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Szasz and Psychosomatics (1947 – 1956)

During the period from 1947 to 1956 Szasz published articles that were fairly exclusively confined to psychosomatic subjects. He published research on patients who had undergone vagotomy for the treatment of peptic ulcers. His role was to find psychoanalytic explanations for the results in accordance with Alexander’s theories. In addition his articles dealt with hypersalivation, constipation and diarrhea, and balding. These studies culminated in a summarizing article on psychoanalysis and the autonomic nervous system and “The Psychosomatic Approach in Medicine” which he wrote with Alexander.

After a brief moratorium, in 1955 and 1956 Szasz published several articles about pain, culminating in his first book, Pain and Pleasure: A Study of Bodily Feelings (1957). This book can be considered a psychoanalytic study of physical feelings, of which pain is the most important. Up to this point Szasz’s writings reflect the tradition of the psychoanalytic research of the day. They include practically no hints of the way his theories will develop in the future. Perhaps an exception is a statement in Pain and Pleasure. Basing himself on Bertrand Russell and Woodger, and taking into consideration that medicine, to the extent that it concerns itself with the body as a physicochemical object, borrows methods from sociology and psychology, he states: “It seems to me, that from the point of view of scientific clarity it would help to restrict the scope of ‘medicine’ to those sciences and techniques that are based on and that use the physicochemical frame of reference. Other sciences, that study human experiences in different frames of reference (such as those of history, sociology, linguistics) would be subsumed under the label ‘socio-psychology’ and would complement ‘medicine’ in the study and change of man.”

On the one hand, Szasz is advocating a sharper demarcation between the study of man in the two worlds of the physical and the psychical; on the other hand he rejects a practically applicable criterion for ascribing the phenomenon of pain to one world or the other, as he wishes to avoid discriminating. The explanation is as follows. Pain is essentially a psychological phenomenon. It is of interest to the somatic physician only insofar as it indicates a physical lesion. Whether there is a demonstrable lesion makes no difference to the experience of pain from the point of view of the person who is feeling it. That is why Szasz resists the usual division of “organic” and psychogenic” pain. After all, it is the examiner’s judgment about the source of the pain that serves as the criterion in this division. “Organic” is used as a neurological, physical concept. “Psychogenic” is used “only” as a psychological phenomenon. Szasz considers this division senseless and discriminatory. By implication, “organic” pain would be understandable, clear, and justified. “Psychogenic” pain would not be understandable, but unjustified and suspicious. In “Language and Pain” he concludes that the physical concept of pain should be abandoned, and pain should be considered exclusively a psychological concept.

To me this creates a dilemma. Whose point of view of pain is more valid, that of the person experiencing it or that of the professional examining it? The differentiation between organic and psychogenic is that of the professional, not of the person in pain. Making a choice between these two points of view implies choosing either the views of the professional and science or the views of the patient. Szasz chooses that of the patient. Much of his later work can be considered a criticism of the notion that the professional’s point of view is the correct one. That is all the more interesting as several years later, when choosing a definition for bodily disease (see section 4.2), he supports the professional’s point of view and not the patient’s. It makes no difference to the patient’s experience of illness whether the cause of it is bodily or psychical. Contrarily, to the professional, it does make a difference. The dilemma is the same whether applied to pain or illness. Szasz’s positions on pain and illness are diametrically opposed. His position about sexual disorders concurs with his position on illness. It is therefore not surprising that in 1980 he writes, “The traditional distinction between organic and psychogenic sexual disorders remains of paramount importance,” (Sex by Prescription, page 7). There will be more on this in Chapter V.
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