Szasz On The Myth Of Mental Illness

This semester, in my Landmarks in Philosophy class, I used Thomas Szasz‘s The Myth of Mental Illness as one of the three texts on the reading list (The other two were Mary Wollstonecraft’s Vindication of the Rights of Woman and William James’ Pragmatism.) Szasz’s argument that mental illness does not exist, that psychiatry is a pseudo-science was, as might be expected, fairly controversial; critics accused him of overstating his case and of drawing too sharp a boundary between the physical and the mental. Be that as it may, there are many, many acute insights in Szasz’s work; these continue to make reading his work a useful experience for any philosophy student.

Among these insights, in no particular order, are the following:

1. Reducing the mental to the physical comes at a cost of explanatory power. Especially when such reduction is merely offered in the form of a promissory note; many existing behavioral disorders still lack physical correlates in neurophysiology. The languages of the mental and the ethical often offer us richer and more useful explanations for understanding our fellow human beings than the language of the physical; many phenomena of social and ethical interest ‘vanish’ when subjected to the lens of the physical.

2. The so-called ‘mentally ill’ are engaged in a species of communication with us; it behooves us to try to translate their ‘speech.’ This leads to a consideration of a hierarchy of languages and a study of the metalanguage and object language distinction.

3. The category ‘mentally ill’ functions, all too often, as a catch-all category used to lump in socially undesirable behavior; what counts as desirable and undesirable is clearly a function of existing social prejudices.  The infamous DSM criteria often encapsulate such prejudices; unsurprisingly these need to be revised over time to accommodate such inclinations. (Remember that Dostoyevsky’s ‘Underground Man‘ was a ‘sick man.’)

4. A game-playing and rule-following model of human behavior offers us interesting and useful interpretations of social situations and interactions within them. (Wittgenstein’s notion of language as a kind of social game immediately comes to mind here and allows for a fruitful investigation of this claim.)

5. Medicine functions within a social, economic, political, and ethical context; the rights of patients and healers emerge within this context.  We should expect medicine to be practiced differently–with different medical outcomes–in different contexts. From this, a larger point about the social construction of science, scientific practice, and scientific knowledge can be seen to follow; the boundaries of science are very often informed by social and legal considerations. Consider, for instance, the testing of cosmetic products or new drugs on laboratory animals, experimental procedures which stand and fall depending on whether they have received legal sanction from the surrounding legal regime.

6. The autonomy and personality of the patient is a moral good worthy of respect; the practice of medicine and the relationship between the doctor and patient should be cognizant of this. (The notion of ‘informed consent’ in modern bioethics can be seen to be powerfully informed by such a consideration.)

The Self As Prison

In his review of Charles Simic‘s The Lunatic: Poems and The Life of Images: Selected Prose Phillip Lopate makes note of Simic’s “cultivation of awe,” his “opening himself to chance, that favorite tactic of Surrealists” and makes note of this pronouncement:

Others pray to God; I pray to chance to show me the way out of this prison I call myself.

I have written here about the difficulties and myths of ‘self-improvement’; one of the possibilities suggested by those difficulties is a terrifying species of realization, of self-discovery, perhaps the most terrifying possibility of all: that we want to change, but find that we cannot, and this knowledge of our inability to do so does not in turn bring about a corresponding diminution of the desire to change. (Hannah Arendt has written of the perennial “wish to escape the human condition;” we may also wish to escape our own personal version of that condition.) We are now locked in a hell of our own making, locked into an eternal ‘repetition compulsion,’ doomed to spend our days like a not-cheerful Sisyphus, one not reconciled to his fate. We wish to change; we find that the combination of this world’s arrangements and workings and our own capacities and inclinations and limitations do not permit such a change; we retreat, defeated time and again in our attempts to transcend ourselves.  We find failure and disgruntlement each time; but rather than accept defeat and ‘go home,’ we, unable to reconcile ourselves to this state of affairs, to the distance now revealed of a bridge too far, persist.

There is nothing noble or heroic about such persistence now; we are not possessed of an amor fati, we do not ‘own it’; we seek to distance ourselves from ourselves, but cannot. We are not reconciled to our being; we are tormented by ourselves, by the bars for this cage we have constructed on our own. Time on the couch does not help; we are urged to construct a narrative of our life that would make sense of the state we find ourselves in, and simultaneously suggest an onward path; we find ourselves unable to write this tale, to take the first step on a new road. And if we do, we find a familiar character populating that myth, we find familiar roadblocks. We are dogged, at every step, by ourselves.

