There’s a perennial debate about the psychiatric concept of mental disorder. Is that concept being abused? Are normal behaviours being pathologized to sell pharmaceuticals? But the truth of mental health and insanity seems far removed from this controversy.
Mental Disorder as Dysfunction
The latest psychiatric manual of disorders, the DSM-5, defines “mental disorder” as “a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”
The key to understanding this definition is the notion of a “function.” The psychiatrist wants to distinguish between normality and pathology, the latter being a deviation from a norm that calls for psychiatric action; more precisely, she wants to cater to cultural presumptions about psychological normality, which is why the definition adds that “An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder” (my emphasis). If a culture sanctions some behaviour, the behaviour cannot be abnormal or dysfunctional—unless the whole culture is backward and deranged from a modern, Western viewpoint. What, then, does “dysfunction” add to the concept of mere statistical abnormality, that is, to the concept of something’s rarity? Here the psychiatrist walks a fine line between calculating the difference between common and uncommon psychological and social patterns, on the one hand, and moralizing on the other. The latter is forbidden to the contemporary psychiatrist who seeks to align her discipline more with the hard sciences than with philosophy, theology, and the arts. In the past, psychiatrists did rationalize theological prejudices regarding the alleged evil of certain dispositions such as homosexuality and femininity. Jews and Christians read in their scriptures that women are inferior to men, and early modern, Western psychiatrists deferred to that unscientific, moralistic judgment, prescribing patronizing means for women to adapt to their alleged inferiority and lack of full personhood. But after R.D. Laing, Foucault, and others showed in the 1960s and ‘70s that the prevailing psychiatric criteria for mental health were subjective, psychiatrists developed objective tests in the form of checklists, thus preserving the scientific image of their discipline. (For a stirring presentation of this recent history, see Part 1 of Adam Curtis’ documentary, The Trap.)
The notion of dysfunction, then, is crucial to this larger psychiatric project. On the one hand, a dysfunction is an inability to carry out some process, to complete some expected relation between cause and effect. The fact that there’s a causal relationship at issue provides the generality to account for the norm which is being violated, since causality is the paramount scientific concept for understanding natural order. Psychiatrists see themselves as scientists exploring the mind and so they posit an order in the mental domain. The order investigated by scientists in general is explained with an instrumental agenda in mind, the goal being not just to understand but to control phenomena. Thus, scientists are minimalists and conservative in their theorizing: they objectify, explaining regularities in terms of force, mass, and other such relatively value-neutral properties. Real patterns are understood in terms of physical necessity—not as happening, for example, by free choice, since that would be a form of magic, a miracle that couldn’t be controlled and therefore couldn’t be scientifically (instrumentally and objectively) understood.
So a dysfunction is a deviation from, or a blockage in the furtherance of, a function, where a function is at least a causal relationship. However, because the psychiatrist sees herself as a medical scientist, she thinks she does well in the world, and so a mental function must be more than a regularity that merely happens regardless of any normative context. Functions are deemed to be good from some perspective, namely by a culture at large. Psychiatrists thus still kowtow to social presumptions, but they do so under the cover of scientific (instrumentalist, objectifying) rhetoric. Mental dysfunctions are, therefore, relatively bad irregularities: violations of social norms, causing suffering which is commonly assumed to be unwanted, and preventing the individual from carrying out her “important activities.” The goodness of mental health depends on a social evaluation, which the psychiatrist merely presupposes, but she’s quick to point out that not every conflict with society is pathological. Political, religious, or sexual rebels aren’t mentally unwell unless their behaviour is brought on by a dysfunction, as the DSM definition says. This means the rebel must suffer because of her inability to function, that is, because of a syndrome reflecting a disturbance in her thought processes.
