Category Archives: schizophrenia

Outline of A Future Science of Humanity

Liah Greenfeld

Humanity as a symbolic phenomenon

The possible emergence of a new intellectual center of the world in East and South Asia, offsetting and eventually nullifying vested interests in the United States [see Social Science from the Turn of the 20th Century], could create the conditions necessary for the rise of a science of humanity, one that would be capable of progressively accumulating objective knowledge of its subject matter. Intellectually, the first step in that direction would be to identify the quality that distinguishes humanity from the subject matter of biology, defining humanity as an ontological category in its own right. Comparative zoology provides the empirical basis for such an identification. Comparing human beings with other animals immediately highlights the astonishing variability and diversity of human societies and human ways of life (what humans actually do in their roles as parents, workers, citizens, and so on) and the relative uniformity of animal societies, even among the most social and intelligent animals, such as wolves, lions, dolphins, and primates. Keeping in mind the minuscule quantitative difference between the genome of Homo sapiens and that of chimpanzees (barely more than 1 percent), it is clear that the enormous difference in variability of ways of life cannot be accounted for genetically—that is, in terms of biological evolution. Instead, it is explained by the fact that, while all other animals transmit their ways of life, or social orders, primarily genetically, humans transmit their ways of life primarily symbolically, through traditions of various kinds and, above all, through language. It is the symbolic transmission of human ways of life (both the symbolic transmission itself and the human ways of life that are necessarily so transmitted) to which the term “culture” implicitly refers. Culture in this sense qualitatively—and radically—separates human beings from the rest of the biological animal kingdom.

This empirical evidence of human distinctiveness shows that humanity is more than just a form of life—i.e., a biological species. It represents a reality of its own, nonorganic kind, justifying the existence of an autonomous science. The justification is provided not by the existence as such of society among humans but by the symbolic manner in which human societies are transmitted and regulated. Stating the point explicitly in this way shifts the focus of inquiry from social structures—the general focus of social sciences—to symbolic processes and opens up a completely new research program, in its significance analogous to the one that Darwin established for biology. Humanity is essentially a symbolic—i.e., cultural, rather than social—phenomenon.

When the science of humanity at last comes into being, it will make use of the information collected in the social sciences but will not be a social science itself. Its subject matter, whichever aspects of human life it explores, will be the symbolic process on its multiple levels—the individual level of the mind and the collective levels of institutions, nations, and civilizations (see below Institutions, nations, and civilizations)—and the multitude of specific processes of which it consists. The science of humanity will be the science of culture, and its subdisciplines will be cultural sciences.

In contrast to the current social sciences, but like biology and physics, the science of humanity will have an inherent general standard for assessing particular claims and theories. As an autonomous reality, humanity is necessarily irreducible to the laws operating within the organic reality of life and to the laws operating within the physical reality of matter. It nevertheless exists within the boundary conditions of those laws—i.e., within the (organic and physical) reality created by the operation of those laws. Consequently, it is impossible without those boundary conditions. All the regularities of autonomous phenomena existing within the boundary conditions of other phenomena of a different nature (i.e., organic regularities existing within the boundary conditions of matter and cultural regularities existing within the boundary conditions of life) must be logically consistent with the laws operating within those boundary conditions. Therefore, every regularity postulated about humanity—every generalization, every theory—beginning with the definition of its distinctiveness, must entail mechanisms that relate that regularity to the human animal organism—mechanisms of translation or mapping onto the organic world. Indeed, the recognition that humanity is a symbolic reality implies such mechanisms, which connect every regularity in that reality to human biological organisms through the mind—the symbolic process supported by the individual brain.

