"The complete list of the works of Thomas S. Szasz": pages 237-253.

Obsessed with the twin beliefs that misbehavior is a medical disorder and that the duty of the state is to protect adults from themselves, we have replaced criminal-punitive sentences with civil-therapeutic 'programs.' The result is the relentless loss of individual liberty, erosion of personal responsibility, and destruction of the security of persons and property - symptoms of the transformation of a Constitutional Republic into a Therapeutic State, unconstrained by the rule of law.

In physics, we use the same laws to explain why airplanes fly, and why they crash. In psychiatry, we use one set of laws to explain sane behaviour, which we attribute to reasons (choices), and another set of laws to explain insane behaviour, which we attribute to causes (diseases). God, man's idea of moral perfection, judges human deeds without distinguishing between sane persons responsible for their behaviour and insane persons deserving to be excused for their evil deeds. It is hubris (...) to pretend that the insanity defence is compassionate, just, or scientific. Mental illness is to psychiatry as phlogiston was to chemistry. Establishing chemistry as a science of the nature of matter required the recognition of the non-existence of phlogiston. Establishing psychiatry as a science of the nature of human behaviour requires the recognition of the non-existence of mental illness. (shrink)

Classically controversial Szasz here challenges "modern" science's attempts to define the human mind as merely a collection of brain functions.

This is a brief comment on Christopher Megone's essay appearing in this issue. Cells, tissues, organs, and human beings qua biological organisms have natural functions, but human beings qua agents do not. Persons-in-society, unlike organs-in-bodies, are the products of culture, not simply of nature. Bodily disease is defined as a deviation from an objectively identifiable biological norm. The natural function of the kidney is to secrete urine; uremia is a literal disease. The social function of adults in American society includes (...) mingling with others in places away from home; "agoraphobia" may thus be called a metaphorical disease. In short, typhoid fever is a literal illness or disease; spring fever is a metaphorical illness or nondisease. Megone, however, rejects the claim that literal diseases "are physical disorders." Would he regard spring fever as a "real disease"? If not, why not? (shrink)

The religious justification for male circumcision proffered by Jewish and Islamic parents is frequently overlooked in current secular (medical/hygienic) discussions that (1) challenge the moral justification of this ancient practice, and (2) question the decisions of today's parents who are committed, on the basis of their religious beliefs, to continue this practice. This paper reviews critically these conflicting values and arguments and calls for compromise in the face of potential state intervention to coerce parents to abandon this practice. Keywords: disease (...) prevention, medicalization, mutilation, religious values, routine neonatal circumcision, therapeutic state CiteULike Connotea Del.icio.us What's this? (shrink)

I thank Professor Fulford for giving me an opportunity to comment on Bracken and Thomas’s essay. Unfortunately, this requires accepting the authors’ focus on discourses rather than deeds, on what psychiatrists say and how they say it rather than on what psychiatrists do and how they justify it. This I cannot do in good conscience. Nevertheless, out of respect to Professor Fulford and the journal Philosophy, Psychiatry, & Psychology, as well as a sense of professional obligation, I offer herewith (...) my brief comments. Bracken and Thomas are not the first persons to compare my work with Foucault’s, nor the first to comment on my writing style. In 2001, a pseudonymous blogger posted this comment (still .. (shrink)

The Council for Secular Humanism identifies Secular Humanism as a "way of thinking and living" committed to rejecting authoritarian beliefs and embracing "individual freedom and responsibility ... and cooperation." The paradigmatic practices of psychiatry are civil commitment and insanity defense, that is, depriving innocent persons of liberty and excusing guilty persons of their crimes: the consequences of both are confinement in institutions ostensibly devoted to the treatment of mental diseases. Black's Law Dictionary states: "Every confinement of the person is an (...) 'imprisonment,' whether it be in a common prison, or in private house, or in the stocks, or even by forcibly detaining one in the public streets." Accordingly, I maintain that Secular Humanism is incompatible with the principles and practices of psychiatry. (shrink)

