Posted on September 24, 2010 - by David

Madness: A Modern Phenomenon

I am working directly from the unpublished text of Liah Greenfeld’s forthcoming book, Mind, Madness, and Modernity: The Impact of Culture on Human Experience. All the original ideas, and all interpretations and analysis of primary and secondary source materials used to support the ideas are attributable to Liah Greenfeld. Read the introduction to the exposition here.

part 1 – Doing Away With Dualism: A Solution to the Mind/Body Problem

part 2 – A Symbolic Reality: The Emergence of Culture and the Mind

“Identity-formation is likely to be faster and more successful the simpler is the (always very complex) cultural environment in which it is formed – i.e., the fewer and the more clearly defined are the relations that must be taken into account in the relationally-constituted self.”

- from Mind, Madness, and Modernity: The Impact of Culture on Human Experience

For most of human history, in most societies, identity was not something one had to go searching for – it was given at birth. For most individuals, the socio-cultural space relevant to their lives was easy to map out, and directions for proper navigation were well understood from a young age. Life may have been extremely difficult in the physical sense, but at least it was not confusing – people knew their proper place.

As Greenfeld has demonstrated since her first major work, this changed in 16^th century England following the War of Roses, which wrecked the nobility and left the rigidly stratified society of orders in disarray. In its place, a new consciousness emerged – nationalism – the modern consciousness, which redefined the possibilities for life in England and in the other societies to which it soon spread. We call this new consciousness nationalism simply because “nation” was the name given to the society in which it emerged by those 16^th century Englishmen who first experienced its dignifying effects.

Nationalism is a fundamentally secular and humanistic consciousness based on the principles of popular sovereignty and egalitarianism. (Three distinctive features which most often take shape along with this consciousness are an open class structure, the state form of government, and an economy oriented towards sustained growth). At the beginning of the 16th century, someone among the newly elevated English aristocracy began equating the word “nation,” which had formerly referred to a political and cultural elite, with the word “people,” which referred originally to the lower classes. This equation of “nation” and “people” both reflected and reinforced the new reality of English society, where the principles of popular sovereignty and egalitarianism made the nation and all its members an elite. No longer confined to a particular station in life by a closed societal structure ordained by Divine Providence, man became his own ruler, the maker of his own destiny. This elevation in dignity for every member of the nation meant that life in the here and now gained much greater importance – eternity was no longer the realm of the meaningful. This is the source of the secularism of modern society – God was not consciously abolished, but was essentially replaced by man.

For the first time in history, identity-formation became the responsibility of each individual, and this has proven to be a mixed blessing. With the opportunity to rise above the position of one’s birth comes the possibility of failing to successfully make the climb, or falling suddenly and senselessly from whatever height one is able to reach. The abundance of options in every aspect of life lets in a nagging suspicion that one has not made the best choice. The presence of circumstantial, or worse, socially imposed, obstacles to one’s advancement clashes with the belief in one’s equality and right to self-governance. Belief in equality becomes the idea of equality with the best, making it difficult to tolerate the sense that another person is better, or better-off. This inability of culture to provide the individuals within it with consistent guidance is called anomie – recognized by the great French sociologist Emile Durkheim over 100 years ago as the most dangerous problem of modernity.

With the changes in the nature of existential experience brought on by the mixed blessing of modernity came changes to the English language. A new vocabulary was needed to express and reinforce the ideas behind this new reality. By following linguistic changes in 16^th century English, we can actually observe the emergence of several aspects of this new experience – at once, so elevating and devastating for the individual mind. That is to say, we can see several specific sources of anomie, which, it is hypothesized, makes identity formation difficult and complicated, leading in some of the worst cases to the development of mental illness.

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Of course, there are many who would react strongly to the idea that changes in language may reflect fundamental changes in the nature of human experience. The same materialist tendencies which have us assuming the universality of schizophrenia lead us to assume the universality of a whole range of human emotions and experiences. If human nature is reduced to a set of biological capacities, the idea that various emotions, (which we must feel are a very important part of being human), have emerged in different places and at different times in history seems outrageous.

