An interesting man, theorist, and psychiatric rouge recently died. While many of his ideas were not often directly related to addiction theory and treatment, a nod needs to be directed to Thomas Szasz.
When Szasz did speak of addiction, he considered the definition one that needed a distinction between proper and improper use of drugs. Medical uses being proper, while improper centered on recreational abuse. Further, he considered addiction to be an ethical matter. It is a behavioral problem. It is was not caused by drug use itself, rather it has its reasons. He considered the way we think of addiction as a stigmatizing matter. A product of culture not the drugs themselves.
Szasz did not consider psychiatric problems to be on a par with medical problems. In his view, mental illnesses were not diseases; this includes addiction portrayed as a brain disease. Mental illnesses are problems in living. And, if psychiatric problems (addiction included) are really not problems, then there can be no psychotherapy. Now don’t get me wrong, Szasz was not completely anti-psychiatrist, he did support psychiatry if it was contractual and non-coercive.
Szasz considered therapy to be a particular type of human relationship, designed to help people cope. He was particularly suspicious of therapists, especially if they proved untrustworthy.
Despite what you might initially think about ol’ Tommy’s ideas, I wish to tip my hat to him. Why? Well, he makes you think, if you allow yourself time to pause and just ponder some of the things he spoke of. I read his classic book The Myth of Mental Illness many years ago. I believe it made me a better therapist (which he might not like), and certainly a better educator.
Sadly, many in our field will just react to ol’ Tommy ideas, blustering about how inappropriate and utterly wrong he was. Those kinds of reactions are typical of the close-mindedness that permeates parts of our field. I want to believe ol’ Tommy crusaded against this kind of “reasoning” through out his entire career.
While I don’t buy everything Szasz stated, I do want to give a nod to a man who made me pause and think.