A sane society?
The Economist (see below) reports a study which suggests that a sizeable minority of Europeans experienced a form of mental disorder in 2010. The most common complaint was depression (30m people or 6.9%). Notwithstanding difficulties with diagnosis (when is depression just rational ‘sadness’?), or the observation that the majority (62%) did not report/get diagnosed with any mental disorder, this phenomenon is worth considering. If we add to that figure the number of suicides, homocides, and deaths due to road traffic accidents (i.e. deaths not related to biological causes) then we have a mounting toll of human misery. Lets also put aside for a moment the mounting burden of the physiological diseases of affluence (diabetes for example) which are of course social in origin.
The experience of mental disorder for individuals can be extremely painful, even causing death. ‘Madness’ for them is not a social construct, it is experienced within themselves as individuals, it is very real. This fact has to be acknowledged. Empirically there is a congruence between traditional ideas of locating madness within individuals and the individuals experience of it. The point here however is that we need to go beyond this conception of madness to confront the issue of social madness – the ‘pathology of normalcy’. It may be that individuals struggle to maintain sanity in the midst of insane societies, and that the ‘normal’ functioning of society is actually pathological.
Again we return to a paradox oft mentioned. Life expectancy has never been higher and GDP has increased enormously (notwithstanding the recent dip following the financial crash of 2008), infant mortality and maternal mortality is largely under control (in the Rich world) and we have defeated (but not eradicated) many infectious diseases. Yet many of us are unhappy and unhealthy.
Psychiatrists and psychologists often seek answers in the individual. Either the cause of mental disturbance is biologically based (chemical imbalances, tumors) or there is a cognitive or affective dysfunction. The answer is to discover what is the cause within the individual and then with the use of surgery, drugs or a talking therapy, correct the dysfunction. Not all locate causes with individuals, occasionally dysfunctional relationships (usually family relationships) are addressed as if not directly causative then at least as antecedents. However this view and that of the ‘Radical Psychiatrists’ such as Thomas Szasz were outliers to the dominant paradigm of psychiatry.
While this is still a reasonable approach to those experiencing very real suffering, it is a partial understanding of sanity.
It is reasonable to ask the question who is actually “mad” here? ‘Normal’ men were responsible for killing probably over 100,000,000 of their ‘normal’ brethren in the last century. ‘Normal’ men planned mutually assured destruction of millions in nuclear war, ‘normal’ men recently sent armies into foreign countries resulting in many thousands of civilian deaths. And yes, it is usually men who plan, send others, and carry out the killing and maiming. ‘Normal’ men in testosterone fuelled frenzies, armed with clever mathematics, and a disregard for the welfare of society, gambled on financial markets and lost. Correction, civil society lost, many of these ‘masters of the universe’ simply (oliver like) asked for ‘more’ as they held out their begging bowls. ‘Normal’ men are sanguine (if not happy) to allow unemployment to rise, houses to be repossessed, healthcare to be inaccessible, health inequalities to continue, because to do otherwise would upset the market and the demands of the bottom line. ‘Normal’ men have prostituted themselves to the idea of the sovereignty of economics, practicing an economics as if people did not matter. ‘Normal’ men design ever more sophisticated means to persuade other ‘normal’ men to buy stuff they did not know they needed, with money they have not got, to impress people they do not know. ‘Normal’ men designed, marketed and sold credit systems to people who would have difficulty paying the sums back in an attempt to correct insufficiency of demand as a result of the flatlining of wages across the developed world.
Society is not sane. Perhaps in the face of this insanity it is normal to be mad?
Erich Fromm presaged these issues in ‘The Sane Society’ (1956), in which he set forth universal criteria by which societies could be judged as sane or otherwise. His conclusion is that both communism and capitalism stifle the human essence and are thus insane societies. For Fromm the human situation stems from the nature of humanities existence in the world, he suggested that their is a universal ‘essence’ which could function as a yardstick for social progress, unlike Foucault who announced the ‘death of man’ (i.e. that there is no human ‘essence’). If we could identify a human essence this could be used as a criterion for mental health across all societies.
Fromm suggested that this essence arises within a tension in the human condition between biological instincts and the non biological characteristics of self awareness, reason and imagination. These last three arise as humans are ‘freaks of nature’ aware (unlike animals) of their separation from nature and of their impending death.
“The problem of man’s existence, then, is unique in the whole of nature: he has fallen out of nature, as it were, and is still in it; he is partly divine, partly animal; partly infinite, partly finite. The necessity to find ever new solutions for the contradictions in his existence, to find ever higher forms of unity with nature, his fellow men and himself, is the source of all psychic forces which motivate man, all of his passions, affects and anxieties.” (p24).
The essential needs of man, which characterise his essence are:
- The need for relatedness with other living beings
- The need for transcendence, to rise above mere existence.
- The need for rootedness, the ties between and within generations.
- The need for self identity.
- The need for a frame of orientation and devotion (religion is an infantile answer to this need that we have now outgrown. Well, some have).
Fromm is a visionary moralist, outlining the ideal essence of man and arguing that psychic tensions arise as a matter of the fact of his existence. Modern societies thwart the above 5 needs of human essence and thus divert physical and psychic energy required for the pacification of the struggle for existence, and thus are sources for madness.
From this perspective, mental health depends to some degree on individual factors (e.g. absence of brain tumours, functional families, healthy cognitive structures), but it is largely a question of what society makes possible. Mental health cannot be defined as the adjustment of the individual to society, rather it has to be defined in terms of the adjustment of society to the (above) needs of man:
‘mental health is characterized by the ability to love and create, by the emergence of incestuous ties to clan and soil, by a sense of identity based on one’s experience of self as the subject of one’s powers, by the grasp of reality inside and outside of ourselves, that is by the development of objectivity and reason’. (p67).
The depressed may experience ‘black dog’ days, however even those who go around grinning may be ‘mad’.
Sep 7th 2011, 14:06 by The Economist online http://tinyurl.com/EUmentalhealth
A new study estimates the number of people with mental disorders in Europe
OVER 38% of all Europeans, or 165m people, suffered from a mental disorder in 2010, according to a new study published this week in European Neuropsychopharmacology. The authors, led by Professor Hans-Ullrich Wittchen of Technische Universität Dresden, analysed 27 conditions using data, studies and surveys for the 27 countries of the European Union, plus Iceland, Norway and Switzerland. The most common condition is depression. Over 30m people were affected by it, or 6.9% of the population. The second most frequent diagnosis is of specific phobias—such as of spiders. Those suffering from alcohol dependence are conservatively estimated at 14.6m, a considerably larger number than the 2.4m people with drug dependency issues (though some may suffer from both).