Thomas Szasz: Cho Enabler?
David Weigel | April 24, 2007, 11:53am
It was probably inevitable that someone would take a whack at Thomas Szasz in the wake of the VT killings. Ladies and gentlemen, Jonathan Kellerman's essay about how 1970s crazies "shut down the asylums" and created a mental health crisis.
The libertarians were fueled by Thomas Szasz, an iconoclastic psychiatrist who was, and remains, an outspoken foe of virtually every aspect of his chosen specialty. Hungarian-born in 1920, and witness to vicious state exploitation of medical practice by the Nazis and the communists, Dr. Szasz pushed an absolutist dogma of individual choice, finding ready converts among members of the Do-Your-Own-Thing generation. Though his early essays offered much-needed critiques of the Orwellian nightmares that can result when autocracy corrupts health care, Dr. Szasz devolved into something of a psychiatric Flat-Earther, insisting in the face of mounting contrary evidence that mental illness simply does not exist. Currently, he serves on a commission, cofounded with the Church of Scientology, that purports to investigate human rights violations perpetrated by mental health professionals.
Sounds like a crazy person, right? Kellerman, in his wisdom, suggests the return of long-term involuntary committment.
If the Virginia Tech shooter had been locked up for careful observation in a humane mental hospital, the worst-case scenario would've been a minor league civil liberties goof: an unpleasant semester break for an odd and hostile young misanthrope who might've even have learned to be more polite. Yes, it's possible confinement would've been futile or even stoked his rage. But a third outcome is also possible: Simply getting a patient through a crisis point can prevent disaster, as happens with suicidal people restrained from self-destruction who lose their enthusiasm for repeat performances.
This is the psychiatrist's version of the Derbyshire gambit - if only the people around Cho had behaved exactly as I would have behaved, this tragedy could have been snuffed out! Except that Derbyshire wasn't arguing for the return of Bedlam. Kellerman does aver a little bit at the end of his piece ("Given the excesses of the past--husbands committing troublesome wives, involuntary sterilization of those judged defective--extreme caution is warranted."), which dilutes the impact (and the point) of his Szasz-bashing.
Worth reading: Jacob Sullum's long Szasz interview from 2000.
Neu Mejican | April 24, 2007, 12:55pm | #
Grotius,
This is the Cochrane review of the issue
"Compulsory community and involuntary outpatient treatment for people with severe mental disorders.
* Kisely S,
* Campbell LA,
* Preston N.
Department of Psychiatry, Community Health & Epidemiology, Dalhousie University, Room 425, Centre for Clinical Research, 5790 University Avenue, Halifax, Nova Scotia, Canada, NS B3H 1V7. Stephen.Kisely@cdha.nshealth.ca
BACKGROUND: There is controversy as to whether compulsory community treatment for people with severe mental illnesses reduces health service use, or improves clinical outcome and social functioning. Given the widespread use of such powers it is important to assess the effects of this type of legislation. OBJECTIVES: To examine the clinical and cost effectiveness of compulsory community treatment for people with severe mental illness. SEARCH STRATEGY: We undertook searches of the Cochrane Schizophrenia Group Register to 2003 and Science Citation Index. We obtained all references of identified studies and contacted authors of each included study. SELECTION CRITERIA: All relevant randomised controlled clinical trials of compulsory community treatment compared with standard care for people with severe mental illness. DATA COLLECTION AND ANALYSIS: We reliably selected and quality assessed studies and extracted data. For binary outcomes, we calculated a fixed effects risk ratio (RR), its 95% confidence interval (CI) and, where possible, the weighted number needed to treat/harm statistic (NNT/H). MAIN RESULTS: We identified two randomised clinical trials (total n=416) of court-ordered 'Outpatient Commitment' (OPC) from the USA. We found little evidence to indicate that compulsory community treatment was effective in any of the main outcome indices: health service use (2 RCTs, n=416, RR readmission to hospital by 11-12 months 0.98 CI 0.79 to 1.2), social functioning (2 RCTs, n=416, RR outcome 'arrested at least once by 11-12 months' 0.97 CI 0.62 to 1.52), mental state, quality of life (2 RCTs, n=416, RR homelessness 0.67 CI 0.39 to 1.15) or satisfaction with care (2 RCTs, n=416, RR perceived coercion 1.36 CI 0.97 to 1.89). However, risk of victimisation may decrease with OPC (1 RCT, n=264, RR 0.5 CI 0.31 to 0.8, NNT 6 CI 6 to 6.5). In terms of numbers needed to treat, it would take 85 OPC orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest. AUTHORS' CONCLUSIONS: Based on current evidence, community treatment orders may not be an effective alternative to standard care. It appears that compulsory community treatment results in no significant difference in service use, social functioning or quality of life compared with standard care. There is currently no evidence of cost effectiveness. People receiving compulsory community treatment were, however, less likely to be victim of violent or non-violent crime. It is, nevertheless, difficult to conceive of another group in society that would be subject to measures that curtail the freedom of 85 people to avoid one admission to hospital or of 238 to avoid one arrest. We urgently require further, good quality randomised controlled studies to consolidate findings and establish whether it is the intensity of treatment in compulsory community treatment or its compulsory nature that affects outcome. Evaluation of a wide range of outcomes should be included if this type of legislation is introduced."
