Notes on Madness #1: Does Madness Even Exist?
Prefatory to an Examination of my Particular Nuttiness in a Very Local Context
When you don’t know where to begin, just… well, begin. If it was good enough for the universe itself some 14 billion years ago, then it’s good enough for me! Here are some disjointed ruminations and musings concerning mental health.
What is the definition of mental illness, what is hisstory, and what are its memes (topoi, to use another wonderful Ancient Greek word: “commonplaces”, or recurrent ideas, trends and concepts)? What’s it all about? I’m bewildered by many things in life (and hope you are too!), notably by what I am trying to achieve in my pursuit of mental health. Consider this an essay in self-creation.
Michel Foucault, Thomas Szasz and Madness as a Construct
By what standards is a person deemed mad? Subjective ones, of course. Indeed, frequently arbitrary ones which are merely products of local cultural narratives. Behaviour which falls consistently outside social conventions, and in particular which inspires interpersonal conflict and leads to marginalization, is either considered criminal or mad (often both, depending upon how much free will, responsibility, and self-reflexiveness the subject is assumed to possess). For Foucault, the false desideratum is that of control—the aim of a nearly inescapable tendency for societies to try to create and maintain order through self-justifying power exercises. Societies are in a constant state of self-construction and self-definition, wherein every detail—in this case, every outlier—has to be dealt with. Historically, this has meant resorting to social categorization; in this case, the opposition of “the criminal” and “the insane” to “the just” and “the reasonable”—simply put, the opposition of elements of disorder vs. those of order. If you are too much of an outlier (too disorderly for anyone’s good), society through its power agencies—civic, religious, and so on—will try to find a way to bring you back closer to the curve.
For Szasz, the false desideratum is that of cure, in that the medical establishment has a tendency to self-servingly engage in unchecked, arrogant pathologization of almost anyone who stands out, originating in the assumptions that a) the moment something looks like a mental problem, it must be a problem (materialistic casuistry!), b) such a problem as defined must be fixed, and c) that science is the way to go about it. As usual, in deciding what constitutes madness a fairly fluid set of standards and conventions is king (pace the DSM-IV); sadly, however, convention is beginning to shift beyond the medical community and across the board we begin see ourselves as all potentially pathological. The result is that we now put kids and even pets on anxiolytics at the slightest provocation.
These are both top-down perspectives that bother me because they don’t do a very good job of reckoning with the day-to-day negotiations people with what I’d loosely call “issues” have when dealing with our private situations. Foucauldian interpretations rest too firmly on specifically institutional power exercises for my taste; unless I am wrong, I would posit that institutions are secondary to informal exercises of power and thus reflect, extend and enshrine folk elements of thought and action even though they are meant to replace them with artificially contrived ideology. Foucault’s stress on official, public decisions and actions should be tempered with the recognition that acceptable and unacceptable behaviour are negotiated to at least as great an extent unofficially and privately in a vast, messy, multivalent, dynamic cloud of consensus. Definitions of craziness float around in the zeitgeist, and while the medical community inevitable has allocated itself the final word, the private community—friends, family, the self—often has the first. Marginalization begins at home.
Szasz is of course correct in his criticisms, especially if we look at them in terms of the “walking worried,” i.e., the bulk of Westerners burdened by the myriad of tournée-du-siècle anxieties. But what are we to make of people who manifest extreme forms of psychosis and schizophrenia, such that they cannot adequately function unassisted in society? The short answer, and one I tend to agree with, is to provide the necessary assistance without regarding them as medicalized persons. How this is to be accomplished globally I have no idea, as I see it as a question for which particular, specific, culturally-appropriate and community-based answers need to be provided. Communities have to take back their standards, in other words. The deaf, blind, and developmentally disabled were once pathologized—yet who in his right mind(!) would dare do so now? These are people whose erstwhile “impairments” are nothing less than signifiers of their entire cultures! Of course, there would need to be a sea-change in everybody’s attitudes and values, as medicalized, pathologized, institutionalized patients (clients, consumers, survivors) worldwide would need to engage in a prise de conscience unheralded in the annals of social movements: for no matter where you go, no matter the demographics, the mad are the marginalized of the marginalized. As for the world of medicine, I’m not optimistic. With its reliance on magic bullet solutions, it views extreme behaviour as necessitating extreme controls (particularly of the chemical variety). Is that it? Surely we can do better.