We are all mad…..

….to paraphrase Lacan (and, indirectly) Freud.  In some ways this seems to be saying nothing new; after all, isn’t part of Freud’s legacy, whether you subscribe to psychoanalysis or not, that we are all, in some way, disturbed?  And doesn’t this mean that we are all either neurotic to some degree or, if we are less fortunate, psychotic?   Of course, these are all stereotypes but it is true that Freud did call into question the whole notion of ‘normality’ within the sphere of ‘mental health’.

Furthermore, if we are all mad in some way, what does this tell us – apart from the fact that those who job it is to decide who is ‘mad’  and who is not, i.e. psychiatrists and clinical psychologists, are themselves mad?   If we are all mad then what is point in having a distinction between ‘mad’ and ‘not mad’?

On the other hand, we may indeed all be mad, but, to paraphrase Orwell this time: ‘some are more mad than others’.   And this is where the idea of a ‘spectrum’ of psychopathology becomes problematic.  There is a (in my view misplaced) notion in both psychoanalytic circles and beyond, that so-called ‘normal’ people are actually neurotic and everyone else is either psychotic, borderline, psychopathic, or suffer from some other terrible (and incurable) mental health condition.   In other words, ‘neurotic’ equals ‘normal’, and ‘psychotic’/’borderline’/’psychopath’ equals ‘mad’/’deeply disturbed’.

The key point here, though, is not the terminology (‘normal’, ‘mad’, ‘neurotic’, ‘psychotic’, etc) but rather the idea of a distinction between particular mental states. This distinction is often referred to as a diagnosis.  Furthermore, there also has to be a position from which such a distinction can be made in the first place; nowadays this position is usually occupied by the psychiatric and clinical psychology professions.   And many people still cherish the idea that such professionals are, at least to a certain degree, relatively ‘normal’.

The idea of making a distinction between particular mental states (and by inference, particular behaviours) is not in itself problematic; rather, it’s the purpose of such distinctions that can become a major problem.  And this purpose usually revolves around the idea of treatment.  The bottom line is that some mental states (and consequently behaviours) are ‘acceptable’ in particular societies and some are not.1  Quite how a consensus regarding ‘acceptable’ and ‘unacceptable’ mental states and behaviours is arrived at remains something of a mystery.  And, of course, notions of ‘acceptable’ and ‘unacceptable’ change over time: for example, just think how attitudes towards homosexuality have changed over the last fifty years.

Could we therefore argue that ‘madness’ is not only a question of degree, but also a matter of the norms and values of the particular society you live in?  Perhaps…and yet there is little doubt that some forms of madness are more troubling than others – both to the individual themselves and to those around them.   And this has little to do with social norms: rather, this is more at the level of lived experience.  For some people, existence itself is quite precarious – not necessarily in practical terms (although it can be), but in terms of their sense of being and how they relate to others.   In my view, the best phenomenological description of this precarious sense of being is still to be found in RD Laing’s The Divided Self2  Although Laing was focusing on schizophrenic individuals, such a description could apply equally as well to a range of mental disorders.

Later on Laing, and other ‘anti-psychiatrists’, would argue that society itself plays a major role in driving people crazy – both in terms of family dynamics and at the wider social level.  However, this belies the fact that not every one is affected in the same way by pathological family relations, and pathological social and political relationships.  In fact some people seem to thrive on precisely those psychological and social relationships that drive other people into deep madness.

However, the answer is not to punish, stigmatise or medicate those who ‘can’t stand the heat’, so to speak, but rather to try and explore with them what it is about their lives and their relationships with the wider world which they find so difficult and, in many cases, so unbearable.  And this is not a case of a ‘healthy expert’, be they a psychiatrist, psychologist, or psychoanalyst, ‘leading’ the troubled individual towards some fantasised version of ‘normality’; rather it is about one human being helping to construct a special kind of relationship with another human being in order that they can begin to explore their particular form of subjectivity in their own way.

  1. Having said that, if the DSM V is anything to go by, any kind of mental state is now problematic and a suitable case for treatment! []
  2. R.D. Laing (1990) The Divided Self: An Existential Study in Sanity and Madness. London, Penguin Books. []