The Myth of Mental Illness; Analyzing the Analysts 
By Brian Doherty

AS THE 20TH CENTURY STAGGERS TO AN END, efforts to quantify and classify its most important figures speed up. A candidate for the most important intellectual influence is Sigmund Freud, the man who mapped the unconscious and launched the pathologization of the everyday.

Freud's idol, Jean-Martin Charcot, may have been the first celebrity psychiatric doctor, but the hysterics he concentrated on were too outlandish and theatrical to hit home for the masses. Freud brought madness to the bourgeois, recasting the tics and troubles of day-to-day life as subtle signs of a new illness called neurosis.
 

As writers Mark Micale and Roy Porter have said, it's thanks to Freud that we now "turn to the psychosciences to run our private relationships, to raise our children, to try our criminals, to interpret our works of art, to improve our sex lives, to tell us why we are unhappy, depressed, anxious, or fatigued. Influence is measured not only in adherents, but also in opponents who feel obligated to grapple with you.
 

Freud triumphs here as well -- tilting at Sigmund is its own industry, though not as large as the psychoanalytic one he fathered. Feminists dislike Freud's turnabout on incest, his conclusion that what he once thought was widespread sexual abuse within respectable Viennese families must instead really be widespread fantasies on the part of confused women.

Philosophers of science consider Freud's theoretical structure unfalsifiable, and thus nonsensical. Within his schema, all behavior was perfectly explicable and all pathological: like the old psychoanalyst joke that the patient who was always early suffered from anxiety, the one always late suffered from hostility, and the one always on time from compulsion.

Less discussed but just as significant, Freud's notion that much human behavior is influenced by the unconscious in ways only a trained professional can suss out angered those who believe in free will and its concomitant, responsibility. This view posits Freud as the father -- though he might deny paternity -- of a nation of mewling whiners, sunk in therapy, unwilling to take responsibility for their behavior or take charge of their lives.

This makes Freud to blame, second hand, for everything from the Eagles' comeback hit "Get Over It" to the success of Dr. Laura Schlessinger. Schlessinger's willingness to bare her all aside, her popularity shows that there's an audience for being told to keep it to yourself -- your troubles stem from your depravity and stupidity, not uncontrollable sickness.

Schlessinger's success also hints that no matter how often and how loudly representatives of psychiatry assure us that mental illness (or "mental disorders," the nonce term -- "mental illness" has, like hysteria and neuroses, disappeared from the profession's vocabulary) is real, terrible, debilitating, a disease like any other, popular skepticism remains.

Spike Lee's Summer of Sam dramatizes two of the arenas in which psychotherapy and Freud's legacy war with what, for lack of a more precise term, we could call common sense. The movie shows two characters who present themselves as mentally ill to some degree: the real-life Son of Sam, serial murderer David Berkowitz, and Vinnie, the constantly straying Italian husband.

Audience reactions to portions of the film indicate some popular doubts about leading paradigms of the psychiatric industry. When Lee dramatizes the most colorful symptom of Berkowitz's alleged insanity -- hearing a dog command him to murder -- the audience at my screening laughed loudly. And when John Legiuzamo's Vinnie attempts to excuse his relentless philandering by whining to his wife that he's sick, and he knows it (in the language of the modern therapist, admitting you're sick is half the fight), the audience is clearly not being set up to sympathize. In Vinnie's case, Lee seems on the side of anti-psychiatric common sense -- a stance that seems less than radical, if only because most of us consciously make a decision to not be that kind of "sick" every day.

In Berkowitz's case, Lee is more sympathetic, even if the audience isn't. However, in actual fact, Berkowitz himself backpedaled from his strategic claims of madness after they failed to get him off the hook for his crimes. He told a reporter bluntly, "This is fictitious, it is invented, it is a lie. There were no real demons, no talking dog, no Satanic henchmen. I made it all up." So, it turns out that the colorful madness of David Berkowitz was in fact more a story than a medical entity, whether we call it "mental disorder" or "mental illness." Foucault would be proud of Berkowitz.

It's not necessarily a slur on the scientific status of psychiatry that its primary entities of a century ago, hysteria and neuroses, have both been tossed in the diagnostic ashheap of history, any more than the fact that physicists no longer talk about ether or chemists about phlogiston means physics and chemistry are inherently untrustworthy. We live and learn, as individuals and disciplines. Still, layperson skepticism over psychiatry is more widespread, popular, and respectable than, say, believing in a flat earth. At the bottom of that suspicion is what Berkowitz tried to tell us: that often apparent madness is more storytelling than disease.

