Friday, 4 February 2011

The Cure of Souls in the Therapeutic State Written by Thomas Szasz

Before I write my much, much, better and much more balanced and moderate article very soon, about progressing and enlightening psychotherapy much much more for the better in my article loosely about and around so-called defences, just read this article about R. D. Laing and psychotherapy to get another side of the picture, because there are always two sides to every story, and we must all admit and be somewhat humble and honest about the reality and the fact that there still needs to be a lot more improvement, enlightenment, creative and practical scientific skills, and much much more knowledge and wisdom for psychotherapy, and that is what I will very much do in my soon to be written forthcoming article on defences, and which be much more positive, progressive, constructionist, and beneficial to all concerned than Thomas Szasz's otherwise great article pasted and posted here.

Peter H. Donnelly

The Cure of Souls in the Therapeutic State

Written by Thomas Szasz

If I accept you as you are, I will make you worse; however, if I treat you as though you are what you are capable of becoming, I help you become that.

--Johann Wolfgang von Goethe

What is psychoanalysis? Who speaks for psychoanalysis? We are familiar with Freud’s many contradictory teachings and the diverse practices he engaged in, calling them all "psychoanalysis." We know that the term is used to refer to a method of diagnosing and treating mental illnesses, detecting mental illness in famous dead persons and in characters invented by poets and writers, explaining and influencing human behavior, and interpreting the "meaning" of works of art. Here are two current examples of what persons officially authorized to speak for psychoanalysis say about it. Richard Fox (2001), president of the American Psychoanalytic Association in 2001, declares: "Psychoanalysis today is a far cry from what it was thirty to forty years ago ...We lobby in Washington ... We work with other groups such as the ACLU to further our goals" (p. 27). These activities are not specific for psychoanalysis, nor is it self-evident, as Fox implies, that they are praiseworthy. During World War II, the ACLU supported and justified the incarceration of innocent Americans diagnosed as "Japanese-Americans." Today, it supports and justifies the incarceration of innocent Americans diagnosed as "mentally ill and dangerous"(Markmann, 1965; Szasz, 1974, 1984).

Fox further reports that the American Psychoanalytic Association no longer bars psychologists from membership: "We have extended our membership ... We have shed our medical orthodoxy and have become more egalitarian." This is not good enough. For its past policies, the American Psychoanalytic Association owes a collective apology not only to psychologists but to homosexuals as well. It would be a mistake to conclude that psychoanalysts have acknowledged that problems in living are not diseases and that listening-and-talking is not a form of medical treatment. On the contrary, they expand the concepts of disease and treatment, assert that "psychotherapy changes the brain," and use that foolish claim to legitimize that psychoanalysis is a treatment for brain diseases. Glenn Gabbard, M.D., Professor of Psychiatry and Director, Baylor Psychiatry Clinic and editor of the International Journal of Psycho-Analysis, declares: "[B]ehavior therapy and drug therapy [are] affecting the same brain areas and in the same manner. ... Psychotherapy seems capable of favorably influencing the minds and bodies of persons with bodily diseases and perhaps is even capable of countering those diseases.... [It is important] to get scientific results that lend credibility to psychotherapy as a real treatment" (cited in Arehart-Treichel, 2001, p. 33, emphasis added).

I stopped identifying myself as a psychoanalyst many years ago. Why? Because I felt strongly that psychoanalysts -- beginning, sadly, with Freud himself -- have betrayed psychoanalysis (Szasz, 1965, 1977). I wanted to be faithful to my belief, which I have held ever since I knew anything about psychoanalysis, that psychoanalysis is a moral dialog, not a medical treatment. Psychoanalysis has nothing whatsoever to do with illness or health, medicine or treatment, or any other idea that places "professional" listening and talking within the purview of the state’s licensing authority as "treatment." If the practice of psychoanalysis is not a form of treatment, what is it? It is a modern reincarnation of the age-old cure of souls as secular-existential dialogue (Szasz, 1978/1988).

