Everyone is excited now about the proposed initiatives to reform mental health care, and though there are numerous references to “mental health services” in H.R. 3200, I have seen little or no discussion about the debates within the fields, for instance, who exactly is qualified to mess with our brains and endocrine systems by treating everything from marital spats to incipient schizophrenia, OCD, or the numerous “personality disorders” covered in DSM IV (soon to be DSM V: I can’t wait). According to the House bill under consideration, mental health services are to be reimbursed as long as the provider has either a doctorate or a master’s degree (i.e., is a clinical psychologist or a social worker), has had two years of supervision in treating clients, and is licensed by the state. I have already asked one psychiatrist friend to comment on how M.D.s are viewing these proposals, and know from personal experience and study in both older practices and more recent cultural history treatments of “madness” (heavily influenced by Michel Foucault) that there is zero agreement among “counselors” (as H.R. 32oo calls these providers) as to what causes mental illness, let alone how to treat, manage, or cure it/them. Meanwhile the Foucauldians instruct the hip young at the better universities that madness is a social construction invented by the bourgeoisie who want to control everyone else. And the writing of history itself is under suspicion: it is a narrative “written by the plebs” to punish geniuses like himself.
Readers of my prior blogs will notice that all of them deal either directly or tangentially with how we feel and act/don’t act in the world, and how we identify the source of evil or account for our own unhappiness or failure, often blaming “the Jews” or modern women (these are conflated in the idea of the femme fatale). Like Freud, I take instruction from the arts, for the major literary figures of the last several centuries were all concerned with what passes for sanity, adjustment, or vigorous, righteous resistance to arbitrary authority, and one recurring theme is the incarceration by conservative families of their dissident young)–a major theme in early nineteenth-century literature.. In this one, short I hope, I want to comment on what I learned from reading passages from Thomas Mann’s The Magic Mountain (1922), particularly in one of the debates between “Naphta” a Jew turned authoritarian Jesuit, and Settembrini, an optimistic bourgeois humanist who believes in amelioration, health, and progress. (Mann is obviously arguing with himself, trying to reconcile or at least examine the warring parts of his own personality: read Dr. Faustus as another case study of Mann’s preoccupation with this theme, as was Herman Melville before him.) Here is an excerpt from Magic Mountain:
[Hans Castorp thinks that “disease was unhuman”:] “On the contrary, Naphta hastened to say. Disease was very human indeed. For to be man was to be ailing. Man was essentially ailing, his state of unhealthiness was what made him man. There were those who wanted to make him “healthy,” to to make him “go back to nature,” when, the truth was, he never had been “natural.” All the propaganda carried on today by the prophets of nature, the experiments in regeneration, the uncooked food, fresh-air cures, sun-bathing, and so on, the whole Rousseauian paraphernalia, had as its goal nothing but the dehumanization, the animalizing of man. They talked of “humanity,” of nobility—but it was the spirit alone that distinguished man, as a creature largely divorced from nature, largely opposed to her in feeling, from all other forms of organic life. In man’s spirit, then, resided his true nobility and his merit—in his state of disease, as it were; in a word, the more ailing he was, by so much was he the more man. The genius of disease was more human than the genius of health. How, then, could one who posed as the friend of man shut his eyes to these fundamental truths concerning man’s humanity? Herr Settembrini had progress ever on his lips: was he aware that all progress, is so far as there was such a thing, was due to illness, and to illness alone? In other words, to genius, which was the same thing? Had not the normal, since time was, lived on the achievements of the abnormal? Men consciously and voluntarily descended into disease and madness, in search of knowledge which, acquired by fanaticism, would lead back to health; after the possession and use of it had ceased to be conditioned by that heroic and abnormal act of sacrifice. That was the true death on the cross, the true Atonement.” [Knopf, 1968 edition, pp. 465-66]
I was astonished to read this paragraph, for it gave me a new clue as to why Melville had written to Hawthorne shortly after he completed Moby-Dick, “I have written a wicked book, and feel as spotless as the lamb.” And does not “crazy” Ahab carry “a crucifixion in his face”? As writer, Melville’s primitivist descent into madness (into the world controlled by the Devil?) accomplished several things for him: 1. as in Typee, he could safely criticize his conservative family and certain missionaries from a distance; but 2. as romantic artist he took the risk of destroying religion, and religion was the route to social cohesion and conservative notions of “order.” And it must be said here that “Naphta” and his predecessors (Nietzsche) knew very little about real “madness” and its multiple causation in genetic inheritance, belief systems that distort reality (and somewhat described in prior blogs here), overwhelming stress, and other factors that physicians have studied and continue to explore with emphasis on the physiology of the brain.
And remember R. D. Laing and the 1960s-70s vogue for his romantic views of madness as a source of connection with the real world? I was reminded too of Diderot’s primitivism in his Supplement to the Voyage of Bougainville (centuries before Laing’s ravings), a fantasy of life in Tahiti where there are no sexual prohibitions whatsoever. Which takes me to the 60s counter-culture/New Left appropriation of primitivism in their astonishing and still existing devotion to rock ‘n roll and/or hip-hop culture as a form of rebellion and self-assertion against the hypocritical dowdy and classical-music, old-standard loving prior generations–the generation they blamed for the Viet Nam war and the election of Richard Nixon.
It is my view that primitivism is no solution to racism, but rather a ratification of the old stereotype conveyed by Diderot: that (perpetual?) adolescents can escape “surplus repression” (Marcuse), or the Performance Principle (Freud) by going native. But in the elevation of black criminal elements (e.g. the Panthers or the Afrocentric pseudo-historians, one of whom repeatedly produced the viciously anti-Western and antisemitic “Afrikan Mental Liberation Weekend” for KPFK in Los Angeles), they are maintaining the stereotype of the black person as savage yet entertaining minstrel, a minstrel supposedly ragging on the upper classes. So sensible black intellectuals who identify with a supposedly (jewified) puritanical and genteel middle-class and the American Dream are seen as uncool killjoys and can be safely ignored.
The primitivist strategy, like pornography, is controversial. For its defenders, though appearing crazy, primitivism is a harmless catharsis for anti-social impulses. I suppose one would have to study individuals and their ideological leanings, including the ability to form and maintain enduring attachments, or conversely, to change their minds as they travel along the road to “objectivity” to make inroads on this judgment. (See Lippmann’s writing on this beneficent transformation, emphasized in my last blog.) More later as I survey existing debates within the field of mental health. Surely the narratives that are constructed for us by our families and teachers relating to our own biographies, to the national biography, and to America’s relations to other groups or societies, are of concern for all workers striving to enhance what is all too loosely described as mental health.