Posts Tagged ‘Greenfeld’

Posted on April 8, 2010 - by David

Health Care Reform and Impossible American Ideals

Since Barack Obama’s election in November of 2008, health care reform has been at the center of our nation’s attention. This debate has been almost inseparable from discussion of the ongoing economic crisis, both because of the question of what effect reform measures might have on the economy, and because many individuals are unemployed or making less money and cannot afford health insurance. Naturally, because the most visible players in this game are politicians, much of the discourse surrounding the health care debate has been boiled down to Democrats vs. Republicans, or, (to essentially say the same thing twice), liberals vs. conservatives. Obama and the Democrats have been demonized by their opposition as socialists instituting a totalitarian regime, and the responses of those pushing for reform have not been much kinder.

As we all know, the new legislation has been passed, and with the sounds of celebration on one side and apocalyptic lament on the other, it still seems easiest to conceive of this issue in terms of a conflict between two political parties or groups with opposed economic interests. It strikes me, though, that there is a more basic and more powerful force driving this debate, and it goes straight to the heart of what it means to be an American. This is the contradiction between our two supreme national values: liberty and equality.

The chapter on America in Liah Greenfeld’s Nationalism: Five Roads to Modernity, provides an excellent analysis of how conflicting ideals of liberty and equality have shaped the nation’s history and identity.

“It must be realized that individualistic-libertarian nationalism sets itself an impossible task. A nation, ideally, is a society composed of individuals equal in their human worth. But in fact such perfect equality cannot be achieved. The reality of an individualistic nation and its ideals are necessarily inconsistent, and this inconsistency breeds discontent and frustration.” (449-450)

Before America was truly a “nation,” (according to Greenfeld’s careful account this was not until after the Civil War), and in fact even before independence from England, liberty and equality existed here to a greater degree than in any country across the Atlantic, conferring on the individuals who experienced these values an unparalleled sense of dignity. Of course, despite rhetoric about the natural birthrights of all mankind, initially only white male land-owners could enjoy these rights. The inconsistency between social reality and the professed ideals would inevitably have to be confronted. Greenfeld writes of the decades preceding the Civil War:

“That equality in American society had advanced beyond anything imaginable elsewhere at the time cannot be disputed. But the American society was also committed to equality to an extent that was unimaginable elsewhere. Thus, while the reality in America in this regard was incomparably better than in any other society, the gap between it and its brilliant ideal was nonetheless wider.”(452)

“Inequality inherent in social reality was blatantly inconsistent with American national commitment. In a society which believed that “all men are created equal,” the denial of equality meant that one was not human, was less of a human than others.” (453)

Of course, slavery, the most blatant contradiction of the national principles, was eventually abolished, and, though it took almost another 60 years, women were given the right to vote in 1920. In many ways, the course of American history can be characterized as an attempt to close the gap between social reality and the national ideals. But there is an important distinction between equality of rights under the law and equality of conditions. Equal rights can be, to a large extent, provided by government, but they cannot guarantee that conditions will be equal. On the contrary, in a free society where individuals are not only able, but expected to achieve for themselves what they can, inequality of conditions will necessarily result. Even if we admit that “all men are created equal” does not mean that everyone is born with the same natural ability, Americans still desire equality of opportunity – the sense that we all start on a level playing field, that achievement will not be dictated by inherited wealth, geography, or social connections. But common sense and observation tell us that equality of opportunity is not achieved through equality of rights. The federal government, then, becomes a means of creating equality of conditions:

“In a society which sets great store by equality, economic inequality acquires a significance which goes beyond the effects of differences in material well-being. It is necessarily seen as unjust by the “have-nots” and is perceived as an affront to their dignity, because it belies the proposition that all men are created equal and have equal rights to life and happiness. Equality in liberty (that is, self-government) becomes less important in such situations. In fact, rather than being regarded as an absolute good, it is likely to be seen as a tool for the perpetuation and concealment of existing inequalities. Liberty is infinitely divisible; other goods are not. An increase in the liberty of another does not imply a proportional decrease in one’s own; increase in another’s share of a finite quantity of something, whether power or wealth, does. When these resources become scarce, the demand for equality of opportunity, dignity, and respect commensurate with one’s abilities gives way to the demand for equality of result. It is clear that equality of opportunity, which does not provide for the equality of result, would appeal more strongly to those who have the qualifications necessary to realize the opportunities open to them. It is also clear that in the early American society, actually characterized by equality of conditions, equality of opportunity would be generally acceptable without special provisions for the equality of result because it would appear that the latter was implied, inherent in the former. But when actual equality of conditions no longer obtains, the provisions for equality of opportunity only (the legal equality of rights) must appear unsatisfactory. The transformation in the nature of desired equality began to be evident in America in the 1830s. It initiated the transformation in the perception of the functions of the government: government as essentially a protective agency (guarding against encroachments on the people’s rights by others) no longer appeared sufficient; there was a feeling that it should act as a distributive agency. This, in turn, affected the attitudes towards centralization, making it acceptable and even necessary.” (439)