Our ambitions, which almost always outstrip our abilities and capacities, may bring us to this pass; so might the ambition of others. This world’s orderings might suggest routes and journeys that are not for us to undertake. They require us to be not ourselves, and we cannot change.

This a terrifying state of affairs; all too many of us find ourselves in this state of being. Hell is here, on earth. It is not other people; as John Milton’s Satan had noted,

A mind not to be changed by place or time.
The mind is its own place, and in itself
Can make a Heaven of Hell, a Hell of Heaven
What matter where, if I be still the same

Hell can be, and very often is, just us.


The Indifferent ‘Pain Of The World’

In All the Pretty Horses (Vintage International, New York, 1993, pp. 256-257), Cormac McCarthy writes:

He imagined the pain of the world to be like some formless parasitic being seeking out the warmth of human souls wherein to incubate and he thought he knew what made one liable to its visitations. What he had not known was that it was mindless and so had no way to know the limits of those souls and what he feared was that there might be no limits.

The ‘pain of the world’–its irreducible melancholia and absurdity, its indifference to our fortunes and loves and fears–can indeed feel like a malevolent being, a beast of a kind, one that may, if provoked, swat us about with a terrible malignity.  Here, in these impressions, we find archaic traces of an older imagination of ours; the formless fears of the child’s world have congealed into a seemingly solid mass, serving now as foundations for our anxious adult being. It is unsurprising that we have found ways to pay obeisance to this beast through prayer and fervent wishing and day dreaming and fantasy and incantations and magic and potions; we hope to pass unnoticed through its gauntlet, afraid to set astir the slumbering beast and provoke its attentions and wrath. As John Grady Cole, McCarthy’s character, notes, we fear two things especially about this beast: we suspect ourselves to be particularly vulnerable to its depredations, a particularly attractive prey for this predator; we fear we sport a bull’s eye on our backs, a scarlet letter that marks us out as an offender to be dealt with harshly; we fear there may be no limits to its appetites; we sense that lightning might strike not once, not twice, but without no constraint whatsoever; perhaps we ain’t seen nothin’ yet, and much more misfortune awaits us around the corner on life’s roads.

In our darkest moments we attribute a malevolent intelligence to this beast, but we know the worst eventuality of all would be a mindless beast, one whose ignorance of us and our capacity to tolerate pain could cause us to plumb unimaginable depths, to experience pain whose qualities defy description. (The fears of these sorts of mental chasms are expressed quite beautifully in Gerard Manley Hopkins’ mournful poem ‘No worst, there is none. Pitched past pitch of grief.’) McCarthy also seems to suggest the possibility of a presumption of ‘too much’ knowledge on Cole’s part–a la Oedipus, a possible arrogant claim to know the ways and means and methods and mind of the beast; but as McCarthy goes on to note, there is no mind here to be known, no rationale to be assessed, no strategy or tactic to be evaluated; there is merely being and man, caught up in its becoming. It is this irrelevance of man and his capacities and attributes to the working of this beast which is Cole’s deepest fear; it is ours too, the root and ground of the absurdist existentialist vision.


Old Battles, Still Waged: Accepting ‘Defeat’ In Self-Improvement

Over the past couple of days, I have engaged in a time-honored academic ritual: the cleaning of one’s office. Old books, journal articles, student papers and blue books, random handouts from academic talks, conference badges–all fodder for the recycling bin. But I went further, looking for especially archaic material; and I found it in my graduate school notebooks. Scribbled notes from graduate seminars filled their pages; but much else too. In their pockets I found syllabi and handouts; and on their back pages, many, many notes written to myself during the seminar class period.

Some of these notes are simple reminders to myself: submit forms, pick up checks, finish reading etc. Yet others are financial calculations; in graduate school, I always lived on the edge, and frequent checks of my financial health were necessary. These, as can be seen, often distracted me even as I thought about metaphysics and ethics. And then, perhaps most poignantly, I find little injunctions and plans for self-improvement: eat more of this, eat less of that, run more, workout regularly, reading and writing schedules, smoke less or quit; and on and on. Sometimes I offer exhortations or admonitions to myself. These blueprints for a new me occur with some regularity; they represent a recurring concern of mine.

Those concerns and the ways in which I negotiate with them persist.

