The Trans Body as Liberty's Limit in Szasz' Critique of Psychiatry
Thomas Szasz is easily among the most famous and infamous critics of psychiatry. His thesis that “mental illness is a myth” used to describe what are in truth “problems of living” is a standard anti-psychiatric position (Myth, 262). In its simplicity, it both consolidated a number of preexisting critiques of psychiatric nosology into a pithy rhetorical call-to-arms and has itself birthed a number of even more fiery battle cries against the profession.
Many people are aware of his connections to the Church of Scientology and his far right-wing libertarian stances on crime and social policy; fewer note his consistent expressions of horror and disgust with “transsexers” (this is the term he uses). I am not the right person to adequately position his particular brand of transphobia in the historical record. Instead, I will aim to simply make his statements clear and situate them in his broader stance against psychiatry and state action.
Szasz’ critique of psychiatry rests on his criteria for determining what is a real pathology versus what is merely presumed or feigned. There are “real,” physical, biological lesions in the brain, and these do, in fact, constitute illness for him. If schizophrenia had been shown to have a clear and consistent underlying lesion associated across all cases, then he would likely have accepted it as being as real as Alzheimer's. In his ahistorical and unproven presentation, “illness meant a bodily disorder whose typical manifestation was an alteration of bodily structure: that is, a visible deformity, disease or lesion” until the middle of the 19th century (Myth, 11). This is his way of saying that psychiatry is a uniquely unstable science, or really not deserving of the title at all. For Szasz, logical coherence takes precedent over history, so, for the sake of his argument, one is supposed to ignore millennia of examples of spiritual or mental sickness that prove this thesis clearly false.
In a way, Szasz is fully in line with the German clinical psychiatric movement’s attempt to connect mental disorder to pathological anatomy in the late 19th century, e.g. Griesinger, Meynert, and Flechsig (see: Myth, 11–13). He just thinks they and everyone after them failed to find any conclusive localizable signs. Based on that criteria, psychiatry is a pseudoscience first of all because it persisted beyond that failed attempt at localization. At a deeper level, his project rests on a critique of the symptom as a sign. In Szasz’ mind, the symptom-sign must correspond typologically to the underlying cause, so, for instance, an illness of the skin must show itself/be expressed as altered or damaged skin. Mental illness, on the other hand, implies (rather than proves and maps) a deterministic chain connecting brain and mental activity. Since the premise itself is faulty, the fact that psychiatrists and pathological anatomists failed to find the glaring proof they wanted to find is not surprising, but inevitable.
Because mental illness cannot be proven to exist as the same sort of chain of determinations as physical diseases, Szasz calls them all metaphors for “problems of living.” Psychiatry is a moral intervention pretending to be a medical one. From this emerges three distinct forms of psychiatric ethics and practice: 1) psychiatry as privately employed moral consultant on language games who primarily organizes knowledge; 2) psychiatry as “applied scientist” or “therapist” (in quotes for Szasz) who organizes actors according to which games they “ought to play” empowered by prestige; and 3) a conspiratorial vision of a profession designed and authorized to act as a “social engineer,” as “priest and policeman” who “compels people [...] to play, or to cease to play, certain games” empowered by the state. (Myth, 260) Szasz had few issues with the first (and worked as such in his practice as a psychiatrist), and harbored some suspicions towards the second. If he had his way, psychiatry would persist but as a totally privatized field divorced from any form of public, social organization. He’s most famous for having elaborated conspiratorial histories of the third for the rest of his life in books like The Manufacture of Madness and Psychiatric Slavery where he so thoroughly emptied the field of any real historical texture that he was able to sustain one-to-one comparisons of psychiatry with witch hunts and slavery. Such comparisons are as weak as they are offensive to the victims of each, but, in a world without history or becoming, where all events are compared by abstract logic alone, everything is comparable.
I’m not inventing an overarching logic by connecting his argument to his horror of the trans body. He himself thought these positions were related: ‘Like much of the medical‐psychiatric mendacity characteristic of our day,’ he wrote in a 1971 New York Times review of The Transsexual Empire by Janice Raymond titled "Male and Female Created He Them”, "the official definition 'transsexualism' as a disease comes down to the strategic abuse of language—epitomized by confusing and equating biological phenomena with social roles (in the present case, chromosomal sexual identity with acting as a man or a woman). Although there are connections between these concepts and facts, neither one 'causes' or 'determines' the other." In Szasz’ universe, Genesis only took two days: on the first day, He created all the stuff, and on the second day, Adam thought up all the words and concepts for stuff. All interpersonal problems stem from a confusion between things with their real determinations and the ideas and names for things that correspond to our beliefs about them.
The marvelous, subtle, and strange strategies of biological life are untethered from their metamorphoses and flattened out onto a static plane of existence from which we derive our “truth”; social life and its historical becomings are reduced to a drab game of roleplay. Interpersonal life is a game played with words, and slimy experts are waiting around every corner to exploit our confusion between the actual world and the game we play in it to control our behavior—except for gender and crime, which are real and require legal provisions to protect us from the mutilation of the body and police to keep us safe from danger. Why are they “real?” Why is the "transsexual male [...] indistinguishable from other males, save by his desire to be a woman’" The “male body” is “real” for Szasz once he’s abstracted that body from any semblance of life, upbringing, desire, interaction, complexity, and anything else that makes life meaningful or worth living. Szasz’ reality, where the “transsexual male is indistinguishable from other males,” is a reality where a corpse is indistinguishable from a living body. Reality is a coroner’s office; “life” is a tragicomedy of automata.
