This paper critically assesses Dr. Thomas Szasz’s article “The Case Against Suicide Prevention” which addresses the issue of coercive suicide prevention and how it undermines individuals, family, and society. Dr. Szasz’s view is that the psychiatric practice of declaring a person insane and in need of coercive suicide prevention is both impractical and immoral in a free society that values freedom, self-responsibility, and choice. Dr. Szasz argues that coercive suicide prevention is impractical because no one can truly take complete responsibility and authority over another person, and immoral as the act pits the general consensus of society at large against the will of the individual. Szasz’s view is that the mainstream society uses scientific authority to judge unhealthy or undesirable behavior as just cause to circumvent an individual’s right to make their own choices and accept responsibility for their actions. Szasz uses biblical, legal, historical, and modern comparisons to argue his point against coercive treatment and instead argues that counselors and clients must agree on treatment in order to respect their personhood.
Suicide and the Right to Choose versus Coercion
Dr. Thomas Szasz was a Hungarian immigrant to the United States who devoted more than a decade of his career addressing the issue of United States society using legalized force to undermine individual choice and freedom. In his article “The Case Against Suicide Prevention”, Szasz argues that for a free society that values freedom, self-responsibility, and choice, the psychiatric practice of declaring a person insane and in need of coercive suicide prevention is both impractical and immoral. Impractical because no one can truly take complete responsibility and authority over another person, and immoral as the act pits the general consensus of society at large against the will of the individual. Zsasz’s view is that the mainstream society uses scientific authority to judge unhealthy or undesirable behavior as just cause to circumvent an individual’s right to make their own choices and accept responsibility for their actions. Zsasz’ uses biblical, legal, historical, and modern comparisons to argue his point against coercive treatment and instead argues that counselors and clients must agree on treatment in order to respect their personhood.
In the article ‘The Case Against Suicide Prevention’, Dr. Thomas Szasz opposes the practice of forcibly preventing people from committing suicide and by extension attacks the state’s right to declare people legally incompetent through insanity. Dr. Szasz’s article can be broadly broken up into three portions. In the first portion, Dr. Szasz provides the historical and intellectual background for his argument. The second portion explains his core argument in terms of its impact on the counselor client relationship. Finally the third portion expands on Szasz’s concerns for the risks posed to human free will and society as a whole.
Dr. Szasz begins his article by referencing traditional Western Judeo-Christian culture, referring to pre U.S. history and more recent judicial cases wherein First Amendment protections of faith excuse biblical counselors from the responsibility of preventing suicide (Szasz, 1987). Dr. Szasz describes the early stigma against suicide as being a violation of God’s sovereign domain over death and life. Szasz posits that this stigma meets a social function of limiting the loss of valuable resources and members for the society at large. Over time, Christian stances on suicide waned, however ostensibly scientific psychiatric theories took up the stigmatizing effort against suicide. In addition to the continued stigma, psychiatry added the concept of irrational and mental degradation to the concept of suicide. This addition made suicide not only morally offensive but a sign of diminished intellect and cognition. The impact this additional factor had on social perspective is that anyone who would commit suicide is considered out of their minds and therefore incompetent (Szasz, 1987).
Personal Choice and Therapeutic Alliance
The second issue Dr. Szasz raises is that it coercive suicide prevention compromises the concept of personal choice on behalf of the client and perverts the therapeutic alliance between the client and counselor into an antagonistic relationship. Dr. Szasz’s reasoning is that by assuming responsibility for preventing a patient from committing suicide, the counselor must also claim authority over that patient and deem them less than human beings. Szasz compares a legally insane person as being less than a slave as they would have no legal presence except as a ward of the state.
Dr. Szasz contends that this antagonism is a natural result of the counselor claiming responsibility for the client’s actions. By accepting the task of preventing suicide against the will of the client, the counselor is in effect claiming supremacy over the client. Szasz says,
In every such situation, the controllers become responsible for what they control, and only for what they control. It follows, then, that anyone who assumes the task of preventing another person from committing suicide must assume the most far-reaching control over that person’s capacity to act. (Szasz, 1987, p.809)
This dominant role in turn invalidates the client’s rights, feelings, and sense of responsibility for their actions (Szasz, 1987, p807). Further, Szasz compares such a client as having less legal standing than a slave (p.809).
Once assuming a place of dominance over the client, the counselor essentially invalidates the client’s personhood and makes them a non-person and ward of the state. This paternalism in turn changes the counselor into an agent of the majority culture whose primary role is in enforcing majority social norms rather than the interests of the client (Szasz, 1987, p.808).
Western Society and Free Will
Throughout the article, Dr. Szasz refers to Christian ideals and Western society as being founded on freedom and responsibility as a necessary duality (Szasz, 1987). Szasz argues first that a person cannot be free without possessing personal responsibility and that the concept of insanity invalidates both personal responsibility and free will (1987, p.809). Szasz asserts that most forms of insanity are less scientific than they are legalized injunctions against socially undesirable behavior and thoughts. While he does not disavow all forms of insanity, he limits them to only the scientifically demonstrable forms and ones that specifically deprive the individual of comprehension of their actions (1987, p.809). What is more, he insists that these coercive interventions be temporary in nature, not impose long term consequences, and be based on more than the counselor’s testimony.