The postulation of the mind and other distinguishing characteristics of humanity follows directly from the recognition of humanity as a symbolic reality, because such characteristics are logically implied in the nature of symbols. Symbols are arbitrary signs: the meanings they convey are defined by the contexts in which they are used. Every context changes with the addition of every new symbol to it—which is to say, every context changes constantly. Every present meaning depends on the context immediately preceding it and conditions the contexts and meanings following it, the changes thus occurring in time. That fact means that symbolic reality is a temporal phenomenon—a process. (It must always be remembered that the concept of structure in discourse about culture can only be a metaphor; nothing stands still in culture—it is essentially historical, in other words.) The symbolic process—that is, the constant assignment and reassignment of meanings to symbols (their interpretation)—happens in the mind, which is implicitly recognized as distinct from the brain (or from whatever other physical organ it may be associated with) in languages in which “mind” is a concept. The mind, supported by and in contrast to the brain, is itself a process—analogous, for instance, to the physical processes of digestion, happening to food in the stomach, or breathing, happening to air in the lungs. More specifically, it is the processing of symbolic stimuli—culture—in the brain. That fact makes culture both a historical and a mental phenomenon. In the science of humanity, moreover, it necessitates a perennial focus on the individual (methodological individualism, indeed already recommended by Weber), the individual being defined as a culturally constituted being and the mind being seen as individualized culture (“culture in the brain”). It also precludes the reification of social structures of whatever kind, be they classes, races, states, or markets. Although the mind is the creative element in culture (the symbolic process in general and the specific processes of which it consists on the collective level), its creativity is necessarily oriented by cultural stimuli operating on it from the outside. The symbolic process, just like the organic process of life, takes place on the individual and the collective levels at once, involving both continuity and contingency. Like genetic mutations in the process of life, change is always a possibility, but its nature (and thus the direction of evolution in the case of life and the direction of history in the case of humanity) can never be predicted.

Identity, will, and the thinking self

From the nature of symbols and symbolic processes one can also formulate hypotheses regarding the inner structure or anatomy of the mind, which can then be methodically tested against empirical evidence—historical, psychological, psychiatric, and even neuroscientific. The variability of human social orders, which is a function of the fact that human ways of life are constituted and transmitted symbolically rather than genetically, implies that, in contrast to all other animals, who are born into a specific ordered world, clearly organized by their genes, human beings are born into a world with numerous, potentially mutually exclusive, possibilities, and very early on in life (from early childhood) they must be able to adapt themselves to the possibilities that happen to be realized around them. Not being genetically equipped for any particular possibility, humans, in the first years of their lives, must grow adaptive mechanisms for focusing on such possibilities. Those mechanisms are the constituent processes of the mind.

Two of those processes can be logically deduced from the essentially indeterminate (arbitrary, potentially variable) nature of human social orders: identity and will. No other animal (with the exception of pets, whose world is the same as their human companions and is thus, by definition, also cultural) has a need for identity and will: their positions vis-à-vis other members of their group and their actions under all likely circumstances—that is, the circumstances of the species’ adaptive niche—are genetically dictated. Being genetically unique, each animal has individuality, but only human individual character has (and is mostly a reflection of) this adaptive subjective dimension. Identity and will constitute functional requirements of the individual’s adaptation to the indeterminate cultural environment. They represent the different aspects of the self, or “I”—identity being a relationally-constituted self and will being the acting self, or agency.

Identity may be understood as symbolic self-definition: the image of one’s position in a sociocultural “space” within a larger image of the relevant sociocultural terrain. The larger image is an individualized microcosm of the particular culture in which one is immersed, a mental map of the variable aspects of the sociocultural environment, analogous to representations of the changing spatial environment yielded by place cells, discovered in neurological experiments with rodents. Like the indication of a rat’s place on the spatial mental map, the human identity map defines the individual’s possibilities of adaptation to the sociocultural environment. Because that environment is so complex, however, the human individual, unlike a rat, is presented in the map with various possibilities of adaptation, which cannot be objectively and clearly ranked. They must be ranked subjectively—i.e., the individual must choose or decide which of them to pursue. This subjective ranking of options is a function of the general character of the mental map (for instance, what place on it is occupied by God and the afterlife, or by the nation, or by one’s favorite sports team, etc.) and where one is placed on it in relation to such other presences.

While identity serves as a representation (and agent) of a particular culture (the culture in which the individual is immersed), will is a function of the symbolic process in general—i.e., it reflects the intentionality of symbols. Human actions (except involuntary reflexes) are not determined reactions but products of decision and choice. The nature of the human response to any stimulus is indeterminate: it is the will that steps in, as it were, in a split-second intermediate stage between stimulus and reaction, deciding in that moment what the response will be. The word “consciousness” is frequently applied to these moments of decision, but, unless rendered problematic by special circumstances, both identity and will are largely unconscious processes in the sense that humans very rarely think about or become consciously aware of them.