Psychiatric pretensions are fought harder outside the realm of psychiatry than within it, for obvious reasons. Two recent books -- Mad Travelers by philosopher Ian Hacking and Hystories by literary critic, Elaine Showalter -- provide strong evidence for the madness-as-stories paradigm, even if the authors don't seem to embrace its full implications. For the full implications, look to the works of renegade psychiatrist Thomas Szasz, professor of psychiatry emeritus at the State University of New York Health Science Center in Syracuse.

Both Hacking and Showalter are talking about the modern wave of hysterias -- Showalter directly, Hacking by implication. Once a welcome sister among feminist theorists, Showalter's book brought her much obloquy because she suggests that many of the victims of today's most telegenic illnesses -- victims of such ailments or assaults as chronic fatigue syndrome, Gulf War Syndrome, Satanic child abuse, or alien abduction -- are in fact not sick at all.

Showalter tries to be kind; she says over and over that she doesn't want to devalue the very real pain and trouble these people are going through. Yet occasionally exasperation shows through, an annoyed shout of "snap out of it, people" can be heard dimly in the back of her measured, sympathetic prose. Showalter goes over the evidence for and against the physical reality behind these complaints and comes to the firm conclusion that these people do have problems, but they are not the result of some mystery virus, gas attack, or felonious assault.

Further, she argues, their tenacious hold on the fictional genesis of their symptoms means their problems will not be solved easily. Showalter strenuously avoids the question of whether or not these people are "crazy." Rather, she goes to rather extraordinary lengths to show the ways in which these modern hysterics, while not the victims of occult forces, are influenced by social ones. To Showalter, the Gulf War Syndrome sufferers, Ritual Satanic Abuse survivors, and alien abductees are reacting to the real world for real reasons -- their symptoms are simply socially acceptable manifestations of whatever sense of betrayal or alienation or injustice they happen to carry around.

Her topics are modern manifestations of the condition that psychiatrists, particularly French ones like Charcot, used to call hysteria -- a diagnosis whose "cultural particularism" has been written about extensively, especially by feminists. Showalter's audacity in applying that same analysis to more modern epidemics is what has earned her such ignominy among some of those same feminists.

Hacking can be read as a more subtle and suggestive shoring up of Showalter's blunt arguments. Hacking details the history of one now-forgotten psychiatric diagnosis, fugueurism, a mental illness that causes one to travel widely, compulsively, and uncontrollably, usually linked with amnesia. Hacking centers his analysis upon the story of the first famous fugueur, Albert Dadas, and the doctor Phillipe Tissié who identified and popularized Dadas' "illness."

The quotes around "illness" are implied throughout Mad Travelers, and with good reason. Hacking writes like a true ironist, undercutting his own explicitly stated meaning with the details he chooses to relate and some of his asides. Though he denies it upfront, the reader can't help but see something of the faker -- no, let's be frank, something of the liar in Dadas' tales.

Hacking takes the trouble to say that the fact of Dadas' traveling has been verified to the greatest extent possible -- he did indeed go to the places he said he went to while on his amnesiac, uncontrollable, fugues. But what can't be verified is the key to Dadas as a fugueur, as a victim, as opposed to Dadas as a cad and a deserter (he abandoned both wife and army on his many "fugues") -- the very uncontrollable or amnesiac quality of his travels. Hacking takes care to point out the many ways in which Dadas was clearly trying to please his doctor -- was Dadas aiding him in the "discovery" of a new "mental illness" by turning a desire to travel at inappropriate times into a literal compulsion?

These inverted quotes get tiresome. Hacking thinks so as well -- he finds the question of whether something is really a mental illness or not tiresome. In a previous book about multiple personality syndrome, a modern hysteria he seems as skeptical of as Showalter is about hers, he expressed the hope that a sophisticated reader would find that question naive and beside the point.

You see, Hacking is not just more subtle than Showalter, he's more meta. Hacking is interested in the ecology of mental disorders -- real or not. He uses the fugueurs as a case study from which he extrapolates a set of parameters for such historical diagnosis, a class which he calls (pun intended, to be sure) "transient mental illnesses." Briefly, Hacking posits that all such diagnosis flourish only in particular times in places -- "niches" -- mapped on vectors he identifies as medical taxonomy, cultural polarity, observability, and release. Hacking, it appears, is not interested in putting psychiatrists out of work, he's simply making more historians.

Psychiatrist Szasz, on the other hand, feels differently. Szasz has been bashing his own profession ever since his 1961 work The Myth of Mental Illness; he sums up his career's writings on the topic in Insanity: The Idea and its Consequences. Szasz does not find the question of the fugueur's sanity naive at all, and considers the answer a lot more important -- and infuriating -- than does Hacking. Szasz says that most so-called mental illnesses are not what the psychiatric profession maintains, and that fact is of great socio-political and ethical importance. 

