Comment on Szasz' "Pharmacracy"

Jacob Sullum, senior editor at Reason Magazine, reviewed a new book by Thomas Szasz, staunch libertarian and longtime radical critic of psychiatry.  In the letter below, published in the April, 2003 edition, I seek to correct Szasz' idea that there's a conflict between a scientific understanding of behavior on the one hand and choice and responsibility on the other.

Letter to Reason


Reason Magazine 

To the Editor:

Quoted in Jacob Sullum’s review of Pharmacracy: Medicine and Politics in America, Thomas Szasz writes that “Attributing mental illnesses, such as addiction and panic disorder, to biological alterations occurring at a ‘subcellular level’ is a parody of the denial of free will, choice, and responsibility".

Extensive research into the brain’s neuroadaptation to drugs shows that at least part of the explanation of addiction lies at the subcellular level.  Dependence, tolerance, and craving for nicotine, alcohol, and other drugs are a function of changes, brought about by substance use, in the number and responsiveness of neurotransmitter binding sites in various brain systems regulating behavior.1  More generally, any scientifically sound and complete explanation of addictive behavior or other disorders, whether at the subcellular, neural, or personal levels,2 must perforce involve the denial of free will,3 since free will (at least in the libertarian sense of an uncaused chooser) is precisely that which can’t be explained by causal analysis.

In order to defend free will, Szasz and others wedded to the notion of libertarian freedom must hold that science can’t fully explain human behavior: that we are in some deep sense causally privileged over the rest of nature.  However, there is no evidence for such causal exceptionalism, only the traditional supposition that in order to hold people responsible, they must be ultimately self-caused in some respect.  But this supposition too is increasingly being called into question, as it becomes clear that moral and criminal responsibility can be reconceived as necessary guides to behavior for rational but nevertheless fully determined agents.4, 5, 6, 7  Holding people responsible helps to create good choices.

A complete scientific explanation of addiction and other disorders, therefore, need not be forsworn in favor of choice and responsibility, since these turn out to be entirely compatible with causality.8  Admitting we are not exceptions to nature can only further the humanitarian mission of learning how and why we behave as we do, whether in sickness or in health.

Thomas W. Clark

Research Associate, Health and Addictions Research, Inc.


1. Blum, K., Cull, J. G., Braverman, E.R., Comings, D.E. (1996) Reward deficiency syndrome, American Scientist, V84, March –April, pp. 132-145.

2. Leshner, A.I. (2001) When the question is drug abuse and addiction, the answer is ‘all of the above’, NIDA Notes, V16 #2, pp. 3-4.

3. Clark, T. W. (1998) To help addicts, look beyond the fiction of free will, The Scientist, V12 #16.

4. Clark, T. W. (1998) Materialism and morality: the problem with Pinker, The Humanist, V58 #6.

5. Morse, S. J. (2002), “Guiding Goodness,” paper presented at the 2000 Congress of the International Academy of Law and Mental Health.

6. Pinker, S. (2002) The Blank Slate, chapter on “The Fear of Determinism,” Viking Press.

7. Flanagan, O. (2002) The Problem of the Soul, Basic Books.

8. Clark, T.W. (2002), Science and freedom, Free Inquiry, V 22 #2.

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