Saturday, October 02, 2010

Madness and Sanity 3

Terminology

Evening Sky, June 2009, Phoenix Park, Dublin
I have never been too quick to jump to conclusions about anyone.  Everyone is worth the benefit of the doubt as they say.  Where the demarcation lines between sanity and madness lie I am not too sure.  Psychiatrists today do not use the substantives "madness" or "insanity" or the related adjectives "mad" or "insane" respectively.  Neither do they use the term "sanity" nor its related adjective "sane."  They prefer to use more clinical, and consequently more definable terms like "mental illness" such as schizophrenia and other psychotic disorders. When discussing mental illness in general terms, "psychopathology" is considered a preferred descriptor.

In English, the word "sane" derives from the Latin adjective "sanus" meaning "healthy". The phrase "mens sana in corpore sano" is often translated to mean a "healthy mind in a healthy body". From this perspective, insanity can be considered as poor health of the mind, not necessarily of the brain as an organ (although that can affect mental health), but rather refers to defective function of mental processes such as reasoning. Another Latin phrase for "sane" is "compos mentis" (lit. "of composed mind"), and a euphemistic term for insanity is "non compos mentis". In law, "mens rea" means having had criminal intent, or a guilty mind, when the act ("actus reus") was committed.

Another view of the evening sky, Phoenix Park, June 2007
In a previous post on madness and sanity I discussed at some length references to madness in Shakespeare's famous tragedy Hamlet.  There were other references to madness in the English literature we read at school.  Here is one we learned off by heart from the great Alexander Pope (1631-1700) :

Great wits are sure to madness near allied -
And thin partitions do their bounds divide. 
Pope was quite insightful in this remark which he confined to the thin line of demarcation between geniuses and mad persons.  He definitely could have gone further by saying that the partitions were equally thin between the normal person and the not so normal person.

With these thoughts long established in my mind I began reading the short but incisive history of madness by the late great scholar and historian of psychiatry Dr. Roy Porter.  This short wee book is entitled Madness: A Brief History (OUP, 2002).


Madness and Sanity 2

Usage

The coastline at Portrane, Co. Dublin
We use the words "madness" and "sanity" almost on a daily basis in our contacts with others.  We protest to others with such exclamations as: "Are you mad?" "That's insane," "It's a mad world," "He/she is simply insane" etc.  We are never, of course, asked to explain or define these words which we have used in an obviously pejorative sense.  It is as if we instinctively know what madness is on the one hand and what sanity is on the other.  We seem also to instinctively divine where the demarcation lines are between madness and sanity.

However, we all know that while our instincts and hunches can give us certain clues and indeed directions in our life, they are not, on balance, very reliable indicators on their own.  Intelligence and logic and commonsense are more important when it comes to getting to grips with the nature of anything whether scientific, historic and even artistic, while instincts, gut feelings and "emotional intelligence" (Daniel Goleman) do come into play, but in tandem with a more considered intellectual analysis and logical overview of the situation and further, to use a culinary metaphor, all of the foregoing recipe should be topped off with a liberal sprinkling of commonsense.

Towards a Definition of Madness and Sanity

Another section of coastline near Portrane
The brain is a delicate organ as we all know only too well.  As a fifty-two year old man I have lived long enough to have known some friends and quite a number of acquaintances who have died either from brain haemorrhages or tumours.  We are learning more and more, almost on a daily basis about the structure and complexity of this wonderful if delicate organ.  Then, we come to what is called the "mind" which we assume is somehow contained rather mysteriously within the brain somewhere.  Obviously, or perhaps not so obviously, the mind is infinitely more complex than we assume.  Once again we have made the assumption over the last several hundred years that somehow the mind or psyche is the very focal point of our personality.  That it exists at all is of course an educated guess, and indeed a most likely one.  As a philosopher one could say that it is a metaphysical reality or as a literatus that it a highly metaphorical term representing the very heart (another metaphor) of what it means to be human.  Once again as a writer one is not at all surprised that our very words are somewhat inadequate to encompass the sheer complexity and indeed mystery of the mind.

