Aren't we all insane?

Schizophrenia also has negative symptoms, not just the positive/florid symptoms that some people may tend to think of; things like lack of motivation, flattening of mood, etc. Schizophrenia isn’t even a single condition with a single set of diagnostic criteria (at least seven types, before you even think about schizo-affective disorders). Disease is a concept that changes over time and may have no real existence in itself; people used to be locked away in asylums because they suffered epilepsy or because they exposed themselves in public. Psychiatric disorders are usually diagnosed through the patient’s subjective experiences, and the value judgements of those making the diagnosis. I can’t provide figures for the number of successful appeals against compulsory detentions, but the fact remains that appeals are successful. Two different doctors might make different diagnoses of the same individual; the same doctor might make two different diagnoses on two separate admissions of the same individual.      

The anti-psychiatry movement that peaked in the 1960s questioned the empirical approach and the medical model, and although its main ideas have subsequently been discredited the movement did raise valid and interesting ideas. Normality is enforced conformity; labelling people as ‘mentally ill’ is a device that society uses to maintain order; society stigmatises the individual and adds to his problems. Glaswegian psychiatrist R. D. Laing viewed illness as ‘the reality which we have lost touch with’ and he even advocated the use of recreational psychedelics. Laing stressed social and environmental factors; symptoms weren’t markers of illness but reactions to stress, e.g. the double bind theory, when one parent says a child is good and the other says the child is bad. The child cannot decide on behaviour, the family can be viewed as dysfunctional and in the broader sense so as can society itself. We all carry concepts of one another, of how we see others and expect others to see us, and here Laing was influenced by the existential philosophy of the likes of Jean-Paul Sartre. For Sartre the ‘self’ is not constant, we adopt different roles and the Superego acts as a filter in restricting our drives. Sartre described the self-deception of ‘bad faith’ where one denies one’s freedom to choose, instead of being true to our own selves.

This ties in with the work of Erving Goffman who defined stigma as ‘the process by which the reaction of others spoils normal identity’. We all put on an act in social interactions to make desired impressions on others. Goffman commented on the segregation of the mentally ill, subject to different rules from society. Russell Barton developed Goffman’s ideas on the ‘wharehousing’ of people and coined the term ‘Institutional Neurosis’ where individuals are robbed of all individuality, inability to make decisions/plan ahead. As recently as thirty years ago there was the phenomenon of ‘schizophrenic trousers’, i.e. schizophrenic patients in long-stay institutions were noted to wear trousers that were too short in the leg, hence ‘schizophrenic trousers’. Of course this says more about society, about the standards of care and the prevailing attitudes to these people at that time. And even today, nanny society seems to want us all to fit in as ‘good patients’.