In an interesting
but puzzling Aeon
essay, Cornell historian Holly Case notes the resemblance
between contemporary
doubts about the scientific foundation of psychiatry and the

critique first laid out by Thomas Szasz half a century ago. “It
might be that the world has only recently come around to his way of
thinking,” Case suggests. Yet she misconstrues an important aspect
of Szasz’s thinking by portraying him as “a staunch Republican” and
a “conservative,” apparently unaware of his
self-proclaimed libertarianism. Szasz, who died last year at
the age of 92, was a Reason contributing editor
for decades. He described
the main motivation for his intellectual career as “my passion
against coercion,” which he opposed (outside of situations
involving the defense of rights) no matter who was advocating it,
left, right, or center. Hence he opposed forced psychiatric
treatment, but he also opposed interference in consensual
transactions between psychiatrists and voluntary patients. Here he
parted company with some left-wing critics of psychiatry. As he
explained in a 2000
interview with Reason:

[R.D.] Laing in particular was completely inattentive to the
legal aspects, so he never really distinguished between involuntary
and voluntary psychiatry. Here my classical liberal convictions are
crucial, in that I firmly believe that there should be no
interference in voluntary relationships between psychiatrists and
patients. If the patient wants a drug, fine. If the patient wants
electric shock, fine. If the patient wants a lobotomy, fine. Now
that doesn’t mean that I like it, any more than I would if the
patient wants to have an abortion just because it’s inconvenient to
have a baby. I don’t think that’s a good idea either. But I don’t
think the law should interfere with it.

Where a classical liberal would see consistent application of a
nonaggression principle, Case sees a kind of pigheaded
perversity:

Being contrarian was [Szasz’s] way of being
right. Throughout his career, even friendly co-optation irked
him. When scholars started associating him with the anti-psychiatry
movement, he wrote a book entitled Antipsychiatry:
Quackery Squared (2009).

But Case focuses mainly on common ground between what she views
as right-wing and left-wing critics of psychiatry. Beginning in the
1960s, she writes, “Right and left sought to eliminate insanity in
order to lionise dissent, legitimise the marginal and condemn the
new normal. Few other issues show a convergence of right and left
so far-reaching, while still allowing both sides to adhere to their
politics and maintain a sense of total opposition.” At the same
time, she says “Szasz was conspicuously alone in mounting the
barricades from the right,” so she really needs him to be a
right-winger. Bending the facts to fit her thesis, she
ascribes to Szasz a “distinctively conservative perspective.” That
label does not jibe with his opposition to
drug prohibition and his forthright defense of the right to

suicide, two major themes of his career that Case tellingly
ignores. Szasz’s position on physician-assisted suicide combined
both of these themes and demonstrated that his perspective was in
fact distinctively libertarian. He opposed Oregon’s Death With
Dignity Act (later imitated by Washington) because it medicalized a
moral decision and required people to meet government-dictated
criteria before they could legally end their lives. If the drug
laws did not make it difficult for people to obtain substances
useful for suicide (such as barbiturates), he said, there would be
no need for physician-assisted suicide.

Case fitfully recognizes that conservatism is not an adequate
description of Szasz’s political philosophy. “In seeking to
discredit the insanity defence in order to preserve morality,” she
writes, “perhaps Szasz and [Hannah] Arendt both came unmoored from
the traditional political spectrum altogether.” She notes that
Szasz criticized attempts to pathologize the ideologies of Barry
Goldwater and Maj. Gen. Edwin Walker, who in 1962 was charged with
incitement for urging resistance to desgregation in
Mississippi. Yet “when Szasz chronicled the history of
ideological quarantine, his own earliest examples tended to feature
conservative henchmen.” Even in his criticism of those who
portrayed Walker’s racism and communist conspiracy theories as
symptoms of mental illness, Szasz does not sound like a
conservative. “Before the Civil War,” he wrote in 2009, “proslavery
physicians in the South diagnosed black slaves who tried to escape
to the North as mentally ill, ‘suffering from drapetomania.’ In the
Walker case, pro-integration psychiatrists in the North diagnosed
white segregationists as mentally ill, ‘suffering from
racism.'”

Szasz’s consistent condemnation of the tendency to portray
political opponents as mentally ill is of a piece with his
consistent condemnation of unjustified coercion. As Case herself
puts it, Szasz believed “right and left needn’t bear any relation
to right and wrong.” In that gloss there is the seed of a more
perceptive essay on the relationship between Szasz’s political
views and his critique of psychiatry.