Normal illusions

Having a good grasp on reality, i.e., an accurate understanding of the role of our self in the world, is often thought to be a prerequisite of mental health.

But this belief may be mistaken.

Some research (see below) suggests that ‘normals’ have an overly positive evaluation of themselves, exaggerated perceptions of control over their circumstances, and an unrealistically optimistic view of the future.

Yet these rosy perceptions grease the wheels of social life.

Paradoxically, mildly depressed people have more realistic estimations of their place in the world and more balanced assessments of their likely future circumstances.

This would be old news to those in the anti-psychiatry movement of the 1960s and 1970s (Laing, Cooper, Szasz). But they have been eclipsed.

What counts as normal is determined by the American Psychiatric Association and the pharmaceutical industry. See Paula Caplan’s They Say You’re Crazy.

But this is a precarious normality.

Broadmoor Hospital

Broadmoor Hospital

Several years ago, the Royal Shakespeare Company in England performed several of Shakespeare’s plays, including Hamlet and Othello, at Broadmoor, a secure hospital/prison for the criminally insane. The plays were performed ‘in the round’, the stage located as in the middle of a circle. So there they were: actors simulating murder and madness surrounded by inmates who had really murdered and who really were mad.

The actors found a kind of truth and honesty in performing to this audience. They discovered how much like them they were; different only in that the inmates had been overtaken by an explosive emotion or had found themselves in the wrong place at the wrong time.

And when the actors returned to Stratford and played before those rows and columns of immobilized but well-heeled customers, they found them more constrained, more imprisoned than the mad in Broadmoor.

Fortune/misfortune are sides. A flip of the coin. Chance.

Yes, normality is a precarious condition.

Further Reading

Shelley E. Taylor and Jonathan D. Brown. ‘Illusion and Well-Being: A Social Psychological Perspective on Mental Health‘. Psychological Bulletin. 1988. vol. 103, no. 2, pp. 193-210.

Shelley E. Taylor and Jonathan D. Brown. ‘Positive Illusions and Well-Being Revisited: Separating Fact from Fiction‘. Psychological Bulletin. vol. 116, no. 1, pp. 21-21.

Shakespeare Comes to Broadmoor: The Actors Are Come Hither : The Performance of Tragedy in a Secure Psychiatric Hospital

Slavoj Žižek and ‘The Coming Insurrection’ Compared

Slavoj Žižek is certainly entertaining, as you will see in the first video.

But the really serious philosophers and social theorists tend to end up in prison. This was the case with the authors of The Coming Insurrection, the subject of the second video. So I’m spending more time on them.

Police swoop on the village of Tarnac, France, to arrest the alleged authors of The Coming Insurrection.

Police swoop on the village of Tarnac, France, to arrest the alleged authors of The Coming Insurrection.

The Coming Insurrection is a short booklet written by ‘The Invisible Committee’ (four men and five women, aged 22 to 34) . It can be found and downloaded on the web  here. The MIT Press has also published it. The video is a sop to those with a crippled attention span. To feel the full force of the message, read it. It’s powerful writing.

If you don’t understand its relevance, you’re not paying attention to what’s happening on the streets of Europe and North America. So, wake up!

Certainly, if it’s good enough for Glenn Beck to attack, it’s good enough for this blog. American news media like only bogus or ineffectual revolutions in distant lands, certainly not an insurrection as close to American interests as that which is ‘coming’.

The Coming Insurrection begins:

From whatever angle you approach it, the present offers no way out. This is not the least of its virtues. From those who seek hope above all, it tears away every firm ground. Those who claim to have solutions are contradicted almost immediately. Everyone agrees that things can only get worse. “The future has no future” is the wisdom of an age that, for all its appearance of perfect normalcy, has reached the level of consciousness of the first punks.

In these circumstances, does Slavoj Žižek have a future?

Interview with Julien Coupat (whose image is in the header)

What is ‘mental’ about ‘mental illness’?

There was no mention of ‘mental illness’ in Nellie Bly’s ‘Ten Days in the Mad-House’ (1887).