Given the character of the human environment, the logical reasons for the existence of identity and will are rather obvious: both “structures” are necessary for the individual’s adaptation to that environment and, therefore, for the individual’s survival. Discoverable only logically, they remain hypothetical until tested against empirical evidence. This is not so as regards the thinking component of the mind—the thinking “I,” or the “I” of self-consciousness (which can also be called “the ‘I’ of Descartes,” because it is to that notion that Descartes referred in his famous dictum, cogito, ergo sum. Each person is aware of a thinking “I.” Its existence is known directly through experience—in other words, empirically. This knowledge is absolute, or certain, in the sense that it is impossible to doubt. It is, in fact, the only certain knowledge available to human beings. The thinking “I” is not necessary for the individual’s adaptation to the sociocultural environment and to his or her survival in it, but human existence in general would be impossible without it. It is a necessary condition for the culture process on the collective level. As the “I” of self-consciousness, the thinking “I” makes possible self-consciousness for any individual human; as the process of self-conscious thought, the one explicitly symbolic process among all symbolic mental processes, it makes possible indirect learning and thereby the transmission of human ways of life across generations and distances. It is not just a process informed and directed by our symbolic environment, but an essentially symbolic process, similar to the development of language, musical tradition, elaboration of a theorem—and to the transmission of culture, in general—in the sense that it actually operates with formal symbols, the formal media of symbolic expression. This is the reason for the dependence of thought on language, which has been frequently noted. Thought extends only as far as the possibilities of the formal symbolic medium in which it operates.

How can one test the anatomy of the mind, most of which is discoverable only through logical deduction? As in medicine, malfunction provides an excellent empirical test. Under normal conditions, the three “structures” of the mind are perfectly integrated, but in cases of mental illness integrated minds disintegrate into the three components, each of which can then be observed in its specific malfunction. This is particularly clear in the case of functional mental disease of unknown organic basis, such as depressive disorders (unipolar or bipolar) and schizophrenia—which in fact are generally identified by clinicians with the loss of aspects of the self or its complete disintegration. Depressive disorders, for example, specifically affect the will: depressed patients lose motivation, sometimes to such an extent that they find it difficult to get out of bed or to do the simplest things. In the manic stage of manic-depressive disorder (bipolar disorder), patients lose control of themselves altogether, being unable to will themselves to act or to stop acting, in retrospect explaining that they “lost their mind” or that the person who acted or did not act “wasn’t me.” The impairment of the will in bipolar disorder entails self-loathing (in the case of depression) and extremely high self-confidence (during acute mania)—i.e., an uncertain, oscillating sense of identity. Both depressive disorders and schizophrenia express themselves in delusions, or beliefs that one is what one definitely is not. Accordingly, both the overall nature of one’s mental map and one’s place on it radically change. In schizophrenia in particular, the thinking “I” completely separates from the mind, and patients experience their own thoughts as implanted from outside and their self-consciousness as being watched or observed by someone else. At the same time, their thinking (which they experience as alien) faithfully reflects the tropes and commonplaces of their cultural environment.

Certain subdisciplines of the science of humanity will make the cultural process on the individual level of the mind their special subject. One possible branch, analogous to cellular biology, might study the interrelations between different symbolic components of the human mental process. Another, analogous to biochemistry or biophysics, might study the interrelations between the symbolic and the organic components of the mental process—that is, the interrelations between the mind and the brain. The formation, transmission, changes, and pathologies of identity, will, and the thinking self will be central subjects in these subdisciplines, which will necessarily inform, and be informed by, the study of the cultural process on the collective level, just as cellular biology, biochemistry, and biophysics are interconnected with the focused study of particular forms of life, from kingdoms to species (e.g., entomology, primatology) and with subdisciplines such as genetics, ecology, and evolutionary biology, which focus on macro-level life processes.

Institutions, nations, and civilizations

Knowledge accumulated (and left uninterpreted) in the course of the history of the social sciences—specifically, knowledge that amounts to comparative history—when examined from the perspective of the science of humanity and in light of the recognition of the symbolic and mental nature of the subject, allows one to identify several layers of the cultural process on the collective level. Those layers can be distinguished analytically, though not empirically, given that all cultural processes are happening simultaneously in several of these layers in various combinations, which in every particular case are subject to empirical investigation.

