Madness and the bed of Procrustes: incongruence and control

Since ancient times, man has been accustomed to regard three things as the most terrifying on earth: death, madness, and imprisonment. … These three events, outside our control and dependent on fate, are in a sense interrelated. Madness is a spiritual death or spiritual imprisonment….[1]

 

Madness today is most often understood metaphorically: as illness. Psychiatrists are thus seen as medical practitioners that diagnose mental illness as an oncologist might cancer.[2] This label is often thought to explain some pattern of phenomena—strange beliefs, for instance, or bizarre behaviour. And efforts continue to further ascribe this to an underlying biological disorder. Depression, for instance, has long been attributed to a neurochemical imbalance. This has been supported in public opinion by the successful pharmacological treatment of depressive symptoms; perhaps especially, selective serotonin reuptake inhibitors. Indeed, biological correlates have been found for many mental illnesses. But it might equally be that the long-term persistence of some abnormal state, such as paranoid fear, causes chemical or even structural changes; it does not imply any obvious causality. People may have perfectly good reasons to be paranoid: someone might really be following them—surely then we would say that this caused the correlate. It is therefore difficult to say with certainty that an observed correlate causes paranoid fear; the fear itself may have brought this about. We may leave aside, therefore, this question of correlates and instead endorse Polonius’ definition:

Mad call I it, for, to define true madness,
What is’t but to be nothing else but mad?[3]

Madness is thus primarily an idea—a more or less formal construct ascribed on the basis of apparent coherence with some loosely specified behavioural pattern.[4] Madness, thus understood, has never the certainty of absolute truth: obviously it cannot explain the very pattern for which it selects. This does not make it useless; it still allows us, for instance, to direct research into determinants and treatments. There we consider the individual as an object, as through the lens of schizophrenia or some such concept; and this is perfectly valid. We may thus more readily handle otherwise inordinate complexity in our practical reasoning and quantitative analysis. But we must also understand the implications of our thinking this way: when we place an individual within an object their subjectivity is obscured. They are then seen as an object with particular properties inhabiting a mechanical constellation of similar entities—animate and inanimate alike, from concrete to abstract. By this means we more easily grasp the world at a spatial and temporal scale far beyond that of immediate experience. Such constructs highlight aspects seen as relevant while hiding most everything else, thus simplifying the scene considerably. Quantitative analysis further requires the relevant properties be conceived numerically. Hence, depending on what is highlighted and what hidden, objectivity may be less neutral than commonly thought—wherein it is often treated as an ethical ideal.

Where these models guide ethical and political choices, for instance, we must be wary; perhaps especially for madness, a concept often as highly loaded as it is poorly understood. Where we treat a bundle symptoms as illness itself we may, insofar as the treatment is effective, mask some other important but as yet hidden determinant. Such construct may also be used to justify extreme measures. Those seen as posing a risk, for instance, may be confined involuntarily or even forcefully subjected to treatment. Best practice here will be determined by policy guidelines and our empirical understanding of the relevant concept.[5] This may be more or less tailored to the individual depending on the professional that applies these standards. We may presume that people who work with mental illness are typically well-intentioned and capable. Irrespective of who wields it, however, such abstract objectivity remains a more or less blunt instrument. Indeed, this is precisely the point: that it thus simplifies complexity to make something more amenable to our purposes.

Psychiatry thus understand the individual as object in that they are primarily something we act upon; hence, requiring only information enough to ascribe a construct and then to apply some relevant guideline. We treat them, in other words, as an object. For when we thus act we do so not upon an individual but rather the symptoms as selected by some ascribed concept. Suppose we visit a doctor, for instance; we express something resembling depression. And there, understanding our communicated experience through a diagnostic construct, they may well prescribe an antidepressant: the diagnosis–prescription pipeline, today increasingly common. This may treat our symptoms, though perhaps leaving untouched other relevant circumstances; an unhealthy relationship, for instance, or lifestyle. The prescribed medication may also have significant side-effects; long-lasting, even irreversible. Some anti-psychotics prescribed today, for instance, can cause irreparable neurological damage.

For our purposes, however, it is the superficiality of this understanding that is most significant, as if all we said amounted only to a single word: depression. That this is common is partly explained by unavoidable constraints on resources and time, hence the emphasis on efficiency.[6] Where successful, the diagnosis–prescription pipeline is undeniably efficient; it lessens the load borne by public mental health services, saves us and our doctor time, and so on. It is much simpler to prescribe a pill, at least to see whether that works; and it is infinitely more simple to manufacture a pill than to train a psychiatric professional. But it also obscures the individual subjectivity behind the label, further masks it by medication. This is natural enough when such disorders are understood metaphorically as illness; diagnosis–treatment is the prototypical model for more literally medical maladies.

