The brain is an organ — like the bones, liver, kidney, and so on — and of course can be diseased. That's the domain of neurology. Since a mind is not a bodily organ, it cannot be diseased, except in a metaphorical sense — in the sense in which we also say that a joke is sick or the economy is sick. Those are metaphorical ways of saying that some behavior or condition is bad, disapproved, causing unhappiness, etc. In other words, talking about "sick minds" is analogous to talking about "sick jokes" or "sick economies." In the case of mental illness, we are dealing with a metaphorical way of expressing the view that the speaker thinks there is something wrong about the behavior of the person to whom he attributes the "illness."

In short, just as there were no witches, only women disapproved and called "witches," so there are no mental diseases, only behaviors of which psychiatrists disapprove and call them "mental illnesses." Let's say a person has a fear of going out into the open. Psychiatrists call that "agoraphobia" and claim it is an illness. Or if a person has odd ideas or perceptions, psychiatrists say he has "delusions" or "hallucinations." Or he uses illegal drugs or commits mass murder. These are all instances of behaviors, not diseases. Nearly everything I say about psychiatry follows from that.

Objective, medical diagnostic tests measure chemical and physical changes in tissues; they do not evaluate or judge ideas or behaviors. Before there were sophisticated diagnostic tests, physicians had a hard time distinguishing between real epilepsy — that is to say, neurological seizures — and what we call "hysterical seizures," which is simply faking epilepsy, pretending to have a seizure. When epilepsy became understood as due to an increased excitability of some area of the brain, then it ceased to be psychopathology or mental illness, and became neuropathology or brain disease. It then becomes a part of neurology. Epilepsy still exists. Neurosyphilis, though very rare, still exists, and is not treated by psychiatrists; it is treated by specialists in infectious diseases, because it's an infection of the brain.

The discovery that all mental diseases are brain diseases would mean the disappearance of psychiatry into neurology. But that would mean that a condition would be a "mental disease" only if it could be demonstrated, by objective tests, that a person has got it, or has not got it. You can prove — objectively, not by making a "clinical diagnosis" — that X has neurosyphilis or does not have it; but you cannot prove, objectively, that X has or does not have schizophrenia or "clinical depression" or post traumatic stress disorder. Like most nouns and verbs, the word "disease" will always be used both literally and metaphorically. As long as psychiatrists are unwilling to fix the literal meaning of mental illness to an objective standard, there will remain no way of distinguishing between literal and metaphorical "mental diseases."

Let me mention another, closely related characteristic of psychiatry, as distinct from the rest of medicine. Only in psychiatry are there "patients" who don't want to be patients. This is crucial because my critique of psychiatry is two-pronged. One of my criticisms is conceptual: that is, that mental illness is not a real illness. The other one is political: that is, that mental illness is a piece of justificatory rhetoric, legitimizing civil commitment and the insanity defense. Dermatologists, ophthalmologists, gynecologists, don't have any patients who don't want to be their patients. But the psychiatrists' patients are paradigmatically involuntarily.

Originally, all mental patients were involuntary, state hospital patients. That concept, that phenomenon, still forms the nucleus of psychiatry. And that is what is basically wrong with psychiatry. In my view, involuntary hospitalization and the insanity defense ought to be abolished, exactly as slavery was abolished, or the disfranchisement of women was abolished, or the persecution of homosexuals was abolished. Only then could we begin to examine so-called "mental illnesses" as forms of behavior, like other behaviors.

That's correct. There are voluntary psychiatric exchanges, at least in principle. As I like to say, I wholeheartedly approve of psychiatric acts between consenting adults. But such acts are pseudo-medical in nature, because the problem at hand is not medical, and also because the transaction often rests on taking advantage of the criminalization of the free market in drugs. Why do you have to go to a doctor to get a sleeping pill or a tranquilizer? A hundred years ago you didn't have to do that, you could go to a drug store, or to Sears Roebuck, and buy all the drugs you wanted — opium, heroin, chloral hydrate. In certain ways, the psychiatric profession lives off the fact that only physicians can prescribe drugs, and the government has made most drugs that people want prescription drugs.

As for insomnia, typically that's a complaint, an indirect communication, to obtain sleeping pills. A person can't go to a physician and tell him: Please write me a prescription for a barbiturate. If he did that, he would be diagnosed and denounced as an addict. So he must say: "I can't sleep." How could the doctor know if that's true?

The important issue is not the "medical model," a badly abused term; the issue is the "pediatric model," the "irresponsibility model" — treating people labeled as mentally ill as if they were little children and as if the psychiatrist was their parent. The pillars of psychiatry are medically rationalized and judicially legitimized coercions and excuses.

