I spent most of my junior year of college consumed with terror. Most days, I would waste hours ruminating on the possibility of contracting a suite of embarrassing infections, after which I would visit the library or the internet to feverishly study said infections—indeed, researching with more rigor than I ever did for classes—in an effort to disprove my fears. The cycle was, as you might imagine, vicious; as soon as I had received my warming but transient assurance, I found reasons to seek it anew. The source of my dread shifted by the month (a wretched disease, social humiliation, hurting loved ones, etc.), but such fears were always animated by the idea that the event in question would render my life unbearable. I was sitting alone in a lightless townhouse when the irony occurred to me that I had already made my life unbearable. I felt bored out, exhausted in some final sense. I called my mother, who worked at a hospital near my college, and asked her to take me home. Not long after, I darkened the door of my first therapist.
I would learn that my tendency had a name—obsessive-compulsive disorder—and that I had carried this sickness since childhood. My problem is that I seek control where I have little or none. A part of me sincerely believes that knowledge is a form of power; that to learn about the horrors for which I am destined is a way of preempting them. OCD is a disease of logic, for I am at my most impeccably logical when I am charting the series of misfortunes that could spell my end. (Foucault: “The marvelous logic of the mad which seems to mock that of the logicians because it resembles it so exactly.”)
I spent the next decade in and out of treatment. It made sense to me, even if only metaphorically, to call the worst experiences of my life symptoms of a disease. There was a certain relief in diagnosis, in seeing the dim chamber in which I had punished myself for decades suddenly flooded with light, its every torturous implement neutralized in the gaze of science. I realized that the paranoia, shame and despair that ruled my daily experience were not stark features of existence but of my broken mind.
Still, I was a strangely reluctant patient. I had finally found the opportunity to exorcise myself of my illness, and yet I could not suppress the suspicion that I was making a mistake. I feared that therapy would destroy a condition that had given me unique insights about the human experience and the derangement of society—insights that are closed off to those of healthy mind. Because I thought of myself as a writer, the worst agonies seemed like they could be transmuted into art and, ultimately, social reward. Even today, it is not unlike me to define my suffering as something you will never taste. These are the perverse gifts of my illness, and they are mine.
How had I wandered into the vice of valuing my greatest source of pointless suffering, and was there another way to relate to it? In time, I would understand that my double bind was a reflection of the broader sensibilities that my generation used to reconsider mental pathology. During the very years I grappled with my own illness, these sensibilities would converge in a social movement called “neurodiversity,” which married our widely held notions of egalitarianism, social justice and meritocracy in a limited but successful renegotiation between the “neurally divergent” and the societies they belong to. Was it possible that what much of society viewed as a curse could in fact be a gift?
The Transmutation of Mental Illness
In the late 1990s, a student at the University of Technology Sydney named Judy Singer wrote an important but muddled thesis that would become the founding document of the last emancipatory movement of that century. “Odd People In” was a polemic that announced a divide between “neurotypical” people and those living with conditions like Asperger’s, as Singer herself did. Although the term “neurodiversity” never appeared in her paper, Singer is generally credited with minting the portmanteau—later popularized by writer Harvey Blume—and for beginning the global challenge to the prevailing “neurologic hegemony.”
Singer identified a new social consciousness among a coalition of “misfits,” whom she described as the “brainy but socially inept nerds at school, the pedants who defy all attempts to divert them from their special interests … those people who hover frozen and blinking at the edges of conversations.” This growing autistic community existed, at the time, almost exclusively on the internet (“a prosthetic device” for “socially-unskilled autistics”), where it spent the 1990s cultivating both “neurological kinship” and a set of new political and cultural ambitions.
Because neurodiversity integrated elements of neuroscience and human genetics into its understanding of mental conditions, Singer expected the movement to remain open to the possibility of scientific medicine enhancing human life—an openness that was often absent in the leftist academic thought that buttressed the movement’s social critique. She saw a cautionary tale in the dogmatism of disability rights theory:
It is not surprising therefore that disability rights theorists have in common a desire to supplant a perceivedly oppressive biological determinism with a hopefully liberating social constructionism. Concessions to the limitations and negative experiences of lived bodies, or acknowledgment of the benefits of medicine are so minimised, as to become almost invisible.
Though Singer labeled her effort a “synthesis,” it was truly a concession to contradiction. She knew how the rhetoric of medicalization had reinforced forms of oppression. But she also understood that much misery and disability are not consequences of social hegemony or state capitalism. Some degree of suffering is intrinsic to the human experience, and its cruel excess in certain lives should be ameliorated when possible through drugs, training and therapy.
