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Subject Area: Political Theory

The Therapeutic State - Leonard P. Liggio, Literature of Liberty, January/March 1978, vol. 1, No. 1 [1978]

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Literature of Liberty: A Review of Contemporary Liberal Thought was published first by the Cato Institute (1978-1979) and later by the Institute for Humane Studies (1980-1982) under the editorial direction of Leonard P. Liggio.

Part of: Literature of Liberty: A Review of Contemporary Liberal Thought, 20 vols. 19781-982

About Liberty Fund:

Liberty Fund, Inc. is a private, educational foundation established to encourage the study of the ideal of a society of free and responsible individuals.


The Therapeutic State

Szasz, Thomas

“Justice in the Therapeutic State.” The Theology of Medicine: The Political-Philosophical Foundations of Medical Ethics. Harper & Row: New York, 1977, chap. 9:118–133.

Today we risk transforming the state from a legal entity concerned with individual justice into a medical therapeutic one. Law and medicine have intertwined to the disadvantage of both. We confuse legal methods of social control with medical methods of social control. Instead of regulating human relations by the rule of law in the form of contract between equals, we slip into discretionary control by medical elites. These elites impose psychiatric treatment on “disturbed” individuals even without any preexisting law to justify the therapeutic sentence. Contract fosters the individual's capacity for independent action; therapeutic discretion frees the “expert” to form any restricting rules of justice.

The rise of modern science in the seventeenth century (with its desire to control the physical world) explains the impulse of experts to “therapeuticize” human relations. Two protagonists of this ideology are the American Founding Father, Benjamin Rush, and the contemporary Karl Menninger.

Benjamin Rush (1745–1813) served as physician general of the Continental Army and fathered American psychiatry (the official seal of the American Psychiatric Association bears his image). He transformed moral questions into medical, scientific problems to be cured at the discretion of the expert rather than by legal due process. You will find the following typical of many of Rush's statements as the architect of the therapeutic state: “Were we to live our lives over again and engage in the same benevolent enterprise [political reform], our means should not be reasoning but bleeding, purging, low diet, and the tranquilizing chair.” Rush consistently championed benevolent despotism justified by medical need. He subordinated free men to the clinical judgment of a medical autocrat.

More recently Karl Menninger, past president of the American Psychoanalytic Association, follows Rush in advocating the therapeutic state. Menninger views human problems as mental illness; all of life is a disease needing the expertise of the psychiatrist—even if in the process he must ignore individual freedom and rights: “Some mental patients must be detained for a time even against their wishes, and the same is true of offenders.”

Menninger would abandon the legal system of limited and prescribed penalties and replace it with a therapeutic system with unlimited, discretionary penalties termed treatments. This therapeutic state mentality seeks prescriptive universal health. Its champions view conflict, especially between the state and the individual, as a symptom of psychopathology. As its chief duty, they claim the state should relieve such conflict by compulsory therapy.

According to individualism, man primarily needs protection from the threats of unlimited government. According to the therapeutic mentality, man needs state instituted protection from the dangers of unlimited illness. Among recent thinkers who have opposed the behavioristic-scientific forces seeking the “abolition of man,” C.S. Lewis reasoned:

“Of all tyrannies a tyranny sincerely exercised for the good of its victims may be the most oppressive.... To be “cured” against one's will and cured of states which we may not regard as disease is to be put on a level with those who have not yet reached the age of reason or those who never will...” [“The Humanitarian Theory of Punishment,” Res Judicatae (Melbourne U., Melbourne, Australia), 6 (1953): 228].

Paradoxically, the more ostensibly “loving” the state becomes, the less humane and just it proves to individuals. Far better to keep unimpaired human freedom: man's ability to make uncoerced choices. In its zeal to “free” us from internal limitations of body, mind, and personality (illness or ignorance), the therapeutic state imposes external limitations which diminish our moral choice.