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Tuesday, July 13, 2010

Faith in Freedom: Libertarian Principles and Psychiatric Practices

Szasz Condemns Liberal and Libertarian Thinkers for Not Addressing Psychiatry

Thomas Szasz, a Freeman columnist and a long-time libertarian hero, thinks that many other libertarian luminaries are slacking on the job. Szasz has fought his intellectual and legal battles for individual liberty—always paired with responsibility—in a particularly contentious arena: the struggle over rights for the so-called mentally ill. Szasz wonders why so many other prominent libertarians have failed to back him up on this or even written things that militate against his efforts.

He explores that question, and offers many stinging rebukes, in his latest book, Faith in Freedom: Libertarian Principles and Psychiatric Practices. Its focus makes this very much an “inside baseball” book for those interested in libertarianism’s philosophical and intellectual history. It’s not a good place to begin dipping into the intellectual richness of Szasz’s huge oeuvre. Often he seems to assume a ready familiarity with his own heterodox thinking about the real nature of mental illness and how contemporary psychiatry deals with it. Szasz condemns as a pernicious myth the popular notion that the behaviors for which people are labeled “mentally ill” are caused by organic brain diseases that segregate those thus labeled from the liberal world of freedom and responsibility. Psychiatry, Szasz asserts, has built a citadel of coercion around that myth, one whose dual purposes are to incarcerate the innocent, through involuntary hospitalization, and exonerate the guilty, through the insanity defense.

Szasz presents his case for these ideas at length elsewhere—most vividly and convincingly, to this reader’s judgment, in his 1987 work Insanity: The Idea and Its Consequences. But here he uses his ideas about mental illness mostly as a set point from which to condemn other liberal and libertarian thinkers for abandoning their frequent bravery and good sense when it comes to psychiatry. Chapters are devoted to how libertarian or liberal thinkers and institutions, including John Stuart Mill, the American Civil Liberties Union, Ayn Rand, Nathaniel Branden, Ludwig von Mises, F. A. Hayek, Murray Rothbard, and Robert Nozick, have dealt with—or not dealt with—these issues to which Szasz has dedicated his career. He finds them all wanting, either through failures of omission or commission.

“I believe that all Americans—especially libertarians—have a moral and intellectual duty to confront the conflict between liberty and psychiatry and articulate their position regarding the idea of mental illness and the psychiatric coercions and excuses it justifies,” Szasz insists. Only the Libertarian Party among contemporary libertarian institutions, he says, fully applies libertarian ideas of self-ownership and the rule of law to the world of psychiatry.

I think Szasz is being somewhat unfair through much of this book. He doesn’t pay proper heed to the economic principles of comparative advantage and opportunity cost. It ought not necessarily be the task of every advocate of libertarianism to man the barricades on every specific application of libertarian ideas to the real world, despite Szasz’s lament that “many libertarians . . . dwell on the importance of free markets, except in psychiatry, and tirelessly recite the mantra that ‘people should be free to do whatever they want in life as long as their conduct is peaceful,’ but do not mention mental health laws, much less advocate their repeal.”

Given the idea, going back within the libertarian tradition at least to Mill, that liberty applies fully only to adults competent to handle their own affairs responsibly, it takes a particularly fierce independence of mind, combined with careful study of his work, to endorse Szasz’s application of classical-liberal principles to the so-called insane. To someone who has aimed his intellectual efforts in other directions—who has not, as Szasz has, studied the world of psychiatry extensively and from the inside—it is a perfectly excusable error for an “educated layman” libertarian to presume, as all the experts insist, that the so-called insane are not, any more than children or Alzheimer’s victims would be, competent individuals deserving all the rights and privileges of such, but are in fact people who require paternalistic care. (Szasz himself has criticized Rand for not recognizing the existence of innocent dependency in the human world, as witness her lack of children or the extremely aged in her work.)

When his complaint is that the writers in question don’t mention the psychiatric-control issues that Szasz has built his career on, not that they have openly advocated the incarceration of the “mentally ill,” his barbs seem especially ill-aimed.

Szasz is a brilliant and brave thinker, and I can understand his frustration that he has slashed and walked paths that few have been prepared to join him on. In this case, that frustration has led to a book not quite up to his highest standards in all its parts, although it still contains valuable chunks of his brilliant and passionate defenses of liberty and responsibility.