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Analysis Mises and Psychiatry by
Thomas S. Szasz As one of the 20th century's
intellectual giants, Ludwig von Mises was a master of many subjects. Psychiatry
was not among them.
Because ours is an age of specialization, we expect
specialists to be particularly knowledgeable about their areas of expertise and,
for other matters, rely on the work of other accredited experts. However, I
believe we ought to expect more from social scientists, especially if their
interests encompass issues of individual liberty and personal responsibility
— namely, that they also familiarize themselves with the truths about the
medical specialty called "psychiatry." Why psychiatry? Because psychiatric
interventions — in particular, civil commitment and diversions from the
criminal justice to the mental health system — are the most common, and most
uncritically accepted, methods used by the modern state to deprive individuals of
liberty and responsibility.
| | Thomas S.
Szasz, M.D., is the author of several classic works on psychiatry, including
"The Myth of Mental Illness." He is professor psychiatry emeritus, SUNY Health
Science Center in Syracuse, N.Y. |
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Unfortunately, even the staunchest advocates of liberty have shown an
uncharacteristic trust and naiveté when it comes to psychiatry, taking what
the authorities say at face value even when it clashes with their own most
fundamental principles. As an illustration, I offer, with some reluctance, a
sample of Ludwig von Mises' comments about psychiatry. Although formally
Ludwig von Mises was an economist, it would be more accurate to view him as a
political philosopher and, in particular, a defender of individual liberty based
on private property and the rule of law. It is also manifest that he was one of
the intellectual and moral giants of the 20th century, and that his magnum opus,
"Human Action," is one of the most important books of that century. The
Two Faces of "Human Action": Praxeology and Psychiatry Unlike conventional, mathematical economists who study issues such
as industrial outputs, interest rates, and money flows, Mises focused on human
action: "No treatment of economic problems proper can avoid starting from acts of
choice; economics becomes a part . . . of a more universal science, praxeology [a
general theory of human action]."* Viewed as the study of human action,
economics and psychiatry are fraternal twins: Economists are concerned mainly
with the material and political consequences of choices and actions;
psychiatrists, mainly with their personal and interpersonal consequences. Yet
economists have shown no interest in psychiatry. In view of the fact that
psychiatry is a thoroughly coercive statist enterprise — its emblematic
institution and locus being the state mental hospital — this is an
especially astonishing omission on the part of free-market economists. Of course,
neither economist nor psychiatrist can avoid trespassing on his sibling's
territory. But since the brothers don't speak the same language, each is ignorant
about his own flesh and blood.
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| Even the staunchest
advocates of liberty have shown an uncharacteristic trust and naiveté when
it comes to psychiatry. |
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Viewed as the study of human action, economics and psychiatry are fraternal
twins: Economists are concerned mainly with the material and political
consequences of choices and actions; psychiatrists, mainly with their personal
and interpersonal consequences. Yet economists have shown no interest in
psychiatry. In view of the fact that psychiatry is a thoroughly coercive statist
enterprise — its emblematic institution and locus being the state
mental hospital — this is an especially astonishing omission on the part of
free-market economists. Of course, neither economist nor psychiatrist can avoid
trespassing on his sibling's territory. But since the brothers don't speak the
same language, each is ignorant about his own flesh and blood. The
profession of psychiatry as a medical specialty rests on the idea of insanity as
an illness — epitomized by the individual beset with "irresistible
impulses," which transform him from a responsible moral agent into a "mental
patient" not responsible for his behavior. That image forms the basis of the
insanity defense and much else in our society. Sir Henry
Maudsley (1835–1918), the undisputed founder of modern British psychiatry,
explained this basic concept of psychiatry: "To hold an insane person responsible
for not controlling an insane impulse . . . is in some cases just as false in
doctrine and just as cruel in practice as it would be to hold a man convulsed by
strychnia responsible for not stopping the convulsions . . . [I]t is a fact that
in certain mental diseases a morbid impulse may take such despotic possession
of the patient as to drive him, in spite of reason and against his will, to a
desperate act of suicide or homicide; like the demoniac of old into whom the
unclean spirit entered, he is possessed by a power which forces him to a deed of
which he has the utmost dread and horror"* (Emphasis added). More than
a hundred years later, psychiatrists and psychiatrically enlightened lawyers and
politicians hold the same view. Michael S. Moore, professor of law and professor
of philosophy at the University of San Diego, writes: "It is not so much that we
excuse them [the mentally ill] from a prima facie case of responsibility;
rather, by being unable to regard them as fully rational beings, we cannot affirm
the essential condition to viewing them as moral agents to begin with. In this
the mentally ill join (to a decreasing degree) infants, wild beasts, plants, and
stones — none of which are responsible because of the absence of any
assumption of rationality."*
These passages present us with nearly all the moral, medical, linguistic, and
legal metaphors and misapprehensions that form the foundations of modern
psychiatry. By medicalizing (mis)behavior, psychiatry replaces the otherworldly
superstitions of religion with the worldly superstitions of scientism. Without
identifying this view with psychiatry, Mises explicitly rejected it: "To punish
criminal offenses committed in a state of emotional excitement or intoxication
more mildly than other offenses is tantamount to encouraging such excesses. . . .
