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Thomas Szasz vs. transgender people

Thomas Szasz was a Hungarian-American psychiatrist and cultural critic best known for foundational work in the anti-psychiatry movement. As part of that work, Szasz was a vocal opponent of disease models of sexual orientation and gender identity, including mental illness diagnoses of trans people.

Szasz was an important figure in the 1979 backlash against trans rights. Szasz expressed a number of anti-transgender views, often using incendiary language. Szasz’s most relevant works in relation to trans rights are The Myth of Mental Illness (1961), The Manufacture of Madness (1970), and Sex by Prescription (1980), as well as a glowing New York Times review of The Transsexual Empire by Janice Raymond.


Thomas Stephen Szasz was born April 15, 1920 in Budapest. The Szasz family moved to Cincinnati, Ohio in 1938. Szasz graduated from University of Cincinnati with an undergraduate degree in physics, followed by a medical degree in 1944. Szasz then earned a postgraduate degree from Chicago Institute for Psychoanalysis, in 1950. Szasz served in the United States Naval Reserve before serving as Professor of Psychiatry at SUNY Upstate Medical University in Syracuse staring in 1956. Szasz was named Emeritus Professor in 1990.

Szasz received many honorary degrees and awards, including

  • Humanist of the Year, American Humanist Association (1973)
  • Award for Greatest Public Service Benefiting the Disadvantaged, American Institute of Public Service (1974)
  • “The Thomas S. Szasz Award for Outstanding Contributions to the Cause of Civil Liberties,” award created in 1991 by Center for Independent Thought
  • George Washington Award, American Hungarian Foundation (2003)
  • Rollo May Award, American Psychological Association (1998)

Szasz was longtime advocate of rational suicide, calling it “autohomicide.” Szasz sustained a spinal injury in a fall and refused the proposed surgical interventions. Szasz committed suicide at home with painkillers about a week after that injury, on September 8, 2012.


Szasz laid out a wide range of provocative ethical positions:


  • medicine, especially psychiatry, as a means of social control
  • the moral and scientific foundations of psychiatry
  • the faulty concepts of “mental illness,” “addiction” and the “insanity defense”
  • civil commitment and involuntary psychiatric treatment, which Szasz considered crimes against humanity
  • “pharmacracy,” or the “therapeutic state,” collusion between politics and medicine to repress socially undesirable thoughts and behaviors
  • disease models of gender identity and expression


  • a radical conceptualization of personal responsibility
  • co-founding the Citizens Commission on Human Rights (CCHR) with the Church of Scientology
  • supporting key gender critical arguments in The Transsexual Empire by Janice Raymond

The Myth of Mental Illness

The summary below was written by Szasz for the 1974 revised edition, pages 267-268.

The principal arguments advanced in this book and their implications may be summarized as follows.

1. Strictly speaking, disease or illness can affect only the body; hence there can be no mental disease.

2. “Mental illness” is a metaphor. Minds can be “sick” only in the sense that jokes are “sick” or economies are “sick”.

3. Psychiatric diagnoses are stigmatizing labels, phrased to resemble medical diagnoses and applied to persons whose behavior annoys or offends others.

4. Those who suffer from and complain of their own behavior are usually classified as “neurotic”; those whose behavior makes others suffer, and about whom others complain, are usually classified as “psychotic”.

5. Mental illness is not something a person has, but is something he does or is.

6. If there is no mental illness there can be no hospitalization, treatment, or cure for it. Of course, people may change their behavior or personality, with or without psychiatric intervention. Such intervention is nowadays called “treatment”, and the change, if it proceeds in a direction approved by society, “recovery” or “cure”.

7. The introduction of psychiatric considerations into the administration of the criminal law–for example, the insanity plea and verdict, diagnoses of mental incompetence to stand trial, and so forth–corrupt the law and victimize the subject on whose behalf they are ostensibly employed.

