Stone accuses Szasz of falsely representing facts. An example is Szasz’s representation of Durham after whom the Durham rule was named. In Psychiatric Justice Szasz states that Durham was black. He uses this to support his position that the exculpation of defendants on grounds of insanity and then locking them up in mental institutions serves to oppress blacks in the United States, as proportionately many more blacks are tried than whites. Stone maintains that Durham was white and thus in Szasz’s terminology, belonged to the oppressors rather than the oppressed. Stone states that Szasz often does such things and that it is a pity, because they are not really essential to his argumentation. Stone does not present more examples which is unfortunate, particularly as the disputed passage about Durham does not appear in the revised edition of Psychiatric Justice (1978), nor, in fact, in the Collier edition of 1971. As Stone’s criticism was published in 1973, it came too late.

Guttmacher describes Law, Liberty, and Psychiatry as “a wealth of misinformation.” He states that the situations in which Szasz presents him in this book are not described accurately. An example is Szasz’s comment that a certain wealthy patient had a better chance to be released from Mental Hospital because she could afford to pay for her own counter-expert. Guttmacher states that his report led to her release but that he was not paid by her. Szasz includes Guttmacher in a group of psychiatrists who believe that most delinquents are sick. Guttmacher denies ever having defended this position, and states that neither did Weihofen and Zilboorg, who also appear on Szasz’s list. This means that Szasz incorrectly quotes others and imputes assertions to them which he subsequently opposes. Guttmacher lists a few more inaccuracies. Szasz states that when two psychiatrists disagree as to whether a person is mentally healthy, the reason is that they each maintain a different concept of mental illness, which Guttmacher disputes. Szasz states that differences of opinion among expert witnesses occur only if they are psychiatrists. Nonsense, says Guttmacher, extreme differences of opinion occur daily, also when the experts are orthopedic surgeons, radiologists, mining engineers, etc. These last two factors seem meaningful to me because Szasz seems to idealize the accuracy of somatic specialists and physical scientists whereas he excessively controverts that of psychiatrists. I will return to this more in detail in 3.3. Finally, Guttmacher denies Szasz’s explanation for why only very few involuntarily hospitalized patients escape from Mental Hospitals. Szasz states that this is “because a person’s sense of identity – that is, his self-esteem and his confidence in his ability to appraise reality and to plan his actions – is more radically undermined by mental hospitalization than by imprisonment.” Guttmacher wonders how often Szasz has been in prisons, “places that utterly violate the dignity and crush the spirit of a man,” according to Guttmacher. I note, however, that this is no longer about facts, but about their explanation.

Once in a while Szasz chooses definitions as premises for argumentation. Clare mentions as an example a definition of disease in Gould’s Medical Dictionary which is used by Szasz in The Second Sin on page 109. In this dictionary the word disease is defined as Szasz defines it. Clare calls this “semantic gymnastics” and quotes a different dictionary with a different definition. In my opinion Clare is in this unjust towards Szasz: the struggle for a correct definition of disease is contended in The Myth of Mental Illness. The Second Sin, a collection of aphorisms, is intended for a broad audience and not as a publication in which theories are construed. Szasz did not use this definition in The Myth of Mental Illness. If he had the criticism would have been justified.

In a 1971 paper Szasz uses a definition for addiction from Webster’s Third New International Dictionary. In response Cohen accuses him of using an insecure definition and that it would have been more fair to use the WHO’s definition. In an article with the same title Szasz picks up this challenge and uses the WHO’s definition. It certainly does not make his argumentation any less convincing.

I have not found clear examples of Szasz misusing this method of basing his arguments on generally accepted meanings of concepts. However, he does sometimes confuse the issue by defining concepts in an unusual way, such as his definition of the concept of religion, and by sometimes ascribing different meanings to concepts in different places. I have already mentioned the different meanings of the concept of freedom. (Chapter III, 2.5) Another example is the concept “explanation.” In The Manufacture of Madness (p. XXI in particular) the concept refers to events as well as behavior; in Psychiatric Slavery (pp. 3-4) only to events and not to behavior. The reason, Szasz says there, is that events can be explained but the word “explanation” is not applicable to what people do. Only words like justification, assumption, and contention are.