The Council for Secular Humanism identifies Secular Humanism as a "way of thinking and living" committed to rejecting authoritarian beliefs and embracing "individual freedom and responsibility... and cooperation." The paradigmatic practices of psychiatry are civil commitment and insanity defense, that is, depriving innocent persons of liberty and excusing guilty persons of their crimes: the consequences of both are confinement in institutions ostensibly devoted to the treatment of mental diseases. Black's Law Dictionary states: "Every confinement of the person is an 'imprisonment,' (...) whether it be in a common prison, or in private house, or in the stocks, or even by forcibly detaining one in the public streets." Accordingly, I maintain that Secular Humanism is incompatible with the principles and practices of psychiatry. (shrink)

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

It is a matter of some irony that psychiatry's most trenchant critic for over four decades is himself a psychiatrist. I refer to Thomas S. Szasz. Szasz's core thesis may be succinctly rendered: mental illness is a “myth”, a “metaphor” which serves only to obscure the social and ethical “problems in living” we face as human beings. This paper reconsiders the conceptual bases of Szasz's assault on psychiatry and assesses recent counter-arguments of his critical interlocutors. It (...) presents a defence of the Szaszian conception and emphasises the continuing relevance of his earliest work. Additionally, the paper discusses Szasz's thesis in light of the work of the influential French philosopher of medicine, Georges Canguilhem. (shrink)

Whether psychopathy is a mental disease or illness can affect whether psychiatrists should treat it and whether it could serve as the basis for an insanity defense in criminal trials. Our understanding of psychopathy has been greatly improved in recent years by new research in psychology and neuroscience. This illuminating research enables us to argue that psychopathy counts as a mental disease on any plausible account of mental disease. In particular, Szasz's and Pickard's eliminativist views and Sedgwick's social constructivist (...) account of mental illness that might exclude psychopathy are not plausible, and there is no reason to exclude psychopathy under Boorse's and Scadding's biomedical accounts, Wakefield's harmful dysfunction account, and the DSM-IV-TR objective harm account of mental disease. The basic reason is that psychopathy involve neural dysfunction that increases risk of serious harm and loss to people with psychopathy. (shrink)

Thomas Szasz wrote over thirty books and several hundred articles, replete with mordant criticism of psychiatry. His works made him arguably one of the world's most recognized psychiatrists, albeit one of the most controversial. This book critically examines the legacy of a man who challenged the very concept of mental illness.

The traditional legal verdict of not guilty by reason of insanity as well as the more recent verdict of guilty but mentally ill rest on often unquestioned epistemological assumptions about human behavior and its causes, unjustified reliance on forensic psychiatrists, and questionable, if not deplorable ethical standards. This paper offers a critique of legal perspectives on insanity, historical and current, based on the altermative epistemological and ethical assumptions of Thomas S. Szasz. In addition, we examine Szasz''s unique (...) rhetorical analysis of mental illness and its implications for forensic psychiatry. (shrink)

This book contains the text of Thomas Kuhn's unfinished book, The Plurality of Worlds: An Evolutionary Theory of Scientific Development, which Kuhn himself described as "a return to the central claims of The Structure of Scientific Revolutions, and the problems that it raised but did not resolve." The Plurality of Worlds is preceded by two related texts that Kuhn publicly delivered but never published in English: his paper "Scientific Knowledge as a Historical Product" and his Shearman Memorial Lectures, "The (...) Presence of Past Science." The book opens with an introduction by the editor that describes the origins and structure of The Plurality of Worlds, and sheds light on its central philosophical problems. Kuhn's aims in his last writings are bold. He sets out to develop an empirically grounded theory of meaning that would allow him to make sense of both the possibility of historical understanding and the inevitability of incommensurability between past and present science. Moreover, he intends to show that incommensurability is fully compatible with a robust notion of a real world that science investigates, with the rationality of scientific belief change, and with the idea that scientific development is progressive. This is a must-read follow-up to The Structure of Scientific Revolutions, one of the most important books of the twentieth century. (shrink)

Thomas S. Kuhn's classic book is now available with a new index.