Of course, a syndrome is also a pattern and a process, which is to say that the “disordered,” unhealthy behaviour exhibits its own order as opposed to being an anomalous event; otherwise, it wouldn’t be a form of behaviour, a general, predictable set of responses subject to scientific explanation. So is the difference between functional and dysfunctional processes in any way objective? The DSM-4 definition provides some more detail which might help: “each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.” From this we can gather that, while seeming oxymoronic, disordered regularities (syndromes) must be those thought patterns that cause the individual pain or a loss of freedom. Disability is painful because the “areas of functioning” are deemed important, and so a healthy person should want to engage in them. The mentally disordered rebel, therefore, mustn’t choose her antisocial course of action, but must be led to it by a thought pattern that causes her distress. She must be internally conflicted, which should make her liable to admit that her conflict with society is ill-advised.
The psychiatrist’s appeal to freedom, though, is curious, because it threatens to undermine the definition’s scientific status. But the question of whether the DSM’s definition of “mental health” is incoherent would be a red herring. The DSM itself acknowledges that “mental health” can’t be adequately defined. The definition is offered only because of its utility: as DSM-4 says, the definition “is as useful as any other available definition and has helped to guide decisions regarding which conditions on the boundary between normality and pathology should be included in DSM-IV.” This isn’t the extent of the definition’s instrumentality, however; as I said, the rhetoric of functionalism allows the psychiatrist to dabble in normative generalizations while clinging to the authority of science in the form of neutral-sounding jargon. The root of the contradiction is psychiatry’s intermediate position as a soft science, a discipline that stands between scientific investigation which necessarily objectifies and thus dehumanizes its subject, and cultural, teleological presumptions about the goodness of “health” and of the goals which a healthy person can achieve. In essence, then, the DSM definition is an act of camouflage.
Inadvertently, however, the definition helps to reveal some underlying social processes which shed light on the difference between so-called mental health and pathology. Step with me through the looking glass and look anew at these conventions we use to congratulate ourselves on our status as either normals or heroic rebels.
Animals and Persons, Slaves and Masters
Notice, then, that the talk of psychological or social functions is implicitly depersonalizing (and so quite at odds with any talk of freedom). At best, functions are roles played by actors, or by people who aren’t free to exhibit their personal preferences, because they have a job to do. For example, they might have to sacrifice their private standards to achieve a goal they’re expected to achieve on account of their prior commitments. This typically happens in the workplace where the worker needs a job to survive, but detests what her company compels her to do in this public role she occupies. For most people, psychological functions derive from social ones in that an individual feels the pressure to behave, to resist certain ways of thinking and feeling only when she contemplates how her actions would be publicly assessed. The roles most of us play are assigned by the myths that define the character of our culture, not by our private creative acts. By carrying out our social functions, we fit into society.
There are three paradigms of “behaviour,” of functional activity in this sense. The first is animal behaviour which corresponds to natural order as determined principally by natural selection. Talk of the functionality or optimality (that is, the pseudo-rightness) of adaptive animal behaviour is a remnant of obsolete deistic thinking in biology. Interaction between the genes and the environment produces body types which in turn act with some regularity; in general, organisms are subject to a life cycle which requires that they seek resources to sustain them so they might contribute to the future of their species by reproducing. But Darwin showed that this process is a matter of sheer causality. Animals tend to approve of most stages of their life cycle (short of the final stage, being death), because their bodies are engineered to result in that approval via the influence of hormones, cognitive restrictions, and the like. They fear certain outcomes and desire others, and functional, adaptive, biologically-determined behaviour is the pattern of responses—by turns awe-inspiring and gruesome—that we see throughout the animal kingdom we’ve almost entirely displaced. Animals hunt for food, craft shelters, put on a show to attract a mate, and sometimes cooperate to raise their offspring, because that’s what they’re built to do. In that respect, their behaviour is robotic: genetically programmed and largely automated.
