Identity Construction and Cultural Madness

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From the Harvard University Press Blog:

It sometimes seems as if each day brings a new raft of articles proclaiming yet another biological or genetic explanation for human behavior and activity. To Liah Greenfeld, that barrage is just a new bubble, and in Mind, Modernity, Madness: The Impact of Culture on Human Experience, she does her best to burst it. While not entirely dismissing biological factors in mental illness, Greenfeld argues that the phenomenon that was for a long time called simply “madness”—today’s schizophrenia, bipolar disorder, and major depression—is actually a symptom of modernity, an effect of our cultural environment.   Continue reading →

“What Do You Want to Be When You Grow Up?”

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Shane Koyczan, in his March 2013 TED Talk (HT Farnam Street Blog):

I hid my heart under the bed because my mother said if your not careful someday someone’s gonna break it. Take it from me, under the bed is not a good hiding spot. I know because I’ve been shot down so many times I get altitude sickness just from standing up for myself. But that’s what we were told, stand up for yourself. That’s hard to do if you don’t know who you are. We are expected to define ourselves at such an early age, and if we didn’t do it, others did it for us. Geek. Fatty. Slut. Fag.

And at the same time we were being told what we were, we were being asked, “What do you want to be when you grow up?” I always thought that was an unfair question. It presupposes that we can’t be what we already are. We were kids. … They asked me what I wanted to be then told me what not to be. … I was being told to accept the identity that others will give me.

Liah Greenfeld in Mind, Modernity, Madness:

Why do the secular focus of nationalism and the two principles embodied in the society constructed on its basis lead to madness–or schizophrenia and manic-depressive illness? All three of these features place the individual in control of his or her destiny, eliminating the expectation of putting things right in the afterlife, making one the ultimate authority in deciding on one’s priorities, encouraging one to strive for a higher social status (since one is presumed to be equal to everyone, but one wants to be equal only to those who are superior) and giving one the right to choose one’s social position (since the presumption of fundamental equality makes everyone interchangeable) and therefore identity. But this very liberty, implied in nationalism, both empowering and encouraging the individual to choose what to be–in contrast to all the religious pre-national societies, in which no one was asked “what do you want to be when you grow up?” since one was whatever one was born–makes the formation of the individual identity problematic, and the more so the more choices for the definition of one’s identity a society offers and the more insistent it is on equality. A clear sense of identity being a condition sine qua non for adequate mental functioning, malformation of identity leads to mental disease, but modern culture cannot help the individual to acquire such clear sense, it is inherently confusing. This cultural insufficiency–the inability of a culture to provide individuals within it with consistent guidance–was named anomie by Durkheim.

Though realized in vastly different ways (depending on the manner in which this form of consciousness developed in a particular society), the three principles of nationalism–secularism, egalitarianism, and popular sovereignty–affect the formation of the individual identity in nations necessarily. A member of a nation can no longer learn who or what s/he is from the environment, as would an individual growing up in an essentially religious and rigidly stratified, non-egalitarian order, where everyone’s position and behavior are defined by birth and divine providence. Beyond the very general category of nationality, a modern individual must decide what s/he is and should do, and thus construct one’s identity oneself. Schizophrenia and depressive (bipolar and unipolar) illnesses, I argue, are caused specifically by the values of equality and self-realization, which make every individual one’s own maker–and the rates of such mental disease increase in accordance with the extent to which a particular society is devoted to these values, inherent in the nationalist image of reality, i.e., in the national consciousness, and the scope allowed to the freedom of choice in it. This turns the prevailing view of the mental diseases in question upside down.

Understanding Schizophrenia

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From “Throughout History, Defining Schizophrenia Has Remained a Challenge [Timeline]” in Scientific American Mind:

Less than two hundred years ago, schizophrenia emerged from a tangle of mental disorders known simply as madness. Yet its diagnosis remains shrouded in ambiguity. Only now is the Diagnostics and Statistical Manual of Mental Disorders, psychiatrists’ primary guidebook, shedding the outdated, nineteenth-century descriptions that have characterized schizophrenia to this day. “There is substantial dissatisfaction with schizophrenia treated as a disease entity, it’s symptoms are like a fever—something is wrong but we don’t know what,” says William Carpenter, a psychiatrist at the University of Maryland and chair of the manual’s Psychotic Disorder Workgroup. Psychiatrists may discover that this disorder is not a single syndrome after all but a bundle of overlapping conditions.

