Category Archives: Mind Modernity Madness

The West’s Struggle for Mental Health

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By Liah Greenfeld

The Wall Street Journal, May 31, 2022

Since the 1990s, there has been talk of a mental-health epidemic in the U.S., particularly among young people. The mass shootings last month in Uvalde, Texas, and Buffalo, N.Y., carried out by 18-year-old gunmen, have heightened fears that something’s gone horribly wrong. But the problem isn’t new. American psychiatrists have been studying rates of functional mental illness, such as depressive disorders and schizophrenia, since the 1840s. These studies show that the ratio of those suffering from such diseases to the mentally healthy population has been consistently rising.

Ten years ago, based on the annual Healthy Minds study of college students, 1 in 5 college students was dealing with mental illness. Between 2013 and 2021, according to Healthy Minds, the share of U.S. college students affected by depression surged 135%. During the same period, the share of students afflicted by any psychiatric illness doubled to more than 40%. “America’s youth,” wrote journalist Neal Freyman in April, “are in the midst of a spiking mental health crisis, and public health experts are racing to identify the root causes before it gets even worse.”

They are right to race. Functional mental illness threatens society’s existence and lies behind its social, economic and political ills.

Functional mental illness has no cure. It can only be managed, for example, with lithium or Prozac. The effectiveness of such management depends on a patient’s rationality, but a symptom of the ailment is irrationality. The epidemic rates of mental illness, even if taken at the 2007 measurement of incidence among adults aged 18 to 54 as 20%, means that 1 in 5 American adults at any point in time are likely to be irrational. That is, their judgments would be erroneous and subjective, reflecting their psychological condition and not objective reality. If we consider the current rates among college students, or tomorrow’s elite, we might expect judgments about economic, military, political or social matters by 2 out of every 5 American decision makers soon to become unreliable.

By definition, functional mental illness is illness of unknown biological origins. The constant, systematic increase in its rates of incidence since the 1840s is proof that its origins are not biological. Yet, against all logic, mental-health research focuses exclusively on biology and doesn’t cast a wider explanatory net. The evidence points to a historical and cultural explanation of the increase in incidence rates. Specifically, it suggests that functional mental illness is a characteristic disease of prosperous and secure liberal democracies.

The more a society is dedicated to the value of equality and the more choices it offers for individual self-determination, the higher its rates of functional mental illness. These rates increase in parallel with the increase in the available occupational, geographical, religious, gender and lifestyle-related choices. This explains why, since the 1970s, the U.S. leads the world as the country most affected by functional mental illness, though other prosperous liberal democracies aren’t far behind. Before the 1970s, first place belonged to the U.K., which lost that ranking together with its empire and the dramatic contraction in the number of choices the nation offered its members as a result. In contrast, rates of functional mental illness in societies that are insecure, poor, inegalitarian or authoritarian are remarkably low. For decades, the World Psychiatric Association has pondered the “perennial puzzle” of the relative immunity to such illnesses in Southeast Asian countries.

Equality inevitably makes self-definition a matter of one’s own choice, and the formation of personal identity—necessary for mental health—becomes personal responsibility, a burden some people can’t shoulder. A relatively high rate of functional mental illness, expressing itself centrally in dissatisfaction with self and, therefore, social maladjustment, thus must be expected in democracies. But while high rates of mental illness are an old problem, the soaring rates of the recent decades aren’t explained by equality alone. They are related, in addition, to what happened to Western values, especially in the U.S., since the dissolution of the Soviet Union.

The disappearance of the West’s common opponent rendered individual identities in the West more confusing and dissatisfying. Having lost sight of what they, as a society, were against, millions of Westerners lost the sense of what they represented, rejecting common reference points, such as personal responsibility, which previously constituted the core of the self in the West. Virtues and vices, Soviet-style, came to be seen as characteristics of groups, significant social groupings were defined genetically, all personal discomfort was attributed to society, and the burden of responsibility was shifted off individual shoulders.