What is widely regarded as the seminal narrative of neurodiversity featured the software engineers and programmers who had flocked to California in the early Aughts. In a short time, the state saw a rise in the diagnoses of Asperger’s and autism that some psychologists and teachers suspected was not entirely attributable to shifting diagnostic criteria. In 2001, the explanation offered by Steve Silberman in “The Geek Syndrome,” published in Wired, was that the labor market of Silicon Valley selected for a kind of personality and skill set that happened to coincide with Asperger’s. The social calculations of the tech firms were stated openly in the business press, where articles like “Neurodiversity Is a Competitive Advantage” mirrored the PR efforts of corporations like Virgin and Microsoft to portray “neurodiverse individuals” as untapped resources. Mental illness had become a kind of human capital.
This transformation required from society only minimal adjustments, which, once made, rendered a new cohort fully available to social and economic activity. But this dazzling alchemy would founder when adherents applied the precepts of neurodiversity to other conditions. Although autism was neurodiversity’s first preoccupation—indeed, its poster child—the movement harbored the seedlings of a more radical intellectual program: the dissolution of the purportedly false dichotomy between “normal” and “abnormal” psychology. Thus one can find in popular media and academic literature a host of wildly different conditions corralled within neurodiversity: dyspraxia, dyslexia, dysnomia, bipolar disorder, sociopathy, schizophrenia, ADHD and many others.
Psychiatrist Thomas Armstrong, in his book The Power of Neurodiversity, has argued for the inclusion of anxiety disorders, including OCD, by postulating that these conditions appear “to be in the gene pool because [they] served some important function in evolution.” OCD, for example, has been documented to have a “unique connection to a wide range of religious rituals,” when the disorder found its proper “niche” in society. It follows, for Armstrong, that those living with OCD today must “channel their worries into constructive pathways,” through which they may contribute to society and foster a career.
Yet Armstrong, whose encomiums to neurodiversity are usually quite explicit, is frustratingly reticent as to what these “pathways” might be. (He only mentions that his father, a physician, likely excelled at medicine because of his obsessive cleanliness.) For more concrete examples of this “constructive” vision, we must turn to popular culture. Communications scholar Davi Johnson Thornton has noted, in an essay called “Managing Mr. Monk,” that for fictional characters with OCD the right pathway is often some form of investigative labor. Monk was a highly praised USA Network television series about a brilliant, obsessive-compulsive detective named Adrian Monk (played by Tony Shalhoub), who is always “yearning for reinstatement” into the police force that expelled him. Thornton observes that in the universe of Monk, imbued with “anti-stigma and neurodiversity rhetorics … madness is not an illness one has, but an identity one is, and each identity is valued as a unique manifestation of human possibility.” In Monk’s case, while OCD is a source of immense anxiety, it is “also the source of the amazing powers of perception that make him a brilliant and successful detective. Monk’s handicap is, in his own trademark phrase, ‘a gift and a curse.’”
This redeeming logic is iterated, albeit with more artistry, in Jonathan Lethem’s successful neo-noir novel, Motherless Brooklyn—adapted into a decidedly less successful film in 2019—about a detective with Tourette’s syndrome and OCD (the two conditions often coincide). Again, we see in the principal character, Lionel Essrog, that the source of his misery is also a careerist boon. The novel is replete with self-conscious observations on the usefulness of mental illness: Essrog explains his “popularity at wiretap” sessions because of his overweening tendency to focus: “give me a key list of trigger words to listen for in a conversation and I’d think about nothing else.”
But while the notion of the obsessive-compulsive investigator has a fabled elegance to it—whether his labor be detective, medical, academic or much else—it is preposterous to realistically consider. As Thornton usefully noted, the obsessive-compulsive occupies himself by “arranging a bewildering array of clues into a rational narrative,” but we should not forget that these narratives are almost always delusional and exaggerated. The obsessive-compulsive detective would, in truth, be something of a conspiracy theorist.
More importantly, this notion neglects that the engine of the obsessive-compulsive’s “investigations” is always terror. He thumbs rosary beads not out of faith but for fear of hell; he washes his hands raw—long before we were all doing so—for fear of disease and shame, not out of some prudent concern for public health. The chronic worrier would divert his neurotic energies into his career, then, only if he was, or became, desperately afraid of losing control over it. I for one am so frightened of professional failure that not a week passes when I fail to excoriate myself for my lack of productivity. Admittedly, I do believe that my self-flagellation has made me a more ambitious writer (another reason to regret losing the “gifts” of OCD to therapy), but if this is my OCD transfigured into a “talent,” then I fear we may have left the subject of “mental health” behind altogether.
