Pharmacracy: Medicine and Politics in America

In his book, Pharmacracy: Medicine and Politics in America, Thomas Szasz argues that medicine has unwittingly become the new de facto religion in America. According to Szasz, health and medicine have superseded religion as a source of values. Medicine has bootlegged values into everyday life through the backdoor of politics.

Szasz has become fond of quoting Adolfo B. Casares to make his point:

Well then, maybe it would be worth mentioning the three periods of history. When man believed that happiness was dependent upon God, he killed for religious reasons. When he believed that happiness was dependent upon the form of government, he killed for political reasons…. After dreams that were too long, true nightmares … we arrived at the present period of history. Man woke up, discovered that which we always knew, that happiness is dependent upon health, and began to kill for therapeutic reasons…. It is medicine that has come to replace both religion and politics in our time.¹

Szasz spends a good deal of time explaining his argument for why behaviors, such as mental illness, are not diseases. It is sort of an updated version of his book, The Myth of Mental Illness. Yet, Pharmacracy, is more concise and easier to read.

Szasz explains the classical concept of disease. He sees diseases as a product of a physical lesion or foreign invasion of the body. For Szasz, this is common sense view has been perverted by modern psychiatry.  Psychiatry invents new diseases, which only they have the cure for. While scientific medicine discovers diseases, psychiatry invents (defines) new ones. To doubt this fact is unfashionable, unkind, and even heretical in modern America.

Szasz writes:

As in a theocracy authorities cannot afford to doubt the reality of God, so in a pharmacracy they cannot afford to doubt the reality of mental illness. Faith in the dominant fiction must he regularly reaffirmed by appropriate rituals. The psychiatrists’ disease-affirming rituals have varied from time to time. Today, psychiatrists proclaim the reality of mental illness by worshiping at the altar of neurobiology and psychopharmacomythology, and by speaking the language of brain disease, chemical imbalance, neurotransmitters, and psychopharmacology. In fact, the history of psychiatry from 1850 to the present is essentially the history of changing psychiatric fashions-from neuropathology to psychoanalysis to psychopharmacology. Modern societies need psychiatry. A world without mental illness seems to frighten people, especially people who pride themselves on their disbelief in God.²

In his book, Szasz takes a birds-eye view of modern American medicine. He looks at it from a sociological perspective, and see the absurdity in it. He is like an anthropologist studying the strange behaviors of primitive cultures; only he points his gaze at American medicine. With clarity, he shows that many of the problems medicine tries to solve are simply not solvable from a medical perspective. Science cannot give values, yet modern medicine pushes values, especially through psychiatry. Values are religious and philosophical in nature, not medical. Szasz explains:

A living human being is not merely a collection of organs, tissues, and cells; he is a person or moral agent. At this point the materialist-scientific approach to understanding and remedying its malfunctions breaks down. The pancreas may be said to have a natural function. But what is the natural function of the person?… That question is like asking, How should we live? What is the meaning of life? These questions are religious-philosophical, not scientific-technical. That is why different religions, different cultures, and different persons offer different answers… When the physician enters the realm of the meaning of life and the control of personal conduct, he ceases to be a biological scientist. Instead, he dons the robes of the priest, the politician, the judge, the prison warden, and even the executioner, determining the legitimacy of moral values, judging the permissibility of personal conduct, punishing misbehavior, and so forth-all in the name of the health of the patient, the community, society, the nation, even mankind.³

Szasz claims that as medicine becomes the new religion legitimized by the state, everything in life gets swallowed up by medicine. As medicine and state grow aligned, the state has endless power to intervene in every aspect of our lives in order to “protect” us from ourselves. He says:

Clearly, the leading cause of death is being alive. The therapeutic state thus swallows up everything human, on the seemingly rational ground that nothing falls outside the province of health and medicine, just as the theological state had swallowed up everything human, on the perfectly rational ground that nothing falls outside the province of God and religion.⁴

Reading Pharmacracy, was an exercise in clear thinking. Szasz always challenges the reader to think outside of the box; to look at old problems in new ways. I recommend this book to anyone interested in looking at the intersection of psychiatry, medicine, values, and politics.