Thomas Szasz and the Rejection of Paradigms

Thomas Szasz’s seminal exploration of the myth and scepticism surrounding mental illness and

psychiatry has elicited a number of questions that need to be explored, analysed, and answered,

encompassed by The Rhetorical Paradigm in Psychiatric History: Thomas Szasz and the Myth of

Mental Illness by Richard E. Vatz and Lee S. Weinberg. Essentially, this essay will examine how

paradigms are constructed in psychiatry, in addition to how ethics are imparted and encoded within

psychiatric practice. Both these components will be scrutinised and critiqued in reference to Szasz’s

conceptualisation of the rhetorical paradigm, a notion that is vital in understanding the role of Szasz’s

scholarship in recalibrating traditional ideas of mental illness in psychiatry, both in practice and

research. Ultimately, this essay will review Vatz and Weinberg’s article through the lens of paradigms

and ethics, while attempting to explore how historical contingencies and theological philosophies

have been inflicted upon the purportedly scientific discipline of psychology.

First and foremost, the rhetorical paradigm must be explained, especially in reference to the

dynamism and progressiveness of Szasz’s conceptualisation. Szasz argues that psychiatry is practiced

in accordance with linguistic rules, arbitrarily applied, political and cultural in nature, and initiated to

ensure social control of deviants and outcasts. The ultimate goal of the pursuing the rhetorical

paradigm in one’s practice is to deprive a patient of their autonomy and assert the psychiatrist’s role

as some sort of omnipotent, deified figure, consecrated by their embrace of oppressive language

structures that enable them primacy over those engaged in socially disvalued behaviours. Szasz

espoused what is essentially a libertarian view, of the primacy of the individual over the collective,

over government; that an individual should have total agency and autonomy over one’s self. Thus, the

coercive institutions that happily embrace the rhetorical paradigm – like psychiatry as an institution –

are anathema to Szasz’s thought, because Szasz argued that it is categorically unethical to deprive a

patient of their autonomy as a method of fixing them – some psychiatric problems are unlike puzzles:

they do not have solutions. However, is there a method through which, although there are no

solutions, the deviant might be fixed? Perhaps.

 Furthermore, the historical component of the rhetorical paradigm highlights both the

contingency of ethics in psychiatry but also how the conglomeration of values in a society can

essentially create pariahs and deviants out of those who do not adhere to the established values of a

society, values that are almost arbitrary in their creation. As Szaszs notes, because psychiatry is

viewed and valued as a scientific discipline, any healthy scepticism of psychiatric practice is seen as

anti-scientific. This, however, is rather ironic, in that modern psychiatry is essentially a reassertion of

theological values, as noted, which is the crux of Szarsz’s thought in some ways: that psychiatry is

moral, not medicinal; theological, not secular; and political, not apolitical. Psychiatry cannot be

divorced from history, but history can progress and it is essential that practitioners scrutinise their

practice so their practice can effectively mirror the progression made in psychiatric theory.

In terms of ethical practice, there are a number of ways to view Szasz’s rhetorical paradigm

and his rejection of traditional psychiatry. First, a deontological analysis provokes a number of

questions: do psychiatrists have a duty to their patients and if so, what kind of duty? Is there an

overall duty or certain duties specific to certain patients? If Kant’s categorical imperative was applied

– act only according to that maxim whereby you can, at the same time, will that it should become a

universal law – would Szasz’s still reject the mainstream mores and norms that underpin professional

psychiatric practice? Second, the utilitarian method: if a practitioner can ensure a patient’s ultimate

happiness, does the process matter? Or, conversely, if the practitioner’s therapeutic methods ensure

the happiness of those surrounding the patient, would that supersede the happiness of the patient?

Perhaps a categorical imperative in psychiatry is far too totalising for such an individualised course of

treatment.

In terms of deontological ethics in application to psychiatric practice, there is undoubtedly a

duty of care from the practitioner to the patient. However, it is this duty of care that Szasz’s takes

issue with, in that he views psychiatrists as creating problems, rather than solving them. Again, some

psychiatric problems are unlike puzzles: they do not have solutions. Szazs posits that the deviant

behaviour that is considered to be mental illness might have no solution; if this is so, then what are

practitioners doing to their patients? How is their duty transformed by the ineluctable fact that the
processes they are inflicting upon their patients are unsettled and disputable? The obvious answer is

encompassed by Szasz’s rhetorical paradigm: psychiatric practitioners are reconstructing the

theological approaches to heresy and applying it to the mentally ill. To even begin rejecting such

theological overtures in the psychiatric profession, a thorough understanding of the historical

moments in the development of psychiatry as an institution must occur.

