, about the meaning of the word "home" as a means to understand the problem of "homelessness" and its possible solutions. He also builds an argument equating child psychiatry with child rape, based on the child's inability to give consent to treatment. Szasz strongly believes in the power of psychiatry to solve life problems--when it is practiced between a consenting adult and his therapist.
This book, coming later in his career, is a bit more apologetic (in a rhetorical sense) than some in its predecessors. There were also a couple of times when his use of commas invoked the sonnets of John Donne. Neither of these stylistic issues dampened my experience with the book.
Szasz is a key libertarian thinker of the Twentieth Century, and this book would be a great one to get your feet wet in Szasz, as it ranges over history,economics, criminal justice, mental illness, homelessness, and more. I think one of his more striking observations is how often otherwise libertarian authors have nearly universally taken for granted the need for the use of coercion against the mentally ill.
Personal disclosure: The diagnosis of schizophrenia is a common one in my immediate and extended family. I lived with a schizophrenic relative for years. So please don't hate on me because you think I live in an ivory tower with respect to mental illness. From time to time an author comes along like an earthquake and tries to reshape the cultural landscape and allow us to see our cultural prejudices and blind spots. Szasz is one such author. Antonie van Leeuwenhoek brought a microscope to water and showed us worlds unimagined. Szasz brings the microscope to bear on mental illness. Maybe everything we have been conditioned to believe about mental illness and its treatment isn't the last word? There is something to make everyone uncomfortable in this book. And that is not necessarily a bad thing.
Oh and as noted I do own a copy I can loan you if you're local.
Szasz in this book sketches the history of mental illness and the social rules governing the unwanted or inconvenient members of society and shows how in fact the two have converged. Also notable is the way that psychiatry got things wrong--really wrong--in the not-so-distant past. The low point might be the assumptions about and isolation of epileptics until the 1950s. Or, Szasz might argue, it might be the present.
While there have been many changes in mental health policy since Szasz began to speak out in the 1950s, he argues those changes really haven't been improvements, because they still don't deal with the core flaws in our philosophy--the trampling of the twin virtues of personal liberty and personal responsibility in our dealings with the so-called mentally ill.
A brilliant rhetorician, Szasz often explores the semantics behind the world views we take for granted. He conducts in this book a profound and probing discussion, for instance, about the meaning of the word "home" as a means to understand the problem of "homelessness" and its possible solutions. He also builds an argument equating child psychiatry with child rape, based on the child's inability to give consent to treatment. Szasz strongly believes in the power of psychiatry to solve life problems--when it is practiced between a consenting adult and his therapist.
This book, coming later in his career, is a bit more apologetic (in a rhetorical sense) than some in its predecessors. There were also a couple of times when his use of commas invoked the sonnets of John Donne. Neither of these stylistic issues dampened my experience with the book.
Szasz is a key libertarian thinker of the Twentieth Century, and this book would be a great one to get your feet wet in Szasz, as it ranges over history,economics, criminal justice, mental illness, homelessness, and more. I think one of his more striking observations is how often otherwise libertarian authors have nearly universally taken for granted the need for the use of coercion against the mentally ill.
Personal disclosure: The diagnosis of schizophrenia is a common one in my immediate and extended family. I lived with a schizophrenic relative for years. So please don't hate on me because you think I live in an ivory tower with respect to mental illness. From time to time an author comes along like an earthquake and tries to reshape the cultural landscape and allow us to see our cultural prejudices and blind spots. Szasz is one such author. Antonie van Leeuwenhoek brought a microscope to water and showed us worlds unimagined. Szasz brings the microscope to bear on mental illness. Maybe everything we have been conditioned to believe about mental illness and its treatment isn't the last word? There is something to make everyone uncomfortable in this book. And that is not necessarily a bad thing.
Oh and as noted I do own a copy I can loan you if you're local.
Read
May 18, 2025**Overview**
*Cruel Compassion: Psychiatric Control of Society's Unwanted* by Thomas Szasz is a provocative critique of the mental health system, particularly how psychiatry is used as a tool of social control rather than healing. Szasz argues that many psychiatric interventions—especially involuntary commitment and forced treatment—masquerade as compassionate care but are in fact mechanisms for managing deviance and marginalizing individuals deemed undesirable by society. He challenges the legitimacy of mental illness as a medical condition and contends that psychiatry often operates more like a legal or political institution than a scientific discipline.
