Sunday, November 9, 2008

Thomas Szasz: "Suicide is not a medical matter"

Thomas Szasz traces the parallels between suicide, contraception, and abortion - especially the "mental illness" (depression and threatened suicide) that, before the days of Roe v. Wade, was a pregnant woman's only hope of getting a "therapeutic abortion":
Regrettably, our memory of the history of medicalization is short and selective: We remember its glories and forget its infamies, especially as they relate to sexual behavior. When I was born, contraception was under complete medical control and abortion was illegal. When I was an intern in a Boston hospital, offering contraceptive advice, much less providing a contraceptive device, was a criminal offense. Only in 1965, in the celebrated case of Griswold v. Connecticut, did the Supreme Court strike down as unconstitutional the statute that made it a crime for a person to "artificially prevent contraception." In that landmark case, the Court repealed the law that prohibited a conduct the law deemed illegal. It did not medicalize the alleged "condition" that motivates such conduct: The Court did not call the fear of pregnancy and the desire to avoid it a "disease," nor did it call engaging in the formerly prohibited conduct "physician-assisted contraception" or classify it as a "treatment." In short, the right to practice contraception was placed in the hands of the people, not in the hands of physicians.

Abortion underwent a similar metamorphosis, from sin to crime to right, with a brief stop-over as a treatment. When abortion was legalized, the mental illness whose treatment justified therapeutic abortion vanished. When suicide is legalized, the mental illness whose treatment justifies its therapeutic prevention will also vanish.

Although performing an abortion and developing effective methods of birth control entail the use of medical knowledge and skill, abortion and contraception are not medical matters. The same is true for suicide. Although killing oneself with a drug entails the use of medical knowledge and requires access to the necessary substance, suicide is not a medical matter. We ought to deal with death control the same way we have dealt with birth control: by removing it from the purview of Medicine and the State, by repealing all medical and legal interference with the act. [Bolded emphasis mine; italics in original; citations omitted.]

From Fatal Freedom: The Ethics and Politics of Suicide, by Thomas Szasz.


  1. I came to agree with Szasz without actually reading any of his books. When I finally read one I was disappointed.

  2. I have only read Fatal Freedom (incompletely) and The Second Sin - the latter was silly, and the former I find hard to read because it's like reading my own thoughts (even his section titles mirror my blog post titles, though I hadn't read him before I started writing).

  3. Szasz wrote too much, and with too much repetition. But the caricatures are still lazy and unfortunate. When he was on, he was just so insightful. And I think it is relevant that many careers demand that he be refuted.

    A strong point in TGGP's critique concerns Szasz's blithe dismissal of the concept of the unconscious, which is inextricably bound up with his broader (and largely justified) critique of Freudian fashion. I wonder if he ever revised his views in light of neuroscience? I should know, but I don't know.

  4. I have to admit I haven't read anything by Szasz, but as you mention the unconscious, is it possible that what he objects to is something that doesn't tamper with scientific explanation? You can use the unconscious as a pure model for scientific explanation. That it uses the same vocabulary as talk about conscious attitudes (want, desire, believe, fear, etc.) is then merely a matter of convenience. What is questionable then is not to differenciente this want1, which is part of the language you formulate your scientific theory in, from want2, which is the everyday wanting that you consciously do and for which you are responsible. Saying that if you unconsciously want1, then you want2 is, in a way, unfair, because the person can't defend themself. This is relevant if you take the view that the self defines itself.

    (I'm afraid this sounded a bit confused... Have I made myself understood nonetheless?)

    PS: Strangely, < sub > ... < /sub > (without the spaces, of course) doesn't work...


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