Liah Greenfeld's Blog - Posts Tagged "mental-illness"
Love, Madness, Terrorism: Connected?
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.
Were these things connected? And, if they were, what were the connections between them? These are the questions I shall be exploring in this blog.
In the course of these explorations we shall
Arrive at a new interpretation of mental diseases with uncertain organic basis, such as schizophrenia and affective disorders, and find their actual causes � sought by psychiatrists without success for the past two centuries;
Resolve the mind/body, or psychophysical, problem which Western philosophy has not been able to resolve in over two millennia, and define the mind;
Redefine what it means to be human, when human life begins, and where the difference between us and other animals lies;
Deepen our appreciation of Shakespeare and Darwin;
Learn to understand (and thus, at the very least, make the first step towards the ability to prevent) tragedies such as Newtown mass shooting and Boston Marathon bombing;
Acquire a new and surprising angle at modern poetry and detective fiction;
Reconsider the bases of psychology;
And prove the empirical reality of the soul.
Possibly, we’ll do more, but certainly no less. This is my promise to the readers of this blog and I invite them to hold me accountable, if any part of it remains unfulfilled.
I come to this online activity after thirty years of research, thinking, and teaching on the subject of modern culture, that is, of the culture of modern societies. It is impossible to understand modern culture without the comparison with other type of cultures, and it is unproductive to study any culture without attention to its relation to the individual mind. Thus, though a social scientist, not a psychologist, by training and profession, I have been led by my research itself to focus on psychology’s central topics, and by the results of this research to conclude that looking at these topics from the social science point of view has a lot to offer to those interested in them. It is a great pleasure for me, therefore, to join the Psychology Today blogging community.
[Originally published on Psychology Today]
Mind, Modernity, Madness: The Impact of Culture on Human Experience
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.
Were these things connected? And, if they were, what were the connections between them? These are the questions I shall be exploring in this blog.
In the course of these explorations we shall
Arrive at a new interpretation of mental diseases with uncertain organic basis, such as schizophrenia and affective disorders, and find their actual causes � sought by psychiatrists without success for the past two centuries;
Resolve the mind/body, or psychophysical, problem which Western philosophy has not been able to resolve in over two millennia, and define the mind;
Redefine what it means to be human, when human life begins, and where the difference between us and other animals lies;
Deepen our appreciation of Shakespeare and Darwin;
Learn to understand (and thus, at the very least, make the first step towards the ability to prevent) tragedies such as Newtown mass shooting and Boston Marathon bombing;
Acquire a new and surprising angle at modern poetry and detective fiction;
Reconsider the bases of psychology;
And prove the empirical reality of the soul.
Possibly, we’ll do more, but certainly no less. This is my promise to the readers of this blog and I invite them to hold me accountable, if any part of it remains unfulfilled.
I come to this online activity after thirty years of research, thinking, and teaching on the subject of modern culture, that is, of the culture of modern societies. It is impossible to understand modern culture without the comparison with other type of cultures, and it is unproductive to study any culture without attention to its relation to the individual mind. Thus, though a social scientist, not a psychologist, by training and profession, I have been led by my research itself to focus on psychology’s central topics, and by the results of this research to conclude that looking at these topics from the social science point of view has a lot to offer to those interested in them. It is a great pleasure for me, therefore, to join the Psychology Today blogging community.
[Originally published on Psychology Today]
Mind, Modernity, Madness: The Impact of Culture on Human Experience
The Modern Mental Disease
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.Mind, Modernity, Madness: The Impact of Culture on Human Experience
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.Mind, Modernity, Madness: The Impact of Culture on Human Experience
Is Depression A Real Disease?
The May 2013 issue of The British Journal of General Practice contains an editorial “Depression as a culture-bound syndrome: implications for primary care� by Dr. Christopher Dowrick, Professor of Primary Medical Care at the Institute of Psychology, Health, and Society of the University of Liverpool. Dr. Dowrick claims that depression “fulfills the criteria for a culture-bound syndrome,� i.e. , one of the “’illnesses�, limited to specific societies or culture areas, composed of localized diagnostic categories,� like, for instance ataque de nervios in Latin America. In the case of depression the culture area affected is “westernized societies.� Putting the word “illness,� when applied to culture-bound syndromes into quotation marks indicates that Dr. Dowrick does not consider such syndromes real illnesses; it follows that depression--a culture-bound syndrome of westernized societies--is also not a real illness. Dr. Dowrick further argues that depression as a diagnostic category cannot be seen as “a universal, transcultural concept,� because it has no validity and utility, and it does not have validity and utility, because “there is no sound evidence for a discrete pathophysiological basis� for depression. I find myself in absolute agreement with Dr. Dowrick’s two specific statements above (that depression is a culture-bound syndrome of westernized societies, and that there is no discrete pathophysiological basis for this diagnostic category), and yet completely disagree with the implication that depression is not a real disease.