This change transformed the understanding of justice from one based on individual actions to one based on collective, biologically determined dispositions. It encouraged social maladjustment because people believing themselves decent were naturally uncomfortable in a society that wasn’t decent. And at the same time it trapped huge numbers within vicious, yet inescapable genetically determined identities. While solving the problem for some, this change in values accelerated the increase in rates of mental illness.

The tragedies in Uvalde and Buffalo underscore the urgency of addressing the mental-health crisis. Understanding its causes will help us do so.

Cherryleaf Library for Children

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CK1

For those of my friends, who have children in the pre-school – elementary school ages:

In Mind, Modernity, Madness I have written that, to arrest the ever-rising rates of functional mental illness in the United States, we would need to revamp our system of education, beginning from kindergarten. (As I am writing to my friends, I presume that you have read Mind, Modernity, Madness.) Onset is occurring earlier and earlier, so that mental disorder is common in middle school and in high school already rampant, and this means that the work of prevention, making children resistant to mental illness, has to begin at an age before the assault starts.

Since the agent of the disease in this case is cultural: the inability of modern – secular, egalitarian, and open – culture to provide large swaths of people with sufficient guidance for the formation of clear identity, the preparation and prevention must also be cultural: the intentional provision of such guidance to young children. To do so through the channels of the educational establishment would require the message of Mind, Modernity, Madness to achieve the status of self-evident truth – something that is evidently not happening right now and unlikely to happen in the near future, and for an entire generation of educators to be educated in its light and know how to help a child to form a clear identity.

The understanding of identity in our society is grossly underdeveloped and the vague ideas regarding it that exist are based precisely on the presuppositions that make the formation of identity in our society so problematic. The chief of these presuppositions, perhaps, is that each individual is born with an unchangeable identity – an essential self, which will, and must be allowed to, have an expression, for its repression condemns one to unhappiness and leads to mental disease. This presupposition encourages people to “discover” themselves, to do which they must focus on themselves, i.e., they are effectively educated to be self-centered. Alongside this presupposition of the essential individual self exists the contradictory idea of identity as the essential self of one’s biologically-defined group, racial (which, upon analysis, includes ethnicity) or sexual (which includes sexual orientation). This presupposition encourages the individual to discover in oneself the identity of one’s presumed group (which, of course, does in no way help one to develop a functioning identity, because it does not locate one in a clear position on the socio-cultural terrain) and to focus on the political defense of this group’s rights, specifically demanding that the group be treated in every respect equally with other groups. Paradoxically, the two presuppositions (of the essential individual self and of the essential biological group self) are combined in the popular consciousness and educational curricula reflecting this consciousness.

To combat this on the level of the educational establishment is beyond the powers of any individual or a small group of individuals. A revolution, a complete breakdown of the social order and the construction of a new one in its place, would be needed to effect the required change of thinking. The only way to help children to form functional identities (and identities are formed, not innate, reflecting some inner essence) and prevent their developing functional mental illness is to do so from the outside of the educational establishment. Children are raised in and by culture, a process consisting of numerous specific processes, interrelated in numerous distinctive ways: the family process, the educational establishment (institutional) process, religion, media, literature, and so on. Our culture, in general, does not offer us sufficient guidance in forming our identities, but some of its constituent processes do help. Formal educational institutions, that is, institutions specifically entrusted with the transmission of the dominant cultural messages, as might be expected, reinforce this cultural insufficiency and the family, which is all-important in the child’s early years, is quite likely to reflect it, because the parents are products of the culture themselves. But literature, for instance, the books we read to our children, when they are little, and books they start to read themselves, is far more heterogeneous. While most books in our bookstores would transmit dominant cultural messages (for instance, the two presuppositions inimical to the formation of a clear stable identity, mentioned above), there are some that can provide a counterweight to them. If organized into a systematic program and read at home from a very early age through kindergarten and elementary school (and, perhaps, in some kindergartens and elementary schools, where individual teachers would appreciate their benefits) such books could help children to form firm identities, which would in turn enable them to withstand the assault of contradictory messages of our secular, egalitarian, open (anomic) society and protect them from mental disease.