Verbal intercourse, especially the psychoanalytic dialogue, entails existential intimacy, often more intense than sexual intimacy. Medicalized psychoanalysis (psychotherapy) denies the quintessential intimacy of its own distinctive "method," illustrated by the obtuse conception that it is something the therapist gives or does to the patient, as if it were like a surgical operation. In surgery, all things being equal, doctor and patient are fungible. In psychotherapy, as in marriage or friendship, each person is a unique, irreplaceable individual.

Few, if any, contemporary psychoanalysts share these views. Most analysts equate psychoanalysis with psychotherapy, consider psychotherapy to be a part of psychiatry, regard problems in living as diseases and verbal and nonverbal communications as treatments. Psychoanalysts cling stubbornly to the fatal deceit that they are real doctors, treating real diseases. In a 2002 Practice Bulletin, the American Psychoanalytic Association reaffirmed its claim that "Psychoanalysis is established as a unitary therapeutic procedure that continues from start to finish and is composed of many psychoanalytic sessions, much as one views a surgical operation a single intervention." The American Psychoanalytic Association took the surgical analogy literally and seriously: "[T]he Executive Council of this organization recommended a procedure by which a patient for whom psychoanalysis (CPT 90845) is prescribed ‘will see a consultant for a second opinion examination similar to that for elective surgery before treatment is funded’" (ibid., emphasis added). In short, psychoanalysis is an "operation," funded by a third party, that the analyst performs on the patient. "As you sow, so you shall reap." Psychoanalysts are now paying for their opportunistic imposture. Newell Fischer, president of the American Psychoanalytic Association, laments: "Our image in the eyes of the public and non-analytic mental health professionals is dismal" (Fischer, 2002). My aim here, then, is to restate my faith in psychoanalysis as a secular-moral "cure of souls." Psychoanalysis possesses a valuable moral core that has never been properly identified and is now virtually unrecognized: it is, or ought to be, a wholly voluntary and reliably confidential human service, initiated and largely controlled by the client who pays for it. Freud himself compared the psychoanalytic relationship with the Catholic confessional. If psychoanalysis is to have a future -- which, in our pharmacratic culture seems doubtful -- it lies in adopting that model to the needs of modern secular man, increasingly isolated from his fellow man and community, and betrayed by the therapeutic state in which he mistakenly seeks protection from the vicissitudes of life (Szasz, 2001/2003).

It is possible to know algebra without knowing anything about its history, but it is impossible to understand psychoanalysis without knowing a good deal about its history. At the end of nineteenth century, Vienna was the crown jewel of Austria-Hungary, a flourishing, multi-ethnic, multi-lingual, multi-religious empire, with glittering sister capitals in Budapest and Prague. Although the country had a sizeable, intellectually vibrant middle class and its politics was increasingly liberal (in the classical sense), it was nevertheless still a highly traditional, Roman Catholic country, with German as its official language. Much as was the United States prior to World War II, it was also a country that was simultaneously anti-Semitic and hospitable toward Jews, especially if they were assimilated and patriotic. Freud’s career as a "Nervenarzt" must be situated in this context.

Freud had many intellectual interests and was not keen about becoming a practicing physician. However, medicine was one of the (then) so-called "free professions," open to Jews, and Freud decided to go medical school. He completed his medical studies but did not want to become a general (family) physician, like his later friend Josef Breuer. Accordingly, Freud studied neuropathology, spent a few months in Paris studying the work of Jean-Martin Charcot, and then started a private medical practice as a "Nervenarzt" (literally, "nerve doctor"), specializing in "nervous diseases." It is important to keep in mind that these were nebulous terms used to identify a medical specialty that was neither neurology nor psychiatry. Why do I say this is important? Because it is here that the misrepresentation of problems of living as diseases and of interpersonal dialogue as treatment originates. The roots of this misconception -- similar to the view that consecrated wine is, literally, blood -- go very Deep.

