It Is Not A Privilege To Be Mad

The Birth of Hyper-normal

Mad Men

I n a more naive time, say in the age of Kennedy, the madman, mentally ill, and psychopath, still gave rise to the images of someone abnormal who was foaming at the mouth with wild eyes. Today, in the age of Trump, madness is no longer so visible and has become so intertwined with our contemporary mores that far from being abnormal, it is hyper-normal and best personified by a CEO with a nice smile and suit.

This is a story of my own personal experience of the emergent hyper-normality, its conflict with the old psychiatric classifications of abnormality, madness and mental illness, and how it shaped my work in mental institutions both as an intern and at the place of a patient. If I have chosen to publish this on Medium, it is to landmark a more modern orientation that addresses the problem of madness and mental illness in a way other than those usually found in the mass medias ( see Psychosis? Hearing Voices is Normal Today and Decentralizing Depression).

T here are hundreds of articles on Medium and elsewhere that tell of people being mad, psychopaths, mentally ill, etc. Indeed, many authors dealing with such questions today in their personal life self-identify and say, “My name is Mr. So and So, I have clinical depression, and not ashamed of being mentally ill”, “My Life as a Psychopath”, “How I Went Mad”, etc.

Yet, to my ears, the use of the terms ‘mad’, ‘psychopath’, and ‘mentally ill’ come from a more naive age. Or maybe there are just places in the world that are stuck in a time warp.

For when someone like ‘the Donald’ can be elected president by a large percentage of the U.S., when a person occupying one of the highest and most respected positions in the country can be accused of being mentally ill, mad, and a psychopath, does it really make sense to call anyone else so? I mean if the bar of sanity has been set so low in the most respected public institutions what gives anyone, an expert or otherwise, the authority to call him/herself or someone else mad? Or does it take a special privilege to do so?

Bob Woodward’s new book Fear in the White House describes the Trump administration as “having a nervous breakdown”; Trump’s former lawyer John Dowd is cited advising Trump not to testify in the Mueller investigation or he would be in an “orange jump suit”; Trump’s Chief of Staff John Kelly calls the administration “Crazytown”, while Trump calls his Attorney General Jeff Sessions “mentally retarded”, etc. No doubt, in the past there may have always been such name calling and insinuation of criminality and mental illness around other world leaders, but what makes it different today is that such language would be accepted either as business as usual and normal or worse, an inertia of ‘fake news’ that nobody can control.

This is not a partisan argument, for the current president is just one example among others. Choose any other mask from the gallery of current day politicians to suit your fancy: Ted Cruz, Hillary Clinton, Sarah Palin, etc. And the same questions are often asked: Are they crazy? Have they gone mad? Or is this fake news?

Yet, the good news is that when the bar of sanity has been set so low in public, nobody need fear being classified as mad, mentally ill, or a psychopath.

For even the psychiatrist’s bible, the DSM-V (Diagnostic Statistics Manual) does not mention mad once, the term psychopath is replaced by APD (Asocial Personality Disorder), and mental illness with mental disorder.

So what is this special privilege that allows people to self-identify as insane or call others mad? What is the disconnect between everyday language and the medical terminology? Especially since the official DSM codebook of not only doctors but insurance companies does not even reference the terms. Trying to get a doctor to admit anyone is mentally ill is difficult enough, but try to get reimbursed for being a psychopath or mad from from your insurance company and see if your request does not fall on empty ears.

Is this change in vocabulary and disconnect from every day language merely linguistic or is it evidence of a more fundamental paradigm shift?

1. If the change/disconnect is merely linguistic, then we can continue to speak as if there were people who were mad, psychopaths, and mentally ill, while knowing this everyday vocabulary is just a cultural and folkloric way of expressing a more biologically based medical terminology.
2. But if the change/disconnect is not merely linguistic, but indicative of a change brought about in the accomplishment of 20th century psychopathology ( the scientific study of mental illness), then we should draw our attention to what this transformation entails, what is its function, and field of operations.

This writing takes the second response to the question. It aims to show why the switch/disconnect of vocabulary is not merely terminological, but evidence of a transformation that occurred in the last century that was so profound that the treatment of mental illness in the U.S. and abroad would never be the same.

So why are people today so self-assured in self-identifying or calling others mad, mentally ill, or psychopathic? The reason is simple:

It is because the words mad, psychopath, mentally ill, loose their significance once everyone can be so and there are no institutions that recognize their use.

You can call anybody anything if it does not matter. A bit like you can call yourself or anyone else a witch or blasphemer today in our Western democracies without being taken seriously. The reasons for this shift away from a paradigm of the abnormal to the hyper-normal requires not only a different understanding, but a whole other approach towards the clinic.

The Emergence of the Hyper-normal

I began to notice a change in what is today called Mental Health when I began working in mental institutions in France during the 1980’s. Not only did the old ideas of the abnormal no longer apply, but a new functional hyper-normality was being used to describe what had been formerly called mental illness, then disorder. Indeed, in many instances the term dis-order or dys-function could be avoided or even replaced by hyper-order and hyper-function in the same way a cancer, strictly speaking, is not a disorder, but an ‘excessive’ or hyper-order of the division of a cell.

Attention Deficiency ‘Disorder’, for example, it is always defined as a continuous function from lows to highs, from inattention and forgetfulness to hyper-activity and impulsiveness. There is, however, never really a mental dis-order, since there are no negatives in Nature: there is no qualitative difference between the normal and abnormal, only a quantitative variation of scale. In fact, Attention Deficiency Disorder must be more fully referred to as Attention Deficiency Hyperactive Disorder. Indeed, many people who identify under this psychiatric terminology, tell of the freedom such a medical term gives them: liberated of any negativity, shame, or moral responsibility, today a mental hyper-order is just a variation from highs to lows that follows the laws of Nature, not those of culture or society.

Not soon after I left France and moved back to the States did I recognize that the mental institutions and insane asylums had disappeared and were replaced with the innocuous sounding mental health centers. No longer were there caged cells, but the mere introduction of different psychotropic drugs had made it possible to manage the more violent cases so that there was now an odd calm. In fact, people were no longer being classified as being mentally ill or mentally disordered, but only as having a mental illness or disorder, which further distanced the person from anything negative.

Of course, you will still find a use of the phrase ‘mental disorder’ in everyday language and in the DSM. But if you listen and read carefully, you can recognize what is actually being referred to is a hyper-functionality of a purely medical and physiological order.

In the 1970’s the DSM-III not only removed any reference to homosexuality and neurosis as a mental disorder, but every reference to any psycho-social cause of a ‘disorder’. It is generally accepted that at this time the phrase mental health was achieved in a positive medical field where the old notions of clinical pathology as a study of abnormality was subsumed by a purely physiological research of the normal.

Without denying the relief this shift of paradigms may provide from the stigmatization of mental illness in the past, and the undoubted ease such medical classifications now provide for the insurance and the pharmaceutical companies, the question remains as to what is being avoided, if anything, in this new field of the hyper-normal and a purely medical mental health.

Has the old negative field of madness, mental illness, and the psychopath been laid to rest? Or has its ghost simply re-emerged today with a new name and vengeance? Not in forms of abnormality, but hyper-normality. It is to this question of a more invisible madness and criminality that I turn next to: How To Be Treated For A Mental Illness You Don’t Have

By the way, in the wake of this shift of paradigms, I recognized there was little need to continue to pursue a psychiatric degree and entered into the cursus in psychoanalysis created by Jacques Lacan in Paris, France.

Aug. 21. 2018