Madness Explained
I found Madness Explained in the Coop Bookshop where I went to shop because I had a voucher. I think I originally planned to buy something else, I can’t remember what, but in any case, it wasn’t there and this book was. As usual I spent more than the voucher allowed me too. I couldn’t choose between this book and a book about syphilis so I bought them both. The book about syphilis was interesting but mostly concerned with proving that historical figures of note and genius were syphilitics. Syphilitics often appear mad in the final stages.
I’m told my great-grandfather was a syphilitic, though family wisdom says he died of a wasting disease. He lived well and made money so the family regarded him as a success, though most of the money was lost afterwards. When he knew he was dying he took his wife to Italy and Egypt, a difficult and expensive trip for someone living at the turn of the 20th century, even if the starting point was Budapest. His wife, my great-grandmother, was not syphilitic and family wisdom also has it that he contracted syphilis when she decided not to sleep with him any more and he was left to meet these needs elsewhere. Despite this he took her away on what must have been an exciting trip, perhaps he loved her or perhaps he just needed a nurse he could trust.
There are vague hints of madness in my family, though I’ve never been able to catch and hold one. Once my sister began screaming, I don’t remember why but there seemed to be a reason. There was certainly a family argument and my stepfather grabbed my sister and began to slap her and dunk her head underwater. I was furious so my mother explained that it was a madness, my sister was a hysteric just like my mother, or so my mother told me. This was the only way to treat hysterics. I was not a hysteric, my mother said, so I didn’t understand. My sister calmed down, she might have thought it was the only way to stop my father hitting her. I don’t remember what happened next but the incident stays in my mind and the emotions associated with it are anger and confusion.
At various times in my life I have had a fear that death will find me, that it is all around and that one wrong move will be the end. While technically this is true for all of us, I was unable to put this fear aside. I had difficulty sleeping and did many things with fear, taking care with all my choices and wondering if this would be the last time I was choosing. It’s hard to live when this fear overtakes you. The first time it happened, my uncle the doctor told my mother to give me sleeping pills. Once I’d slept the problem went away. In later life, I preferred to deal with it myself, either by sleeping in the daytime or making promises to myself that if I did things a certain way I would be safe. I believe they call that an obsessional disorder. I told a friend about it and he told me his mother had suffered the same thing. After that it lost its sting.
Madness Explained begins by discussing the initial classifications as described in the nineteenth century by Emil Kraepelin. He believed mental illness had a biological cause and classified psychoses into three main types: dementia praecox (later called
schizophrenia), manic depressive disorder and the barely discussed paranoia. According to Kraepelin’s research, schizophrenia develops in adolescence and gets worse, the prognosis is that it will worsen till one is no longer a useful member of society. Here are Kraepelin’s symptoms:
“Patients might experience an absence of emotion, or their emotional responses might be highly inappropriate (for example, a patient might laugh at a funeral). They might display stereotyped behaviour (for example, clapping five times before entering a room) or adopt catatonic postures. Problems of attention were also common, so that patients became distractible and easily confused. They might suffer from strange perceptions, particularly auditory (hearing imaginary voices) and tactile (feel something touching them in the absence of an actual stimulus) hallucinations. Irrational beliefs were also frequently observed, particularly delusions of persecution (for example, patients might believe they were being persecuted by the German royal family) or of grandiosity (believing that they had improbably powers). However, the common underlying feature that was always present was an irreversible deterioration of the intellectual functions. Dementia praecox patients became mentally disabled, unable to lead productive lives, and they never recovered.” (p. 15)
This scared me because I have had most of these symptoms at one time or another. I laughed at my grandmother’s funeral (though not my mother’s). I had rituals to avoid my fear of death (though I didn’t clap five times before entering a room). I’ve even had possible hallucinations, I hear my name being called occasionally and have tickling feelings or a sense of being touched. I don’t know about the grandiosity and strange beliefs, I’m probably not the appropriate judge, but I seem to lead a productive life with only occasional catatonic tendencies when I get a problem I don’t want to tackle.
