Szasz’s Unsettling Legacy by Anne Plumb

In the 1960s, the Myth of Mental Illness was hailed by those of us adamant that our experiences had nothing to do with ‘chemical imbalances’, though I never got beyond the first few pages of The Manufacture of Madness.

In the mid 1980s I was drawn to the draft policy statement of the international Mental Health System Survivors (MHSSs) Mental health system survivors are people who are neither ‘crazy’ not ‘mentally ill’ nor genetically distinguishable from anyone else. …There never was nor will be anything ‘wrong’ with us. Rather we have been victimised by ‘the mental health system’ because of our hurts … Because of our trying to get help in the only ways or places we know of, because we belong to certain oppressed groups, or refuse to fulfil some of society’s prescribed roles, or protest the wrongs of society … Our bodies and lives have … been damaged and constrained by interacting with the system. (Mental Health System Survivors, 1987)

However, I joined neither the re-evaluation counselling communities which developed following on from this statement, nor the later peer counselling. However, some survivors have written of the helpfulness of RC counselling (Read, 2001; Simpson, 2001).

Then, some decades later, Szasz was the keynote speaker at a conference in Manchester organised jointly by UCLAN, The International Network of Philosophy & Psychiatry(INPP) and The European Network of Users & Survivors of Psychiatry (ENUSP). I was appalled by Szasz’s views and behaviour. He shouted down Peter Lehmann, even as Peter was trying to acknowledge Szasz’s role in ‘psychiatric wills’ being made legal in Germany. “Extreme right-wing”, I thought. Others murmured: “neoliberal”.

But for the UN Convention on the Rights of People with Disabilities, that would be that. Whilst the World Network of Users and Survivors of Psychiatry (WNUSP) was actively involved in this document, it bothers me. It strikes me that it is underpinned by Szaszian ideology. WNUSP celebrates achieving ‘legal capacity’ as its basis. This includes the right to accept or decline medical treatment, to go to prison for breaking the law (although Article 12 says the sentence should be ‘proportional and tailored to the person’s circumstances’) and, under Article 14: The Right to Liberty, the right to take one’s own life.

But for many of us who, in a crisis due to an altered state of mind or feeling suicidal, there are few meaningful alternatives (at least in England) and this Convention, specific as it is on some needs for people with physical disabilities (e.g., Article 9 on Accessibility), is more or less silent on this point. Forced treatment is viewed as torture but psychiatry itself is let off lightly, with people allowed to choose its interventions if they wish. What of the damaging interventions to which people agree out of desperation, and what about the role of the pharmaceutical companies?

Reflecting on this, the US, for example, has a strong contingent in WNUSP and also a long tradition of psychoanalysis and psychotherapy. I had not realised that Szasz was a psychotherapist. His own stance is revealing. He says his libertarian stance means regarding people as adults, responsible for their behaviour, expecting them to support themselves, instead of being supported by government, expecting them to pay for what they want, instead of getting it from the doctors or the state because they need it … The law should protect people in their rights to life, liberty, and property – from other people who want to deprive them of these goods. The law should not protect people from themselves. ( interview/thomas-szasz)

Delving further, it seems that people who don’t gain from therapy are ‘losers’; people value what they pay for (a stick for compliance?); and it’s up to the patients [sic] “to change themselves, to recognise what extent … he [sic] is willing to recognize his evasions of responsibility, often expressed as ‘symptoms’.

What about the ‘hurt’ identified by the organisation of Mental Health System Survivors? Szasz saw no problem there: if people found their therapy unhelpful, they could simply select another therapist.

Szasz said some of the people he saw would have been diagnosed as ‘psychotic’. But I get no sense of him understanding these altered-state or perceptual differences that so easily land us on psychiatric wards, being treated without consent – especially at the first appearance, when we are confronted with something sudden and about which we have no prior experience.

More than this, psychotherapy is not without its critics and it is not uncontested by some survivors and service users. Jeffrey Masson’s book Against Therapy might be regarded as a kind of ‘Szasz for psychotherapy’.

I have long maintained that treatment without consent is a violation of body and self, but I am not happy with this Convention. I perceive Szasz’s influence. This is an unsettling legacy.


Masson, J. M. (1988). Against Therapy: Emotional Tyranny and the Myth of Psychological Healing. New York: Athenaum.

Mental Health System Survivors (1987). Draft Policy statement. Recovery and Re-emergence, no 4.

Read, J. (2001). Re-evaluation counselling: A radical alternative to psychiatry. In J. Read (ed) Something Inside So Strong: Strategies For Surviving Mental Distress. London: Mental Health Foundation.

Szasz, T. Interview. thomas-szasz

Simpson, T. (2001). No limit to what you are. In J. Read (ed) Something Inside So Strong: Strategies For Surviving Mental Distress. London: Mental Health Foundation.

United Nations (2008). Convention on the Rights of Persons With Disabilities. Optional Protocol: disabilities/convention/conventionfull.shtml wikipedia: Convention on the Rights of Persons with Disabilities.

Anne Plumb is a mental health system survivor with a particular interest in survivor voices and activism.


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