Friday, October 08, 2010

Madness and Sanity 6

Chapter two of Porter's book is called "Gods and demons."  What we humans could not explain by reason or commonsense we attributed to divine intervention, whether that intervention was through a pantheon of gods in more remote times or through that of one deity only in more recent years.  When I was studying theology and philosophy in the old days we described this human attribution to outside divine powers as "the God of the Gaps" mentality.

How did early humankind explain such mental illnesses that we now call by a legion of psychiatric terms which forms a complicated nomenclature that can be readily accessed in the DSM-IV-TR which was published in 2000?  I often consult this Diagnostic and Statistical Manual of Mental Disorders which is used by many and varying professional bodies associated with the health industry around the world.

Archaeologists have unearthed skulls datable back to at least 5000 BC which have been trephined or trepanned - that is to say that small round holes have been bored in them with unsophisticated flint tools.  This evidence supports the conclusion that these early human beings believed these poor unfortunate souls to have been possessed by devils who could only have been freed by such drastic measures as boring holes in skulls.

William Blake's Nebuchadnezzar crawls away in madness
In a previous post I listed a plethora of adjectives associated with the term "madness", and taken together they have many pejorative associations.  It is little surprise, then, to even the most unenlightened reader that violence, grief, bloodlust and even cannibalism have been associated with insanity.  This chapter is a multi-stop tour of ancient to medieval and post-medieval beliefs with respect to madness.  Porter firstly stops off at Deuteronomy 6:5 where the Lord God of the Jews punished Nebuchadnezzar of the Neo-Babylonian Empire, who reigned c. 605 BC – 562 BC, by reducing him to bestial madness.  He then stops off at another historical stop in Ancient Greece, courtesy of the historian Herodotus who described the crazy King Cambyses of Persia who mocked religion - only a madman would do such a terrible thing.

Get your very own Werewolf t-shirt
We then stop off in India where we learn that the ancient Hindus had a special demon called Grahi who is held responsible for epileptic convulsions.  We are then informed of the links of madness with dogs and werewolves.  We learn an interesting word here from Porter, viz., lycanthropy or "wolf-madness" - that is a "wolf-man" or lycanthrope who prowls about graves and bays at the moon in sheer frenzied madness.  This reminds me also of Dr Anthony Storr's reference to Winston Churchill's black dog, the name he had for his deep depression which hit him quite often.

Ancient image of dramatist Sophocles
We then stop off in Babylon, Mesopotamia, Assyria where epileptic symptoms were ascribed to possession by devils.  These ancient beings do not possess clearly delineated personas, faculties or psyches as do the heroic characters of such later Greek tragedians as Sophocles, Aeschylus or Euripides, still less than those found in Shakespeare or in the reported medical cases in the works of Freud.  I have already referred to the fact that the growth of the sense of the individual was a fairly late emergence in the history of personal or psychological development - see my many posts on Dr Anthony Storr with respect of this matter.  Indeed, Homer's Iliad (written around 800 BCE) has no word at all for "person" or "oneself."

Because the individual psyche, any form of individual character or sense of personality was so ill-defined human beings in these early works of literature are presented as being mere puppets of the gods.  They are literally in the grips of terrible unknown forces beyond their control.  Another way of saying this is that the human being's inner life or persona or conscience, call it what you will, was then at a very early stage of development. 

Interestingly, the great pioneer of Western medicine, Hippocrates (c. 460 - 357 BC) could find little supernatural influence in mental diseases or illnesses which to his mind were simply diseases of the brain.

Christian Madness:

In Christian belief, the Holy Ghost and the Devil battled for possession of the individual soul and the battleground was none other than the very mind (or soul) of the individual which portrayed symptoms of despair, anguish and other mental disturbances, the results of that on-going battle.  Porter refers to the "good madness" illustrated in the lives of saints and mystics - the good or holy madness of the Cross, holy innocents, prophets, ascetics, mystics and visionaries who could be said to be "possessed" by the "good madness."

However, derangement was more commonly viewed as diabolic, schemed initially by Satan and spread by witches and heretics.  The Roman Catholic Church has a veritable evil history in its dealings with those wretched souls whom it adjudged as being heretics, witches or sorcerors.  Let us quote the words of Porter here:

The witch craze which gathered momentum across Europe from the late fifteenth century, peaking around 1650, likewise viewed uncontrolled speech and behaviour as symptoms as symptoms of satanic malificium (malice) directed by witches who had compacted with the Devil.  In the conflagration of heresy-accusations and burnings stoked by the Reformation ans Counter-Reformation, false doctrine and delusion formed two sides of the same coin: the mad were judged to be possessed, and religious adversaries were deemed to be out of their mind.  (op.cit., pp. 19-21) 
Also, in early Anglican circles, madness was seen as a desperate and acute phase in the trial and redemption of souls, because it brought the sinner into a state of crisis, and provided the prelude to recovery.  In all this, it appears and has always appeared to me that the Anglican position was always far more "reasonable" and middle-of-the-road or balanced than the more extreme ones of either right wing Roman Catholicism or more fundamentalist or Evangelical Protestantism.