On this occasion, and in this place, I feel that I ought, and am probably expected, to look back at the things which have happened to the philosophy of science since I first began to take an interest in it over half a century ago. But I am both too much an outsider and too much a protagonist to undertake that assignment. Rather than attempt to situate the present state of philosophy of science with respect to its past — a (...) subject on which I’ve little authority — I shall try to situate my present state in philosophy of science with respect to its own past — a subject on which, however imperfect, I’m probably the best authority there is.As a number of you know, I’m at work on a book, and what I mean to attempt here is an exceedingly brief and dogmatic sketch of its main themes. I think of my project as a return, now underway for a decade, to the philosophical problems left over from the Structure of Scientific Revolutions. (shrink)

It has become a mantra, that doping is immorally and therefore should be punished with exclusion, fines and stigmatization. In most parts of the world, the doping debate is characterised by an extreme tunnel vision since all athletes, politicians and sports managers who have public airtime express that doping is bad or the invention of the devil. -/- The purpose of 'Doping in Sport: A Defence' is to identify, clarify and challenge some of the central arguments that are used in (...) the often extremely emotional debate that primarily focuses on rejecting the use of doping. I hope that my effort to clarify and challenge the arguments will help cultivate a productive dialogue where all arguments are given a fair trial instead of the prevailing one-sided condemnation of doping. An open dialogue about doping is important since the question of where the line should be drawn when it comes to doping in sports is highly relevant in terms of the scope within which athletes, sports physicians, sports managers, coaches and pharmaceutical companies can operate in the world of sports. (shrink)

The paper critically discusses the moral view that neurotechnological behavioural treatment for criminal offenders should only be offered if it is in their best interests. First, I show that it is difficult to apply and assess the notion of the offender's best interests unless one has a clear idea of what ‘best interests’ means. Second, I argue that if one accepts that harmful punishment of offenders has a place in the criminal justice system, it seems inconsistent not to accept the (...) practice of offering offenders treatment even when the state will harm them in applying the treatment. Finally, leading penal theories like consequentialists and retributivists would not accept that the offender's best interests, at least in certain situations, impose a necessary condition for the treatment of an offender. (shrink)

Bioethics, Volume 35, Issue 7, Page 714-717, September 2021.

Medical academics are increasingly bringing critical race theory (CRT) or its corollaries to their discourse, to their curricula, and to their analyses of health and medical treatment disparities. The author argues that this is an error. The author considers the history of CRT, its claims, and its current presence in the medical literature. He contends that CRT is inimical to usual academic modes of inquiry and has obscured rather than aided the analysis of social and medical treatment disparities. Remedies for (...) racism suggested by CRT advocates will not work and some of them will make things worse. Academic medicine should avoid the embrace of CRT and should maintain an allegiance to rigorous empirical inquiry and to treating patients not as essentialized ethnic group members but as individual human beings in need of care. (shrink)

The aim of this article is to articulate and critically discuss different answers to the following question: How should decision-makers deal with conflicts that arise when the values usually entailed in ethical guidelines – such as accuracy, privacy, non-discrimination and transparency – for the use of Artificial Intelligence clash with one another? To begin with, I focus on clarifying some of the general advantages of using such guidelines in an ethical analysis of the use of AI. Some disadvantages will also (...) be presented and critically discussed. Second, I will show that we need to distinguish between three kinds of conflict that can exist for ethical guidelines used in the moral assessment of AI. This section will be followed by a critical discussion of different answers to the question of how to handle what we shall call internal and external values conflicts. Finally, I will wrap up with a critical discussion of three different strategies to resolve what is called a ‘genuine value conflict’. These strategies are: the ‘accepting the existence of irresolvable conflict’ view, the ranking view, and value monism. This article defends the ‘accepting the existence of irresolvable conflict’ view. It also argues that even though the ranking view and value monism, from a merely theoretical point of view, are better equipped to solve genuine value conflicts among values in ethical guidelines for artificial intelligence, this is not the case in real-life decision-making. Keywords: AI; ethical guidelines; algorithm-based sentencing; value conflicts. (shrink)