Like the abject horror many feel when confronted with a dead body, Szasz cannot conceal his genuine disgust with the idea of surgically altering the human body. For all his emphasis on exposing logic/word games as the fog in the way of the “real,” he starts off both his New York Times article and his section on “transsexualism” in Sex by Prescription with gratuitous descriptions of vaginoplasty procedures. That he centers his graphic description around transwomen in particular combined with that fact that he, in the Times article, crudely describes it as having a “penis amputated,” gives the reader a fairly clear idea of where his real anxieties lie. Szasz, the iconoclastic realist living in his castle of words, thinks it’s good enough to simply describe such surgeries and put all references to trans people in quotes to prove the obviousness of his argument. How could you believe in the validity of transgender people when they are so clearly abhorrent?
A true feminist supports women against the encroachment of “fake women.” (Sex by Prescription, 87-8) Things are real because Szasz really feels like they should be real, or because the alternative gives him an icky feeling. It is relevant in this respect that Szasz only ever considers trans people from the perspective of psychiatrists. For him, it is just another "problem of living" being colonized by the psychiatric profession. He stands here on the verge of a historical insight, but he quickly finds that, unlike other such problems that should be left to individuals and their "word-game" intermediaries, this one is naturally and socially unacceptable, i.e. basically on the same order as crime. Szasz’ fear of the trans body reveals the great iconoclast who exposes psychiatry’s falsity and pretensions of social engineering through simple facts to be a rather crude and basic rhetorician who uses the same kind of emotional arguments he supposedly exposes to defend his own preferred police state (you know the one!) where all the perverts will be held in disgust and all the criminals will go to jail for their “real crimes.” No discretion involved. “Our” disgust is as obvious as the mechanical punishment of a legal infraction: “if the madman commits a crime, justice demands that we take him seriously and punish him for his deed.” (‘Does Insanity Cause Crime?’) Well, if “justice demands” it, it must be right!
One might think a libertarian like Szasz would defend peoples' right to get any surgery they want, but even the most hard-line libertarianism has limits and, amazingly, the limits to individual freedom happen to coincide with exactly those decisions Szasz himself finds disagreeable. Szasz is just the man to distinguish real choices from medicine's tyrannical control and defend us from the neo-Soviet creep. In allegiance to his own favorite general abstractions, sex surgery and the insanity defense are out; social shaming and the police are here to stay, because we all know gender is hardwired and justice demands crime be punished.
Szasz’ high position in the historical lineage of psychiatric critique is secured: many have taken some of his basic ideas and used them to elaborate their own—often more sophisticated and historical—takes on psychiatric language without knowing about Szasz’ conservatism. Some were likely only aware that he provided his considerable public weight to the campaign against the pathologization of homosexuality in the early 70s. We should bear this in mind when reading critical works from the past. But his position continues to provide fodder for the "fact-based" right-wing attack on trans people. His stalwart opposition to psychiatry is not based on a fear of the imperial aspirations of a field progressively desocializing social ills nor is it in favor of a robust collective process of transformation as it is for many who were inspired by his critique. His vision of the world is profoundly asocial; his political ideal is one of an untethered market regulated only by the absolute normative judgement of self-styled "reasonable ones." A cruel vision indeed. If our goal is to inhabit a social world not just “tolerant of” but defined and sustained by difference, it is incumbent on us to tease out what ties his particular brand of critique to an anti-social vision of the world and oppose this without reservation.
Szasz does not feel the need to explain the apparently obvious fact that a disease of the eye, for example, would always manifest in signs present in the eye; we are asked to just accept this as fact. Szasz' theory of determination supposedly grounds itself in a maxim of identity (the affection or damage must be of the same essence as the thing affected), but, given that he seems to believe a pathology must visibly alter or in some sense reflect the organ to which it belongs, this is a notion of identity based on simple appearances.
His legal presuppositions are presented most clearly in interviews and in his articles on Hayek and von Mises. His only disagreement with their work is that they accepted psychiatry, which he thought was a diminution of their otherwise thoroughgoing libertarianism and exaltation of the free market. In von Mises case, he laments that he did not recognize psychiatry as a "statist pseudo-liberationism" in line with the two modern forms of "slavery", Nazism and Communism. Hayek came closer to what Szasz considered the correct position. The latter even agrees with Hayek's contention that "in public life freedom requires that we be regarded as types, not as unique individuals," he just thinks he committed a logical fallacy by equating "categories identified by objective criteria, exemplified by 'persons accused of crimes' or 'persons convicted of crimes'" with the "subjective judgement" of someone as schizophrenic, for instance. Anything can be objective if you know how to draw a circle: the nature of crime is that it's natural. Why some things comes to regarded as criminal at any particular time, or how crime is actually treated by the various authorities who make it their object of intervention goes completely unexamined.
Szasz, Thomas S. ‘Does insanity "cause" crime?’ Ideas on Liberty 50, no. 31–32 (March): 2000.
Szasz, Thomas S. “Male and Female Created He Them.” The New York Times, 1979. https://www.nytimes.com/1979/06/10/archives/male-and-female-created-he-them-transexual.html
Szasz, Thomas S. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New York: Perennial Library, 1974.
Szasz, Thomas S. Sex by Prescription: The Startling Truth About Today's Sex Therapy. Syracuse, N.Y.: Syracuse University Press, 1990.