Key Takeaways
"Crazy" is a complex term with dual connotations, reflecting both derision and praise, akin to historical literary reversals of values.
American culture's "trickle-up effect" influences global perceptions, exporting psychiatric concepts and cultural elements worldwide.
The series will explore "crazy" through popular culture and philosophy, challenging the dominance of rationalism and technology in understanding mental health.
A deeper understanding of madness is advocated, beyond traditional psychiatric frameworks, incorporating cultural, historical, and philosophical perspectives.
SECOND THOUGHTS
Mad, bad, and dangerous to know.
– Lady Caroline Lamb on Lord Byron
In the 19th century, the most common expression for irrationality and insanity was “madness,” as the English poet Lord Byron’s lover attested. In this century, it is probably “crazy”—which we will get to shortly. But what exactly did Lady Caroline Lamb mean? She seems to have made sure she covered several possibilities—not just mad but bad—and dangerous to boot. And today, “crazy” seems to cover all of them, which is why we need to deconstruct its meaning.
Another late 19th century figure of English literature, Samuel Butler wrote a novel called Erewhon (“nowhere” backwards) that is classified as utopian fiction. We can also read it as a satire on Victorian British society and a visionary attempt to extrapolate Darwin’s evolution to the industrial revolution to imagine machine consciousness and self-replicating machines. His themes could be ripped out of today’s headlines.
As a psychiatrist, however, the most provocative idea in Erewhon is the satirical reversal of attitudes to crime and illness. In Erewhonian law, offenders are treated as ill and sick individuals are treated like criminals. Either way, Lady Caroline Lamb had Byron covered! In Erewhon, Butler portrays this reversal with scenes of neighbors visiting the family of an offender with flowers and condolences while someone who falls ill is treated with avoidance and scorn. Nothing in the entire utopian/dystopian genre since Thomas More’s Utopia (“nowhere” in Greek, published in Latin in 1516) is more striking than this reversal of values, reminiscent of German philosopher Friedrich Nietzsche’s “transvaluation of all values” and recalls George Orwell’s Newspeak in Nineteen Eighty-Four where everything is the opposite of its ascribed name.4 The Ministry of Truth, for example, is concerned with lies.
“The Trickle-Up Effect”
In English today, we use the word crazy much more often than mad in an expansive popular take on “madness.” And like the reversals in Butler’s and Orwell’s dystopias, crazy can now be a term of derision and dismissal, condescension and disqualification on one hand, or on the other hand, approval, even praise, and an invitation to a different, transgressive way of being (eg, the songs “Crazy” by Seal and “Let’s Get Crazy” by Prince).
Two things are top of mind in this series and they are both very American. The first, which I enjoy, is America’s secret cultural strength: how things bubble up from lower classes, from the street to mainstream culture. “Bottom up” instead of “top down” like the European culture of symphonies and operas. Think about the music that spawned from the American underclass and its marginalized groups: New Orleans’ ragtime, jazz, blues, rhythm and blues, rock’n’roll, and Detroit’s Motown and New York’s hip-hop. Think about Hollywood’s noir films that went from B movies to cult classics. Think about lowrider culture in East LA. In the opposite of trickle-down economics, we can call it the “trickle-up effect.” The incarnation of the American dream.
One of the striking things about my professors of philosophy is their marriage of high and low culture. Not just analyses of Greek myths like “Antigone” (one of my favorites) or Verdi’s opera “Aida” (another favorite) but English rocker David Bowie (Simon Critchley), Russian feminist protest group Pussy Riot (Slavoj Žižek), and Valerie Solanas’ radical feminist “SCUM Manifesto” (Avital Ronell). Slavoj Žižek edited a book called Everything You Wanted to Know About Lacan (But Were Afraid to Ask Hitchcock) where Hitchcock’s thrillers are used to explore concepts in Lacanian psychoanalysis. Simon Critchley has a column on philosophy called “The Stone” in The New York Times and has participated in and written about the punk movement in England.
The queen of this approach is Avital Ronell at New York University, who was a student of Algerian French philosopher Jacques Derrida, and applies his deconstructive method to popular culture. She investigates things that appear in the margins like the “SCUM Manifesto” and the everyday notion of “stupidity” which is like a “black hole devouring the light of rationality” (as a reviewer wrote). In this way, Ronell takes on the “repressed conditions of knowledge” and makes them accessible and relevant for the mainstream and for philosophy.