Man is a being capable of subduing his instincts, emotions, and impulses . . .
He is not a puppet of his appetites. . . . he chooses; in short, he acts.
. . . Human action is necessarily always rational. The term 'rational
action' is therefore pleonastic and must be rejected as such" (Emphasis added.
HA, p. 16, 18). These ideas have formed the basis for my views on "mental
illness" and psychiatry. If all human action is rational, then no action is
irrational or, as psychiatrists and their admirers like to put it, "senseless."
It is only a short step from Mises' assertion that human action is always
rational, to my assertion that mental illness is a myth.
| Viewed as the study of
human action, economics and psychiatry are fraternal twins: Economists are
concerned mainly with the material and political consequences of choices and
actions; psychiatrists, mainly with their personal and interpersonal
consequences. |
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Nevertheless, in his many references to insanity, Mises expresses an
uncritical acceptance of standard psychiatric mythology. "Human
Action" After arguing the intrinsic superiority of cooperation over
coercion and anarchy, Mises wrote: "Even if we admit that every sane adult
is endowed with the faculty of realizing the good of social cooperation and of
acting accordingly, there still remains the problem of infants, the aged, and the
insane. We may agree that he who acts antisocially should be considered
mentally sick and in need of care" (Emphasis added. HA, 149). I
respect Mises too much to comment on this unfortunate statement.
Sometimes, Mises contradicted himself, criticizing psychiatry in one sentence,
and embracing it in the next. He declared: "No better is the propensity, very
popular nowadays, to brand supporters of other ideologies as lunatics.
Psychiatrists are vague in drawing a line between sanity and insanity" (HA, 185).
But he then added: "It would be preposterous for laymen to interfere with this
fundamental issue of psychiatry." Since the issue is not merely drawing a line
between sanity and insanity as abstract concepts, but determining which
individuals innocent of lawbreaking ought to be deprived of liberty and
responsibility, why is it "preposterous for laymen to interfere with this
fundamental issue of psychiatry"? Indeed, Mises proceeded to do just that,
albeit much too timidly: "However, it is clear that if the mere fact that a man
shares erroneous views and acts according to his errors qualifies him as mentally
disabled, it would be very hard to discover an individual to which the epithet
sane or normal could be attributed. . . . If to err were the characteristic
feature of mental disability, then everybody should be called mentally disabled"
(HA, 185–6). That is precisely what Freud did, and Mises admired him for
it. Mises refrained from saying, outright, that having a delusion ought to
be regarded as a fundamental human right, lest all disagreements with authority
be disqualified as mental illnesses. Probably he did not say so because he did
not believe it to be the case. The evidence points in this direction: "If a
statement were not exposed as logically erroneous, psychopathology would not be
in a position to qualify the state of mind from which it stems as pathological.