Although she does not name the illness for which she was diagnosed, it was ‘hysteria’, an affliction doctors ascribed especially to young, independent and assertive women. It was often regarded as short-hand for sexual voraciousness. Rather obviously, then, hysteria involved the entire body, not just the ‘mental’ bit.

Nor was she admitted to a ‘mental hospital’. She was admitted to Blackwell’s Island Insane Asylum. No room for ambiguity there. The asylum in those days was an unhappy marriage of a prison and a hospital. The insane were on the inside and the sane were on the outside.

Notwithstanding the title of David Rosenhan’s ‘On Being Sane in Insane Places’ (1973), he and his fellow pseudo-patients walked into the categorizing arms of the Diagnostic and Statistical Manual (1968) of the American Psychiatric Association. No binary divisions here, but 182 ‘disorders’. (There are a lot more now). One pseudo-patient was categorized as manic-depressive and the rest as schizophrenic. All bona fide ‘mental’ illnesses.

They were admitted and detained in what were variously described as psychiatric or mental hospitals.

So what had happened between the 1880s and the 1970s for the ‘mental’ to break free of its bodily moorings?

Some preliminary points.

The counterpart of ‘mental’ is physical, which, in this case, means bodily or somatic. There are ‘real’ illnesses and there are intangible ‘mental’ illnesses.

And within the ‘mind’ of the mentally ill there is an imbalance between cognition and emotion—as in ‘he killed himself because the balance of his mind was disturbed’. People are mad or mentally ill because their behaviour is uncontrolled by reason or judgment. Treatment focuses on how best to recalibrate this disturbed balance, using psychotherapy and/or psychopharmacology.

But as anyone who has been diagnosed with a mental illness knows, it effects every fibre of your being, including most of your organs and limbs. It’s not just the bit above your shoulders that’s a problem.

And as anyone socially connected with a mentally-ill person knows only too well, all who come into contact with this person get to be affected too. For example, a depressed person is a black hole of negative energy, draining the life out their nearest and dearest. Not since the days of Newton has there been such an example of action-at-a-distance.

Mental illness is simultaneously mental, somatic and social. Running between these levels is the emotional. Perhaps we should be speaking of emotional rather than mental health?

In fact, the causation may run in both directions.

Consider the possibility that the mentally-ill embody social ills, in the same way that canaries down mines detected gas by dying. Perhaps mental illness is a rational response to mad social situations. If that were so, we’re doing the equivalent of resuscitating canaries and sending them back down the mine.

Like the fool in Shakespeare’s plays, perhaps the ‘mad’ are the only ones who get to speak the truth.

Sane Nellie Bly spends ten days in a Mad House (1886) and writes about it

Getting a sane person admitted into an asylum for the insane was nothing new (re Being Sane in Insane Places: The Rosenhan experiment.) ‘Nellie Bly’, the pen name of Elizabeth Jane Cochrane, was ahead of David Rosenhan and his colleagues by almost a 100 years.

She was trying to establish herself as an investigative journalist on the New York World when, as she recounts:

I was asked if I could have myself committed to one of the asylums for the insane in New York, with a view to writing a plain and unvarnished narrative of the treatment of the patients therein and the methods of management, etc. (Nellie Bly, Ten Days in a Mad-House. p. 3).

Before commenting on her report of her experience, may I say that she was an exceptionally able and courageous woman (this photograph suggests as much) and a fine investigative journalist. Her writing is as clear as a bell. She’s an admirable role model. Even now, her writing speaks to us.

She did as requested. After her 10 days she wrote a series of revelatory news articles in the World and these created an uproar. The following year she rewrote the articles in the form of a short book, Ten-Days in a Mad-House. ‘Plain and unvarnished’ makes gripping writing. It can be read in a couple of hours and is hard to put down.

‘Nellie Bly’s’ Ten Days in a Mad-House’ (1887) and Rosenhan’s ‘On Being Sane in Insane Places‘ (1973) bear reading side-by-side.

Like Rosenhan and his fellow pseudo-patients, Bly had no trouble gaining admittance to the asylum. ‘Pronounced insane by four expert doctors and shut up behind the unmerciful bolts and bars of a madhouse!’ (Bly, p. 45).