The ad hominem argument is a pseudo-argument attacking not a certain opinion but a person’s integrity. Szasz has protested vehemently against ad hominem arguments which he claims are not infrequently used by psychoanalysts. One of his examples is Wittel’s criticism of Kraus, the tireless critic of psychoanalysis. Wittel claimed that Kraus’s criticism was motivated by an unresolved Oedipus complex. (Karl Kraus and the Soul Doctors, p. 32-35) I am of the opinion that Szasz, too, has been guilty of ad hominem arguments, in particular regarding Freud. (See Chapter I, 7.2.) The ninth chapter of The Myth of Psychotherapy is titled, “Sigmund Freud, the Jewish Avenger” even though the book is not intended as a personal description of Freud but as an “unmythologization” of psychotherapy. The chapter so titled begins with the sentence, “Because I regard psychotherapy as a moral rather than a medical enterprise, it is reasonable to inquire into the religious origin, development, and self-identification of the founder of psychoanalysis.” I would like to counter that regardless whether psychotherapy is moral or scientific, it should be judged on its own merit. Whatever is thought of Freud’s religion, development, and self-identification, his ideas should be judged on their own merit.

Simplifications can be found in Szasz’s writings. I already mentioned the “shorthand” descriptions for mental illness in the paragraph on presentation. Another simplification is that disease is something that happens to a person whereas a psychiatric disorder is something that one does and is. The one comes falling out of the sky, the other one makes oneself. In this form the description is untenable, even misleading. That is relevant because such descriptions are presented as correct in the argumentation and form the foundation of conclusions. I will return to this in the next chapter.

Sometimes generalizations creep into the argumentation without in themselves being argued. In The Myth of Mental Illness Szasz generalizes that what applies to hysteria applies to all psychiatric disorders, mutatis mutandis. On pages 25-26 of Ceremonial Chemistry he generalizes the scapegoat theory, (see Chapter I, 4.2) which is so broad that everyone becomes a scapegoat and whoever rejects this role often does it by becoming a scapegoater. But dividing up practically the entire human race into oppressors and the oppressed deprives the scapegoat theory – which tries to clarify a typical human trait and phenomenon – of its specific, unique character, and with that a large part of its value. In a 1971 article on addiction Szasz generalizes that as most medicines are not freely available, but must be prescribed by a physician, self-medication is the same as medication-abuse. This generalization makes a parallel possible: that which is autonomous is called abuse, and from this standpoint he advocates “freedom of self-medication as a fundamental right.”

Circular reasoning is common in Szasz’s argumentation. Sometimes it is pure circular reasoning, with that which is to be demonstrated returning in the argumentation. More often, however, it is a repetition of that which is to be demonstrated in the form of a contention. (See 3, 3.1.) Some examples will be given in 4.2 below.

Sometimes Szasz tries to demonstrate a contradiction by showing that people react differently to similar behaviors. For example, why are some drugs prohibited whereas others are freely available? Alcohol and tobacco are no less addictive than some drugs that are everywhere illegal. The one group richly contributes to the national treasury, the other is prohibited by the government. Another example is: if the suspicion that someone may be dangerous to himself is a reason for involuntary hospitalization, then why not also commit motor racers, trapeze artists, and stunt men? Such a way of reasoning constitutes quite a simplification of a complex reality. People or things that resemble each other in certain aspects are assumed to resemble each other in other aspects as well. A convincing counter-argument is harder to find regarding drugs than regarding involuntary commitment. In the latter case the crux is the grounds on which some people are dangerous for themselves. Why are some people who have a proclivity to be dangerous for themselves approached differently than other people with such a proclivity? Because they differ in other aspects than this one. Lettuce and foxglove are both plants with green leaves. Why do we eat one and not the other? The answer is because one is not toxic and the other is. In short, they are spectacular arguments with a very varied degree of applicability.

