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MADNESS AS APOSTHUMOUS DIAGNOSIS

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THOMAS S. SZASZUntil recently, people knew a madmanwhen they saw one. Or they thought theydid. They also knew what to do with amadman: they put him behind bars, usual-ly for life. Now, for the first time in modernhistory, there is some reason to believe thatthe long night of the psychiatric Dark Agesis coming to an end.Although neither psychiatrists nor lay-

men could ever satisfactorily define sanity,they all knew that if a person claims to beJesus, then he is mad-insane, psychotic,schizophrenic, whatever. But crazy, forsure. Similarly, although no one couldclearly define the criteria for commitmentto an insane asylum, everyone knew that ifa person announces that he is going to killhimself, then he ought to be locked up-toprotect him from himself, to cure his psy-chosis or schizophrenia or whatever. Ern-est Hemingway, for example, was lockedup and given electric shock treatmentsagainst his will for precisely such reasons.For several years before the carnage in

THE LIBERTARIAN REVIEW

Guyana, the Reverend Jim Jones repeatedly claimed that hewas Jesus. He also repeatedly threatened to kill himself-and to take his followers with him in a mass suicide-if peo-ple didn't do as he told them. Many knew that Jim Jonesmade such a claim about himself and uttered such a threatagainst others. Many who knew this were intelligent and in-fluential some of them physicians and lawyers. Butnot one of them said that Jones was mad or suggested thathe ought to be committed to a mental hospital.Why didn't anyone "discover" that Jones was "mentally

ill" before he died, especially since that "diagnosis" seemsnow so obvious to everyone? Because he had powerful poli-tical friends? That cannot explain it. Secretary of DefenseJames Forrestal had much more powerful political friendsand sought only his own death, whereas the Rev. Jonessought the death of his family and followers as well. Never-theless, Forrestal was captured, confined, and psychiatri-cally destroyed, but Jones was not.Did Jim Jones escape psychiatric diagnosis and detention

because he made a good impression on people? That cannotexplain it either. Marilyn Monroe made a much better im-pression, but was made to suffer the indignity of involun-tary mental hospitalization nevertheless.The answer, I. think, is simple. The American people-

and, most importantly, journalists and judges and politi-cians-have opened their eyes and ears and are beginning tolook at and listen to madmen as well as mad-doctors. WhenJones declared that he was Jesus, people interpreted this tomean that he wanted to be like Him, that he wanted to beadmired like he is, and so forth. This view of madness isboth a cause and a consequence of a dramatic shift in thepublic perception of madness and the public policy towardit (each affecting the other).Until recently, when madmen asserted certain (possibly)

metaphorical claims, their assertions were invariably inter-preted literally. If the "patient" said he was Jesus, then

everyone insistedcrazy. It was of noplained, in word anthat he wanted love, faual "goods" that many eraand that was that.Now the tables are turned.

don't know, we cannot possibly ,that claim literally or figuratively (or 0'"the public, journalists, politicians-acted as "asserting a metaphorical claim; ergo, he was not craz .more Jones escalated his claims, the more "charismatic'(confident)-and the less "crazy" (deluded)-.,.he appeareIndeed, even in his pen\;lltimate performance, one could ndistinguish the literal from the metaphorical, the real frothe fake, from what Jones said. The truth about Jonbecame known only after the bodies were counted. Thethe chorus called him crazy."Why;' asks Patrick J. Buchanan uncomprehendingly,

"wasn't the Secret Service alerted to keep Mrs. Carter miles:away from a certifiable madman like the Rev. Jim Jones?"What Buchanan does not understand, perhaps does not'want to understand, is that whether a person is considered;;mad depends not on what he does but on how we interpret"what he does. For a number of reasons (among which the"changing attitude toward madness is probably only one),!Jones's self-definition as Jesus was regarded as a symbol ofhis "humanitarianism"-rather than as a symptom of hismegalomania; similarly, his rituals of mass suicide wereviewed as the thunderings of an angry prophet-rather thanas the blackmailings of a blood-thirsty terrorist.President and Mrs. Carter say that they are "born-again"

Christians. We interpret that claim metaphorically-andeither approve it or ignore it. But what if we gave thatmessage a literal reading? We might then expect each ofthem to produce two birth certificates to substantiate their

" '. ,t'y, if we

6P,born more, Omatic of a psy-

,,]/born-again Chris-"reted. But the anal-

; have been (mis)in-.ust such < . , "'e years ago, after one ofmysin whictt;,I,/made this point, a colleague cameold me this story. As a supervising psychiatrist

'ental hospital, he was asked to review a recentThe patient was a middle-aged woman who hadf intense anxiety. In the admission record she"delusional" and was diagnosed "psychot-tient said nothing to the consultant that he

< usional;' he turned to the admitting psychia-Sa recent immigrant from Eastern Europe, forion. "She kept saying she had butterflies in hereplied the doctor, who might have been a poet in, ngue but was deaf to the music of a metaphoricuttering in an English-speaking stomach.world's a stage;' observed Shakespeare. He is

;:;etry, politics, and psychiatry all come down toge-to the ancient truth which we forget at our own

. that it is by controlling words that we control:iLet us rejoice at the prospect of a world freed of its

psychiatric blinders. Perhaps the time is now near whenmadness will be a purely posthumous diagnosis. That daywill be a new dawn for liberty. D

Thomas S. Szasz is professor of psychiatry at the State University ofNew York's Upstate Medical Center in Syracuse, and a contri-buting editor of Inquiry. He has long been a leader in' the fightagainst involuntary mental hospitalization. His many booksinclude The Myth of Mental Illness, The Theology of Medicine,Schizophrenia, and, most recently, The Myth ofPsychotherapy.

JANUARY 1979

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