Liah Greenfeld in “Madness in its Pure Form,” Chapter 3 in Mind, Modernity, Madness:

The root of the schizophrenic experience, from the earliest stages and throughout the episode, is the problem with the self, specifically the acting self: the dissolution of the will. The difference between the early, middle, acutely psychotic, and elaborate delusional stages for the patient consists in that, during the prodrome, the loss of the acting self is experienced indirectly, through changed experience of the outside world, becoming more and more direct through the middle stages, culminating in the sense of the loss of the mind (and both relationally-constituted self and the thinking self) in the stage of acute psychosis, and continuing in a partial restitution of identity and the thinking self, or the reconstruction of the self-in-the-world in the elaborate delusion. The structure of self-consciousness or the “I of Descartes” is involved at every stage in the disease process, but it changes its function from that of the thinking self to the one of the “eye of an external observer” and back, or, in other words, transforms from the part of the mind (individualized culture) to culture in general and back, confusing the levels of the mental and symbolic process. The different phases or stages of the illness, obviously, cannot be strictly separated but seamlessly flow and transmogrify one into another.

I would like to draw the reader’s attention to two points. 1. Seen in this light, as a mental, rather than a brain, disease, as the disorder of the mind, and therefore, a cultural phenomenon, schizophrenia appears to be of a piece. All of its symptoms (however contradictory they may seem when seen in other frameworks) can be accounted for by the loss of the acting self and related to each other through this overarching relationship to the impairment of the will. One is no longer forced to consider the extreme variability of abnormalities to be the single invariable characteristic of schizophrenia. There is, after all, an organizing principle which makes it possible to integrate all of its features into an understandable whole. 2. To arrive at this interpretation of schizophrenia and depict its underlying psychological structure, there was no need to step outside the theory of the healthy mind as outlined in Chapter 2, “The Mind as an Emergent Phenomenon.” No abnormality was interpreted ad hoc, proving the sufficiency of this theory. The analysis of schizophrenia, it is possible to claim, provides a strong support for its hypotheses regarding the structure of the mind.

It still remains to us, of course, to explain schizophrenia causally. As was stated in the Introduction, the explanation I propose is that modern society, based on the principles of nationalism, is profoundly anomic and, as such, makes the formation of identity (the relationally constituted self) problematic. Malformed identity, in turn, necessarily impairs the will. This hypothesis will be tested in two stages: first, through an examination of a well-documented contemporary case (the case of John Nash) and then, much more thoroughly, on the basis of comparative-historical analysis of the development of relevant aspects of the modern culture.

Mind vs. Matter or Matter, Life, and Mind as 3 Autonomous but Related Layers of Reality?

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Marcelo Gleiser in “Mind And Matter: Confessions Of A Perplexed Soul” on the NPR blog 13.7 Cosmos and Culture:

To facilitate things, let’s say that mind is a faculty that conscious, intelligent beings have, the ability to think, feel and reflect about the world and the subjective experiences it presents. It is then legitimate to ask whether other animals have minds or whether machines can one day have them too. This is a key aspect of the debate, since the mind-body problem has traditionally split the line between two sides: Mind is a property of brains that reach a certain level of cognitive complexity and hence a state of matter; or mind is not matter — it is something that can’t be reduced to how the brain works.

Of course, this kind of mind-matter dualism dates back at least to Descartes, something that nowadays is mostly not seriously considered, at least by cognitive neuroscientists. …

What we call the world happens inside our brains, teased from the outside or from the inside. (Dreams are worlds within, with arbitrary physical laws and narrative rules.) A key question to be answered is whether consciousness needs organic matter to sustain it or whether it can exist merely through electronic circuits. Of course, we all like to think that circuits will do it, that it is a matter of time before we build an intelligent, conscious machine. But we don’t really know whether that’s even possible, do we?

Liah Greenfeld in Chapter 1, “Premises,” of Mind, Modernity, Madness:

…the recognition of the tremendous world of life as an emergent phenomenon proves that such improbable new autonomous worlds are possible. And this, in turn, suggests that experiential reality which is conceived of since the beginning of the Western philosophical tradition as having only two aspects, the real or material and the ideal or spiritual (both or only one of which may be considered essential and autonomous), may be approached from an altogether different perspective. Reality may be imagined as consisting of three autonomous but related layers, with the two upper ones being emergent phenomena — the layer of matter, the layer of life, and the layer of the mind. This opens the way to the scientific investigation of the mind.

 

On DSM-V and the Diagnosis of Mental Illness

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Allen Frances in “Diagnosing the D.S.M.,” The New York Times

…the D.S.M. is the victim of its own success and is accorded the authority of a bible in areas well beyond its competence. It has become the arbiter of who is ill and who is not — and often the primary determinant of treatment decisions, insurance eligibility, disability payments and who gets special school services. D.S.M. drives the direction of research and the approval of new drugs. It is widely used (and misused) in the courts… Psychiatric diagnosis is simply too important to be left exclusively in the hands of psychiatrists. They will always be an essential part of the mix but should no longer be permitted to call all the shots.

