Madness and Civilization
It’s a curious thing, madness.
There isn’t anything that scares us more than the mad — those people that see something in reality that we don’t (which is probably just a fancy way of say that we’re all mad the moment that we stop oppressing our notions of reality as conformity and embrace the strangeness that we are, in truth, surrounded by). But for those that adhere to more rigid definitions, the mad represent a deeply disturbing segment of the population: a counterpoint to settled life; a way of straining against its limitations and boundaries.
But it’s bigger than our comfort levels. The story of mental health is really the story of civilization — that vast enterprise that really makes it possible for us to become fully human. Civilization depends on establishing shared views and interests; to reach a common conclusions about relations between people. Maintaining and understanding sanity has to do with how we have kept an accounting and engineer progress around what constitutes tolerable thought. In other words, for a civilization to know itself, it most know something of what it is not. Step too far, see too much, and you stumble outside the realm of what constitutes that which is acceptable — the normal. And that way lies madness. And probably death. So it’s only natural that various institutions have taken up the mantle of enforcement — schools, law enforcement, psychological societies, nationalist organizations, and so on. All of these are, to one degree or another, responsible for enforcing the limits of conformity — of dividing the mad from the sane.
In the modern era, with such attention having been paid to it, madness has come to define the contours of the state. To maintain such an entity, we must all agree on a specific set of conditions and responses — Donald Trump would maintain that nothing done in his name can be called treason. Is this madness, or simply a mirror of the more acceptable idea that nothing none in the name of the nation he attempted to deface can be? Every polity is shaped by how they organize countervailing impulses between constituents. A constituent is “mad” when they refuse to conform to the expectations of the larger group.
The trouble is that conformity is myopic, and requires (on the surface) little thought to affect. Human beings learn to be chameleons as regards their relationships with others. Which means that oppositional positions can come to have immense value. Consider the great thinkers of the past who ushered in vast changes across their respective zones of influence — the Confuciuses or an Einsteins, Marxes and Platos. How many times have I seen that meme claiming that Jesus would have been considered a domestic terrorist today?
“Revolutionary” thinkers are seldom aligned with the societies they emerge from. Something triggers them to step outside the routinized thinking of their fellows. Something persuades them to take a stand against the easier road offered by conformity. And yet there is a balance. The difference between a prophet and a screaming vagrant has something to do with how they relate, but the basic problem remains: every challenge to the status quo carries the risk of edging sanity, as it were.
As I’ve fixated on before, experience is contingent on context, language, and exposure. Looked at this way, madness is a question of perspective which renders it into a measure of relative suffering. The world we live in is one seldom satisfied with ambiguity. Better to assign a label and a prescription. Thus the problem with our casual attitude towards mental health: healthy people are just those that are better at keeping their problems to themselves. The unhealthy make the mistake of telling (or showing) the rest of us. Once they do, the next steps are, in theory, automated. A quick interview, a reference to some diagnostic criteria, and the a quick trip through a maze of drug interactions. No wonder this mechanism healing often leaves its victims in as deep a hole as the one they were trying to crawl out of.
Psychoanalysis, perhaps the first attempt to understand something of the life of the mind (beyond that prescribed by religious doctrine), didn’t really do a great job of creating criteria that institutions could adopt. The object of the psychoanalytic approach, so-called talk therapy, discovered that vast mental tensions can be resolved through simply working through the language of oppression. In effect, by helping people say what they mean rather than what is expected.
And so each generation has overwritten older codes as they seek to refine the prejudices and superstitions of the last. And this has yielded an impressive system of mental sublimation. Today’s psychiatrists need only 30 minutes to determine what section of the DSM you’re shackled to; it matters little that this shorthand does a poor job of explaining the life of the mind. This simplification probably feels necessary though — insurance agencies and HR departments need quick answers to complex questions. Bureaucracies are like databases, and every database is built on an ever-expanding number of primary keys. And perhaps this is the problem with the history of psychology — we went from a few baselines to a million specifics. The act of justifying these categorizations has left us all at risk — suddenly everyone is mad (mind you, everyone was mad before). And just as suddenly, there’s a pill for you. The irritation introduced by the early psychologists really had to do with being over broad: if you’ve only got a few categories to work with — if we’re all kinda that way, no one can really move forward. All you can do is negotiate terms, otherwise known as layering up on diagnostic complexity.
The thing that they mean by meaning (as it were) is commonly framed by the term “desire”. In this way, the language of desire comes to occupy the central place in the life of the subject, and the fidget spinner of mental life can start to appear a little more orderly. But the approach is slow and perhaps overly dependent on the raw conversational skills of the therapist.
