Thomas S. Szasz has been a conspicuous phenomenon in psychiatry during the last 25 years. In his up until today [1984] 18* books and more than 350 articles, he demands attention for the iniquity of current health care systems, psychiatry in particular. He points out psychiatry’s unwholesome alliance with the state, a paternalistic system of services and rules that violates people’s freedom and autonomy, and deprives them of responsibility for their own life and well-being.

Szasz is a psychiatrist and psychoanalyst. He criticizes his profession from within, much to the annoyance of many psychiatrists. He is in the unique position of being a member of the psychiatric establishment while constantly rebelling against it. Although this too arouses anger among his colleagues, he astutely understands that this status prevents others from waving his views away as unprofessional or irrelevant.

Szasz, with his often rigorous criticism of current psychiatric practice, is not comparable with any other psychiatrist, not even Laing and Cooper, the founders of antipsychiatry. His political philosophy is likewise far removed from Basaglia and Italian democratic psychiatry. As some of Szasz’s recommendations resemble those of the Italians, he, along with them, is often considered an antipsychiatrist. He himself categorically rejects this title.

At least as noteworthy as his oeuvre itself are the reactions to his work. It has gained attention and elicited appreciation mostly beyond the psychiatric profession. Inside the profession the responses are two-fold. Initially, attempts are made to ignore him. Discussion is avoided. Professional journals are reluctant to publish his articles. When he cannot be ignored, most critics in psychiatry focus on the way he expresses himself. In 1973 Stone summed it up thus: “One intriguing aspect of the Dr. Szasz situation is the seeming helplessness of the psychiatric establishment in coping with his charges.”

This challenge is my first motive for writing this book. My second motive is that in recent years we are increasingly experiencing, in the Netherlands as well, the state interventions in health care to which Szasz is so averse. These interventions are becoming increasingly intensive and invasive, while hardly any voices are being heard that oppose it, or even pose the question whether this is a desirable development. My third reason for writing this book is that if psychiatry is a branch of medicine, it is unclear why the social reality of this branch is so different from other branches of medicine. Why do precisely psychiatrists, who work with concepts that are so less well defined than those in other branches of medicine, have so much more social power, and are involved with so many non-medical questions? Lastly, contemplation about the fundamental concepts of psychiatry and psychiatric treatment is most advisable in these times, when the former chairman of the [Psychiatric] Clients’ Union, representing the Dutch Patients’ Movement, is sounding serious criticism of psychiatry. He concludes that it “has terrible shortcomings.”

The motives mentioned above form the blueprint for this book. In Part I, a summary of Szasz’s theories, assertions, and insights are presented (Chapter I). Afterwards is a sketch of several historical developments that are important for determining the position of Szasz’s work (Chapter II), followed by a description of Szasz’s personal, political, and moral philosophies (Chapter III). After Szasz having been described as well as possible with only minimal comment in these three chapters, Chapter IV will examine Szasz’s use of language and his arguments.

Part II offers a commentary on Szasz’s main themes in three chapters. Chapter V proposes a theoretical concept of illness and mental illness. In Chapter VI the theoretical concept of illness and mental illness is further examined in light of the way physicians, patients, and institutions approach it in practice. Finally, Chapter VII focuses on Szasz’s central theme of psychiatry as a repressive institution: the involuntary commitment.

Obviously it is impossible to do justice to all aspects of Szasz’s work in the confines of this book. In selecting issues, a certain amount of subjectivity is unavoidable. I have chosen to stress general principles and fundaments, as Szasz himself does, rather than going into the details of procedural problems and legal cases. Psychiatric hospitals and other psychiatric institutions are mentioned only incidentally. An examination of the different psychiatric institutions would require a separate study, all the more as there are rather large differences between for instance the state mental hospitals of the United States and psychiatric hospitals in the Netherlands. Also, I have minimized attention to matters that are major issues in the United States but scarcely at all in the Netherlands, such as a person’s competence to stand trial.

Finally, some technical notes:

I have designated the word patient for a person who is being treated by a physician or psychiatrist, in accordance with medical tradition. The word patient is to be seen as defining a social role.

In accordance with linguistic tradition, I have used the male pronoun to designate both men and women. Also other nouns, such as those that represent professional or other status, are intended to include the female counterpart.

Cross references are made by referring to the chapters in Roman numerals, and the sections in Arabic numerals.

In referring to Szasz’s books, only the title is given. A list of his books that were used for preparing this work appears in the appendix.

*At time of publication of this translation two decades later, Szasz has published over 30 books over a period of well over 50 years. For titles, see the appendix. – translator