Analogies were already mentioned in the paragraph on presentation. When an analogy is used it is to declare the implication of a phenomenon applicable regarding a different phenomenon, on grounds that both phenomena resemble each other in one or more important aspects. This form of reasoning can be risky. A certain commonality in a particular aspect can never lead to the conclusion that this commonality exists in other aspects as well. An analogy can never determine the identity of different phenomena. And that is exactly what Szasz means to do. He invites us to concede to the identicalness, from a socio-political point of view, of complex phenomena as the Inquisition, slavery, racial discrimination, and institutional psychiatry, whereas he shows only that they are comparable in a limited number of aspects. The object of this equation is to make the amorality of the first three applicable to the fourth. From a purely argumentative point of view it remains to be proven that the analogy applies in that aspect as well. Instead, by calling these phenomena identical, Szasz concludes that institutional psychiatry is amoral.

Moreover, when stating something about the sense and applicability of an analogy is wished, not only must that which is in common be taken into consideration, but also the differences among the compared phenomena. Usually when Szasz discusses analogies he does not include a systematic evaluation of the differences. They may be mentioned incidentally but not systematically. For instance, Szasz compares psychoanalysis to a game of chess listing seven aspects in common, but never mentions whether there are also differences. The same holds true for his analogy of the mind/body to a television program/television set. (See Chapter III, 3.2.) In The Manufacture of Madness there is no systematic examination of the differences between the Inquisition and institutional psychiatry.

Glaser sees an anti-synthetic inclination in the structure of Szasz’s dialectic reasoning, an emphasis on contrasts. The dialectic of individual freedom and social responsibility is turned into that of psychiatry and law. Just as Szasz does not seek a possible synthesis between mind and body but rather whets the antithesis, so he seeks no possible synthesis between psychiatry and law. Glaser calls this “the dichotomy game.”

Together with the tendency to overemphasize commonality, as discussed in 8 above, the overemphasis of differences leads to a reality sketched in black and white, lacking subtlety. Such a style, although risky, is not unacceptable as long as contrast is not turned into contradiction and analogy is not turned into identicalness.

Stone calls “the dichotomy game” Szasz’s “principle conceptual device.” I suspect that he is ascribing to this term a wider significance than Glaser. It is not uncommon that in his argumentation Szasz posits that a certain phenomenon A is part of one of the two mutually exclusive classifications X and Y. He then does not leave room for the possibility that A is part of neither, or both, or a third classification that has not been mentioned. Also the classification descriptions may appear incomplete or incorrect, or the classifications are not mutually exclusive after all. Stone mentions the example of the “lie-mistake” argumentation in The Myth of Mental Illness. (pp. 135-136) There Szasz states that “lies” and “mistakes” are two kinds of misinformation. The difference is that the lie aims at an effect whereas the mistake is indifferent regarding consequence. This dichotomy is not correct according to Stone. There are mistakes that are indifferent and mistakes that are not. The category of not-indifferent mistakes encompasses both lies and mistakes made in good faith the consequence of which is not indifferent. Szasz applies this dichotomy to hysteria. That the application is only relevant in case of agreement with Szasz that hysteria is no more than a form of communication of an untrue message is but implied. If after that Szasz is joined in his opinion that hysterical behavior follows rules and aims at a goal – only then – is Szasz’s conclusion inescapable: “It is more accurate to regard hysteria as a lie than as a mistake.”

Stone’s description of the dichotomy game encompasses more than Glaser’s because Glaser only notes that Szasz stresses antitheses. Stone, on the other hand, presents an image of Szasz’s argumentation leading the reader to a fork in the road and then allowing only one choice, either right or left, whereas other choices or refraining from choice are equally possible. In other words, Szasz presents dilemmas, the choice being possible only after accepting the premises.

