486 - The Theology of Medicine: The Political-Philosophical Foundations of Medical Ethics

The Theology of Medicine: The Political-Philosophical Foundations of Medical Ethics
By Thomas Szasz
New York, Harper and Row, 1977, 170 pp. $3.95.

For nearly twenty years Thomas Szasz, a psychoanalyst teaching at the State University of New York at Syracuse, has been berating his colleagues in psychiatry for their lack of sensitivity to human rights of those incarcerated in mental hospitals. He has consistently urged that the term "mental illness" is a misnomer applied to persons having difficulty with human communication, and that psychiatric "diseases" are labels which society and its agents, the psychiatrists, apply to troublesome people in order to control and manipulate them. During this time, Szasz has established himself as the number one gadfly of the psychiatric establishment. He gets attention, and, if sometimes his charges are exaggerated and his remedies extreme, nevertheless some of his arrows have struck home.

It is against this background that we have this recent volume in which he takes on the whole medical profession, leveling against them the same general charges he has long hurled at his more immediate colleagues, even though he does not suggest that all diseases are phoney. Using the First Amendment prohibition against the establishment of religion as his analogical base, Szasz states his "thesis" in the following paragraph:

In the essays assembled in this volume, I try to show that this principle (First Amendment) applies, and ought to be applied, to medical or so-called therapeutic interventions as well. I maintain, in other words, that suffering caused by illness-regardless of whether it is actual bodily illness or alleged mental illness-cannot be the ground, in American law, for depriving a person of liberty, even if the incarceration is called hospitalization, and even if the intervention is called treatment. I contend that such use of state power-whether rationalized as the necessary deployment of the police power or as the therapeutic application of the principle of parens patriae-is contrary to the ideas and ideals enshrined in the First Amendment to the Constitution.

Here we can see where the title of the book comes from. It comes from Szasz's belief that the medical profession constitutes a kind of twentieth century prescribed religion. Physicians are double agents, at best. At worst they serve only the state, disregarding altogether the central need of human beings to be treated as persons, capable of choice.

In this volume, for the first time for this writer, a long time reader of Szasz, it becomes clear where the intellectual roots of his position lie. They are found, as we might have long suspected, in the "pure" liberal tradition, with which John Stuart Mill is linked rightly to Szasz. In this

487 - The Theology of Medicine: The Political-Philosophical Foundations of Medical Ethics

tradition a right is something persons have, not something upon which they think and others think they have a claim (the position of twentieth century liberals). Since liberty is chief among such rights, the state has no right to deprive persons of it, even if such a right is invoked in the name of protecting persons from themselves, as in suicide or drug abuse. Szasz believes that all medical intervention on behalf of potential suicides and addicts should cease-except as such persons themselves freely choose it, and that the vast machinery of medicine and state to protect them from themselves should be dismantled, as it serves primarily to keep thousands dubiously employed. Persons do have a right to health, and the state a duty to protect it from polutants and other noxious influences in the environment beyond the control of the person (p. 115).

In a day when we are increasingly aware that physicians are in fact double agents-with medicare scandals abounding, and the hallowed doctor-patient relationship intruded upon by corporate medicine, state and federal agencies, and private insurance carriers, Szasz's argument for the fundamental character of personal liberty, as taking precedence over all others, save in cases where society has been adjudged harmed in a court of law, has considerable appeal. Nor has he, in my opinion, vitiated his argument in this book by overstating his case to the extent that he has often done in past works.

I cannot agree with him that evident free choice is so seemingly easy a principle to apply to all cases-since in many human crises involving possible medical intervention free choice is anything but clear. It seems to me that a psychoanalyst should know that, and perhaps he does, but chose not to discuss the question in this opening salvo directed at the whole medical profession.

I recommend this book to anyone who wants a deeper understanding of the human issues that underlie the current debates about what is called "health care delivery systems" (a term from which libertarians of Szasz's stripe recoil). No better apologist for the classical liberal tradition is to be found, even though his allies may be found on the far right as well as among civil libertarians.

James N. Lapsley
Princeton Theological Seminary
Princeton, New Jersey