but against the smuggling of categories of crime and punishment,rnfor example, into the definition of mental illness. In a recentrnessay, Szasz adroitly sums up the dual edge to his critiquernof contemporary psychiatry: “The focus of my conceptual critiquernis the distinction between the literal and metaphoricalrnuse of language; and the focus of my moral-political critique isrnthe distinction between dealing with grown persons as adults,rnpossessing free will and rights and responsibilities, as againstrndealing with them as if they were infants or idiots lacking freernwill and rights and responsibilities.”rnI f there is another living psychiatristrnwho has suffered morernprofessional obliquity whilernsustaining great public recognition,rnthis person escapes my recognition.rnOne might claim that even the conceptual critique is saturatedrnwith political judgment—since the literal and metaphoricalrnuse of language has, over time, been well understood tornhave a high political content. For what else has given GeorgernOrwell his permanent niche in the world of letters if not thisrndeep appreciation of language as a symbolic tool of manipulation,rnno less than a prosaic tool in communication? It is thernlanguage of medicine—the certitude with which the idea ofrnmental patients having mental diseases and medical claimantsrnhaving scientific rigor that is a basic source of the politics ofrnmental health—that is, the presumption that a subset of professionalsrncan impose its will and judgments over a large set ofrnmedical practitioners.rnThe stakes in this intellectual struggle are so high—rangingrnfrom fees to be collected to worldviews to be protected—that itrnis little wonder that Szasz has been pilloried in a manner andrnwith a drumbeat that surely would have sent a less determinedrnindividual to Coventry and back. Hardly a book or article hernwrites fails to produce a legion of critics. The lines of criticismrnseem to divide the political and the professional.rnIn the former category, we are told that Szasz does not representrna consensus of opinion and is therefore wrong, or he sorndistorts psychiatry that the normative foundations of societyrnwould be undermined by his judgments. On the professionalrnlevel, the usual criticism is that he is mistaken on specificrnpoints of psychiatric practice, to the more recent and quiternfashionable critique that psychopharmacology has given preciselyrnthe sort of chemical basis to neurosis and psychoses thatrnSzasz’s work largely if not categorically denies. Since Szaszrnhimself has responded at great length to these other charges, Irnshall eschew a defense of his work as such, and move on to thernpolitical and economic sources of those assaults. But beforerndoing so, it might be worthwhile to explain what elements inrnhis work have enraged his professional colleagues. At least inrnthis way, the ethical battleground of psychiatric practice canrnperhaps be sharply etched.rnUltimately, Szasz’s achievement is his unique ability tornbring into a discipline, which, ostensibly at least, hasrncome to pride itself on its indifference to moral claims, preciselyrna sense of morality—an ethic of responsibility. In a universernin which everyone claims victim status, a liberal virus threatensrnto undermine a liberal society. When everyone from the streetrnpusher to the university president can claim victim status, it isrnprecisely this sense of ethical responsibility that vanishes behindrna cloud of psychiatric smoke. Such vague notions asrnethics are given meaning by Szasz, to wit, sufficient educationrnto make distinctions as to what is right and wrong, good andrnevil, no less than true and false.rnAnd while Szasz has been, improperly in my view, classifiedrnas anti-Freudian, he is perhaps the most Freudian of the presentrnlot of analysts—for to rekindle the phrase of Philip Rieff,rnSzasz shares with Freud the “mind of the moralist” in definingrnthe field and developing scenarios for the determination ofrnneurosis and normalcy in the conduct of everyday affairs. Forrnwithout a moral sensibility, prospects for the reconstruction ofrnsociety become null and void. Egoism comes to replace civilization,rnand the discontents are able only to undermine, ratherrnthan restore, that sense of purpose that gives reason its place inrnthe human mind.rnThis is not to deny that Szasz has been critical of manyrnpropositions within the Freudian corpus—from the Oedipalrncomplex and notions of philogenetic memory traces to Freud’srnjudgments about the analytic setting of doctor-patient relations;rnthis hardly makes Szasz unique. Indeed, there are manyrnpractitioners of psychiatry who are far more severe in theirrnjudgments of Freud, who nonetheless earn Szasz’s wrath. It isrnthe singular merit of Szasz that his concerns extend far beyondrnthe parochial boundaries of biography or, for that matter, therndangers of digressing from an established corpus of the master’srnwritings. Rather, in a sense of the goals of medicine; the prolongationrnof life, and even the goals of analysis, the ability ofrnthe person to make free and rational choices however such bigrnwords are defined, I find the two far closer in spirit, than thosernwho believe that in attacking Szasz they are somehow protectingrnFreud.rnFor in reviewing the constancy over 35 years of his majorrnthemes, one senses the “ought” behind the “is”—the impulsernto liberty as free choice even more than the lack of efficacy ofrnpsychiatric treatment and counseling. Indeed, in his most recentrnbook, Cruel Compassion, which can be viewed as a finalrnmanifesto on his lifelong themes, there is a sharper polarity:rnearing for others by means of coercion, or doing so with theirrnconsent. The libertarian motif became text rather than subtext.rnTo those who claim that a theory of consent is not feasiblernwith those labeled as mentally ill, he reminds his critics thatrnit is they who continually utilize and invoke the medial analogies.rnAnd if this analogy between the physical and the psychicrnis accurate, then, too, must the right of the patient to solicitrntreatment be viewed as inviolable by extension.rnPerhaps certain levels of coercion are required. But Szasz’srnanswers—not always fully worked out—are two in number: ifrnthis be the case, then the analog to medicine in general mustrnbe abandoned or seriously revised. But more important, to arguernthe case for coercive practice is to move dangerously closernto the identification of the scientific community with the po-rn24/CHRONICLESrnrnrn