We know that equality of health care does not exist, and this bothers us. It is difficult to accept that some individuals might be held back from achieving their goals or providing for their families, that children might not grow up to enjoy life on earth to the fullest, because they could not afford a treatment that millions of others receive. At the same time, we understand that health care is not an infinite resource – many opponents of the new legislation who are more or less satisfied with their current health insurance fear there will be “rationing” of care. This idea is offensive to the American mind, because it limits the individual’s ability to obtain the level of care he has worked hard for. Those wealthier individuals who currently enjoy a high level of care also fear having to pay a greater portion than others in order to fund a system which threatens to limit their choices. Can coverage be expanded without also being limited? It seems some must give more so others can receive more. While the goals may be liberty and equality, this legislation may actually send a contradictory message. If some people experience a reduction in their level of care, does that tell them that hard work doesn’t pay off after all? Does providing coverage to the uninsured send the message that they are unable to provide for themselves?

Of course there are also serious concerns about how this health care bill will impact the national debt. If the nation’s commitment to equality results in a worsening of the economic situation, liberty and equality will be put at further risk.  But the supreme value we place on the individual life, and the belief in equal access to all forms of treatment as a fundamental right, may prove to be dangerously expensive. In a March 31^st article from the New England Journal of Medicine, Dr. Molly Cooke says it’s time to give up the old lie that doctors give 100% to each and every patient, and advises that considerations of cost must be taught in med school:

“…we must abandon the myth of the physician as single-minded advocate for any amount of benefit for every patient. We make all kinds of choices in caring for patients; some involve denying care that patients perceive as — and that might actually be — beneficial. Given that we make value-based decisions about the deployment of other finite resources, such as our time and the use of beds in the intensive care unit, why not about costly treatments? In fact, numerous studies in the United States and Europe confirm that bedside rationing of care is common practice. Problematically, it is done in an occult and unpredictable manner.”

Practical as this sounds, I think these are tough words to hear for most Americans. When it comes to health and life, the idea of dollar-value calculations is extremely distasteful to us. It is not that we are fundamentally opposed to the idea of discontinuing care or deciding against a potentially beneficial treatment. It makes perfect sense to us when a family decides it’s time to “pull the plug” on a relative whose chance of recovery is virtually non-existent. We don’t question the cancer patient who finally elects to move home and receive hospice care rather than undergo another risky and painful surgery, even though it could buy him some extra time. We accept these decisions because they are made on the basis of individual dignity and liberty. Of course, with advances in medicine and technology our options are constantly multiplying. That any of these options might be denied to us on the basis of cost almost amounts to cultural blasphemy, but this may be the reality.

A New York Times article published online yesterday also acknowledged the impending cost crisis in health care. Author David Leonhardt identifies some of the same cultural values I mentioned above as obstacles, but is hopeful that reform measures which require that patients be provided with more information may actually help to keep spending down:

“The health act requires Medicare and other agencies to help hospitals and doctors give patients more information — which is practically a no-lose proposition. In the course of receiving more control and more choice, two distinctly American values, patients will probably help hold down costs.”

Whether or not this proves to be true, it’s interesting that this potential solution still relies on the sense of individual liberty and dignity.

My intention is not to guess at whether or not health care reform will work, but to suggest that the principles driving this national debate are older than the nation itself. In an introduction to President Obama’s speech following the historic signing, Vice-President Joe Biden told us that, “For much too long, for much too long, Americans have been denied what every human being is entitled to — decent, affordable health care.” I am sure that 200 years ago, no one in the nation could have imagined health care as a basic human right, but the identification of the American value of equality with basic human rights would have made perfect historical sense. For better or worse, it seems America will keep striving to create a world that matches our impossible ideals.

Posted on March 2, 2010 - by David

‘Analytical Rumination’:Depression as an Adaptive Response?

I read an article last week in the New York Times Magazine by Jonah Lehrer called Depression’s Upside, exploring the possibility that depression is an adaptive, evolved response which helps people focus cognitive resources on solving complex problems. The idea comes from a paper by Paul W. Andrews and J. Anderson Thomson, Jr. published in July of 2009 in the Psychological Review, titled The Bright Side of Being Blue: Depression as an Adaptation for Analyzing Complex Problems.  Lehrer’s clever lede uses a description of Darwin’s own mental anguish to slide into yet another evolutionary explanation for the workings of the mind. The following paragraph describes the theoretical view from which the work springs:

In the late 1990s, Thomson became interested in evolutionary psychology, which tries to explain the features of the human mind in terms of natural selection. The starting premise of the field is that the brain has a vast evolutionary history, and that this history shapes human nature. We are not a blank slate but a byproduct of imperfect adaptations, stuck with a mind that was designed to meet the needs of Pleistocene hunter-gatherers on the African savanna. While the specifics of evolutionary psychology remain controversial — it’s never easy proving theories about the distant past — its underlying assumption is largely accepted by mainstream scientists. There is no longer much debate over whether evolution sculptured the fleshy machine inside our head. Instead, researchers have moved on to new questions like when and how this sculpturing happened and which of our mental traits are adaptations and which are accidents.