The problem, according to the book, is, though everyone would like to posit a biological origin for mental illness (then we can fix the biology, right?), no one can agree on diagnoses. One therapist diagnoses schizophrenia and the next calls the same patient a manic depressive (now called bipolar disorder, or unipolar if it’s just depression. And if you’re just manic, I guess you like to party). So over the last 150 years there have been numerous attempts to set standards and produce diagnostic manuals to try and get all therapists reading the same page, so to speak.
This lead to discussions of who defines mental illness, the most interesting and frightening result of which was the definition of symptoms of mental illness in the Soviet Union as including ‘reformism’, ‘social contentiousness’ and ‘philosophical concerns’ (p. 53). The criteria were written in such a way that most doctors tended to believe they were genuine, so political dissenters found their way to mental asylums.
By p. 105 I was feeling a little more relieved with regard to my possible schizophrenia when the discussion turned to schizotaxia, the existence of people with a genetic tendency to schizophrenia who never actually developed it (or never came upon the circumstances that would bring it out). Schizotaxics might occasionally experience ‘cognitive slippage (a loosening of associations)’ and ‘anhedonia’ (an inability to experience pleasure).
I’m not sure what loose associations are so I can’t say I’ve ever had them. The term ‘loosening of associations’ disturbs me, it seems to imply that we all have to have the right type of associations and I wonder what they might be. What if associations such as George Bush = good and Iraq = bad are considered right associations? As for anhedonia, don’t even get me started on how a whole generation of women have difficulty with sexual pleasure because we were brought up to control ourselves. It was believed that men couldn’t and it was emphasized that it would be our fault if we were raped or ended up pregnant.
Schizotaxic personalities often also developed eccentric beliefs and magical thinking. Quite frankly, I would miss magical thinking if I didn’t have it. I like to believe that by desperately hoping for something I can make it happen. I think a lot of people do, in my opinion it explains the popularity of Harry Potter.
It was believed that schizotaxia could be detected by ‘examining unusual responses to conventional personality questionnaires’. I do hope I’ve amused a lot of otherwise dull, right-thinking, non-magical psychologists. Actually, it might even be fun to invent a few ‘unusual responses’ and give them some excitement. They can’t commit me just for doing that, can they?
At this point in the book, Bentall seems to be saying:
- That the psychoses are all one, expressed by a variety of symptoms, not all of which are always present
- That there is a continuum between sanity and madness
He seems to be saying this more clearly in his terminology and descriptions of people’s theories than in any studies he cites. The assumptions in some of his text are quite scary, especially the biomedical assumptions, which, though possible given how much of our thoughts and emotions seem to be chemical, make me fear that we might find a cure one day for eccentricity and even intelligence. What if our ‘madness’ is all that distinguishes humanity from other animals?
More interesting was the discussion about depression and coping styles. Ruminating about depression seems to extend it whereas distracting oneself seems to shorten the time of depression and often results in mania if the problems become too difficult to handle. Figured that one out myself a while ago, if things look bad, find something good to think about.
The depressed person also apparently does dangerous things, such as driving like a lunatic and taking drugs, which also tend to prolong the depression. I think this has something to do with feeling out of control. You do dangerous things to feel you can control even a dangerous situation. Maybe it has something to do with anhedonia as well, doing extreme things to create some excitement. There is discussion about negative self image and beliefs about the discrepancies between the actual self and the ideal/ought self. I would think that all of us have an ideal self and believe that we don’t really measure up. I think this is even more the case with the images of heroes on display in the cinema and on television.
Bentall explains that most people credit themselves with success but blame external factors for any failure but depressed people tend to do the opposite. For myself I think you can learn and grow more if you see what you did wrong this time instead of blaming others. Blaming yourself and blaming others are both counterproductive but it helps to sort out where you went wrong and what factors were beyond your control. The idea that being oversensitive to people’s facial expressions and body language might cause paranoia doesn’t surprise me. I’m like that and it took me a long time to realise that people aren’t always conscious of facial expressions and tone of voice.
The owner of the forceful tone and the slight frown doesn’t always realise he or she has produced them and can be quite stunned with an equally aggressive response. I’m sure a lot of people still think I’m paranoid. The general discussion on paranoia intrigued me, how we attribute causes to events based on our self-referential models.