There are within psychiatry, of course, dissenting perspectives; models which include, for instance, familial and spiritual aspects.[7] Such views have gained significant ground but any eventual ascendance is unlikely in the current political economy, wherein the more efficient medical model reigns supreme. We mention these efforts, though somewhat tangential, that we not be thought unfair—our focus remains on the common tendency toward objectivity in psychiatry. This we do, for one, to understand psychiatry; and second, and perhaps more importantly, to understand objectivity itself—though this will be apparent only later. Psychiatry, moreover, derives from its ostensible objectivity and political support a broad mandate for potential interference. One may happily accept some intervention; as in agreeing to try an anti-depressant, wherein by biology we alter behaviour. But there are also extreme cases, as of involuntary commitment. Such cases must entail a further obligation: that this be only where necessary, hence implying a duty to somehow determine their necessity. We may find, for instance, that some compromise is possible. Where we must disregard another’s freedom, we must instead seek to understand madness on its own terms; that is, as a unique existential perspective characterised by wholeness of experience and movement of will.

Madness as a subjective movement

Though this be madness, yet there is method in’t.[8]

What Polonius here says of Hamlet contradicts the medical-objective view: madness does not explain itself, rather has its own method. Madness thus seen is no horizon of the understanding; it is only label, not an exhaustive cause. There is a method and this may be understood. And the label, from this perspective, does not entail a horizon of the understanding but often seems rather to reflect one. We may thus think of madness as an image which stands in for a gap, whereby we grasp something otherwise not understood. This may be necessary, even helpful. But such an understanding barely touches the actual individual; that we do not understand does not entail that we never will or ought not try.

Suppose we work in a psychiatric ward, for instance: one patient is frequently violent. We may easily restrain or sedate him. This is sensible enough if we understand this violence only as symptom of madness, otherwise inexplicable; there to sedate or restrain is seen as treatment, hence ethically neutral. But this, however neutral, will surely also be debilitating. We must prevent further harm but we ought to intervene only as proportionate: we must seek the motive of this mad violence to this end, that a less crippling compromise might be sought. This may sometimes be impossible, even often; still we are not freed of this duty unless near certainty is attained. Take the following report by Vladimir Bukovsky, for instance, whose dissident activity landed him in a Soviet psychiatric institution:

I had never seen a patient attack someone without reason, but the reason was not always easy to guess. One day I only just succeeded in getting away from one husky fellow who jumped on me as I passed his bed. The reason was that he regarded an area of the floor around his bed as his territory, and he was prepared to slaughter anyone who stepped inside it. It was extremely important to find out your neighbor’s quirks as quickly as possible, so you could live in safety…[9]

The point, here, is that madness can often be understood—albeit necessarily on its own terms. This understanding thus entails an imaginative striving towards their subjectivity. We sometimes accomplish this quite simply; by asking them, for instance, or talking a while. Some may require a more indirect approach, as where they are unwilling or might not know. And certain cases more obscure still may require a wider view, as that of Sanity, Madness and the Family.

Laing and Esterson here present eleven case studies of young women diagnosed with schizophrenia; in each they aim to render intelligible such apparently schizophrenic conduct as was the basis of the diagnosis. [10] To this end they interviewed individuals and their family, separately and in clusters. This material grounded their imaginative effort to grasp the family nexus: “not only the family seen by us from without, but the ‘family’ as experienced by each of its members from inside.”[11] We will here take one family as emblematic: that of the Heads. Their now-married daughter, Jean, had been admitted once before, three years earlier, when she had a nervous breakdown wherein she believe her fiancé and parents to be dead.[12] She was treated successfully then and had been well until three weeks before her second admission. Jean then became increasingly paranoid, culminating in her seeking police protection having “suddenly ‘realised’ that her husband was dead.”[13] We will leave aside her other symptoms and focus on this particular delusion: that her husband David, though apparently quite alive, was really dead.

The interviews, to begin, revealed an impossible ideal to which Jean had long been held by parents, later also her husband; and importantly, showed also their denying doing so and deploying further mystification as cover. Jean’s parents, devout Christians, expected she show the same piety. Indeed, they so believed this that they denied any and all disjunction; that Jean had sexual fantasies, for instance, was not seen as wrong but instead denied entirely. This denial handily resolved such issues and maintained their disjunctive idea of Jean; and this denial was, in turn, itself also denied. Jean’s parents thus suppressed Jean and imposed their ideal, ensuring this scheme by denial and mystification; and then she married David, who saw her similarly—that is, not at all. Indeed, after her first admission he even acquired a new trick: he simply attributed apparent disjunction to her illness—she was Jane when she loved him, for instance, and when she did not, then she was ill. These layers of control and mystification, but particularly the central disjunctive ideal, are the key to seeing the method in her madness:

Unable to express, and inwardly forbidden to feel, dissatisfaction with, or disappointment in, her husband, she said he was not her husband. Not daring to reject or to defy her parents openly, she did so quite clearly but in a way that is ‘schizophrenic.’[14]

Jean’s delusion, that her husband was dead, can thus be seen as something like a psychic aneurysm. And from this perspective we find her apparently bizarre belief is surprisingly sensible. It answers, however crudely, an otherwise impossible dilemma; that ideal Jean, which she had internalised, was satisfied with her husband, whereas Jean was not. She thus solved this monstrous equation quite logically: David was not her husband—her husband, who she loved, was dead.

