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

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

Does Freedom Make Every Other Person Sick?

The stimulating, often exciting and occasionally whimsical work of the sociologist Liah Greenfeld charts the gains and costs which come with being modern.

See here for the full review (in German):

Frankfurter Allgemeine Zeitung, May 14, 2014

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