Ordinary madness

There is a myth within our culture, and within mainstream psychiatry and psychotherapy, that most people are (relatively) ‘normal’.  To be fair, psychoanalysts are more likely to say that most people are ‘neurotic’, or that by ‘normal’ we mean neurotic, but essentially it amounts to the same thing.  To put it another way, the myth is that the majority of people are not ‘mad’, i.e. psychotic.  However, there is actually no clinical evidence, as far as I’m aware, to substantiate this viewpoint.  The best we can say is that most people do not exhibit, at least in the vicinity of mental health professionals, signs of madness.

Of course, this immediately begs the question as to what these signs might be.  A psychiatrist would probably at this point refer to the DSM-IV or the ICD-10, which are the most commonly used diagnostic manuals, and which list various symptoms that correlate with specific psychiatric disorders.  So for example, the DSM-IV entry for schizophrenia lists as ‘characteristic symptoms’:

(1) delusions

(2) hallucinations

(3) disorganized speech (e.g., frequent derailment or incoherence)

(4) grossly disorganized or catatonic behavior

(5) negative symptoms, i.e., affective flattening, alogia (poverty of speech), or avolition (lack of drive or motivation)1

Certainly, anyone presenting two or more such symptoms for a month or longer (the DSM-IV requirement) may well be suffering from a psychotic illness, and quite possibly schizophrenia.  However, the fact that an individual is not exhibiting any of these symptoms does not mean they are not psychotic.  Of course, it is impossible to prove a negative, but the point I am getting at here is that there is a difference between symptoms (or signs) and clinical structure.

As Darian Leader points out in his excellent book What is Madness? most psychotic people are likely to go through life without ever presenting themselves to a psychiatrist, or even exhibiting (at least not to others) recognised signs of psychosis, i.e. in terms of clusters of symptoms which are the basis for psychiatric diagnosis. 2 Many psychotic individuals have found ways to cope with their madness which work perfectly well for them most of the time.

Lacanians have a term for such ‘unnoticed’ or ‘hidden’ madness: ordinary psychosis.  However, as Leader points out, classical psychiatry, i.e. psychiatry in the early twentieth century, was well aware of this phenomenon.  And by definition it’s virtually impossible to ascertain how many people within a particular society might be said to be ‘ordinarily psychotic’: it’s usually only when it becomes ‘extraordinary’, i.e. the individual experiences a psychotic episode in the sense of exhibiting the (psychiatrically) recognised symptoms of psychosis, that they are likely to come to the attention of the mental health profession.

Why, therefore, this idea that most people are (relatively) ‘normal’?  Ironically perhaps, I think one reason is to do with the spread of psychoanalytic ideas into mainstream culture.  Even nowadays, when there is a great deal of scepticism regarding psychoanalysis, and a great deal of ‘competition’ from other talking treatments, many of Freud’s ideas permeate our culture.   Many people talk about ‘unconscious’ ideas and fantasies, and often talk about ‘repressed’ (or, somewhat incorrectly ‘suppressed’) feelings.  It seems to be generally accepted that we live in a society that represses/suppresses many of its more unsavoury and disruptive aspects: in fact, I think most people realise that society can only ‘work’ with a degree of repression.  In other words, we have accepted, albeit unconsciously in many cases, Freud’s notion of a discontented civilisation and much of the discourse of psychoanalysis.

And Freud’s civilisation is a neurotic one first and foremost.  So, in a sense, we can argue that we are all neurotic, that we are ‘all Freudians now’ (except for the exceptions, i.e. the psychotics), even if the vast majority of the population never go anywhere near a psychoanalyst or psychotherapist.  But, of course, this is where the argument starts to unravel.  If most people never go anywhere near a psychoanalyst or therapist, or indeed any other mental health professional, how can we possibly make a proper clinical judgement about them?

There is an even more fundamental issue here: to what extent do we still live in a ‘Freudian’ culture, i.e. one that functions on repression?  In fact, did we ever live in such a culture?   One of the defining characteristics of the last one hundred years has been continual, unmitigated physical and psychological violence, much of it in the heart of Western ‘civilisation’, or in proxy wars and conflicts fought on behalf of the West.  Furthermore, there is nothing ‘repressed’ in the nature of global capitalism, in its unending drive for more profit.

On the other hand, perhaps it suits at least some of us to believe that we still live in a culture that functions through the repression of the drive – which is Freud’s basic argument in Civilisation and its Discontents. 3  To start with, at least for those versed in Freudian psychoanalysis, there is something familiar and even comforting about this argument.  Secondly, and perhaps more significantly, the alternative could be even worse.  If ours is not a ‘Freudian’ culture, if we are not neurotic, then what are we…….?

  1. http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=411# []
  2. Leader, D. (2011) What is Madness? London, Hamsih Hamilton. []
  3. Freud, S. (1930) Civilisation and its Discontents. In: The Standard Edition. London, Vintage/Hogarth Press, pp.59–145. []

Leave a Reply

Your email address will not be published. Required fields are marked *