Thursday, January 03, 2019

The pathology of normalcy—or the shared mental pathologies of millions—and the quest for a sane society

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Some years ago, after one of the many and more horrific mass shootings in the U.S., a reader responded to a Crooked Timber blogger’s argument about the possible and probable underlying socio-cultural (and I would add ‘psychological’ and spiritual) conditions that appear to be responsible for making such shootings all too commonplace in this country (and, in this respect, atypical of similar affluent welfare state capitalist democracies): 

“…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?” 
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Herewith my reply to the original post and subsequent response to the reader above, more or less, as it is now edited (I have both subtracted and added material):

I think my country, the United States, is a rather militaristic and violent society generally, from its military industrial complex, national security state, and criminal justice system, to its popular films, video games, television shows, and other forms of “entertainment.” Now of course not everyone who votes supports the “pentagon of power” and mass incarceration, nor does everyone ritually or habitually indulge in such forms of (escapist) entertainment. And more notably, not everyone is likely to be affected, in a moral psychological sense, in just the same way by such things, and there’s the rub. The variety of personalities or temperaments and character types, combined with genetic inheritance and socialization processes across a spectrum of socio-economic conditions, leaves some individuals more liable to being affected by such phenomena than others: they’re intrinsically vulnerable we might say (and that vulnerability is likely to be expressed in symptoms of mental illness). Of course it is hard to precisely identify beforehand just who such individuals are or might be by way of lessening any potential harm or violence they may do to themselves or others, although not infrequently, those who have intimately interacted with such individuals have hunches, suspicions or concerns, have seen “warning signs,” and so forth (although when these are verbalized ex post facto, they may not be genuine), which they may or may not act upon owing to any number of reasons: not wanting to get involved, uncertainty, or fear, for example. To make matters worse, the mental health system in this country is a mess, one egregious example of which is the number of people with serious mental illness who are incarcerated, be it in the short-term or serving prison sentences. Some of our mental health problems arose as a direct result of “de-institutionalization” of the mental health care system, which has had some well-known perverse effects not anticipated by those who may have earlier summoned humane and principled reasons on its behalf. 

More than a few of the rhetorical characterizations of those guilty of mass shootings exemplify a more generalizable tendency to avoid examining how the larger society and regnant cultural ethos bear some measure of responsibility for the kinds of individuals (and communities) that compose it. Moral responsibility is not simply individual but collective and shared, and many forms of violence have identifiable background conditions and variables that can be changed or eliminated by way of dramatically reducing the risk of the worst kinds of interpersonal violence. Individual lives are not lived in vacuums, and there are myriad effects on these lives, some of them identifiable and even predictable, others hidden or mysterious. If only in the beginning as an heuristic exercise or thought experiment, however painful or inchoate, I think it behooves us to see ourselves as sharing in some degree, however small and indirectly, in the enabling or complicity of such acts, or the creation of mental illness itself, at least insofar as we’ve done nothing to change a society which is incredibly punitive, aggressive, and violent, and in which an astonishingly large number of people display symptoms of mental illness. 

Erich Fromm memorably spoke of the “pathology of normalcy” (while the particular locution was his, the idea has ancient pedigree). Setting aside for the moment the conspicuous forms of violence (be it random, drug- or gang-based, the domestic kind, mass shootings, drone strikes, or aerial bombing), Fromm argued that much of our cultural and political life evidences the expression of low-grade, chronic schizoid tendencies. In brief, our society is in many respects “sick.”

As for the question of why and how entire societies or even civilizations might be “sick” in more than a metaphorical sense (although I would think even a descriptive metaphorical reference is damning), I have the audacity—or is it temerity—to recommend (this is not a complete inventory) works from the philosophical traditions of Daoism, Buddhism, and Stoicism; writings penned by Rousseau, Tolstoy and Simone Weil; the young Gandhi’s scathing tract (‘written [in Gujurati] with terse directness and solemn fervor’), Hind Swaraj; lastly, and more succinctly in a contemporary theoretical idiom, Arno Gruen’s The Insanity of Normality—Realism as Sickness: Toward Understanding Human Destructiveness (Grove Weidenfeld, 1992), and the chapter, “Consensus, Conformity, and False Consciousness: ‘The Pathology of Normalcy,’” in Daniel Burston, The Legacy of Erich Fromm (Harvard University Press, 1991). 