I use this Catholic metaphor here to re-emphasize the crucial importance of confidentiality in psychoanalysis, and its predecessor, catharsis. Actually, it was Josef Breuer who first used the confessional to explain the workings of his method of "mental treatment." He wrote: "We meet the same urge [to verbally reveal secrets] as one of the basic factors of a major historical institution -- the Roman Catholic confessional" (Breuer and Freud, 1893-1895/1953-1974, vol. 2, p. 211). In a similar vein, Freud uses the model of the confessional in The Question of Lay Analysis (1926). He writes: ... our Impartial Person [says]. "You assume that every neurotic has something oppressing him, some secret. And by getting him to tell you about it you relieve his oppression and do him good. That, of course, is the principle of Confession, which the Catholic Church has used from time immemorial in order to make secure its dominance over people’s minds." We must reply: "Yes and no!" ... In Confession the sinner tells what he knows; in analysis the neurotic has to tell more. Nor have we heard that Confession has ever developed enough power to get rid of actual pathological symptoms" (vol. 20, p. 189, emphasis added). Revealingly, Freud condemns the confessional in Catholic hands as a tool of religious domination, and praises it in psychoanalytic hands as a medical method of psychical liberation. Why medical? Because it frees the "patient" of pathological symptoms. To top it off, Freud advances the absurd claim that whereas the penitent in the confessional tells only what he knows, the client in analysis also tells what he does not know. The rest, as the saying goes, is history: the analyst knows the client better than the client knows himself. This is not the place to expand on the consequences of this pernicious idea. Despite the historical record, many people -- mental health professionals, writers, book reviewers -- often erroneously identify Freud as a psychiatrist (Who was Sigmund Freud? 2002). Freud was not, and could not have been, a psychiatrist. Why not? Because he was a Jew. Psychiatry" is a nineteenth-century term. What did it mean to be a psychiatrist in those days? It meant being an employee of the state in a state mental hospital: the psychiatrist oversaw the operation of a state insane asylum or worked as an asylum physician, assumed that mental diseases are brain diseases, and studied the brains of deceased mad persons. His patients were, de facto, prisoners (Szasz, 2002). In 1925, William A. White, the famed director of St. izabeths Hospital in Washington, D.C. -- founded in 1855 as the Government hospital for the Insane -- stated: "The state hospital, as it stands today, is the very foundation of psychiatry" (cited in Arieti, 1974, vol. 2, p. 686). Many young and not so young psychiatrists are no longer aware that, from its birth in the eighteenth century until the beginning of the twentieth century, psychiatry (originally mad-doctoring) was synonymous with practice in the insane asylum and the state mental hospital; all patients were committed patients; all psychiatry was actually or potentially adversarial psychiatry. To be sure, it was not seen or defined that way. How was that possible? By not questioning the transformation of the cooperative-contractual doctor-patient relationship typical of medical practice into the coercive-paternalistic guardian-ward relationship typical of psychiatric practice. De jure, the guardian represents the ward’s best interests. Similarly, by definition, the coercive-paternalistic psychiatrist represents the involuntary mental patient’s best interests. Theodor Meynert (1833-1892), one of the founders of modern neuropsychiatry, began his textbook, Psychiatry (1884), with this statement: "The reader will find no other definition of 'Psychiatry' in this book but the one given on the title page: Clinical Treatise on Diseases of the Forebrain. The historical term for psychiatry, i.e., 'treatment of the soul,' implies more than we can accomplish, and transcends the bounds of accurate scientific investigation" (Meynert, 1985, p. V).

Since being a psychiatrist meant being an employee of a state hospital, in Austria-Hungary Jewish doctors could not become psychiatrists. However, they could become "nerve doctors," listen and talk to their clients, call what they do "psychoanalysis" (or "psychotherapy"), and sell their services to fee-paying customers. The psychoanalytic client, like the customer of any service supplied by entrepreneurs in the free market, sought out the analyst, went to his office, received a service, and paid a fee for it. The client was on top, the therapist on tap. This was a radical departure from the tradition of psychiatry. For centuries, the only patients of maddoctors, alienists, and psychiatrists were persons who did not want to be patients. Court-ordered mental hospitalization and treatment and the threat of such sanctions still form the core of the practice of psychiatry and the mental health professions generally (Szasz, 2002).

