Thomas Szasz is an idiot. Thomas Szasz is, apart from being the only psychiatrist to have a Batman villainnamed after him, the guy responsible for what is known as antipsychiatry, essentially the belief that mental illness does not exist, and that it is all the invention of the pharmaceutical companies to bilk money out of people whose only crime is not being normal. That’s easy to say for someone who has no severe emotional distress.

Hariet Hall, in her wisdom, has a great pieceabout antipsychiatry. I just wanted to touch on a few of the issues.

The problem with psychiatric medications is that the symptomology is subjective and and the drugs are essentially a cash cow. That doesn’t mean they don’t work, but the pharmaceutical industry pushes them so heavily that they often get used for minor behavioral issues when the patient reports exacerbated symptoms to the doctor. Hall points us to a New England Journal of Medicine article which finds that medication plus therapy is more effective than other options for treatment. The complaint that I hear from most psychiatrists is that they don’t have time to practice any signifigant therapy because of managed care and the cost of psychiatry vs. psychotherapy. So how about we agree to not give anyone medications until they see a therapist. And that goes for General Practice doctors as well. I’m still trying to figure out why I see clients on 2 or 3 different SSRIs.

As far as the science thing…we do our best with what we have. Some of us focus all of our energies on trying to find treatments that have been scientifically validated, which means that we are typically cognitive-behavioral therapists. Hall mentions the Scientific Review of Mental Health Practice, edited by Scott Lilienfeld at Emory University. The journal is excellent, and many of the articles are available for free. Scott is great, too. I sent him an article about emotional freedom therapy (EFT) that I eventually submitted to the APA journal Psychotherapy, and Scott gave me great notes and didn’t complain once about being bothered by some punk kid. (As a matter of fact, I need to send him a fruit basket or something.)

There are many issues that we still need to work on to give psychology and psychiatry the scientific validity that it needs to survive in an age when we can image individual neurons. Szasz does nothing to help the situation.


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