Genius and Madness

There is no "real" psychology

William Todd Schultz — Fri, 29 May 2009 17:53:16 +0000

A recent post on "real psychology"--as opposed to all the fake or unreal psychology out there--got me thinking. The day we all decide on what real psychology is, is the day psychology dies. Real psychology equals dead-ended, myopic, oversimplification--of subject matter and of methodology. Real psychology is a means-centered approach. That is to say: only psychologists making use of prescribed, narrowly-defined "scientistic" methods are allowed into the fold. All others are touchy-feely, hopelessly subjective trespassers. Such a stance is 1) naïve, 2) unhistorical, and 3) regressive.

The study of the mind goes way back, of course, but let's just look at the 20th century. We had Wundt and his "experimental introspection," research into things like reaction time. We had the wonderfully overreaching brilliance of William James, who was into the same things as Wundt--attention, memory, sensation--but also psychic phenomena, religious experience, and philosophy and art. We had Freud and psychoanalysis. We had Jung and his association experiments. Then there was the biologically reductionistic doings of psychiatry that led, by the 1950s, to seizure therapies and lobotomy. Skinner's radical behaviorism had its day, followed by the cognitive revolution and, in time, by neuroscience. Lots always going on, in other words, from lots of different angles. Methodologically speaking, there was case study, experimentation, introspection, animal behavior, surveys, projective techniques, dream analysis, phenomenology, lesion studies--the list goes on and on. Methodological pluralism was/is the norm. But still today, let's face it, psychology is more or less in the Stone Ages. No doubt much has been accomplished. Powerful mid-level theories do exist that are promisingly predictive. But as for the great big questions, those enduring mysteries, we've taken only very small steps. We still don't know why we dream. We still don't know what causes schizophrenia. We still can't make solid sense of the function of consciousness. So let's not start proclaiming what real psychology is. Better to keep that question helpfully unanswered.

Psychology's disorder now is multiple personality, and in a way that's fine. What we've got is something like 60 sub-disciplines leaving in their wake a farrago of sub sub-disciplines. Each sub-discipline is pretty insular, there is little harmony overall (far more cacophony), and what's especially funny is this: every sub-discipline tends to believe--according to an in-group, out-group dynamic--that it is THE ONLY ONE DOING REAL PSYCHOLOGY. In fact, each is focusing on its own little hiccup of mind, its own pet variables, while mainly neglecting the questions other sub-disciplines find so essential. So each sub-discipline inflates the importance of its methods/questions while devaluing the methods/questions of other sub-disciplines. That attitude was on hair-raising display in the post cited at the top of this one.

Take my situation. I have a PhD in Personality from UC Davis. Now, presently, with some important exceptions, Social Psychologists sometimes devalue Personality Science while Personality Psychologists sometimes devalue Social Psychology. I like to think of this as the narcissism of minor differences, but that's another subject altogether.

I also do qualitative case study research that in my case goes by the name of Psychobiography. According to some, that's not real psychology because it is not experimental. Well, someone should have clued in Piaget, Erikson, Maslow, Freud, Jung, James, Skinner (who also used single-subject design), RD Laing, Henry Murray, Silvan Tomkins, etc etc etc, ALL OF WHOM DID CASE STUDY AND ALL OF WHOM ARE REGARDED AS SEMINAL FIGURES IN THE FIELD. I don't know, it's a strangely territorial neurotic mind-set that 1) believes itself in possession of true knowledge and 2) feels a need to tell lowly others that what they are up to is BS.

I say this: we psychologists know a lot less than we think we do, and at this very early stage of the game in the study of mind, all promising approaches and questions are welcome. The more the merrier. Does anything go? No. But is there one real psychology? Double no.