The map and the territory

In time, those Unconscionable Maps no longer satisfied, and the Cartographers Guilds struck a Map of the Empire whose size was that of the Empire, and which coincided point for point with it. The following Generations, who were not so fond of the Study of Cartography as their Forebears had been, saw that that vast Map was Useless, and not without some Pitilessness was it, that they delivered it up to the Inclemencies of Sun and Winters.[15]

Here we see the absurdity of confusing map and territory: we must clearly distinguish between the actuality of the territory and the reality of the map. Actuality entails an embodied centre of immediate experience wherein one is physically compelled to exist; it includes, in other words, all concrete determinants of existence. It is reality, however, of which we speak when we describe madness as a break; properly understood it is more a matter of relative distance or coherence than breaking with an absolute. There can be no absolute break so long as the individual is still compelled to inhabit and survive within the physical world; perhaps only a completely catatonic patient could even come close. Madness thus entails a relative distance from reality; it reflects, in other words, an apparently intractable incongruence between the subjectivity of one and what is taken for reality by another. While the land remains the same it is as if each has a different map.

From here we will take a somewhat scenic route. We may begin by seeing a specific territory as a metaphorical container which our understanding imposes upon actuality. It is a circumscribed region as defined by a more or less specified boundary. We encounter similar containers daily as we go about our lives. Most obviously, we might think of a building or room. There the container is concretely demarcated: walls, ceiling, floor. But there are also many more abstract cases—roads, for instance, or forests. And more abstract still are such containers as we impose upon time; hours and minutes, but also work and leisure. Most of these containers will entail an ought structure; what during work hours is appropriate, for instance, and what is not. We may, of course, seem to another to be within a container without realising as much as ourselves; that is, we neither perceive the boundary nor understand its normative structure. We may also see but instead choose to disregard an ought structure, perhaps something else supersedes it or some desire compels us more strongly. Others that witness our behaviour may experience it as incongruent, even deviant, in that we thereby diverge from what is therein expected.

And where we so deviate there may well be consequences. For these containers, though metaphorical, are nevertheless often quite real—in the pragmatic sense, at least, wherein reality is whatever we are forced to take account of. These containers, therefore, exist as realised in actuality and activity. Their boundary need not be physically apparent, many are primarily metaphorical projections; while a room has a clearly defined existence, say, a forest may not. While nevertheless real, they are not so physically compelling as the natural boundaries of the material world. Their ought structure may be indicated; no smoking, for instance, can be indicated by a symbol or in words. But where they are not actually compelling in themselves, as a wall might be, then the situation is that of a sign in the Simpsons: “keep out, or enter—I’m a sign, not a cop.” We can thus ignore the ought structure of an ideal container, as when one slacks off at work or talks in the library. But this ideal structure may also be realised by actual agents; a librarian, say, or security guard. We may quickly get back to work, for instance, when our boss comes to talk with a colleague beside us. Such agents may enforce the ought structure in actuality where incongruence is apparent. They may reprimand or threaten us, for instance; or perhaps even impose a cost, whether monetary or by some physical harm.

This view is equally applicable to the territorially aggressive man encountered by Bukovsky in a Soviet psychiatric ward; that his territory was imagined did not make him mad, all territory is more or less imaginary. Notably, however, there the boundary was not clearly demarcated and thus, at least initially, not understood. And yet once Bukovsky grasped this quirk he immediately updated his map and thereafter respected this territory, mainly to avoid being attacked. We may think his behaviour mad but not his territory, only his motive and not what he accomplished—Bukovsky by minding this quirk realised the territory around his bed. Now here we may take a step back from this small territory, for this was not the only spatial structure in this scenario: there is also that of the mental ward in which this anecdote occurred. This ward, little different from a prison, is also a metaphorical container. It differs only from territory as described above in that the rule is here inverted: it is not entry but exit which this boundary prohibited. Metaphorical containers, therefore, can as much prevent our movement as hold us in place. These really amount to much the same thing, with each limiting our freedom of movement.

Of the ward, then, we may note also that this container is not universal; rather it is relative to the particular identity ascribed to an individual. The patient inhabits a different ought structure, for instance, from that of an orderly or doctor; only the latter may leave freely. And it is this identity, more than mere walls, which ensures our continual confinement. You might perfectly disguise yourself as an orderly, say, or persuade the doctors you are now sane; then the walls will not stop you. These structures, moreover, often also depend on relative identities: one might be expected to show more deference towards a doctor, for instance, than an orderly or janitor. And they may also further differ within a class between particulars, as when one doctor is stricter than another. All these structures are most obviously realised insofar as a doctor, for instance, can readily enforce them: as when those who are disrespectful or violent are sedated or isolated. There is thus, so to speak, a more or less narrow pathway within which one ought to walk lest some consequence follow.