As Lehrer points out earlier in his article, the prevalence of depression poses a problem for those who are “trying to explain the features of the human mind in terms of natural selection.” The only solution for them seems to be to demonstrate that depression actually has evolutionary benefits. Meanwhile a disorder like schizophrenia is rare enough, and a case for its adaptive benefits would be so difficult to make, that I guess it’s easier for them to chalk it up to a kind of glitch in the system.

My first problem is that this point of view fundamentally disregards the symbolic reality of culture. Once again, I’ll quote from Liah Greenfeld’s essay, Nationalism and the Mind, to give background on the view of culture as an emergent phenomenon:

On the most general level, culture is the process of transmission of historical ways of life and forms of human association across generations and distances… In distinction to other animal species, such transmission of ways of life and social organization, in the case of humanity, is not genetic, but symbolic. Humans are the only biological species, the continuation of whose existence is dependent on symbolic transmission.

The products of this cultural process are stored in the environment within which our biological life takes place, but the process itself goes on inside us. In other words, culture exists dynamically, develops, regenerates, transforms only by means of our minds – which makes culture a mental process. Let me reiterate: culture is a symbolic and a mental process. The fact that it is a mental process means that it occurs by means of the mechanisms of the brain. The fact that it is a symbolic process means that its logic cannot be reduced to the logic of the brain mechanisms, that it is an emergent phenomenon and a reality sui generis. In other words: the neural processes by means of which the cultural process occurs serve only as boundary conditions outside of which it cannot occur, but are powerless to shape the nature and direction of the cultural process. In contrast, culture itself consistently directs the brain, by means of which it occurs, forcing brain mechanisms into patterns of organization and operation which (though, obviously, not impossible) are most improbable given all that we may know of the biological functioning of the brain. (15-16)

The idea of culture as an emergent phenomenon leads to a view of the human mind as the individualized process of culture,  and this obviously clashes with the argument made by Andrews and Thomson which seeks to explain the human mind as a product of biological evolution. Nevertheless, their argument is based upon an implicit acceptance of the idea that problems in the cultural environment affect the function of the brain.

I think it’s best now to look at the paper itself. On page 6, they describe the theory one claim at a time:

“In summary, we hypothesize that depression is a stress response mechanism: (1) that is triggered by analytically difficult problems that influence important fitness-related goals; (2) that coordinates changes in body systems to promote sustained analysis of the triggering problem, otherwise known as depressive rumination; (3) that helps people generate and evaluate potential solutions to the triggering problem; and (4) that makes tradeoffs with other goals in order to promote analysis of the triggering problem, including reduced accuracy on laboratory tasks. Collectively, we refer to this suite of claims as the analytical rumination (AR) hypothesis.”

By calling depression “a stress response mechanism,” they make it analogous to any animal’s response to a problem (such as the presence of predator) in the physical environment. On page 4, they write that “negative emotions are stress response mechanisms – they are involuntary response to environmental challenges with important fitness consequences, and they evolved to coordinate changes in physiology, immune function, attention and cognition, physical activity and other body systems to meet those challenges.” This view both cuts out the cultural (therefore symbolic) aspect of emotion and fails to acknowledge that “environmental challenges” are cultural challenges – for humans, the most important and challenging terrain that must be navigated is not the physical but the cultural world. When they write that “different environmental stressors trigger different emotions…” the only way to make sense of this is to read “environmental stressors” as “cultural stressors. The “stressor” may be present in the physical environment – a boss, an ex-wife, a place of work – but it is the cultural significance attached to these things which can “trigger different emotions.” I think we can safely assume that the “stress response” of a rabbit exposed to a wolf has never been based on symbolic reality and has probably been consistent over thousands of years. But for humans, both what constitutes a complex problem, and responses to such complex problems, has not been consistent over time and between places.

The authors focus on social dilemmas as the classic example of a complex problem that triggers depression. But you can’t talk about social dilemmas just in terms of evolution, cutting out the symbolic process of culture. Otherwise, each culture and its particularities must represent a separate human evolution. They use sexual infidelity as an example of an evolutionary fitness-related social dilemma, but it doesn’t take an anthropologist or an historian to figure out that such a situation differs widely over time and from culture to culture. It’s like they’re moving between descriptions of humans as just another species of animals and humans as cultural beings without ever acknowledging the difference.  On the one hand they write “if his wife gets pregnant…” and then they mention “access to mates.” So are we cultural beings with institutions like marriage or just animals who need mates? They are speculating about the social dilemmas of hunter-gatherer groups and trying to relate this to the depression of modern people who live in a radically different cultural environment, but they don’t seem to see the disconnect.