In summary, then, in these more remote times we may say there was a widespread belief in the existence of supernaturally induced madness.  Thankfully, there are instances, listed by Porter, of more reasonable academics and medical persons who began to see that there could be some human weaknesses involved within the person, rather than the more horrific idea of possession from some maleficium or malice from a personified evil which exists outside him or her. Indeed, once again the Anglican Church showed a way more balanced approach to mental illness than either the Roman Catholic Church or the more fundamentalist Evangelical churches which both took an all-too-easy refuge in the idea of possession of the individual soul by demonic forces. 

Wednesday, October 06, 2010

Madness and Sanity 5

The first chapter of Roy Porter's Madness: A Brief History (OUP, 2002) provides a succinct introduction to the history of madness or insanity.  I have already pointed out that these terms are very loaded and prejudicial terms.

Indeed, the above terms "madness" and "insanity" conjure up many strange ideas, loaded with prejudices in the opinionated person's mind that are described by the following adjectives: "strange," "weird," "scary," "peculiar," "cracked," "crazed," "crazy," "unstable," "senseless," "nutty," "rabid," "unbalanced," "unsound," "unsafe," and probably "dangerous."  Obviously all of these synonyms have different shades of meaning, but collectively them sum up the range of pejorative associations linked to the concept of madness in our minds.

Porter starts by describing two exstremes or poles within psychiatry with regards to madness, the first which denies its existence as a scientific category at all and the second which upholds it as a very important such category. 

Built in 1784, Vienna's  Narrenturm, German for lunatics' tower, one of the oldest buildings which are specifically designed as a "madhouse"

Dr Thomas Szasz (1920- )
Dr. Thomas Szasz, (born Budapest, 1920), emeritus Professor of Psychiatry at Syracuse University, New York.  Szasz (pronounced Saas) denied that there was any such thing at all as "mental illness" - it was not a fact of nature, but a man-made "myth."  He put these views forward mainly in two books: The Myth of Mental Illness (1961) and The Manufacture of Madness (1970).  He was and is very scathing in his views of psychiatry which he lambastes as being "in the same category" as alchemy and astrology and quite simply is a pseudoscience.  For Szasz, mental illness simply is not a disease, whose nature can be described and elucidated by science.  It is, rather, a strong myth, fabricated by psychiatrists for reasons of personal advancement and monetary return.  This myth is in turn endorsed by society because it proposes and sanctions easy solutions for problems people have.

It is interesting that Szasz goes back to Gilbert Ryle's concept of the "category mistake" in arguing against the very existence of psychiatry as a science or mental illness as a disease. A category mistake, or category error, is a semantic or ontological error by which a property is ascribed to a thing that could not possibly have that property.

We read, in the words of Roy Porter that

All expectations of finding the aetiology of mental illness in mind or in body - not to mention some Freudian underworld - is, un Szasz's view, a category mistake or sheer bad faith: "mental illness" and the "unconscious" are but metaphors, and misleading ones at that.  In reifying such loose talk, psychiatrists have either naively pictorialized the psyche or been complicit in shady professional imperialism, pretending to expertise they do not possess. (Op.cit., p. 2)
The Anti-Psychiatry Movement:

While Porter does not use this term, Thomas Szasz belongs to a group of outspoken psychiatrists who belonged to a group called loosely the Anti-psychiatry Movement. This group emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing, along with Thomas Szasz in the USA and, in Italy, Franco Basaglia. The term was first used by the psychiatrist David Cooper in 1967.  I have outlined briefly the strong views of R.D. Laing before in these pages, chiefly here Ronnie Laing and elsewhere if you use search this blog facility on the right of this blog.  Porter does refer to the work of Michel Foucault (1926 - 1984) in his brief introduction to this book.  Foucault, sociologist, philosopher and historian of thought argued that an history of psychiatry which aimed to be comprehensive and critical would be not only an account of mental disease and its treatment but would also deal with such big and thorny questions as freedom and its denial to patients, and finally control and abuse of knowledge and power.