As such dilemmas occur regularly in Szasz’s work this can be considered an important element of his argumentation. Brody, in his commentary on a 1977 article by Szasz, mentions an example when wondering why Szasz makes a categorical distinction between descriptive and prescriptive concepts. Concepts may have both descriptive and prescriptive implications, and are more likely to be complementary than mutually exclusive. Psychiatric Slavery presents us another example. In it Szasz, speaking about the inclination to reify mental illness as the cause of crime, asserts, “Either we accept this psychiatric idolatry – in which case we regard the principles and practices of modern forensic psychiatry as progressive and scientific, or we reject it – in which case we regard psychiatric pronouncements on the human mind, especially when offered in courts of law, as agnostics regard theological pronouncements on God.” (p. 5) There are many other examples, among them The Myth of Mental Illness, pages 94-95, page 271, and in the revised edition page 87; The Manufacture of Madness, page 241; a 1958 paper on psychoanalytic training, and a 1974 article entitled “The Myth of Mental Illness: Three Addenda.” For the sake of brevity I will not discuss all of these.

In order to clarify some other elements of Szasz’s argumentation I must interrupt this list to present an explanation and a theoretical framework from which these elements can be viewed, as several very important building blocks in Szasz’s argumentation are based on what Perelman calls the dissociation of concepts. He explains this dissociation as the pair of concepts semblance/reality. Semblance is reality as it presents itself to the immediate experience, reality at first glance. Semblance may correspond with reality. Semblance may also be irreconcilable with reality, for instance when a straight stick in water looks broken. So semblance has two sides: sometimes it reflects reality and sometimes it is a source of illusion and error. Inconsistencies and contradictions in the immediate experience of reality, which Perelman calls “Term I,” therefore lead to seeking a second reality, which Perelman calls “Term II,” behind the first semblance of reality. Term II offers a criterion, a standard, by which legitimate and illegitimate aspects of Term I can be distinguished. At the same time Term II’s design becomes a construction that determines reality. Term II is normative as well as explanatory, and distinguishes between semblance that deceives and semblance that reflects reality.

History has judged the relationship between Term I and Term II quite divergently. To Plato, the world of ideas was the “true reality,” which he valued more highly than perceivable reality. Throughout history, however, the value attributed to these terms varied from regarding Term I practically worthless and ascribing essence to term II, to practically eliminating Term II. Kuiper says about this, “It is an expectable idea that a different reality hides behind the one that is immediately experienced, one which determines our culture, religion, art, and science. We cannot do without the distinction between that which is immediately visible and experienced, and that which is at first concealed. It is of utmost importance to our thought and existence, as people are constantly pursuing the deeper insight that imparts sense and happiness to life, a pursuit that also presents itself in science.”

Aside from enthusiasm for the all but limitless possibilities of the semblance/reality approach, I counsel skepticism. Kuiper himself warns that people in power are benefited by an ideology that presents the reality of the physical sciences as the “real” reality, because physical science enables the control of reality. It seems to me that in every ideology, like in Term II, there is an inherent danger that it will serve as justification for oppressing others or committing violence against them. The history of our culture has already amply proved that this is the case in matters of religion. The same holds true for national socialism, communism, and Marxism, except maybe for those who believe in such an ideology. My point is not whether one ideology is more beneficial than the other, but the danger inherent in every ideology. It is exactly the pretense of Term II that it describes and determines reality as it actually is which poses this danger.

Szasz’s most important criticism of psychoanalysis is that Term II is speculative and scientifically unprovable, yet masquerades as truth. As examples I suggest the following quotes from Fromm: “Freud realized that most of what is our reality is not conscious, and that most of what is conscious is not reality. Freud’s relentless search for the internal reality opened a new dimension of truth;” “Man, who is so proud of his freedom to think and choose, is actually a puppet that is animated by strings behind and above him, and these strings are in turn moved by forces that are unknown to his conscience.” Fromm’s choice of words indicates that he does not consider psychoanalytic insights views but rather that to him they are the revelation of authentic truth. When it is considered that psychoanalytic theory reveals the true nature of the forces that move the puppet strings, my conclusion that the psychoanalyst knows this truth about man, and is therefore in Fromm’s view at a higher level than normal mortals as the high priest with his understanding and insight into the mysteries and secrets of godliness is at a higher level than the “normal” faithful, is inescapable.