Books that can help in the process of identity formation in an anomic society do so in a way very different from societies that simply impose identities on people in them by limiting individual experience to a particular, very limited area on the cognitive map of the socio-cultural terrain. They do this, instead, by presenting one with the picture of human behaviors, probable in open societies, distinguishing (in the manner of presentation) between right and wrong, good and evil actions, and provoking sympathy with the suffering of others and antipathy towards those who cause this suffering. The confusing reality of contemporary society is simplified, presented, underneath apparent heterogeneity of observable behaviors, as the confrontation of good and evil, defined basically as kindness vs. cruelty (intentional causing of suffering), with other behaviors and attitudes ranged in between.

When one’s cognitive map of the socio-cultural terrain is drawn in these simple terms, being a good person becomes the core of one’s ideal identity – what one strives to be, the goal of one’s self-realization. One is encouraged to take advantage of the freedom and equality offered by the open society not to “discover,” but to “make” oneself, to cultivate one’s empathy (which presupposes focusing on others), to be actively kind, useful to those who are weaker, in need of help, and must be protected from suffering. Competitiveness, constant self-comparison to others, self-measurement against them in quantitative terms of relative achievement and virtue (do I have more or less money, accolades, professional success, intelligence, beauty, and so on, than x, y, z, to whom I should be equal) which are encouraged by the egalitarianism and freedom of the open anomic society, in turn encouraging envy, self-doubt, insecurity, sense of inferiority which contribute to social maladjustment and in so many cases ultimately lead to mental illness, fade into near-irrelevance. One’s identity-map is no longer the map of an endless race-track with oneself as one of the racers, constantly in danger of being left behind or overturned. It is no longer one’s comparison to others, but the calls for one’s help that determine one’s position on the map; wherever they come from on one’s socio-cultural terrain, there one gravitates, one’s conduct is oriented by these calls, by thinking about the needs of others.

This must appear too simplistic a characterization of the complex masterpieces of the 18th and especially 19th centuries, be it Dickens’s Great Expectations, Flaubert’s Madame Bovary, or Dostoyevsky’s Brothers Karamazov, and, of course, the message is more or less explicit even in different books by the same author. Such, nevertheless, is the common basic message of the great modern – psychological — novel, called into being by the need to make sense (for the authors, in the first place) of the secular, egalitarian, anomic society. All these novels treat of the provocations with which anomie of the open society presents to the individual, unanchored by a clear identity, all see mental illness as a constantly lurking danger. Depictions in black and white contrasts as in the “sensationalist” best-sellers of Wilkie Collins are not to be met among greater artists, whose novels are likely to focus on the behaviors of the middle range, eschewing absolute good and absolute evil. Still, they all advise: be guided by the understanding of fundamental right and wrong, focus on the world, not yourself, be kind, above all, and things may turn all right – at the very least, they won’t go horribly wrong: you won’t go mad.

Psychological novels of the 18th, 19th, and early 20th centuries, from Moll Flanders to An American Tragedy are a great antidote to the disorientation of the open egalitarian society and a very powerful educational tool. Whether encouraged at home or integrated into school curricula, this literature can be very helpful for young people trying to come to grips – and form their identity – in the baffling anomic world. This literature is rich and may provide emotional support for years. Unfortunately, it is not a preventative therapy, because it cannot be administered to pre-teenage children. Yet, it is among the pre-teens that defenses against anomie must be built.