But as was demonstrated in the previous post, it is culture – the symbolic transmission of human ways of life – which distinguishes our species from all others and makes humanity a reality of its own kind. Culture is a fundamentally historical process, which means that the possibilities for thought and emotion for an individual at any one place and time are dependent on context  – the context of what has gone on before and what is going on around the individual, the infinitely complex history of connections and intersections of the variety of  symbolic systems which collectively make up that individual’s cultural resources.

This doesn’t mean that emotions are purely cultural phenomena. At the most basic level, emotions are physical sensations – we feel them. We know we must share certain primary emotions with animals – pleasure and pain, fear, positive and negative excitement – which we assume they experience through neurobiological processes similar to ours. We can see also that certain animals experience secondary emotions like affection and sorrow, which are once removed from their physical expression, and usually serve to strengthen social ties within a group. Considering this, it is obvious that human emotional functioning depends to a large extent on biological capacities that we share with other species. But inevitably, culture interacts with these biological capacities, creating more complex emotions which are tied to particular beliefs and ideas – specific experiences of a symbolic nature – which cannot be reduced to a combination of physical sensations.

When a new idea/emotion/experience emerges, it is usually closely linked to a particular word or set of words – either new words, new derivatives of old words, or old words with new or increased significance, evidenced by changes in usage and context. Ignoring these cultural developments under the mistaken assumption that all human experience is essentially the same results in a few common problems of backwards translation:

• the new meaning of a word is attributed to earlier uses of the same word, obscuring the historical shift in definition (and lived experience)
• other words which denote phenomena which may be related or similar to, but are nonetheless distinct from, the phenomenon to which the new word refers, are taken to be synonyms of the new term.

In both of these cases, differences between cultures and over time are blurred, making it nearly impossible to use the history of a language as empirical evidence. But if language, the most important of the various symbolic systems which collectively make up culture, is off limits as evidence, then no meaningful argument about culture can ever be made.

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The two new great passions of modernity – the ultimate expressions of the sovereignty of the self – were ambition and love. The opening of these two realms of choice, and their importance in the formation of individual identity is reflected in the growth of the vocabulary of related terms soon after the birth of the English nation.

While ambition was not a new word, before modernity it usually carried a negative connotation, meaning basically an overgrown (and therefore sinful) desire for honor. Over time, though, it became more neutral, meaning something like “a strong desire”. Thanks to the principles of nationalism, such a desire for attainment of an earthly goal was legitimized and even encouraged, making ambition in many instances a virtue rather than a sin. A positive or negative qualifier would introduce the word to denote which type of ambition was being referenced.

The language of ambition was bolstered by other shifts in meaning and new derivative words. The OED finds only one instance of the use of the word “aspire” in 15^th century, with all its derivatives – aspiration, aspiring, and aspirer – appearing mostly in the late 16th century.  The verb to achieve acquired a new meaning of gaining dignity by effort, (as in Shakespeare’s: “Some are born great, some atchieue greatnesse”), and from this were derived achievement, achiever, and achievance. The use of the verb to better, referring to improvement by human action, (e.g “bettering oneself), was another permanent addition to the language.  Success, which was originally a neutral term meaning any outcome of an attempt, came to refer only to a positive or desired outcome,  and its derivatives, successful and successfully, obviously carried this new meaning as well.

Love, (first defined as a passion by Shakespeare), became a calling, a means of defining, or perhaps more accurately, discovering, who one was. While the word love had been commonly used with a variety of meanings – from the ideal of Christian, brotherly love, to the divine love of God, to the essentially sinful sexual lust – the 16th century English concept of love — which is our concept – was dramatically different. “Romantic” love, as it is sometimes called, occurred between a man and woman – therefore it retained clear sexual connotations – but it was above all a union of two minds (or souls, for by this point, the words mind and soul were nearly synonyms). In love, one recognized one’s true self through identification with another, giving meaning and purpose to life in this strangely open world where God, formerly the source of meaning, was conspicuously absent.