Like them, Bly acted normally when inside the asylum/mental hospital. Yet ‘the more sanely I talked and acted the crazier I was thought to be’ and ‘the more I endeavoured to assure them of my sanity the more they doubted it’ (Bly, p. 84).

Although she had been pronounced insane by four doctors, the other patients were not so sure.

‘They looked at us curiously, and one came up to me and asked: “Who sent you here?” “The doctors,” I answered. “What for?” she persisted.”‘Well, they say I am insane,” I admitted. “Insane!” she repeated, incredulously. “It cannot be seen in your face” (pp. 45-46).

A little over eighty years later, Rosenhal and his co-pseudopatients found real patients similarly perceptive.

‘It was quite common for the patients to “detect” the pseudo patients’ sanity. During the first three hospitalizations, when accurate counts were kept, 35 out of a total of 118 patients on the admissions ward voiced their suspicions, some vigorously. “You’re not crazy. You’re a journalist or a professor…. You’re checking up on the hospital.’ This leads Rosenhal to comment: ‘The face that the patients often recognized normality when staff did not raises important questions’ (Rosenhal, p. 252).

She passed through several stages before being incarcerated:

A. Temporary Home for Females, No. 84, Second Avenue, New York: ‘.. secures to women out of employment clean, cheap lodging away from the haunts of vice.’ (Report of the Commissioner of Labor, 1888, p. 46.)

B. Essex Market Police Courtroom (location): here she noted the presence of ‘poorly dressed men and women with stories printed on their faces of hard lives, abuse and poverty’ (Bly, p. 21).

C. Bellevue Hospital for the Insane (location):

D. And finally Blackwell’s Island Insane Asylum. She called it a rat-trap. ‘It is easy to get in, but once there it is impossible to get out’ (p. 86). In her assessment, many of her sister inmates were as sane as she. They were stressed by unremitting poverty or had been brought there by husbands who had no further use for them. Once inside: ‘I watched the insanity slowly creep over the mind that had appeared to be all right’ (p. 69). The plight of Miss Millie Maynard caught my eye.

In this image of the asylum we can see two spokes of buildings emanating from a central tower. The tower is octagonal and more spokes were intended but the money ran out. Had it not, the plan view of the building would have resembled Bentham’s panopticon. This is the building as depicted on a map of the time:

It is telling that the only part of the building to survive to now is that panoptic octagonal tower.

Being Sane in Insane Places: The Rosenhan experiment

Day Hospital (Luca Rossato: fotografo) Click to enlarge.

Simulating is not pretending: Observations on Mairead and Mick Philpott

Real or false grief?: couple charged with killing own children

Reading Faces, Inferring Intent

‘Sane enough’: The case of Anders Breivik

The Marketing of the President

You can tell a lot from a face

Contrasting poems on the balance between living and dying

All are titles of recent posts. A common thread is, How do we know what is emotionally real? How can we tell?

And then, last night when I was cleaning my fridge (or at least its door) this came on the World Service: The Rosenhan Experiment (this link is to a 10 minute podcast.) Here is the written introduction:

In 1969 an American psychologist called David Rosenhan put psychiatrists to the test.

He and several volunteers had themselves admitted to psychiatric hospitals, although they were perfectly sane.

They then waited for the doctors to notice their normal behaviour.

You’ll have to listen to the podcast to find out what happened. The bottom line, however, is that it is more difficult than one might think to know what is emotionally real, to distinguish between the sane and the insane. Perhaps we’re all just ‘sane enough’.

A 30minute podcast by Claudia Hammond on the Rosenhan’s study is here.

Rosenhan’s famous paper: On Being Sane in Insane Places (pdf). Science, vol. 179, no. 4070, 1973, pp. 250-258.

Psychiatrists were very upset by Rosenhan’s paper. They will say that it’s all different now and this would never happen again.

But what do you think?

[To give you some ideas, a discussion forum on this question is here.]