Identity-formation-facilitating literature for young children, ages 3 to 12, where it is especially needed, is very sparse. In English, even if one includes translations, there is nothing of this nature for children under 6 or 7 years of age. Taking whatever exists into consideration, I set myself the goal of creating an English-language corpus of such identity-formation-supporting children’s literature, organized as a continuous stream of age-appropriate reading from stories to toddlers through older preschoolers, kindergarten, and to older elementary school children. Readings for 3-5-year-olds would have to be created, and I intend to use the work of the exceptional Russian writer Korney Chukovsky, who wrote for very young children, as the foundation for this segment. Chukovsky’s goal in writing was to cultivate in the child kindness (humane disposition) and empathy, “this marvelous ability to worry about other people’s misfortunes, to rejoice at other people’s joys, and to experience another person’s destiny as one’s own.”  He did not think that Russian children of the early 20th century needed aid in identity-formation, but his “tales” provided this aid nonetheless, while teaching the child to focus on others, not on oneself, and to consider being good, actively kind, to the defenseless and helpless as the most important quality of a person. In fact, Chukovsky’s tales are the only equivalent of modern psychological novel for very young children – at least, the only one which is relatively well-known. Even in Russian, which can boast of a very distinguished tradition of children’s literature, there is nothing else of the kind.

Having for over a century contributed to the upbringing of Russian, Soviet, and post-Soviet children (and served as a counterweight for literature faithfully expressing the social values and cultural presuppositions, dominant in each of these periods), Chukovsky’s tales have been translated into many languages. Even in English there are some translations. The problem is that in the original these tales are poems. While in the original text, reflecting the creative process in the mind of the author, prosody and content develop organically, mutually inspiring and reinforcing each other, in translation, the very desire to keep the rhymed form obscures the meaning of the tale and interferes with the delivery of its message. Therefore, instead of attempting another rhymed translation, I decided to re-tell Chukovsky’s tales in prose. I selected five of them that appeared to me most directly relevant to the project of assisting very young children in identity formation – preparing them to meet the challenges, while resisting the pressures, of our society, and immunizing them to some extent against mental disease. I hope to publish them as individual picture books, which would allow parents to read and re-read them to their children and children to leaf through them and let illustrations remind them of the story told for months. But securing a publisher may take a long time, and I would like to make the identity-formation-supporting literature for the very young available immediately. So, please, watch for Cherryleaf Library for Children on YouTube: I’ll read the tales on video as soon as I figure out how to do so.

Why Cherryleaf? In honor of my mother, Victoria Kirshenblat (Kirschenblatt = Cherryleaf), who was an exceptionally good person, actively kind under all circumstances, daily diminishing suffering wherever she found it – among people and animals alike. She was a pediatrician by the grace of God, an extraordinary children’s doctor. For decades she had patients whose parents were her patients; by the end of her working life, she had patients whose grandparents were her patients. While in medical school, she thought of becoming a psychiatrist. So she was acutely aware of the realities of mental disease. She would certainly support this new undertaking of mine, and I prefer it to be associated with her name, rather than with mine: “Professor Greenfeld” would mean nothing to children and nothing but an imposition of academic authority to their parents.

I also intend to start reading books for the slightly older, 6-year-old+ children, beginning with “Nobody’s Boy” by Hector Malot. This is one of the tiny identity-formation-assisting corpus of literature for this age-group that I mentioned. It is available in English, but is quite unknown, and reading it aloud online, I believe, would attract more attention to it than simply recommending it. So please watch for the Cherryleaf Library podcast.

Liah Greenfeld

Review of Mind, Modernity, Madness in American Journal of Sociology

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By Karen A. Cerulo, Rutgers University

Mind, Modernity, and Madness is the final installment in a trilogy of books penned by sociologist Liah Greenfeld. The projects were conceived as vehicles to help us better understand the political, economic, and psychological aspects of modern culture. Like her earlier books, Nationalism: Five Roads to Modernity (Harvard University Press, 1992) and The Spirit of Capitalism: Nationalism and Economic Growth (Harvard University Press, 2001), this is a substantial piece of writing, impeccably researched, ambitious in its execution, provocative and fresh in its approach.