As I just hinted at, that paradigm of behaviour is in the process of being superseded, as domesticated animals replace wild ones and thus as a social order revolutionizes the prior, natural one. The second paradigm, then, is of animals conforming not to their phenotype or to their habitat, but to the dictates of a particular, godlike species that acts as their global master. While deism was a hangover from a time of mass medieval confusion, the behaviour of most large animals is indeed now intelligently designed, because those animals are almost all domesticated or on the verge of extinction. Domesticated animals fulfill social rather than “natural” (naturally selected) functions in so far as they’re forced to act as our slaves (as pets or livestock). For example, they live in pens or cages and so have their basic needs met not by the fitness of their labour but by the power of corporate farming conglomerates and by the insatiable demand of spoiled and deluded human consumers that drives the farming industry. Instead of caring for their offspring in the wild, domesticated sows have their piglets forcibly removed soon after they’re born so the mothers can return to their social function of pumping out another round of offspring.
The third paradigm carries over our practice of domesticating (enslaving) wild animals, into the nonorganic realm of technology, yielding robots and other machines that likewise can function or malfunction according to whether they fulfill their programs. Sheep, pigs, and chickens, along with pets and zoo animals must be forcibly trained to behave as demanded by their masters, because their social function conflicts with their natural one, and so there’s always the risk that the animals will resist when the opportunity presents itself. Technology lacks any such ambivalence, of course, because machines have no prior programming.
These are the three touchstones of our notion of functionality. When applied to people, then, as in the case of the psychiatric conception of mental health, functional individuals are at least implicitly compared to wild or domesticated animals or to machines. In either case, notice that whereas mental health is supposed to be a benefit or even a precondition of our achieving our ultimate goal in life, such as happiness, virtually no one would approve of being compared to animals or to machines. And yet mental health is defined in terms of functionality, pathology in terms of dysfunction. Indeed, putting aside the idiosyncrasies of the DSM definitions, we generally think of mentally healthy individuals as those who successfully go about their business, thus performing one or another social function, the latter being a culturally-sanctioned pursuit such as a family life or a career. Like animals that have prior programming or like machines that are developed from their moment of invention to achieve a single purpose, so-called healthy human individuals are animalistic or mechanical in their social interactions.
But this raises the question of how the analogy might be extended to take into account the input of the masters. Who is assigning healthy, normal individuals their social roles? The answer follows upon our observing that the mass of normal “individuals” or “persons” are betas in the ethological respect: they’re followers in a dominance hierarchy, perhaps working their way to becoming alphas (leaders who enjoy privileged access to the group’s resources) or perhaps content with the security of their station. If human societies are composed of mammalian dominance hierarchies, at least at some level of analysis, there must be human alphas who have an outsized impact on societal standards. Historically, these alphas have been political rulers, including the lords and aristocrats who employed troubadours, playwrights, and painters to mythologize their exploits, but whose tastes and habits typically repulsed the unwashed masses, leading to violent overthrows as in the French, American, and Communist revolutions. More recently, thanks to the rise of public relations propaganda and to capitalistic and democratic assimilations of the potential for mass resentment about grotesque economic inequality, oligarchic tastes have trickled down to the conventions that outline what we might call the middleclass life cycle. A normal, healthy, middleclass beta would be alternately shocked, appalled, and jealous were she treated to an insider’s view of a plutocrat’s lifestyle, just as anyone who glimpsed a deity would be simultaneously terror-stricken and drawn towards the transcendent reality (as Rudolph Otto said about an experience of the numinous). Just as alpha and beta wolves don’t live in the same way, since the alpha has many more privileges and free rein whereas the beta must knuckle under or risk its life by staging a duel, human upper and middle classes might as well reside on different planets—as caricatured in the movie Elysium. For example, whereas a middleclass drudge must wade through the masses at the airport to board a crowded plane, the upper class member typically has access to a private jet or yacht.
