Why madness is rampant
Reviewed by Michael Strong
Is mental illness caused by the freedom bestowed on us by modernity? Liah Greenfeld, a social-science professor at Boston University, argues in this scholarly study that in the modern world, the expectation that each of us be the author of our own destiny has indeed resulted in a historically unprecedented epidemic of mental illness.
Traditional cultures, by contrast, defined our personal roles in life by the family and socioeconomic group into which we were born. In religious cultures, there was a socially sanctioned transcendent realm beyond our ken, and our lives were largely subject to the rules of that realm as defined by its earthly interpreters. But modernity brought a new kind of culture in which individual effort based on one’s personal identity became the cultural norm. According to Greenfeld, modern “mental illness” arose for the first time, as well.
The author is careful to differentiate some kinds of madness that have always been with us, such as the dementia of the elderly, from the “big three”: major depression, bipolar disorder, and schizophrenia. It is these forms of madness that she regards as the collateral damage of our new-found opportunity to be autonomous beings.
Greenfeld takes issue with the current view that mental illness will be treatable as soon as we find the biological cause that will then be corrected by the right drugs. While she acknowledges that there are biological and genetic factors that predispose us to madness, she rejects them as causal factors. Medications currently used to “treat” emotional disorders may ameliorate the symptoms, but they do not address the causes, as Sigmund Freud famously insisted.
She then makes a compelling case that how we construct meaning and identity in our lives is a significant causal factor in madness. Insofar as mental diseases like schizophrenia are caused by the struggle with self-definition in open modern societies, drugs will never be a wholly adequate approach.
Three cases of mental illness are analyzed in fascinating detail: James Matthews, subject of the first clinical record of schizophrenic delusion, published in 1810; Nobel Prize-winning mathematician John Nash, subject of the book and film A Beautiful Mind; and Kay Jamison, an eminent psychiatrist and author of the autobiographical memoir An Unquiet Mind. Greenfeld applies her analysis of identify formation to each of their clinical histories, showing how specific life events would naturally result in mental disorders that each of them experienced.
There is no returning to an unfree world, even if that were desirable. But if the thesis of Mind, Modernity, Madness is valid, we ought to focus on the impact of identity-formation on mental illness as much as we focus on pharmaceutical remedies.