Justin M. Stoddard | April 24, 2007, 2:39pm | #
I was 6 years old when I was first brought to a child psychologist. In his after-action write up, he noted that I had a very short attention span. His anecdotal evidence for this was...wait for it...I wandered around the office looking at stuff and could not sit still for more than 5 minutes.
Now, I ask you, what 6 year old sits still for 5 minutes at a time? What 6 year old does not "wander around" checking out his environment?
Not matter, it was Ritalin for me. The psychologist also recommended that a screen be placed around me in my class-room so I would not be distracted by the other children. Now, I don't know about you, but something like that is a sure invitation for a playground ass whoppin', if you know what I mean.
Fast forward 29 years. I have a fantastic job and am finishing up my own degree in psychology. I am a huge advocate of therapy. Hey, if you need to talk to someone, freaking talk to them. Having read Szasz, I admire his take on private therapy...two consenting adults talking things through. No fuss, no muss.
I think Jennifer and others taking her point of view hit it spot on. Psychologists, just like every other profession, can be whores. There are good and bad, no doubt. Thankfully, the free market helps a bit in sorting them out.
However, when you have psychiatrists locking people up on their whim...well, mostly only bad can follow. The free market cannot flush out the difference.
This is a weird time loop enigma. 33 people would not be dead were Cho locked up. But, then again, how the hell would we know if Cho being locked up would have prevented 33 deaths if they never happened? Weird.
Phony Handle | April 24, 2007, 6:03pm | #
Note: I'm a regular poster who is going anonymous temporarily.
I was top 10 student in high school. I excelled at several non-sports-related extracurriculars, and while I was nothing like a BMOC, I had a regular circle of friends. Due to a late in the year birthday I was one of the youngest kids in my class, and was a bit of a slow mover in school social circles. Still, by the time I was 17-year-old senior I was attending the occasional party, had downed a beer or two, gotten my learner's permit and even managed to wangle a prom date with a cute 17-year-old blonde from the junior class. I had gotten to know her from one of my afterschool activities. By the time I had graduated, I was still a virgin, but at least I had kissed a girl.
I received scholarship offers from nearly every college I applied to. Those schools ranged from some nice, small liberal arts schools to some nationally prestigious universities. I enrolled at what was probably my third choice, a decent enough school that gave me a much nicer financial aid package than the two above it on my list. I would be living more than a day's drive from home, in a dormitory on campus. I was invited to join the honors program, so, ambitious nerd-boy that I was, I signed up for that. After my first two semesters I had a grade point safely over 3.0, and thought I had the college thing down. I wasn't getting anywhere with girls, but I hadn't been trying too hard on that front. Hitting the bars with the guys was plenty fun, and the only extracurriculars I had put myself down for was "binging and booting."
In my sophomore and junior years I ran into some trouble. Coursework was getting harder. My honors sections were no longer only in areas where I had a strong background, but in some disciplines I hadn't had any formal exposure to before. As a high schooler I could attend class, take good notes, do assigned textbook readings, regurgitate facts to please my teachers and lock down an "A." In my college courses the supplemental reading was as important, if not moreso, than the lectures, and I was not used to putting in the time to keep up with all of it. It wasn't that I didn't like to read. I gobbled down non-assigned books on a recreational basis just as I did before I matriculated. My poor time management was seldom a problem in high school, as a last minute burst of effort, combined with my natural ability, had always saved my butt from academic disaster. In college, I was soon to find that was going to be a neater trick to pull off. The demands of written assignments started to trip me up, and I had to plead for extensions, and wound up taking incompletes in some courses until I could get my work in. I dropped one honors class because I felt the workload required for a course outside my major was unrealistic . Eventually the honors program dropped me.
I made a huge mistake by taking up a couple of extracurricular activities I had participated in in high school. In both cases a pal of mine who found out I had once been so involved talked me into signing up. One group made enormous demands on my time, while the other even required that we travel around our state and spend some weekends away from campus. I went into these with the idea that I'd be studying during the "down periods," but I wound up pissing that time away. I got quite a bit out of those experiences, but I was really messing up my transcript. Eventually my scholarship was pulled, and I wasn't making timely progress towards my degree. I wound up having to take some summer courses at another school in order to have some hope of graduating on time, and I didn't manage to complete all of those.