It is instructive to compare the differences between the roles of the psychiatrist and the psychoanalyst in Freud’s Vienna with the differences, in medieval Christendom, between the roles of a priest and a rabbi. The priest and psychiatrist had power: the priest could burn the heretic at the stake, the psychiatrist could imprison and torture the psychotic. In contrast, the rabbi and the psychoanalyst lacked power: the rabbi could engage only in voluntary relations with his fellow Jews, the psychoanalyst could "treat" only person who sought his services.

The psychoanalyst, unlike the psychiatrist, lacks power over his client: either because he is economically, socially, and politically weaker than the client, or because he voluntarily renounces the use of force, even if the state offers it to him. Thus, a weak and noncoercive psychoanalysis is antagonistic to and incompatible with a powerful and coercive psychiatry, just as peaceful Diaspora Judaism is antagonistic to and incompatible with militant Zionism (or as pacific Christianity or Islam are incompatible with their militant versions). I maintain that the single most fundamental characteristic of the psychoanalyst is his principled rejection of coercing his client, or indeed engaging in any action for or against him outside the boundaries of their meetings.

Sadly, this posture did not issue from Freud’s moral outlook on human relations but was forced on him by his social circumstances. Freud did not reject medical power. He loved it. He never questioned the psychiatrist’s paradigmatic practices, involuntary mental hospitalization and the insanity defense. Like psychiatrists, Freud made medical diagnoses of his clients and maintained that they suffered from mental illnesses that were, at bottom, brain diseases. As a result, psychoanalysis became absorbed into psychiatry and medicine, especially in the United States after World War II.

Although the seeds of the practice of psychoanalysis were sown and germinated in the soil of the free market and depended on it for their survival, neither Freud nor the early analysts understood the market or supported its values. They only took advantage of it. As soon as Freud got on his feet, economically and professionally, he embraced the style of the conquering hero, to which he always aspired. In 1900, he wrote: "I am not at all a man of science, not an observer, not an experimenter, not a thinker. I am by temperament nothing but a conquistador" (Freud, 1985, p. 398). To Jung he announced that psychoanalysis must "conquer the whole field of mythology" (cited in Clark, 1980, p. 339). Freud's self-image as a "conquistador" meshed with his ambition to conquer psychiatry for psychoanalysis. The result was exactly the opposite: psychoanalysis became corrupted by psychiatry.

Like the core element of the classic concept of liberty, the core element of psychoanalysis is best stated as a negative, that is, as the absence of factors antagonistic to its aims and values. Political liberty is the absence of the coercions characteristic of the traditional relations between rulers and ruled. Similarly, psychoanalysis is the absence of the coercions characteristic of traditional relations between psychiatrists and mental patients. Consider the contrasts: the psychiatrist controls and coerces, the psychoanalyst contracts and cooperates. Again, I speak here of the practice of psychoanalysis as I conceive of it, which excludes such aberrations as the "psychoanalysis" of persons imprisoned in mental hospitals, training analysis, and child analysis. Ironically, when I speak of my ideal model of psychoanalysis, I am simply taking seriously what Freud once said about it.

I refer to Freud’s description of the relationship between analyst and client as similar to the relationship between the vendor of an expensive personal service -- say, a portrait painter -- and a financially independent adult purchaser of his services. Neither party has power over the other; each is responsible for his side of an agreement. Freud (1915-1917) framed this as following the rule "of not taking on a patient for treatment unless he was sui juris, not dependent on anyone else in the essential relations of his life" (vol. 16, p. 460, emphasis added). Thanks to the untiring efforts of enthusiasts for pharmacratic regulations -- giving us Medicare, Medicaid, SSSI, HMOs, the DEA and drug regulations, the wars on depression and suicide, the duty to protect patients from themselves and others from the patients, and malpractice litigation -- analysts and clients alike are effectively deprived of the very possibility of being sui juris. The therapeutic state compels everyone, without exception, to be dependent on the state in the essential medical and pharmacological aspects of his life (Szasz, 2001).