The ultimate end of ambition and love was another modern concept: happiness. This word refers to a phenomenon distinct from many of the historically earlier ideas with which it is sometimes identified. It is not luck, which could be either bad or good and was beyond one’s control; not eudemonia, freedom from fear of death which depended in large measure on avoiding excessive enjoyment of life; not the Christian felicity of certitude of salvation, requiring denial of bodily pleasures up to the point of martyrdom. Happiness was rather conceived of as a living experience, a pleasant one, which was purely good and could be pursued. The OED shows the first instance of this general meaning for the word happy in 1525; the same meaning of the noun form – happiness – doesn’t appear until 1591.

Happiness was knowing who and what one was, being content with one’s place in the world – in other words, successfully creating a satisfactory identity. But what was to become of those whose ambitions were left frustrated and unfulfilled? Of those who lost, or failed to find true love, or were kept, either by circumstance or society, from experiencing true love once it was found? What happened to those sensitive minds for whom the responsibility of building an identity proved too great a struggle?

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In the same 16th century England which brought the world ambition and love,  a new form of mental disease – Madness – appeared. While previously known forms of mental illness were temporary, related perhaps to an infection, an accident damaging the brain, a pregnancy, a bodily illness like “pox” (syphilis), or old age, madness was chronic – usually appearing at a fairly young age (without evidence of an organic cause) and lasting till death. Another of its names, lunacy, reflected the suspicion of a physical cause – specifically implicating the waxing and waning of the moon in the periodic alterations in the character and symptoms of the sufferers. The word insanity entered English at that time too, apparently referring to the same phenomenon as madness and lunacy.

The chronic nature of madness made it a legal issue from the very beginning; the first provision in English law for mentally disturbed individuals — referred to, specifically, as “madmen and lunatics” — dates back only to 1541. Also in the middle of the 16^th century, Bethlehem Hospital – more commonly known as Bedlam, the world’s first mental asylum – became a public institution, transferred to the city of London in 1547. While there was probably little to be praised in terms of humane treatment and comfortable accommodations, Bedlam continued to expand into the 17^th century to meet what seemed to be a growing need to house the severely mentally ill.

Important for this argument is the fact that folly was separated from madness.  Though it sometimes referred to a moral deficiency, folly was generally a synonym for idiocy – a mental dysfunction or deficiency but not a disease. In ‘An Essay on Human Understanding,’(1689) John Locke summarized the difference between madness and folly as such:

In fine the defect in naturals [fools], seems to proceed from want of quickness, activity, and motion, in the intellectual faculties, whereby they are deprived of reason, whereas madmen, on the other side, seem to suffer by other extreme. For they do not appear to me to have lost the faculty of reasoning, but having joined together some ideas very wrongly they mistake them for truths… as though incoherent ideas have been cemented together so powerfully as to remain united. But there are degrees of madness, as of folly; the disorderly jumbling ideas together in some more in some less. In short herein seems to lie the difference between idiots and madmen. That madmen put wrong ideas together, and so make wrong propositions but argue and reason right from them. But idiots make very few or no propositions, but argue and reason scarce at all.

Physicians of the day sought to describe and understand this new phenomenon, but their methods, sources, and interpretations were thoroughly mixed. Their reliance on classical Greek and Latin terms of mental disturbance resulted in a liberal blend of (their interpretation of) the old ideas with the new reality, and though they attempted to draw distinctions between conditions, they were far from clear. The cause was usually assumed to be organic. The common attribution of madness to an imbalance of the four humors shows the strong influence of the classical medical understanding. (The use of the term melancholy as a name for mental illness in general or a particular variety of it is a prime example). Insanity might also be explained by the stars under which one was born. Some authors distinguished between organic madness and spiritual madness caused by demonic influence. Still others focused on mental states that could in turn affect the body.