There are three autonomous layers. In order of increasing generality they are: (1) the layer of social institutions, or established “ways of thinking and acting” (as Durkheim defined them) in the various spheres of social life, such as economy, family, politics, and so on; (2) the layer of nations (in the past, mostly religions), understood as functionally-integrated, geopolitically bounded systems of social institutions; and (3) the layer of civilizations, the most durable and causally significant of the three layers. Civilizations are family sets of autonomous systems, sharing the same (civilizational) first principles (e.g., monotheism and logic) and, although not systematically related to each other, interdependent in their development. The mind is the active element in the collective cultural process at all layers, constantly involved in their perpetuation and change while being constantly affected, constrained, and stimulated by them. Civilizations constitute the independent and thus the fundamental layer of the cultural process on the collective level, in the sense of depending on no other cultural process on that level but only on the mind in their origins. They are a framework subsuming all the others and subsumed in none, causally significant in every layer below and—together with mind—ultimately responsible for cultural diversity in the world.

The only concept from the social sciences that can be appropriated and built upon within the science of humanity is Durkheim’s concept of anomie, which implicates the psychological mechanisms that connect cause and effect in any particular case (connecting the mind and culture in one process) and therefore lends itself easily to investigation by empirical evidence. Anomie refers to a condition of systemic inconsistency among collective representations, directly affecting individual experience and creating profound psychological discomfort. The discomfort motivates participants in the situation in question to resolve the bothersome inconsistency. Thus the concept encompasses the most generally applicable theory of sociocultural change—a change in identity, which leads to changes in established ways of thinking and acting within more or less extended areas of experience.

Applications of the science of humanity: nationalism, economic growth, and mental illness

This minimal exposition of the ground principles of the science of humanity already provides a sufficient basis for raising and answering, logically and empirically, questions regarding phenomena that the current social sciences are capable of approaching, if at all, only speculatively. As examples, one can focus on three such phenomena that have been at the center of public discussion since at least the late 19th century: nationalism, economic growth, and functional mental illness. The amount of information collected about them is enormous; all three have been subjects of voluminous descriptive and “theoretical” (speculative) literature. Yet, this literature has not been able to explain them, failing to answer the fundamental question of what causes these phenomena, or why they exist. The practical effects of this inability to understand the forces controlling human life cannot be exaggerated.

Within the framework of the science of humanity, one would approach nationalism, economic growth, and functional mental illness without any preconceptions other than that they are symbolic, by definition historical phenomena—i.e., products of new symbolic contexts, created by the reinterpretation of certain collective representations by certain minds at certain specific moments in the cultural process. The first step would be to establish when and where—in what circumstances—these moments occurred. An appearance of new vocabularies (to explicitly record new experiences and transmit new meanings) is by far the best, though not the only, indicator. In the case of nationalism, the name itself orients research toward European languages. Their examination before the concept enters broad circulation—that is, beginning in the 18th century and moving backward—reveals that the concept of the nation as generally understood today—as the people to which one belongs, from which one derives one’s essential identity, and to which one owes allegiance—first appeared in the early 16th century in England, signaling a dramatic change in the meanings of the words nation and people. Before that time, nation referred to exceedingly small groups of very highly placed individuals, representatives of temporal and ecclesiastical rulers at church councils, each such group a tiny elite making decisions determining the collective fates of large populations, and people denoted the overwhelming majorities within those populations—i.e., their common, or lower, classes, the “rabble” or plebs. Whereas membership in the conciliar nation communicated a sense of great power and dignity, there was none in being one of the people; membership in a people meant being a nobody. This distinction existed within the context of the European feudal “society of orders,” which divided the population of every Christian principality into separate categories of humanity, as different from each other as species of animals are. Indeed, they were thought to differ even in the nature of their blood (which could not be mixed): the small upper military order of the nobility (comprising 2 to 4 percent of the population) was believed to have blue blood, while the huge lower order of the people was believed to have red blood.

In the second half of the 15th century, however, protracted conflict between the two branches of the English royal family, known as the Wars of the Roses, actually destroyed the blue-blooded upper order. A new (in fact plebeian) family assumed the crown; the new king needed help from the new aristocracy to carry out his rule; a period of mass, generally upward, mobility began; and enterprising individuals who knew that their blood was “red” found themselves occupying positions which formerly could be occupied only by those whose blood was “blue.” Their experience was positive but not understandable to them. Attempting to explain it to themselves and to make it seem legitimate, they stumbled upon the paradoxical but extremely appealing idea that the English people themselves were a nation. The equation of the two concepts, people and nation, symbolically elevated the masses, making all of the English equal. Their identity—the place of each individual on his or her mental map of the sociocultural terrain—was transformed as it became the dignified national identity that is inclusively granted to members of a sovereign community of fundamentally equal members.

