‘Mental disorder’ is difficult to define. Generally speaking, mental disorders are conditions that involve either loss of contact with reality or distress and impairment. These experiences lie on a continuum of normal human experience, and so it is impossible to define the point at which they become pathological. Furthermore, concepts such as schizophrenia, depression, and personality disorder listed in classifications of mental disorders may not in fact map onto any real or distinct disease entities; even if they do, the symptoms and clinical manifestations that define them are open to subjective interpretation.
To address these problems, classifications of mental disorders adopt a ‘menu of symptoms’ approach and rigidly define each symptom in meticulous scientific terms that are often far removed from a person’s felt experience. This may encourage mental health experts to focus too closely on validating and treating an abstract diagnosis, and not enough on the person’s distress, its context, and its significance or meaning. Despite using complex aetiological models, mental health experts frequently neglect that a person’s felt experience often has a meaning in and of itself, even if this meaning is broad, complex, or difficult to interpret. By recognizing this meaning the person may be able to identify and address the source of her distress, and so make a quicker and more sustainable recovery; she may also gain important insights into herself and a more refined and nuanced perspective over life.
In terms of the origins of mental disorders, conditions such as anxiety disorders, depression, and personality disorders may have arisen from our need to cope with our environment and to make sense of the human experience. For example, there seems to be an innate predisposition to developing certain specific phobias such as phobias of spiders or snakes. Such innate predispositions are intended to protect us from the potential dangers commonly faced by our ancestors, and so to increase our chances of surviving and reproducing. The high level of background anxiety sometimes referred to as ‘neurosis’ may arise from existential anxiety, and facing up to it may enable us to put our life into perspective, see it in its entirety, and thereby give it a sense of unity. In some cases, neurosis can also hold us ‘with iron grip’ and force us to develop our individual potentialities.
Depression may be triggered by a significant life event or an existential crisis, and so tell us that something is seriously wrong and needs working through or changing. It may also enable us to withdraw from the mindless frenzy of social living and create the solitude in which to gain perspective and understanding. ‘Depressive realism’ may enable some people with depression to shed the Polyanna-ish optimism and rose-tinted spectacles that shield so many of us from reality, to see the world more accurately, and to judge it accordingly. For such people the concept of depression may be turned onto its head and positively redefined as ‘the healthy suspicion that life has no meaning and that modern society is not worth participating in’. If anxiety and depression so often occur together, it may be because they both have roots in our existential concerns. (For more on the adaptive role of sadness, see my TED talk, Can Depression be Good for You?)
Personality disorders may give us not only greater scope and opportunities for self-understanding but also the drive and personality traits that predispose to success in certain fields. For example, people with histrionic personality disorder may be adept at charming and manipulating others, and therefore at building and exercising business relationships; people with narcissistic personality disorder may be highly ambitious, confident, and self-focused, and able to exploit people and situations to their best advantage; and people with anankastic personality disorder may get quite far up the corporate and professional ladders simply by being overly devoted to work and productivity.
Whilst some mental disorders such as anxiety disorders, depression, and personality disorders may have arisen from our need to cope with being human and to make sense of the human experience, other mental disorders such as schizophrenia and bipolar disorder may have arisen from characteristics such as language and creativity that set us apart from other animals and define us as human beings. Schizophrenia may have arisen from the evolution of the human brain to accommodate a language centre in the dominant left brain hemisphere. This lateralization of function leads to an anatomical asymmetry in the brain, subtle deviations in which predispose to psychotic symptoms. Language is not necessary for communication, but it is able to give rise to symbolism and thereby to emotionalism and creative activity. These unique assets not only make us by far the most adaptable of all animals, but also enable us to engage in pursuits such as art, music, and religion, and so define us as human beings. Subtle deviations in the lateralization of function may in some cases lead to schizophrenia, but in many other cases it may lead to a greater capacity for creativity and spirituality, that is, to a greater capacity to make use of symbolic language.
Unusually among mental or indeed physical disorders, bipolar disorder is more common in higher socioeconomic groups, suggesting that the genes that predispose to bipolar disorder also predispose to greater achievement and success in the relatives of people with bipolar disorder and sometimes also in people with bipolar disorder themselves. Whilst the genes responsible for bipolar disorder may lead to adaptive advantages at the individual level, they may also lead to adaptive advantages at the level of the population group. Compared to neighbouring population groups, population groups with a high proportion of creative individuals are likely to be more artistically and culturally developed, lending them a stronger sense of identity and purpose and tighter social cohesion; they are also likely to be more scientifically and technologically advanced, and so more economically and militarily successful.
It is interesting to note that both the genes that predispose to schizophrenia and the genes that predispose to bipolar disorder may also predispose to creativity, especially given that both disorders may lie on a single spectrum of psychotic disorders. This may account for Plato’s early observation, in the Phaedrus, that ‘according to the evidence provided by our ancestors, madness is a nobler thing than sober sense ... madness comes from God, whereas sober sense is merely human.’
Yet it is important that mental disorders are not romanticized, sought out, or left untreated, simply because they may or may not predispose to creativity, problem-solving, or personal development. The most severe forms of mental disorder have a strong biological basis and are not simply ‘in the mind’. All mental disorders are drab and intensely painful, and most people who suffer from one would never wish it on anyone, least of all themself. In many cases mental disorders can lead to serious harm or even to death through accident, self-neglect, or self-harm. Even highly successful people with a mental disorder such as Sylvia Plath or Virginia Woolf committed suicide in the end, and more than 90 per cent of people who commit suicide are thought to suffer from a mental disorder.
Rather than being stigmatized or romanticized, mental disorders should be seen for nothing more and nothing less than what they are, an expression of our deepest human nature. By recognizing their traits in ourselves and reflecting upon them, we may be able both to contain them and to put them to good use.
This is, no doubt, the highest form of genius.
Les choses les plus belles sont celles que souffle la folie et qu’écrit la raison. Il faut demeurer entre les deux, tout près de la folie quand on rêve, tout près de la raison quand on écrit.
[The most beautiful things are those that are whispered by madness and written down by reason. We must steer a course between the two, close to madness in our dreams, but close to reason in our writing.]
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