Political liberty is contingent on the state's respect for private property and non-interference with acts between consenting adults. Psychoanalysis is contingent on the therapist's respect for the client's autonomy and non-interference with the client's life. This means that the therapist must limit his interaction with his client to listening and talking to him in the therapist's office and must abstain from meddling into the client's affairs and life. Thus conceived, the psychoanalytic relationship was a new development in the history of mad-doctoring: it introduced into psychiatry and society a new form of "therapy for mental illness," one in which the expert eschewed coercing deviants and housing dependents and confined himself to conducting a particular kind of confidential dialogue. In the psychoanalytic situation, there is, in the medical and psychiatric sense, neither patient nor doctor, neither disease nor treatment. The dialogue between analyst and client is therapeutic in a metaphorical sense only. Purged of jargon, the psychoanalytic "procedure" consists only of listening and talking. So conceived, psychoanalysis undermines psychiatry as a medical specialty and system of social control. Psychiatry did not acquire, and could not have acquired, any of the real substance of psychoanalysis. The two enterprises rested on different premises and entailed mutually incompatible practices. The marriage between the psychiatrist and the psychoanalyst was a misalliance from the start, each party disdaining and exploiting its partner. Psychiatry acquired the worst features of psychoanalysis -- a preoccupation with sex and the past, an elastic vocabulary of stigmatizations, and a readiness for fabricating pseudo-explanations. Psychoanalysis acquired the worst features of psychiatry -- coercion, mental hospitalization, and disloyalty to the client. Bereft of professional integrity, post-war American psychoanalysts enjoyed a brief period of irrational professional exuberance, followed by moral bankruptcy.

What do I mean when I say that psychoanalysts, qua psychoanalysts, have become morally bankrupt? I mean that psychoanalysts do not mind their own business and instead mind the client’s business. The analyst’s business is to earn the client’s confidence and trust by entering into a clear contract with him and by conscientiously abiding its terms. The Bill of Rights limits the powers of the state vis-a-vis the citizen, not the citizen’s vis-a-vis the state. Similarly, the analytic contract limits the powers of the therapist vis-a-vis the client, not vice versa. The analyst’s overriding obligation to the client is to protect his confidences. This obligation permits no exceptions. If the analyst morally abhors what his client tells him, he has the option, like a defense attorney, of discontinuing the relationship. Under no circumstances does the psychoanalyst have the option to betray his client’s confidence and use the information he has acquired, especially against what the client considers his own interest. We often speak of empowering this or that politically weak or disfranchised individual or group. But people cannot be empowered directly. They can be empowered only indirectly, by taking power away from, or not giving power to, individuals or institutions that have actual or potential control over them. This is a lesson every parent must learn if he wants his child to become an independent adult. It is a lesson that all forms of psychiatrized psychotherapy violate, indeed indignantly reject -- by assuming responsibility for the client’s health, safety, and general well-being.

Suicide is an ubiquitous occurrence in all societies, ancient and modern. In Freud’s day, it did not occur to people -- least of all to lawyers or psychiatrists -- that it was the analyst’s duty to protect his client from killing himself. Nor would it have occurred to people that it was the analyst’s duty to protect so-called third parties or the community from the potential violence of the client. Today, protecting the "mental patient" from himself -- the anorexic from starving to death, the depressed from killing himself, the manic from spending his money -- is regarded as one of the foremost duties of anyone categorized as a mental health professional, psychoanalysts included. For half a century, I have argued and showed that a person professing to help a fellow human being in distress cannot be a double agent: he must choose between serving the interests of the client, as the client defines them; or serving the interests of the client’s family or employer or insurance company, or the interests of his profession, religion, community, or the state, as they define them. As a rule, this view is either ignored or dismissed with the claim that a so-called mental patient’s "true (mentally healthy) interests" cannot conflict with the interests of his "loved ones" or those of the community. If they do, it is because of his mental illness. The denial that the therapist deals with persons in conflict with others and that the process called "therapy" cannot -- except accidentally or derivatively -- help persons whose interests oppose or thwart those of the client characterizes virtually all modern therapies. For example, Constance T. Fischer, professor of psychology at Dusquesne University, introduces the 2002 special double issue of The Humanistic Psychologist with this sentence: "In this collection of articles, psychologists’ approaches to assessment are compassionate, caring, deeply respectful of the humanity of the clients, and courageous in efforts to be genuinely helpful to all parties" (Fischer, 2002, p. 1, emphasis in the original). This is self-congratulation concealing personal and professional self-aggrandizement. People whose lives are full of harmonious cooperation with others do not seek and are not subjected to mental health services.

