A Short History of Stupid

by Helen Razer

  The internet knows that you are absent. And the realms of work and of consumption and health could be said to develop something very like a ‘dark profile’ if you ‘choose’ not to participate in their conventions.

  One cannot simply not participate in a range of institutions. Not, at least, without a superhuman effort. To describe one’s involvement in the world as ‘social pressure’ doesn’t really begin to describe the demands of life which is formed in large part by institutions. Not only our self-esteem but our livelihood is contingent on participation in and some adherence to a dizzying set of norms in the workplace, in the way we look and in our physical health.

  In short, there’s a lot of stuff we are supposed to do. And it is pretty easy to fail a lot more in the face of so many daily tests. Yet, we naturalise all of these standardised tests and we naturally believe it is our shortcoming when we screw them up. When we fail at life as it is so broadly and meticulously prescribed, we call it mental illness. We have failed life. We are not permitted to think it is the conventions of life that have failed us.

  Of course, mental illness can be a useful category. There are those who seem beset by what we would have once called demons. There are certainly people in urgent need of patient care. Even if we have trouble with the sort of extreme medicalisation that leads us to diagnose Willy with depressive disorder and not a bad case of life, we can still agree that it might have been nice if he could have talked through his issues with a professional; maybe even taken some drugs. But it is unlikely that Willy would get much more than drugs even if he did seek help today. Medicalisation, a process that characterises and treats some problems or conditions in medical terms, doesn’t have much time for the kind of talk that Freud proposed.

  In a complex era that produces complex problems, we are forced to rational solutions. Instrumental medicine might not be ideal in the way it treats the results of life experience as illness, but it’s what we’ve got. Perhaps treating, as we do, things like libido or alcoholism or a lack of socially sanctioned beauty is not the best approach. Perhaps it would be better to reform the world, or to reform the patient’s understanding, as Freud suggested, of her place within it. But sometimes it’s just more efficient to recognise and treat a problem as a disease. Get your nose fixed. Dry out in a hospital. Take Viagra as prescribed. These may not be ideal solutions to problems we can argue only exist because of social forces and could be fixed by drug-free years in the therapist’s suites. But, they are, sometimes, solutions.

  But I don’t know if we can be quite so permissive when it comes to the medicalisation of Willy Loman. That people are improved by a one-size-fits-most treatment of the ‘symptoms’ described as anxiety and depression is quite uncertain. The pharmaceutical solution, which is so overwhelmingly and easily offered—in the 2004–2005 financial year, more than twelve million prescriptions for antidepressants were written for Australians—is no solution. In fact, it comes from Stupid. (Actually, I personally found that it produced Stupid. I have never been more Stupid than when I was taking one of the SNRI class of drugs.)

  Again, it would just be foolish to reject medicine in its treatment of psychiatric disorders. And this is in no way an account of the Evils of Big Pharma. (Although, like a lot of large institutions, the pharmaceutical industry may fall into patterns of evil.) What I want to do is to take, like Freud would, a patient history of psychiatry itself. Perhaps we can talk out its problems when it comes to treating ‘everyday’ illnesses such as the anxiety and depression of Willy Loman.

  There have been moments in history where we were almost admiring of mental illness; according to one of psychiatry’s best-known critics, Michel Foucault, seventeenth-century Europe was ‘hospitable’ towards the mad. In Madness and Civilisation, he takes us on a tour of those moments when the mad have been identified romantically or worshipped as prophets, through those where they have been confined and tortured as devils, to a time (now) where they are medicated and known as ‘mentally ill’. Foucault’s big book of mad is long and difficult and one I can only recommend to the studiously insane. But its central idea that madness as we now know it is in fact a product of the Age of Reason is a really good one.