Nearly all of Greenfeld’s works emanate from an interest in the culture of nationalism. In Mind, Modernity, and Madness, she links those concerns to the emergence of psychiatric disorders, particularly schizophrenia, manic depression, and bipolar disease. Unlike other recent books that suggest we must choose between biological and cultural etiologies of mental illness, Greenfeld argues that the two are intricately entwined and situated in the creation of nations. “It is obvious that the dramatic transformation in the image of reality,” she writes, stems from a consciousness imposed by nationalism,s three core characteristics: popular sovereignty, equality, and secularism; these elements “significantly affect the nature of the existential experience—the very way life is felt” (p. 3). And here lies the crux of Greenfeld’s thesis. From the days of its origins, nationalism has remade the notion of individual identity, putting the individual in the proverbial driver,s seat. In the world of nationalism, individuals are the ultimate decision makers, the architects of their destiny. This way of “feeling life” is, at once, empowering and overwhelming. Thus as biological predispositions to mental disease meet the pressure of self-authorship, the perfect storm ensues. In a very real and documentable way, the culture of nationalism drives some to the throes of madness.

Greenfeld builds her argument on a theoretical foundation that challenges long-standing conceptions of mind. She suggests that we replace dominant dualistic approaches in this realm—those that partition the material and the spiritual—and instead treat reality as a tripartite structure “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” (p. 58). As her argument unfolds, she focuses more specifically on the qualities of mind, identifying the biological elements from which mind grows and by which its development is constrained. She also explores the ways in which symbolic culture transforms and expands the biological mind, making it a far more complex and dynamic entity that reforms and reconfigures itself, ever emerging in relation to changing environmental events.

The most impressive contribution of the book comes in its historical chapters. Here, Greenfeld uses an extensive array of data to convincingly illustrate the nationalistically based roots of madness. With Greenfeld, we approach the historical starting line of 16th-century England; we sprint across nations and through time, over a terrain of literature and history, and into the minds of philosophers and psychiatrists. All roads lead to one empirically based conclusion. Greenfeld’s examples and explanations illustrate the ways in which both an opened social structure and the anomie born of multiple, often contradictory, cultural messages, make the formation of self-identity—the very thing that nationalism expects its inhabitants to produce—difficult for many and debilitating for some. Identity issues, argues Greenfeld, lead to collective malaise (at best), and for those who fail the challenges of identity formation, mental impairment, dysfunction, and derangement. In some ways, the book is not simply about madness, but about the costs and sufferings of the modern world. Moreover, it is a book about the future of nations. For in her provocative conclusion, Greenfeld asks us to reflect on the ways in which a madness born of nationalism becomes a mobilizing force, creating a politics of sheer ideology and shaping a destructive form of political action that is more therapeutic than productive.

If I were to identify any weakness in the book, it might be the author’s base for a cultural study of the mind. Greenfeld seems to ignore a strong sociological tradition in this arena, including both classic and contemporary works done by symbolic interactionists, social constructionists, sociologists of knowledge, ethnomethodologists, and sociolinguists. Weaving such works together with those of biologists, cognitive scientists, and philosophers would only have strengthened the foundation of the authors, arguments.

Still this fault is small in a book that is otherwise a tour de force. Indeed, this book will make a new and interesting contribution to the study of mental illness, the sociology of science and knowledge, and political and cultural sociology. It also presents a host of testable propositions that should be enthusiastically pursued by sociologists of culture and politics. Finally, the book provides stimulating material for graduate classes that address cultural or historical analysis. Indeed, Mind, Modernity, and Madness is the kind of book that remaps intellectual terrain, prodding us to rethink our conclusions and refocus our sights.

American Journal of Sociology, Vol. 119, No. 5 (March 2014), pp. 1527-1528

 

Review of Mind, Modernity, Madness in Barron’s

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Stormy Minds
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.

http://online.barrons.com/news/articles/SB50001424053111903506304579382811218816056

 

Review of Mind, Modernity, Madness in The American Journal of Psychiatry

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Is our culture, with one-fourth of adults mentally ill, devastating itself ? Greenfeld contends that it is.