8. Personal conduct is always rule-following, strategic, and meaningful. Patterns of interpersonal and social relations may be regarded and analyzed as if they were games, the behavior of the players being governed by explicit or tacit game rules.

9. In most types of voluntary psychotherapy, the therapist tries to elucidate the inexplicit game rules by which the client conducts himself; and to help the client scrutinize the goals and values of the life games he plays.

10. There is no medical, moral, or legal justification for involuntary psychiatric interventions. They are crimes against humanity.

The Transsexual Empire

Szasz was one of the most enthusiastic supporters of Janice Raymond’s book The Transsexual Empire and the political backlash that followed. In a review for The New York Times, Szasz called Raymond’s book “flawless” and reiterated nearly every key transphobic talking point from 1979.

  • Szasz compares trans surgeries to cutting off a limb or reattaching a foreskin, and says “transsexual” is akin to calling an old person who wants to be young “transchronological” or a poor person desiring wealth “transeconomical.” Szasz echoes Raymond’s claims that “such operations reiterate and reinforce traditional patriarchal sex-role expectations and stereotypes.”
  • Szasz claims “transsexual propagandists” use the phrase “a woman trapped in a man’s body” as the standard rhetorical form of this claim.
  • The 1979 flashpoint was trans athletes because of Renee Richards’ foray into tennis.
  • Selected passages:
    • “‘Transsexualism’ as a disease comes down to the strategic abuse of language —epitomized by confusing and equating biological phenomena with social roles (in the present case, chromosomal sexual identity with acting as a man or a woman).”
    • “The ‘transsexual empire’ is thus a Trojan horse in the battle between the sexes, helping men to seduce unsuspecting women, or women who ought to know better, to join forces with their oppressors.”
    • “What makes transsexual surgery a male-supremacist obscenity is the fact that transsexing surgeons do not perform the operation on all clients (just for the money) but insist that the client prove that he can ‘pass‘ as a woman.”

Selected publications

Szasz TS (1974). The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Harper & Row; Revised edition ISBN 978-0060141967

  • Szasz began working on this book in 1954 following several papers questioning accepted wisdom in psychiatry. The manuscript was initially rejected.
  • The original version under this title appeared as Szasz TS (1960.) The Myth of Mental Illness. American Psychologist15, 113-118. [PDF]
  • Paul B. Hoeber, Jr. (October 11, 1914–April 28, 1991), whose father also directed the medical division of Harper & Brothers, published the original trade paperback in 1961 under the Hoeber-Harper imprint.
  • A 1961 trade paperback with a cover by Allegro was also published by Delta Book/Dell Publishing Co., Inc., New York.
  • The version that included Szasz’s summary of the book appeared in the 1974 Revised edition [PDF]

Szasz TS (June 10, 1979). Male and female created he them. [review of The Transsexual Empire: The Making Of The She-Male by Janice G. Raymond]. New York Times Book Review. 11, 39. Reprinted in The Therapeutic State (1984) [PDF]

Szasz TS (1980, revised 1990). Sex By Prescription: The Startling Truth about Today’s Sex Therapy. Syracuse University Press


Marianai, John (September 12, 2012). Thomas Szasz, Manlius psychiatrist who disputed existence of mental illness, dies at 92. Syracuse Post-Standard

Zagria (October 2009). Thomas Szasz (1920 – 2012) psychiatry professor. A Gender Variance Who’s Who

Carey, Benedict (September 11, 2012). Dr. Thomas Szasz, Psychiatrist Who Led Movement Against His Field, Dies at 92. New York Times


The Thomas S. Szasz, M.D. Cybercenter for Liberty and Responsibility (

Syracuse University Libraries (

SUNY Upstate Medical University (

Thomas Stephen Szasz (

  • Für Freiheit und Verantwortung [For Freedom and Responsibility]
  • Publikationsliste [Publication list]

Citizens Commission on Human Rights (

Wikipedia (