lice force. And here Szasz, in his full passion, returns to the ethicalrnbasis of all issues connected with health. It is worth quotingrna passage from his Cruel Compassion, because it is both anrnapt summary of his ethical position and, no less, a warning tornthose with a monopoly of power—including the power to treatrnpatients.rnIt is dishonest to pretend that caring coercively for thernmentally ill invariably helps him, and that abstainingrnfrom such coercion is tantamount to ‘withholding treatment’rnfrom him. Every social policy entails benefits asrnwell as harms. Although our ideas about benefits andrnharms varv from time to time, all history teaches us tornbeware of benefactors who deprive their beneficiaries ofrnliberty.rnOf course, it might be argued that this is a straw man, thatrnmany individuals do indeed seek the very sort of treatmentrnwhich Szasz finds reprehensible. But that is another matter—rnhaving to do with the empirical efficacy of specific techniquesrnof treatment. One might say that there is an ethical break betweenrnpsychiatric control of society’s unwanted, and psychiatricrntreatment of society’s elite. One might say that “the mythrnof mental illness” may be common to all segments of society,rnwhile the reality of psychiatry as a mode of coercion is uniquernonly to special segments of an advanced society. I am not surernthat Szasz has worked out the parameters of this relationship ofrnvoluntary and involuntary patients, and libertarian and authoritarianrnpsychiatrists. Perhaps this is a work yet to come.rnMy own view is that the gap between psychology and psychiatryrnin general, and to psychoanalyses in particular, will bothrnwiden and deepen. The uses of psychology—from testing andrnmeasuring individual performance to defining the structure ofrnperception and conception—have expanded over time. Andrnwhile this expansion may not always be uniform, or for thatrnmatter, even welcome, it is real enough. One might well arguernthat far too much reliance on psychologists has crept into everythingrnfrom evaluating career capabilities to defining studentsrnas haying learning disabilities. Nonetheless, this aspect ofrnprofessional psychology has expanded enormously—the sizernand outreach of professions and journals attest to this.rnAt the level of psychoanalysis, the situation is far different. Itrnis a sub-branch of psychiatry, and one that has great strengthrnonly in isolated pockets—usually suburban areas where timernand wealth conspire to permit its practice. The need to compressrnyears into days has had a variety of consequences: muchrnhigher use of drug therapies on one hand and a reinterpretationrnof behavior to widen the area of the permissible and reducernthat which is considered bizarre. And here it is not the moralrnassault by libertarian critics like Szasz that has proven effective,rnso much as the economic assault of the marketplace and the socialrnassault of contemporary relativism.rnSo Szasz can be said to have scored some substantial victoriesrnin his crusade for a libertarian option, but also a few majorrnsetbacks. He himself realizes as much, since the rise of Medicarernand Medicaid programs, inclusive of psychiatry, has expandedrnthe payment basis for mental illness of all sorts; and thisrnis coupled with the license given to psychiatrists to define hugernnumbers of society’s unwanted as mentally ill rather than physicallyrndangerous. There are, in short, dynamics at work withinrnthe society that tend to subvert the very goals Szasz seeks. Butrnthere are also tendencies that reinforce his position. Just howrnthese social considerations affect the theory and practice ofrnpsychiatry is beginning to occupy many talented people—includingrnSzasz himself—for whom the larger context of the fieldrnhas transformed the world of professional analysis into one ofrnpublic discourse.rnBut quite beyond minoritarian fashions such as libertarianismrnlurks the mind of the moralist. And it is this which providesrnthe umbilical cord between Szasz and Freud—one that cannotrnbe severed, no matter how severe Szasz’s reservations might bernabout the therapeutic process itself, or the conduct of its practitioners.rnI am reminded of the fact that Philip Rieff, some 30rnyears ago, wrote a book on Freud: The Mind of the Moralist. It isrnin the dramaturgy of good and evil that Rieff saw the stayingrnpower of Freudianism as an ideology. While Szasz’s sa’age critiquernof “the manufacture of madness” by psychiatrists andrnwitch hunters prevents him from exercising the power of anrn”ism” (nor I hasten to add would he desire such an appellation),rnthe burden of his work is precisely to reannounce the dramaturgicalrnaspects of psychiatry: the confrontation of oppressorrnand oppressed, of good and evil, of science versus mystification.rnIwould argue that this aspect of Szasz’s work—his morallyrncentered critique of a branch of both medical science and socialrnscience—has led to certain shifts in his objects of wrathrnover time. But these have been minor in contrast to the shiftsrnin those who support and oppose him. I know of few figures inrnmodern intellectual history who can enlist the wrath and supportrnof a conventional “left” and “right.” And thus it is that anrnEdgar Z. Friedenberg, a grand guru of the I960’s and the anti-rnAmerican generation, can praise “the depth of Szasz’s commitmentrnto human freedom and the precision with which he perceivesrnthat psychiatry has created highly effective forms ofrnhuman bondage” while an equally powerful voice in the conservativernmovement, Ernest van den Haag, can claim to havernbeen “entranced by the originality of Szasz’s ideas and the brilliancernand cogency of the presentation.”rnBut yvhat links scholars like Friedenberg on the left and vanrnden Haag on the right—if one can still use such tattered termsrnin a meaningful way—is their marginality. And that must ultimatelyrnbe said of Szasz as well. For what we have with Szasz isrnan attack on the center of a profession, on its established habitsrnof advancement and promotion no less than patterns of professionalization.rnWhile I have concentrated on the relatively wellrnknown aspects of Szasz’s critiques of the latter, it is his implicitrnassault on the former—on ways in which a profession awardsrnand rewards—that so excites his opponents. This is not arnpleasant academic discourse, but a bitter struggle over the faternof a science on one side and its economic foundations on thernother.rnFor Szasz makes a direct appeal to a larger, intelligent publicrn—the sort of individuals who might see a psychiatrist for betterrnor for worse—to reconsider their basic notions of superordinationrnand subordination. And to do so is a direct querying ofrntrust. To pay money to an analyst, to allow the analyst to sit inrnjudgment, whether through expert testimony in legal mattersrnor direct decisions about incarceration in medical matters, arernweighty concerns. I suspect that at the outset of his career,rnwhen he first started raising fundamental questions about thernscientific status of psychiatry, Szasz thought little, if at all,rnabout the politics and economics of such considerations. Butrnas his analytic skills sharpened, and the target of his criticismsrnbecame increasingly focused, so too did the resistance of thernJANUARY 1996/25rnrnrn