All of this applies, of course, as much in ordinary life as in a mental institution. For we also have certain expectations of how others ought to act towards and around us in certain places and at certain times. There again we find an area of relative freedom, wherein we may act more or less without concern. This zone of relative freedom can be called a window of coherence. What we see as falling within this will be experienced as congruent—it conforms, in other words, to our subjective understanding of how things ought to be. Extending outward from this there is a penumbra of ambiguity. And finally more readily perceived yet will be such incongruence as seems to contradict our current aim—as shown by the invisible gorilla, salience partly depends on our purpose. [16] Where such conflict is perceived it will not be ambiguous but fall plainly within the zone of incongruence. And such movement may further be seen as deviant, wrong, or even evil—wherein the incongruence attains more and more moral force. Conflict results insofar as a movement is unambiguously incongruent; its severity will vary according to the speed and distance of the breach.

The precise boundary will vary between individuals and across spaces. One may act very differently at a dinner in one’s own home, for instance, than at that of a friend; and one ought not act towards this friend’s wife as we would our own. We may also find ourselves caught between a rock and a hard place, as where find ourselves caught between contradictory structures—as a child among friends, for instance, when a parent arrives. All this gives rise to the layered structure here described: window of coherence, penumbra of ambiguity, zone of incongruence. This is an essentially moral structure which we unconsciously impose upon immediate experience, including also many things more mundane than typically thought of as moral—as much how we ought to order a burger, for instance, as how we ought to treat our children. It includes, further still, even our expectations of the natural world and inanimate objects; we expect certainly things of technology also—that it work easily, for instance, and we are frustrated when it inevitably does not. We will thus here frame all such ought structures alike; of which morality is but one aspect, albeit often the most obvious.

Taken together, these reflect the subjective structure which we each impose upon immediate experience that we may thus act smoothly in the world, especially in coordinated activity. It includes not only what we expect of others and even objects but also of ourselves, including what we expect others expect of us.[17] It includes also cultural and legal norms to the extent that these have been internalised. We do not call these to mind and then apply them intellectually as doctrine; rather they are internalised as habits of behaviour and judgment. We may describe this as an imagined reality with the caveat that it is not, like visual imagery, something which we call to mind or even of which we are usually aware. Instead we unconsciously represent our experience and knowledge as an imagined whole which is then projected upon our immediate experience where coherent, thereby guiding our behaviour. We see, for instance, a cup—which, based on our prior knowledge and experience of cups, we understand as signifying certain possibilities. It is not necessary, of course, that every cup be identical. The particular advantage of mankind is our capacity to generalise abstract forms. We understand a cup not strictly on the basis of a correspondence in physical appearance but as a gestalt and by family resemblance to some prototype. It is thus not so much that the cup before us corresponds to a cup in our mind; rather its form and especially function need only be coherent with our understanding. Use is a particularly prominent aspect of the projected meaning here described; such purposeful activity is central to our understanding of the world and our place within it. An example of incongruence, then, is something that resembles a cup in form but is incapable of fulfilling its function; such as, say, a teacup made of ice.

Suppose, for instance, that we want to order a burger; assume we have done so prior, as has the employee at the counter. We may thus, insofar as these understandings align, proceed smoothly to realise our purpose. This is analogous to ordering by some device, wherein we do so by pressing a particular pattern of buttons in some specific sequence. We must grasp first, that this machine embodies this possibility; and second, how we must interface with it to realise this aim. This differs from ordering at the counter only in degree—there the employee is understood similarly. Their uniform and position, by our understanding, signify a possibility which is rendered salient by our desire; that we want a burger. For us to thus project our understanding requires a relative coherence between the current experience and prior knowledge: we may then project upon actuality an ought structure which indicates the appropriate path by which to achieve our purpose. And it is here we encounter the layered structure outlined above: coherence, ambiguity, incongruence. Some variance is obviously unavoidable, even preferable as against an uncanny monotony. The sound of their voice may differ, for instance, or the precise wording they use. All this will go unnoticed insofar as it falls within the window of coherence. It is only when something moves beyond this boundary that we will experience it as incongruent.

Responding to incongruence

It is often jarring to encounter incongruence, wherein our immediate experience deviates suddenly and significantly from the imagined reality through which we had been moving smoothly. It is as if walking down a set of stairs we believe there two more to go when really there is only one. Here we receive a bodily jolt when this expectation, embodied in our movement, collides with actuality; but there is also a mental jolt, as actuality thereby forces an update to our imagined reality. We can do little about such a stumble, of course, except perhaps curse quietly to ourselves. And while the cost of this incongruence was minor, more severe outcomes are equally possible. We may, for instance, endeavour to make some dangerous leap, perhaps to land safely in some bushes, only to misjudge the distance. Or there may be some psychological effect; as in the so-called Paris syndrome, wherein the actuality of this famous city so disappoints some Japanese tourists that they suffer acute stress and even psychiatric symptoms.[18] Where incongruence thus results from some mistake, actuality may intervene to correct us. We have previously discussed incongruence as a movement: one which exceeds coherence, even ambiguity. This is the case here also, though the movement is only relative and imagined; from this perspective, it is as if the ground suddenly moved to collide with us rather than our having collided with it. We readily recognise, however, that actuality does not move suddenly and more or less accept our mistake. But where we attribute conscious agency to the movement, there things will differ.