The suicidal course of our species began when the emerging human larynx and brain facilitated speech 20,000 to 30,000 years ago. This transformation enabled a radical progression from articulating signs (an animal capacity) to articulating symbols. Unlike signs, symbols represented phenomena of which they were not part. Symbolic thinking begat the mind, com-posed of the brain plus ideas gleaned from culturally created environments. Minds became “individualized culture.”

Symbolic thought has yielded both boon and burden for the human species and its emerging mind. Logic and observation, the origins of science, comprise thought forms permitting contradiction. Much symbolic thinking consists of abstractions not liable to contradiction (e.g., shared religious and political beliefs, cultural norms and values) or liable to contradiction only if reduced to stark numbers. Symbolic thoughts, coalesced into systems, show varying consistency and thus are not wholly logical, coherent, or liable to contradiction. For better and worse, symbolic thinking can change suddenly, produce indecision arising from its own incongruities, and even veer from reality. Within the mind’s capacity for symbolism exist the seeds for disabling “madness” or “insanity.”

Next, Greenfeld cogently deconstructs notions of schizophrenia (“pure madness”) and manic depression (“muddled madness”). These key sections elucidate core material for the ensuing sections. They encompass psychiatric history, theory, epidemiology, descriptive psychopathology, and ethnopsychiatry, as well as germane aspects of history, economics, politics, and even theater.

For the remaining half of the book, Greenfeld expounds her thesis. Prior to the Renaissance, religious beliefs were widely shared, and sociopolitical organization was hierarchical. Status was ascribed rather than achieved. And insanity prevalence was low, albeit with special vulnerability among learned, politically elite, and artistic people. Beginning during the 17th and 18th centuries in England, insanity proliferated geometrically from prevalence rates of one in thousands to one in hundreds. In parallel, a modern statehood model (termed “nationalism”) appeared, marked by secularism, growing egalitarianism, social mobility from parent to offspring, rising literacy, novel occupations, university learning, passion, and romance. The first western mental institution appeared (Bedlam in London), followed by the steady evolution of psychiatry within medicine and insanity law within jurisprudence. From England, the insanity epidemic (along with its companion, suicide) spread across Europe and North America within a few centuries.

Numerous studies have shown insanity prevalence rates still growing steadily in the United States. For example, in 1987 one person in 184 received Social Security Disability for a psychiatric disorder; this number increased by 2.5 times to 1 person in 76 by 2007. National Institute of Mental Health-supported national surveys have shown current and life-time prevalence increases in recent decades, with increasing comorbid conditions. These figures proffer prime evidence for cultural causes of insanity and against narrow biogenetic causation generating steady rates over time. Biological processes fabricate insanity, but mind-borne culture precipitates these biological processes. Although hereditary factors affect vulnerability to insanity, extreme culture-bred pathogens can overcome hereditary hardiness and produce insanity. Like-wise, cultural compensations can counteract high hereditary vulnerability and prevent insanity.

Finally, psychiatrist-like, Greenfeld makes a diagnosis and prescribes an intervention for often-addled modern minds. She ascribes our insanity pandemic to “unstable identities” (Durkheim’s “anomie”) ensuing from minds weakened, immobilized, disabled, and ultimately deranged by the complexities of modern “nationalism.” For this malady, she prescribes educational interventions aimed at aiding students to cope with pathogens inherent within their challenging cultures and reflected in their emerging minds.

