Theories of Madness
June 22, 2009
IN HIS A History of Madness, Roy Porter describes a dichotomy that has divided the profession of psychiatry for years. Can the rational talk with the irrational? Is there a meaningful dialogue that the sane can have with the insane?
Many think not. The doctors treating King George III “chose not to read any psychiatric significance into the fantasies he was recorded as uttering while out of his mind, including fears that sinful London was about to suffer a total deluge.” The idea, common at the time, was that madness transpired from underlying physical causes and the noises it made was not itself meaningful. “Hence the utterings of the insane were but cries of distress – and not necessarily even good clues to its nature. You don’t crack mental illness by decoding what the mad say.”
This was the institutionalization and isolation and quarantining of madness of which the likes of Foucault and R.D. Laing often spoke. Doctors are not teasing out and untying the mental knots: they are cutting them off completely with quack lobotomies and trepannings and drug cocktails. The idea is that you cannot solve madness on its own terms. You have to hack away at its foundations, which are themselves ridden with madness.
Even Freud, the pioneer of the talking cure, thought psychoanalysis could be reduced to physics – to genuinely observable scientific fact - even though he is better known for creating unstable and manmade artefacts like the Oedipus Complex.
Laing on the other hand claimed that madness was the only option available in a mad world, and that only dialogue could truly solve the problem by disentangling the confusions. During my own semi-mad period, I thought the same as Laing. Only by accepting my problems on their own terms, only by treating them existentially, could I possibly hope to resolve them, I thought.
My own depression, I thought, had become an integral part of who I was, a genuine historical problem that arose from my identity and the various historical facts that made me. I scoffed at the idea that there could be a simple pharmaceutical solution to my problems. I resented the idea that my problems were mechanical in nature, and arose from some basic endocrinological malfunction. Because if that was the case, it would undermine the value of everything I had ever thought, every apercu, every epiphany, every finely-honed phrase or aphorism that arose during my bouts of melancholy or neurasthenia or whatever you want to call them.
Porter doesn’t mention Nietzsche, but if you accept that Nietzsche’s entire life was spent in absolute physical and mental agony brought about by a billion vicious spirochetes eating away at his brain, then you start to think that his entire philosophy was somehow a symptom of his underlying physical condition, and was therefore worthless.
This is all related to the medicalisation of politics. When I studied “political psychology” decades ago I came across dozens of books laced with spurious looking formulae designed to explain the pathologies of particular political persuasions. Immeasurable abstractions like “extroversion” and “introversion” were used as if they were precise, scientifically unambiguous concepts that could be calculated like water in a beaker. Fascists were reconfigured as mental cases suffering from unresolved Oedipal urges and latent homosexuality.
Somehow, they were trying to imagine there own liberal perspectives on life were “true” in some Platonically perfect way, and that any other opinion was not only wrong, but actually pathological. Political ideas were thus reduced to nosology. This was a mild version, I suppose, of the way Communist regimes cynically consigned their dissidents to mental hospitals. While madness is still often entirely somatic, it still feels wrong to deny its right to speak.