On a personal level I experienced what is commonly called a "nervous breakdown" at the age of forty - exactly twelve years ago now.  I was eventually diagnosed with clinical depression and am still on medication which has indeed kept me "sane" for the past twelve years.  In the interim, that is, since my diagnosis, I have experienced little or no adverse side effects to my medication besides feeling somewhat tired at times.  This I can live with, but certainly not with the severe existential crisis and indeed mental torment brought on by a bad bout of clinical depression.  Twelve years ago I spent some several weeks in hospital - a lovely protective private institution with all the modern conveniences, thankfully, as I was luckily fully insured.  During that existential crisis I began from the very pit of despair to ask such deep existential questions as Who am I?  What is my mind?  What is my personality at all?  Is it some fluid chemical reality in my brain?  At one stage I remember thinking that I was nothing really but a collocation of chemicals - Bertrand Russell's definition of the human being as a collocation of molecules was somewhere rattling around in my brain or "mind" - whatever that was or is.  Is my personality also so fluid as to be a mere chemical phenomenon?  Indeed, I became very sure that my very personality was such a mere chemical collocation of atoms and molecules which went to make up the various neurons in my brain.  Moreover, I became further convinced that my personality could be changed or controlled by the administration of the various medications which the psychiatrists were using to stabilise my situation, and thereby somehow stop my horrific existential crisis or my experience of severe mental pain.  Thankfully for me the medical/chemical interventions worked and are still working. Before I went into hospital I was a questioning individual who accepted such things as the stability and solidity of such commonly accepted "assumptions" as the existence of God, the existence of the mind as a virtually unassailable entity, the existence of my personality as set almost in stone and other related assumptions.  When I left hospital I was very uncertain as to any of these so-called "fixed" ideas or categories.  From my fortieth year onwards all concepts and assumptions are just that, mere concepts and assumptions, which can be traded on the market of open debate for other concepts and assumptions.  They can be knocked down and done without as their use for my own personal existence or development ceases and replaced by other more useful idaes and concepts which will always cease to be real for me when they are no longer useful in their turn.

Personal Relationships

In consequence of the above preliminary thoughts, relationships become way more fluid also.  One becomes far less set in one ways and indeed far less judgemental of others - thankfully.  One becomes less likely to make assumptions, espercially rigid ones.  I remember reading aomewhere in Eugene Gendlin's work that those patients who present as all-knowing and all-certain as to their psychological problems are the less likely candidates to succeed in effecting a change in their lives.  In the light of my own experiences this is, on reflection on that experience of course, most patently obvious.  But, I suppose everyone must experience such on the very pulses of their being (some poet of the Romantic era, whose name I have forgotten, used this lovely metaphor) to realise the truth of what Gendlin, phiulospher and psychologist, is getting at.

I spent somewhat over a year in a relationship with a woman who suffered from schizophrenia and this relationship was one of the most rewarding human encounters I have made in my life.  From it I learned to be more deeply compassionate.  I learned to appreciate what mental health and ill-health really are.  I began to read more widely in psychology, psychiatry, psychotherapy and indeed psychoanalysis.  I was not solely reading to expand my knowledge.  I was now reading to understand myself and the other person, and to understand what that relationship meant at all - or, indeed, what any relationship means.  Both from my own experience of depression and from the year-long engagement woith another "suffering" human being I began to question what we mean by the words "madness" and "sanity" anyway.  I began to realise that we are too quick to use such terms.  In fact, we use them in far too simplified and judgemental ways.  I learned on the very pulses of my own being the true import of the words of Hamlet to his great friend Horatio:  "There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy."

I have spent a lot of time, and indeed money, buying books about schizophrenia, manic (or bipolar) depression (a cousin and some friends suffer from this form of depression) and on many other cognate themes within psychiatry/psychology.  This has been, and continues to be, both an interesting and rewarding passtime for me.  I have gone to lectures on these mental illnesses and heard sufferers describe their experiences.  All of this has led me to question the easy categories we as a society profess to believe in and ascribe to others of our number. 

In the next several posts I wish to comment on a short but incisive history of madness by the late great scholar and historian of psychiatry Dr. Roy Porter.  This short wee book is entitled Madness: A Brief History (OUP, 2002).

Sunday, September 26, 2010

Madness and Sanity 1

I was a small boy when I first heard of strange or mad people.  As a little boy in those years - the early 1960s - parents were wont to frighten their children by threatening them with the "bogey man" if they were bold.  They also warned us not to stray off lest we met with such an individual.  I suppose they were scaring us so that we might not wander off and get lost.  In our particular town in the early 1960s locals warned us about a strange man called "Joe Leavey" who we were told was mad, or indeed was the very bogeyman aforementioned.  Whether this poor old man deserved his reputation I know not.  However, the town's people, along with my parents, used him as a threat.  The poor soul certainly was odd, different, strange, use whatever synonym you wish.

