The Last Interview of Thomas Szasz
Directed by Philip Singer, PhD • Documentary • 2013 • 50 minutes
A Traditional Healing Productions Film • Witness Films (www.witnessfilms.com)
Directed by Philip Singer, PhD • Documentary • 2013 • 50 minutes
A Traditional Healing Productions Film • Witness Films (www.witnessfilms.com)
Written by: Zimri S. Yaseen MD, Clinician at the Family Center for Bipolar
The Last Interview of Thomas Szasz would make
an excellent discussion piece for a psychiatry residency ethics seminar,
because it pushes the viewer to think more deeply about the issues and
principles that underlie capacity and informed consent. It would also serve
well in any introduction to a psychotherapy course, since it draws out
distinctly and compellingly the question, “What is the nature of the therapeutic
conversation?”
Thomas Szasz, a
psychiatrist and psychoanalyst, reportedly ended his own life
last year, at the age of 92, after a spinal compression fracture.1
His suicide might be a topic of debate, however, because some obituaries report
that Dr Szasz “died of a fall.”2
Director Philip Singer, PhD, a
medical anthropologist whose focus has been the cross-cultural study of healing
practices, interviewed Szasz 2 years before his death. The interview focuses on
the central argument in the 1961 book The Myth of Mental Illness:
Foundations of a Theory of Personal Conduct, for which Szasz is
best known. It forms the core of Szasz’s career-long sermon, a radical—which is
to say, epistemological—attack on the construct of mental illness. Namely, he
argues that illness belongs to bodies and not to minds; the brain can be sick,
but the mind cannot.3
An important and elusive corollary
of this observation is that mental illnesses must be defined
syndromically in terms of mental and behavioral symptoms. The lack of change in
the basic diagnostic system of DSM-5, which follows DSM-IV in this approach,
speaks to this logic. What is easy to lose sight of is that where symptoms of
an illness typically represent problems for the ill, those of mental illnesses,
while certainly presenting problems for their sufferers, may more often also represent
problems for somebody else; after all, many of the patients we see have been
brought to us by loved ones who are distressed by the patient’s behavior or by
the police for disturbing the peace.
This epistemological argument is
ultimately motivated, however, by Szasz’s unbending libertarian ethics; the
point of saying minds cannot be sick is revealed in this interview to be a
principled guarding against the intrusions of society on personal liberty and
liberty of thought. Permitting such an intrusion might also allow for society
to slip into totalitarianism. This might be paraphrased as “Don’t call your
distress at someone else’s behavior their sickness; if a person wants help with
a problem, it is their own responsibility to seek it. If they are bothering
you, that is your problem.” Although Szasz indicates that some societal
controls are acceptable, he resents the presentation of such controls as
medical matters, a tactic that quietly removes them from the realm of social
debate.
Although principled, in this
context, it is also a deeply emotional defense. That hidden emotionality makes
the discussion difficult, but it also highlights its importance. In fact, such
an argument highlights the importance of a questioning approach to the concepts
that make up “mental illness,” and this emotionality should perhaps also be
understood as a necessary “flaw” in the discussion. The questions themselves
are essentially emotional ones. Insofar as we are social animals, the complex
functions of a mind are necessarily to a great extent socially constructed,
even as they necessarily have biological underpinnings (a physical event in the
organism underlies the non-physical event of a thought). The controversial
elimination of the bereavement exclusion from
the major depressive episode criteria in DSM-5 is a prime example.
Dr Szasz places equal demands on
patient and doctor—of doctors, to act only in accord with the patient’s
immediate (free) will, and of the patients, to act in accord with their best
interests or (freely) suffer the consequences of their poor choices or bad
luck.
Singer, attempting to find a
situation Szasz might regard as a moral gray zone in his critique of common
psychiatric practice, is driven to call him “Jesuit” in his adherence to his
conclusions. Here, something emotional has come into play; how do we recognize
the imbalances in a doctor-patient relationship and how do we feel about them?
Szasz’s avoidance here is telling.
Indeed, the perplexing power of
Szasz’s epistemological problem with “mental illness” is obscured at times by
its complex, often tenuous, connection to the libertarianism that motivates it.
This is not to say that his libertarianism is not powerfully thought-provoking
in its own right and must give any psychiatrist pause when pursuing involuntary
commitment or treatment over objection. Even if one is ultimately to disagree
with Szasz (as, in practice at least, almost all psychiatrists do), such pause
is an invaluable burden.
Beyond these matters, which are
readily available in Szasz’s writings, Singer’s film allows us to meet Szasz near the end of
his life. I cannot help but feel that the hard edges of his arguments serve as
guards against survivor guilt that could otherwise cripple a man of evidently
deep, tender, and curious humanity. (Szasz emigrated to the US in 1938 to study
medicine, wittingly escaping the storm of fascism already overtaking central
Europe.)
Throughout the interview, we find
Szasz demands that the discussion be on his terms. “I never saw anyone before
talking to them myself,” he explains. “My secretary didn’t make any
appointments.” To explore this, Singer plays a prospective patient: “Help me to
want to live again,” to which Szasz replies, “That’s not the kind of thing I
can do. I would not make an appointment.” A pause ensues and, slightly
frustrated, Singer tries again: “Okay. I’ve heard, Dr Szasz, that you’re a very
good psychiatrist and I just don’t feel I can live this way anymore; can you
help me?” Szasz responds, “Perhaps. Okay. We can have a conversation; come and
see me.” The transcript reads perhaps as harsh, but in Szasz’s voice there is
something ameliorating. When he says, “Come and see me,” he does not sound
clinical. Rather, one hears a genuine and fully willed invitation.
What is the difference between
Singer’s first, rebuffed, approach and his second, accepted one, besides the
compliment to Szasz? In the first, Singer lacks agency. He positions himself as
seeking rescue. In the second, he seems similarly distressed but he takes
ownership of his choice to seek Szasz’s help. Szasz demands ownership of his
own choices; he decides whether he will see someone, but he demands that
ownership of choice of others as well. “The goal,” he says, “is to assume more
responsibility and therefore more liberty and more control over one’s own life.”
Szasz’s fierce independence and his
symmetric insistence on the responsibility of others for their own fate read to
me as a defense against the emotional burden of having escaped the Holocaust.
Indeed, that fierce independence seems to be one that he held to the death.
Singer asks, “If you were dependent on someone else, caretakers . . . would you
think . . . of killing yourself?” Szasz pauses and smiles before replying, “Off
the record.”
Should Szasz’s alleged suicide,
then, be seen as a courageous adherence to the principles by which he lived or
a symptom of a pathological avoidance of helplessness? Dr Szasz might reply
that either way, it was his choice.
- See more at:
http://www.psychiatrictimes.com/film-and-book-reviews/film-review-last-interview-thomas-szasz/page/0/2#sthash.mT3cwc2X.dpuf
