Curing the Therapeutic State

Thomas Szasz on the medicalization of American life

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Reason: You may have seen the TV commercials in which drug companies urge people suffering from “social anxiety disorder” or “generalized anxiety disorder” to ask their doctor for a certain brand of pill. These ads reinforce the idea that anxiety and other kinds of psychological problems are medical issues, and they highlight the physician’s role as pharmacological gatekeeper. But they could also be seen as empowering individuals by encouraging them to be assertive with their doctors. On balance, do you see this kind of message as a positive or a negative development?

Szasz: This phenomenon illustrates what I call the creeping therapeutic state. I see it as insidious, especially given the cooperation between the government and the media. This is allowed on television. But advertising Scotch, a legal drink, is not allowed. This subtly undermines the rule of law, the principle that if something is legal, then it’s legal, and if it’s illegal, then it’s illegal. A prescription drug is illegal; pharmacists cannot sell it to you unless you have a prescription. These are illegal drugs, but nobody calls them illegal drugs. So I see this as pernicious, as an example of what F.A. Hayek and Ludwig von Mises talked about–that the opposite of freedom is not brutal tyranny but capriciousness.

Reason: Suppose someone feels depressed, and he finds that when he takes Prozac he feels better. Or suppose he’s anxious, and he finds that he calms down when he takes a Xanax. He can get these pills from his doctor. Is he doing anything wrong by taking these drugs?

Szasz: I don’t think he’s doing anything wrong, except I think he should be able to buy these drugs in the free market so he can compare them to opium, marijuana, or other drugs. There is no competition now between the prescription drugs and the traditional drugs which people took when they felt bad. After all, people have medicated themselves since time immemorial. I suspect that opium in small doses is safer over a long period of time than these complicated organic compounds.

Reason: In recent years, we’re told, this country has been hit by an epidemic of “attention deficit hyperactivity disorder.” What are the roots of this epidemic?

Szasz: I would first say that the epidemic doesn’t exist. No one explains where this disease came from, why it didn’t exist 50 years ago. No one is able to diagnose it with objective tests. It’s diagnosed by a teacher complaining or a parent complaining. People are referring to the fact that they don’t like misbehaving children, mainly boys, in the schools. The diagnosis helps tranquilize the parent, tranquilize the school system. It offers them the sense that they are doing something about the problem, that they are dealing with it in a rational, scientific way. It’s a kind of pharmacological magic.

Reason: What do you think the consequences of prescribing Ritalin for all of these kids will be?

Szasz: We may not know all of the medical consequences for another 20 or 30 years. In social terms, it gives the impression to people that behavioral problems are medical and should be handled with drugs; it imposes a certain stigma on the child, possibly on the family. It medicalizes educational and child- rearing problems, and it may cause biological problems in the person taking the drug. I don’t know if the average person on Main Street realizes that if a 30-year-old man has a pocketful of Ritalin, he can go to jail for years. This is called “speed.” And this is what they give as a treatment to schoolchildren when there’s absolutely no laboratory or medical evidence that they are sick.

Reason: Recently we’ve heard Tipper Gore and other people say that health insurers should be forced to cover mental health treatment on the same terms as medical treatment. What do you think the consequences of such “parity” will be?

Szasz: We are talking about a situation where the government is mandating that an ostensibly private insurance company provide coverage for a disease which doesn’t exist. There is so much to say about it, I don’t know where to begin. The people who clamor for this–mainly politicians and psychiatrists–want parity for mental illness, but they don’t want parity for the mental patient, because ordinary patients can reject treatment.

They don’t mean therapy; they mean getting a foot in the door for involuntarily treating people and having these huge bowls of money going into psychiatry and psychiatric drugs. Again, cui bono: Who profits from this? It finally came out that Eli Lilly is a big donor to the National Alliance for the Mentally Ill, and they have millions of dollars to propagandize their views. The critics don’t have any money to propagandize their views. This is a completely one-sided, government-sponsored movement.


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