Why Freud and Jung Broke Up: Part II

William Todd Schultz — Thu, 21 May 2009 16:42:39 +0000

Fellow blogger Dr. Stephen A. Diamond objects (here) to my recent post titled "Why Freud and Jung Broke Up," calling it "an overly simplistic and fundamentally flawed Freudian interpretation" revolving around "repressed" homosexuality. That's a pretty thorough indictment, to say the least! I think my relative terseness at the time made what I said sound a bit too strident. Let me elaborate some, but with the following proviso: walls of books have been written on this topic, so it is impossible in the space and time allowed to do any more than identify a few of the most important threads of what is a massively complex and overdetermined discussion.

What I wrote was this: that Freud and Jung "broke up" because of homosexual feelings that destabilized their relationship in ways they could not deal with effectively. Freud was crystal clear on this. He proclaimed it openly in a letter, as I already described. Jung is quite a bit more dilatory in his self-analysis, but no less explicit. Here are the relevant portions. "I confess this to you with a struggle," writes Jung. "I have a boundless admiration for you both as a man and a researcher, and I bear you no conscious grudge" (the qualifier "conscious" is more than a little interesting)..., [but] my veneration for you has something of the character of a ‘religious' crush. Though it does not really bother me, I still feel it is disgusting and ridiculous because of its undeniable erotic undertone. This abominable feeling comes from the fact that as a boy I was the victim of a sexual assault by a man I once worshipped [as Jung now worshiped Freud]... This feeling hampers me considerably. Another manifestation of it is that I find psychological insight makes relations with colleagues who have a strong transference towards me [as Freud had towards Jung] downright disgusting. I therefore fear your confidence. I also fear the same reaction from you when I speak of my intimate affairs." Freud's response? First he says that "transference on a religious basis would be most disastrous." Then he says, I think wisely: "I shall do my best to show you that I am unfit to be an object of worship."

Later the topic comes up again, though less directly. A colleague describes to Jung a patient who dreamed that he and Jung were swimming in the Zurichsee and that Jung somehow helped him. This patient was a homosexual; the colleague asked Jung if he would consent to see the man. "I don't want to," Jung replied. Once more he refers to having been the victim of a sexual advance by an older family friend. Then he adds: "You see, that's the reason why I was afraid of Freud's approaches.... No, no, no, [I thought at the time], I don't want to belong to anybody."

Now, given statements like those above, I have to say I find it uncontroversial to assert--just as Jung and Freud did themselves--that homosexual feelings played a role in derailing their collaboration. I'm not so much offering a "Freudian" interpretation as I am reporting facts. Am I saying that the homosexual element was the only factor? No. As Diamond does a very effective job of pointing out, innumerable factors were at work, many purely intellectual, some more emotional. Yet I do contend--and this seems to be where Diamond and I respectfully disagree--that these "unruly" homosexual feelings, as Freud put it, were at the core of the conflict. They were the preeminent factor. Here I feel as if I am on pretty solid ground, since Freud and Jung said the same, more or less.

Diamond also asserts that I'm inferring "repressed" homosexual feelings. Not exactly. Freud and Jung directly expressed them; they therefore were not technically repressed, but avowed openly. No doubt the feelings ran pretty deep in both men, especially Jung, given what he says about his "sexual assault" and its aftereffects. Freud and Jung knew the feelings were there; but they did not work them through adequately at the time, or even later perhaps.

One thing I find compelling and even sort of poignant about this whole episode is the way in which Freud and Jung tried--unsuccessfully, it seems, but no less courageously--to share, talk over, and understand feelings that many, especially in the very early 1900s, would do almost anything to avoid. In other words, they "walked the walk." They were willing to confront painful truths that put each of them in a vulnerable position. I find that fact cheering.

Why Freud and Jung Broke Up

William Todd Schultz — Tue, 19 May 2009 19:41:40 +0000

Just finished a class called Freud and Jung. Learned a lot, not so much about theory, which is already firmly cemented in my head, but the personal factors at work in the relationship. On that subject: WOW. So much going on. From the very beginning--the first meeting and fevered discussion for something like 13 hours straight--a sense of high promise combined with undeniable doom. Freud had always been the victim of intense anti-Semitism; he saw in Jung a stronger, younger man, full of charisma, yet also, maybe most importantly, a gentile, someone who could take psychoanalysis into places denied him. For a few brief years Jung was content to follow, to champion Freud's ideas--even about sexuality--in fact, to be more adamantly Freudian than Freud himself, yet always, and inevitably, there comes a time when the son must kill the father. It got messy, to say the least. There were charges and counter-charges. Freud fainted several times while in Jung's presence. Freud says Jung harbored death wishes towards him; Jung laughed the idea off. (I tend to side with Freud on that one).