Now, in term of political philosophy, libertarianism is what, in the 19th century, was called liberalism. Nowadays it's sometimes also called "classical liberalism." It's a political ideology that views the state as an apparatus with a monopoly on the legitimate use of force and hence a danger to individual liberty. Contrariwise, the modern "Liberal" view regards the state as a protector, a benevolent parent who provides security for its citizens as quasi-children. To me, being a libertarian means regarding people as adults, responsible for their behavior; expecting them to support themselves, instead of being supported by the government; expecting them to pay for what they want, instead of getting it from doctors or the state because they need it; it's the old Jeffersonian idea that he who governs least, governs best. The law should protect people in their rights to life, liberty, and property — from other people who want to deprive them of these goods. The law should not protect people from themselves.

This means that, as far as possible, medical care ought to be distributed, economically speaking, as a personal service in the free market. There is much wisdom in the adage, "People pay for what they value, and value what they pay for." It's dangerous to depart too far from this principle.

Let me elaborate on this. Economists and epidemiologist have shown, beyond a shadow of a doubt, that the two variables that correlate most closely with good health are the right to property and individual liberty — the free market. The people who enjoy the best health today are people in the Western capitalist countries and in Japan; and those in the poorest health are the people who enjoyed the blessings of 80 years of paternalistic statist, Communism. In the Soviet Union, where people's political liberty and economic well being were systematically undermined by the state — where they enjoyed "equal misery for all" — life expectancy dropped from more than 70 years to about 55 years. During the same period, in advanced countries, it increased steadily and is now almost 80. And medical care has little to do with it, since Russia had access to medical science and technology. It's primarily a matter of life style — of what used to be called good habits versus bad habits. And of good public health, in the sense of having a safe physical environment.

The proper analogies to psychotherapy are not medical treatment but marriage or raising children. How should a man relate to his wife, and vice versa? How do you raise your child? Different people relate differently to their wives or husbands or children. As long as their life style works for them, that's all there is to it. So, first I say that I believe that any kind of so-called "therapy" — any kind of human helping situation that makes sense to both participants and that can be entered and exited and conducted wholly consensually, voluntary, and that is devoid of force and fraud — any and all of that is, by definition, helpful. If it were not helpful, the client wouldn't come and pay for it. The fact that a client returns and pays for what he gets from a therapist is, prima facie evidence for me, that he finds it helpful.

I would compare it, once again, to religion, to going to church. Personally, I'm not religious. But I respect religions and people who find solace in their faith. Millions of persons the world over continue to go to church. They wouldn't be going to church if they didn't find it helpful, assuming they're not just going for purely social reasons, in which case they still find it useful, though not for strictly theological reasons.

It was crucial that my patients selected themselves. They came when they wanted; they came to see me, because they wanted to see me, not someone else. And there wasn't any of this business about being "ready" to end therapy. Just as the patient decided when or whether to begin therapy, so he decided when or whether to end therapy. There isn't any of this business that the therapist has to change the patient, or make him better, or control his behavior, or protect him from himself, and so forth. It is up to the patient to change himself. The therapist's job is to help him change in the direction in which the patient wants to change, provided that's acceptable to the therapist. If it's not acceptable, then it is therapist's job to discuss that with the patient and end the relationship.

What can you do? Nothing. We have managed to make the free practice of psychotherapy de facto illegal! The psychotherapist has been transformed into a reporting agent, an agent of the state whose job is to betray his patient. Child abuse, drug abuse, violence, suicide — the therapist must stop, must prevent, all these things. The therapist must be a policeman pretending to be therapist. Increasingly, people complain about one or another of these "problems of confidentiality," but they don't see the larger picture. They don't see that this has to do with the alliance of psychiatry and psychotherapy with the state, replicating the alliance of church and state and all its implications.

Modern psychotherapy is based on psychoanalysis, and the psychoanalytic relationship was based on the relationship between priest and penitent in the confessional. The crux of the confessional is self-accusation on the part of the penitent, and the secure promise, by the priest, that the confession he hears will and can have no consequences for the self-accuser in this world (but only in the next). A priest hearing confession and working as a spy for the state would be a moral obscenity. Not in the darkest days of totalitarianism did such a thing occur.

The same thing is true for psychotherapy based on confidentiality and on the premise that the patient "accuses" himself in the hope that, by so doing and with the help of the therapist, he might be able to change himself. What is truly ugly about psychotherapy today is that many patients labor under the false belief that what they say to the therapist is confidential, and that therapists do not tell patients, up front, that if they utter certain thought and words, the therapist will report them to the appropriate authorities, they may be deprived of liberty, of their job, of their good names, and so forth.

Now, it should be clear that to place psychotherapy under the control of an insurance company or the state — that's just heaping nonsense upon nonsense. We can still call it psychotherapy, and we can treat it as if doing psychotherapy, "curing souls," were in principle no different from doing orthopedic surgery, setting a fractured bone. But, psychotherapy is like going to church. You go there voluntarily for a certain kind of service from a certain person. And it's spiritual. It's not physical.