Szasz’s Political Views
Szasz’s political views, inasmuch as they are about regulating relations among citizens, can be characterized as “libertarian,” at least, when this word is understood in the meaning that the word “liberal” had for the founders of the United States of America. Szasz often quotes these Founding Fathers approvingly, and he not infrequently refers to the United States Constitution in his arguments. In Law, Liberty, and Psychiatry he even dedicated a chapter to it, in which he notes which basic legal rights are unjustly denied psychiatric patients.
In addition, Szasz’s political views are strongly influenced by Hayek. Like Hayek, Szasz believes that the state functions most optimally when it interferes as little as possible in the lives of its citizens, and aims to ensure maximal individual freedom for them. “Legislative prescriptions, no matter how enlightened, will not create a good society. Our best chance for success still lies in a political system that is consistently noncoercive, limiting its power to the prevention and punishment of crime, and deploying its resources to providing relatively equal opportunities for various kinds of personal self-development.” (Law, Liberty, and Psychiatry, p. 222)
In an interview with professor Kuntz, published in The Theology of Medicine (1977, pp. 145-162) Szasz supplies some more details of his political views. The state is to limit its regulation of life as much as possible in order to not hinder the personal freedom of its citizens. Szasz considers certain social benefits necessary. He specifically names national defense, the police, and certain public works such as the water supply and trash disposal. As far as health services are concerned, government should restrict itself to the above matters. The addition of certain substances to the water supply or bread goes too far for Szasz. “The state can’t protect people beyond a certain, very minimal point without denying them their freedom of choice.” (p. 155) When the state wishes to proceed beyond that minimum, the consequences are always serious. Szasz illustrates this with the government’s attitude towards drugs, which he considers ambiguous. Some drugs are forbidden and war is vigorously waged on them; other drugs provide income for the government through taxation. He points out that increasing governmental regulation is leading up to a totalitarian state. He considers freedom of speech the most important difference between communist and non-communist countries, but immediately adds that education and health care are completely regulated by the state in both systems. He wonders how it is that in the West, freedom of speech is considered essential, whereas citizens can buy almost no medicines without a prescription. Is penicillin, bought without a prescription, so much more dangerous than all the lies in the newspapers?
Medicine and health care have fused with the state, a type of state religion. The state exercises complete control over medical schools, both financially and in content, by way of subsidies and authorization. Physicians serve the state in various ways: by reporting birth and death, controlling deviant behavior, and so forth. The state grants “official” medicine a monopoly and guarantees a good income for physicians. Physicians in turn support and validate government in all sorts of ways. Szasz advocates complete separation of health care and state. State regulation of medical schools is to be abolished, and the schools must be self-supporting. State authorization of the medical profession, together with its monopoly, should be exchanged for free market competition by all who offer healing services. They can “validate” themselves by revealing their education and special skills. Medicines and drugs are to be freely available to all adults. Elementary medicine is to be taught in schools in order to instill in people the capacity to critically assess the best course of action when they are ill. On the side, note that Szasz unfortunately does not elaborate on the question who is to determine what people should learn about medicine in school, and whether for instance physicians or alternative healers are to provide these lessons. The question of how people can become more knowledgeable regarding their own health seems so important to me, that it is a pity that he did not further elaborate on these matters.
In the [former] USSR, the state aspires to make a better life for its people – definitely a paternalistic attitude. The citizen is considered as a child who cannot care for himself. In the United States and other democracies the relationship between state and citizen used to be comparable to the relationship between a father and his grown children, a relationship based on equality and mutual respect. In time, democracies have also started to show paternalistic tendencies, which led to our “collectivist welfare state.”
The most important implication of psychiatry as a social institution (see Chapter I, 4.2.4 and further) may be that it gave birth to the “Therapeutic State.” That is a state that considers it its duty to care for its citizens, and to shape and educate them according to what the state deems best. (Law, Liberty, and Psychiatry, pp. 212-222) As an example Szasz names the increasing habit – he is writing this in 1963 – to punish sexual psychopaths with a sentence of unlimited duration. The purpose of the punishment is treating the offender. Aside from the fact that the concept of sexual psychopathology is not accurately defined, which risks arbitrariness, and aside from the fact that the provision of adequate treatment facilities has been neglected, this has been a fundamental change in the application of criminal law. The principle that the law is applied on equal terms and in equal measures to each citizen has been abandoned. It is no longer the crime that is punished, but the criminal. The punishment no longer fits the crime, but fits the assessment of the offender’s personality by others. In addition, the principle that the state, when punishing an offender, is his adversary, is exchanged for the paternalistic attitude that the state considers it its duty not only to punish but also to educate and adjust the person through treatment. Criminal law should conform to the Rule of Law, as Hayek described it, among other places, in The Road to Serfdom (1944). All acts of government are bound to rules that are determined and publicized in advance, and that are equal for all citizens.
Literally, Szasz says that criminal law should satisfy a double objective. On the one hand it should protect the state against the citizen, and on the other hand it should protect the citizen against the state. (The Theology of Medicine, p. 157) In this description, too, Szasz reminds us that government can serve the individual, but government can also have a conflict with the individual. And as, in the latter case, government always has infinitely more power than the individual, there should be guarantees – paternalistic or not – that the individual will not be overrun.
As a second example of the development of the “therapeutic state” Szasz names the right to psychiatric treatment for the person who “needs it,” regardless of whether he wants it. Both these problems appear to be psychiatric but are in reality political, and illustrate how government deals with deviant citizens.
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