But in the end, deeply ironically, the "break up"--and that is exactly what it was, down to the sophomoric connotation of the phrase--was all about sex. Not Freud's theory of sex, but sexual feelings between the two. I always knew these were in play, but not to the degree I discovered. Freud, in a letter to a colleague, referred to "unruly homosexual feelings transferred from another part"--the part in question being a previous collaborator, Wilhelm Fliess. Jung recognized the same in himself. Because of early sexual trauma at the hands of an older, trusted male figure, Jung found intimacy with other males repulsive. He came to feel towards Freud a "religious crush." Yet gradually the attraction disgusted him, betraying its baser origins, and so Jung had to move away. He was filled with paranoia--displaced homosexual feelings--and that made any subsequent collaboration impossible. Again, this was nothing new for Jung. As many were to observe, he always had trouble sustaining close male friendships. Woman were, of course, another matter entirely. Jung tended to find females endlessly enthralling, so much so that he posited a female archetype--the anima--in every man. She was a guide to the male's cloaked interior. She showed men themselves because, without her, they tended to go nowhere...

Jung spent so much time decrying Freud's tendency to find sex under every rock. But in the end, their relationship confirmed that emphasis. Sex derailed the work.

We tend to think of theory development as emerging out of an objective, scientific attitude. Wrong. All theory is autobiography. The person the theorist really wants to understand, more than anyone, is himself. The subjective can never be elbowed aside. It hovers inescapably, like an off-stage voice, whispering, whispering, whispering...

The "Pornification" of Human Consciousness

William Todd Schultz — Thu, 26 Mar 2009 20:39:18 +0000

Porn is the new metaphor. But it doesn't stop there. It is also the new universally shared experience. The nation has been "pornified." It's everywhere. It's open 24/7. And chances are good, judging from research into internet habits, that before or after reading this post, a high percentage of you will visit a porn site. Maybe you just did. The point is, if you did, you are hardly alone.

I don't want to judge the morality of porn viewing here. The last time I discussed even the definition of pornography, I got into a shouting match with my father-in-law (whom I really like). I'm actually interested in frying slightly fancier fish. Because just like playing video games, or tuning into hours of nonstop TV, or texting, or commenting on facebook, porn is an experience, and that experience would seem to--given its repetitiveness--have a cumulative effect on human consciousness, our emotional and psychological life.

I have not watched a so-called "porno" since college days, so I'm no expert. But off the top of my head, these seem to be some of porn's characteristics:

a lack of real intimacy;
an absence of genuine relationship;
a relentless onslaught of high-intensity imagery;
a certain formulaic-ness;
a mechanicalness;
anonymousness;
compulsivity (some claim to be sex-addicts);
visualness as opposed to narrative story;
both men and women reductively stereotyped;
intermittent violence and degradation;

The list goes on. Doubtless you may think of features I've omitted. The question is, Do these porn features duplicate, to whatever degree, trends in the structuring of human consciousness and of psychological life? I think they do.

A colleague of mine, Louis Sass, wrote a masterpiece of a book titled Madness and Modernism, in which he compared elements of modern and postmodern art to the experience of schizophrenia. His aim was not so much to argue on behalf of a causal link, but more to "seek the form of understanding that consists in seeing connections." Likewise, one could compare elements of porn to facets of the postmodern psyche. And boy, is there a lot to compare. Are we, or are we not, becoming more anonymous, more compulsive? Is a preference for story and narrative losing its strength in comparison with hungry needs for visual imagery? Are intimate relationships rarer, replaced by mechanical, formulaic interactions such as those found on, say, facebook? People don't so much talk anymore or connect face to face; we text or instant message or post or share files or "network socially."