The Sickness in Society
These other interactions between social order and mental illness were forgotten or ignored by the leading lights of neurodiversity, but they did not escape the “anti-psychiatrists” of the Sixties and Seventies. Whereas neurodiversity asked for adjustment so that the madman may slip between the gears of social operation, the anti-psychiatrists investigated the phenomenology of madness that these gears obscured, hoping to demonstrate that the liberation of the insane would come only with social metamorphosis.
Perhaps the most notorious of the anti-psychiatrists was Thomas Szasz, a Hungarian-American psychotherapist who in 1961 wrote the Myth of Mental Illness, a book that initiated Szasz’s losing battle against the idea that any personal dilemma could constitute an illness. The medicalization of his craft, Szasz believed, was a knight’s move over the inevitably moral character of psychiatry. An austere and repetitive writer, Szasz longed for a psychotherapy that fostered human dignity by presupposing free will rather than untenable determinisms, that emphasized the individual even as it acknowledged how constrained he is by society.
His critique begins in observing that “disease” has a technical definition—“a pathological alteration of cells, tissues or organs”—that, as an etiological standard, mental illness has never satisfied. He is correct: what we call mental “illness” is a metaphor for phenomena residing outside of medicine per se, and when we forget this we make a grievous category error. “This is what happens,” Szasz wrote, “when explanatory metaphors are mistaken for the things they are supposed to explain.”
This confusion was exemplified in “hysteria,” a now obsolete diagnosis that was commonly given to women in eighteenth-century Europe before Jean-Martin Charcot redefined hysteria, in the late 1800s, as a neurological disorder. The brain supplanted the uterus as the faulty organ, and hysteria was soon shown to more commonly affect men. For Szasz a somewhat strategic example, hysteria was a particularly ludicrous diagnosis—characterized by insomnia, fluid retention, irritability, decreased appetite, anxiety, fainting and much else—that betrayed its function to pathologize the grievances and needs of women.
The story of hysteria marks the beginning of a troubling pattern in the history of psychiatry. Doctors routinely treated diseases of the mind with powerful, bizarre, often harmful therapies—pelvic massage, lobotomy, electroshock therapy, good old-fashioned tranquilizers—that promised to free the patient from their experience of madness by muting or destroying it, with the side effect of subduing the patient’s socially forbidden behavior (the real purpose of such therapies, in Szasz’s mind.) But if psychiatrists were nothing more than enforcers of social norms, then what of the symptoms that brought patients to the good doctor to begin with? Szasz does not quibble: mental patients are not only mistaken but lying, faking it, malingering—albeit for profound and often unconscious reasons.
Szasz explained mental illness with a structuralist approach to the communication between patient and therapist; he believed people visit psychiatrists to engage in a social transaction, not to seek treatment. The patient, who struggles to express certain sentiments (rage, humiliation, shame) wants certain things from his therapist (assurance, absolution, social recognition.) And because patients are often socialized in ways that make frank discussion difficult, they may choose to adopt certain idioms and social roles—say, the symptoms of hysteria—as a vehicle for communicating their otherwise ineffable distress.
For Szasz, what we call mental illnesses are in truth “problems in living” that have political and moral dimensions that patients communicate indirectly. The proper task of the psychotherapist, therefore, is to make the patient aware of the social determinants of their behavior, to translate the fraudulent idiom of mental illness into the languages of ethics and politics. The psychotherapist will, without ever imposing their own values, help the patient understand his desires and ambitions, as well as the resistance, legitimate or not, that he can expect from society.
But are schizophrenics lying about their widely reported auditory hallucinations? Are those suffering from depression not actually experiencing a form of despair that others are spared?
However dimly, Szasz knew that the rigid positivist standards he used to deny the experiences of the insane would also undermine his theory that they were lying as part of a social strategy. He conceded that evidence for this theory would have to be “scientific rather than social.” “It will be necessary to perform certain ‘operations’ or ‘tests,’” he wrote, “to secure more information on which to base further inferences.” What these operations or tests are he does not say; one suspects because they’ve never existed.
Szasz’s theoretical program could have coexisted with the idea that mental illnesses are not “diseases” in the technical sense but useful heuristics for capturing the varieties of exorbitant suffering among human beings. And yet his alternative psychotherapy exhibits many of the flaws of the befuddled psychiatry he despised. Szasz believed the modern psychiatrist’s urge to analyze had masked his need to moralize, to set the patient right without ever inquiring into her own values and ambitions. Yet how a psychotherapy that assumed its patients were coercive liars would avoid this failing is unclear. Szasz had indeed demonstrated the moral nature of psychiatry, in part by revealing its unavoidable paternalism.