With regard to the question(s) of “measurement,” I strongly doubt such claims are amenable to decisive or convincing measurement, at least not in a way that would satisfy biomedically derived epidemiological assumptions and standards (which themselves are contestable*), although I do believe we can assemble evidence and construct reasons of various kinds on behalf of such a claim. At least one reason for this 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.”

And we are well served by remembering, again with Burston, that the very idea of Erich Fromm’s locution, the “pathology of normalcy,” is found in ancient Greece before, during, and after the time of Plato (e.g., Hellenistic ethical philosophies like Epicureanism and Stoicism), as well as among Hindu and Buddhist philosophers, Daoist sages, and some (Judaic) rabbinical traditions. Nonetheless, assessed largely within the strictures of and standards provided by the aforementioned biomedical criteria and thus conceding the increasing psychological “medicalization” of certain otherwise normal mental attitudes, moods, dispositions, or emotional states like depression, sadness or shyness (see works, for example, by Allan Horowitz and Jermoe Wakefield, and Christopher Lane), it does appear to be the case 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.” (Marcia Angell in the New York Review of Books)

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Of course this raises all sorts of questions, the most important of which Angell herself 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?”

Well short of here answering (or even beginning to answer) the necessary and urgent questions posed by Angell, and relying largely upon mental health and well-being criteria found within the above philosophical traditions, writers (be they political philosophers, activist intellectuals, or karma-yogins defying ready-made classification, like Gandhi), as well as the Freudian (and post-Freudian) psychoanalytic tradition,  I think one can, if only reluctantly or uneasily, correctly conclude that American society (and perhaps more than a few elements essential to modern civilization) is (are), generally speaking, “sick” (this was of course originally written a number of years before Donald Trump’s presidency). I am inclined to believe that there are in fact a lot of people who are, routinely, quite unhappy (to the point of episodic or even chronic depression), miserable, anxious, fearful, insecure, and prone to an unusual degree in their structural susceptibility to living daily with self-deception, (debilitating forms of) wishful thinking, and states of denial, in addition to a welter of illusions and, in the worst cases, delusional thinking. The extent of such symptomatic and often pathological behavior is such that we might safely claim there are an alarming number of people in this society that lack a reliable disposition to truth, have a tenuous grip on reality and a corresponding untenable notion of what constitutes a fact, and a stubbornly elusive moral compass.

Insofar as this is indeed the case, existing capacities for individuation have been thwarted or stunted and the quest for generalized (in a Marxist sense or otherwise) self-realization (or what Rudolf Bahro termed ‘general emancipation’) becomes purely utopian or but a mere dream. Can we assert, with confidence, or make an unambiguous judgment to the effect that this adds up to widespread mental illness as defined by contemporary psychiatrists and psychologists? Perhaps … or sometimes (if only because of the different kinds of psychiatry and psychology: from the ostensibly ‘scientific’ to the humanely psychotherapeutic). 

To be sure, the boundaries between ordinary unhappiness, everyday depression and generalized anxiety and the exhibition of pathological symptoms are not always hard and fast. But it is all too clear that there is precious little evidence, so to speak, of eudaimonia or flourishing among the masses, and thus a widespread dearth of meaningful or true self-fulfillment, suggesting the absence of basic mental health, if not the presence of mental illness of various kinds and degrees of severity. The main problem with the former is that it is liable to be a breeding ground for the latter. People in this country are in fact, at least in the first instance and as a manner of speaking, self-diagnosing (which becomes self-fulfilling or -confirming in the clinic) and self-treating or self-medicating (again, often or later in collusion with a biomedically disposed health care system and health insurance agencies), and the disturbing results and nefarious consequences are all around us, in both the daily round and public realms. 

* See the formidable critique in Sridhar Venkatapuram’s “crucial and impressive work,” Health Justice: An Argument from the Capabilities Approach (Polity Press, 2011).
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Relevant Bibliographies:
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