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Mind, Brain, and Mental Illness

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Andrew Brown in “Depression is not a ‘brain disorder‘” in The Guardian

The mind is not just some decorative pattern read off the brain and mistaken for the real thing. Consciousness is not just the whistle on the steam train, as William James put it. Treating unhappiness as a problem in the brain is good for the profits of drug companies, but doesn’t actually make us all happier in the long run.

To say that the mind depends on the brain is easy enough – and true, so far as we know. But that doesn’t mean that they are the same thing, or that understanding the one will supply a sufficient understanding of the other. Talking about depression as a brain disease is a warning sign that someone has their ideas all wrong – and that’s not a problem with their brain.

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The Psychology of Terrorism

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John M. Grohol, founder and editor-in-chief of PsychCentral, writes in “The Psychology of Terrorism“:

“Arie Kruglanski PhD, co-director of the National Consortium for the Study of Terrorism and Responses to Terrorism (START), conducted a study that surveyed thousands of people in 15 countries. In the yet-unpublished research, he found that ‘Muslims who have a more collectivistic mentality are more likely to support terrorist attacks against Americans than those with more individualistic leanings. The research also found that the lower people’s reported personal success in life, the greater their tendency to endorse collectivistic ideas and to support attacks against Americans. The findings suggest that joining terrorist groups may confer a sense of security and meaning that people do not feel as individuals.’ …     Continue reading →

Biological Psychiatry, Psychodynamic Psychiatry, and a New Approach to Understanding Mental Illness

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In Psychiatric Times, Dr. James Knoll IV writes in “The Humanities and Psychiatry: The Rebirth of Mind“:

What place do the humanities have in psychiatry? One might as well ask: What place does the mind have in the brain? What place does clinical experience have in medicine? What is the utility of the empty space within the vessel?…  In this article, I focus on the importance of the humanities to psychiatry, via the perennial conflict between biological psychiatry and psychodynamically oriented psychiatry. I hope to use a humanist approach to show that these “two cultures” depend on each other for balanced progress in the field…

Biological psychiatry has made truly impressive progress, yet it remains the case in 2013 that “biological psychiatrists do not hold the panacea for serious mental disorders,”particularly when standing on the lone pillar of science. The art of medicine remains a critical foundational structure in psychiatry, and both pillars are necessary for the stability of the field. One might say that the humanities and/or psychoanalytic thought helps provide science with the relevant questions on which to focus its “piecemeal work.”Put another way: the humanities provide the wonder, which science then illuminates.

It is sometimes the case that older theories are not proved false—rather, the very progress they contributed to now shows their limits.

In Mind, Modernity, Madness: The Impact of Culture on Human Experience, Liah Greenfeld writes:

Today we know an awful lot about schizophrenia and manic-depressive illness. An enormous amount of information has been collected about the psychological and biological expressions of these diseases — about the personal experience and outward behaviors corresponding to them, the anatomical abnormalities which show themselves in certain groups of patients and neurochemical dynamics characteristic of others — about patterns of their transmission in families and certain genetic elements involved. But this information refuses to combine into a “case” — an explanatory argument based on the available evidence: there are gaping lacunae where pieces of the puzzle are supposed to dovetail; and none of the things we know can be said to constitute the smoking gun. We still do not know what causes these diseases and thus cannot either understand their nature or cure them. After two hundred years neither of the two approaches — the biological and the psychodynamic — in which psychiatry put its hopes brought these understanding and cure any closer. Therefore, I feel justified to offer a new – radically different — approach that has never been tried.

The historical recency, the timing of the spread in different societies, and the increase in the rates of mental disease of unknown etiology indicates that it cannot be understood in terms of any universal, biological or psychological, propensity of human nature, or explained by the characteristics of the individual human organism or personality as such. The observable trends (however incredible) pertain to and distinguish between specific societies and historical periods, and therefore must be accounted for historically. …

My intention is not to prove either the biological or the psychodynamic approach to mental disease wrong, but to complement them, adding to psychiatry a necessary element which has been heretofore missing. All the findings of the biological research, specifically, should be consistent with the approach I propose and, in cases they are not, the fault would lie with the approach rather than the findings. Culture, personality, and biology are different, but not mutually exclusive realities, and for this reason cultural, psychological, and biological arguments should not be mutually exclusive.