Mental(izing) Health: On Madness

Newsletter, #60

I-Stock, BravissimoS

Struggling to welcome the new year? A brisk, no-nonsense beginning might be fitting: “madness” is the word that pops into my mind. And then I wonder: is madness is still a meaningful term? Has it become politically-suspect, conjuring images of people who are wild, regressed and scary? Is it an inherently stigmatizing attribute? But what if, in doing away with madness, we are less able to name and make sense of states of the mind that do exist? What if we are jeopardizing connection to an extensive history that has accepted and even honored madness?

What if, by aspiring to embrace putatively “scientific” categories of psychopathology, we have found a way to deny that, under some conditions, reality is unbearable? What if, as Davoie and Gaudellière (2004) claimed, madness can be produced by historical traumas— actually, vicariously and passed on generationally?[i] What if we are witnessing a new modification of this phenomenon, in which madness descends concurrently with the events? What if, in an even more extreme case, we anticipate traumatic events before they occur, as we launch headway into them?

Madness must have something to do with ignoring, denying or forsaking reality. If we experiment, we might say that madness means opting for a new reality that differs from the reality that is conventionally accepted. Put this way, there is the potential for the new reality to be justifiable or at least that it might be regarded as an adaptable, alternative to reality. Reality #2 might have features that overlap with Reality #1, and who knows, maybe Reality #2 even has virtues that Reality #1 lacks? Artists sometimes transfigure our perception of reality beyond what is familiar or comfortable for us. Children invent and play games that, we might argue, are partial to Reality #2 over Reality #1. Of course, we should not glamorize Reality #2 without facing up to how it is likely to clash with Reality #1. Reality #2 can be haunted by psychopathology, and it can be deleterious to self and others.

Memoirs provide an excellent source for thinking about madness. A surprising number of memoirists choose to use the term madness to describe their experience, including some of the ones that have been most acclaimed. This is convincing counterevidence that madness is not merely a term that others impose on people who have a mental disorder. Elyn Saks’ memoir about her schizophrenia diagnosis is titled The Center Will Not Hold, but the subtitle is My Journey Through Madness.[ii] Saks is a gifted scholar, but her mind betrays her, leaving her in miserable, tortured states. Her life is transformed through psychoanalysis, and her recovery leads her on a path to be a Professor of Law at USC and a MacArthur fellow who created an interdisciplinary institute for mental health advocacy.

Two memoirs about bipolar disorder also invoke madness. The title of Kay Redfield Jamison’s memoir is An Unquiet Mind, but the subtitle is A Memoir of Moods and Madness,[iii] and Marya Hornbacher’s memoir is entitled Madness: A Bipolar Life.[iv] Both document the vicissitudes of wrestling with a serious diagnosis, the ups and downs of extreme mood states, but also the struggle against the madness that occurs in denying their plight. Jamison is fully cognizant of how questionable the term “madness” has become, and her associations with it are not positive. She is disturbed recognizing her pleasure in manic states and informs us of her failure to realize the severity of bipolar disorder, that, in her words, is “unpredictable and not uncommonly fatal” (p. 144).

Hornbacher is more cynical than Jamison about having a mental illness; yet she is also unexpectedly amusing. For example, she describes a profoundly mis-attuned interaction with one of her many therapists whom she regards as out of her depth. The well-intentioned therapist tried to encourage Hornbacher to appreciate the progress she has made in terms of experiencing her feelings and says: “I think you’ve finally really, truly made the decision to stay alive. That’s enormous. Can you see that? Can you be proud of yourself?” Hornbacher devastating rejoinder is to point out that: “I’m cutting my arms up every night” (p. 48). Her memoir documents her dual diagnosis, bipolar disorder and substance abuse, and her recovery through several treatments that did not work (like DBT), leading to her successful work with a psychoanalyst.

While these memoirs are excellent examples of madness from the framework of psychopathology, they do not entertain broader perspectives about madness as a manifestation of the external environment. Madness can originate in traumatic events—war, genocide, environmental disasters—and it inhabits individuals in circuitous, ongoing ways, even affecting those far removed from the sources. An extraordinary example of this is found in Grace Cho’s Tastes Like War, which documents her mother’s schizophrenia, which emerged only many years after having survived immigration to the US, the Korean War, and the Japanese occupation of Korea (see my newsletter August 2023 for a more extensive discussion: https://elliot4cc.substack.com/p/mentalizing-health-5ea).[v]

Cho’s memoir is about her mother, but it is also about herself—how she was affected during different periods of her mother’s life, how she tries to help her by learning how to cook Korean dishes, and how she makes sense of the intergenerational transmission of trauma.

