Dangerousness Is Not a Disease

by Thomas Szasz

Thomas Szasz, M.D., is professor of psychiatry emeritus at the Upstate Medical University, State University of New York, Syracuse, and author of the forthcoming Coercion as Cure: A Critical History of Psychiatry (Transaction).

Mourning the massacre at Virginia Tech, President Bush solemnly declared: What we do know is that this was a deeply troubled young man…. Our society continues to wrestle with the question of how to handle individuals whose mental health problems can make them a danger to themselves and to others.

Troubled, mental health problem, dangerous to himself and others – these are the cliches people use to characterize Cho Seung-Hui. They are the cliches we cling to, like drowning men to a life raft, whenever we confront murder and suicide close to home. Let us try to separate fact from fiction, undisputed observation from interpretation masquerading as explanation.

Cho did not talk. When spoken to, he did not answer. When asked to write his name in class, he wrote a question mark. Nevertheless, he was in college, where the coin of realm is the spoken word. We know that at least one of his professors did not tolerate Cho's behavior and kicked him out of her class and that another was so intimidated by him that she worked out a code with her assistant: if she mentioned the name of a dead professor, her assistant would know it was time to call security.

We also know that, in 2005, Cho's behavior brought him to the attention of the campus police and mental-health system, that a counselor recommended involuntary commitment and a judge declared him to be dangerous to himself and others and sent him to a psychiatric hospital for an evaluation. A psychiatrist at the hospital diagnosed Cho as mentally ill, but not an imminent danger. The judge declined to commit him and instead ordered outpatient treatment. After these conventionally proper psychiatric interventions, Cho decided to commit mass murder and suicide.

These are facts. A person of common sense might conclude that Cho should have been asked to leave the campus or expelled long before his senior year. Why wasn't he? Because in America today it is conventional wisdom that it is the responsibility of universities to provide mental-health services for its mentally ill students. Universities are very old institutions. Prior to World War II it would not have occurred to anyone that treating mental illness was the business of institutions of higher education. Now no one dares to question that duty. As a result, faculty and students saw Cho's patently abnormal behavior through the socially required fictions of psychiatry.

Faced with disturbing (not disturbed) behavior, we prefer false explanations couched in the language of pseudoscience to simple truths. We turn to psychiatry, the magic science that explains good behavior by attributing it to choice and bad behavior by attributing it to the physical cause we call mental illness.

Cho prepared for mass murder like other students prepare for final examination. He decided to kill and be killed; he intended to kill others and himself; and he did so. He and he alone is responsible for what he did, though others may, and I believe have, contributed to his reasons for carrying out his sensational deed.

Foremost among the factors that may have contributed to Cho's final act is our psychiatric-legal system that commingles two radically different acts, suicide and murder. Killing oneself is a basic civil right. Killing others is a basic criminal offense. Combining and conflating these two very different acts, psychiatry and law define dangerousness as a (literal) disease and expect psychiatrists to diagnose and treat it. As the chain of events at Virginia Tech illustrates, there are worse things than suicide, such as mass murder plus suicide. Perhaps we should rethink suicide prevention programs. Dangerousness is not a disease.

Inherently Stigmatizing

We act as if psychiatric interventions imposed on young persons could only help them. But is that true? No! Such interventions are inherently stigmatizing. Being formally classified as mentally ill and forced to be on psychiatric drugs are stigmas. We call the subjects patients and the psychiatric interventions help. They call themselves victims and regard the experience as condescending and demeaning. They are right. Psychiatrists are agents of the state's security system pretending to be physicians and therapists. Honest sanctions are preferable to coercions called care.

To be sure, dangerousness is a problem, but it is not a medical problem. It is a human problem — a moral, legal, economic, social, and political problem — a problem for everyone in the dangerous person's social ambit.

Still, many psychiatric experts claim that psychiatric drugs can effectively control dangerousness and prevent homicide and suicide. Many other psychiatric experts even more confidently claim that the drugs psychiatrists use to prevent mayhem cause suicide and murder. The Swiftian result is that colleges and counselors are held responsible for tort damages no matter which psychiatric course they take. If they preventively incarcerate the disturbed student, they are liable for damages for false imprisonment. If they do not incarcerate him and he kills himself or others, they are liable for failure to prevent harm.

Could the very basis of psychiatry — that mental illness is a medical problem and that coercion is a cure — be flat-out wrong? Or are those premises and the institutions that rest on them so necessary for our society that we cannot entertain that possibility?

Further Reading