If a man imagines himself to be the king of Siam, the first thing which the
psychiatrist has to establish is whether or not he really is what he believes
himself to be. Only if the question is answered in the negative can the man be
considered insane" (Emphasis added. HA, 316). Mises must have known that
persons considered insane are incarcerated in mental hospitals, but remained
silent on the subject. Mises failed to consider the possibility that the
man who says he is the king of Siam may be an actor, playing the role of the
king; or that he may be lying — that is malingering — to avoid a duty
or punishment, such as military service or the death penalty; or that he may be
protesting his insignificance, his false self-identification representing a
metaphorical compensation for it; or, most importantly, that believing oneself to
be the king of Siam — like believing that, after dying, one will go to
heaven or hell — ought to be viewed as the right to be wrong, and hence
should not be ground for incarcerating the speaker in a prison, even if that
prison is called "hospital." "Liberalism" "Liberalism," written in German more than 20 years before "Human
Action," contains more embarrassing psychiatric indiscretions. In the
Introduction, Mises declared, in typical psychiatric style: "This opposition [to
liberalism] does not stem from reason, but from a pathological mental attitude
— from resentment and from a neurasthenic condition that one might call a
Fourier complex, after the French socialist of that name."* In the jargon of Freudian psychobabble, Mises
continued:
| Believing oneself to be
the king of Siam — like believing that, after dying, one will go to heaven
or hell — ought to be viewed as the right to be wrong, and hence should not
be ground for incarcerating the speaker in a prison, even if that prison is
called "hospital." |
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"The Fourier complex is much harder to combat. What is involved in this
case is a serious disease of the nervous system, a neurosis, which is more
properly the concern of the psychologist than of the legislator. . . .
Unfortunately, medical men have hitherto scarcely concerned themselves with the
problem presented by the Fourier complex. Indeed, they have hardly been noticed
even by Freud, the great master of psychology, or by his followers in
their theory of neurosis, though it is to psychoanalysis that we are indebted for
having opened up the path that alone leads to a coherent and systematic
understanding of mental disorders of this kind. . . . Only the theory of
neurosis can explain the success enjoyed by Fourierism, the mad product of a
seriously deranged brain. This is not the place to adduce evidence of
Fourier's psychosis by quoting passages from his writings." (Emphasis
added. L, 14–15) Mises strongly opposed — in both "Liberalism"
and "Human Action" — the view that drug addictions are diseases and that it
is the proper function of the state to punish such behaviors. Nevertheless, in
"Omnipotent Government" [1944] he wrote: "The League of Nations may continue to
combat contagious disease, the drug traffic, and prostitution" (303).
Conclusion Regardless of official title or professional
affiliation, anyone who addresses the human condition and writes about how human
beings live and ought to live is influenced by the kinds of life he cherishes and
condemns. Mises was no exception. He was a great man, but not because he
established praxeology as a science of human action — for there can be no
such science.* Mises was a great man
because he recognized that the 20th century's great collectivist movements of
"liberation," National Socialism (Nazism) and International Socialism
(Communism), were simply new versions of slavery — and fought tirelessly,
and against great odds, against them. It is regrettable that Mises did not
see that psychiatry (and psychoanalysis, through its alliance with psychiatry)
was and is also a form of statist pseudo-liberationism; and that, because
psychiatry is allied with medicine and healing rather than with militarism and
killing, it is the most insidious and, in the long run, the most dangerous form
of statism yet developed by man.
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| * | Ludwig von Mises, "Human Action: A Treatise on Economics" (Yale
University Press, 1949.) Page 3. |
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| * | Henry Maudsley, "Responsibility in Mental Disease," 4th ed.
(Kegan Paul, Trench & Co., 1885.) Pages viii & 133. |
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| * | Michael S. Moore, "Some myths about 'mental illness,'" Archives
of General Psychiatry, (December, 1975); page 1495. |
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| * | Ludwig von Mises, "Liberalism: A Socio-Economic Exposition"
[1927], translated by Ralph Raico, edited by Arthur Goddard (Sheed Andrews and
McMeel, 1978) p. 13. |
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| * | This is not a criticism of Mises. In my view, use of the term
"science" ought to be restricted to the hard (physical) sciences. This does not
make other branches of learning any less important. |
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