Schematically, the circumstances in which nationalism emerged can be described as follows: the personal experience of a significant number of well-placed (influential) individuals contradicts existing collective representations, resulting in an irritating anomic situation; because the experience is positive, these individuals reinterpret collective representations in a way that makes it normal (understandable and legitimate); the image of reality and personal identity change to reflect this reinterpretation, establishing different ways of thinking and, therefore, acting in the society at large. The change in identity and the image of social reality in the first place affects status arrangements (i.e., the organization of social positions, the system of social stratification): nationalism creates a polity-wide community of equals, making individuals interchangeable and mobility between strata possible, expected, and ultimately dependent on individual choice (making one free) and effort. This, in turn, changes the nature of political institutions. Defined as the decision-making elite (nation), the entire community must now be represented in the government: the impersonal state, as the abstraction of popular sovereignty, replaces the personal government of kings. Other specific institutions are similarly affected. Eventually, the dignity implied in nationalism brings to it new converts, and national consciousness spreads first to England’s colonies and neighbors and then farther and farther around the world.

The growing influence of England and then Great Britain, which rapidly emerged as the preeminent European power carefully watched everywhere, was an important factor in the attention nationalism initially attracted, and England’s own precocious nationalism was the reason why the country’s influence grew. Nationalism is an inherently competitive form of consciousness. National membership endows with dignity the personal identity of every national, making national populations deeply invested in the dignity of the nation as a whole, or its standing among other nations (into which the national image of reality from the moment of its emergence divides the world). Standing among others is always relative and cannot be achieved once and for all. Nations are impelled to compete for dignity—prestige, respect of others—constantly. They choose to compete for it in those areas which offer them the best chances to end up on top: Russia, for instance, from the outset of its existence as a nation in the 18th century staked its national dignity on military strength, adding to it, when the time was right, the splendor of its high culture (science, literature, ballet, and so on) but never competing in the economic arena. England, the first nation, became ardently competitive when it faced no challengers, having its pick of competitive arenas. Answering the need to justify the personal experience of upward mobility, English nationalism prioritized the individual, and it was natural for England to challenge the world to economic competition, which directly involved the great majority of its people. Nationalist competitiveness—a race whose finish line is ever-receding, because the prize is a nation’s standing relative to others—drove the classes engaged in economic activity to produce a new, modern economy, the one since called “capitalist,” which differed drastically from the traditional economies that had existed everywhere before nationalism. Whereas traditional economies were oriented toward subsistence, nationalism reoriented the English and then other economies toward growth. With economic performance the basis of international prestige, nations opting for competition in the economic arena cannot afford to stop growing, whatever the costs—political, psychological, or other. This explains another central dimension of modern life, which has preoccupied social thinkers for at least 250 years and which the social sciences have never been able to account for, and thus regard as “natural”: economic growth, and specifically the reorientation of national economies toward economic growth beginning in the late 16th century.

The reorientation of the English economy (the first to reorient) toward growth occurred within decades of the emergence of national identity and consciousness. Another phenomenon that closely accompanied that cultural (symbolic and mental) change was the noticeable rise in rates of functional mental illnesses, which would eventually be identified as schizophrenia and affective disorders. Although individual cases of such illnesses had been recorded well before the 15th century (indeed as far back as the Bible and ancient Greece), with the rise of nationalism they became a public-health and social problem of the first order. Other societies that acquired national identity and consciousness after England also experienced sharply increased incidences of such illnesses, which continued to rise as nationalism spread in them, reaching epidemic proportions in some countries (e.g., the United States).

For more than 200 years, psychiatry, which emerged in response to this problem, has attempted to combat functional mental disease, which nevertheless remains unexplained and, as a result, incurable (though their symptoms can sometimes be alleviated through medication or therapeutic intervention). Considered in the framework of the science of humanity as outlined above, however, its causes become clear. Nationalism necessarily affects the formation of individual identity. A member of a nation can no longer learn who or what he or she is from the environment, as would an individual growing up in an essentially religious and rigidly stratified, nonegalitarian order, in which each person’s position and behavior are defined by birth and (supposedly) divine providence. Beyond the very general category of nationality (national identity), a modern individual must decide what he or she is and should do and, on that basis, construct his or her own personal identity. Schizophrenia and depressive (unipolar and bipolar) illnesses are caused specifically by the values of equality and freedom as self-realization, which make every individual his or her own maker. The rates of such mental diseases 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 of freedom of choice within it. Conflicting collective representations do not allow for the construction of a meaningful mental map, and blurred or nonexistent identity impairs the will and dissolves the self, destroying the mind as individualized culture and leaving the individual to experience his or her thinking “I,” untethered to identity and will, as an alien presence.

