Saturday, July 21, 2012

The Aurora Massacre, Violence, and the Sick Society

I think my country, the United States, is a rather militaristic and violent society generally, from the military industrial complex and the national security state, through popular films, video games, television shows, and even sports (e.g., boxing, ultimate fighting). Violence is ubiquitous, and it is not all “gun” violence (and Chris Bertram has pointed out that while ‘the murder rate might have declined in the US since the mid-70s…spree killing seems to have taken off in the 1980s and not to have happened much before then.’). And of course not everyone who has been exposed to real or virtual violence is affected in the same way, and there’s the rub. The wide variety of personalities or temperaments and character types, combined with genetic inheritance and socialization processes, leaves some individuals more prone to being affected by such things than others: they’re intrinsically vulnerable we might say (and that vulnerability is frequently expressed in symptoms of mental illness). Of course it is hard to identify just who are such individuals, but often, especially in intimate social interactions, people have hunches, suspicions, concerns, and so forth, which they may or may not act upon owing to, among other things, not wanting to get involved, uncertainty, or fear, for example.

Recent reports state that the shooter in this case, one James Holmes, “was shy, well-mannered and highly intelligent and showed no signs of someone about to erupt.” That may very well be true, and I’m not going to engage in an armchair diagnosis except to note that it does appear that few if any individuals were very close—intimate friends—with Holmes. Perhaps Holmes’ “character armour” (Wilhelm Reich) was such that he did not express his true feelings around those who knew him socially, or perhaps he was adept at repression. Whatever the explanation, and this is sheer speculation, I would not be surprised to learn the fact that he “had begun the process of withdrawing from the [doctoral] program [in neuroscience at the University of Colorado Denver Anschutz Medical Campus] last month was some sort of “tipping point” or causal variable here, especially if much of his personal identity was wrapped up in the career path of a promising neuroscientist: “It is not clear what triggered his decision to drop out, although some reports suggested he was having troubles with his studies.” As I mention below, there can be a fine line or porous boundary between simple depression, dispositional sadness, anxiety or insecurity, anger or rage, and other normal psychological phenomena and pathological signs and symptoms. All of this takes place in the socio-cultural shadow of a mental health system that is, simply, a mess, in part as a result of “de-institutionalization,” which had some perverse effects probably not anticipated by those who successfully advocated several decades ago for (in some measure necessary) changes in mental health care and treatment.

I’m not sure who the government official was speaking at one of the press conferences immediately following the shooting, but he referred to the suspect as something on the order of a “freak of nature,” while yet another public official spoke of this as an “isolated incident” (which, literally, it appears to be). Both of these descriptions are not at all helpful in our attempts to explain or make some sense of this act of violence. Nor are accounts which speak of this as simply an inexplicable act of evil. Such characterizations permit us to avoid looking at how our society and culture bear some measure of responsibility for the kinds of individuals (and communities) that compose it, and I say that without in any way wanting to diminish the notion of individual moral responsibility. Individual lives are not lived in vacuums, and there are myriad effects on them, some of them identifiable, others hidden or mysterious. I prefer, however painful or inchoate, to see all of us as sharing in the complicity of such acts in a general sense insofar as we’ve done nothing to change a society which is clearly violent and in which an incredibly large number of people display symptoms of mental illness. Erich Fromm got close to the problem in speaking of a “pathology of normalcy” (the particular locution was his but the idea has ancient pedigree). As far back as the 1950s, Fromm wrote that much of our cultural and political life evidence expressions of low-grade, chronic schizoid tendencies. In short, our society is in many respects “sick,” and this latest incident is one of the more visible and terrible symptoms of that sickness.

At the Crooked Timber blog, a reader by the name of Matt McIrvin had a reasonable response to the above argument about the underlying socio-cultural conditions that make violent events like the Aurora shootings all too commonplace in this country:

“…I am always a bit suspicious of claims that the modern world or modern America is unusually prone to psychosis, or is somehow generally schizotypal in ways that other places and times are not. It’s entirely possible, but how would one even begin to measure that, with changes in diagnostic criteria and changes in the way people deal with mental illness?”