In regards to the utilitarian mode of ethics, it is this theory of psychiatric practice that Szasz’s

argues against, in the sense that utilising the tools of social control to manage and dominate social

deviants for the purported benefit of society as a whole is utilitarian in essence. This is further

emphasised in Vatz and Weinberg’s review when they argue that “the concept of mental illness

replaced evil”. If evil is considered synonymous with sadness – or whatever emotion is to be

considered the opposite of happiness in a utilitarian thought experiment – then the expurgation of

mental illness in society should theoretically be equivalent to the proliferation of happiness in the

totality of society. Therefore, the utilitarian analysis of Szasz’s opposite to traditional modes of

psychiatry would argue, in accordance with medical beneficence and hard interventionism, that the

coercive structures of psychiatry are ethically justifiable for the ultimate benefit of all in society, even

at the expense of the evil, deviant heretics in society.

By exploring these two ethical schools and applying them to Szasz’s rhetorical paradigm and

preferred methodology, it seems that even traditional systems of ethical practice are constructed in

favour of those with the tools of social control, like the psychiatric institution. This is a particularly

interesting revelation, in that Szasz’s posits that psychiatric problems are moral problems, not medical

problems. However, this essentially completes the analysis of ethics in psychiatry in this essay, as it

reaffirms that the traditional structures implemented in society are historically contingent and for

ethical and psychiatric paradigms to shift, it comes from a moral foundation, not medical, especially

in concern to psychiatry.

Progressing from ethics in psychiatry, the notion of paradigm shift in psychiatry is one that

has underpinned this essay so far, articulated mostly in how theology mutated into psychiatry, how
heretics mutated into deviants into the mentally ill, and so forth. The central idea behind paradigms is

essentially of a series of explanations joined together in a school of thought, a phase of thinking that

explains the totality of whatever observations are being made. A rather important paradigm, distinct

from psychiatry, is the heliocentric model, or that the sun is at the centre of the solar system, as

opposed to the geocentric model. Furthermore, these models have historical attachments, systems of

culture and politics that enabled social control; for instance, the Catholic opposition to the Copernican

Revolution and Galileo’s scientific discoveries.

Essentially, Szasz’s desires a transition from the rhetorical paradigm he articulated into a

more libertarian, autonomous paradigm, inclusive of patient’s desires and agency, forgoing coercive

practices, and accommodating outlandish behaviour instead of decrying it as a modern heresy or

deviant behaviour. Furthermore, Szasz argues that this paradigm should shift from medical to moral,

thus recasting mental illness in a new framework or a divergent discourse, one that regards mental

illness as fundamentally something that one does and not what one has. The shift from disorder to

behaviour represents a paradigm shift that is almost existential in nature, something that resonates

with the phenomenological nature of paradigms in psychiatry.

As a matter of evaluation, this essay posits that Szasz’s theories might never become the

dominant paradigm; rather, Szasz’s theories will continue to subvert and destabilise the conventions

of traditional psychiatric practice. Is this an outcome that will be for the benefit of patients involved in

traditional psychiatric practice? Or is it rather that the shift from the rhetorical paradigm to Szasz’s

notion of good practitioner conduct is far too difficult? Or is Szasz wrong? All these questions elicit

essays of their own, purely because the history surrounding psychiatry, and social control, and politics

and culture, and the transition from theology to psychiatry is manifold and complex, driven by forces

that are above and beyond the considerations of mainstream practitioners. To consider a paradigm

shift from the rhetorical paradigm to a new, novel paradigm is not a simple task, purely because – as

this essay has shown – even the ethical foundations of psychiatry are developed in a way that

facilitates the sort of psychiatry that Szaszs detests.

Ultimately, this essay pertaining to the review of Thomas Szasz’s work, The Rhetorical Paradigm in

Psychiatric History: Thomas Szasz and the Myth of Mental Illnes by Richard E. Vatz and Lee S.

Weinberg, has explored how conventional ethics have enabled psychiatry to continue with the

rhetorical paradigm. Furthermore, by exploring how paradigms are created, there is the distant

possibility of change, of furthering Szasz’s ideas to ensure a society where psychiatric practice is

centred on patient autonomy and agency, where mental illness is seen as moral and not medicinal, and

where political and cultural practices are not channelled in psychiatry. Ultimately, this essay argues

that while Szasz may be undoubtedly correct on his core assertions, there is a long way to go before

the utopia of his vision occurs.