Suggestions that academic medicine is systemically racist are increasingly common in the medical literature. Such suggestions often rely upon expansive notions of systemic racism that are deeply controversial. The author argues for an empirical concept of systemic racism and offers a counter argument to a recent suggestion that academic medicine is systemically racist in its treatment of medical trainees: Anderson et al.’s (Academic Medicine, 98(8S), S28–S36, 2023) “The Long Shadow: a Historical Perspective on Racism in Medical Education.” Contra the authors (...) of “The Long Shadow,” the author argues that racial performance disparities in medical education cannot be validly attributed to racism without careful empirical confirmation; he further argues that standards of assessment in medical education cannot be properly deemed racist merely because minority trainees are disproportionately disadvantaged by them. Furthermore, the history of medicine and society in the Anglo-European West is not, as argued by the authors of “The Long Shadow,” best viewed as one long tale of racial oppression culminating in the present day pervasive racism of academic medicine in the United States. Racism is a deplorable stain on our history and our present but it is not the historical essence of Christianity, European civilization, Western medicine, or contemporary academic medical institutions. (shrink)

The policy adopted by housing authorities of denying prospective tenants with a criminal record access to housing is an important barrier to ex-offenders seeking somewhere to live. The policy is legal, but are there any good reasons in favor of it when we know that having no, or limited, access to secure and affordable housing increases the probability of recidivism? The primary aim of this article is to critically discuss two central reasons that have been given for denying people with (...) criminal records access to housing: that doing so will prevent crime, and that the policy reduces fear of crime. We also try to evaluate an argument for the conclusion that current law, and the policies that follows wrongfully discriminate against people with criminal records. The general thrust of the article is that arguments for this practice turning on its crime preventive effect, and its role in reducing or preventing fear of crime, are unpersuasive. We then explained why, in our view, excluding ex-offenders from housing amounts to wrongful discrimination against them. Our analysis suggests that ex-offenders, apart from a few excemptions, ought to be allowed access to housing to the same extent as other people. (shrink)

This keynote takes a fresh look at Schutz’s essay on “The Stranger” of 1944. After a brief reflection on the probably universal topos of the stranger, it discerns three different kinds of strangeness in that essay: 1. the otherness of the other and the inaccessibility of the other’s experiences; 2. the strangeness vs. familiarity of elements of knowledge; and 3. the social acceptance by the in-group. Then some methodological implications of Schutz’s approach are pondered, his somewhat hidden offer of an (...) alternative sociology and the postulate of adequacy. Subsequently, two critical issues are discussed: Schutz’s handling of values and value-relations and his complete omission of affects and emotions in spite of all the hardship the immigrants at that time suffered from. An outlook on future Schutzian research concludes the paper. (shrink)

Digital technologies can be an asset to serving communities and societies through data analytics and management to achieve greater good. However, care must be exercised in that societies without digital access do not get overlooked or, worse, face abuses of privacy disclosure or exploitation. Regulations exist to prevent this happening, but ethical considerations are important in deciding in what is allowable and what is not. The further risk of artificial intelligence where computers start to make autonomous decisions and the vulnerabilities (...) we are exposed to is considered. Steps are proposed to develop an ethics-based digital strategy and how to mitigate cyber risk. (shrink)

This article brings an account of reasonable expectations to bear on the question of when unauthorized immigrants have a right to be regularized—that is, to be formally guaranteed freedom from the threat of deportation. Contrary to the current literature, which implicitly relies on a flawed understanding of reasonable expectations, this article argues that only those unauthorized immigrants who have both been tacitly permitted by the state despite lacking formal authorization and have remained long enough to develop deep social roots in (...) the state have a right to regularization. (shrink)

