Against the winds

For those of us who are meant to be sane, these are disturbing times in which to confront mental illness – Roy Porter

Making note of Madness – A Brief History by Roy Porter Oxford University Press, 2002

It’s been quite some time that I’ve read a book that keeps me engrossed for a whole day in a library. Ray Porter has intellectually invited me to seep through the amazing annals of Madness and in the course, one of the fields in which I’m of late taking immense interest, Psychiatry. The book is a feat of fragrant fear galloping across few thousand years of medicinal mysteries about madness: mania and melancholy in particular.

Porter begins with a widespread speculation about Psychiatry: whether mental illnesses are manufactured or natural? That is, whether mental illnesses - which are the quintessential quarter of psychiatry - are reasonably natural or are they concocted myths of psychiatrists for professional progress. Questions are being asked about the very foundations on which psychiatry is based – thereby mooting over madness.

Porter cites the psychiatrist from Syracuse University, Thomas Szasz, who vehemently doubts the discipline of psychiatry in The Myth of Mental Illness:
Psychiatry is conventionally defined as a medical specialty concerned with diagnosis and treatment of mental diseases. I submit that this definition, which is still widely accepted, places psychiatry in the company of alchemy and astrology and commits it to the category of pseudoscience.

Szasz feels that mental illness is a “manmade myth.” This myth was glorified by medical community who were “involved in self-serving ‘manufacture of madness’ by affixing psychiatric labels to people who are social pests.” I don’t approve of such acerbic pinning of patients as social pests. Their plight cannot be stigmatized in this manner rather I - as a dilettante - have a strong belief in the benevolent and patient treatment of patients.

Szasz even accuses the psychoanalytic coterie of Freud of inventing the Unconscious to revivify the “defunct metaphysics of the mind and theologies of soul.” Mental illness and unconscious are misleading metaphors, Szasz feels, and so psychiatry is a packaged product of illicit assumptions. Though Szasz doesn’t decline that illness is not a real experience but he strongly concurs that mental illnesses share little in common with physical illnesses. Szasz summarizes: ‘Mental illness is not something a person has, it is something he does or is’

This thought has been generously attested by the French philosopher, Michel Foucault, in Madness and Civilization, in which he treated mental illness as a “cultural construct.” So, the history of madness is not manifested by diseases and their treatments but with the tales of control of knowledge and power.

Porter gathers similar thought in the book Three Hundred Years of Psychiatry 1535-1860 by “two highly respected” British psychiatrists Richard Hunter and Ida Macalpine:

There is not even an objective method of describing or communicating clinical findings without subjective interpretation and no exact or uniform terminology which conveys precisely the same to all…[in psychiatry, there is] an ever changing nomenclature

So, do psychiatrists manipulate their patient’s condition to drag them into an illusory idyll of illnesses? Not really. As Edward Shorter, who wrote one of the best introductions to Psychiatry {in A History of Psychiatry} points: psychosomatic illnesses have symptoms which change over time and cultural conditions are a major stimulus for symptoms. So, a dynamic discipline like psychiatry can’t be expected to have a standard strict-minded approach to a growing gang of illnesses.

But, an intellectual historian, David Ingleby writes in Critical Psychiatry: The Politics of Mental Health (Penguin, 1981)

One cherished illusion which must be lost before we can hope to understand ‘mental illness’ is the myth which helps to keep orthodox psychiatry on the move: the belief that what we need is simply more ‘findings’ - that round the corner lies some vital new fact which will settle the arguments once and for all. It is this conviction which has inspired the prodigious volume of research that the past half-century has produced in an ever-increasing flow. But despite this profusion of findings, it is doubtful whether we understand matters any better now than we did fifty years ago: as Coulter puts it, ‘the literature on mental disorders is quite out of proportion to the adequacy of our knowledge about them’.