The draining of emotion is everywhere.

And though women getting objectified is nothing new, the predeliction for doing so appears to have intensified; at least it seems a lot more flagrant. Anyone ever watch VH1's "Rock of Love" or "Flavor of Love?" Also, the line between how Britney Spears is "marketed" and how a porn star presents herself seems almost undetectable to the naked eye. Female pop stars in general, in fact, have also been getting more and more "pornified." That much seems undebatable. Check out some of the videos.

I guess, in the end, I am being a bit moralistic, insofar as porn may effectively implant its aesthetic globally, and by any measure the aesthetic is one-dimensional, base, and lacking ambiguity. What's next? Probably something like "Battle of the Adult Network Stars." Seems inevitable, doesn't it?

The Psychological Consequences of Fame

William Todd Schultz — Thu, 26 Mar 2009 16:03:25 +0000

I'm teaching a class on Psychobiography now, my area of specialization. This time around we're studying the lives of John Lennon, Elvis, and Kurt Cobain, and like psychobiographers do, trying to superimpose the life and personality on the art to see how the subjective origins of the art can be illuminated. Quite a lot always comes up, but one theme that interpenetrates when it comes to Lennon, Elvis, and Cobain concerns the psychological consequences of fame itself. I find this a fascinating subject. How do people contend with fame and its often absurd demands? Do they enjoy or resent it? What do they think of their fans? The media scrutiny? The sense that their lives are not their own?

It's a bit of a Catch-22 sometimes. Artists want fame, they seek it, they purposely do things to achieve it, but then when it comes, they can't get away from it fast enough.

My sense is that some people are simply temperamentally unsuited to be famous. Their talents merit fame, but their personalities don't stand up to it. And I think that, to varying degrees, this is the case for Lennon, Elvis, and Cobain.

John Lennon is probably the most mixed case. For the most part he seemed to enjoy fame, particularly early on, and he was quite competitive in measuring himself up against peers. He read Billboard avidly and followed his chart success. But he was basically shy, nervous, insecure, traumatized by an early childhood full of loss and abandonment. Before performing he often threw up, or at the last second felt he could not go on. This occurred more and more as his live performances became less frequent. And as most people know, in the years before he was killed, he dropped out of the game altogether to raise his son and bake bread. The dream is over, he said. I was the dreamweaver, but now I'm reborn. He was John now, not the "walrus."

Elvis had an incredibly deep sense of inferiority stemming mainly from his poor roots in the South. He was "white trash" singing what many called "nigger music." When he was 3 his daddy was jailed for forging a check. In his amazing so-called Comeback Special (go rent it; you won't regret it), he's palpably discombobulated, especially when talking instead of singing. In the unplugged portions of the filming, he was so clearly agonized that producers begged his backup band to joke and make endless small talk just to calm him down. This was a habit Elvis relied on increasingly: joking and running himself down and even sabatoging his own songs in order to combat anxiety (see my earlier post on Are You Lonesome Tonight?). Drugs provided relief too, as did women, many of whom--even, weirdly, young girls--were steered by Elvis into playing the role of a comforting mother, particularly after his real mother Gladys, to whom he was deeply devoted, died. I don't know. I don't think Elvis enjoyed fame. Almost literally, he couldn't live with it. Did it kill him? Perhaps, to a degree. Most think it killed his mother, who simply could not deal with Elvis being ELVIS! Consciously or unconsciously, he blamed himself for her loss.

