Suicide Prohibition: The Shame of Medicine

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Suicide Prohibition: The Shame of Medicine. Thomas Szasz, Syracuse, New York: Syracuse University Press, 2011, 105 pp., $19.95 (hardcover)

In Szasz Under Fire, Szasz is given the opportunity to reply to a dozen well-reasoned critiques and detractions of his philosophical, moral, and medical views. Richard Bentall bravely proclaims that Szasz's "conclusions [that mental illness is a myth] do not stand up to careful scrutiny." Szasz replies lightly, "That is an error: it is my premise," not conclusion.

The power and unnerving nature of Szasz's analyses in the fields of psychiatry and psychology are that he will not allow his detractors to skirt the issue of their premises. For Szasz, an escapee of Nazi eastern Europe in 1938, the essential question is "Who owns you?" In his latest book, Suicide Prohibition, The Shame of Medicine, he offers three potential answers to that question:

1. The State owns you. Until relatively recently most states (of the United States) made suicide- or what Szasz prefers "autohomicide"-a crime. And with the aid of the "therapeutic state," suicidality being deemed a symptom of mental illness, psychiatrists now hold the keys to the locked mental institutions depriving the freedom of suicidal mental patients. In fact, they, the psychiatrists, are responsible and must prevent suicide. Szasz argues forcefully that they do not prevent but prohibit, thus the title of his book.

2. God owns you, or if you prefer to think of "God" as metaphor for "natural," life must follow its natural course. As Jews say in their Yom Kippur service, "Life is a journey. Death is the destination," and only God's natural forces are allowed to deprive someone of life.

3. You own you! Szasz likes to quote the 17th century English philosopher, John Locke who declares man's inherent right to his own life, liberty, and property. And the only legitimate function of the state is to protect those rights. Since you are your own property, it is your choice to live or to take your leave. You belong to you.

One must be careful not to misread into Szasz's work. I could imagine those who misguidedly will surmise somehow that Szasz is a shrill proponent of suicide. He makes it quite clear that it is not for him, or any psychiatrist, let alone any agent of the state to decide whose life is worth living. Nor is it the right or within the ability of an "expert" to determine what is "normal" thinking about such matters. (In other works, he renders the whole notion of "thought disorder" a complete hoax.) If judging the health of one's thinking is beyond us, if our very premise is that we are free to think and act (provided we don't threaten the lives of others) any way we choose, how could we ever have the chutzpah to declare an individual a "threat" to themselves and imprison them (civil commitment in U.S., sectioning in Great Britain), and then call it psychiatric treatment?

In Szasz's view, rather than preventing suicide, the suicide prohibitionists actually make matters worse. They "have succeeded in preventing people from having an honest, private conversation about life and death" (p. 82) because to talk openly subjects the patient potentially to forced hospitalization and the therapist to malpractice legal liability. The notion that it is the duty of the psychiatrist to prevent (prohibit) suicide is abhorrent to Szasz; just another nail in the coffin of self-responsibility. How can a patient trust a doctor who will call the cops/parents/friends at the first mention of suicide consideration? He sums, "Physicians deserve to be lauded for saving the lives of individuals who want to live. Equally, they deserve to be loathed for depriving individuals who want to stop living of the liberty to end their lives" (p. 45).

Szasz's argument against the suicide prohibitionists stands or falls on his insistence that what has come to be called mental illness is not a disease but rather a metaphor for moral, philosophical, political, and social struggle. …