Last week I was involved in organising the first Open Learning Ireland week long education festival.
For the festival I prepared a talk on ‘Madness, Pyschotherapy & Medication’ (slides and notes). Delivering this talk, and discussing the issues raised with attendees, helped focus my mind on something I’ve been thinking about since college, the nature of meaning and mind in mental illness.
The medical model situates syndromal mental illness squarely in the individual (and more specifically the brain, subjected to stress and diagnosed with a psychiatric disorder): Extending a disease model analogy beyond it’s diagnostic, aetiologic and prognostic utility. While the psychoanalytic object relations model perceives pathological defences / illusions rooted in childhood trauma / attachment difficulties as a core element of pathology.
We are however social beings, and our emotional dysfunctions manifest in socially prescribed ways. Mental and emotional difficulties, like language exist at a meta-individual level. Viewing the individual alone, whether as the possessor of a dysfunctional brain, maladaptive cognitive schema or dysfunctional reality testing will never be sufficient for understanding the meaning of their ‘disorder’. Illusion (Winnicott’s term) is possibility, potential energy. It’s also social – symbols are perceptions generalised and shared, and culture can be viewed as the use of collective symbols and symbolic actions. Thus our contemporary ‘mental illnesses’ manifest as inevitable extremes or dysphoric projections of our schizoid visual culture / information society.
The psychologist Gottrschalk writes of telephrenia, believing oneself the subject of direct communication from the mass media – and this is a prototypic example of the blurred lines between metaphor and reality in relation to the cultural mediation of belief and mental health. Today’s delusions centre around feeling the subject of surveillance and conspiracy, or secret communication. Defences of paranoia / pronoia are employed by individuals with an uncertain sense of self, threatened by a lack of real recognition (coupled with a sense of being constantly seen). At a time when the panopticon is moving from metaphor to reality (online, from surveillance drones, CCTV and via the sousveillance of the ever present smartphone), the gap between delusion and metaphor can become thin indeed – especially when the deluded themselves become the subject of surveillance (due to their socially unacceptable behaviour). Are these delusions merely socially shaped, or are they socially derived, intrinsically linked not only in syndrome but causation with our collective alienation?
Two troublesome disorders in the DSM-IV-TR, conduct disorder and oppositional defiant disorder, centre around the individuals obedience to the collective. Here we see a direct line between conformity pressures and the diagnosis of pathology, little different from the traditional psychodynamic understanding of homosexuality / paraphilia as ‘inversion’. I don’t mean to suggest for a moment that mental illness is not real, or amenable to individual treatment – but I do want to question our ideas concerning the function and causes of illness (for the individual, their family and the culture at large). If prevention is the goal, the monistic alienation of consumerism needs to be addressed.
Heidegger differentiated between the nature of being, and the question of being as such. “The question is: Why is there any being at all and not rather Nothing?” (Heidegger, 1949). This elicits the unasked ‘why’ in mental illness, if being as such (the meaning of the symptom / sinpthone) is ignored – psychology becomes merely a taxonomic exercise (as in the DSM).
For more on the individual-cultural intersection in madness, check out Dan Costigan’s article ‘On Being Normal & Other Mental Illnesses‘. In my next couple of posts I will talk about some more socially and somatically grounded, multi-dimensional conceptions of the mind and mental illness that have emerged from the culture and health, and clinical psychology perspectives.