The point isn’t that oligarchs explicitly plot to domesticate the masses, deciding step-by-step how the latter might be controlled. But the indoctrination and training do unfold organically as a result of loopholes in democracy and capitalism which implement old forms of social control in new guises, the old ones being theocratic or megamechanical, as in Lewis Mumford's conception of the latter. For example, in liberal societies, civic religion replaces theism as the noble lie that sways the citizens to trust in the society’s systems and laws (see Simon Critchley’s The Faith of the Faithless). And capitalism perpetuates the myth that narrow-minded selfishness is the engine of progress, which tricks consumers into accepting vast status quo inequalities. All of which is most glaringly apparent in the political and economic dynamics of the United States. That country does indeed lead the free world in that it reveals how the progress of liberal humanism is due to a Faustian bargain. Humanism is evidently powerless to create a truly progressive civilization, one that does away with premodern forms of barbarism. On the contrary, the U.S.-centered, post-WWII global civilization we think of honourifically as “modern” only perfects the master-slave relationship. We use technology to accelerate the demise of all wild, uncivilized forms of life, meaning all nonhuman species, and then the strongest, most cunning or remorseless human leaders turn our predatory instrumentalism to the task of enslaving the bulk of humanity to boot. Now Hollywood and corporate advertising indoctrinate the masses with market-tested myths to cultivate our selfishness and materialism as well as stoking our fantasies and unconscious fears, to prolong the palpably unsustainable form of civilization at the apex of which is necessarily a quintessentially insane leadership.
And so we reach the surreal irony that the standard of mental health for the masses, namely social functionality, civility or domestication, is established by indoctrination flowing from a liberal, capitalistic (selfish and materialistic) civilization that reserves its most godlike rewards for those who are palpably unwell. To wit, oligarchs are typically psychopaths. They’re either able to peck their way to the top of the pecking order because they’re biologically unencumbered by a conscience which would otherwise retard their ambition, or else they accustom themselves to the inhumanity of their enterprise and so lose their scruples as they acquire more and more corrupting power, as in the case of U.S. President Obama. We middleclass folks—with access to computers and the internet and time to spare perusing blogs—may think it’s important to distinguish between the mentally healthy and the unhealthy, and we’d further conceive of the happy middleclass family that we see on TV ads or in 1950s Hollywood as the paragon of sanity. The smiling parents with their adoring children and pet dog are the sanest because they’ve completely conformed to mass cultural expectations. They beam their smiles not because all is well with them, but because they’re uninterested in learning how their lifestyle is endangered by blowback from the atrocities committed by those buried, as it were, in the matted fur growing from their nation’s repulsive underbelly.
What we fail to grasp is that the controversy over this middleclass distinction between mental health and insanity, where the latter is understood as mere social dysfunction, is a tempest in a teapot. Looked at in the context I’ve laid out above, what we call mental health is akin to the unknowing tranquility adopted by a victim of Stockholm Syndrome. We long to be the godlike oligarchs who have maximum prestige and freedom in our rapacious societies even as we shy away from seeing clearly either those leaders or those societies. Our complacence and passivity are functional means of preserving an unstable, highly-destructive civilization that’s represented by fittingly-monstrous avatars such as Donald Trump and his ilk. That is, our “healthy” normality entails our social functionality, which means we must focus narrowly on our middleclass life cycle, ignoring the global ramifications and the hideous deformities that naturally fester in the leaders of this delusion-fueled way of life. We think we’re sane and healthy when we do our jobs even though we long effectively to be perfectly insane (from this middleclass vantage point). We wish we were oligarchs—even though the oligarchs aren’t fully human; they lack the capacity for complex emotions, because were they burdened by a conscience, they couldn’t manage the massive cognitive dissonance that must form in the mind of any rational person who participates in the upper echelons of so grotesque and blinkered a civilization as the one in which we modern liberal humanists have created for ourselves. The point should be emphasized that the sociopathy of the top one percent of wealthy and powerful individuals is hardly accidental. While not all members of this upper class are equally inhuman, the process by which any average person is liable to be corrupted by their dominance over others and over the world in general is familiar, although we prefer not to dwell on the implications for our self-image, according to which we’re innocent followers of those leaders.