The core of their theory is the claim that depression can be seen as adaptive rather than a disorder, because the analytical rumination characteristic of depression actually leads people to solutions for their complex problems. I’d like to consider this view in relation to the view of Allan Horwitz and Jerome Wakefield as described in the Loss of Sadness. Horwitz and Wakefield believe that certain symptoms of depression are normal reactions to difficult life events, and can even lead to personal growth of some kind, but they don’t consider these reactions to be true cases of depression. They consider true depression to have no apparent cause or context, or to last longer and have more severe symptoms than “normal sorrow.” Andrews and Thomson, on the other hand, see no qualitative difference between major depression and subclinical depression, claiming that “…depressive symptoms are better characterized on a single continuum of severity, duration, and liability” (7).  While there may be good reasons for the continuum view, I believe this allows Andrews and Thomson to make their adaptive response argument for depression on the basis of evidence drawn mostly from subclinical cases and even from subjects in which “depressed affect” was induced by sad music or film clips. I don’t doubt that for some people, rumination may lead to a better understanding of their problems which could in turn lead to resolution or avoidance of future problems, but critics are quick to point out that this is probably not the way it works for severely depressed people. Lehrer quotes Peter Kramer, Brown University professor of psychiatry and human behavior and author of Listening to Prozac, who wrote, “this study says nothing about chronic depression and the sort of self-hating, paralyzing, hopeless, circular rumination it inspires.”

Andrews and Thomson are clearly interested in proposing new methods of treatment for depression, and believe that therapies which facilitate the process of rumination may be effective in dealing with the underlying problems causing depression. They describe a method which involves “having patients write about their strongest thoughts and feelings about their depressive episode in a journal (25). Journal entries were later examined and coded for “avoidance and processing.” The study found that:

“…the peak in processing was also associated with a spike in depressive symptomatology. Thus, the authors viewed the temporary spike in depression as a positive sign of growth and insight during treatment. This suggests that depression may enhance processing that promotes growth and insight into problems and may facilitate the resolution of the episode. “ (26)

I simply don’t see what leads them to conclude that “depression may enhance processing,” except that this view fits with their hypothesis. It would seem more logical to me to conclude that the increase in processing of negative thoughts and emotions caused the “temporary spike in depression.” They also fail to acknowledge the huge difference between depressive rumination in isolation, and carefully facilitated processing which occurs in the context of therapy. “Analytical rumination” may very well be a common feature of depression, but there is no reason this has to be seen as an evolutionary adaptation, and I doubt that it often leads to the resolution of complex problems without some form of outside help that can orient this rumination towards action.

As their paper draws to a close, Andrews and Thomson restate their claims and review the evidence they’ve used to try to demonstrate that “depression evolved by natural selection, probably because it helped people analyze and solve the problems they were ruminating about.” (41) I have to say, I was extremely frustrated by the number of times that “social dilemmas” and “complex problems” were mentioned, without any real examination of what this means for a depressed person today, or any apparent consideration of differences between cultures and over time. Then, I read this little paragraph:

A design analysis does not require depressive rumination to be currently adaptive because modern and evolutionary environments may differ in important ways (Thornhill 1990, 1997). All that is required is that, on average, depressive rumination helped people analyze and solve the problems they were ruminating about in ancestral environments. Still, strong, replicable evidence that depression rumination currently helps people analyze and solve the problems they ruminate about would support the evolutionary argument, and more research is needed here. (41)

Wow. Now they say something about this? So how do these environments differ, and why? They move between their ideas of the evolutionary past and today without blinking an eye, implying continuity and giving the appearance that they are in fact arguing that depressive rumination is “currently adaptive,” and then with only a few pages left to go in the paper they throw this in? So what has the point of all this been?

In looking at ‘now and then,’ so to speak, they suggest that today, compared to the “ancestral environment,” there are more ways to distract oneself from depression and the “complex problems” which trigger it, meaning that we are robbed of the potential benefit of depressive rumination. However, nowhere do they consider the obvious possibility- that the problems that individuals in modern societies face are of a much different nature than those of the “evolutionary past.” In the end, they seem to be saying the same thing Horwitz and Wakefield say, only they take a much more circuitous and frustrating path to arrive at their final statement:

Depression is the primary emotional condition for which people seek help. The current therapeutic emphasis on antidepressant medications taps into the evolved desire to find quick fixes for pain. But learning how to endure and utilize emotional pain may be part of the evolutionary heritage of depression, which may explain venerable philosophical traditions that view emotional pain as the impetus for growth and insight into oneself and the problems of life. (43-44)

I guess by this point, I shouldn’t be surprised when our “venerable philosophical traditions” get reduced to byproducts of evolution, but it still leaves me shaking my head.

