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Saturday, April 27, 2019

A Remarkable Book

I recently re-connected with a sociologist whom I had met many years ago, Liah Greenfeld, who has been a university professor at Boston University for many years.  I had met her in the early 1990s after discussing her first big book, on nationalism, at a conference, and stayed in touch for a while, but had not kept up.  In the course of a long conversation, she mentioned her most recent book, Mind, Modernity, Madness: The Impact of Culture on Human Experience.  I have since read it.  It's a remarkable work.

Greenfeld writes unique books, partly because she has a unique background.  Her parents, two physicians,  were Soviet Jews who emigrated to Israel in 1972, and she earned her doctorate at the Hebrew University. Coming to the United States in 1982, she spent 9 years as an assistant professor at Harvard (she had recently been denied tenure when I first met her), and then moved to BU.  (For additional information, see her wikipedia entry.) Her work as clearly been inspired by the founders of her discipline, and particularly by Emile Durkheim, whose ideas heavily influenced Mind, Modernity, and Madness.  She also works easily in all the major European languages and moves quickly from one discipline to another. She takes almost nothing on faith and readily attacks conventional wisdom of many different kinds. In short, she is a late-nineteenth century intellectual in a 20th-21st century body, which allows her, like me, to write books that literally no one else today would ever undertake.

By "madness," Greenfeld means the three most common major mental illnesses in the modern world: schizophrenia, manic-depressive disorder, and severe depression.  In one of her many ambitious claims, she argues that these are really only two different illnesses, not three, because the first two are really the same illness.  She has plenty of evidence for this--it has been shown, for instance, that people diagnosed with schizophrenia in the US are likely to be diagnosed as manic-depressives in Britain, and vice versa--and I have learned talking to a research psychiatrist that other authorities share this view.  More controversially, she argues that these are diseases of the modern world that had not been observed or identified before the 16th century, when they appeared in Britain as a result of the development of a new idea of nationalism.  By nationalism she means a society of equal rights, a shared political community, and elected government--all of which, to be sure, were only embryonic at best in 16th century Britain.  Those ideas, of course, spread through the western world (and even into Russia) in succeeding centuries, and she makes  a convincing case that modern forms of madness spread with them.  Her most fascinating evidence, for me, came from the United States, the real pioneer of nationalism as she describes it, and specifically from several 19th-century scientists who helped found our first mental institutions and wrote at length about their patients.  They understood that they were seeing new disorders, and some of them saw how the difficulties of coping with the newly modern world were making their patients crazy.  And because they had no formal training such as therapists and psychologists must undergo today, nothing stood in the way of their observation and record of what they saw before their own eyes.

Culture, Greenfield argues, is a system of ideas an symbols within which we place ourselves to form an identity.   Because for the last few centuries anyone can, in theory, be anything, this has become a burden for us all, and for a certain percentage of us, she argues, the burden is too much and leads to madness.  This is the hardest part of the argument to document systematically.  To illustrate what schizophrenia and manic-depression are, Greenfeld discussed at length the cases of the mathematician John Nash, who has been the subject of a biography and a not-very-accurate film, and a therapist, Kay Jamison--nearly an exact contemporary of my own, who turns out to be just two degrees of separation away--who became a therapist and has described her own struggles in a book.  Both of them had family backgrounds that made it harder for them to figure out exactly where they fit into American society, but I couldn't help feeling that millions of other people whose backgrounds were equally or more problematic had not gone mad.  Some other factors must be at work--but one such might be another common trait, their extraordinary intelligence.  Another might be the specific dynamics of their families.  In short, while Greenfeld makes a persuasive case, bolstered by additional data I shall discuss below, that madness is a modern disease, she hasn't in my opinion be able to explain exactly why some people get it and others don't.

I could not help thinking, as I read the book, of what I had learned from a 19th-century giant, Tocqueville, when I read him in college--particularly The Old Regime and the French Revoluion, which is at least as important a book as Democracy in America.  Tocqueville understood that the society of orders and privleges from which he came was dying all over the world and could not survive, but he also appreciated its strengths.  Belonging to a particular order in society gave one a certain security that the new social equality could not offer.  I remember thinking 50 years ago that peasants and artisans in traditional society could blame their fate on a higher power, while we twentieth century men and women could only blame ours on ourselves.  That makes modern life a terrible burden, and a growing one, now, as we cast aside the policies that the US and other advanced countries adopted in the mid-twentieth century to try to assure a decent life for everyone.  The burden has also grown because everyone--women a well as men, all racial and ethnic groups, and people of all sexual orientations--also have total responsibility for their own future--the flip side of our social equality. In my opinion--and Greenfeld does not explore this point--the explosion of tribalism among those groups is in fact a response to the terror of facing the world alone.