"Three may keep a secret if two of them are dead," observed Benjamin Franklin. This witticism is painfully true, especially today. Virtually everyone, in and out of the therapy business, now believes that when the chips are down, the therapist must betray his client’s confidences, in his "own best interest." Hence, in the present American legal and political context, there can be no secular cure of souls. For such a cure to be possible, it is necessary not only for the therapist to disarm himself of the power he possesses over the client, but also for custom and law to permit him to do so, much as the priest in the confessional disarms himself and is permitted to do so. It is not the priest’s duty to protect the penitent from himself or the community from the penitent. He is not expected to protect the would-be suicide from killing himself, or the community from the acts of a would-be murderer, by denouncing them to the health or law enforcement authorities of the state. Indeed, the priest is expressly forbidden to betray the person whose confession he hears. Regrettably, psychoanalysts have shown no interest in what, some forty years ago, I called "the ethics of psychoanalysis," by which, inter alia, I meant the analyst’s moral obligation to protect the client’s confidences unhindered by conflicting obligations (Szasz, 1965/1988). Nor were they in a position to do so as long as they categorized their activity as a type of health care and treatment. Had they been willing to acknowledge that all they do is listen and talk to the persons who seek their services, they might, like librarians, have been able to secure legal recognition and protection of their role. Librarians and booksellers do not pretend that they help their patrons improve their minds, their mental health, or their morals, or that they protect the public by preventing patrons from reading certain books. They recognize, and everyone recognizes, that their function is to manage libraries and sell book. Our right to freedom of the press and speech includes the right to privacy about what we read (American Library Association).

Is the privacy of librarians and booksellers more deserving of legal protection than the privacy of psychoanalysts? Or is it that the former have valued and fought for these liberties, and the latter have neither valued nor fought for Them?

Sad to say, there has never existed an institutionalized system of psychoanalytic practice truly respectful of the client’s autonomy and privacy. A few analysts may have aspired to such an ethic, but, as a group, psychoanalysts rejected it. The image of the analyst, a man sitting in a chair listening sympathetically to a woman lying on a couch, the analyst recoiling from the very idea of harming her, let alone imprisoning her, has no basis in reality. Many celebrated psychoanalysts -- Harry Stack Sullivan, Erik Erikson, Karl Menninger, Frieda Fromm-Reichman, Thomas Freeman -- "analyzed" involuntarily hospitalized "Patients." Because psychoanalysis is a moral enterprise, we must acknowledge that the analyst’s personal conduct is relevant to our understanding and judgment of his persona and professional activities. Actions speak louder than words, says the proverb. I would go further: when actions and words conflict, we must view the actions as the truth, and the words as lies. To dramatize the frequent disjunction between deeds and words in psychoanalysis, I cite the practices of two famous psychoanalysts. Here, first, is a vignette of Jacques Lacan in Action. In 1945, when Picasso rejected his long-time mistress and model Dora Maar in favor of Francoise Gilot, Maar became depressed and annoyed Picasso. In a review in the Times Literary Supplement (2000, April 25), Marilyn McCully, writes: "A terrified Picasso, who abhorred illness, especially in women ... contacted Jacques Lacan, who had her admitted to a psychiatric clinic. Doujoune Ortiz [the Spanish author of a biography of Maar] goes into details about Lacan’s machinations in looking after Maar and the horrific shock treatments that were prescribed as part of her therapy. She also makes the perceptive observation that Picasso’s paintings of Maar as the weeping woman eerily anticipate the terrors she must have suffered in the moments before the shock treatments were administered" (p. 28).