My reply:

On the question of why and how entire societies might be “sick,” I would recommend the chapter, “Consensus, Conformity, and False Consciousness: ‘The Pathology of Normalcy,’” in Daniel Burston, The Legacy of Erich Fromm (1991). As to questions of “measurement,” I’m not confident that such claims are amenable to measurement, at least not in any definitive sense in a way that my satisfy current epidemiological standards (which themselves are contestable), although I do believe we can assemble evidence and reasons of various kinds on behalf of such a claim. At least one reason for epidemiological skepticism is provided by Burston: “When it comes to questions of fundamental sanity, laypeople and clinicians alike are accustomed to gauging the sanity of thought processes in terms of the degree of consensual validation that attaches to their content, and in terms of the adequacy or intelligibility of their underlying process (so far as we can apprehend it). Many of the diagnostic instruments and protocols used by mental health professionals are merely refined and systematic extensions of these commonsense assumptions.”

In addition, the very idea of the pathology of normalcy is found in ancient Greece before, with, and after Plato (e.g., Hellenistic ethical philosophies like Epicureanism and Stoicism), as well as among Hindu and Buddhist philosophers, Daoist sages, and rabbinical traditions.

Leaving that aside, and conceding the increasing psychological “medicalization” of certain otherwise normal mental attitudes, moods, dispositions, or emotional states like sadness or shyness (see works by Allan Horowitz and Jerome Wakefield, and Christopher Lane, respectively),

“It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for it. The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from one in 184 Americans to one in seventy-six. For children, the rise is even more startling—a thirty-five-fold increase in the same two decades. Mental illness is now the leading cause of disability in children, well ahead of physical disabilities like cerebral palsy or Down syndrome, for which the federal programs were created.

A large survey of randomly selected adults, sponsored by the National Institute of Mental Health (NIMH) and conducted between 2001 and 2003, found that an astonishing 46 percent met criteria established by the American Psychiatric Association (APA) for having had at least one mental illness within four broad categories at some time in their lives. The categories were ‘anxiety disorders,’ including, among other subcategories, phobias and post-traumatic stress disorder (PTSD); ‘mood disorders,’ including major depression and bipolar disorders; ‘impulse-control disorders,’ including various behavioral problems and attention-deficit/hyperactivity disorder (ADHD); and ‘substance use disorders,’ including alcohol and drug abuse. Most met criteria for more than one diagnosis. Of a subgroup affected within the previous year, a third were under treatment—up from a fifth in a similar survey ten years earlier.” (See Marcia Angell, June 23 and July 14, 2011, in the New York Review of Books)

Of course this raises all sorts of questions, the most important of which Angell asks:

“What is going on here? Is the prevalence of mental illness really that high and still climbing? Particularly if these disorders are biologically determined and not a result of environmental influences, is it plausible to suppose that such an increase is real? Or are we learning to recognize and diagnose mental disorders that were always there? On the other hand, are we simply expanding the criteria for mental illness so that nearly everyone has one? And what about the drugs that are now the mainstay of treatment? Do they work? If they do, shouldn’t we expect the prevalence of mental illness to be declining, not rising?”

I do think American society is “sick” generally, and I think there are in fact a lot of people who are quite unhappy, miserable, anxious, fearful, and to such an extent that we cannot understand them to be in any way flourishing, mentally speaking. Does this amount to mental illness as defined by psychiatrists and psychologists? Sometimes, and of course the boundaries between unhappiness, everyday depression, and generalized anxiety or insecurity, anger or rage, and the exhibition of pathological symptoms is not always clear. In short, there is precious little evidence of eudaimonia among the populace and sufficient evidence of widespread mental illness of various kinds and degrees of severity. The main problem with the former is that it may be a breeding ground for the latter. People are in fact, at least in the first instance and as a matter of speaking, self-diagnosing (and then they proceed to the clinic, hoping for a prescription for a psychoactive drug), as well as self-medicating (is drug use declining?).


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