“Crazy Like Us”
The second thing is more equivocal and that is how America exports its culture worldwide in what political scientists call “soft power.” Hollywood movies, American music from rock’n’roll to hip hop, fast food (see my column on fast food and slow thought), and how we imagine health and mental health. American journalist Ethan Watters describes this in his book, Crazy Like Us: The Globalization of the American Psyche. In it, Watters points to the rise of anorexia in Hong Kong, the American invention and spread of posttraumatic stress disorder, and other cases. I would argue that not only does the West’s most powerful centripetal culture dominate psychiatry and mental health worldwide, but that its fads, obsessions, and blind spots get exported along with our best intentions.
Going Deep by Staying Shallow
In this new series in “Second Thoughts,” I will explore what we mean by crazy through popular culture (going deep by staying shallow) and the humanities (cinema, history, literature, philosophy)—all with a psychiatrist’s eye. And how the reciprocal relationships between American psychiatry and popular culture create a product that gets exported around the world. The Global Mental Health Movement may have started elsewhere but it is now fully embraced by academic psychiatry and funding sources in Canada and the US, and my North American colleagues are spreading this with messianic zeal.
We are going to have some fun with this. Yet, just in case you think it is not serious, we will also revisit the anti-stigma campaigns that I see as part of social psychiatry’s “public works projects.” And we will try to understand the push by those who call themselves “progressives” towards the enlightenment project of progress through rationality and science. My question about that is:
When did science (and a narrow and restrictive notion of science at that) become the measure of all things?
For there is a dark side to this progressive rationalism in which we see a general intolerance for what is subjective and irrational. As Neil Postman, America’s foremost critic of education and media put it in his masterful polemic Technopoly, defined as the surrender of culture to technology, “Technopoly is at war with subjectivity.”
The real intolerance towards those with mental illness, in my view, is not that we are ill-informed or prejudiced (we are, including psychiatrists, sometimes). Rather, that there is no room in a society dominated by technology and a narrow view of science for real diversity and subjectivity, not to mention eccentricity, playfulness, and satire. No amount of political correctness about the neurodivergent has really moved the needle on public acceptance of diversity. Individuals on the autistic spectrum have become the object of comedy (think of Sheldon Cooper, the eccentric genius of “The Big Bang Theory” TV series).
As a social philosopher, “crazy” offers an apparatus or tool to study how ideology takes root to colonize the popular imagination, creating hegemony with this fluid yet pernicious cultural category. I will define these key words. As a psychiatrist, “crazy” (and “insane” which may be more offensive) overlaps imperfectly with the subject of psychiatry. Schizophrenia, coined by Eugen Bleuler, MD, in 1908, is the medical psychiatric version of “crazy.” As the central psychiatric term of the 20th century, schizophrenia has been called “the sublime object of psychiatry.”
Along the way, we will examine French philosopher Michel Foucault’s Madness and Civilization (which may well be the trigger that made me want to become a psychiatrist after Marcel Lemieux, MD, introduced me to him 50 years ago [see my column: “The Revolving Door”]) and other histories of psychiatry and madness. We will separate histories: the history of psychiatry, the history of the social and cultural construction of madness (which is what Foucault attempted), and finally, the history of the lived experience of madness which has been undertaken by the social sciences, historians, and humanists, with very limited results. What is new and refreshing in this is the voice of individuals experiencing mental, relational, and social suffering themselves.
We will also revisit Derrida’s deconstruction and other tools for doing philosophical archaeology, digging down deep into our cultural origins to root out how we came to think and feel the way we do about something like “crazy.” Finally, beyond deconstruction, we desperately need a philosophy of madness, and we will review the dense work of Wouter Kusters, a brave Dutch philosopher and linguist who offers just that.
My next column will take on a popular view of “crazy.” “Crazy, manic, twisted, suicidal, psychotic”—this is a view of psychiatry through one of the most important vehicles of culture in our time: popular music. Or, Everything you wanted to know about crazy, but forgot to ask your DJ. Get ready for “Help!” (The Beatles), “Suicide Is Painless” (the M.A.S.H. theme), “Manic Depression” (Jimi Hendrix), “19th Nervous Breakdown” (The Rolling Stones), and “Psychotic Reaction” (The Count Five).
Note: This article originally appeared on Psychiatric Times.
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