I still make lists of plans, I still draw up schedules of work and abstinence; I’m still struggling. Now, you can find the blueprints I speak of in my hard drive, tucked away into files; I don’t scribble them anymore.  But I continue to obsess over how I can get over this weakness, this flaw, this thing that is ‘holding me back’; I continue to obsess over how I can ‘change’ and ‘improve’ and be ‘better.’ When I see my notebooks, I see that I’m fighting many of the same battles that I used to fight back then; against distraction, anxiety, lack of discipline in my personal habits, in my ‘work ethic.’ I used to dream of transcending these, of moving on; it seems like I still am. Perhaps battles that have been waged this long are indicators of persistent failure on my part, a depressing thought at the best of times.

I’ve often written on this blog about the difficulties and myths of ‘self-improvement’; perhaps talk of ‘self-improvement’ is a sham, a distracting disturbance that does not allow us to become truly comfortable with, and accepting of, ourselves. Perhaps we have not reconciled ourselves to who we are. But perhaps that’s who I am, the kind of person who will always be obsessed with making these kinds of changes and ‘improvements,’ who will never make them, or never in the way that I want, but yet never accept ‘defeat’ or ‘get the hint.’ In that case, perhaps the best way for me to accept who I am, to ‘become who you are!‘ is to not disdain this activity of constantly plotting and scheming to escape myself. To engage in it is to be me.

On Congratulating A ‘Dropout’

A few years ago, I went out for dinner and drinks with some friends of mine at a Manhattan restaurant. As we placed our orders, I noticed my waiter looked familiar; he smiled, walked over, and said, “Hey professor, remember me? It’s D_; I took your Modern Philosophy class a couple of years ago.” Indeed, I did; I remembered him quite clearly as a budding comic book artist, someone who was normally quiet and reserved in class, but sometimes spoke up to offer a thoughtful comment or two. His facial expressions were often more eloquent; he frequently seemed to perk up in response to either the passages read out loud in class, or to the commentary I offered. (Truth be told, this form of feedback was highly gratifying; it often helped sustain me during our long class meetings at night.) D_ was also a thoughtful writer, keen to improve his writing, and to this end, often came to meet me in my office hours to discuss his papers. In any case, I asked him what he was up to now, fully expecting to hear a variant of the usual “I’ve got x more classes before I finish,” or “I graduated last year and am now doing y.” D_’s response was “Professor, your class changed my life; after I took it, I dropped out of college!”

My student did not offer me too elaborate an explanation of what influence my class had had on him, and given my social commitments, I could not press much further. He did say that he was now spending more time on what he really wanted to do; from my perspective, he seemed much happier than I had ever seen him before. I can only venture a guess as to what effect the content of our class–one devoted largely to sixteenth and seventeenth century metaphysics and epistemology–could have had on my student: I suspect that talking about these sorts of foundational issues might have broadened my student’s perspectives on his own life and his attendant scheme of priorities. Thinking critically in one domain can often prompt critical inquiry in others; perhaps my student had realized that he was in college for the wrong reasons; perhaps he was merely going through the motions, and that his true passions lay elsewhere. Perhaps the concentration on questions in my class that were never asked elsewhere in my student’s life had prompted him to examine further those unexamined verities in his life that were keeping him in college; the result of that inquiry might  have been to prompt him reorder his life’s priorities and make a bold decision to reconfigure how he lived it; perhaps he had realized that he had merely been molding himself into an ‘acceptable’ and ‘respectable’ form for the ‘real world.’ Perhaps philosophy had enabled the examined life and found it wanting in crucial regards. My student had made an existential choice in response.

After D_ made this pronouncement, I slapped him on the back and said, “Well done!” It’s not everyday that I congratulate a ‘drop-out.’ But D_ was sincere; and he had, like many others before him, showed that that term is far more pejorative than it needs to be. Alasdair Macintyre reportedly once said that “The point of a modern university education should be to ensure that it leaves the student entirely unfitted to the modern world.” There is a great deal to disagree with the way the modern world is structured and run; and too much of modern university education merely aids and abets those pathologies. I’m happy to have contributed, if only in the most minor of ways, to weakening one person’s allegiance to a way of life he had not chosen for himself, and had no further interest in pursuing.

Irène Nèmirovsky On The Failure To Recognize Failure

In The Fires of Autumn (Vintage International, New York, 2015, p. 186) Irène Nèmirovsky writes:

Mankind can only easily get used to happiness and success. When it comes to failure, human nature puts up insurmountable barriers of hope. The sense of despair has to remove those barriers one by one, and only then does penetrate to the heart of man who gradually recognizes the enemy, calls it by name, and is horrified.

