Sex: Facts, Frauds and Follies 
by Thomas Szasz.
Blackwell, 194 pp., £8.95, July 1981, 0 631 12736 4
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Otherwise identical with last year’s American edition, the English version has abandoned the original title, Sex by Prescription – in order, it appears, to gratify the author’s veritable passion for alliteration. He isn’t aware how lucky he is that his latest book has appeared at this particular stage in the history of our culture’s reflections on medicine – or rather, by now he is: I happen to know that recently he was shown Ian Kennedy’s Reith Lectures (which, highly indebted to Szasz without acknowledgment, criticise him for what he hasn’t said), and has decided to remain silent. For me, the relation between the two is particularly baffling: a few years ago I sat on a brains trust with both of them, and Kennedy was highly critical of those very elements in Szasz’s philosophy which he has meanwhile assimilated.

One of the few clear points at the centre of Kennedy’s case is, of course, the proposition that ‘illness’ is what he calls a ‘judgmental term’. And where, in his submission, Szasz is ‘flawed’ is in his ‘failure to understand that illness, in the form of alleged physical illness’, is as normative or judgmental a notion as is the concept of mental disease. One wonders whether Mr Kennedy will be surprised to read, in the book under review, about ‘the quasitheological character of medicine as a social enterprise’: has he totally repressed what he has learnt from Szasz? For the present book is not, of course, the first that articulates Szasz’s thoughts on the mythological side of physical medicine: his crucial exposition of this side of his philosophy appeared as early as 1977 in The Theology of Medicine: The Political-Philosophical Foundations of Medical Ethics.

Even on a purely factual level, Kennedy simplifies and sensationalises the very issues he tackles à la Szasz, whose new book contains, by sheer chance, timely corrections. We all remember Kennedy’s dramatic opening shot:

Six years ago the American Psychiatric Association took a vote and decided homosexuality was not an illness. So, since 1974, it hasn’t been an illness.

Now compare Szasz’s latest careful analysis of the current state of homosexual affairs in the United States:

The belief that homosexuality is a disease was, until quite recently, medical dogma. Many physicians, and especially psychiatrists, still think it is ... That in American psychiatry homosexuality continues to be considered a disease ... is evidenced by the chapter on this subject in the latest (1974) edition of the ... American Handbook of Psychiatry ... The unremitting hostility of psychiatrists and psychoanalysts to homosexuals is, in my opinion, now greatly underestimated, especially by homosexual organisations and their leaders.

And by Kennedy. It is amazing, admittedly, that the confusions of the Reith Lectures develop against the clear background of Szasz’s revolutionary insight – but there they are, demonstrably epigonic all the way, so that one wonders how the fact can have escaped people at the editorial end, i.e. the BBC producers responsible.

Or were they ignorant of Szasz’s work? I find it difficult not to feel strongly about the matter, since I myself produced some Szasz talks for the BBC, including one which, in the event, I was not allowed to transmit: it was on the reasons why, in Szasz’s view, all drug laws should be repealed. From a letter to the Listener the public has gathered that Kennedy has availed himself, without any acknowledgment, of quite a few sources, but the writer seemed unfamiliar with Szasz’s work – which, in my submission, remains Kennedy’s central source. And having been exposed last year to this weekly dose of what I would call arrested thought (in that no single line of thought is pursued to its logical end), I find it a liberating pleasure to return, or rather progress, to the latest product of Szasz’s own relentless logic.

Mind you, its relentlessness doesn’t render it faultless, and at times there even is more relentlessness than logic. Freud in particular has become Szasz’s bugbear; the anti-psychoanalytic psychoanalyst is no longer able to view this genius’s work dispassionately. While he is right, of course, in suggesting that Freud played a founding role in ‘the progressive medicalisation of sex’ which his book is about, it’s wilful blindness after the event simply to say that Freud’s theory of sexuality offers ‘some elementary descriptions and fanciful speculations about sexual development in children’. In fact, some 130 pages later, Szasz tells us that ‘the care and control of the sexual life of children is a responsibility of parents (and parent surrogates) and should ... fall outside the scope of the criminal law.’ Is Professor Szasz unaware, then, that without Freud, he would have been unable to write about the care and control of the sexual life of children? For before Freud, children had no sexual life.