Cobain detested fame, and detested most of his fans as well, since in his mind they resembled--and sometimes were--the very same small-minded, misogynistic, racist, homophobic, hate-filled high schoolers he ran up against repeatedly in his hometown of Aberdeen, Washington. Like Lennon and Elvis, Cobain (despite his various bizarre, extraverted-seeming antics) was an introvert, fond of drawing, tormented by his parents' divorce. Like Elvis, he often undermined performances of hits like Smells Like Teen Spirit, singing the song in a slowed-down lower register, channeling a kind of punk Dean Martin. He took to wearing dresses when performing or making videos. And fame gradually forced him more and more inward, not always a reassuring place for Cobain to be--from an early age he was depressed and fantasized suicide. He also, as a kid, experimented with a huge array of drugs--he huffed, he puffed, he did acid, he drank. Heroin was the final stop. He says he began using it to treat a chronic stomach ailment. Ironically, when he took his own life, he wrote an apology to his fans, saying essentially that he could not bear to go on faking it anymore. He was sick of the act. He chose not to "fade away," killing himself as he predicted he would do even before he achieved the slightest measure of fame.

Now, of course, a lot of people seem to deal with fame just fine. They manage it. They like it. It likes them, you might say. So I am not saying that fame is somehow intrinsically destructive. But it can be crazy-making for some. The psychological cost, for some, is too high. For Elvis and Cobain especially, it's the old "be careful what you wish for."

The Nemesis: Everyone's Own Personal Satan

William Todd Schultz — Thu, 12 Mar 2009 19:28:40 +0000

Recently I've been thinking about a concept that really has no precise name, but which I started calling the "Nemesis." I was teaching a class called Autobiography, Fiction, and Self-Invention, and I was struck by the number of people, my students included, whose life story prominently featured an "adversary" figure. This nemesis tends to haunt the person's early childhood. He/She is typically a classmate or a person in the neighborhood. The nemesis incites a lot of fear and anxiety, and a feeling of foreboding. Occasionally he/she is vanquished, but more often than not the nemesis simply eventually disappears or moves or transfers to a different school. Rarely does the nemesis turn into a friend, though of course anything's possible. But the person does struggle against this figure, face the nemesis in battles big and small, sometimes temporarily and briefly winning, sometimes losing dreadfully.

A question is: What's the function of the nemesis in a person's life story? Well, it's hardly a new metaphor. Christ had Satan, Buddha had Devadatta, Popeye had Bluto, Austin Powers had Dr. Evil (and Mini-Me), etc etc. It seems to me that, even if our life in fact lacks a genuine nemesis figure, we more or less invent one. Why? As a means of depicting conflict, as a projected repository for what Jung might have called our "shadow," as the alternate self that we do NOT aspire to, in the sense described by personality researcher Dan Ogilvie (who has written on the topic of the undesired self). We know who we are by knowing who we are not, just as much as knowing what we would like to be and do. Also, by constructing a nemesis, we personify our weaknesses and fears and insecurities in a way that, post hoc, allows us to dramatize them, script them.

So thank you, nemeses, for the small part you played in helping me know who I am.

Superego Tripping

William Todd Schultz — Sat, 07 Mar 2009 17:03:31 +0000

You know the (by now) ancient rite. It's embarrassingly formulaic, and like all such formulas, pathological in its compulsiveness and utter lack of imagination. Some major or even minor celebrity/notable says or does something he or she "shouldn't" have. The press and mainstream media pounce (24 hour news cycle! Got to have something to say something about). Over one or more days the celebrity/notable is pilloried. Much fake abashed righteous indignation ensues. Then the celebrity/notable appears on Larry King or Oprah or Wolf Blitzer and issues a hackneyed and clearly less than heartfelt apology accompanied, if he or she can act, by crocodile tears.
A recent example is Connecticut basketball coach Jim Calhoun who, of all things, yelled at a reporter and called him stupid. Dutifully, Calhoun apologized to Jim Nance. There was Howard Dean, who screamed at a rally-so unpresidential! (Personally, I figure Presidents ought to scream a lot more). He lost his lead in the polls, apologized (naturally), and dropped out of the primary. Long ago John Lennon said the Beatles were more popular than Jesus. True, of course. He too issued the requisite bewildered and in his case sideways apology. This list goes on and on. Doubtless you've already thought of about a zillion additional examples.
This got me thinking. First of all about how pathetically thin-skinned and fake polite we all are. But then about Alan Elms's wonderful concept of the "super-ego trip." Everyone's heard the expression ego-trip. The super-ego trip ought to be just as well known. What is the super-ego? An internalized conscience, our mostly unconscious sense of guilt. It's one portion of Freud's tripartite structural model of the mind, along with the ego and the id. It-the super-ego-stands above the ego as its judge and censor.
So, here's the moral of the story. These sanctimonious, indulgent, pompous, morally superior reactions to celebrity acting out episodes are our little superego-trips. We get to feel puffed up with censorious pride by denouncing behavior that in fact deserves far less attention than it receives. We get to pretend that we don't yell and call people stupid (Calhoun), that we don't scream with excitement in a way that conflicts with our artificial role in the world (Dean), that we don't point out obvious but possibly offensive facts (Lennon). The harsh reality is that, at least in Freud's view, the more punitive the super-ego, the more repressed we all are. Nasty, overreaching super-egos are a sign of psychological weakness, a fear of our own impulses. So lighten the heck up. When something like a "nipple slip" sends us into seizures of simulated shame, we've got a problem. Don't we?