And this leads us to Greenfeld's bottom line: that madness is increasing, not declining, all over the modern world.  (She seems to think, by the way, that the modern forms of madness that she is focusing on are much less common in Asia than here.  I could cite some anecdotal evidence from South Korea suggesting that that is not true, and in any case, I suspect that if it is, it won't stay true for much longer in the more advanced countries of Asia.)  A lot of statistical evidence supports her.  The problem is complicated in the US, too, by the decision we reached several decades ago, to stop institutionalizing hundreds of thousands of people (perhaps as many as one million in 1960) in mental hospitals. (Many such people, of course, are now in prison.)  One reason Greenfeld wrote the book, she informs us, was the prevalence of depression among her own students at BU.  Suicide, the  ultimate symptom of madness, has been increasing in the US, especially among young people, with enormous costs to the living as well as the dead.

As I read the book I also began to think about the role of madness in our current political life.  Two key symptoms of schizophrenia are paranoia and megalomania.  Paranoia dominates the thinking of both the left and the right today; both see their world at risk from vast conspiracies. Madness is the enemy of rationality, and we all see how the role of rational thought has declined in our public life.  We now have  President who sees himself beset by enemies on all sides, and who has told us, repeatedly, that he, the greatest man who ever lived, is the only person who can solve all our problems.  More significantly, 40% of the population has hitched their wagon to his star.  All this, obviously, is food for thought in the years to come.

This book, whether one accepts all its conclusions or not, should have had great interest not only for sociologists, but quite obviously for psychologists and for historians like myself.  In that way it also resembles some of the great works of the 19th century.  But it is not surprising, it turns out, that I had never heard of it--it was not even reviewed in either the New York Times or the New York Review of Books.  I too have found that works of unusual ambition tend nowadays to fall through the cracks.  They remain tributes to the western intellectual tradition, however, and those fortunate enough to discover them will still find that they make us think.


Bozon said...

Wonderful, highly provocative, comment on Greenfield.
Thank you for posting it.
I am still reading it, but here is just a side note, on some topics broached here:
I was once invited, by a student, to give a talk on The Grand Inquisitor, at an all male Catholic High School, by a friend there.
I mainly just read excerpts to the audience.
All the best

Ed Boyle said...

Madness is either organic/genetic, social, spiritual or a mixture. In a medieval village or town one could be a mad fool, eccentric and ignored and perhaps burnt for witchcraft, having familiars. Hallucinations would be communion with evil spirits, possession symptoms or in prechristian times one would be tricked by fairies, etc. Interpretation depends on worldview. Latin soounding scientific descriptions of brain disorders occurred parallel with rise of industrialism, nation states, large cities, scientific rationalism, decline of religion, superstition and localism, belief in nature spirits and animism. So her theoory is based on a correlation of effects, not a cause. I am certain people were having similar problems but they were integrated into another worldview. Nowadays a near madman can be an artistic genius. In middle ages it might have been a saint having visions of christ. Those who in neither worldview manage to adjust their high intelligence abnormal behavior are shunned, punished in some way. I tend to think evolution is continual and as humans evolve by increases in brain size that maladjusted genetic mutations tend to be in this area. Successful ones get passed on. Brain capacity increases on average over centuries presumably. I woud need to check if skull size has flattened on a curve. Well preserved skeletons from ancient graves might determine this. Perhaps this is unimportant however. I heard Einstein's brain was dissected. The neurons are more thickly packed. His first son with jugoslavian physicist was schizophrenic.

Ed Boyle said...

I believe higher levels of modern stress due to urbanization, media consumption, lack of exercise and low nature experience stresses us. On weekend I sat in first sunny days cheek on jowl with other neighbours. One has to ignore their presence and/or have a high, thick hedge. I recall 19th century people were irritated by this greatly, having come from rural backgrounds and so they drank a lot in lower classes and uper classes became prudish, a form of extreme moral social control when living under closer observation without fresh air, physical freedoms previously enjoyed. In effect the city is a kind of self enforced communal prison and the inmates go quite mad. The next generations adjust gradually but rebel in various ways, sexual promiscuity and drug abuse being common. 7,5 bilion people and cities of 5-10 million globally is quite a stressor. So we see phenomena like formation of ISIS and sister organizations throughout 3rd woorld as identity forming for dislocated males.

