In Memoriam-Thomas Stephen Szasz, MD

In early September 2012, a psychiatric colleague and friend passed away. Thomas Stephen Szasz, MD, was Professor Emeritus of Psychiatry at the State University of New York Upstate Medical University in Syracuse. Dr Szasz was far too accomplished for me to write about his status in and impact on the field of psychiatry-this has already been done by others and much better than I could. Further, I could not attempt to capture in so brief a space, his social and moral criticisms of the scientific foundations of psychiatry. Nor could I here do justice to the ramifications of his work on how the field has developed since the publication of his influential book The Myth of Mental Illness.

Instead, I prefer to give a personal reflection of the man I met, learned from, and considered a friend and colleague. He was much beloved in the psychiatry department at Upstate, particularly for his cultivation of intellectual freedom. He devoted his life to independence of thought, which was greatly respected by his colleagues. In the relatively brief time that I knew him, I found that we shared a passionate interest in certain topics, although our views often differed. Within the departmental culture he had helped create, this diversity of views was entirely acceptable. Indeed, it was celebrated, for we respected and honored the variety of each other’s scholarly explorations.

One of my fondest recollections was a teaching session Dr Szasz gave to my forensic fellows. The session was scheduled for only 1 hour, but the lively and intellectually crisp Szasz, at age 92, was fully prepared to go for 2 hours, and did just that, without any loss of enthusiasm. In fact, the energy in the room seemed to gain momentum. He was impressive-thoughtful, rational, and intellectual. He spoke with a vast perspective and knowledge of history and literature, but in a way that was sincere and not the slightest bit pretentious. What follows are my recollections of this meeting, which occurred on May 17, 2012. Much was covered in this session, and I have selected what I believe is now most appropriate.

The interchanges between Szasz and my forensic fellows were, to me, endearing and illuminating. Forensic psychiatrists, by and large, are trained not to shrink from controversy. Thus, a fellow took the opportunity to ask a pointed question about the “anti-psychiatry” movement. Szasz responded, “I do not like the so-called anti-psychiatry movement. They have misinterpreted my writings. I am not saying psychiatry is good or bad. I am only saying that ideas have consequences.” Emboldened, one the fellows had the following exchange with him:

     Forensic Fellow: We testify sometimes in competency hearings, and the patient does not believe he is mentally ill. . . .
    Szasz: Stop right there! Already you have a problem. What is the problem? You have used the word "patient." What is a patient? Someone who comes to you and asks for your help and then pays you for it. In this case, what is the individual saying? He is saying: Leave me alone. Do not label me. I am not asking for your help. And he should be able to do this.

Szasz continued, in his Socratic style, on these issues of power, control and liberty: “Who ultimately has authority to tell another what to do? This is a question man has been struggling with since well before the time of the Romans. Money, which is another word for power, is what now decides this question. The facts and surface of life changes, but this main theme does not.”

Throughout the year, fellows are heavily exposed to the concept of de-institutionalization, trans-institutionalization and see first-hand the long-term effects. In a beautiful display of vicarious acting out on my behalf, one the fellows confronted Szasz with the concept of de-institutionalization. In an unruffled, congenial tone, Szasz gave us his views on this phenomenon, and I was grateful that my fellows got to hear them from the very individual who (along with attorney Bruce Ennis) arguably helped set things in motion.

At the close of our session, one of the fellows asked him what advice he would give to a young psychiatrist struggling with the conflicts prevalent in our field in this day and age. Szasz replied, “Advice giving is serious business. I think it best to provide discussion, information and let you make your own decision. There are no ultimate answers.”

I also recall one last statement he made that day which sticks with me for a variety of reasons: “Being alive is a great existential responsibility. We free or enslave ourselves with language.”

My last recollection of Dr Szasz was at the graduation ceremony for psychiatry residents and fellows at SUNY Upstate this past June. In my graduation speech, I felt compelled to mention my appreciation for the time he spent teaching the fellows and me. Afterward, I distinctly recall walking past the table at which the distinguished and emeritus psychiatry professors sat together. As I approached, I met a pair of crystal clear eyes and a smiling face that addressed me. “Jim!” Szasz said with a warm smile. I will not forget the look in his eyes that radiated, at once, a towering intellect and an expansive compassion for the human condition.

Thomas Stephen Szasz, MD, was a man who thought deeply about freedom. Toward the end of his life, he helped me better understand this sacred and vitally important idea. Being free or liberated is at the very core of what psychiatry attempts to assist patients with. In this sense, psychiatry is a transcendent endeavor that seeks to bring about greater degrees of freedom, enhance choice, and offer release from mental prisons. Both psychiatry and Dr Szasz have had the courage to give voice to their existential responsibility: Semper Liber!