Michel Foucault published his famous book Madness and Civilization (in French) as early as 1961, interestingly enough the same year in which Thomas Szasz also published his.  Foucault argued that mental illness must be understood not as a natural fact but as a cultural construct sustained by "a grid of administrative and medico-psychiatric practices." (ibid., p. 3)

Porter then adverts to two English psychiatrists who were less radical but tended somewhat towards the anti-psychiatric trend in psychiatry and held a sort of middle ground.  I must admit I never heard of either of them, viz., Richard Hunter and Ida Macalpine who both insisted that psychiatry had ended up in a profound muddle - for them there was far too much subjectivity in diagnosis (subjective interpretation) and not enough scientific objectivity in the field at all.  These two psychiatrists also lamented the "ever-changing nomenclature, as well as a surfeit of hypotheses which tend to be presented as fact." (Quoted ibid., p. 3)  From perusal of the net I find that these two psychiatrists were a mother and son team who researched the history of their profession and wrote jointly two famous histories of the subject.

However, Porter balances his introductory notes with the contrary view of psychiatry.  In this regard he refers to the work of Drs Martin Roth and Jerome Kroll who argue a more orthodox medical line.  They rebut roundly and robustly the views adumbrated by these writers and scholars adverted to above.  In their The Reality of Mental Illness (1986) they counter-argue that "the stability of psychiatric symptoms over times shows that mental illness is no mere label or scapegoating device, but a real psychopathological entity, with an authentic organic basis." (Quoted ibid., p. 4) 

Sir Aubrey Lewis and wife Hilda, also a leading psychiatrist
Porter also quotes at length from Sir Aubrey Lewis's (1900 - 1974) review of Foucault's book mentioned above.  Lewis, an Australian Jew, educated by the Irish Christian Brothers on that continent, was the eminent director of The Institute of Psychiatry at Maudsley Hospital in London.  Therein, this academic leader proferred a good overview of the history of psychiatry which he saw as getting progressively more humane and more inclusive of multidisciplinary approaches.  Lewis argued in moderate and sympathetic tones that "the conventional picture" of psychiatry and its history is one of "progress and enlightenment." (Quoted ibid.,  pp. 5-7)

To be continued

Sunday, October 03, 2010

Madness and Sanity 4

A Little History

Having both a personal/experiential as well as an academic interest in psychiatry, I have always been interested in how healing is effected in the daily living of the patient.  Having spent some seven weeks in one of the leading psychiatric hospitals in Ireland, if not in the British Isles, St Patrick's here in Dublin, Ireland, I am convinced that care and consideration of the patient is of equal, if not of more importance than the psychopharmacological interventions that are made.

Let me briefly here advert to the father of Western medicine the great, and somewhat legendary,  Hippocrates of Cos or Hippokrates of Kos (ca. 460 BC – ca. 370 BC).  This genius was an ancient Greek physician of the Age of Pericles (Classical Athens), and is considered one of the most outstanding figures in the history of medicine. He is referred to as the Western father of medicine in recognition of his lasting contributions to the field as the founder of the Hippocratic School of medicine. This intellectual school revolutionized medicine in ancient Greece, establishing it as a discipline distinct from other fields.  However, here, I would like to make a list of quotations from this great pioneer of Western medicine, quotations which show the great compassionate base of the profession of medicine.

1. A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses.

2. Cure sometimes, treat often, comfort always.

3. It is more important to know what sort of person has a disease than to know what sort of disease a person has.

4. Make a habit of two things: to help; or at least to do no harm.

5. If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.

6. Natural forces within us are the true healers of disease.

7. There are in fact two things, science and opinion; the former begets knowledge, the later ignorance.

8. Wherever the art of medicine is loved, there is also a love of humanity.
These quotations above appeal to me because they are at the very heart of medicine - be it physiological or psychiatric because they are based on fundamental humanistic and humanitarian principles.  Indeed any doctor, to my mind, must seek to "heal" the whole person as an entity or feeling and thinking human being, not just to seek to cure or get rid of the symptom.  Notice the words used by Hippocrates: "comfort," "know" the type of person you're treating, "help," "do no harm," "nourishment," "exercise," "natural forces within," " true healers," "science" and "love of humanity."  Who would not want their doctors to subscribe to all the principles these words represent?  In the next paragraph I will attempt to list some of the really great doctors or healers we have known in the history of Werstern medicine.

Great Doctors like Albert Schweitzer, Joseph Lister, Jonas Salk, Louis Pasteur, Robert Koch and indeed the pioneers of the profession of nursing, so essential a part of medicine, like Florence Nightengale and Elizabeth Blackwell did such great work in laying down the sound foundations of modern medicine.  To my mind, the work of psychiatrists (and psychotherapists/psychoanalysts among them) like the great Sigmund Freud, Carl Gustave Jung and the legions of followers of these two pioneers, Dr. Ronnie Laing (Scotland and the  U.K.), Dr. Anthony Storr (U.K.) and our own Professor Ivor Browne did extraordinary work in the field of mental health.  Now, I am no historian of medicine, but I have outlined my interest in the field in the opening paragraph.  I may indeed have left out many important figures in this preliminary canter through the history of psychiatry, but these last have been the ones I am familiar with and whose work I have read.