It is important to remember what a disease, or illness, in general, is. Both terms clearly focus on the personal, subjective experience of suffering: dis-ease as opposed to ease, illness as opposed to wellness. So does the word “pathology,� which derives from the Greek for “suffering� (pathos) and Greek for “knowledge� or “understanding� (logos). Thus pathology = understanding of suffering. Even health professionals, whose task is to alleviate suffering, first of all, often forget this, and think that “pathology� refers not to the understanding of the patient’s suffering, but to an objective morbid condition underlying it, and also equate “disease� and “illness� with such objective morbid condition. Moreover, they also believe that such objective morbid condition is necessarily material, i.e., biological. As a result, the absence of “a discrete pathophysiological basis� for depression can lead Dr. Dowrick to the conclusion that depression is not a real illness, but a category, invented for commercial and professional reasons of pharmaceutical companies and medical practitioners who want to get paid for services rendered, which was developed on the basis of “an ethic of happiness, within which aberrations from the norm are assumed to indicate illness.� But, as my previous post [The Real Trouble With DSM-5] argued, mental diseases are likely to be caused by culture, rather than biology, because the mind, or the mental process, while occurring in the brain, is mostly processing intakes from the cultural, symbolic environment, in which it is unlike digestion or breathing, which process intakes from the material, physical and organic, environment. There is an objective underlying condition for the disease (i.e., the suffering) of depression, but this condition is cultural: it is the cultural condition of anomie, caused by the openness of modern Western societies and the bewildering multiplicity of choices for possible self-definition they offer their members [see The Modern Mental Disease]. Depression is, indeed, a culture-bound syndrome and at the same time it is a terrible disease, which cannot and should not be equated with low or bad mood, sadness, or any other “aberration from the norm of happiness�: it differs from these normal mental states symptomatically in the intensity of suffering experienced, in its character (such as resistance to distraction and other symptoms of the paralysis of the will, expressed among other things in the characteristic lack of motivation), and in its functional effects. An occasionally sad person is not dysfunctional, a depressed one is--depression destroys relationships and renders one incapable of performing one’s duties, it is as real and serious a handicap as any physical one. Neither should depression be seen as an exaggeration of normal mental states, differing from them only quantitatively, or equated with normal reactions to particularly traumatic life events, such as bereavement. (Indeed, Dr. Dowrick, like many other critics, justly castigates DSM-5 for including in the depressive diagnosis grief lasting more than two weeks--as if it were normal, in either statistical or medical sense of the word, to fully adjust to the loss of a close family member in two weeks!) One of the central characteristics of depression--and an exacerbating factor of the suffering it causes--is precisely its lack of connection to specific life events. As anyone who has experienced depression or observed closely persons suffering from depression knows, this absence of an external cause often leads the suffering individual to suspect oneself of madness. The most characteristic feature of severe depression, expressive of the intensity of suffering associated with it, is suicidal thinking. Twenty percent of people suffering from depression eventually commit suicide, which makes it one of the deadliest diseases today. It would be quite irresponsible of a health professional to let the lack of a “discrete pathophysiological basis� obscure this.
Because depression is a real disease, severe and often lethal, it requires the attention of a health professional. Because the causes of depression are cultural, it stands to reason that methods used for the treatment of physical diseases won’t be successful in its treatment. This does not mean that medications won’t have any effect. Pharmaceutical substances are powerful agents, just like alcohol or recreational drugs, and will influence the chemical balance in the brain, sometimes wreaking havoc in it and sometimes alleviating some of the symptoms. But even when the effects of medications are positive, they won’t address the cause of the disease. That’s why, so far, depression has no cure. It is a recurrent, or chronic, illness. Dr. Dowrick suggests that the primary physician serve as a spiritual advisor of sorts to the patient who comes to the clinic with such a mental complaint, talk to such a patient about life problems, ask about the patient’s “physical, psychological, and social circumstances…propose ideas for change� offer hope of an alternative.� But this, while a reflection of kindness and sympathy, is similar to treating cancer with cold compresses, the medication being physical like the disease, unlikely to cause any damage, but also totally irrelevant. Depression has an objective cause; to cure the disease, the therapy, just like in cancer, must focus on this objective cause and neutralize it. In depression, unlike in cancer, this objective cause is cultural. In the case of cancer, a responsible primary physician will refer the patient to an oncologist. In the case of depression, the physician must refer the patient to a specialist who understands the cultural causes of this awful disease and can treat it. There are no such specialists today. Psychiatry must recognize the cultural causes of depression and make cultural expertise an essential element of its therapeutic arsenal. Depression is a culture-bound syndrome. It is also a terrible real disease. It can be cured. But we must at last open our eyes to its cultural causation.