**Key Concepts and Actionable Ideas**
**1. Psychiatry as Social Control**
* Szasz argues that psychiatry has become a means of controlling people whose behavior is socially unacceptable but not criminal.
* "Compassion" is weaponized to justify confinement, coercion, and removal from society under the guise of treatment.
**Action:** Critically evaluate the intent behind psychiatric interventions—especially involuntary ones. Ask whether they protect individual liberty or primarily serve institutional convenience.
**2. Myth of Mental Illness**
* The book expands on Szasz’s earlier claim that “mental illness” is not a literal disease but a metaphor for behaviors society disapproves of.
* Medical language gives moral judgments scientific legitimacy, obscuring the subjective nature of psychiatric labeling.
**Action:** Challenge pathologizing language in everyday life. When confronted with a diagnosis, distinguish between biological dysfunctions and behavioral norms dressed as medical facts.
**3. Involuntary Commitment as Coercion**
* Involuntary hospitalization is seen as a civil rights violation, not a therapeutic necessity.
* Szasz contends that locking people up for being different or disruptive—under the pretext of help—is an abuse of power.
**Action:** Support legal reforms that prioritize informed consent and due process. Advocate for mental health systems that rely on voluntary participation and respect autonomy.
**4. Paternalism Disguised as Care**
* The state, supported by psychiatric institutions, acts as a "parent" to adults labeled mentally ill, removing their right to choose.
* This infantilization strips individuals of responsibility and dignity.
**Action:** Promote models of care that empower decision-making and responsibility, rather than imposing compliance through coercion or forced dependence.
**5. The Expansion of Psychiatric Authority**
* Psychiatry’s influence has expanded into schools, prisons, and workplaces, where deviant or inconvenient behavior is medicalized and controlled.
* Szasz warns that this undermines personal accountability and promotes passive victimhood.
**Action:** Push back against the normalization of psychiatric intervention in non-clinical settings. Encourage educational and disciplinary responses that don’t rely on labels or medication as first-line solutions.
**6. The Therapeutic State**
* Szasz introduces the concept of the "therapeutic state," where medical professionals collaborate with the state to regulate behavior under the banner of health and safety.
* This blurs the line between healing and policing.
**Action:** Scrutinize public policies that use mental health justifications to curtail freedoms (e.g., mandatory treatment laws, psychiatric evaluations for political dissenters).
**7. Psychiatry vs. Law**
* Unlike legal institutions, psychiatry often bypasses due process, applying subjective diagnoses with the power to detain indefinitely.
* Szasz advocates that conflicts involving adult behavior should be handled within the legal system, not under psychiatric authority.
**Action:** Support clear legal boundaries between therapeutic and judicial systems. Encourage transparency, accountability, and third-party oversight of psychiatric practices.
**8. Compassion Without Coercion**
* Szasz insists that true compassion requires respecting a person’s right to make choices—even choices that seem irrational or self-destructive.
* Helping must be consensual, not forced.
**Action:** In professional or personal care roles, prioritize active listening and voluntary support. Offer options, not ultimatums.
**9. Dangers of Diagnostic Inflation**
* The tendency to label more behaviors and emotions as "disorders" creates a culture of overdiagnosis and overmedication.
* This reinforces the idea that personal or social problems are best solved with psychiatric treatment.
**Action:** Educate others about the distinction between medical conditions and normal human distress. Encourage critical thinking before accepting psychiatric labels.
**10. Personal Responsibility and Freedom**
* Central to Szasz’s philosophy is the belief in individual freedom and responsibility.
* He sees the psychiatric model as eroding this by shifting agency from the person to the institution.
**Action:** Promote narratives of empowerment in mental health—focusing on capability, growth, and ownership of one’s decisions rather than dependency or pathology.
**Conclusion**
*Cruel Compassion* is a sharp indictment of modern psychiatry's role in enforcing conformity and suppressing inconvenient individuals through the language of care. Szasz challenges readers to see beyond institutional benevolence and to recognize the coercive underpinnings of many psychiatric practices. The book advocates for a system rooted in liberty, responsibility, and respect for autonomy—reminding us that compassion, if it denies freedom, can become its opposite.
*Cruel Compassion: Psychiatric Control of Society's Unwanted* by Thomas Szasz is a provocative critique of the mental health system, particularly how psychiatry is used as a tool of social control rather than healing. Szasz argues that many psychiatric interventions—especially involuntary commitment and forced treatment—masquerade as compassionate care but are in fact mechanisms for managing deviance and marginalizing individuals deemed undesirable by society. He challenges the legitimacy of mental illness as a medical condition and contends that psychiatry often operates more like a legal or political institution than a scientific discipline.