A psychiatrist responds:

Spitzer, Robert L. “On Pseudoscience in Science, Logic in Remission, and Psychiatric Diagnosis: A Critique of Rosenhan’s “On Being Sane in Insane Places” Journal of Abnormal Psychiatry.” 1975, Vol. 84, No. 5: 442–452.

‘Sane enough’: The case of Anders Breivik

Years ago, I lived near Stratford-upon-Avon in England, where the Royal Shakespeare Company is based. About once a month, I’d go to see whatever play was running. As soon as the curtain goes down, the actors would wash off their make up and leg it down to the Mucky Duck, a pub just down the road. This was, and is, a real pub. A coal fire, bare floorboards, the risk of cigarette ash in your beer ever present.

Some of the audience, me included, would arrive 10 minutes later. So you could rub shoulders with someone who’d just been involved in some drama. A murder perhaps, perhaps lots of murders,  a comedic deception here, an act of incest there. I remember well Mark Rylance as a manic Hamlet. Hamlet causes the death of quite a lot of people (and don’t get me going on what he did to Ophelia) and he expects—and gets—empathy.

My lasting impression of the actors, especially the rank-and-file actors, is that they regarded acting as a craft, a job. They were very down-to-earth.

One year, the RSC went to Broadmoor, a hospital for the criminally insane. There they performed several plays. I cannot remember which but I do know that Hamlet was one of them. They performed these plays ‘in-the-round’, in street clothes, with the audience of inmates gathered round. So, these actors became imagined characters who had committed all sorts of depravity—and they were watched by inmates who had really committed all sorts of depravity. They knew what murder felt like, so these actors really had to be at the top of their game.

The RSC published a book about the experience: Shakespeare Comes to Broadmoor. I no longer have it, but I do remember the reflections of one of the actors (it may even have been Rylance). He remarked how normal the inmates seemed, and how fine the line between sanity and madness. They were there because of an ‘emotional storm’ which had consumed them and their victims. He remarked also that when they returned to perform at the RSC’s main theatre in Stratford, he felt that the audience—immobilized in rows and columns—felt more imprisoned and constrained than the mad of Broadmoor.

Some of you may have heard of Broadmoor through the book The Professor and the Madman: A Tale of Murder, Insanity, and the Making of the Oxford English Dictionary, by Simon Winchester. The madman was Dr. William Chester Minor, a surgeon who murdered and ended up in Broadmoor. The professor was James Murray. It was he who was responsible for putting together the first edition of the OED. The OED is a historical dictionary. It relied on an army of volunteers to seek out key appearances of each word over the centuries and submit this information to Oxford. The ‘madman’ was one of the dictionary’s most prolific contributors. He was mad enough to be in Broadmoor. He was sane enough to contribute to the OED.

I thought of all this when I read accounts of the trial of Anders Breivik. The current stage of the trial is to determine if he is sane or insane. Or, rather, if he is ‘sane enough’ to be held responsible for these crimes.

Sane enough.

Breivik’s case is a special one in that he claims his actions were politically motivated. He was ‘defending’ Norway from multi-culturalism. This claim is for the court to judge. As has been noted by some commentators, however, his rationale for this act of terrorism is interesting because it is not unlike the rationale of the United States in its ‘war on terror’. It is a matter of getting one’s retaliation in first.

As Hamlet says (to his mother)

I must be cruel only to be kind.
Thus bad begins and worse remains behind.

This sort of rationale, then, has a long history.

Note his claim to have consciously shut off his emotions. If he empathized with his victims he could not have done what he did. So he dehumanized himself. This, he explained to the court, enabled him to feel no empathy, show no mercy, to his victims. He may well add: is this not what soldiers are trained to do? Isn’t keeping emotions under control a normal precondition for rationality?

Ordinarily, one would think that someone who kills 77 innocent people, most of them still in their youth, would be insane by definition. But most acts of insanity are by people who ‘lose’ their reason, who are ‘overcome’ by emotion, not by people who have an ‘excess’ of reason.

Breivik’s audacious defence—that he is a sane political extremist— can illuminate what we regard as normal emotional behaviour. It is, however, not a defence that any court can accept, for rather obvious reasons.

It will be interesting to see how the court handles this.