The various historical connections between different layers of the cultural process come into sharper focus when one considers the spread of nationalism into Japan and China—that is, beyond the family of cultures, all embedded in monotheism, in which nationalism emerged. Nationalism was introduced in Japan by the Western powers who bent the small country to their will by their show of military strength in 1853, deeply humiliating its elites. Recognizing the implications of nationalism for collective dignity, these elites convert to the new consciousness, the country became extremely competitive, and within a few decades it emerged as a formidable military and economic power. The humiliation of China’s defeat in the First Sino-Japanese War (1894–95) was the reason for the birth of Chinese nationalism; Chinese elites also adopted it in an effort to restore the dignity of their empire. The colossal Chinese population remained unengaged until the ideological turn initiated by Deng Xiaoping (1904–97) connected national dignity to economic performance, thereby dignifying the population’s main activity. Accordingly, both nationalism and capitalism (understood as an economic system oriented toward growth) spread in Japan and China. But, unlike monotheistic civilizations—in which, by definition, reality is imagined as a consistently ordered universe and which, therefore, place great value on logical consistency—cultures (and minds) within the Sinic civilization (all cultures rooted in China) are not bothered by contradictions. As a result, conflicting collective representations (anomie), which are implicit in the freedom and equality implied by nationalism, do not have there the disorienting psychological effects that they have in societies embedded in monotheism. Remarkably, East Asian societies, as epidemiologists have repeatedly stressed, remain largely immune from functional mental illness.

The prospect of a science of humanity, like the pursuit of objective knowledge through the method of conjecture and refutation about any aspect of empirical reality, holds great promise. But it can develop only in conditions that would allow for its institutionalization. Although such conditions do not exist today, they may yet exist in the future.

What’s Really Wrong with DSM-5

By Liah Greenfeld

The essence of the DSM-5 consists in the modifications it introduces in the extensive psychiatric nosology, specifically adding diagnostic categories to diseases of unknown biological origin and uncertain etiology. But the real problem lies much deeper – in the understanding of such diseases itself. It is the problem with the old, fundamental, and universally accepted diagnostic categories of thought disorder- vs. affective disorders, or schizophrenia vs. manic and unipolar depression, on which all the other diagnostic categories of mental illness of unknown etiology, new and not so new, are based. DSM-5’s approach is similar to attempting to salvage a house, falling apart because it is built on an unsound foundation, by adding to it a fresh coat of paint and new shutters.

What Mind, Modernity, Madness does, in contrast, is to dismantle the structure, establish a sound foundation, and then rebuild the house on top of it. I begin by questioning and analyzing the fundamental diagnostic categories themselves, consider them against the existing clinical, neurobiological, genetic, and epidemiological evidence, bring into the mix the never-before-considered cultural data, and on this basis propose that the two (schizophrenia and manic-depressive illness) or even three (schizophrenia, manic depression, and unipolar depression) discreet diseases are better conceptualized–and therefore treated–as the same disease, with one cause, which expresses itself differently depending on the circumstances in which this cause becomes operative. Psychiatric epidemiologists, at least, have long suspected that “the black box of culture” is an important contributing factor in these diseases. However, as the phrase indicates, they lack the means to understand or even examine its contribution. By unpacking the “black box” (and showing, specifically, how it is reflected in the logically necessary structures of the mind, such as identity, will, and thinking self), I add a missing yet essential dimension to the diagnostic tool-kit, which the DSM-5, like the previous editions, disregards.

Love, Madness, Terrorism: Connected?

By Liah Greenfeld

In the 16th century, in England, several remarkable things happened:

Social mobility, inconceivable before, became legitimate and common;

The ideal of Romantic love between a man and a woman emerged and “true love,” as we understand it today, was added to the human emotional range;

The word “people,” which earlier referred to the lower classes, became synonymous with “nation,” which at the time had the meaning of “an elite”;

Numerous new words appeared, among them “aspiration,” “happiness,” and “madness”;

The English society, previously a society of hierarchically arranged orders of nobility, clergy, and laborers under the sovereignty of God and his Vicar in Rome, was redefined as a sovereign community of equals;

The nature of violent crime, personal and political, changed, with crime that was not rational in the sense of self-interested becoming much more common;

The attitude to pets, especially dogs and cats, changed, transforming these animals in many cases from living multi-purpose tools to our friends and soul-mates;

The pursuit of growth — rather than survival, as was the case before – became the goal of the economy;

Mental diseases which were later to be named “schizophrenia,” “manic-depressive illness,” and “depression” were first observed, shifting the interest of the medical profession, in particular, from other, numerous, mental diseases that were known since the times of antiquity.

