Mad Knowledge

Somewhere in amongst all that growing up a sense of identity has been forged. Events beat the malleable self on the anvil of the genetic and cultural mix. Those events just keep on coming– refining and tempering throughout life. A sense of self is one of those concepts, like mind, that take fright and fly away when focused on. We probably don’t dwell very often on the nature of our selves, although bookshelves groaning under the weight of ‘self-help’ volumes might suggest otherwise, but we do know how we feel when we are ignored or recognized. Crucially, how we react to both criticism, praise or circumstance can build or diminish confidence in the person we are becoming. Insights into that process are best provided by fiction writers from the Ancient Greeks, Chaucer, Shakespeare to Jane Austin, Tolstoy and many from the 20th and 21stcentury rather than the quasi-medical discipline of psychology and its antonym psychiatry. Thus, by way of offering an answer to one of my questions about the usefulness of knowledge, a brief look at a history of how madness is viewed and treated follows.

I realise questioning the validity of an entire academic discipline does sound just a touch arrogant. Please indulge my explanation. It seems to me that the rigorous and persistent study of human biology has over the years revealed an increasing complexity in the ways the physical body functions both endogenously and with the environment. The application of this scientifically accumulated knowledge has undoubtedly decreased morbidity of whole populations. This uncontroversial statement goes part way to answering my question about knowledge. However, the same lifesaving results cannot be said about knowledge derived from studying the mind. Despite the advances in untangling the relationship between neuroscience and pharmacology the brain still resides behind a locked door. It is the least understood organ. Even if every last electrochemical process in the neuronal universe was revealed the resultant knowledge would contribute little to understanding emotional distress we suffer from time to time.

The phrase ‘mental illness’ or ‘mental health’ stem from a long etiological history. The metaphor that best encapsulates that history is the pendulum. Even in Ancient Greece it swung from mental abnormality being caused by intervention by the gods or demons to an early version of the medical model with Hippocrates’ humours in the brain being out of balance. Then it swung back during the Ecclesiastical state of the Middle Ages. Instead of antiquarian intervention by gods, the mad were possessed by Satan, Jews or heretics. (On Religious and Psychiatric Atheism: The Success of Epicurus, the Failure of Thomas Szasz, Michael Fontaine, Aug.26th 2014)

Fast forward to a post Scientific, Age of Reason, Enlightenment influenced Europe, the insane, having been incarcerated for the amusement of the gentry, at least now had the opportunity to roam around in the ample grounds of mental asylums. So that by late 19th century, the pendulum had swung back to Hippocrates only this time humours have been replaced by diseases of the central nervous system. This process leads to the German Physician Emil Kraepelin (1856 – 1927) formulating a syndrome ‘dementia praecox’ a label which later became ‘schizophrenia’ whose causes were completely organic. (A Social History of Madness, Roy Porter,1987) The consequences of this return to chemistry which Foucault labelled the construction of the ‘psychiatric patient’ or a shift from madness to ‘psychiatric pathology’, meant that anything uttered by the mad was ignored as symptomatic gibberish and justified their incarceration in ever larger numbers. (Porter,1987) In order to legitimate psychiatry as a medical discipline “…a shameful series of pseudoscientific rationales {were used} to justify the use of inhumane, and often barbaric treatment protocols such as insulin coma therapy, lobotomy, shock therapy, and most recently, the prescribing of antipsychotics…” (The Science and Pseudoscience of Mental Health Podcast, Sharna Olfman, Sept. 27th 2018, MIA)

Meanwhile post Scientific, Age of Reason, Enlightenment influenced Europe, the insane, having been incarcerated for the amusement of the gentry, at least now had the opportunity to roam around in the ample grounds of mental asylums. So that by late 19th century, the pendulum had swung back to Hippocrates only this time humours have been replaced by diseases of the central nervous system. This process leads to the German Physician Emil Kraepelin (1856 – 1927) formulating a syndrome ‘dementia praecox’ a label which later became ‘schizophrenia’ whose causes were completely organic. (A Social History of Madness, Roy Porter,1987) The consequences of this return to chemistry which Foucault labelled the construction of the ‘psychiatric patient’ or a shift from madness to ‘psychiatric pathology’, meant that anything uttered by the mad was ignored as symptomatic gibberish and justified their incarceration in ever larger numbers. (Porter,1987) In order to legitimate psychiatry as a medical discipline “…a shameful series of pseudoscientific rationales {were used} to justify the use of inhumane, and often barbaric treatment protocols such as insulin coma therapy, lobotomy, shock therapy, and most recently, the prescribing of antipsychotics…” (The Science and Pseudoscience of Mental Health Podcast, Sharna Olfman, Sept. 27th 2018, MIA)

While broadly agreeing with Kelmenson’s de-coupling abnormal behaviour from the disease model, there are occasions when some sort of drastic intervention is called for. In my case, after passing out post declaiming with messianic fervour to a bunch of my relatives perhaps a dose of smelling salts was not quite enough. Whether my catatonia justified the use of ECT I’ll never know but given that I did recover from an acute hypomanic nervous breakdown I have to conclude it worked. However, I’m not convinced the neuroleptic tranquillizers used to treat my ‘paranoid schizophrenia’ were necessary. Sure, they speeded up the diminution of the florid symptoms, but I had already had my alternative reality punctured by Tom on one occasion and my parents on another while in Ashford Remand. I don’t think it’s too much of a stretch to imagine I would have slowly come to accept that not everyone I didn’t know were Arab spies. Recovery might have been possible simply with enough reciprocal trust and empathy built up slowly in a setting such as Longrove. But then that would have taken too long for parents who were used to outsourcing emotional support. As Alwine said “It’s marvellous what those drugs can do these days!”

As this is supposed to be a critique of knowledge as it pertains to the vexed relationship between the abnormal and the normal mind and body, how has treatment of schizophrenia progressed in the last 50 years? According to Simon McCarthy-Jones, (Assoc Prof in clinical Psychology and Neuropsychology, Trinity College, Dublin. 2017) “…the proportion of people {diagnosed schizophrenic} who recover hasn’t increased over time.” The answer, the good professor proposes, is to hasten the end of the label schizophrenia.

Questions such as ‘who is Tom? Who is Alwine? What was Longrove and why Arabs? will be answered when I post chapters from my memoire. So stay tuned… Oh yes, that “growing sense of identity” I referred to relates to my early 20s.