Anti-psychiatry both emerged and dissipated during the Cold War, which prompted the observation that the same societies that passed judgment on the mad had so rationally brought the world to the verge of nuclear holocaust. It was during this cultural moment that mental illness was reconfigured as a rare effulgence of sanity in a dark age—a sort of neurocognitive ressentiment. This would be remembered as one of the central gestures of anti-psychiatry, and it is largely attributable to the work of R. D. Laing, a Scottish psychiatrist who in 1967 published The Politics of Experience and The Bird of Paradise. Like Szasz, Laing believed modern psychiatry was an enterprise that too often lost track of its metaphors. In opposition to Szasz, however, Laing sought to revise psychiatry by placing the subjective experience reported by the patient at the center of analysis.
To treat a human being as if they were an object of study—a mass of tissue exhibiting certain signs—was to forget the essential “interexperience” that exists between all human beings, including the therapist and her patient. The therapist does not experience the patient’s experience, but rather experiences the patient experiencing her, and experiences herself experiencing the patient. This gets as convoluted as you like; Laing’s larger argument is that the human subject can be accessed only in these endless refractions of experience. Any “objective” mode of inquiry (which, for Laing, is always a conceit) will lose sight of the inextricable link between experience and behavior.
Laing believed the distinction between the inner world of the mind and the outer world of objects—which had long ago become folk wisdom—allowed us to artificially restrict the domain of imagination. The social function of this restriction was to consign certain experiences to the category of “nonbeing,” a term that conveyed the extent to which our inner experiences were neglected, repressed or shunned. We hear the judgments, complaints and insults of others within our minds as a means of managing our conduct and thinking, and we often attempt to induce precisely this effect in others. Laing called this a “dynamism divorced from the individuals,” which he illustrates in a series of plausible situations:
John and Mary have a love affair, and just as they are ending it Mary finds she is pregnant. Both families are informed. Mary does not want to marry John. John does not want to marry Mary. But John thinks Mary wants him to marry her, and Mary does not want to hurt John’s feelings by telling him that she does not want to marry him—as she thinks he wants to marry her, and that he thinks she wants to marry him.
When the parents of John and Mary enter the picture, the emotional dynamics get complicated, but Laing’s basic point is how alienated this entire tableau is from the immediate desires of the individuals who compose it. (Would it be difficult to imagine John and Mary together for decades before realizing that neither of them ever wanted marriage?)
Laing seemed ambivalent about whether the great alienation of the human creature could ever be remedied, but he believed that if psychotherapy was to help it must become “an obstinate attempt of two people [patient and therapist] to recover the wholeness of being human through the relationship between them.” Notice this paradigm does not revolve around treating the insane. This is because the mad are seen as refusing to play the social games that “normal” people engage in. In interpreting the case studies of schizophrenics, Laing argues that schizophrenia manifests in an individual as a result of society’s “extremely disturbed and disturbing patterns of communication.” “Experience and behavior that gets labeled schizophrenic is a special strategy that a person invents in order to live in an unlivable situation,” he observes. It can be characterized as a retreat into the “total inner space and time” that we have taught ourselves to avoid at all costs. (Some of these people return to us; some remain forever inside.)
Laing’s psychotherapist should encourage schizophrenics and psychotics “to go mad”—an experience Laing described as one of subjective absorption, immortality, eternity and ego death—before bringing them back into the “outer” world, where we await the wisdom they have won from their journey. The psychiatrist, in other words, becomes a literal soul doctor, a shaman, while going insane becomes a ceremony that marks the human being’s passage from “cosmic fetalization to an existential rebirth.”
Those who find such notions irresponsible would have found good company in Laing’s heyday. Indeed, the only anti-psychiatrist whose reputation has fared worse than Laing’s is that of L. Ron Hubbard. Though Laing denied he “idealized” mental illness, it’s hard not to get that impression from his work. Even if one accepts that mental illnesses are strategies for surviving in a troubled world (I believe many of them are), it does not follow that the strategies themselves are manifestations of sanity, wisdom or spiritual preservation. Laing inverted our idea of mental illness, emptied it out and studied its vessel for the deformities of society. He believed, falsely, that this beckoned a revolutionary form of psychotherapy. In fact, even if it had been possible to put these practices into place, they almost surely would have ushered in new regimes of human misery and dysfunction.
