Review of INSANITY: The Idea and Its Consequences


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RASKOLNIKOV COULD COP A PLEA

By DAVA SOBEL

Date: March 15, 1987,
Sunday, Late City Final Edition Section 7; Page 22, Column 1

Dava Sobel, a former reporter for The New York Times, writes about science and medicine for several magazines.

INSANITY The Idea and Its Consequences. By Thomas Szasz. 414 pp. New York: John Wiley & Sons. $17.95.

IN this, the latest battle of his Thirty Years War with organized psychiatry, Thomas Szasz argues that insanity is the 20th-century version of demonic possession, and that treatments for insanity are about as scientific as exorcism. In Dr. Szasz' view, the theories of insanity and demonic possession both arose from our need to explain away aberrant behavior. Because it is too horrible to think that a human being would want and choose to act in certain ways (murder innocents, for example, or live in a cardboard box on the street), society creates dark forces that are said to overpower such individuals and make them do the things they do. These dark forces, once called devils, are now known as mental disorders. Dr. Szasz, a professor of psychiatry at the State University of New York Health Science Center in Syracuse, holds that mental illness and brain disease are wholly different entities. Brain disease, such as that caused by neurosyphilis, is easily documented and well described in pathology textbooks. Mental illness, on the other hand, is a myth, a metaphor, a legal fiction, a powerful, coercive tool for the incarceration of innocent people in mental hospitals and the exoneration of guilty ones by declaring them ''not responsible'' for their crimes.

Dr. Szasz is a brilliant debater, and the unpopularity of his position only serves to hone his formidable writing talent. He can turn a topic as somber as insanity and its social context into a book that is extraordinarily entertaining. He is as likely to quote Shakespeare or Moliere as Freud and Jung, and when it suits him he quotes Ann Landers and Dear Abby, too. His irreverence and moral outrage fairly sizzle on the page. The worst thing I can say about him as a writer is that he sometimes sputters with too much passion.

A look at some of his earlier works (''The Myth of Mental Illness,'' ''Schizophrenia: The Sacred Symbol of Psychiatry'') will show that the central theme of ''Insanity: The Idea and Its Consequences'' is not new. But the author apparently justifies this fresh attack on an old enemy by the fact that the concept of mental illness continues to wreak havoc in society. One of Dr. Szasz' favorite examples of this havoc is the insanity defense, which he views as psychiatry's destruction of ''the old principle of moral agency and personal responsibility.'' Prize trophies from his vast collection of newspaper accounts of reprehensible crimes help him expose the insanity defense as a travesty of justice and a travesty of psychiatry. He cites a 1985 report in The New York Times in one such case: ''The [ U.S. Supreme ] Court agreed to hear a prosecutor's appeal . . . suppressing the confession of a murder defendant as involuntary because he was mentally ill. [ Dr. Szasz' emphasis. ] . . . The man had approached a police officer on the street in Denver and said he wanted to confess a homicide. The policeman told him of his rights to remain silent and to have a lawyer present. The man said he understood, and proceeded to confess the killing of a 14-year-old girl and to lead police to the scene and to other evidence.''

''It would be difficult,'' Dr. Szasz continues, ''to imagine what other evidence one would need to conclude that this man knew what he was doing: after all, it is not as if he had confessed to a murder and was unable to provide evidence of his guilt except his confession. How, then, did someone get the idea that this man was mad rather than a murderer? Obviously, the killer did not want to talk to a psychiatrist: had he wanted to, he could have sought one out, just as he had sought out a policeman. No doubt, as it is now customary in murder cases in the United States, the authorities arranged for him to 'be seen' by a psychiatrist. Sure enough, the killer told the psychiatrists exactly what they expected to hear in such a case: 'God's voice had told him to confess.' How psychiatrists, lawyers, and judges know that the defendant used the phrase God's voice literally, rather than as a metaphor for his conscience, the report in the Times does not say. So much for Raskolnikov. While it may be sad that Dostoevski has been rendered irrelevant by the march of psychiatric science, it is reassuring to realize that Raskolnikov was innocent after all.'' What further infuriates Dr. Szasz about his fellow psychiatrists is that they are not content to treat those who come to them for help, but choose instead to occupy ''every nook and cranny of human behavior,'' and insist on searching ''for the twisted molecule behind every twisted thought.'' Thus we have ''tobacco dependence'' and ''pathological gambling'' listed as bona fide entries in the official ''Diagnostic and Statistical Manual of Mental Disorders.''