It will be different, therefore, when we collide instead with a possibility impressed upon us by another individual. This is particularly because, where actuality maintains its own structure, reality must be somehow maintained; inter-subjective coherence is necessary for social coordination to proceed smoothly—and our response to incongruence here must be understood in this context. Now, each individual holds their own imagined reality which we may call ideality. This does not mean an unbound subjectivism, wherein things would fall apart. That this doesn’t happen suggests there must be some means by which coherence is maintained. It is only thus that we could so effectively coordinate our social activity into families, companies, institutions, and so on. We have already mentioned that actuality itself acts as a constraint. Another part of the answer is surely our capacity for imitation; or rather, over-imitation—for humans, much more than chimpanzees, tend to imitate even obviously unnecessary steps when they learn by observing another.[19] This may give rise to a ‘ratchet effect’ wherein, the argument goes, this quirk of human observational learning allows the sustained development of cultural traditions. This includes language: imagine, for instance, trying to teach what words mean to someone who continually asks why each words means what it does. “Because the dictionary says so,” is hardly convincing; we might as well point to God.

That over-imitation is thus related to language learning supports its role in reality coherence: our inter-subjective reality is largely constructed through language. And chimpanzees, we might imagine, would surely struggle with coherence if every generation insisted on constructing language anew. The word itself, after all, is irrelevant; the meaning is all that matters. Meaning, however, requires coherence: to understand another we must imagine with reasonable accuracy what they meant. The meaning of a word, for instance, consists in its usage; not just any usage, its proper usage—that is, how it ought to be used. We may take, therefore, language as our prototype in this section. Here we will ask of language: why do things not fall apart? Part of the answer we know already: it is over-imitation. This surely functions not only in initial learning but throughout life. We tend, for instance, to pick up on verbal habits of those we spend time around. And it is the same for words, these also we learn by imitation. When we encounter a new word, for instance, we try to grasp what the speaker intended. As we encounter it again and again our understanding steadily grows. And all this not by a dictionary, which only ever gives us a foothold from which understanding and imitation might climb in tandem.

But imitation, even over-imitation, flows only inward; might not coherence also flow outward? Indeed, we have noted there is a proper meaning of a word: that is, how it ought to be used. Meaning, in other words, is maintained as if by a sort of morality. And this makes sense, especially as such an enforcement mechanism would be undeniably useful. Now, today the stakes are a lot lower; mostly trivial, perhaps we get a different burger than we expect. But way back when, things were different: accurate communication, and hence coherence, could then easily be a matter of life and death. It makes sense, therefore, that there would be some selective pressure towards this morality of meaning. And here we return to where we left off. We can describe the meaning of a word with exactly the same model earlier outlined: window of coherence, penumbra of ambiguity, zone of incongruence. The first, in other words, is coherent insofar as we don’t even notice their usage; the second might be confusing in specific circumstances, but we know what they mean; and finally, they use the word wrong—or the wrong word, tough to tell really.

Suppose you are walking your dog, a Golden Retriever, when someone comes up to you and says: “Nice Labrador, mate.” What do you do? To them the dog really is a Labrador, at least insofar it appears coherent with their understanding; and this is sensible enough, they do look very similar. Knowing this, and knowing also that they are wrong, you have three options. You could avoid it entirely, perhaps you simply ignore them and walk away. Or you could say, “Actually, this is a Golden Retriever and his name is Edward.” But maybe you would rather not seem a git, so you might just say: “Yeah, thanks.” Now, what just happened? They first communicated a possibility, that this dog is a Labrador. You recognised this as incongruent, really this dog is not a Labrador. But then, instead of avoiding or opposing them, you instead submitted to the possibility they imposed upon you. And you thereby validated, in their eyes at least, this as reality. What happens if you run into them somewhere else and they ask about your Labrador? You could say, “Actually, he’s a Golden Retriever.” But you crumbled the first time and it would only be more awkward now, so you probably just say: “He’s good, thanks.” You might begin to see how this could get out of control. What if you become friends, when do you tell him? Or worse yet: what if when he next asks after your Labrador another friend is with you and they say, “Actually, he’s a Golden Retriever.” And the guy just stares at you, dumbfounded.

This case, however trivial, demonstrates how we may be trapped by submitting to incongruence. Suppose that someone lies to us, says that we never paid them back some money borrowed. We know we did, what are we to do? There are many situations, therefore, where we may wish to respond another way. One has always the same three options presented already: avoidance, opposition, submission.[20] We will begin with avoidance, wherein we opt out entirely. This is distinguishable as a mostly actual movement; we seek to deny the incongruence by physically avoiding it. Where someone has behaved unacceptably, for instance, rather than confronting them we may simply steer clear thereafter. This still involves a shift in ideality, wherein we adjust our ought structure; it entails, for instance, we ought to leave where they are, avoid wherever they may be, and so on. But avoidance is not always possible: the Soviet Union, for instance, was not easily escaped. Or one might otherwise be unable or unwilling to flee—as children, for instance, we typically depend on our families for food, affection, and so on. We may also engage in a more partial avoidance, as where we avoid certain movements which might render apparent an otherwise latent incongruence; or when we seek to avoid something as much as possible within some constraint.

