Deconstructing Crazy

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SECOND THOUGHTS

Mad, bad, and dangerous to know.

– Lady Caroline Lamb on Lord Byron

In the 19th century, the most common expression for irrationality and insanity was “madness,” as the English poet Lord Byron’s lover attested. In this century, it is probably “crazy”—which we will get to shortly. But what exactly did Lady Caroline Lamb mean? She seems to have made sure she covered several possibilities—not just mad but bad—and dangerous to boot. And today, “crazy” seems to cover all of them, which is why we need to deconstruct its meaning.

Another late 19th century figure of English literature, Samuel Butler wrote a novel called Erewhon (“nowhere” backwards) that is classified as utopian fiction.¹ We can also read it as a satire on Victorian British society and a visionary attempt to extrapolate Darwin’s evolution to the industrial revolution to imagine machine consciousness and self-replicating machines. His themes could be ripped out of today’s headlines.

As a psychiatrist, however, the most provocative idea in Erewhon is the satirical reversal of attitudes to crime and illness. In Erewhonian law, offenders are treated as ill and sick individuals are treated like criminals. Either way, Lady Caroline Lamb had Byron covered! In Erewhon, Butler portrays this reversal with scenes of neighbors visiting the family of an offender with flowers and condolences while someone who falls ill is treated with avoidance and scorn. Nothing in the entire utopian/dystopian genre since Thomas More’s Utopia (“nowhere” in Greek, published in Latin in 1516)² is more striking than this reversal of values, reminiscent of German philosopher Friedrich Nietzsche’s “transvaluation of all values”³ and recalls George Orwell’s Newspeak in Nineteen Eighty-Four where everything is the opposite of its ascribed name.⁴ The Ministry of Truth, for example, is concerned with lies.

“The Trickle-Up Effect”

In English today, we use the word crazy much more often than mad in an expansive popular take on “madness.” And like the reversals in Butler’s and Orwell’s dystopias, crazy can now be a term of derision and dismissal, condescension and disqualification on one hand, or on the other hand, approval, even praise, and an invitation to a different, transgressive way of being (eg, the songs “Crazy” by Seal and “Let’s Get Crazy” by Prince).

Two things are top of mind in this series and they are both very American. The first, which I enjoy, is America’s secret cultural strength: how things bubble up from lower classes, from the street to mainstream culture. “Bottom up” instead of “top down” like the European culture of symphonies and operas. Think about the music that spawned from the American underclass and its marginalized groups: New Orleans’ ragtime, jazz, blues, rhythm and blues, rock’n’roll, and Detroit’s Motown and New York’s hip-hop. Think about Hollywood’s noir films that went from B movies to cult classics. Think about lowrider culture in East LA. In the opposite of trickle-down economics, we can call it the “trickle-up effect.” The incarnation of the American dream.

One of the striking things about my professors of philosophy is their marriage of high and low culture. Not just analyses of Greek myths like “Antigone” (one of my favorites) or Verdi’s opera “Aida” (another favorite) but English rocker David Bowie (Simon Critchley),⁵ Russian feminist protest group Pussy Riot (Slavoj Žižek),⁶ and Valerie Solanas’ radical feminist “SCUM Manifesto” (Avital Ronell).⁷ Slavoj Žižek edited a book called Everything You Wanted to Know About Lacan (But Were Afraid to Ask Hitchcock) where Hitchcock’s thrillers are used to explore concepts in Lacanian psychoanalysis.⁸ Simon Critchley has a column on philosophy called “The Stone” in The New York Times and has participated in and written about the punk movement in England.

The queen of this approach is Avital Ronell at New York University, who was a student of Algerian French philosopher Jacques Derrida, and applies his deconstructive method to popular culture. She investigates things that appear in the margins like the “SCUM Manifesto”⁷ and the everyday notion of “stupidity”⁹ which is like a “black hole devouring the light of rationality” (as a reviewer wrote). In this way, Ronell takes on the “repressed conditions of knowledge” and makes them accessible and relevant for the mainstream and for philosophy.

“Crazy Like Us”

The second thing is more equivocal and that is how America exports its culture worldwide in what political scientists call “soft power.” Hollywood movies, American music from rock’n’roll to hip hop, fast food (see my column on fast food and slow thought), and how we imagine health and mental health. American journalist Ethan Watters describes this in his book, Crazy Like Us: The Globalization of the American Psyche.¹⁰ In it, Watters points to the rise of anorexia in Hong Kong, the American invention and spread of posttraumatic stress disorder, and other cases. I would argue that not only does the West’s most powerful centripetal culture dominate psychiatry and mental health worldwide, but that its fads, obsessions, and blind spots get exported along with our best intentions.