William Shakespeare, 1564-1616
The next mention of madness I heard was from my father who recounted how two or three strong men had to bind a neighbour with ropes so that he could safely be brought away to the nearest asylum.  It was years later that I encountered the concept of madness in Shakespeare's wonderful play Hamlet which we read for our Leaving Certificate examinations here in Ireland.  There are many wonderful quotations on the subject in that great tragedy.  I will list some of them below:
1. HAMLET:

How strange or odd soe'er I bear myself,
As ... I perchance hereafter shall think meet
To put an antic disposition on
(1.5.58)
 
2. OPHELIA:

My lord, as I was sewing in my closet,
... Lord Hamlet, with his doublet all unbraced;
No hat upon his head; his stockings foul'd,
Ungarter'd, and down-gyved to his ancle;
Pale as his shirt; his knees knocking each other;
And with a look so piteous in purport
As if he had been loosed out of hell
To speak of horrors,—he comes before me.

LORD POLONIUS:

Mad for thy love?

OPHELIA:

My lord, I do not know;
But truly, I do fear it.

LORD POLONIUS:

What said he?

OPHELIA:

He took me by the wrist and held me hard;
Then goes he to the length of all his arm;
And, with his other hand thus o'er his brow,
He falls to such perusal of my face
As he would draw it. Long stay'd he so;
At last, a little shaking of mine arm
And thrice his head thus waving up and down,
He raised a sigh so piteous and profound
As it did seem to shatter all his bulk
And end his being: that done, he lets me go:
And, with his head over his shoulder turn'd,
He seem'd to find his way without his eyes;
For out o' doors he went without their helps,
And, to the last, bended their light on me.
                              (2.1.1)
 
3. POLONIUS:

He knew me not at first; he said I
... was a fishmonger: he is far gone, far gone: and
truly in my youth I suffered much extremity for
love; very near this.
(2.2.8)
4. POLONIUS:

What is the matter, my lord?

HAMLET:

Between who?

POLONIUS:

I mean, the matter that you read, my lord.

HAMLET:

Slanders, sir; for the satirical rogue says here that old men
have grey beards, that their faces are wrinkled, their eyes purging thick amber and plum-tree gum, and that they have a plentiful lack of wit, together with most weak hams; all which, sir, though I most powerfully and potently believe, yet I hold it not honesty to have it thus set down, for yourself, sir, shall grow old as I am, if like a crab you could go backward.

POLONIUS:

[Aside] Though this be madness, yet there is method in't.

         Hamlet Act 2, scene 2, 193–206
                    5. HAMLET:

How is it with you, lady?

QUEEN GERTRUDE:

Alas, ... how is't with you,
That you do bend your eye on vacancy
And with the incorporal air do hold discourse?
Forth at your eyes your spirits wildly peep;
And, as the sleeping soldiers in the alarm,
Your bedded hair, like life in excrements,
Starts up, and stands on end. O gentle son,
Upon the heat and flame of thy distemper
Sprinkle cool patience. Whereon do you look?

(3.4.18)

6. KING CLAUDIUS :

What, Gertrude? How does Hamlet?

QUEEN GERTRUDE:

Mad ... as the sea and wind, when both contend
Which is the mightier: in his lawless fit,
Behind the arras hearing something stir,
Whips out his rapier, cries, 'A rat, a rat!'
And, in this brainish apprehension, kills
The unseen good old man.

(4.1.2)

7. […] poor Ophelia
Divided from herself and her fair judgment,
... Without the which we are pictures, or mere beasts:
(4.5.5)
I have selected seven quotations from Hamlet above to illustrate the theme of madness in this tragedy.  In the first quotation Hamlet tells us, the audience, that he will act mad, that is he will put on "an antic disposition" to show that he is "strange" or "odd."  In other words, it is the strange and the odd people who are deemed mad.  In quotation two from Ophelia we have a discription of a deranged fellow, or at least one who has no cares at all as to the way he is dressed, who goes about badly dressed or partially so, not to mention the fact that his clothes are "fouled." Then she opines that the poor wretch looks as if he had been "loosed out of hell." (Here we have the ancient theme of madness as demonic possession).  Then she tells her father Polonius that she fears this madness in Hamlet.  Once again we have a topic closely associated with madness, namely the fear engendered in others by the one who has gone mad.