Dr. Szasz places a heavy emphasis on the conviction that free societies must uphold and protect the rights of all individuals to live their lives how they see fit. This is seen when he asserts that people ought to be presumed sane, despite their beliefs, until they can be proven actually insane, even in situations where the individual intends to end their own lives (1987, p.811). Dr. Szasz also compares
Szasz claims that as the client’s right to make their own decisions is an invariable right and so specific cases need not be examined in order to prove his belief.
Dr. Thomas Szasz’s primary concept can be summarized by the phrase coercive suicide prevention. Throughout Szasz’ article, he enumerates the same essential concept that individuals possess a personal ability to choose their own actions and that they ought to bear the consequences of their actions. Szasz argues that the concept of insanity, mental instability, and psychological diseases are all used to validate the majority society and psychiatric community stripping away the rights of other human beings. This concept is important to the multi-cultural minded counselor because it addresses a primary concern of multiculturalism, namely that of whether or not the mainstream culture and society has the right and ability to decide whether what the individual does or thinks is rational or not.
Underpinning Szasz’s logic is that if the state is given jurisdiction over determining a person to be insane, the state is in essence given jurisdiction over determining what is and is not rational, acceptable behavior. This power then becomes a wedge that compromises individual freedom and the counseling relationship. Whereas Dr. Szasz’s belief is that the counselor ought to work for the client, he argues that the act of superseding a suicidal client’s wishes actually invalidate the client’s right to make decisions and accept these consequences.
Dr. Szasz’s argument for why coercive suicide prevention has merit to a point however his fundamental argument is lacking as even he makes the observation that certain illnesses truly compromise the individual’s cognitive abilities. His assertion that he need not address specific instances because of a fundamental right to free will demonstrates his true motives as being to defend and uphold free will with little regard for circumstances. Despite this bias, Dr. Szasz’s argument that the majority should not dictate life values onto dissenting people, like minorities or religious believers, speaks to the social issues of today. Additionally, Dr. Szasz’s observation that giving psychiatrists control over their patients undermines the therapeutic alliance is valid and in fact reflects on issues Christians and mainstream psychiatry has been dealing with throughout the last century.
The significance of Szasz’s point is paramount to modern issues in Christian evangelism. As Western values are strongly tied to Christian values, U.S. mainstream culture has associations with Christianity which carry implications for minority groups. Just as Szasz notes that giving power to counselors and the courts to determine a person’s personhood sets the person against the counselor and the court, so too has Christian values forced through the courts damaged Christianity’s testimony. Defining of alternative lifestyles such as homosexuality as a mental abnormality, women suffragettes being labeled as insane for their food strikes, sets up barriers for communicating Christ’s love and hope of redemption. In essence Christian values forced onto minorities through the mainstream culture set up inequalities and social tensions which inadvertently work counter to God’s mission to spread the Gospel with patience and love.
From the beginning, Szasz takes on the role of justifying his position through various cultural and historical proofs, calling on both traditional American concepts of freedom and self-determination as well as Christian ideals. Szasz begins by referencing a then recent court case in which a Protestant church was deemed not guilty via the freedom of religion clause in the 1st Amendment, and then follows with references to older cases in U.S. history wherein people were punished posthumously for committing suicide, which was then considered a sin (Szasz, 1987). Szasz’s justifications from scripture however are for the most part cultural and European American centric. He is appealing to Christians to side with him rather trying to move Christianity in a better direction.
The Christian critique of Dr. Szasz’s argument is mixed as there are relatively few verses dealing with suicide, apart from peripheral mentions of King Saul (1 Chronicles 10:4), Judas Iscariot (Matthew 27:5), and other murky characters committing suicide, the Bible does not speak on the issue of suicide. Scripture does however offer insight into God’s value on human life, for instance Genesis 1:27, Jeremiah 1:5, Genesis 9:5-6, all contribute to the view that God has made man in His image and that human life is sacred. Dr. Szasz’s implicit argument that suicidal individuals are making rational decisions is therefore unconvincing because he does adequately defend his view.
Biblical Christianity has much in agreement with Dr. Szasz’s wider argument for personal freedom and mutual respect. In the Book of Acts, Ananias and Sapphira’s right to personal choices was affirmed, and the punishment for their sins came from God rather than society or the Church specifically (Acts 5). Paul in Colossians 4:5-6 instructs believers to treat unbelievers with patience and grace (Colossians 4:5-6).
Dr. Szasz’ article adds context and validation to the idea of freedom and multiculturalism. The freedom to choose one’s own path is a necessary component to a multicultural society where individuals are free to live out their lives in non-mainstream or counter-cultural ways. More importantly for Christians is Dr. Szasz’s observation that a lack of respect on the behalf of counselors for their client’s personal choices and views damages the therapeutic alliance as well as sets up barriers for communicating Christ’s love.
Szasz, T. (1987). The case against suicide prevention. American Psychologist, 41(7), 806-812. Retrieved from http://dx.doi.org/10.1037/0003-066x.41.7.806