Let us consider another variation of madness, where madness derives from the external world. This is a more speculative category of experience, where the madness is not an after-effect of an event, but a change in beliefs that overwhelm a society. It descends upon all, unbalancing reality in ways that are confusing and disturbing. The unbalancing that occurs reminds me of Freud’s warning in Civilization and its Discontents that there is always a delicate balance between being civilized and its opposite, and the former is perpetually subject to attack. Aggression can prevail, but even worse, the aggression can wander from self-interest into sheer destructiveness.

It ought to be apparent that my worry here about madness is not abstract: that I sense and fear that a form of madness has descended upon us and has been germinating. Authoritarian leaders around the world see themselves as empowered to throw their weight around and conspicuously forsake concern for the welfare of all. Hats with slogans do not mean much, divorced from specific policies and practices. Trump has often been characterized as someone who, at heart, operates solely based on his self-interest. However much this might be an informative way to understand his motivation, the results he seems poised to cause might well be more gravely destructive.

What evidence exists to support a radical idea like that a madness has descended and is threatening us all? At first glance, this might well sound hyperbolic or even bizarre. However, in my reading of the media, there is a serious underestimation of the risks, given the current state of the world. It has been shocking to see politicians and business leaders flock to kneel to the new king. How is it possible that Trump nominated Matt Gaetz to be the highest legal officer in the country, and then took no flack when Gaetz’s bad behavior was revealed publicly (not to mention that of course, Trump must have been informed beforehand)? And I ask you: how can we understand the persistence of the claim that the election of 2020 was fraudulent in the face of well-documented evidence that this was not the case? Is it not madness that we are about to witness the pardoning of people convicted of crimes from breaking into the Capitol building on January 6 and possibly the prosecution of public officials who brought those charges? How could someone go from being convicted of felonies, and accused of many more crimes, to manage to escape justice? If anyone had forecast these things as the reality of life in America prior to the Trump era, people would have been convinced that we were all completely mad.

The current ethos that Trump can and will do whatever he wants has been endorsed by Trumpians who misrepresent the election as a landslide victory. I don’t know if he will turn out to be as bad as I fear, but there is reason to be concerned about a collective disturbance in our perception of reality. And this “Reality 2” is not ludic or remotely concerned with accuracy; it is based on a cynical worldview, where the winners take all, with little empathy for the throw-away category of “losers.” In the intention to carry out mass deportations, there is a viciousness, which revels in the gratification of treating people roughly and hostilely. There does not seem to be an honest intention to grapple with the problem of how to deal with illegal immigration—that would require some recognition of Reality 1.

How insane is it to threaten war over Greenland with a peace-loving Scandinavian country like Denmark, a country that was, in fact, a founding member of NATO? And why not throw in a little bullying of local neighbors, Canada and Panama? This is bizarre; but let’s not be naïve: it serves a purpose, the nefarious purpose of pushing other, more combustible crises out of the picture, like the Middle East or Ukraine.

Have you noticed the uptick of violence at the collegiate and pro levels, in both football and basketball games? This is something to pay attention to, as there is an impact of violent language on violent action.

The crucial issue is not about Trump’s sanity. It is about the consequences of identifications with him, both adulatory and condemnatory. We exist in a splintered state, with the accurate count of some 77 million people who voted for Trump (and 74 million people who voted against him, many of whom were revolted by him). That 77 million people have faith in Trump’s leadership must be respected, but it does not negate my concern about madness. As mentioned, Trumpians believe they have won a mandate to move ahead with agendas, like mass deportations, ruthlessly shrinking the government, building asylums to house people who have mental illnesses, and ruinous new healthcare and environmental policies. I expect that we will witness the consequences of madness in our work with patients. I expect that clinicians themselves will be affected, which I hope to track.

Madness escapes words. The image of madness is discernable, though, in the combination of extravagant power and incompetence, justifying the legitimacy of fear, even if the threat of madness ultimately recedes. The madness came into being and it will go out of being. That’s about all I can say in conclusion. At least, as the new year gets underway, we can take some satisfaction in imagining a future in which we can look back at the present as a time to protest, endure and survive.

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[i] F. Davoine and J-M. Gaudellière. History Beyond Trauma. Other Press.

[ii] E. Saks (2007). The Center Will Not Hold: My Journey Through Madness. Hyperion.

[iii] K. Jamison (1995). An Unquiet Mind: A Memoir of Moods and Madness. Vintage.

[iv] M. Hornbacher (2008). Madness: A Bipolar Life. Houghton Mifflin Harcourt.

[v] G. Cho. (2021). Tastes Like War: A Memoir. Feminist Press.