[Originally published on Psychology Today]
Mind, Modernity, Madness: The Impact of Culture on Human Experience
It is important to remember what a disease, or illness, in general, is. Both terms clearly focus on the personal, subjective experience of suffering: dis-ease as opposed to ease, illness as opposed to wellness. So does the word “pathology,� which derives from the Greek for “suffering� (pathos) and Greek for “knowledge� or “understanding� (logos). Thus pathology = understanding of suffering. Even health professionals, whose task is to alleviate suffering, first of all, often forget this, and think that “pathology� refers not to the understanding of the patient’s suffering, but to an objective morbid condition underlying it, and also equate “disease� and “illness� with such objective morbid condition. Moreover, they also believe that such objective morbid condition is necessarily material, i.e., biological. As a result, the absence of “a discrete pathophysiological basis� for depression can lead Dr. Dowrick to the conclusion that depression is not a real illness, but a category, invented for commercial and professional reasons of pharmaceutical companies and medical practitioners who want to get paid for services rendered, which was developed on the basis of “an ethic of happiness, within which aberrations from the norm are assumed to indicate illness.� But, as my previous post [The Real Trouble With DSM-5] argued, mental diseases are likely to be caused by culture, rather than biology, because the mind, or the mental process, while occurring in the brain, is mostly processing intakes from the cultural, symbolic environment, in which it is unlike digestion or breathing, which process intakes from the material, physical and organic, environment. There is an objective underlying condition for the disease (i.e., the suffering) of depression, but this condition is cultural: it is the cultural condition of anomie, caused by the openness of modern Western societies and the bewildering multiplicity of choices for possible self-definition they offer their members [see The Modern Mental Disease]. Depression is, indeed, a culture-bound syndrome and at the same time it is a terrible disease, which cannot and should not be equated with low or bad mood, sadness, or any other “aberration from the norm of happiness�: it differs from these normal mental states symptomatically in the intensity of suffering experienced, in its character (such as resistance to distraction and other symptoms of the paralysis of the will, expressed among other things in the characteristic lack of motivation), and in its functional effects. An occasionally sad person is not dysfunctional, a depressed one is--depression destroys relationships and renders one incapable of performing one’s duties, it is as real and serious a handicap as any physical one. Neither should depression be seen as an exaggeration of normal mental states, differing from them only quantitatively, or equated with normal reactions to particularly traumatic life events, such as bereavement. (Indeed, Dr. Dowrick, like many other critics, justly castigates DSM-5 for including in the depressive diagnosis grief lasting more than two weeks--as if it were normal, in either statistical or medical sense of the word, to fully adjust to the loss of a close family member in two weeks!) One of the central characteristics of depression--and an exacerbating factor of the suffering it causes--is precisely its lack of connection to specific life events. As anyone who has experienced depression or observed closely persons suffering from depression knows, this absence of an external cause often leads the suffering individual to suspect oneself of madness. The most characteristic feature of severe depression, expressive of the intensity of suffering associated with it, is suicidal thinking. Twenty percent of people suffering from depression eventually commit suicide, which makes it one of the deadliest diseases today. It would be quite irresponsible of a health professional to let the lack of a “discrete pathophysiological basis� obscure this.
Because depression is a real disease, severe and often lethal, it requires the attention of a health professional. Because the causes of depression are cultural, it stands to reason that methods used for the treatment of physical diseases won’t be successful in its treatment. This does not mean that medications won’t have any effect. Pharmaceutical substances are powerful agents, just like alcohol or recreational drugs, and will influence the chemical balance in the brain, sometimes wreaking havoc in it and sometimes alleviating some of the symptoms. But even when the effects of medications are positive, they won’t address the cause of the disease. That’s why, so far, depression has no cure. It is a recurrent, or chronic, illness. Dr. Dowrick suggests that the primary physician serve as a spiritual advisor of sorts to the patient who comes to the clinic with such a mental complaint, talk to such a patient about life problems, ask about the patient’s “physical, psychological, and social circumstances…propose ideas for change� offer hope of an alternative.� But this, while a reflection of kindness and sympathy, is similar to treating cancer with cold compresses, the medication being physical like the disease, unlikely to cause any damage, but also totally irrelevant. Depression has an objective cause; to cure the disease, the therapy, just like in cancer, must focus on this objective cause and neutralize it. In depression, unlike in cancer, this objective cause is cultural. In the case of cancer, a responsible primary physician will refer the patient to an oncologist. In the case of depression, the physician must refer the patient to a specialist who understands the cultural causes of this awful disease and can treat it. There are no such specialists today. Psychiatry must recognize the cultural causes of depression and make cultural expertise an essential element of its therapeutic arsenal. Depression is a culture-bound syndrome. It is also a terrible real disease. It can be cured. But we must at last open our eyes to its cultural causation.
[Originally published on Psychology Today]
Mind, Modernity, Madness: The Impact of Culture on Human Experience