Emile Wauters: The Madness of Hugo van der Goes
Ophelia goes on, once again a little later in quotation number two to mention that Hamlet did strange things like sighing heavily, looking into the middle distance and seeming to walk without looking where he was going - all symptoms of those who are so-called mad, that is they are seen as losing contact with the reality communicated by their senses.  In quotation three Hamlet mistakes Polonius as a fishmonger, and the latter describes him as "far gone."  Once again here we have withdrawal from reality - not knowing what is real and what is not.  Polonius here ascribes this to the madness engendered by love.

In quotation four Hamlet pretends to misundestand the purport of Polonius's use of the word "matter."  Again the so-called mad person will not understand the meanings implied by the use of the words of others.  In fact in this quotation Hamlet almost overdoes it with exaggeration, leaving Polonius to be suspicious insofar as he believes there might be method in the tragic hero's madness.  There is irony here as we the audience know that Polonius has, unbeknownst to himself, interpreted things correctly indeed.  In quotation five, once again we have observations about Hamlet's staring into the middle distance and talking to the empty air, this time on the lips of his mother Queen Gertrude.

In quotation six we have mention of the elements, that is, Shakespeare, as well as many of his contemporaries and indeed the literati of many previous generations, compares madness to the disruption of the elements by the likes of storms, strong winds and overpowering seas.  Madness is also seen in Queen Gertrude's report to Claudius of Hamlet's murder of Polonius, which she sees as consequent on his madness and sheer disturbance of mind.  In short madness is dangerous.

In the last quotation above, we have the observation of Hamlet that Ophelia has now gone mad because her lover is lost to madness and beyond true communication with her.  In fact, her personality or psyche, to use very modern terms unknown to Shakespeare, is now divided or split.  Here we have a very salient and indeed disturbing implication that the madness of one lover can make the other raving mad, too.  And further we know that this is not solely the madness of love, but also the madness of revenge and hatred.  And, dear readers, we learn of all these qualities of madness in Shakespeare some four hundred years before psychology or psychiatry came on the scene.

To be continued.


Solitude and its Graces 13

This is my final post on Anthony Storr's small classic Solitude.  He finishes the book with a chapter on the pursuit of wholeness, or  in other words the search for that elusive unity in life.  All of this may also, of course, be described as soul work, as the search for personal integration, for individuation (as Jung puts it), or for self-realization (as the Estern religions put it) or for self-actualization (Abraham Maslow and others).  These are all ways of saying the same thing in essence, though the emphases may vary.

The Image of the Ocean

Il Mar Ionio non lontano dalla nostra casa a Isca Marina
We humans have never ceased being in awe of the oceans which surround us on our little patch of earth. 70.8% (71%) of the surface of the earth is water, 29.2 % is land.  No wonder then that we are fascinated by it.  Also roughly 55% and 60% respectively of the human body is basically water depending on whether one is female or male.  Also when we trace our origins, all life - the human included - came from the watery womb of the ocean.  Water, one could say, is the very source and summit of life. Consequently, it is not alone highly important for physical survival but also for various symbolic meanings in all cultures.  Once again, the ocean itself is a symbol of the unconscious - that is, the great unknown level of the human psyche when one looks at the topographical model of the mind.

The Oceanic Feeling

This expression, I believe, is a wonderful one which means that ecstatic feeling we humans get on occasions when we experience a unity with a greater "power," or find ourselves overwhelmed by the mystery of life, or are carried away by falling in love with another, or are aesthetically moved by some piece of art, or, if you are religious, you will call this an experience of or an encounter with the divine.  These are all ways basically of describing one's encounter with the oceanic Freud reduced practically all our desires ultimately to the sexual impulse and the thwarting and repression of those desires to be the cause of our neuroses. I am one with Storr in his acknowledgement that Freud was right in seeing a similarity between the feeling of unity with the universe and the feeling of unity with the beloved person, but very wrong indeed to dismiss such experiences as merely regressive illusions.