Next, submission: here the individual is reshaped by the pressure of an incongruence, as if a dent in metal.[21] The incongruence thereby impresses its shape into our ideality. It does so, at first, merely as possibility. But submission is specifically where one accepts this possibility as reality and thereby resolves the incongruence. Most obviously, this may sometimes be accomplished by way of some apparent actuality. The possibility may, for instance, be demonstrated; or as much may, as by some trickery, seem to have been shown. Such cases may be complete, as when one accepts something as demonstrably true. But one may also submit only partially or temporarily. Submission thus varies in the degree to which we accept an imposed possibility as reality. One may, as if an actor, follow a script without entering into it as reality. That we so accept the possibility imposed upon us entails that we see it either as the only possibility; or it may simply be most desirable possibility. This may be due to actual physical force, as when we are somehow restrained and made to submit; or may involve only the threat of violence or some other harm. But this can also be far subtler; as, for instance, within an established hierarchy such as a family.

The third option, that of opposition, also entails the impression of a possibility. This is not the possibility as intended but as understood; as refracted by the receiving subjectivity, for instance, and coloured by their purposes. But opposition differs from submission in that we here reject the possibility as impressed and seek to impose our own. This requires, of course, an apparent and desirable possibility whereby we might so respond. It will depend, for instance, on our relative capacity and authority. Both opposition and submission are thus first a subjective possibility. They differ in that opposition rejects this possibility, whereas submission accepts it as reality. Submission receives a dent, in other words, whereas in opposition the metal bounces back. This bounce takes the form of social control, wherein the incongruence is defined further as being deviant; it is, in other words, wrong.[22] Here we may exert ourselves to oppose this; that is, to right the wrong. There are many forms this may take.[23] And yet each of these shares this trait: that they oppose movement—they ‘push back against’ or ‘correct the course’ of some deviant movement. This need not always target the specific individual; one may identify them with a larger group, as when an individual movement leads to targeted retaliations against a wider social or ethnic group. But our specific focus is here on a relation between two individuals. These responses may occur involuntarily, as when emotion dictates our course; or we may react otherwise unconsciously, such as by subtle shifts in body language. Or we may consciously consider our path including, for instance, what we think possible and desirable—which will often entail we expect some conclusive success.

Here we may well be mistaken or have otherwise acted unwisely. Our response, after all, also imposes a possibility and may thus begin again the above process. We may be opposed by the other party, which we ourselves then oppose; each, in turn, incurring a further response—and that another, and so on. Blood feuds between families reflect one such intractable conflict; wherein a cycle of tit-for-tat retaliations occur over generations, perhaps long after the original dispute has been forgotten. This will end only when one family submits, they somehow come to a compromise, or something else intervenes. Some authority, such as the police, may put an end to this conflict by forcing both sides to submit to the possibility they impose. There is thus a further option, beyond the three above: that of third-party intervention. This final option, which we may call mediation, amounts to each party submitting to a single possibility as imposed by some external authority. This is not, however, neutral—it really amounts to a second-order conflict. The initial conflict is settled by the capacity of the third-party to induce coherence. This entails their imposing a possibility upon the initial conflict as a whole. That they can do so is dependent on their authority and capacity to exert social control.

Psychiatry, for instance, is legitimised and supported here by the power of the state; ultimately, that is, by physical force. This is the final backstop—whatever else apparently supports it, whether scientific prestige or public opinion, and however it may define itself. Of course, psychiatry understands itself quite differently: as a healer.[24] And most people share this view, seeing their role as restorative; rarely as entailing social control. It is instead understood as easing distress and avoiding harm. But we may also understand psychiatry, from another perspective, as intervening to resolve incongruence and determine objectivity. They operate similarly to, for instance, the judiciary; the difference is that where the courts intervene obviously, psychiatry does so far more subtly. That they operate this way, however one wishes to evaluate that fact, is undeniable. Those who present as depressed, for instance, are guided back to the objectivity—why, they may ask us, do you feel life to be so bad? And they will work to get us in line with the objective view; that life is good, or at least bearable. This they do in accordance with their training and some imagined ideal, while making adjustments as necessary to the particularities of a given situation.

