All Commentary
Sunday, October 1, 2006

The Therapeutic State ~ The Therapeutic Temptation

Lead us not into temptation, but deliver us from evil,” enjoins the Lord’s Prayer. Temptation to commit what wrongful act? For the men who wrote that warning and the people to whom it was addressed, there was no doubt about the answer: concupiscence.

Today, the term is obsolete and the bodily-mental state to which it refers—intense sexual desire—is not an evil from which we seek deliverance but a psychosexual condition we crave and endeavor to achieve by means of drugs prescribed by doctors.

In the Age of Faith people feared engaging in behaviors prohibited by God. Modern secular man—although liberated from fearing God—still fears being led into temptation. To be sure, he no longer calls the object of the dreaded behavior “sin.” He calls it “sickness.” Worshiping health and especially mental health, people fear the temptation of engaging in behaviors prohibited by mental-health laws. Deprived of the moral vocabulary of agency and action, modern man does not conceptualize his experience as temptation and sinning. Instead, he fears “falling ill” with the great “no-fault diseases” of our age—drug abuse-addiction and depression-suicide.

A woman physician is sentenced to 50 years in prison for “overprescribing” pain medications and “causing” several people to kill themselves. She says: “I’m saddened by the fact that those that I tried to help so hard, to improve their lives, to reduce their suffering, turn against me and make me look like the devil.” A parent who had lost her daughter and son asked the judge to give her the maximum sentence: “I have two children, your honor, that I’ll never see again. . . . The only way I get to see them is at the graveyard.”

Charged with drug-law violations, radio talk-show host Rush Limbaugh repents, confesses his sins, and submits to a purification of his faith. “As a primary condition of the dismissal [of the charges against him], Mr. Limbaugh must continue to seek treatment,” explained his lawyer. Limbaugh the drug-user is not a responsible agent but the victim of an illness brought on by temptation. William Bennett, America ‘s self-appointed expert on virtue, is a victim of gambling addiction. Do I exaggerate? Alas, if only that were so. The American Medical Association, the American Psychiatric Association, the U.S. Supreme Court, the media, and the public all define addiction as a disease. Diseases have causes. The causes are the individuals who tempt the addict or fail to prevent his “illness.”

Fearful as the temptation to take drugs may be, it pales in comparison with the temptation Americans dread the most—suicide. Of course, in this case too, the language of action and responsibility is taboo. No “psychiatrically enlightened” person talks about the temptation to kill oneself. Such persons know that suicide is the cardinal consequence of the no-fault disease called “bipolar illness,” a.k.a. “depression.” How right Josh Billings was when he observed, the “trouble with people is not that they don’t know but that they know so much that ain’t so.”

On May 22 the feature article of Time magazine was titled, “When Colleges Go On Suicide Watch.” The subtitle spelled out the problem: “Schools are getting sued for doing too little—and too much—to help mentally ill students.” The “problem” is part of the false premise that lies at heart of the article, namely, that it is, in some undefined way, the job of colleges to prevent their students from killing themselves. Suicide is an action. The only person who can control—bring about or prevent—an action is the actor. Why not hold colleges responsible for students becoming obese or going bankrupt?

Ought implies can. Since no one can prevent another person from killing himself, the expectation that colleges, psychiatrists, or anyone else ought to be responsible for preventing a student’s suicide is nonsense. An individual held responsible for another person’s suicide has only one viable option, separating himself from the subject deemed “dangerous to himself.” This may take the form of: 1) depriving the “offender” of liberty, by incarcerating him, with the aid of psychiatrists, in a mental “hospital”; or 2) divorcing him, literally, if the subject is a spouse, metaphorically, if he is a college administrator and the offender a student. We may do well to remember that only a few decades ago—before the advent of the suicide-prevention lobby—no one seriously expected anyone to prevent suicide.

Sadly, none of what I am saying here can be said in the pages of the mainstream press. Revealingly, the subtitle of the Time article treats as fact a non-fact: it calls students regarded as suicide risks “mentally fragile”: The number of students “diagnosed as mentally fragile appears to be rising. . . . A lot of students who may not have gone to college five years ago are able to attend today because their illness has been recognized earlier and they are on medication,” explains a bureaucrat at a New York-based “college suicide-prevention program.”

To be sure, many a college-age student faces a difficult period of life that has nothing to do with his “mental ill health.” It has to do with the fact that he is leaving childhood and entering adulthood. Expelled, literally or figuratively, from the home of his parents, the young person is suddenly homeless. He must make a temporary home for himself at college, a challenge some are better prepared to meet than others. Redefine this elementary existential trial as a medical disease amenable to diagnosis, prevention, and treatment—and students, parents, psychiatrists, and colleges are off to the races.

The transition from childhood dependence to adult independence is often experienced as depressing. It is dangerous to frame this in psychiatric terms. The Time article presents the story of a young woman “struggling” with anorexia who told a Cornell University counselor that she felt like killing herself. What did she expect the counselor to do? The student “agreed to spend the winter break at a psychiatric hospital.” After the university “threatened to suspend her,” she “took a voluntary medical leave.” The key terms in these sentences are as phony as is the medicalization of growing up.

Troublesome, Not Troubled

The students’ parents and psychiatrists call such students “troubled.” Again, the wrong term. Such students are “troubling” and “troublesome”: they are “trouble” for universities, which are held responsible by courts for their suicides. Trying to escape that trap, some colleges opt to expel troublesome students. But if they do that, the students or their parents sue the school for discrimination under the provisions of the Americans with Disabilities Act, which “protects” people suffering from mental illnesses. From what?

Each party affected by this Alice in Wonderland tragicomedy deserves the fate that, some 30 years ago, I predicted would follow inexorably from defining the voluntary act of self-killing as the unintended consequence of a no-fault disease.

Cornell University , we learn, “pushes a hundred or so of its students each year to take a voluntary medical leave.” “Voluntary medical leave” is code for involuntary psychiatric leave. The anorexic Cornell student continues to be clueless about what happened. “I knew if I stayed at Cornell one more week, I would kill myself,” she told Time. “After lengthy discussions with her therapists [sic],” the student went home and entered a mental hospital. She “is disappointed that Cornell hasn’t made any follow-up calls to see how she is doing.”

This woman has been unable to resist the temptation to think of herself as having a disease. This is what happens when Sartrean “bad faith” becomes “good faith”—when the person who lies to himself comes to truly believe his own self-deception.

  • Dr. Thomas Szasz (1920-2012) was a Psychiatrist, academic, and champion of individual rights. He devoted much of his life to campaigning against many aspects of conventional psychiatry, in particular involuntary psychiatric treatment and commitment.