Hacking and Szasz make intriguing reflections of each other, the sly ironist and passionate polemicist forming a front and back of a single image. Though neither Hacking nor Showalter cite or mention Szasz, by reading them in tandem one can see his image in them, with Showalter seeming somewhat of a kindly Szasz and Hacking an ironic one. They all agree that most major mental illnesses are more behavior -- however eccentric or damaging -- than disease, even if they don't use the same language. All three tell of how diagnoses and illnesses enter the official psychiatric guidebooks through lobbying, not advances in medical knowledge.

Szasz says the category of "mental illness" turns willed behavior into a disease, taking away both rights and responsibilities from the actor just because his actions strikes a doctor, family member, or judge as inexplicably bizarre and strange. In pragmatic terms, Szasz avers, "incarcerating innocent persons in mental hospitals and freeing guilty persons from prison... continue to be the psychiatrist's two most important social functions." He takes a cui bono? approach, asking what the psychiatric profession gains from the idea of mental illness (prestige, power, money) and what the patient gains (exculpation for bad actions or crime, relief from responsibility). Szasz is politically appalled by the coercion inherent in the modern psychiatric enterprise, and always credits even the most seemingly mad with humanity and intentionality. 

On the contrary, psychiatrists rarely credit the lunatic with having any sense or rationality behind his actions -- even when it's clear that there is some rational goal in mind. "A berserk lunatic may claim to be Jesus or kill his wife," Szasz writes. "The point of such a person's behavior, I dare say, is to be revered like Jesus or be rid of his wife. (Why a person chooses such ends and means is another question, the answer to which is often easily obtained by asking him.)"

"Above all, hysteria tells a story," Showalter writes. Hacking takes the responsibility of telling one hysteric's story in enough detail that madness is by no means the simplest explanation the alert reader could conjure. If someone with a dull or dire life chooses to escape it through running away, then claims no recollection of his actions when he comes to a bad end because of that choice, perhaps no entity called a "mental illness" is required for explanation. Whatever they are, mental illnesses manifest themselves in the way people talk and act, thus they are inevitably seen as literary. The real question is whether they are purely such -- purely part of the wide, sometimes wonderful and sometimes wacky, pageant of human choice and action -- or determined and controlled by as-yet-undiscovered organic diseases of the brain.

As to why it matters, that brings us back to Freud, the fountainhead of modern notions of mental illness and therapy, and to responsibility. Freud's unconscious is a useful exculpating tool for all of us -- it may not be, perhaps, that we don't understand our subterranean motivations, or those of the so-called insane, but that certain motivations are too difficult or embarrassing to admit to openly, or to acknowledge in others.

Modern science doesn't like introspective answers, even in the human sciences. Economics is turned into a matter of math and macroaggregates rather than human behavior, psychiatry into a science of drugs and brain regions rather than human choices. We pore over poor Einstein's dead brain, as if some answer will echo back from its cold, dead, gray folds. As a recent issue of FEED showed, we are fascinated by the search for materialist/reductionist explanations for the introspective realities of human choice, volition, and emotion. We know -- many of us from experience -- that drugs can change feelings and behavior. (This is not synonymous, as some psychiatric imperialists maintain, with curing a disease.) 

Szasz's answer, the classical, commonsense answer of irreducible free will seems too simple to the neurosciences, though it is in fact very complicated. But it's a complication that is impenetrable by material science, giving it nowhere further to go. It does, however, leave the novelist, the moralist, and the artist their usual infinite range to explore. The mind is the last turf of the war between scientific rationalism and literary idealism, which might be an unconscious motivation for the literary Showalter and philosophical Hacking to reclaim some territory back from medicine and for the mysterious human subject.

In day-to-day terms, the concept of insanity is more a matter of language than medicine. We need a word, after all, to explain behavior like Berkowitz's. It doesn't matter what he says now -- anyone who does the things he did must be crazy. And if by that we merely mean beyond the pale of civilized sensible behavior, it's a useful term, a needed category. But if by that we mean under the influence of some as-yet undiscovered organic illness and thus outside the realm of volition and responsibility, it remains unproved, and can lead to troublesome results. 

Showalter tells us of some of the reasons why, against the desires of many of her erstwhile comrades, she chose to speak out against the organic reality of the modern hysterias she discusses. She says that the hysterical epidemics she limns "prevent us from claiming our full humanity as free and responsible beings." Sometimes, if you are, say, David Berkowitz, or a homeless person refusing mental hospitalization, that humanity might be all you have left, and you'll cling to it tightly.

Brian Doherty is a fellow at the Competitive Enterprise Institute.