Harvard University Press, 2013.
688pp., US $45.00, hardcover
According to Liah Greenfeld, author of Mind, Modernity, Madness, “culture is an empirical reality of the first order in human life – that it, in the most profound sense of the word makes us human and defines human experience.” As such, the symbolic cultural framework of our time (in particular nationalism and a related, “pervasive anomie”) is THE causal factor behind “the big three” psychiatric disorders: schizophrenia, bipolar disorder, and major depressive disorder.
This is a bold book from a leading intellectual, the third in a trilogy (Nationalism: Five Roads to Modernity and The Spirit of Capitalism: Nationalism and Economic Growth), and it covers a lot of territory – history, sociology, philosophy, psychology, psychiatry, and neuroscience. The book is an analytic tour de force in terms of trying to understand what Laurence Kirmayer calls our “cultural biology.” But it’s also a deeply personal and imaginative work: the ubiquity of depression among Greenfeld’s young students has made mental illness a personal problem, and she addresses the problem in the manner of the best fiction – Middlemarch immediately comes to mind – by delving into the “dim lights and tangled circumstances” of our cultural history (to borrow a phrase from Elliott) and trying to create a coherent narrative universe.
Greenfeld defines nationalism as “a form of consciousness, an essentially secular view of reality, whose socio-political component rests on the principles of fundamental equality of membership in a community and popular sovereignty,” which “makes an earthly community the source of all law [and] drastically diminishes the importance of transcendental forces – of God, above all – in human life. The importance of human life grows proportionately, and before long the transcendental sphere fades from view and man (and eventually woman too) emerges as one’s own maker.”
Our society pays a psychological price for grinding out individuals instead of divine light. The way we treat mental problems (and I think try to recapture some of our awe) is by looking inside our own skulls. And we’re totally captivated. The brain is no longer a black box, nor is it analogized to a computer or a subway ride; it’s a magisterial work of art or nature – a symphony (William Calvin), a tangled forest (Sebastian Seung), the Milky Way (Thomas Insel). Unfortunately, according to Greenfeld, even the most severe psychiatric illnesses are not biologically determined and our reliance on brain-based research “makes impossible both their cure and formation of policies that could arrest the rise in their rates.
Mind, Modernity, Madness is divided into three sections – (1) Philosophical (“Premises” – the building up of science as a social institution and the misguided belief in the material nature of empirically knowable reality; “The Mind as an Emergent Phenomena”); (2) Psychological (“Madness in its Purse Form: Schizophrenia”; “Madness Muddled: Manic Depressive Illness”); (3) Historical (“The Cradle of Madness”; “Going International: The Spread of Madness in Europe”; “Madder Than Them All: From the Records of American Insanity”); and an afterword. The analytic skills Greenfeld employs in each of these domains allows her to present a much more complicated argument than the social construction of X. Her account is absolutely complementary to biological and psychodynamic approaches to understanding mental illness. (“Culture, personality, and biology are different but not mutually exclusive realities, and for this reason cultural, psychological, and biological arguments should not be mutually exclusive.”)
Readers may have issues with a number of her claims; for the purposes of this review, I’ll focus on schizophrenia. For example, Greenfeld argues that: (1) mental illnesses may have existed “since time immemorial,” but “madness” (by which she means psychosis, i.e., any illness with a “delusionary quality”) emerged in sixteenth-century England, requiring a neologism (she claims that Michel Foucault’s use of folie fatally conflated the two kinds of disorders), and subsequently spread to other countries like an infection, one that was caused by the values of equality and self-realization; (2) reality is multi-layered, and the uppermost layer (mind and culture – neither of which can be understood without the other) are composed of irreducible or “emergent” phenomena; (3) schizophrenia is a disorder at the level of mind and culture (all of the symptoms “can be accounted for by the loss of the acting self, the dissolution of will”), in consequence of which we will never find neurobiological abnormalities; it’s not a disease of that level. Another drawback may be her reliance by way of examples on James Matthew, John Nash, and Kay Jamison in Section 2 (“Psychological”). Section 3 (“Historical”) covers the history of madness traced through literature and institutions in England, France, Germany, and ultimately the United States (“Madder Than Them All”), which may already be familiar to readers.
The reason I find her argument so interesting is that it fits with a new kind of thinking, exemplified by Beyond the Brain: How Body and Environment Shape Animal and Human Minds, Louise Barrett’s short, elegant book on embodied cognition which came out a few years ago. Both books look at how complex behavior emerges from the various ways in which brains, bodies, and environments “work together.” (In Barrett’s use of the term, cognition is “the way in which animals come to know and engage with their environments, and not simply as a matter of having internal ‘thought processes’ that are more or less similar to our own.”) Barrett’s book contains all sorts of fascinating examples from human and animal research – wasps, honeybees, crickets, jumping spiders, and scrub jays – as well as the Mars Rover, but the overall message is that “complex behavior doesn’t necessarily require complex internal mechanisms.” Animals (and humans) are “situated in a web of causal influences.” Nest building, for example “emerges from the interaction between the birds’ bodily activities and the growing structure of the nest itself, rather than reflecting the execution of a preformed plan inside the birds’ head.” Greenfeld is focusing exclusively on the symbolic environment, but the implication is similar: unless we recognize the unity of brain, mind, body, environment, we will never be able to solve our mental predicaments.
This makes mental illness a transdisciplinary rather than an interdisciplinary issue of gigantic scale. One of the great gifts of this book is the recognition of that fact in a way that makes it a viable starting point.
Constance A. Cummings is Project Director of the non-profit The Foundation for Psychocultural Research, which supports and advances interdisciplinary research and scholarship at the intersection of brain, mind, culture, and mental health and illness. She is co-editor (with Carol Worthman, Paul Plotsky, and Dan Schechter) of Formative Experiences: The Interaction of Caregiving, Culture, and Developmental Psychobiology (New York: Cambridge University Press, 2010). She received her doctorate in theoretical linguistics from New York University.
Angell, Marcia. (2011, June 23). “The epidemic of mental illness: Why?” [Review of The Emperor’s New Drugs: Exploding the Antidepressant Myth, by Irving Kirsch; Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America, by Robert Whitaker; Unhinged: The Trouble with Psychiatry: A Doctor’s Revelations About a Profession in Crisis, by Daniel Carlat]. New York Review of Books.
Louise Barrett. (2011). Beyond the Brain: How Body and Environment Shape Animal and Human Minds. Princeton, NJ: Princeton University Press.
Kleinman, Arthur. (2012). “Medical anthropology and mental health: Five questions for the next fifty years.” In M. C. Inhorn & E. A. Wentzell, Medical anthropology at the intersections (pp. 116–128). Durham, NC: Duke University Press.