Thomas Szasz

Thomas Stephen Szasz (1920–2012) was a Hungarian-American psychiatrist, academic, and social critic of psychiatry. Szasz spent most of his academic career as a professor of psychiatry at the State University of New York Upstate Medical University in Syracuse, later becoming professor emeritus. He is best known for his critique of coercive psychiatry, involuntary hospitalization, and the use of psychiatric diagnosis as a tool of social control.

Medicalization

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Szasz used the term medicalization to describe the process by which human conduct, moral conflict, social deviance, or legal wrongdoing is redefined as illness. In his view, this process does not merely change vocabulary. It changes social power. Once a behavior is called a disease, physicians and psychiatrists become authorities over it, and courts or institutions may treat the person not as a responsible moral agent, but as an object without free will.

In Psychiatry: The Science of Lies, Thomas Szasz described medicalization as taking two forms. Medicalization from above occurs when authorities (psychiatrists, physicians, courts, or the state) redefine unwanted, deviant, or criminal behavior as illness. Its function is social control, allowing coercion, confinement, punishment, and moral regulation to be presented as “treatment.” Medicalization from below occurs when individuals seek or accept a medical label for their behavior because it offers excuse, sympathy, protection, or relief from responsibility. In Szasz’s view, both forms blur the line between disease and conduct, turning moral and social problems into medical ones.

While far from pro-c views, he also paid attention to medicalization of child sexual abuse and pedophilia, specifically in the following two books.

"Sex by Prescription"

In Sex by Prescription, Szasz criticized psychiatry’s historical role in policing sexuality. He argued that psychiatrists had long classified certain sexual behaviors as deviant, perverse, psychopathic, or mentally abnormal, presenting moral condemnation as medical diagnosis. In his view, these labels were not neutral scientific descriptions but stigmatizing categories that reflected dominant moral norms and helped legal authorities persecute or punish those so labeled.

Szasz was especially critical of “sexual psychopath” laws, which treated sexual offenders or sexual deviants as mentally ill rather than as ordinary criminals. Supporters of these laws claimed that such people needed treatment rather than punishment because they were supposedly unable to control their sexual patterns. Szasz rejected this claim, arguing that there was no evidence that people with stigmatized sexual preferences were less capable of resisting their erotic preferences than religious people were of resisting their theological commitments.

For Szasz, the label “sexual psychopath” did not merely describe a person, it helped create the impression that the person was sick, dangerous, and dehumanized. When authorities described “perverts” or “paraphilic” persons as mentally abnormal and called for indefinite segregation or compulsory treatment, they were not practicing medicine. They were using medical rhetoric to justify social exclusion, punishment disguised as treatment, and potentially lifelong confinement. If a person is imprisoned for a crime, the boundary of punishment is at least explicit, but if he is confined because he is considered sexually abnormal (and virtually untreatable), the boundaries of punishment disappear.

"The Medicalization of Everyday Life"

In The Medicalization of Everyday Life, Szasz discussed pedophilia in the context of psychiatric diagnosis, moral agency, and responsibility.

Szasz criticized the assumption that “abnormal” sexual impulses are harder to resist than “normal” ones. In his view, this claim was often implied in psychiatric discussions of sexual perversion but was not empirically established. He likewise challenged the belief that sex offenders (in general) are uniquely prone to reoffending. His point was to reject the pseudomedical idea that sex offenders are categorically different because their impulses are supposedly uncontrollable.

[...] the widespread belief that sex offenders are more likely than other criminals to commit new crimes, an assumption that is not supported by the evidence. Tracking a sample of state prisoners who were released in 1983, the Bureau of Justice Statistics found that 52 percent of rapists and 48 percent of other sex offenders were arrested for a new crime within three years, compared to 60 percent of all violent offenders. The recidivism rates for nonviolent crimes were even higher: 70 percent for burglary and 78 percent for car theft, for example.

Note: re-offending rate for child sexual offenses specifically may be much lower. See Research: Recidivism and other offending figures

Szasz distinguished pedophilia, understood as sexual attraction to children, from the act of sexually using a child. He states that an adult who uses a child sexually commits a wrongful act. But his reasoning was based not on psychiatric “harm” models, but on comprehension of consent, authority, and responsibility concepts. The outcome of the act, whether described as harmful, neutral, or beneficial, does not determine its permissibility.

Szasz did not deny that people have sexual problems. He acknowledged that people may struggle with sexuality just as they struggle with family, work, money, children, religion, or personal identity. His objection was to the classification of such problems as medical illnesses. In Szasz’s view, the medicalization of sex expands medical power into domains that properly belong to personal life, ethics, religion, law, and culture.

Selected major works

• 1961 — The Myth of Mental Illness

Szasz’s best-known work, arguing that “mental illness” is often a metaphorical label for problems in living rather than a disease in the medical sense.

• 1970 — Ideology and Insanity

A collection of essays on the way psychiatric language, in Szasz’s view, de-ethicizes and depoliticizes human conduct by translating moral and social conflicts into medical terms.

• 1970 — The Manufacture of Madness

A comparative study of the Inquisition and the mental health movement. It is especially important for his analysis of how societies manufacture scapegoats, including masturbators, homosexuals, and other sexual “deviants.”

• 1980 — Sex by Prescription

Szasz’s major book on the medicalization of sex and sex therapy. It criticizes the psychiatric classification of sexual deviance, “sexual psychopath” laws, and the transformation of sexual problems into medical disorders.

• 1994 — Cruel Compassion

A critique of coercive helping and psychiatric control over society’s unwanted persons, including those treated as dependent, dangerous, or incapable of self-government.

• 2007 — The Medicalization of Everyday Life

A late collection of essays on the transformation of everyday conduct, suffering, sexuality, crime, and moral conflict into medical problems. It includes his discussion of pedophilia, sexual offending, and moral responsibility.

• 2008 — Psychiatry: The Science of Lies

A late work presenting psychiatry as a system built around diagnosis, deception, malingering, excuse-making, stigma, and the medicalization of conduct.

A fuller bibliography of Szasz’s writings is available on his official site.