Obviously, early observers of madness were far from a uniform hypothesis as to its nature and cause. Nevertheless, these sources do contain some revealing descriptions and suggestions. Andrew Boorde recommended that the patient be kept from “musynge and studieng,” (implying very obviously a literate madman), and likewise Thomas Cogan, a physician and head master of a grammar school,  advised against “studying in the night” deeming “wearinesse of the minde”  worse than “wearinesse of the bodie.” Sir Thomas Elyot noted a “sorowe,” or “hevynesse of mynde” which affected the memory and the ability to reason properly, relating it to such experiences as the death of a child and even disappointed ambition. Christopher Langton saw “sorrow” as a chronic condition, the most serious of four “affections of the mynde” that could “make great alteration in all the body.” Philip Barrough’s description of melancholy, (which he calls “an alienation of the mind troubling reason..”), mentions mood swings, suicidal thinking, hallucinations, and paranoid delusions – in short, some of the most characteristic features of major psychosis which might be diagnosed alternately as bipolar or schizophrenia today. Timothy Bright’s ‘Treatise of Melancholie’ contains the idea that being “over-passionate,” put one at risk for mental disease.

By far the longest and most famous book on the topic in the early modern period was The Anatomy of Melancholy by Robert Burton, first published in 1621. It was essentially a collection all the information he could find on mental disease  – both past and present -  and therefore (unfortunately) contributed greatly to the confusion of terms, translating as “madness” a whole variety of words from Latin and Greek sources. Despite his mistake, which allowed him to find English madness scattered throughout history, it seemed to him a particularly pressing problem in his day. He noted among his “chief motives” for writing the book “the generality of the disease, the necessity of the cure, and the commodity or common good that will arise to all men by the knowledge of it.” Burton’s description of his society as a “world turned upside downward” is loaded with colorful yet tragic examples of apparent inconsistency and injustice – in a word, sources of anomie common to modern life. One can hypothesize that the inclusion of such a description of the contradictions within culture, in a work that is dedicated to the understanding of what is deemed a medical illness with an essentially organic cause, is related to Burton’s sense that the two phenomena – anomie and mental illness – are related. Indeed, some of the mental symptoms of melancholy “common to all or most” – “fear and sorrow without a just cause, suspicion, jealousy, discontent, solitariness, irksomeness, continual cogitations, restless thoughts, vain imaginations” – begin to make sense if mental illness is seen as stemming from fundamental problems with identity caused by anomie. Some of these symptoms appear identical to the causes of melancholy which fall under Burton’s general category of “passions and perturbations of the mind.” Ambition and related passions like envy and emulation figure prominently here, but most striking of all is the inclusion of love – the cause, apparently of a special madness called “love-melancholy” which afflicted primarily men of the upper classes.

But perhaps the greatest early chronicler of madness was William Shakespeare. Dr. Amariah Brigham and Dr. Isaac Ray, ( two of the most important figures in 19^th century American psychiatry), each devoted an extensive article in the early years of the American Journal of Insanity (today the American Journal of Psychiatry) to the consideration of his work. They saw in his plays, (in particular King Lear and Hamlet), such accurate portrayals of insanity that they were certain he must have drawn his inspiration at least partly from first-hand observation. Whatever might be said today in criticism of the method of these doctors, who had no qualms about using literary study to supplement clinical observation, it is significant that the mental illness they observed in their asylums was the same as that which Shakespeare brought to life in his tragedies more than two and half centuries earlier.

Apparently, the medical understanding of madness, lunacy, insanity, melancholy – whichever name one chooses – had not advanced very far from the time of Shakespeare to the middle of the 1800’s. “But,” most of us would confidently assume and assert,”since then we have come a long way, we know so much more now.” But do we? Certainly at the time when Brigham and Ray were writing about Shakespeare , serious psychiatric establishments were already taking shape in a number of modern nations. The growth that has taken place since the 19th century within this medical specialization in terms of publications, practitioners, institutions, associations, research, and treatments would have been difficult to imagine. But are we really any closer to identifying a cause, or having a cure to offer to those who suffer from mental illness?

The next post will look at what we know about the schizophrenia and the range of diagnoses which fall under the category of manic-depressive illness.

10/1 – Schizophrenia and Manic-Depressive Illness: What do we Know?

10/8 – Diseases of the Will: Schizophrenia and MDI as One Illness