Greenfeld’s magnificent sweep of several fields leaves her discourse open to quibbles. Her education-based intervention would require clinical trials. Cultural interventions already known and practiced among community psychiatrists might reduce insanity, but they would also warrant research, greater efficiency, and wider implementation (e.g., employ-ment initiatives for all [1], producing self-aware citizens with greater stress resilience [2]). Cultural psychiatrists could elab-orate her “anomie,” which arises from depleted “intimate social networks” (3), pathogenic migrations (4), and discrep-ancies in actual versus ideal norms that wrench minds loose from their problem-solving proclivities (5). Further, substance disorders—which Greenfeld notes, but briefly—have accom-panied and increased insanity. Alcohol and opium epidemics also appeared in the 1600s and 1700s (6) and endure endlessly anew, as exemplified in our raging iatrogenic opioid epidemic. Regardless, these points support rather than dislodge Green-feld’s case. Most telling, her strong contentions overwhelm the brittle claims of biological determinism and alert culture brokers to their urgent tasks.

Those apt to gain most from Greenfeld’s remarkable tome are biological psychiatrists, legislators, and community leaders. Physicians, behavioral scientists, futurists, parents, and academicians will find the read exhilarating and useful. Cultural psychiatrists, ethnopsychiatric investigators, and psychiatric epidemiologists—those least apt to realize totally new understandings—will still find their comprehensions expanded in unanticipated ways.

References

1. Linn MW, Sandifer R, Stein S: Effects of unemployment on mental and physical health. Am J Public Health 1985; 75:502–506

2. Galambos NL, Barker ET, Almeida DM: Parents do matter: tra-jectories of change in externalizing and internalizing problems in early adolescence. Child Dev 2003; 74:578–594

3. Westermeyer J, Pattison EM: Social networks and mental illness in a peasant society. Schizophr Bull 1981; 7:125–134

4. Takeuchi DT, Zane N, Hong S, Chae DH, Gong F, Gee GC, Walton E, Sue S, Alegría M: Immigration-related factors and mental disor-ders among Asian Americans. Am J Public Health 2007; 97:84–90

5. Slonim-Nevo V, Sharaga Y, Mirsky J, Petrovsky V, Borodenko M: Ethnicity versus migration: two hypotheses about the psychoso-cial adjustment of immigrant adolescents. Int J Soc Psychiatry 2006; 52:41–53

6. Westermeyer J: The pursuit of intoxication: our 100 century-old romance with psychoactive substances. Am J Drug Alcohol Abuse 1988; 14:175–187

JOSEPH WESTERMEYER, M.D., M.P.H., PH.D.

Dr. Westermeyer is Staff Psychiatrist at the Minneapolis VA Health Care Center and Professor of Psychiatry and Adjunct Professor of Anthropology at the University of Minnesota, Minneapolis.

Review on the American Journal of Psychiatry Website

Review: Mind, Modernity, Madness by Liah Greenfeld

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Greenfeld’s book persuasively demonstrates the lack of consensus in the scientific community and beyond, over the causes, treatment and prevalence of schizophrenia and manic depression, both in America and worldwide. As this review is being prepared a new edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, is being released in the United States to some controversy. Liah Greenfeld’s call for a broader understanding of the role of culture in the growth of the illnesses of schizophrenia and manic depression seems perfectly timed to join the debate over the balance between science and culture in the diagnosis and treatment of these complex illnesses.

Catherine McKenna, MAKE

The Modern Mental Disease

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By Liah Greenfeld

Modern humans—that is, people who live in societies such as ours, democratic, prosperous, relatively secure, and offering its members numerous life-choices, people like you and me, in other words—are different from humans who lived or live in other types of societies. We experience life differently from them: perceive reality differently and feel emotions that other humans did not have.