Going Deep by Staying Shallow

In this new series in “Second Thoughts,” I will explore what we mean by crazy through popular culture (going deep by staying shallow) and the humanities (cinema, history, literature, philosophy)—all with a psychiatrist’s eye. And how the reciprocal relationships between American psychiatry and popular culture create a product that gets exported around the world. The Global Mental Health Movement may have started elsewhere but it is now fully embraced by academic psychiatry and funding sources in Canada and the US, and my North American colleagues are spreading this with messianic zeal.¹¹

We are going to have some fun with this. Yet, just in case you think it is not serious, we will also revisit the anti-stigma campaigns that I see as part of social psychiatry’s “public works projects.”^12,13 And we will try to understand the push by those who call themselves “progressives” towards the enlightenment project of progress through rationality and science.¹⁴ My question about that is:

When did science (and a narrow and restrictive notion of science at that) become the measure of all things?

For there is a dark side to this progressive rationalism in which we see a general intolerance for what is subjective and irrational. As Neil Postman, America’s foremost critic of education and media put it in his masterful polemic Technopoly, defined as the surrender of culture to technology, “Technopoly is at war with subjectivity.”¹⁵

The real intolerance towards those with mental illness, in my view, is not that we are ill-informed or prejudiced (we are, including psychiatrists, sometimes). Rather, that there is no room in a society dominated by technology and a narrow view of science for real diversity and subjectivity, not to mention eccentricity, playfulness, and satire. No amount of political correctness about the neurodivergent has really moved the needle on public acceptance of diversity. Individuals on the autistic spectrum have become the object of comedy (think of Sheldon Cooper, the eccentric genius of “The Big Bang Theory” TV series).

As a social philosopher, “crazy” offers an apparatus or tool to study how ideology takes root to colonize the popular imagination, creating hegemony with this fluid yet pernicious cultural category. I will define these key words. As a psychiatrist, “crazy” (and “insane” which may be more offensive) overlaps imperfectly with the subject of psychiatry. Schizophrenia, coined by Eugen Bleuler, MD, in 1908, is the medical psychiatric version of “crazy.” As the central psychiatric term of the 20th century, schizophrenia has been called “the sublime object of psychiatry.”¹⁶

Along the way, we will examine French philosopher Michel Foucault’s Madness and Civilization¹⁷ (which may well be the trigger that made me want to become a psychiatrist after Marcel Lemieux, MD, introduced me to him 50 years ago [see my column: “The Revolving Door”]) and other histories of psychiatry and madness. We will separate 3 histories: the history of psychiatry, the history of the social and cultural construction of madness (which is what Foucault attempted), and finally, the history of the lived experience of madness which has been undertaken by the social sciences, historians, and humanists, with very limited results. What is new and refreshing in this is the voice of individuals experiencing mental, relational, and social suffering themselves.

We will also revisit Derrida’s deconstruction¹⁸ and other tools for doing philosophical archaeology,¹⁹ digging down deep into our cultural origins to root out how we came to think and feel the way we do about something like “crazy.” Finally, beyond deconstruction, we desperately need a philosophy of madness, and we will review the dense work of Wouter Kusters, a brave Dutch philosopher and linguist who offers just that.²⁰ (See his interview in Psychiatric Times here.)

My next column will take on a popular view of “crazy.” “Crazy, manic, twisted, suicidal, psychotic”—this is a view of psychiatry through one of the most important vehicles of culture in our time: popular music. Or, Everything you wanted to know about crazy, but forgot to ask your DJ. Get ready for “Help!” (The Beatles), “Suicide Is Painless” (the M.A.S.H. theme), “Manic Depression” (Jimi Hendrix), “19th Nervous Breakdown” (The Rolling Stones), and “Psychotic Reaction” (The Count Five).

Resources

To prepare for a deep dive into popular culture through music, I recommend reading 2 brilliant musicians, one who changed “modern song” and the other who changed how we understand “your brain on music”:

• Bob Dylan. The Philosophy of Modern Song. Simon & Schuster (2022). See Chapter 51: “I’ve Always Been Crazy – Waylon Jennings.” Mr Dylan won the Nobel Prize in Literature (2016), both an Academy Award and a Golden Globe Award for Best Original Song (2001), and 11 Grammy Awards, including the Lifetime Achievement Award (1991), and was inducted into the Rock and Roll Hall of Fame (1988).
• Daniel J. Levitan. This Is Your Brain on Music: The Science of a Human Obsession. Dutton/Penguin (2006), and The World in Six Songs: How the Musical Brain Created Human Nature. Dutton/Penguin (2008). Dr Levitan is a musician, record producer, cognitive psychologist, and neuroscientist at McGill University. His achievements range from having produced platinum records by Stevie Wonder, Eric Clapton, and Steely Dan, to being elected a Fellow of the American Association for the Advancement of Science and the Royal Society of Canada.