Outsiders Liberated from the Rat Race
Who, then, are the truly sane ones? We can begin to answer this with a non-normative distinction, between those who are clearly unwell, according to the forgoing analysis, and any remaining folks who at least have that potential for mental wellness. If we eliminate the betas who are called mentally healthy but who are actually dupes in a freakish and heinous system, and we set aside the alphas who are either full-blown sociopaths or who are at least corrupted to some extent by their escalating engagements with hedonism and sadism, we’re left mainly with the losers who correspond, ethologically, to omegas. These last to receive the group’s bounties stand outside the dominance hierarchy because they’re too weak or unreliable to be trusted with the job of defending the territory or of securing the group’s next meal. That very outsider status, however, should allow omegas to appreciate the sublime horror that counts for daily life in the wild. Of course, this assumes that the social species in question have the capacity to feel that sort of abstract, existential fear, which presumably isn’t the case for most of them. Human omegas are in that position and yet that alone doesn’t make them sane. Some of these omegas are homeless and starving and thus ill-equipped to think clearly. Some are depressed or schizophrenic or otherwise deranged. Other, learned outsiders succumb to mystical balderdash and exploit beta herds as their cult leaders. Some graduate to beta status themselves as monks or nuns of a holy order.
In any case, the question of sanity isn’t the one to ask. While we can speak biologically of normal and abnormal brain functioning, and of debilitating disorders such as Alzheimer’s or schizophrenia, the general notion of mental health is part of the beta’s self-delusion. The kind of health we have in mind is the pet’s passivity, the ability to function in the socially accepted way. Mental health is measured by your tendency to contribute to society, especially by raising a family and earning a living. Above all, the healthy person must fit into a culturally-prescribed role. In that respect, she’s more animal or machine than person. To borrow from the DSM definition’s hodgepodge of sophistries, the hallmark of personhood is autonomy—indeed the very freedom that has no place in functionality. Existentialists like Dostoevsky, Heidegger, Camus, and Sartre have exhaustively analyzed the concept of personal freedom, particularly from the phenomenological end. They emphasized the onerous burden of responsibility placed on the free individual, the dread and angst she suffers knowing that because she’s free, she has no foundation to rest on, no axioms to guide her choice of a direction in life. Indeed, the existentially-free individual seems deranged in her ruminations. Like Dostoevsky’s Raskolnikov, the free person will be inwardly conflicted and crushed beneath the magnitude of her decisions, given that a precondition of her freedom is that she understands we alone must decide on our life’s meaning. And like Camus’ stranger, the free person is liable to be alienated from feel-good, beta society. If we ask the broader question—not "Who is sane?" but "What ought we to do?"—the person who is free to obey social conventions or to reject them as farcical may be both mentally unwell in some sense, but also heroically superhuman.
Incidentally, this is why the DSM’s point about the connection between suffering and dysfunction is so telling. The “well-adjusted” beta multitudes shouldn’t suffer because they’re sheeple, and disturbing their domesticity would be as rude as scaring babies. But genuine, enlightened people will likely suffer for their self-understanding: they know that they’re free, that mass culture is obscene, and thus that they’re on their own as outsiders in the whole uncaring universe. Why wouldn’t they suffer? But also, if that existential suffering makes them “dysfunctional” or even antisocial, why is that worse than being an apologist for a “humanistic,” “progressive” civilization that dehumanizes the masses and enslaves or exterminates most forms of life like the crazed aliens you see wreaking havoc in old sci-fi movies?