Nevertheless, his insight that mental illness has some social significance remains worth recovering at a time when the practical wisdom approaches the other extreme: today, if you kvetch about society during therapy, it will likely be registered as a manifestation of your personal neurosis. For all their differences, Szasz and Laing agreed that whatever we meant by mental illness required an examination of how individuals related to society and power, a principle best articulated by Szasz: “The laws of psychology cannot be formulated independently of the laws of sociology.”
The New Politics of Experience
“Certain difficulties inherent in the very nature of culture,” Freud wrote, “will not yield to any efforts at reform.” The competing schools of anti-psychiatry and their inheritors in the neurodiversity movement are, in effect, attempting to distinguish which of those social difficulties will bend to correction and which will not.
Szasz banished the phenomenology of madness, and with it, the social legitimacy of psychiatry. Unwittingly, he revealed the false antagonism between therapy and social reform. He argued that conventional psychiatry was often merely a way of reinforcing the expectations of the current social order, and he was correct. As opposed to a fatal criticism of psychiatry, however, this might just as easily be received as a description of a practice that was designed to help imperfect individuals live in an imperfect society. It is no surprise that, to the extent that they endeavored to supplant conventional psychiatric practice, the anti-psychiatrists failed without exception. Their fatal flaw was to proffer new psychotherapies that vied for the wayward mind of the individual, even if their intellectual vigor had been expended upon the idea that society was a crucial element in the variegated equation of mental health.
In its youth as a movement, neurodiversity was disciplined by notions of “competitive advantage” that emerged in the postwar tide of globalization and neoliberal economics.
As we have seen, though, the central ambition of neurodiversity breaks against the reality that many mental illnesses, including severe forms of autism, will simply not be socially useful as this utility is presently defined. Yet for the neurodivergent, treatment and social reform may seem so antagonistic in part because the warnings of the anti-psychiatrists were not respected. Szasz, a libertarian to his bones, stridently opposed the infantilizing tendencies of the psychiatric institutions sanctioned through state power. Laing believed both mental illness and the oppressive behavior of civilization were symptoms of a deep problem in our socialization, invariably originating in the nuclear families that raise the modern child.
Though their political suggestions were overwhelmingly ignored, the basic social critique within anti-psychiatry continues to bear fruit today, especially for a resurgent left hoping to emphasize the material conditions underlying mental illness. In Capitalist Realism, the British anti-capitalist commentator Mark Fisher chided the anti-psychiatrists for fixating on “extreme mental conditions” as opposed to the “politicization of much more common disorders,” like mood, anxiety and substance abuse disorders. In these diseases, the defects of the prevailing social and economic systems are “neurologically instantiated” in the individual. Fisher writes, “The ‘mental health plague’ in capitalist societies would suggest that, instead of being the only social system that works, capitalism is inherently dysfunctional.”
Today, Fisher’s call for “repoliticizing mental illness” has been heeded from all kinds of ideological quarters. Even Jonathan Haidt and Greg Lukianoff’s prosaic diagnosis of campus illiberalism, The Coddling of the American Mind, acknowledges that the rise of anxiety and depression among Gen Z is more attributable to the “rapid spread of smartphones and social media” than to the “culture of safetyism” they first thought to blame. Johann Hari’s “Lost Connections” rebukes the impoverished notion that anxiety and depression are fundamentally neural diseases; instead, Hari argues, the causes of those ordinary woes can be found “largely in the world, and the way we are living in it.”
I have observed how the bellicose demands of my own illness resemble the central directive of the deregulated liberal economy. To me, America often seems a frenzied agora, where the market efficiently serves our urges to control. (We may ship our DNA to a company that will foretell the maladies that will eat us from the inside, even as we fill our phone with apps monitoring every aspect of daily existence.) To see how the gnarled forest of my personal anguish has its roots in civilization provokes intellectual exhilaration and, especially, catharsis. Yet I have also noticed that the kind of thinking that would attribute my suffering to any social order was therapeutically useless, if not detrimental. One remembers that Mark Fisher was plagued by crippling depression for most of his life, a self-hatred tellingly centered around his meandering career and the conviction that he was “literally good for nothing.” Fisher’s ideas arguably anticipated the recent social analyses of mental illness, but they were not enough to save him. (He committed suicide in 2017.)
I accept that healing is my responsibility alone, but I also suspect that it will necessitate rejecting the aspects of social life that exacerbate my sickness. What perhaps distinguishes my condition is the extent to which I believed that I could dispel any limitation the world placed upon me—along with the suffering that came with learning, in endless cycles, that this is simply not the case. You could say that my susceptibility to our collective delusion is indeed a talent, or a gift. But all gifts are first given, and this is one I do not intend to keep.
Image credit: Yumi Krum (CC BY / Flickr)