Posted on February 24, 2010 - by David

A response to Dr. Sally Satel’s review of ‘The Loss of Sadness’

I was happy to see that Dr. Sally Satel commented on Monday’s post which linked to her WSJ article about the proposed revisions for the DSM-V. She posted a link to this article, written two years ago, which is actually a review of The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder, by Allan Horwitz and Jerome Wakefield. Written from the perspective of a psychiatrist critical of the direction the field is moving in, it’s plenty more than a book review. Dr. Satel incorporates her own knowledge of the history of psychiatry and the difficulties of diagnosis and treatment as she considers the book’s contributions and shortcomings.

I realize that some of my criticisms are really directed at Horwitz and Wakefield, and I may be repeating some of things I wrote in my post on the Horwitz interview, but here goes anyway:

Satel gives some valuable history on the state of affairs in psychiatry during the 60’s and 70’s leading up to the publication of DSM-III. I’ll just say that Horwitz and Wakefield identify the publication of the DSM-III in 1980 with a shift towards symptom-based diagnosis which effectively eliminated considerations of context. The biggest problem they see resulting from this, (as the title of their book implies), is that the normal expression of sorrow in the wake of difficult life events is being diagnosed as depression. They believe this leads to unnecessary prescription of medication, inflated rates of mental illness, and a culture-wide loss of the ability to integrate hardship and sadness into a normal, healthy life.

The book seems to argue (as Horwitz stated in the contexts interview) that there are two types of real depression. 1. Depression that appears without cause or context, and 2. Depression which begins with an apparent cause or context but persists longer than appropriate with more severe symptoms than normal.

From Satel’s article:

In the classic form of uncaused depression — referred to in the pre-DSM-III days as endogenous depression or melancholia — symptoms arise mysteriously out of the blue when life is otherwise good. It seems clear that whatever biological mechanism that regulates mood has gone badly awry.

Yet clinical depression need not always have a spontaneous onset; it can also arise in the aftermath of loss. The important distinction between normal sorrow and major depression, the authors say, is that in the latter the symptoms triggered by circumstances eventually lose their contextual moorings. Either they persist long beyond the resolution of the stressful situation, or the point at which an otherwise healthy person would have adapted to a new condition; or they mutate into overt psychosis, suicidal impulses or actions, or physical immobilization. A patient in the pathological realm is beset by self-reproach and ruminations. He does not brighten when, say, a beloved grandchild visits, and he cannot imagine anything ever making him happy again.

While I would agree that this idea makes sense on the surface, I see a real problem. When someone reacts too strongly for too long to some loss or crisis, we might say something went wrong to make this person overly-sensitive to either loss in general, or the particular loss that was suffered. But this is still much different from depression which arises “mysteriously out of the blue when life is otherwise good.” Perhaps the way we look at context or what we consider “context” to mean  leads us to see symptoms arising from nowhere which actually do have an explanation outside of a brain malfunction.

The argument presented in The Loss of Sadness seems to rest on the claim that real depression is the same today as it was over 2000 years ago – that culture has changed our understanding of mental illness but mental illness itself (assumed to be biologically caused) has not changed. To me, this implies that “normal sorrow” should look similar between cultures and over time, with some differences that can be accounted for by cultural and historical context.

I believe this view obscures the dramatic cultural change that modernity brings. We may take it for granted that a certain type of loss is difficult and a cause for deep sadness, but to extend this response to all of history and humanity is ignorant.  (I think Ethan Watters chapter on PTSD in Sri Lanka is helpful in looking at cultural differences in response to tragedy). Sure, some depression might be easier for us (as modern people) to understand given the context or spark. But if our “normal responses” to loss closely resemble pathological states, perhaps Horwitz’s conclusion isn’t the only one that can be drawn.  The authors are saying we have pathologized normal human emotions, but perhaps our responses to “normal life events” have actually become more pathological. Of course, if the broad cultural changes that accompany the rise of modernity are not considered important and human emotions and attitudes (or even Western emotions and attitudes) are seen as historically consistent, then this second possibility doesn’t even show up on the radar.

The principles inherent in nationalism provide the basis for modern culture – the only form of consciousness most people reading this blog have ever known. As defined by Liah Greenfeld, “nationalism is a fundamentally secular and humanistic consciousness based on the principles of popular sovereignty and egalitarianism.” For this discussion, it is important to recognize two aspects of modern culture: 1. It’s openness gives individuals great freedom, but very little guidance in forming identity 2. It changes what we hope for and what we expect out of life, therefore changing the nature of what constitutes “loss” and interfering with our ability to accept loss. Consider the following from Greenfeld’s essay, Nationalism and the Mind:

The focus on the life in this world dramatically increases the value of this life to the individual and inevitably leads to the insistence on a good life, however defined. One is no longer expected to submit to suffering or deprivation, unless one has special reasons to do so, for the general reasons for such submission – the expectation of rewards in the beyond, transmutation and migration of the souls, the duty to serve witness to the glory of God wherever one is called, or the sheer impossibility to change one’s condition – no longer apply.