Stress adjustment is not just asocial as in nationalism, mental illness, agression. Religion, spirituality are purposeful nonentropic adjustment, healing mechanisms. It is then no coincidence that the older societies in India, china developed meditation, yoga, martial arts. I was fairly maladjusted in my youth and found yoga, meditation, tai chi, bicycling to be extremely useful. I read that 30 million in USA practice yoga. This can be nonsectarian. I read that the intense gymnastic form was developed by sandinaviabn military and used by British raj for soldier fitness in 19th century. Original yoga postures were simpler. Western religious devotion of nonviolence in gospels seems more adaptable to urban life than greco-roman religious traditions. So cultural adaptations help. Our nervous systems need adjustment to change from huntergatherer to sedentary farmers to urban clamour. Ideologies come and go. Deep peace helps us adjust in the moment to whatever comes. Maladjustment accumulates day for day and over generations. On average people follow the crowd. Generational crisis cycle of wars and mental illness individually results. Communal madness one might say. One feels it now. Basically as an individual and society we must touch bottom once in a while. Like when you experience a deep personal tragedy and see how unimportant you are. Then daily problems can pass you by and you are a better, more resilient person. Like fed ex founder was a viet nam war veteran. Living in hell makes or breaks us. We see in political and social arena our current mmaturity as a society. Shadow projection is a key psychological phrase for people always finding evil in others but not dealing with own deeper problems. Once people have lived through blood letting episode and felt extreme self loathing upon realization personal capability for evil and that of every man then society might be able to live in peace again for fear of consequences of letting our id control us.

Gloucon X said...

Thank you for the illuminating report. You might be interested in The Devils of Loudun, Aldous Huxley’s brilliant and disturbing study, which reads like a novel, of supposed demonic possession that occurred in 17th-century France. The book left me with the impression that Church authorities found a way to channel madness into forms that reinforced the Christian faith and their own power. It also makes me wonder if, during the many centuries of de facto Christian theocratic dominance, madness was simply labeled as other things, and may have been just as prevalent as today. And when you consider that today’s world is crowded with more people by a factor of 12 compared to the 17th century, and that accurate records of mental illness were nonexistent, it seems rather difficult to quantify the level of mental illness between eras.

Rupert Chapman said...

From time to time you write a column which is of really outstanding interest, and I think this is one of them. The book is one of which I hadn't heard, and in that, it seems, I'm not alone. The thesis which you outline is essentially the difference between the traditional 'closed' and 'open' societies described so well by Karl Popper in his 'The Open Society and Its Enemies'. To that I would add the anthropological concept of 'acculturation', which comes into play when people find themselves in changing social situations, in which old traditions and certainties are irretrievably lost, without new ones being put in their place. For many years I have taken the metaphor of the wave of change, and have felt that there are some people are not merely able to surf that wave, but are born to do so, while others are the opposite. It would seem that these are the people who, in the view of the author of the book, succumb to the new forms of mental disorder. It seems like one of the books I should read. I grew up in the Deep South, in the 1950s and 1960s, and this resonates deeply with me from my experiences there and then.

Bruce Wilder said...

Very interesting. I had been unaware that schizophrenia was thought by some to overlap bi-polar syndromes. The word, dysthymia, is in professional use but not popular circulation, to distinguish deep "clinical" depression from a recurrent pattern of life-long depressive episodes that look a lot like comparatively mild schizophrenia.

An interesting person to hear talk is Greg Boyle, S.J., a Catholic priest who founded Homeboy Industries in Los Angeles. He has a lot of interesting things to say about how "rationalist" public policy projects onto the phenomena of gang violence patterns of cause-and-effect that are not there. It seems like another window on madness in modern society.

Roger Bigod said...

There's a condition with symptoms of both, called "schizo-affective disorder". But it's clearly distinguished from bipolar disorder and depression. There's a sharp distinction between both conditions with persistent delusions and affective disorders without disordered thinking argues strongly against her formulation of a pervasive effect of "nationalism". As does the fairly constant incidence of schizophrenia between societies and over time.

Patients with these conditions are much better off than they were before the development of drug treatments. If her theory had been accepted, no one would have bothered to develop them.

Jude Hammerle said...

Dear Dr. Kaiser,

In her most famous work and in this one, her nationalism gives rise both to the motive force of capitalism and to madness. Her evidence indicates an interesting amount of concurrence among these circumstances.

It's possible though that all three are effects of a single root force--that is an increase in the incidence of individual competition.

Viewed in this light, the capitalist spirit and madness would remain effects, and nationalism would become an effect too. You wisely note that tribalism may be a response to the stress of "facing the world alone," in other words of individual competition. I'm suggesting here that her nationalism is simply a form of tribalism.

Accepting this makes it possible to ignore identity and culture as freestanding concepts and so to move two shaky aspects of her argument to solid ground. In place of a presumed search for identity, we could view each player's relative success, failure and mental health as outcomes of her/his competitive strategy. And, in place of a presumed all-powerful culture, we could view the state of any society at any time as the outcomes of many individual competitive choices.

This approach would move the social sciences into consilience with the natural sciences, and so solidify our understanding of madness. Happiness would be simply strategy that works; madness would be strategy that does not work.

Now, since we have eliminated nationalism as a potential causal force, all we need to do is to identify what really triggered the initial rise in individual competition, and when it really happened.

Jude Hammerle