When I went back to school for my senior year, it was pretty clear to me that I would have to work like a dog to complete a full load and bring my cumulative average up to something respectable. The pressure weighed on me. I wasn't able to completely banish my virulent procrastination, and I pulled more than my share of all-nighters before big tests or paper deadlines. We were having a hard winter, and a flu that was spread around college campuses by one of our basketball opponents got me. I had three bouts with it, or something like it, before midterms, and missed a lot of class. A recurring problem I had with sleeping through my alarm clock wasn't helping me any. I even failed a course in my major when I overslept and missed a final.
When I visited my family over spring break, I was a wreck. My midterm grades were going to be poor, and the folks, shelling out more for my education than we had planned at its outset, were not going to be happy. I'd already had lectures on buckling down and not wasting my potential, not to mention money. I woke up one morning in tremendous pain, as I had broken out in an awful head-to-toe rash. I had to be rushed to the local emergency room and shot up with some steroid or other. I didn't have a history of allergic reactions. I never did get a clear diagnosis of what was wrong with me. Maybe I was bitten by a tick or something when I had taken a walk in the woods the previous day. Maybe the Indian blanket that covered my bed that night, a souvenir my brother had brought back from New Mexico, contained some irritant. Maybe that rash was a result of stress. Who knows? In any case, I managed to get back to school.
Once there, I proceeded to fall to pieces. My attempts to get current with all my work exhausted me. I eventually gave up, and turned my attentions to other pursuits. I got back in touch with a girl at another local school who I had dated a bit, and made a big deal about her birthday. I rearranged the furniture in my dorm room several different ways. I decided that now was a good time to lose weight, and all but stopped eating. I dropped some courses I was flailing in, and even looked into withdrawing from school altogether. I had some off-campus friends I was spending a lot of time with, and was feeling one of them out as a possible source of a full-time job. Things came to a head when I volunteered to help organize a party co-hosted by our floor, and proposed turning it into a much larger event and charity fundraiser, complete with 17-page color-coded diagram and procedural manual, complete with codenames.
I had totally flipped out.
I had chats with our R.A., and with the dorm chaplain, who happened to live on our floor. (Yeah, it was a private school.) Somebody looked into my academic status, and found that I wasn't carrying enough credits to be considered a full-time student, which meant that I was technically not supposed to be eligible for a dorm room. My parents were called. After a plane flight I'm sure they were happy to shell out for on short notice, not to mention burning personal days from work, I was confronted by them, my sister who also attended my school, and those I had confided in. I was convinced to voluntarily enter a psychiatric ward for a week's observation. I put my foot down when the plan was to send me to the county hospital in a campus patrol car driven by a uniformed rent-a-cop. Instead I went to a private hospital near campus. My mumblings about not wanting to have a public record of a psychological commitment, since I might want to run for office someday was taken as evidence of "delusions of grandeur."
The school allowed me to withdraw for medical reasons, without any restriction on returning. No mention of psychological problems were on the paperwork, thank entropy.
The upshot was that I was in a voluntary lockup for a week, was calmed down by psychoactive drugs and some talk-therapy, and released into my parents' care. No judicial process ever took place. Everyone was very concerned about whether or not I had ever considered suicide. {I was a college student who had been assigned to read Camus and Plato's
Apologia. Of course I had considered the intellectual arguments for suicide. That doesn't mean I ever wanted to follow through with that. Perhaps if I'm ever an 85-year-old with terminal liver-cancer....)
Back home I went to an outpatient facility, once. After the initial interview, where the Doc in charge of admitting seemed to think that my admission of college-boy levels of alcohol use [nowadays called "binge drinking"] might be indicative of a substance abuse problem, we decided to do without further treatment. I hung around the house until I could get a job. After about a year I moved back to the city where I had been going to school and found other employment. When I had managed to arrange my life and finances sufficiently, I reenrolled as a part-time student. After three semesters I finally picked up my degree. As a "grown-up" paying my own way I got my best grades ever. Had I done so well over my entire collegiate career I would have graduated with honors.
Why am I telling you this? First, because I can do so anonymously. I don't tell anyone about my stint in the "booby hatch," unless I am compelled to. I would tell the woman I loved, before I asked her to marry me. I don't know what the best term is for what happened to me. In the bad old days we would have called it a "nervous breakdown." It wasn't a "psychotic break" of the violent kind. If anything, I was more social, garrulous and outgoing than I normally was. I wanted everyone to be my friend, and at least one girl for a sweetheart. I was only interested in enjoying myself, and had no desire to hurt anybody, least of all myself. But I was definitely not in control of my emotions, and acting without any good sense. Maybe all I needed was to leave school, lie on the beach for a couple of weeks, eat some good food, get a little exercise and lay off the booze. Follow that with a kick in the ass and a copy of the want ads. Repeat as necessary. Once I had been calmed down, that's essentially what I got.