The underestimation and active neglect of Freud’s epoch-making discoveries have become chronic features of Szasz’s writings, and when he says that Freud ‘viewed sex either as a disease or as a treatment’, the straight answer is, he didn’t: the burden of proof rests heavily upon Professor Szasz – and significantly enough, he offers no evidence. It is downright unfair, moreover, to saddle Freud with the concept of ‘neurasthenia’ – a meaningless term he thoughtlessly accepted in 1898, but to which he violently objected as soon as he started to develop his own theory of neuroses. The only way I can think of in which one can make clear to Szasz what he is doing to (and getting from) Freud is to remind him that his manner of biting the hand that fed him is not altogether unlike Ian Kennedy’s. Of course, compared to what Szasz fed Kennedy, the food which the self-supporting Szasz received from Freud is mere sweets and biscuits (candy and cookies to him), nor does he ever misrepresent Freud’s thought as his. The psychological reminder remains that whenever we feel like biting, we might usefully ask ourselves whether, by any chance, the object of our cannibalistic aggression has fed us in the past.

As for sheer logic, while Szasz rightly argues that transsexualism, ‘the disease most recently discovered by sexologists’, isn’t anything of the sort, his reasons, though not wrong, are not the rightest – the most invalidating. He quotes Harry Benjamin (‘who invented the disease’) as follows: ‘What both treatments’ – insulin for diabetes, sex-reassignment for transsexuals – ‘accomplish is the preservation of the life of the patient. Otherwise, many of those people would commit suicide. There is no doubt, in my mind, that sex-reassignment surgery can be life-saving and frequently is just that.’ His criticism of this line of argument is that ‘the analogy between the diabetic and the transsexual is specious, to say the least. If insulin is withheld from the diabetic, he dies from his disease, not from suicide. Unlike the diabetic, the transsexual cannot die of his disease.’ True enough, but the fundamental fallacy is that while insulin counteracts diabetes, sex-reassignment acts out transsexualism! By resorting to Harry Benjamin’s reasoning, Szasz says, ‘virtually anything displeasing to a person could be defined as a disease’ – but the condition of transsexualism is not displeasing if a surgical sex-change takes place, if physical reality replaces mere psychic reality! The cure, in other words, corresponds to crowning somebody who imagines that he is the Emperor of China as Emperor of China.

While it is, inevitably, entertaining thus to apply, critically, Szasz’s characteristic, passionately concrete logic to his own argument, it must be stressed that the body of the book is free from illogicalities. Paraphrasing Voltaire’s ‘Theology is to religion what poisons are to food,’ he submits, as his central contention, that ‘sexology is to human sexuality what slavery is to freedom.’ The two main sections of the book are, accordingly, ‘Sexual Medicine’ and ‘Sex Education’, and ‘Sex as Treatment’ plays a prominent role in the medical section: the book’s American title is the more informative.

The naive amongst us, myself included, do not realise the economic consequences of the time-honoured fact that ‘prostitutes are sometimes accorded the status of therapists’ – at any rate in the United States, where the Internal Revenue Service recently upheld the contention that prostitution is therapy, with stunning financial results:

A physician suggested to a man that he engage the services of a prostitute. He did so and deducted his payments to her on his income tax. The deduction was allowed on the condition that he ‘co-operate with the IRS in their investigation of the prostitute. Result: the man saved $200 in taxes, and the woman was hit with a claim for $90,000 in back taxes.’

This, mind you, is ‘the old sex therapy’: medically speaking, the prostitute is an amateur. In the new, fully medicalised sex therapy, sexual services are rendered by professionals – sexologists if not doctors. As for the doctors themselves, Szasz makes the revealing point that they ‘now seem eager to enable persons to perform sexually, regardless of how or with whom’, whereas ‘until recently they were just as eager to disable persons with “perverse” erotic interests from satisfying their sexual appetites.’ Thus the history of medicine’s own attitude to sex proffers conclusive evidence against its medicalisation; it isn’t that one and the same disease has received opposite cures, but that opposite conditions have been regarded as sickness and health respectively.

In fact, as Szasz reminds us in the (anti-) educational part of his book, ‘the dominion of the theologians over sex has now been largely replaced by the dominion of the therapists. Of course, the clinicians maintain, just as did the clergymen, that their aim is not to dominate or coerce, but to inform and help.’ In his well-substantiated submission, our age’s sex educators treat human beings as animals, ‘forgetting that the ultimate organ of human sexuality is not the genital but the mind. They are also mendacious – because they claim to be value-free scientists when, in fact, they are value-laden moralists.’

Together with The Theology of Medicine, then, Sex: Facts, Frauds and Follies is a frontal assault on ‘the quasi-theological character of medicine as a social enterprise’, and as opposed to Ian Kennedy, whose knowledge of medicine is gravely limited, Szasz, a medical man, knows precisely where to attack and where not to attack: none of the excited medical points which filled successive correspondence pages of the Listener in response to Kennedy’s own assault on medical attitudes has the remotest relevance to Szasz’s clear-sighted defence of individual dignity, individual choice and, last but first, the truth. The sex educators’ pretence, he says, ‘is the very antithesis of science, whose first commandment is telling the truth’. ‘Untruthful Sex’ would be his book’s ideal title, with his American title as a subtitle.

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