Human experience was revolutionized in the 16th century England. In the previous posts we have already discussed such new emotions as ambition, love, happiness, and their connection to the new form of consciousness, which came to be called “nationalism” and formed the cultural framework of modernity. Nationalism implied a special image of society as a sovereign community of equal members (a “nation”) and of reality in general. In its original, English, form it was essentially democratic. As it spread, it carried the seeds of democracy everywhere. Considering a living community sovereign (the source of all laws), it implicitly but drastically reduced the relevance of God and, even when combined with religion and presented in a religious idiom, which happened often, was to all intents and purposes secular. It was dramatically different, in other words, from the fundamentally religious, hierarchical consciousness which it replaced, and it shaped the way we live today. Among other things, the new consciousness made the human individual one’s own maker: it implied we had the choice to decide what we want to be; it dramatically increased the value of human life, encouraging us to realize it to the fullest extent—in other words, it gave us dignity and freedom. The society built on its premises of equality and popular sovereignty was an open society, in which the individual had the right to define one’s own identity, a society which made one’s identity one’s own business.  It is not coincidental that the new emotions discussed in previous posts, which emerged when the English society was redefined as a “nation,” were in some way connected to the individual’s ability to define oneself and that the two great modern passions—ambition and love—in fact answered a new need which this ability created: the need for help in identity-formation.

Unfortunately all these benefits of nationalism—the dignity, freedom, and equality, both empowering and encouraging the individual to choose what to be – did not come unaccompanied by costs, and for all the enrichment of our life experience contributed by love and happiness, these costs would be impossible to disregard.  The liberty to define oneself has made the formation of the individual identity problematic. A member of a nation cannot 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.  Modern culture cannot provide individuals within it with consistent guidance, with which other cultures provide its members. By providing inconsistent guidance (for we are inevitably guided by our cultural environment), it in fact actively disorients us. Such cultural insufficiency is called anomie. Already over a century ago, it was recognized as the most dangerous problem of modernity. For many people, the necessity to construct one’s identity, to choose what to make of oneself, became an unbearable burden.

At the same time as the English society was redefined as a nation, and ambition, happiness, and love made their first appearances among our emotions, a special variety of mental illness, different from a multitude of mental illnesses known since antiquity, was first observed. It expressed itself in degrees of mental impairment, derangement, and dysfunction, the common symptoms of which were social maladjustment (chronic discomfort in one’s environment) and chronic discomfort (dis-ease) with one’s self, the sense of self oscillating between self-loathing and megalomania and in rare cases deteriorating into the terrifying experience of a complete loss of self. Some of the signs of the new disorder were similar to the symptoms of familiar mental abnormalities. In particular, the new illness, like some previously known conditions, would express itself in abnormal affect—extreme excitement and paralyzing sadness. But, in distinction to the known conditions in which these symptoms were temporary, in the new ailment they were chronic and recurrent. The essence of the new disorder, however, was its delusionary quality, that is the inability to distinguish between the inner world and the outside, which specifically disturbed the experience of self, confusing one regarding one’s identity, making one dissatisfied with, and/or insecure it, it, splitting one’s self in an inner conflict, even dissolving it altogether into the environment. Sixteenth-century English phrases such as “losing one’s mind,” “going out of one’s mind,” and “not being oneself” captured this disturbed experience, which expressed itself in out-of-control behaviors (that is, behaviors out of one’s control, out of the control of the self), and, as a result, in maladjustment and functional incapacitation.

None of the terms in the extensive medical vocabulary of the time (which included numerous categories of mental diseases) applied to the new mental illness; neither could it be treated with the means with which the previously known mental illnesses were treated. It required a new term—and was called “madness.” It also called into being the first hospital in the sense in which we understand the word (the famous Bedlam), the first medical specialization, eventually named “psychiatry,” and special legislation regarding the “mad.”  It is this clearly bipolar and delusional disease which would be three centuries later classified as distinct syndromes of schizophrenia and affective (depressive and manic-depressive) disorders.

We shall follow the history of this modern disease and analyze it in the following posts.

[Originally published on Psychology Today]

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Her sociology class was among the most influential (probably the most) of my formal education. The aim of her research is a better understanding of manic depression and schizophrenia, diseases which even today are poorly understood by most scientists and psychiatrists. Greenfeld’s theory of symbolic reality, the symbolic basis of both the mind and culture, has had immeasurable effect on my thinking, personal philosophy, and writing. And it’s a perfect example of a foundation of worldview to which other elements have adhered over time. This is what The Nerdwriter is all about.