This is probably because subjectivity refers to the subliminal haze that makes language the needed thing that it is (our evolution depends on it). So crafting an order that is somehow comprehensible requires a new flexibility in every engagement. In other words, it’s a practice — something that can’t simply be turned into a checklist. It defies the modern obsession with clarity of language and proscription (again, the world we have built is obsessed with meaning. It hates ambiguity and struggles when an outcome isn’t preordained — proceeding as expected). The thing we all hope for is to know the answer. The fact that we can’t introduces a tension that opens the door to what we call madness.
And I suppose this is how we come to rely on doctors — the people that we suppose to know. We suppose them to know because they speak in a kind of code that connects the experience to a manageable reality. This codification intentionally breaks down when it moves outside its realm, and so mental sickness is somehow caught up in the patient’s inability to speak the language of the specialist. Specialists aren’t all that special of course — they’re people. They just memorized the right complex of stuff (to be fair, everyone I meet seems to be some kind of specialist — even if not an immediately apparent one). But if you study a little psychology, you can probably persuade whatever diagnosis you might want. Doctors are suckers for the pretense of knowledge.
The idea of a doctor is an old one. A PhD, granted as the pinnacle of educational achievement, is short form for doctor of philosophy — one who understand the way of knowledge. In this sense, they are no longer thought to be bound to a specialty as such. Instead, they should feel free to explore outside. After all, knowledge, whatever its obvious boundaries, is an assemblage of practices. Practices mostly concerned with the integration and disintegration of information. Its attainment should bring with it a chilling humility, but this isn’t how that usually goes. Exploration is only possible if you’re willing to accept meaning as malleable. Most people who get PhD are consumed with proving they really know a thing.
In this sense, perhaps all doctors are ultimately responsible for stitching, a process that usually follows from something called cutting (with all respect to Alfred Hitchcock). There’s a lot of ways to stitch, just as there are a lot of ways to cut. But in the life of the mind, cutting and stitching means reorienting experience around signifiers — creating, understanding, and revising networks of associated meaning; echolocating the web that surrounds you. And potentially staring madness in the face as a result.
There’s a couple ways to do this of course. Wikipedia (at the time of writing) lists 45 different schools of psychological thought; six get a special mention on account of being the “most influential”. Given this range of options, it’s little wonder that the tools of psychology have proven so useful to the fascists and marketers. Anything can be justified, if understood the right way. In part, this is because mental health is something that we consider to be outcomes-based — getting a person back to the point where they don’t need to bring it up any more. The value of these outcomes, it would seem, have turned out to be highly subjective.
But this is only natural. The human being is, when you really boil it down, just a signal processing device. A living filter that transmutes the background radiation of the universe into your favorite episode of Star Trek. And language, the most essential, yet least reliable tool at our disposal, is hard to communicate outside its host. Between individuals, language is imprecise: the closer it gets to the core of a being, the less dependable it becomes. Our natural inclination is simply wrong: language thrives on abstraction, not precision.
Because of this, it follows that every doctor has a private understanding of their specialist’s language, one they might even believe they share with other professionals. The patient, almost by definition, lacks this code, and must learn it through their interactions with their doctor. This means that great care must be taken when introducing a diagnosis, lest the patient come to identify with it. Thus the existential challenge we face when confronted with those we suppose to know. They can teach us to not just recognize, but to identify with our symptoms.
This suggests that an over-identification is just a symptom of a breakdown in communication. Breakdowns like this always are to do with a failure to translate. Mistranslations, to over-extend a metaphor, mean that we have mistaken one symbol for another. The most extreme example, say a case of hysterical blindness, is really a mistranslation between the function of the eyes and the trauma they were intended to account for. Chronic illness may be the fault of your DNA, or simply a misunderstanding of how to interpret the experience of discomfort. What constitutes a minor backache of one might just as well be a call to complete collapse in another. Is it better to remove the splinter, or simply learn a way to live with it? Preferably one that includes state disability insurance…
As Laozi once said, “short and tall define one another.” So it is with the sane and insane. One exists to provide a space for the other. Or maybe it’s easier to say that the moment you think you understand something, you have gone mad. Or perhaps the wrong diagnosis makes for infinite remedy: an essential component of the capitalist model. After all, it’s only snake oil if you don’t believe it. We depend on missing the point in order to make any kind of progress.
Which is just another way of saying go on and be crazy. We need you. And if you’re lucky, you’ll get an apology and a hug for your trouble.
But then again, maybe you just need Xanax.
