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“In the animal kingdom, the rule is eat or be eaten. In the human kingdom, define or be defined.” —Thomas Szasz (1973, p. 20)
Our national mindset is at a point where patients would often rather have surgery that drives screws into cervical vertebrae or take medications promoted on TV than attend a Pilates class. Biomedical devices drive the stock market, prescription opioid abuse is causing 70,000 deaths a year, and psychiatry's hottest new drug for suicide in part dissociates patients from the realities of their lives. My patients are disabled by obesity and chronic pain, living solitary divorced lives estranged from children and former friends, and often unable to find a good reason to continue living. When I ask them what they care about that might restore meaningful activity to their lives, many find this question difficult in a way that surprises me afresh every time. So with my EMR, I point and click at something that may take away some of their anxiety or keep their moods or perceptions from swinging to uncomfortable extremes. Retired Americans spend up to 35% of their lifetime savings on this kind of “health,” dramatically devoid of personal awareness, responsibility, and existential meaning.
This zeitgeist is part of the reason I was drawn to review this book. Increasingly, we are confronted with the consequences of the biological revolution of psychiatry and the economic revolution of American medical care delivery. The mind is reduced to chemicals, personal un-happiness and behavioral excesses are illnesses supported by a vast and profitable economic machine, and self-definition is defined by what you click on in a Netflix menu or your approval of what is actually hacked political manipulation by a hostile superpower.
“There is no psychology; there is only biography and autobiography.”
Enter Thomas Szasz, or at least my desire to know more about him and his ideas. Thomas Szasz died at age 92 in 2012, at his own hand, accordi