The Morality of Mental Illness

Abstract

"Mental illness" is not truly a medical diagnosis, argues Thomas Szasz. Instead, it is a moral judgment that society passes on its deviant members. "Mental illness" relieves a person of responsibility for his or her actions, but in so doing it also justifies appropriating that person's freedom of choice, the necessary prerequisite of responsible action. Psychiatry is a social tool for accomplishing these goals, the results of which are involuntary commitment and the insanity defense. For Szasz, "persons" are characterizable above all else by their autonomy. An autonomous person makes uncoerced choices and accepts responsibility for those choices. Psychiatry undermines both characteristics of autonomy. Involuntary commitment allows psychiatrists to appropriate patients' freedom of choice. The insanity defense allows persons to escape the responsibility for their actions. Both procedures turn patients into nonpersons. Szasz wishes to replace the hidden moral judgment operative in psychiatric diagnoses with an open moral judgment. Psychiatrists and patients both need to return to the moral community. Psychiatrists do this when they stop appropriating the autonomy of others while pretending to practice medicine. Patients do this when they accept responsibility for their own choices and actions. One cannot be relieved of this responsibility without losing his or her place in the moral community as well.