Now, leaving aside the value of this, we may thus look at psychiatry according to the perspective we have here pursued. Psychiatry’s task, then, is essentially epistemic and political; its fundamental concern: what is real? When Jean said her husband was dead, for instance, this was readily diagnosed as a delusion. Her belief, in other words, was determined to be incongruent with objectivity as identified by psychiatry. They neither submitted to nor avoided this incongruence, rather they opposed it. This is the task set for psychiatry: to determine reality, oppose incongruence, and impose objectivity. And it can be said to succeed only insofar as the individual submits. As an example: a delusion is thus seen as objectively false, even nonsensical. It is perhaps natural to conclude as much when you see someone declare their husband dead, for instance, though he stands right there beside her. And yet as we see in Laing and Esterson, this delusion also contained a certain truth; subjective maybe, but certainly still meaningful. But if we consider objectivity as the standard and its attainment as the end of psychiatry, then all this would easily be missed. And so as Jean’s parents trapped her in an false ideal, so too would psychiatry serve to trap her again in an abstract object—which was, in fact, precisely what happened after her first admission:

… to David, his wife really agrees with him. If she disagrees it is not because she is using her mind but because she cannot use it by reason of exhaustion or illness. Disagreement therefore becomes a sign of illness.[25]

Conclusion

As we began with madness, here too we will end. We have come some way since, even taken the scenic route. But all this has been to provide an alternative perspective, that we might see anew. It has often, however, been an all too abstract journey; we shall thus conclude with something more concrete. These cases resemble that of the dog’s identity, as presented earlier, wherein one may submit to a possibility and find oneself trapped. There we might well have avoided this, those that follow concern the impossibility of this. Indeed, we concluded the previous section with one such case: that of Jean, wherein her illness was used to deny agency to her opposition. This allowed her husband to contain any apparent incongruence. We may understand these cases as involving an I-It relation: we interact not with a You but an It—other as object, really an image of our own making.[26] This is common enough, perhaps even necessary; and yet surely some masks fit better than others. For sometimes the ideality thus ascribed fits so poorly that, where it is also rigidly enforced, we may recall Procrustes:

… who tortured those whom he captured by placing them on one of his two iron beds. If his victim was short, he put him on the longest bed, crying, “How short thou art! But wait, I will soon make thee taller,” and he stretched the limbs of his wretched prisoner till he tore him in pieces. If on the contrary the captive was tall, Procrustes placed him on the smaller bed. “Thou art much too large,” he would say, “but soon will I fit thee to the bed,” and then he cut off his legs and head.[27]

Maya was eight when she went to live with her grandparents. When fourteen she returned to her parents’ home, they complained she had changed: “She was no longer their little girl.”[28] Her parents saw this, in hindsight, as the first sign of her illness: at eighteen, Maya was diagnosed with paranoid schizophrenia. Her parents, she said, were poisoning her—they wanted to get rid of her. She spent nine of the next ten years in a psychiatric ward. And then, at twenty-eight, she was interviewed along with her parents. It emerged that they had never really let go of their little girl; though she developed, their image remained. Whenever she proved incongruent with this ideal, where we might see development, her mother saw illness: “since she’s ill, she’s never accepted anything anymore. She’s had to reason it out herself, and if she couldn’t reason it out herself, then she didn’t seem to take my word for it.”[29]

Time and again opposed by her parents, she never managed to realise her developing autonomy—they did not see her, she felt, “as the person that I am.”[30] Wherever she sought to oppose this restrictive ideal or grew frustrated at her position, there again her parents saw only illness. She was unable even to get away, to “bury herself in her books.”[31] She read too much, her parents said; she was selfish, it hurt that she avoided them. They trapped her within a false shape, buried her beneath layers of mystification; that she felt, for instance, her parents wished to “obliterate” her mind—what a mad thing to think.[32] And so, in the end, Maya submitted as best she could. That she felt unreal, therefore, was perhaps only natural; in a sense, she was.

I was never allowed to do anything for myself so I never learned to do things. The world doesn’t seem quite real.[33]

It was 1958 when Laing and Esterson first started to investigate the families of schizophrenics in the United Kingdom, including Maya and her family. Meanwhile, Betty Friedan had the year before begun to study another “schizophrenic split,” this time in the United States:

There was a strange discrepancy between the reality of our lives as women and the image to which we were trying to conform, the image that I came to call the feminine mystique.[34]

Several years later, Friedan published The Feminine Mystique, in which she set out to address “the problem that has no name.”[35] She noted some women were even turning to psychiatry to address this nagging sense of dissatisfaction with a life that was meant to be the pinnacle of feminine fulfilment. The women Friedan describes express themselves only vaguely, often reminding one of Maya: “I feel empty somehow … incomplete,” for instance, and “I feel as if I don’t exist.”[36] The problem, she identifies, was that this ideal—that of the modern house-wife as a model for feminine fulfilment—was presented as the single proper pathway for women. While they may well have opted otherwise, that this ideal was illusory was not obvious and, moreover, to do otherwise was seen as deviant. We see here, therefore, a scenario akin to that of Maya but at a far larger scale. This ideal was not only imposed by others but was also, so to speak, in the water. The feminine mystique was a pervasive cultural presence in magazines, for instance, and on television.