Why Palin Can't Perform

William Todd Schultz — Tue, 30 Sep 2008 20:31:24 +0000

Of course, there are in fact several reasons why Palin can’t perform, prominent ones being her lack of knowledge and her apparently unreflective, incurious nature. But there may be something else at work too, something a bit more psychological. Last year two of my undergraduate students did their Senior Thesis on the subject of “choking.” As they investigated the phenomenon, they came across a concept I had never heard of before: reinvestment. What is reinvestment exactly? It boils down to controlled processing, or what might be better described as overcontrolled processing. When people overthink what they are doing, explicitly review the usually implicit rules of performance as they perform, what results is skill failure due to the disruption of automatic functioning. Moreover, high reinvesters (as measured by a reinvestment scale) are more liable to choke under pressure because, in a word, they think when they ought to be doing.

Anyway, this is what seems to be going on with Palin. What for her used to be automatic—talking to people and expressing her ideas, thoughts, opinions—has become disastrously deautomatized, with the result being the kind of stammering, incoherent, virtually thought-blocked interviews she’s been giving of late, especially the one with Katie Couric. Palin needs to get out of her own way. She needs to stop processing her every sentence. If, on the other hand, she continues to reinvest—and it is a hard thing to stop overnight—Thursday night (the night of the VP debate) is going to be a nightmare. We’ll see soon.

Is Political Conservatism a Mild Form of Insanity?

William Todd Schultz — Sat, 06 Sep 2008 16:53:58 +0000

A few years ago I was standing on the deck of a beach house on the 4th of July and a person who had obviously drunk too much told me, “The secret of my life is that I always need someone to hate.”

I was reminded of this exchange while watching the stupendously ruthless Republican National Convention over the last several days. Is there anything that conservatives do not hate? Maybe drilling. In fact, they appear utterly phallically obsessed with drilling (a practice that, in about 10 years or so, might reduce gas prices by 2 or 3 cents per gallon). But otherwise, what we learned from the recent hatefest is that Republicans hate community organizers, liberals (surprise!), Madonna, the “east coast elite,” the “angry left” media, trial lawyers, people who are too smart, people who are “cosmopolitan”—the list goes on into eternity.

Listening to this litany on Wednesday night in particular reminded me of a research article that came out roughly 5 years ago on political conservatism and motivated social cognition (Jost, Glaser, Kruglanski & Sulloway, “Political Conservatism as Motivated Social Cognition,” Psychological Bulletin). In a nutshell, the article—by Stanford and UC Berkeley researchers—seems to suggest that conservatism is a mild form of insanity.

Here are the facts. A meta-analysis culled from 88 samples in 12 countries, and with an N of 22,818, revealed that “several psychological variables predicted political conservatism.” Which variables exactly? In order of predictive power: Death anxiety, system instability, dogmatism/intolerance of ambiguity, closed-mindedness, low tolerance of uncertainty, high needs for order, structure, and closure, low integrative complexity, fear of threat and loss, and low self-esteem. The researchers conclude, a little chillingly, that “the core ideology of conservatism stresses resistance to change and a justification of inequality.”