These remarks regarding psychoanalytic theory as Term II are intended to be an elucidation of the significance of Term I and Term II. The point here is how Szasz uses Term I and Term II in his argumentation, and the consequences thereof. Now I will return to the list.



Often Szasz goes even further and posits that the consequences of an action are also its intention. This ploy assumes the nature of an accusation in those cases that the consequence is in some aspects worthy of condemnation.

In psychoanalysis, the discrepancy between intention and consequence is typically resolved using the concept of the unconscious. The intention is considered a conscious motivation for an action but the consequence is unconsciously desired. The effect is two-fold: as the true motivation is unconscious, the person cannot be blamed for it, but at the same time, the person cannot be regarded as responsible for the consequences of his actions. Thus the concept of the unconscious exculpates and infantilizes in one and the same maneuver. Szasz prefers a different route: the person is responsible for his actions as well as their consequences, which, when the consequence could not have been reasonably foreseen, leads to accusation. As such a structure occurs frequently in Szasz’s writings, I list two examples here:

1. “This search for the physical causation of so-called psychopathological phenomena is motivated more by a need for prestige on the part of the investigators than by a quest for scientific clarity.” (The Myth of Mental Illness, p. 92) “The quest for clarity” corresponds to Term I, contextual meaning, and in Szasz’s opinion is a claimed motive; “a need for prestige” corresponds to Term II, strategic significance, and in Szasz’s opinion is the true motive.
2. Which factor determines whether an act is to be considered a crime or a (product of) mental illness? “The answer is simple: first we decide how we want to deal with the problem or person. If we want to spirit the culprit away and pull a curtain of secrecy and silence around the issues involved and the social conflicts which may be mobilized by inquiry into them, then we decide that the person responsible is mentally ill. Conversely if there is no objection to free inquiry into the problem opened up by the socially deviant act – or, even more, if the act can be used to influence particular social issues in certain desired directions – then no recourse to mental illness is taken and the great public drama of a trial follows.” Here Term I, the contextual aspect of mental illness, has disappeared entirely, and Term II, the strategic implication, is presented as the only relevant reality. In comparable cases (Law, Liberty, and Psychiatry, pp. 154-159, and from p. 193) Szasz at least states that unusual motives and unconventional behavior, or more generally, the question, “How is all this possible?” evoke the idea of a psychiatric disorder.

There are many arguments of this type: Ceremonial Chemistry, page 4; The Myth of Psychotherapy, pages 128 and 137; Law Liberty, and Psychiatry, page 194.

Sometimes the dissociation of concepts expresses itself as a way of explaining a certain reality which is presented as an alternative, for instance, the “official” explanation, or the psychoanalytic one. Here are some examples:

1. How can the origin of depression be explained? Is it the result of a series of events (so considered [pseudo-]causative), or is it the expression of a person’s view of himself and his world? To Szasz, the former implies that depression is a disease, the latter is but an ethical judgment. This is another example where contrast is turned into contradiction, as alternative explanations are presented as contradictions.
2. In the review of a book on Robert Kennedy’s assassination Szasz suggests an alternative explanation for the assassin’s motives, which rather contrasts the “official” psychiatric explanation.
3. A similar structure is to be found in Law, Liberty, and Psychiatry, pages 154-159. Szasz’s explanations are more existential-phenomenological than psychoanalytic.

The most important reason for Szasz to offer these alternatives is probably that he, by presenting a different view, demonstrates the fragility of psychoanalytic explanations, that after all are no more than opinions, and in particular opinions on Term II.