|The Emergence of God at the Reversal of Fate|
The more pertinent distinction isn’t between dysfunction and mental health, but between animality and personhood. Animals and machines follow training and rules; their behaviour is programmed and so they’re slaves to a master. Again, existentially speaking, most humans, namely the beta class, are animals and machines, not persons: we live as functionaries in one system or another, playing roles without much self-awareness or appreciation for the cosmic tragedy—the destruction of the biosphere—to which we’re contributing in our workaday fashion. Those with the greater potential for autonomy are the omegas, the social outsiders who thus bear the weight of the existential choice of what to do with themselves, since they have no role to play. Again, the stakes are no longer pathology and health, but automatism and personhood. Instead of wondering whether we’re normal or deranged, we should be considering whether we’re authentic persons in the first place. Are the beta masses that follow the megalomaniacal predators of the top one percent healthy for doing so just because they thereby maintain some social order? Is it sane to pursue the long-term destruction of all life or to shirk your responsibility as a potentially self-aware human, by acting out natural and social roles instead of making a philosophically-informed choice of how to live? What is one deluded nobody’s happiness worth in the shadow of the dreadful con of which she’s a victim? If we shift our perspective to one that appreciates the existential stakes, we begin to discern that the majority that’s called healthy, sane, and normal aren’t even fully human. Their minds are inauthentic, because they haven’t been liberated by a philosophical awakening. Plato and Jesus both called them vulgar swine, those controlled by their lusts or who wouldn’t recognize pearls of wisdom even were they dropped at their feet.
Interestingly, once we set aside the psychiatrist’s narrow, half-hearted teleology, we can see that despite the alphas' psychopathy, they too have a greater capacity for authenticity since like the omegas they’re not imprisoned by any social system. Whereas the omega’s freedom derives from her marginalization and by the higher-order thoughts that afflict and alienate her as she retreats inward in hyper-reflection, the alpha is liberated precisely by his amorality and transnational perspective. Not committed to any national ethos, not trapped in any rat race, but godlike in his command over the experiences he chooses to have, the alpha stands above and thus apart from mass society. As you might have gleaned, freedom isn’t necessarily a gift. We’re most free when we’re detached from everything else, including our home and loved ones, when we’re isolated and left to stew over some weighty decision we alone can shoulder the responsibility for. The homeless and the forgotten losers, the nomads and beatniks, the introverted artists paralyzed by sensitivity, the misfits and drifters and fools and freaks and itinerant monks and above all the outsiders—these are the freest creatures on earth and thus they alone are fully human in so far as our species is supposed to be populated by people rather than by animals or machines. And if the plutocrats and mob bosses and emperors and dictators are warped by their power and celebrity, they can be just as superhuman as the sage, regardless of the alpha’s insanity or evil. Alphas wouldn't be fully human in the biological sense, because of their limited capacity for complex emotions, as I said, but they might be psychologically superhuman, given their detachment from mass society and from its social roles and norms. In any case, there's no guarantee that our best representatives are especially clear-headed and benevolent; on the contrary, we may be afflicted with the leaders we deserve because those masters may develop our human potential to its terrifying endpoint.
In a founding myth of Western civilization, Yahweh said about Adam that he should have a helpmate, because it’s not good for man to be alone, and so Yahweh made Eve (Gen.2:18). But this myth was a rewriting of earlier, Sumerian stories that reflected our animistic past, when our ancestors perceived all of nature as being alive, and so instead of being bent on controlling natural mechanisms, the ancients assumed they could socialize with the world. As Daniel Dennett explains in Breaking the Spell, animism and theism were caused by the overuse of our instinct for relating to each other as minds. On the whole, the ancient animists were thus also more akin to childlike animals than to authentic, liberated and forlorn persons. Far from being rationally alienated from nature and society, the ancients projected social categories onto the whole world and so felt at home everywhere and under all circumstances. Animists would have abhorred the prospect of being alone, because their aptitude for socialization and personification, which Dennett calls the intentional stance, was hyperactive. But solitude is almost a precondition for freedom and thus for personhood. This is why the introvert’s inner life transcends the extrovert’s monkey-like preoccupation with making acquaintances and flirting and gossiping and the like; the introvert’s presence graces the animal kingdom with something new, something virtually supernatural, with a godlike being that can do what it alone likes. The price for this emergence of godhood—which is almost synonymous with personhood—may be mental disorder in the form of cognitive or emotional dysfunction, because an absolute, posthuman god would be tortured by the sovereignty that alienates it from everything else. But there’s a fate worse than not fitting into an irresponsible society, and that’s being the human animal or machine that depends on the delusions keeping that society afloat.