Moreover, in a self-sufficient world, changeable and shaped by people, suffering is generally believed to be man-made. Even natural disasters are likely to be so interpreted: a famine, an earthquake, or an epidemic are as often as not attributed to some human agent’s withholding of the needed but available resources or negligence; personal misfortunes, such as debilitating, life-threatening, and incurable illnesses are blamed on artificially-created environmental conditions (second-hand smoke, lead paint, etc.) or on doctors’ incompetence. None of these natural disasters, it is said, “have to happen”: they are no longer believed to be in the nature of things. Of course, the right to a life free of suffering is most clearly asserted when suffering is caused – as it is mostly, in modern societies — by social evils: war, economic or political conditions, competition for precedence, and so forth. Humiliation, rejection, thwarted ambition are felt as unjust – as contrary to expectations and thus resulting from illegitimate intervention of malicious others.

Greenfeld’s argument is that modern culture causes problems with identity formation which can lead to “biologically real” mental illness. She is therefore arguing that diseases like schizophrenia, bipolar, and depression are not as old as humanity, but really began appearing about 500 years ago with the rise of nationalism.

Her work proceeds from the view that culture- the symbolic process by which human ways of life are transmitted historically, is an emergent phenomenon, logically consistent with the laws of physics and biology, but nonetheless autonomous. This is absolutely critical. It is this first view which distinguishes Greenfeld from the many biologists and anthropologists who see human culture as dictated by biologically evolved brain mechanisms and natural selection.

For Greenfeld, the mind is the individualized cultural process, or “culture in the brain.” The individualized cultural process is therefore dependent upon, but not determined by, the biological functions of the brain. Just as organic brain damage can cause symptoms of mental illness- problems with thought, mood, and speech for example – Greenfeld believes that problems with the mind (problems with culture, that is) can lead to problems with brain function.

Obviously, all I can do here is prevent a bare-bones, unsupported version of Greenfeld’s theory and set in against the dominant view of the day. She is well along in the process of writing a book on this very subject and I look forward to its publication. Her work is not meant to go against, but to complement and elucidate research on the biology and genetics of mental illness. Genetic susceptibility probably goes a long way in explaining why only certain individuals experience mental illness, but it is important to acknowledge, (as Dr. Satel’ article does) that the extensive research to date hasn’t revealed a genetic cause of mental illness:

Psychiatry, alas, has a long way to go. “Although the past two decades have produced a great deal of progress in neurobiological investigations,” notes a recent paper written to guide preparation of the forthcoming DSM-V, “the field has thus far failed to identify a single neurobiological phenotypic marker or gene that is useful in making a diagnosis of a major psychiatric disorder or for predicting response to psychopharmacological treatment.” Indeed, almost all of the recent genetic findings are not specific. A particular gene associated with bipolar illness was later discovered to occur in people with schizophrenia. The same goes for almost every other major finding — leading to the current hypothesis that these various genes confer risk for psychopathology, but not for any specific kind.

Nevertheless, the dogmatic view that true, serious mental illnesses are caused by a problem in the brain hasn’t lost any steam. Satel writes:

As brain-based etiologies of classic serious mental illnesses, such as schizophrenia and bipolar illness, are uncovered, psychiatry will probably lose those diagnoses to neurology. Perhaps one day psychiatry will cater only to patients suffering from existential crises. But not anytime soon.

Dr. Satel seems to feel that as a psychiatrist, her job is not to figure out the exact nature and cause of mental illness, but to provide the best patient-care possible, and I guess I can’t argue with this.

… in his essay the weary Dr. Spitzer admitted that, “I doubt that clinicians will ever be very concerned with what illness itself is…. Concerns with defining medical or psychiatric illness or disorder are generally left to sociologists, psychologists, philosophers of science, and members of the legal profession.” This is deeply true. Front-line clinicians will not be joining the fray anytime soon. The academic debate over the evolutionary history of their patients’ woes is irrelevant to everyday practice.

I suppose that so far, academic attempts to define mental illness have been “irrelevant to everyday practice” because they haven’t resulted in any understanding of etiology or pathogenesis that could be translated into treatment and prevention strategies. But just because nothing has been solved so far, doesn’t mean a radical new approach might not prove to be more than added noise in the “academic debate.”

Satel concludes that “in the end, the most we can say about mental illnesses is that they are the result of various interrelated causes unfolding at different levels of explanation: biological (genetic or cellular), cognitive (information processing), and psychological (the generation of meanings in contexts).” I believe Greenfeld’s view of the mind as the individualized cultural process can help put together this causal puzzle that Dr. Satel describes. But this can only begin if we allow for the possibility that human experience is not determined by our biology. If we persist in the hope, (which I believe Satel holds), that we will one day grasp “how those swirling galaxies of neurons and molecules make us who we are, both in sickness and in mental health,” we will never stop “struggling in the dark.”