Continue reading

Identity Construction and Cultural Madness

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

Understanding Schizophrenia

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.

Schizophrenia and Manic-Depressive Illness: What do We Know about Biological Causes?

By David Phillipi

While the technological advancements of recent decades allow us to map the human genome and look at the brain on the molecular level, the enormous amount of data that has been amassed is virtually useless for psychiatrists trying to diagnose their sick patients because the assumed biological causes of schizophrenia and manic-depressive illness have not been found. No brain abnormalities that are specific to either illness or present in all cases have been identified. Nevertheless, the experts who study and treat schizophrenia and manic-depressive illness (MDI) keep the faith (quite literally) that a breakthrough is just around the corner.

For years, genetic research has appeared to be the most promising of the recently opened avenues, but the excitement seems unwarranted by the findings. The relatively large number of chromosomal regions which may be implicated in susceptibility for bipolar disorder means that hope of finding a specific bipolar gene or even a small number of genes must be given up. Some researchers think the way to go is to narrow the search by looking for genes associated with specific aspects of the disease. Of course, this further refinement is only possible because of the huge variation in symptoms and experiences of those who fall under the MDI/bipolar umbrella, and we are once again reminded of the difficulty of defining what this illness or group of illnesses even is. Furthermore, even the distinction between schizophrenia and MDI seems to collapse in light of the genetic linkage data. In Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression (2nd Edition), Drs. Frederick Goodwin and Kay Redfield Jamison write:

While the search for predisposing genes had traditionally tended to proceed under the assumption that schizophrenia and bipolar disorder are separate disease entities with different underlying etiologies, emerging findings from many fields of psychiatric research do not fit well with this model. Most notably, the pattern of findings emerging from genetic studies shows increasing evidence for an overlap in genetic susceptibility across the traditional classification categories. (49)

Genetic studies in the schizophrenia research community lead to pretty much the same hypothesis as with bipolar: genetic susceptibility is most likely polygenic, meaning dependent on the total number of certain genes which may contribute to vulnerability. It must be noted that genetic vulnerability is a condition, not a cause of schizophrenia and bipolar – something else must be acting on this vulnerability. In one way or another, this fact is usually noted in the literature that deals with genetic data, but it is often obscured by a tone of confidence which suggests the information may be more meaningful and explanatory than it truly is.

Even when a specific gene has been well studied across illnesses, its usefulness in understanding genetic susceptibility may be extremely limited. Some studies in both schizophrenia and MDI have found an increased risk of illness for those who possess the short form of the serotonin transporter promoter gene 5-HTT. The thing is, each of us has two copies of this gene, and over two-thirds of us have one long and one short form, meaning that having the normal variant of the gene is the risk factor! If most of us possess a gene which puts us at risk for an illness which only a small minority of people have, then this particular trait is obviously not much of a causal explanation.

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Psychiatric Disorders Linked Genetically

By Gil Press

In the Wall Street Journal today, Shirley S. Wang reports on a new study published today in The Lancet, which “provides early evidence that several disorders  thought to be distinct appear to have some genetic overlap, and it may help in one day diagnosing mental illness based on faulty biological processes, and not just on behavioral symptoms.”

The study compared the genes of some 33,000 people with schizophrenia, bipolar disorder, major depression, autism or attention-deficit hyperactivity disorder, and also compared them with a group of nearly 28,000 controls. It “identified several regions of the genome that were associated with all five diseases.”

In Mind, Modernity, Madness, Liah Greenfeld came to a similar conclusion that viewing manic-depressive illness and schizophrenia as distinct illnesses, each with its own biological causes, is wrong. Instead, she argues that they should be placed on a continuum of the complexity of the will-impairment caused by the anomie inherent in modern culture. This argument, linking mental illness to individuals’ (varied) response to the pressures of modern society, could also explain why “the findings don’t mean that an individual with one or more of these gene variants has or will develop the condition,” as the Wall Street Journal article–and the authors of the study–conclude.