The above list of variables is more than a little unsavory. We are talking about someone full of fear, with a poor sense of self, and a lack of mental dexterity. I always tell my students that tolerance of ambiguity is one especially excellent mark of psychological maturity. It isn’t a black and white world. According to the research, conservatives possess precisely the opposite: an intolerance of ambiguity and an inability to deal with complexity. Maybe that’s one reason why Obama seems so distasteful to them: he is a nuanced, multi-faceted thinker who can see things from several different perspectives simultaneously. And he isn’t preaching fear, either.

The Mental "Illness" Metaphor Has Not Worked: What's Next?

William Todd Schultz — Wed, 30 Jul 2008 22:18:42 +0000

Several decades ago the philosopher Ludwig Wittgenstein said it was time to start comparing mental “illnesses” to something different. That is, to move away from the “illness” metaphor. I could not agree more. Insisting on thinking of people with mental problems as “diseased” has been and still is a strategic and practical failure.

It was at the start of the 20^th century that medicine managed to wrest control of the treatment of the insane away from non-medical moral treaters, many of whom were Quakers. There then commenced what my friend the sociological historian Andy Scull has called an “orgy of experimentation” on the mad (see Scull’s wonderful book, Social Order/Mental Disorder, UC Press). Medicine had no clue what to do. The mad were injected with horse’s blood and malarial fever, placed in refrigerated “mummy bags,” given camphor derived seizures, subjected to various “heating” therapies--the list goes on. One theory, proposed by Henry Andrews Cotton, held that all forms of insanity, from juvenile delinquency to schizophrenia, were caused by infected third molars or “wisdom” teeth. His treatment? Tooth extraction. All such approaches were steeped in biological reductionism, and they all boasted astronomically high cure rates of 70, 80, even 100 percent. It was during this time that the “illness” model took firm hold. Soon there would be additional types of seizure models, coma models, and eventually lobotomy. At last antipsychotics arrived, and when they did they were referred to as “chemical lobotomies” because their chief effect was to produce disinterest and apathy (just like today, in my opinion).

The sad fact is that in over 100 years of research into mental “illness” driven by a defect-based disease model, the yield in terms of true understanding has been negligible. That may sound unrealistically unkind, but here is what I mean. Still today, we have no idea what schizophrenia even is, let alone what causes it or how to effectively treat it (to take just one example). As a disorder it is extremely heterogeneous; it looks different in everyone who “has” it. This heterogeneity bedevils research into causality since to find what causes something we have to first know what that “something” is. And speaking of causality: no causal model of schizophrenia has ever panned out. No specific site of brain pathology has been reliably identified. And the biochemical models focusing on dopamine (or D2 receptors) are deeply flawed, as most will readily admit. Lastly, as to treatment, antipsychotics are simply terrible drugs. A recent study (in the New England Journal of Medicine) of the newer agents found a 72% discontinuation rate. Why so high? Because the side-effects are debilitating.

Although it may seem different, the case is much the same for depression. We do not know what causes it—though there are lots of theories—and the antidepressant medicines on average only slightly outperform placebo in clinical trials (one study, for instance, found a 89% placebo duplication rate for Prozac in particular).

I’m no simple-minded Szaszian, but let’s be honest: mental problems do not resemble most illnesses in the least. My daughter had a compound fracture of her wrist. The MD took an X-Ray, and lo and behold, there was the break, for all to see. There was no mystery as to what caused the break, and also no mystery as to how to treat it. With mental problems, diagnosis is sketchy and almost never definitive (no UA or blood draw or brain scan tells me what you “have”), causality is a mystery, and treatment is trial and error (for instance, no one knows with any degree of certainty which antidepressant will work for which individual).

Prima facie, the disease model makes very little sense. And, even more importantly, it hasn’t gotten us anywhere. Psychiatry is in the stone ages.

A new metaphor, one to replace “illness” and “disease,” is called for. The question is: What form should it take?