Thanks again to Dr. Sally Satel for the comment that sparked this post. You can read more of her writing here.

Posted on December 30, 2009 - by David

Busyness in America

In the “busy” spirit of the season, I share with you this essay by Liah Greenfeld, published in 2005 in Social Research, on busyness in contemporary American society. By comparing the lives of Americans today with life in other historical and some contemporary societies, she argues that the sense of busyness we experience is not actually caused by how much we have to do:

We are busy not because our physical and economic survival requires constant exertion on our part, leaving us little opportunity for spiritual restoration–relaxing, getting rid of the sense of busyness–but because we are incapable of perceiving and taking advantage of the opportunities for repose. We are restless. And our busyness is an expression of this inability to rest, rather than its cause. Much of our busyness comes from our leisure activities, in fact: preparations for and participation in family gatherings, holiday shopping (how often every one of us heard–or exclaimed–the desperate “Oh my! It is December 15, and I have not yet done my Christmas shopping!”), visits to the hairdresser and the gym; the phrase itself, “leisure activities,” is telling. We regard all these occasions for relaxation as duties and external pressures: we exercise not because we like it and can afford to indulge ourselves, but because one must keep in shape. We read New York Times over breakfast because one must be informed; go to concerts, movies, and dinners with friends because it is important to be culturally au currant and sociable. We are veritably torn into pieces by all these simultaneous and necessarily conflicting demands that oppress us every minute of our waking life and eventually invade our sleep.

So, if work conditions have improved and hours have gotten shorter, if quality of live has risen steadily and our options for relaxation and entertainment are constantly expanding, why do so many of us feel busy to the point of anxiety and exhaustion? Greenfeld claims that in distinction to past societies:

Americans who suffer from busyness today do not prioritize. They treat all their occupations– work, family, and even leisure–as equally important…

This disturbing inability to prioritize, which is the direct, proximate, cause of our oppressive sense of busyness, is undoubtedly related to the difficulty modern men and women, Americans above all, have forming their identities.

As in her other work, Greenfeld states here that the problem of identity formation stems from the anomie which comes as a built-in feature of modern culture, which is organized around the principles of popular sovereignty and egalitarianism. These principles, which open wide a world of possibilities, also fundamentally change the way identity is formed, because we must now create for ourselves what was once provided to us by culture:

Modern culture cannot provide us with a sense of order because its constitutive beliefs and attitudes, its supreme values and norms, consistently undermine order…

To insist on the fundamental equality of members in a community is to leave them fundamentally undefined vis-à-vis each other, to leave them without an identity. To proclaim and defend popular sovereignty and the individual’s freedom to make oneself is to demand that each one construct one’s identity on one’s own. Lifting limits from our desires, paradoxically, places very heavy burdens on our shoulders.

For me, this explanation rings true. I seem to feel busy all of the time, whether working, in the car with a junior bacon cheeseburger in one hand and my cell phone in the other, or just sitting on the couch in sweatpants with a book and a cup of coffee. I’ve asked myself again and again recently, how can I possibly be so busy and have so little to show for it? While I haven’t pinned down one identity for myself yet, I know that I can do a better job of prioritizing and actually relaxing when that’s what the moment calls for.

So, take a break from this sensation of busyness, enjoy the long weekend, and have a happy new year.

Posted on December 22, 2009 - by David

Is ‘Postmodernity’ a Reality?

It seems that any time I come across the word ‘postmodern’ in my reading, I wind up stopping for a minute to try to figure out what it actually means. I guess I’ve been conditioned to react this way ever since I began studying with Liah Greenfeld and the word ‘modern’ took on some real significance for me. Still, (out of laziness), I always wound up shrugging the question off without trying to answer it.

Yesterday, I finally went to the dictionary in hopes of finding some commonly agreed upon definitions.

From Merriam-Webster online:

Main Entry: ¹mod·ern

Pronunciation: \ˈmä-dərn, ÷ˈmä-d(ə-)rən\

Function: adjective

Etymology: Late Latin modernus, from Latin modo just now, from modus measure — more at mete

Date: 1585

1 a : of, relating to, or characteristic of the present or the immediate past : contemporary b : of, relating to, or characteristic of a period extending from a relevant remote past to the present time
2 : involving recent techniques, methods, or ideas : up-to-date
3 capitalized : of, relating to, or having the characteristics of the present or most recent period of development of a language
4 : of or relating to modernism : modernist

