REVIEW OF: FATAL FREEDOM, THE ETHICS AND POLITICS OF SUICIDE By: Thomas Szasz

REVIEW OF:

FATAL FREEDOM, THE ETHICS AND POLITICS OF SUICIDE

By: Thomas Szasz

Syracuse University Press, 1999

Thomas Szasz, an American psychiatrist, first came to prominence in the 1960’s with the publication of his seminal paper, The Myth of Mental Illness, in which he argued that mental illness was merely a metaphor. By equating mental and life-coping problems with real illness, a rationale was provided for “therapeutic statism” to do its work. The concept of mental illness provided a mechanism for incarcerating those with objectionable behaviours and infantilising others by relieving them of responsibility for their actions.

Szasz, born a Hungarian Jew, left for the United States as a teenager when the pre-Second World War wave of anti-Semitism was on the rise. He developed an abhorrence of state control and, in his view, medicine’s complicity. His political and philosophical views were unapologetically Jeffersonian and Libertarian. The only role of the state should be to protect its members from outside and inside attack.

Since the Myth of Mental Illness, Szasz has published several books and innumerable papers all around the general topic of the freedom of the individual from interference by the state even to the extent of advocating abolition of controls on drugs.

It is no surprise, therefore, that he has turned his attention, formidable intellect and polemical powers to the controversial topic of suicide.

Szasz regards suicide as one of the last taboos of Western society. He compares our richly nuanced vocabulary for homicide, but “for killing ourselves, we only have a single word which we hate to utter”. Such denial prevents us from thinking clearly about the topic and examining how its moral status might vary depending on the circumstances.

Tracing historical attitudes towards suicide, he identifies Plato’s view as pre-figuring the Christian viewpoint--men are one of God’s possessions and should not put an end to themselves until God sends some compulsion. Since self-killing was wrong, it should be punished in a solitary, anonymous grave. Roman law prohibited the suicide of slaves and of people accused of crime. However, the Patrician class had a set of criteria which made suicide morally acceptable. After the Christianisation of Rome, the Church adopted the platonic principle that all human life belongs to God and civil law viewed suicide as a criminal act punishable by forfeiture of estate to the King. Inquest jurors in the 18th and 19th Centuries, aware of the injustice to families deprived of the suicide’s estate, evolved the excuse of unsoundness of mind. In the U.K., the Suicide Act of 1961 removed attempted suicide as a crime under the law. According to Szasz, thereafter, unsuccessful suicides were punished by deprivation of liberty in the insane asylum.

“As a society, we are unwilling to accept suicide as suicide and attribute its cause from nearly everything from rock music to natural disasters and above all else, mental illness, except the subject’s own decision.”

Szasz states emphatically that what he calls coercive psychiatric suicide prevention (CPSP) does not prevent and suggests that the practice may actually increase suicide quoting study conclusions that suicide prevention centres do not reach the highest risk population, but may actually shape the low-risk person towards the act. He points out that the fear of psychiatric incarceration may actually provoke suicide. He praises the Samaritan movement for its lack of coercive potential and for its association with reduction in suicide rate.

Szasz accuses the medical profession of preaching water, but drinking wine in terms of suicide. “They preach suicide prevention, but kill themselves more often than lay persons.”

Szasz’s visceral antipathy to the socialised medicine of the Nazi regime and its corruption in terms of euthanasia, he believes, lay the foundation for the Holocaust. Thus, the foundation of his objection to the medicalisation of life.

He is equally against the concept of physician assisted suicide. He believes there is no “right” to suicide as a right has a corresponding duty. If a right to suicide exists, it is a passive form of right and not a natural one. Physician assisted suicide (PAS), he states, is plainly not suicide as it is the physician/psychiatrist who chooses who shall be eligible for this procedure. He argues that no conscious person is ever so incapacitated that life cannot be ended by avoidance of eating and drinking. He excoriates Jack Kevorkian and Timothy Quill essentially as self-serving publicity seekers who, while paying lip service to the concept of patient autonomy, are taking delight in controlling people’s lives and deaths.

Birth control was regarded as a taboo subject not long ago. He advocates death control whereby the individual has the right to decide the means of their own deaths.

Other taboos such as masturbation and homosexuality (each, in turn, “diagnosed” as diseases) have been re-defined and rendered acceptable to society. He believes it is only a matter of time before suicidal behaviour is treated similarly.

Szasz’s solution is to de-criminalise the drug laws, thus allowing individuals access to lethal drugs. Having a means of exiting life if conditions become too tough can act as a “safety valve…..just in case….” and, in the vast majority of cases, will not be used. Finally, he advocates the de-stigmatising of suicidal behaviour by de-classifying it as mental illness and argues for the abolition of Draconian mental health legislation.

Szasz does not shy away from forceful exposition of his views and is a superb polemicist. In this book, he tackles issues head-on and does not cringe from hard-hitting “two-footed tackles” of critics of his position. Stylistically, though he can be somewhat repetitive. His best passage involves his description of Nazi socialised medicine and its corruptions. Here is obviously the well-spring and drive for his philosophy.