Thoughts Inspired by Andrew Scull’s Madness in Civilization

Scull’s book disappointed me or, to be more accurate, the first half of the book disappointed me. The author tried to write a comprehensive history of insanity and ended up producing the world’s longest blue book essay for a Western Civ final. I don’t know if anybody is really up to the task of writing a cross-cultural history of madness, but Scull is not that guy. Heck, his effort reminded me my high school report on ancient attitudes to insanity, which I reread the other day while cleaning out some old papers. On the other hand, when Scull finally gets around to the last two centuries, he’s much better, passionate and on-point about the intellectual and moral scandal of the era of the mass incarceration of the insane, the hubris of the psychiatrists, the indifference of the politicians, and the incoherence of the law. Exposing the absurdity of the DSM is not especially difficult, I guess; but it sure is necessary.

I’m not quite up to writing a proper review of Scull’s book, but reading it occasioned a few random reflections:

• For most of history, the care of the insane has been an exercise in law enforcement, which is why there are no firm dividing lines between treatment, punishment, and torture. Celsus recommended whipping lunatics to restore them to sanity. St Loyola recommended whipping yourself to atone for the crime of being a human being. For the first part of our history, we Americans put difficult people in madhouses. Later we put the same kind of people in prisons. Neither approach works very well.
• “Insanity” does not name a natural group. Particular ailments that can indeed be separated out because of their clear causation have been identified from time to time and ceased to be though of as forms of madness. Indeed, the Greeks already distinguished delirium associated with fever from other kinds of aberrant behavior. Later epilepsy, Parkinson’s, Alzheimer’s, and the psychiatric manifestations of tertiary syphilis were hived off.  It seems likely that manic depression and schizophrenia may eventually follow, though that remains to be seen; but most of the conditions identified in the various editions of the DSM are far slippery than something like agitated catatonia. It’s almost as if a problem has to be an ongoing category mistake in order to count as a proper entry in the Chinese encyclopedia that is the official nosology.
• Simply getting a bunch of doctors to agree to call a set of behaviors a disease is not the same as making a discovery. I was in the audience in Toronto when the shrinks decided by a show of hands that homosexuality isn’t a psychiatric disorder. I almost laughed out loud, not because I think homosexuality is a kind of madness—I don’t and didn’t—but because of the stupidity of the whole procedure, which, to put it mildly, didn’t have much to do with satisfying Koch’s postulates.
• People are far more fouled up than we want to believe. Normality is as mythical as God almighty.
• A tremendous amount of psychiatry is merely a new version of phrenology. Though officially and even truculently materialist, the focus on neurology is actually rather Cartesian. It replaces one form of dualism with another. The world isn’t divided between things and souls, but between the brain and the rest of the world. Hence the obviously false notion that selves are located in certain parts of the brain and are identical with particular cerebral structures.
• I am not my body. After all, my body knows how to synthesize proteins from amino acids. I certainly don’t. The self is a parasite rather like those fungi you read about that control the behavior of ants.  The analogy is actually rather close. In Plato, the rational self is pictured as the driver of a team of unruly horses that resist his efforts to guide the chariot upwards. In ants, the fungus gets the infected insect to climb the highest twig, the better to spread the spores that will burst from its swollen head.
• For all its failings, psychoanalysis at least recognized that what’s at stake, at least for the most part, are meanings rather than brain chemicals. Scull is very good on this point. The fatal flaw of analysis is that you can’t get your insurance company to pay for it. The fact, if it is a fact, that it doesn’t do you any good is not the problem.
• The Freudian view of things is not dissimilar to Buddhism. The difference is that the Freudians more or less clear-headedly vote for samsara. They recognize that the ego is an illusion; but they opt for the illusion. To quote an old line of my own: of course we’re fucked up. Angst in the Tao of the West—the alternative, as Nietzsche accurately pointed out, is European Buddhism.