My conclusions from all of this? Sometimes psychiatry/psychology can do some good. Not every student who cracks up is dangerous. Discreetly pushing a troubled young person into observation and/or treatment may be the best thing for him, but the fear of being stigmatized might scare them off that path. I could have avoided an involuntary commitment. The state my college was in had very strict standards for that, and unless it could be shown that I was dangerous I would not be locked up against my will. My school could certainly have kicked me out of the dorm, out of class, and even suspended or expelled me if I didn't agree to take care of my problems. I don't know how much of that our local state university could have done.
Just so you know, I've never had a recurrence of any kind of psychological problems stronger than "the blues." [Note: No, I have never experienced clinical depression, AFAIK.] I've done stupid things when I've had to much to drink, or when some woman dumped me, and the combination of the two was no picnic. I did get some counseling once to explore whether I might have a problem with alcohol. We concluded that, while I might have some tendencies in that direction, I should get educated about the difference between moderate use and abuse. Since then I've avoided drinking like a college-boy, and been the soul of moderation.
sushil_yadav | April 25, 2007, 5:39am | #
Crimes of the "Military Industrial Complex" are millions of times greater than the crime of Cho.
The abnormality of "Industrial Society" is millions of times greater than the abnormality of Cho.
Criminality and Abnormality.
Industrial Society has collectively killed billions of Animals and Trees [ Remember - plant and animal species developed over a period of millions ofyears]
It has also killed most of Water and Air [ Please note - polluting Water and Air is equivalent to killing Water and Air ]
The soil was not fertile when the earth was created. It became fertile - very slowly - over a period of millions of years. And look what man has done - He has covered millions and millions of hectares of land with cement and concrete. All the land that has been covered with cement and concrete has been killed.
Man has stockpiled thousands of tonnes of highly radioactive nuclear material and nuclear waste which is going to remain highly radioactive and carcinogenic for the next thousands of years - and which has already leaked into the environment hundreds of times.
There is an arsenal of 50,000 nuclear missiles that can destroy the planet several times over.
What could be more criminal than this.
What could be more abnormal than this.
Lawyers and Judges are trying to catch a few criminals.
They don’t realize the entire Industrial Society is criminal.
Psychologists and Psychiatrists are trying to classify a few people as abnormal.
They don’t realize the entire Industrial Society is abnormal.
Industrial Society is collectively making billions of tonnes of weapons and explosives [of all kinds] every year – and then it wonders why there is so much violence in this world.
Big Mystery.
If you make billions of tonnes of weapons and explosives on earth they are going to be used on earth – they are not going to be used on Mars.
The link between Mind and Social / Environmental-Issues.
The fast-paced, consumerist lifestyle of Industrial Society is causing exponential rise in psychological problems besides destroying the environment. All issues are interlinked. Our Minds cannot be peaceful when attention-spans are down to nanoseconds, microseconds and milliseconds. Our Minds cannot be peaceful if we destroy Nature.
Industrial Society Destroys Mind and Environment.
Subject : In a fast society slow emotions become extinct.
Subject : A thinking mind cannot feel.
Subject : Scientific/ Industrial/ Financial thinking destroys the planet.
Emotion is what we experience during gaps in our thinking.
If there are no gaps there is no emotion.
Today people are thinking all the time and are mistaking thought (words/ language) for emotion.
When society switches-over from physical work (agriculture) to mental work (scientific/ industrial/ financial/ fast visuals/ fast words ) the speed of thinking keeps on accelerating and the gaps between thinking go on decreasing.
There comes a time when there are almost no gaps.
People become incapable of experiencing/ tolerating gaps.
Emotion ends.
Man becomes machine.
A society that speeds up mentally experiences every mental slowing-down as Depression / Anxiety.
A ( travelling )society that speeds up physically experiences every physical slowing-down as Depression / Anxiety.
A society that entertains itself daily experiences every non-entertaining moment as Depression / Anxiety.
Fast visuals/ words make slow emotions extinct.
Scientific/ Industrial/ Financial thinking destroys emotional circuits.
A fast (large) society cannot feel pain / remorse / empathy.
A fast (large) society will always be cruel to Animals/ Trees/ Air/ Water/ Land and to Itself.
To read the complete article please follow any of these links :
PlanetSave
FreeInfoSociety
ePhilosopher
sushil_yadav
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