Indeed; so easy is it to get used to happiness and success that that pair of supposedly elusive and desirable entities can rapidly lose their allure once they are in our possession. We may even tire of them, find them oppressive, and seek relief in some kind of novelty, some kind of deviation. (Freud quotes Goethe in Civilization and its Discontents as noting that ““nothing is so hard to bear as a train of happy days.”) As for despair, we are, after all, the creatures who can “bear almost any how” so long as we have “a why to live.” As Nèmirovsky notes, such a “why,” a hope, is sought by us almost instinctively; we seek to make sense of, ascribe meaning to, our misfortunes; we seek to make them explainable and comprehensible; we are reluctant to admit that the end of the road has been reached, that the rope has run out. Such maneuvers can indeed make our potential despair bearable; for instance, we may assign some reason, some cause, some purpose, to seeming disasters, and thus decorate our misfortune to make its appearance more palatable. Its true dimensions may remain hidden to us; we are, as existentialist philosophy realizes, meaning-creating and meaning-assigning creatures; true despair only becomes possible when we realize the absurdity of our situation in this world. Such endless evasion is not to be scorned; it enables tremendously creative and productive moves on our part. Poetry and religion and philosophy issue forth. The oft-told tales of returns from the brink of the abyss–of whatever kind, mental or physical–reassure us that sustenance provided by hope is not illusory, that it ‘works.’

Sometimes hope falters, unable to withstand the assaults of despair; the walls crumble, and our last ramparts are overrun. We are horrified by what awaits us, by the true dimensions of the pickle we find ourselves in. What then? Nèmirovsky leaves out our responses to this state of horror; but here too, we do not and cannot dwell too long. This recognition of the actual dimensions of our failure, our misfortune, is all too soon, I suspect, the spur for further discovery of hope. Even in this pitch-black chamber, we start to recognize forms and shapes by which we can begin to navigate and make our way about. Our missteps and our fumbles suggest to us that we are deluded, but we ignore these signals. This is not our resting place; we move on. Optimism begins where we have allowed pessimism its rightful place, allowed it its time in the sun.

Nèmirovsky is not describing a terminus, I think, but rather, the valley, in a series of troughs and peaks.


Polonius On The Necessity Of Authenticity And Self-Discovery

A Facebook friend asked on her timeline for some clarification of Polonius‘ famous lines in Hamlet, which he offers as–perhaps sententious–advice to Laertes:

This above all: to thine own self be true,
And it must follow, as the night the day,
Thou canst not then be false to any man.
Farewell, my blessing season this in thee!

[Act 1, Scene III, 78–82]

Polonius here finds the roots of our dishonesty, our moral failures, in our inauthenticity: we are disingenuous in our dealings with others because, fundamentally, we are dishonest with ourselves. We maintain masks and put-on affectations in social interactions; we are comfortable in these maneuvers because we have practiced them with our own selves. We often ignore messages from within that inform us of who might be in favor of something else altogether: perhaps a dimly glimpsed and poorly understood vision of some socially desirable personality, perhaps some aspirational ideal that is not in concordance with our desired ends and aims and our actual capacities and talents.  It is a commonplace wisdom that the telling of one lie facilitates and makes possible the telling of many others. We lie frequently to ourselves about who we are, about what our motivations for an action or utterance are; we then go on to invent self-serving rationalizations intended for consumption by others. So we should expect dishonesty, double-dealing, backbiting, lying, and many other sins in a world whose actors and moral agents are not even honest with themselves; honesty begins at home. Cure a local affliction, much else follows.  Polonius then, is bidding us to do no less than to undertake a project of self-discovery as a means of ensuring greater honesty in our dealings with the rest of the world. Without those efforts we are destined to repeat our ‘local errors’ on a global scale.

Of course, Polonius seems to think that the authenticity we might derive from such discovery will automatically and necessarily authenticate our interactions with others. Of this, I’m not so sure. It seems possible to me that we might invent yet other reasons to be dishonest with others; we might find some of our ends realized by precisely such falseness. Our experiences have many shades and complexities to them; who knows how these might exert compulsion on us? But at least then, in those cases where we are dishonest with others, we will be transparent to ourselves; we will not be able to convince ourselves that we acted honestly when we did not. This has great value for projects of ‘self-improvement’; when we cast a retrospective glance backwards at our lives and sift through its events, looking for points of departure, we will be able to pick out genuine examples of dishonesty on our part, which may then serve as correctives for the future. Someone deluded in their dealings with themselves will already have covered up the past with layers of self-serving dishonesty, thus making correction and emendation impossible.

Unsurprisingly, as always, self-discovery appears fundamental and necessary.

Note: I realize that this is a charitable reading of a character Shakespeare intended to be understood a little less charitably.