The Scottish psychiatrist and psychoanalyst Ronald D. Laing’s name is often bracketed with mine. Erroneously, Laing is often credited with opposing involuntary mental hospitalization and coercive psychiatric treatment. In The Divided Self, Laing (1960) wrote: "When I certify someone insane, I am not equivocating when I write that he is of unsound mind, may be dangerous to himself and others, and requires care and attention in a mental hospital" (p. 27, emphasis added). Contemptuously and explicitly, Laing dismissed my critique of the medical metaphor and my call for the abolition of psychiatric slavery. Even if all that I propose came to pass, he declared, "it would all be much the same" (Laing, 1979). British psychoanalyst Anthony Stadlen (1979) did not let Laing’s review stand uncorrected. He wrote: Dr. Laing’s new role as the "perfectly decent" defender of psychiatry against Szasz’s "insulting and abusive fuss" calls for comment. Laing is saying unequivocally that "it would all be much the same" to him whether involuntary psychiatry be retained or abolished. He is saying "it would all be much the same" whether voluntary interventions, including his own, are intended as medical treatments for illness or as interpersonal counseling, ethical exploration, existential analysis. He implies quite clearly that he is one of "the rest of us" who do use the medical metaphor. Although Laing co-invented the stupidly self-stigmatizing label, "antipsychiatry," he claimed he was not an antipsychiatrist. David Cooper, in the Introduction to his book, The Dialectics of Liberation, wrote: "The organizing group [of the "Congress on the Dialectics of Liberation," held in London in 1967] consisted of four psychiatrists who ... counter-label[ed] their discipline as anti-psychiatry. The four were Dr. R. D. Laing and myself, also Dr. Joseph Berke and Dr. Leon Redler" (Cooper, 1968, p. 7). Adrian Laing (1994) -- in a sympathetic biography of his father -- comments: "Ronnie made two mistakes with David’s introduction. First, he did not insist on reading it prior to publication. Ronnie did not consider himself an ‘anti-psychiatrist’ ...The damage, however, had been done. David managed to label Ronnie an anti-psychiatrist. Ronnie was furious at this move, but made a more serious mistake in not taking immediate and effective action to rectify his position" (p. 138).

Were these inactions "mistakes"? Or did they represent Laing’s typical way of having his cake and eating it too, as Adrian aptly puts it? The evidence supports the latter interpretation. Laing’s response to his oldest daughter Fiona’s existential crisis is emblematic of his rejection of parental responsibility and lack of moral and intellectual integrity. In 1976, Fiona, then twenty-four years old, is rejected by her boyfriend: "She had ‘cracked up,’ and had been found weeping outside a church" near the family home. Committed to a local mental hospital, she is given ECT. Laing biographer John Clay (1981) writes: He [Adrian] rang his father up and asked him "in despair and anger" what he was going to do about it. Laing reassured him that he would visit Fiona and "do everything in his power" to ensure that she was not given ECT, but when it came to the crunch, as Adrian Laing relates, all he could say was "Well, Ruskin Place [the family home] or Gartnavel [the mental hospital] -- what’s the difference?" Such a scathing and deprecatory remark showed once again an avoidance of responsibility for his first family, indefensible since his line had been that the breakdown of children could be attributed to parents and families. Instead, Laing went into denial. When he gave an interview shortly afterwards in New Society he declared, "I enjoy living in a family. I think the family is still the best thing that exists biologically as a natural thing" (p. 181). There is worse. According to Adrian, Laing pitied himself, was a petty despot, and, when drunk, which was often, he was prone to violence. In one such episode, No sooner had he got through the door ... than he attacked Karen [his daughter], then aged seventeen, and started to beat her unmercifully, until Paul and I intervened and restrained him. It was very frightening for all concerned" (Laing, A.C., p. 176). An honest man is said to be as good as his word. By that measure, Laing was a very dishonest man indeed.