Main Entry: post·mod·ern

Pronunciation: \ˌpōs(t)-ˈmä-dərn, ÷-ˈmä-d(ə-)rən\

Function: adjective

Date: 1925

1 : of, relating to, or being an era after a modern one <postmodern times> <a postmodern metropolis>
2 a : of, relating to, or being any of various movements in reaction to modernism that are typically characterized by a return to traditional materials and forms (as in architecture) or by ironic self-reference and absurdity (as in literature) b : of, relating to, or being a theory that involves a radical reappraisal of modern assumptions about culture, identity, history, or language <postmodern feminism>

Main Entry: mod·ern·ism

Pronunciation: \ˈmä-dər-ˌni-zəm\

Function: noun

Date: 1737

1 : a practice, usage, or expression peculiar to modern times
2 often capitalized : a tendency in theology to accommodate traditional religious teaching to contemporary thought and especially to devalue supernatural elements
3 : modern artistic or literary philosophy and practice; especially : a self-conscious break with the past and a search for new forms of expression

From Oxford College Dictionary, 2^nd Ed:

modern history- n. history up to the present day, from some arbitrary point taken to represent the end of the middle ages

postmodernism- n. a late 20^th century style in the arts, architecture, and criticism that represents a departure from modernism.

The two main causes of confusion are revealed in these definitions. First, there are no distinctive characteristics, and no clear time frame given to tell us what modernity is or when it takes place. Webster’s ambiguously refers to a “relevant remote past,” and the Oxford College Dictionary gives us “some arbitrary point taken to represent the end of the middle ages.” Another definition makes it more or less a synonym for ‘contemporary.’ Also, the definitions contain no distinction between contemporary societies that are modern and those that are not (i.e traditional societies).

Modernism and postmodernism refer to artistic movements and philosophies. The two definitions of postmodernism refer to it as “a reaction to modernism” and “a departure from modernism.” The question then becomes, if postmodernism is in fact a coherent movement or philosophy, does it correspond to an actual change in culture such that we should consider the period we are living in now as distinct from modernity? Is ‘postmodernity’ a reality?

Liah Greenfeld, in a chapter titled ‘Is Modernity Possible without Nationalism?’ in Michel Seymour’s book, The Fate of the Nation State, addresses the problem of modernity’s various meaningless or contradictory definitions. According to Greenfeld, modernity is a quality or characteristic of certain societies- what she calls “a species of society” (39). In general, modern societies have three distinctive features: an open class structure, “the impersonal and abstract, or state, form of government,” and an economy oriented to sustained growth (39) These features are not fully developed in all modern societies, but in all cases, she claims, their development is made possible by nationalism- a fundamentally secular and humanistic consciousness based on the principles of popular sovereignty and egalitarianism.

Now this definition of modernity is certainly not universally accepted, but it is nevertheless a definition which means something. [Rather than get into a more detailed description of different types of nationalism and modern societies, I encourage you to read the chapter in this free google books preview (p.38-50), as well as her essay, ‘Nationalism and the Mind’]. If we consider the term ‘postmodernity’ in light of Greenfeld’s definition, it would have to mean a fundamental change in the organization and consciousness of society. From everything I see, this has not happened.

I am not claiming to have said all there is to say about the modern vs. postmodern question, and I am not dismissing all postmodern theory out of hand. What I am saying is that it is important to have some definition of modernity, Greenfeld gives us this, and if we accept it, then the phenomena which some have characterized as postmodern can be considered as either new or modified developments in culture that are still consistent with nationalism and modernity.

Posted on December 2, 2009 - by David

Brain=Mind=?

One of the main problems with discussion of this topic is the ambiguity of certain terms. A little reading (books, blogs, etc.) quickly reveals the confusion. The other day, I found this blog post, though a little old it’s worth checking out.  What struck me was the first sentence of an abstract of the paper the post references:

“Our brains and minds are shaped by our experiences, which mainly occur in the context of the culture in which we develop and live.”
(more…)

Posted on December 1, 2009 - by David

Greenfeld’s Nationalism and the Mind

Boston University professor Liah Greenfeld in her essay Nationalism and the Mind gives an overview of her theory of modern culture and the mind.

The fundamental points…

• Humanity is distinguished from the other animal species by the symbolic (cultural)… instead of genetic… transmission of its ways of life across generations. (p.1)
• “Nationalism is a fundamentally secular and humanistic consciousness based on the principles of popular sovereignty and egalitarianism.”(p.4)
• Nationalism is the modern culture (p.4)
• “Modern societies… because of their very secularism, openness, and the elevation of the individual, are necessarily anomic,” making anomie “the fundamental structural problem of modernity.”(p.13-14)
• Anomie (a product of nationalism, the modern culture) “inhibits the formation and normal functioning of the human mind.”(p.15)
• “…culture creates the human mind. The mind is also a symbolic and a mental process: it is supported by biological brain mechanisms, but is generated by culture outside the brain.”(p.16)
• She essentially states that by impairing the formation and normal functioning of the human mind, modern culture causes mental illness.

These ideas are certainly controversial, not widely held, and may seem preposterous to some. Please read the essay for yourself and see what you think.