 Let us return to Storr's words here for insight and illumination:

Admiral Byrd as a young Naval Commander
The sense of perfect harmony with the universe, of perfect harmony with another person, and of perfect harmony within the self are intimately connected; indeed, I believe them to be essentially the same phenomenon.  The triggers for these experiences are of many different kinds.  Marghanita Laski lists 'nature, art, religion, sexual love, childbirth, knowledge, creative work, certain forms of exercise,' as being the most common.  Admiral Byrd's description of feeling at one with the universe...is a characteristic example for which the triggers were solitude, silence and the magic of the Antarctic.  Experiences of this kind can also occur spontaneously in solitude without the aid of any external stimulus.  Such transcendental experiences are closely connected with aspects of trhe creative process; with suddenly being able to make sense out of what had previously appeared impenetrable, or with making a new unity by linking together concepts which had formerly seemed to be quite separate.  (Solitude, p. 188)
There is much "food for thought" in the above paragraph, because it firmly describes "transcendental experiences" within the ambit out our psychology as living humans.  It does not need to posit the existence of an external deity to be the source of such transcendental experiences either.  It has long been my own deeply held thought and equally deeply held feeling that much, if not all, of religious experiences can be firmly situated within the psychological make-up of the human mind. 

Bertrand Russell
To this extent I am in no way surprised that Bertrand Russell, one of the greatest philosophers and one of the foremost mathematicians of the early twentieth century, and life-long atheist, described how as an eleven year old he had such an experience in doing mathematicis, an experience tantamount to a transcendental one, which he later described as "one of the great events of my life, as dazzling as first love." (Quoted ibid., p. 188)


Biology and Depth Psychology

Without a doubt biology plays a very important role in the human psyche by way of sexual desires and impulses, but such is most particularly evident during the first part of the human lifespan.  We owe much to Carl Gustave Jung for this insight, for it was he who said that the human lifespan can be divided roughly into two parts, phases or halves - the first which runs from 0 to 35 and the second from 35 onwards.  In the first part of life, the human creature seeks to propagate its species, form unions with other creatures and form families.  The second phase is concerned with making some meaning of what life is in itself anyway, what the overarching purpose of life is and how he or she can find their true vocation or life project.  This second period is one of exploring the depths of the psyche - hence the term "depth psychology."  It is also a time for the exploration of the personal unconscious and indeed the collective unconscious, or in the famous words of Freud, it is a period where we "make the unconscious conscious."

So the second part of life is all about the pursuit of meaning and purpose in life, of plumbing the depths of the psyche for direction, unity and integrity.  Here we return to all those virtually synonymous terms I listed in my opening paragraph above.  In all this, I find Jung's idiosyncratic insights into depth psychology personally rewarding, especially the Jungian way of working with and teasing out one's dreams.  To this extent, I love his definition of personality which runs thus: "the supreme realization of the innate idiosyncrasy of a living being." ((Quoted, ibid., p. 191)


Freud and Jung, left and right in front row
On the one hand Freud dismissed  all religion as illusion, while on the other Jung pursued what could be argued to be a substitute religion in his specific brand of depth psychology. (The Self is, as it were, the God within!)  Often, Jung's Freudian critics often dismissed his views as nothing short of unregenerate obscurantism.  The same criticisms could be levelled at the archetype psychology of James Hillman.

In summary, then, we may say that the goal for every human creature is "individuation" according to Jung or, if you wish, any of the synonymous terms I have listed above in my opening paragraph.  Basically the "process of individuation" tends towards the goal of "wholeness" or integration.  This wholeness may be also described variously as an overwhelming experience of unity or "oneness" with the universe or the source of that universe.  Call it what you wish.  You may wish to call it a religious experience or not.  You may wish to call it a transcendental experience or you may not.  You may wish to call it simply a deep or overwhelming experience.  Still more, you may wish to call it an aesthetic experience, an artistic experience, a depth experience, a profound experience, or simply a depth psychological experience.  In short, mysticism may not be that extraordinary an experience at all, if one locates its locus within the human psyche both conscious and unconscious.  Obviously, mysticism will never cease to be extraordinary if you wish to locate its locus firmly outside the human mind and in the very transcendence of a totally other and divine source traditionally called God.  Wherever you place the locus, the experience cannot be gainsaid.  And that, dear readers, is all we need to know.  Let us never denigrate the sincerity of either believers or non-believers.  Let us, in all reasonableness and compassion, accept them for their sincerity and honesty of conviction.