I have endeavored to re-articulate what I regard as the moral and political-economic core of, and the social conditions for, the psychoanalytic situation. They are: the inviolable privacy of the professional-client relationship; the client’s willingness to assume responsibility for his behavior and pay for the service he receives; the analyst’s willingness to eschew coercion justified by the legal-psychiatric principle of the "duty to protect" (the client from himself and the community from the client); the legal system’s willingness to exempt the analyst from this principle (at present an integral part of the mental health professional’s legal and social mandate); and the public’s willingness to accept that a secure guarantee of privacy and confidentiality, similar to that granted the priest, as an indispensable condition for the proper conduct of psychoanalysis as a secular "cure of souls." These conditions are absent in the therapeutic state. The result is a tragic loss of liberty for client, "therapist," and society (Szasz, 2001). Psychoanalysis was conceived, raised, and over-indulged by medicine. As a result, it failed to grow up and fulfill its potential, that is, adopt an explicitly anti-paternalist, libertarian stance as the proper posture towards adults who seek and are willing to pay for a private, confidential, secular, and trustworthy setting for looking into their hearts and souls and, perhaps, making themselves better persons.

The psychoanalyst’s job is to help his client live his life as honestly and as responsibly, and hence as freely, as he can or wants to. This task has nothing to do with illness and treatment in the sense in which these terms are used in medicine and psychiatry. However, it has a great deal to do with custom, law, economics, politics, and especially with religion as ethics. The term "psychoanalytic treatment" refers to, or ought to refer to, a particular kind of strictly confidential, private human relationship, similar to the Catholic confessional: it is a type of secular "cure of souls." The analyst’s duty is to listen, speak, and fulfill his contract with the client, for example, by keeping the client’s communications inviolably confidential and punctually collecting the fees due for his services.

The Christian believes that God does not hear the sinner. To be heard, the person must first cleanse his heart. That is a powerful metaphor. The wisdom it expresses is timeless. Where does this leave the atheist, the man who does not believe and hence does not fear God? It leaves him fearing himself and having to cleanse his own heart, and do so even more conscientiously. The God-fearing man can more easily persuade himself that God is listening to his prayers than the godless man can persuade himself that he is listening to himself. For the former, cleansing the heart can easily become an empty ritual. For the latter, it cannot. It is easier for a man to hide from God than from Himself.


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Tattered Cover victorious in battle against search warrant (2002).

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1. Psychoanalysis is a particular kind of dialog, one person providing a service, and another person receiving and paying for it. Accordingly, wherever possible, I refer to the recipient of the service as a client, not patient. I continue to use the word "therapist" because we lack an appropriate term to identify his role and function as secular, moral counselor.

2. "The First and Fourteenth Amendments to the U.S. Constitution support barrier-free access to information on all points of view and the freedom to read in order to become informed citizens. Librarians are ethically responsible to protect this freedom through maintaining confidentiality of all library user records" ( /issues.html;; "Tattered Cover victorious in battle against search warrant," http://www. freeexpression. org/newswire/0408_2002.htm).

3. For another, similar version of this story, see Gilot and Lake (1964/1981). They write: "He [Picasso] wanted to call Doctor Lacan, the psychoanalyst he used for most of his medical problems, but didn’t want to telephone in front of Dora, so he sent Sabartes [his chauffeur and all-purpose lackey] out to call, ... Lacan came at once. ... Professor Lacan kept Dora at the clinic for three weeks. At the end of that period he let her go home. He continued to treat her and she underwent analysis with him" ( pp. 83-85, emphasis added).

4. Clancy Sigal’s Zone of the Interior (1976/1978 ) provides a vivid account of the moral squalor of Laing’s life style and psychoanalytic practice. * Based on the Hans Loewald Award Address, The International Federation for Psychoanalytic Education, Fort Lauderdale, Florida, October 25-27, 2002.

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