In this article, our aim is to show why increasing the effectiveness of detecting doping fraud in sport by the use of artificial intelligence (AI) may be morally wrong. The first argument in favour of this conclusion is that using AI to make a non-ideal antidoping policy even more effective can be morally wrong. Whether the increased effectiveness is morally wrong depends on whether you believe that the current antidoping system administrated by the World Anti-Doping Agency is already morally wrong. (...) The second argument is based on the possibility of scenarios in which a more effective AI system may be morally worse than a less effective but non-AI system. We cannot, of course, conclude that the increased effectiveness of doping detection is always morally wrong. But our point is that whether the introduction of AI to increase detection of doping fraud is a moral improvement depends on the moral plausibility of the current system and the distribution of harm that will follow from false positive and false negative errors. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Aquinas and Black Natural LawThomas S. HibbsIn 1857, after the United States Supreme Court ruling in Dred Scott, Frederick Douglass chastised the court for arrogating to itself the role of God, that of being absolute judge. While the Supreme Court has its own authority, he argued, "the Supreme Court of the Almighty is greater. Taney can do many things but he cannot change the essential nature of things—making evil (...) good and good, evil."1 The passage is one of many in Vincent Lloyd's Black Natural Law that underscore the appeals of African American leaders, as part of their critique of slavery and segregation, to a higher or more fundamental law than that of human law. Lloyd describes the function of natural law reasoning, which he traces through the writings of Douglass, Anna Julia Cooper, W. E. B. Du Bois, and Martin Luther King Jr., in this way: From the careful examination of a "particular view of human nature" and its implications, they "apply those implications to the specifics of an ethical or political debate."2 That sounds similar to the way some contemporary Catholic proponents of natural law depict their own deployment of it. Early in the book, Lloyd suggests that "European and Catholic natural law traditions can learn much from the black natural tradition."3Concerning what might be learned, he focuses on an expansive conception of reason in the African American tradition, a conception of reason that is integrated with the role of emotion or passion and that is not [End Page 943] individualistic, but communal. He also underscores the epistemic privilege of the oppressed, the way suffering injustice attunes us to justice. Beyond the themes mentioned explicitly by Lloyd, I would add the paradoxical claim that natural law teaching is not just about the accessibility of fundamental precepts of justice, but also about the human capacity for moral blindness and the way in which the violation of the natural law is in important ways its own punishment. Because of the regularity of such blindness, attention to the obstacles to the perception of the natural law must become "part of the very activity of natural law." The ways in which these matters are articulated by African American authors can be, as Lloyd suggests, highly instructive. I would add that Lloyd's treatment of natural law in the African American tradition can also be fruitful for recovering neglected features of Aquinas's account. In what follows, I want to take up each of these themes and set them in conversation with the texts of Aquinas. As Alasdair MacIntyre, among others, has urged, seeing one's own tradition from the perspective of another, can, at a minimum, help us see it more clearly.4 As MacIntyre also notes, any such attempt faces the difficulties of translating from one tradition or community of inquiry to another. I must, accordingly, stress the limitations to the current essay, which can be nothing more than a preliminary investigation. I will largely be taking Lloyd's interpretation of the authors he studies as my assumed starting point, although in some cases I will offer my own reading of texts and authors he considers.5 What I will provide will be no more than an initial conversation, a first reading of Lloyd's theses in relation to germane themes and arguments in Aquinas. A much longer exchange, based on an immersive study of selected African American texts and the chief commentaries on them would be needed to advance the [End Page 944] conversation further. Before doing so, however, I want to provide a further reason that Catholic natural law thinkers should be eager to engage the Black natural law tradition, a reason derived from Joseph Ratzinger's reflection on the strange situation of natural law in the modern world.Ratzinger on the Vanishing Evidence for Natural Law and the Engagement of Wisdom TraditionsAs the contemporary Catholic natural law theorist Russell Hittinger has shown,6 Ratzinger, as a ressourcement theologian, is a critic of "rationalism," with "little confidence" in the older, "moral-juridical manualist and casuistical approach to natural law, which was prominent in casuistical approaches."7 In fact, he thinks that... (shrink)

The aim of this article is to present and critically discuss a gametheory- based argument in favour of the view that sports organizations ought to ban the use of performance-enhancing drugs in sport. After presenting the argument in detail, I try to show that the argument is not convincing. First, the argument cannot be used to argue in favour of WADA’s (World Anti-Doping Agency) current ban on doping, at least if it rests on the assumption, that doping use is always (...) harmful. However, that in itself may not be a problem for adherents of the argument, and they can and should modify the harm assumption to cover only harmful use of doping. Second, even with this modification, it is argued that the harm assumption is flawed, for example, because it is not obvious why we should accept certain harms in sport but not harm to athletes caused by doping. Third, the argument is also flawed because it entails the non-competitive assumption: if all athletes dope, then no competitive advantages are gained by any athletes assumptions. The noncompetitive assumption is challenged in view of the observations that doping can have some non-competitive advantages and is, so to speak, not only a positional good and because doping, due to unequal responsiveness, can give some highly responsive athletes a competitive advantage over less responsive athletes. (shrink)