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.