Dr Di Nicola is a child psychiatrist, family psychotherapist, and philosopher in Montreal, Quebec, Canada, where he is professor of psychiatry & addiction medicine at the University of Montreal. He is also clinical professor of psychiatry & behavioral health at The George Washington University and president of the World Association of Social Psychiatry (WASP). Dr Di Nicola has received numerous national and international awards, honorary professorships, and fellowships. Of note, Dr Di Nicola was elected a Fellow of the Canadian Academy of Health Sciences (FCAHS), given the Distinguished Service Award of the American Psychiatric Association (APA), and is a Fellow-Elect of the American College of Psychiatrists (FACPsych). His work straddles psychiatry and psychotherapy on one side and philosophy and poetry on the other. Dr Di Nicola’s publications include: A Stranger in the Family: Culture, Families and Therapy (WW Norton, 1997), Letters to a Young Therapist (Atropos Press, 2011, winner of a prize from the Quebec Psychiatric Association), and Psychiatry in Crisis: At the Crossroads of Social Sciences, the Humanities, and Neuroscience (with D. Stoyanov; Springer Nature, 2021).

Acknowledgements

This new series on “deconstructing crazy” is based on my show idea and song list for an episode of “Randy Bachman’s Vinyl Tap” on CBC Radio which aired on January 9, 2011. Mr Bachman was the lead guitarist for the Canadian musical groups The Guess Who and Bachman-Turner Overdrive (BTO). And here’s a shout-out to my philosophy professors at the European Graduate School—SlavojŽižek, Simon Critchley, and Avital Ronell, all also associated with New York University—who seamlessly integrate high and low culture.

References

1. Butler S. Erewhon: Or, Over the Range. Trüber & Ballantyne; 1872.
2. More T. Utopia, Dolan JP, trans. In: Greene JJ, Dolan JP, eds. The Essential Thomas More. New American Library; 1516/1967.
3. Nietzsche F. The Antichrist. 2nd ed. Mencken HL, trans. Alfred A. Knopf; 1918.
4. Orwell G. Nineteen Eighty-Four: A Novel. Secker & Warburg; 1949.
5. Critchley S. Bowie. expanded ed. Serpent’s Tail; 2016.
6. Žižek S, Tolokonnikova N. "Nadezhda Tolokonnikova of Pussy Riot's prison letters to Slavoj Žižek". The Guardian. Archived December 13, 2016. Accessed November 20, 2024.
7. Solanas V, Ronell A. Introduction. SCUM Manifesto. Verso Books; 2004.
8. Žižek S, ed. Everything You Wanted to Know About Lacan (But Were Afraid to Ask Hitchcock). New & Expanded Edition. Verso Books; 2010.
9. Ronell A. Stupidity. University of Illinois Press; 2002.
10. Watters E. Crazy Like Us: The Globalization of the American Psyche. Free Press; 2010.
11. Cohen A, Patel V, Minas H. A very brief history of global mental health. In: Patel V, Minas H, Cohen A, Prince MJ, eds. Global Mental Health: Principles and Practice. Oxford University Press; 2013:3-26.
12. Arboleda-Flórez J, Sartorius N, eds. Understanding the Stigma of Mental Illness: Theory and Interventions. Wiley; 2008.
13. Di Nicola V. “A person is a person through other persons”: a manifesto for 21st century social psychiatry. In: RR Gogineni, AJ Pumariega, R Kallivayalil, et al, eds. The WASP Textbook on Social Psychiatry: Historical, Developmental, Cultural, and Clinical Perspectives. Oxford University Press; 2023:44-67.
14. Pinker S. Rationality: What It Is, Why It Seems Scarce, Why It Matters. Viking; 2021.
15. Postman N. Technopoly: The Surrender of Culture to Technology. Vintage; 2011.
16. Woods A. The Sublime Object of Psychiatry: Schizophrenia in Clinical and Cultural Theory. Oxford University Press; 2011.
17. Foucault M. Madness and Civilization: A History of Insanity in the Age of Reason. Vintage; 1973.
18. Derrida J. Writing and Difference. Bass A, trans. University of Chicago Press; 1978.
19. Agamben G. Philosophical archaeology. The Signature of All Things. D’Isanto L, Attell K, trans. Zone Books; 2009:81-111.
20. Kusters W. A Philosophy of Madness: The Experience of Psychotic Thinking. MIT Press; 2020.