That this is a Procrustean identity is apparent insofar as women were everywhere asking themselves: “Is this all?” They had internalised an ideal, understood and organised their lives according to its promises only to find it ultimately empty; thus falling so far short of fulfilment, something was felt to be missing. But this was not something material; indeed, Friedan found plenty that while comfortable were far from content. Something was wrong, that was clear; but hardly anyone knew what, indeed few dared ask. It is hardly comfortable, to say the least, to discover one’s life has been built upon a false and restrictive ideal. And so long as the feeling remains vague, so long as it can still be pushed down whenever it arises—then perhaps it is better not to see. The Feminine Mystique, however, blew this wide open. It would be as if someone gave Maya a copy of her case history as presented by Laing and Esterson. Each of these texts excels as an imaginative endeavour in that once obscure and nebulous aspects of subjectivity were thereafter given new solidity and form.

Indeed, we may well look at the world today and wonder, as Betty Friedan did sixty years prior, whether there might be again a problem as yet without a name; some aspect now as nebulous and obscure as those above were then. We certainly see much alike with what she saw; that, for instance, again comfort brings no contentment. And we may note with concern also that in the last reported year over six-hundred New Zealanders committed suicide.[37] Or that in 2018 it was reported that more than eight-percent of the same population had used anti-depressants in the last year.[38] Such statistics have only been increasing, often rapidly—and worse yet, no one knows why or what to do. Time and again funding is promised, even delivered; all this and for what, certainly little more than a dent. Still we look at all this and think at least we know the true name of the problem we face, that we thus have power over it: we point to depression, for instance, or suicide—that is the problem, we might say, right there. And yet neither depression nor madness causes itself; these are not properly objects but movements, only frozen by our understanding that we may grasp them. Such objects can be ascribed insofar as some pattern is understood as coherent; yet they can contain neither cause nor movement.

Instead we must make an imaginative effort to understand the subjectivity of all those that suffer—not as It but each as an individual You. Perhaps we may there glimpse some segment of a hidden figure, some vast Procrustean ideality by which our spirits have been collectively imprisoned, and which now ever more people rush to escape. The world has certainly changed, the tectonic plates of culture and even truth shift more wildly than ever before—all this, moreover, accelerated and sent around the world in an instant. Has none of this affected us, or is it simply still too nebulous? For now all this remains as a problem with no name, existing only amorphously in the subjectivity of those that suffer; which our objects may obscure, even imprison, but never contain. Someday perhaps we will see some figure that all the while lay hidden in the carpet, that submerged form which may well underlie much of what in modernity has been written on madness and the current crisis of mental illness:

It stretches, this little trick of mine, from book to book, and everything else, comparatively, plays over the surface of it. The order, the form, the texture of my books will perhaps some day constitute for the initiated a complete representation of it.[39]

 

 

 

 

 

References

Alexander, Mitchell; reporting for Newshub—“Revealed: The number of Kiwis using antidepressants,” https://www.newshub.co.nz/home/lifestyle/2018/11/revealed-the-number-of-kiwis-using-antidepressants.html

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub, 2013.

Bateman, Sophie; reporting for Newshub—“New Zealand's suicide statistics increase on last year,” retrieved from https://www.newshub.co.nz/home/new-zealand/2019/08/new-zealand-s-suicide-statistics-increase-on-last-year.html

Black, Donald. Moral time. Oxford University Press, 2011.

Black, Donald. The social structure of right and wrong. Academic Press, 2014.

Borges, Jorge Luis. "Of exactitude in science." QUADERNS-BARCELONA-COLLEGI D ARQUITECTES DE CATALUNYA- (2002): 12-12.

Buber, Martin. I and Thou. eBookIt. com, 2012.

Bukovsky, Vladimir Konstantinovich, and Michael Scammell. To build a castle: My life as a dissenter. A. Deutsch, 1978.

Chabris, Christopher F., and Daniel J. Simons. The invisible gorilla: And other ways our intuitions deceive us. Harmony, 2010.

Durie, M. "Te Whare Tapa Whā model." In Paper delivered at Hui Taumata and shared as part of training to the New Zealand Psychologists Conference Palmerston North, New Zealand, March 10th. 1982.

Friedan, Betty. The feminine mystique. WW Norton & Company, 2010.

Hirschman, Albert O. Exit, voice, and loyalty: Responses to decline in firms, organizations, and states. Vol. 25. Harvard university press, 1970.

James, Henry. The figure in the carpet. The Floating Press, 2011.

Laing, Ronald David, and Aaron Esterson. Sanity, madness and the family. Taylor & Francis, 2016.

Nösselt, Friedrich and A. W. Hall. Mythology, Greek and Roman. Kerby & Endean, 1885.

Whiten, Andrew, Gillian Allan, Siobahn Devlin, Natalie Kseib, Nicola Raw, and Nicola McGuigan. "Social learning in the real-world: ‘Over-imitation’ occurs in both children and adults unaware of participation in an experiment and independently of social interaction." PloS one 11, no. 7 (2016): e0159920.

Wyatt, Caroline. "Paris syndrome strikes Japanese." BBC news 20 (2006): 12.