THIS NEW BOOK by Thomas Szasz is probably his most important since The Myth of Mental Illness and The Ethics of Psychoanalysis. It will cause widespread controversy amongst psychotherapists and the "helping" professions if they take it seriously. This they may not do, since, as usual. Szasz overstates his case, and expresses himself in such intemperate language that he may preclude his ideas being taken as seriously as he would like, or as they should be.
What are Szasz's main contentions? As we know from his previous books, he considers mental illness to be a myth. The only true illnesses are physical, with demonstrable organic pathology. Medical treatment, in which something is done by one person to another person's body, is the only true form of treatment. Psychotherapy, in which all that passes between persons is talk, is not treatment at all, and to call it so is a category mistake which confuses thought. Moreover, to label psychotherapy "treatment" is to run the risk that various kinds of psychiatric intervention may be used illegitimately and fraudulently to coerce people and deprive them of autonomy. "The basic ingredients of psychotherapy are religion, rhetoric, and repression, which are themselves mutually overlapping categories."
So far, so good, Szasz propounds a thesis which, though many psychotherapists would disagree with him, is at least arguable.
However, he goes on to weaken his case by abandoning rational argument for the "base rhetoric" which Szasz accuses others of employing. After a historical survey of such precursers of psychotherapy as Mesmer and Heinroth, he launches a furious attack on Freud. He refers to Freud's claims about psychoanalysis as "false and fraudulent" calls his leadership "deceitful," and accuses him of a "desire to inflict vengeance on Christianity for its traditional anti-Semitism," using psychoanalysis as "a rhetoric of execration." He particularly deplores Freud's attempt at making psychoanalysis into a deterministic science of the mind on the ground that it deprives man of what Szasz prizes most, his autonomous power of decision.
I would agree that determinism is untenable in regard to human affairs as a whole; but Szasz seems to have abandoned the idea that anyone can be genuinely unconscious of their true motives, as one passage about the neuroses of war demonstrates. He treats everyone as if their symptoms were a matter of the conscious will.
But surely the point about having neurotic symptoms is that the patient complains of something which seems to afflicts him, which he does not understand, and of which he wants to be rid. People do not choose to perform obsessional rituals, or to be claustrophobic, or to have eccentric sexual preferences. In practice, Freud's deterministic outlook was profoundly modified by his distinction between those areas in which the patient could freely choose and make decisions, and those in which he was the victim of compulsions because of factors of which he was unconscious. Hence Freud's aspiration: "Where id was, there shall ego be." I don't think many people will agree with Szasz's view that Freud was fundamentally dishonest and more concerned with self-advancement than with understanding how the mind works.
To my mind, Szasz also discounts what may in fact be one of the most important "healing" factors in psychotherapy. He fails to take into account the fact that having the worst aspects of oneself accepted and understood by a tolerant, understanding person is enormously helpful.
This mars his later comparsion of Freud and Jung. He compares Jung favorably with Freud in that the recognized psychotherapy to be a "cure of souls" which has something in common with the healing effects of a religious faith. But Szasz underestimates the extent to which Jung regarded the therapeutic effect of his form of analysis as the consequence of the relationship which develops between providing the latter with an explanatory scheme which makes sense out of his disorder.
Much of what Szasz is valid. Psychiatrists do misuse language, are sometimes oppressive rather than liberating. It is probable that psychotherapy should be removed from the medical model. What a pity that Szasz diminishes the value of his arguments by recourse to base rhetoric and malicious polemic.