**Key Concepts and Actionable Ideas**
**1. Psychiatry as Social Control**
* Szasz argues that psychiatry has become a means of controlling people whose behavior is socially unacceptable but not criminal.
* "Compassion" is weaponized to justify confinement, coercion, and removal from society under the guise of treatment.
**Action:** Critically evaluate the intent behind psychiatric interventions—especially involuntary ones. Ask whether they protect individual liberty or primarily serve institutional convenience.
**2. Myth of Mental Illness**
* The book expands on Szasz’s earlier claim that “mental illness” is not a literal disease but a metaphor for behaviors society disapproves of.
* Medical language gives moral judgments scientific legitimacy, obscuring the subjective nature of psychiatric labeling.
**Action:** Challenge pathologizing language in everyday life. When confronted with a diagnosis, distinguish between biological dysfunctions and behavioral norms dressed as medical facts.
**3. Involuntary Commitment as Coercion**
* Involuntary hospitalization is seen as a civil rights violation, not a therapeutic necessity.
* Szasz contends that locking people up for being different or disruptive—under the pretext of help—is an abuse of power.
**Action:** Support legal reforms that prioritize informed consent and due process. Advocate for mental health systems that rely on voluntary participation and respect autonomy.
**4. Paternalism Disguised as Care**
* The state, supported by psychiatric institutions, acts as a "parent" to adults labeled mentally ill, removing their right to choose.
* This infantilization strips individuals of responsibility and dignity.
**Action:** Promote models of care that empower decision-making and responsibility, rather than imposing compliance through coercion or forced dependence.
**5. The Expansion of Psychiatric Authority**
* Psychiatry’s influence has expanded into schools, prisons, and workplaces, where deviant or inconvenient behavior is medicalized and controlled.
* Szasz warns that this undermines personal accountability and promotes passive victimhood.
**Action:** Push back against the normalization of psychiatric intervention in non-clinical settings. Encourage educational and disciplinary responses that don’t rely on labels or medication as first-line solutions.
**6. The Therapeutic State**
* Szasz introduces the concept of the "therapeutic state," where medical professionals collaborate with the state to regulate behavior under the banner of health and safety.
* This blurs the line between healing and policing.
**Action:** Scrutinize public policies that use mental health justifications to curtail freedoms (e.g., mandatory treatment laws, psychiatric evaluations for political dissenters).
**7. Psychiatry vs. Law**
* Unlike legal institutions, psychiatry often bypasses due process, applying subjective diagnoses with the power to detain indefinitely.
* Szasz advocates that conflicts involving adult behavior should be handled within the legal system, not under psychiatric authority.
**Action:** Support clear legal boundaries between therapeutic and judicial systems. Encourage transparency, accountability, and third-party oversight of psychiatric practices.
**8. Compassion Without Coercion**
* Szasz insists that true compassion requires respecting a person’s right to make choices—even choices that seem irrational or self-destructive.
* Helping must be consensual, not forced.
**Action:** In professional or personal care roles, prioritize active listening and voluntary support. Offer options, not ultimatums.
**9. Dangers of Diagnostic Inflation**
* The tendency to label more behaviors and emotions as "disorders" creates a culture of overdiagnosis and overmedication.
* This reinforces the idea that personal or social problems are best solved with psychiatric treatment.
**Action:** Educate others about the distinction between medical conditions and normal human distress. Encourage critical thinking before accepting psychiatric labels.
**10. Personal Responsibility and Freedom**
* Central to Szasz’s philosophy is the belief in individual freedom and responsibility.
* He sees the psychiatric model as eroding this by shifting agency from the person to the institution.
**Action:** Promote narratives of empowerment in mental health—focusing on capability, growth, and ownership of one’s decisions rather than dependency or pathology.
**Conclusion**
*Cruel Compassion* is a sharp indictment of modern psychiatry's role in enforcing conformity and suppressing inconvenient individuals through the language of care. Szasz challenges readers to see beyond institutional benevolence and to recognize the coercive underpinnings of many psychiatric practices. The book advocates for a system rooted in liberty, responsibility, and respect for autonomy—reminding us that compassion, if it denies freedom, can become its opposite.
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