  Even if you have no time for Foucault—and, man, he is an effort—you probably know about history’s idealised madman. Even now, some hopeless romantics think of the mentally ill as seers; as people whose view is not so much impaired as it is enhanced. But this view has all but disappeared. Today, depression—the most common form of recognised madness—is typically seen as limited vision and not at all as something that can give anyone any particular insight. Every now and then, some nutty scientist will tell us that depression has an upside; that there is a benefit to depression in that it seems to create the conditions for deep thought. Certainly, Aristotle thought of it as a useful pest. In The Problems, he notes that ‘all men who have attained excellence in philosophy, in poetry, in art and in politics, even Socrates and Plato, had a melancholic habitus; indeed some suffered even from melancholic disease’. In 2009, a paper in US journal The Psychological Review called ‘The bright side of being blue: Depression as an adaptation for analyzing complex problems’ (Andrews, Thomson and Anderson) caused a fuss when the authors advanced the possibility that depression has some cognitive benefits.

  Mostly, though, the view of depression is that it is bad thinking that needs to be fixed. If you have had an experience of the collection of symptoms psychiatry calls depression, you will agree that it is something that needs to be fixed. But perhaps you might also agree—if not now, then a little further along—that if it does need to be fixed, then we are certainly going about fixing it in a Stupid way. There is an argument to be made that depression, and mood disorders in general, aren’t getting a whole lot better. Which is to say, maybe this is one of the things that our enlightened age has not illuminated but darkened.

  Even if we are not ourselves told by our doctor that we are mentally unwell, there is a very good chance someone in our lives will be afflicted by what we call ‘mental illness’. And in the very rare case that you do not have the experience of knowing someone with a diagnosis of mental illness, you will have certainly heard a statistic like ‘one in three Australians’ or the World Health Organization’s declaration that mental illness will be a major health concern in coming decades.

  Now, there are many good practitioners who will critique this view of mental health and remind us that what we often have when we are diagnosed with ‘mental illness’ is a perfectly logical reaction to life. Psychiatry has long been Stupid. Well, to be fair, it has been Stupid on and off. It wasn’t Stupid where Freud was concerned. This is the guy who gives us the useful idea of the unconscious mind. Before Freud, we heard preludes to the idea that we have a big numb beast inside us. Jesus is thought to have said, ‘They know not what they do.’ Marx, who half described the unconscious mind as ‘ideology’, said, ‘They don’t know what they are doing, but they are doing it.’ Nietzsche saw something very close to Freud’s idea of the unconscious mind. He called it the ‘will to power’. These accounts of how and why we are so often so fucked up and out of our own control appear throughout history. There’s stuff inside us that we are very good at keeping in the dark.

  Let’s just pause to shine a little light on Freud, the Prince of Psychiatric Darkness. Freud talked about the conscious mind being like a stronghold in a great city. This ‘ego’ is the thing we need, and the thing that develops in most human children, to make us social. If we were solitary creatures, we’d have no need of ego (nor super-ego, the semi-conscious part of us that stores away morality and ‘conscience’); we would just need our id, or our unconscious. Our unconscious, of course, is the city. The big messy ancient city that stores unexamined memory in the darkness. At another point, Freud describes the unconscious mind like a horse and the ego, or the conscious mind, as its puny rider.

  We don’t know what we do but we are doing it. The biggest part of us is always in the dark. Actua
lly, I think the city describes it best. If we think of the dark city, we can begin to see how this development of consciousness is reflected in history.

  The city of the self is in darkness at childhood, so let’s say that the Dark Ages are something we remember as our intellectual infancy. We build the garrison at the Enlightenment. And from this little stronghold of conscious thought, we form the ability to engage in all kinds of complex social interaction. It is here, in this tiny space, that conscious miracles are made. We learn to describe and govern ourselves and others. Our capacity to think and to organise and to reason evolves at speed. We have grown into and built a conscious social adult world that gives us powerful principles like science, reason and liberal democracy. We no longer need God to assuage the dark fears felt by the barely conscious child and we feel that our world is bathed in light.

  But what we consciously forget while we’re in this small garrison full of light is that the city full of darkness sustains it. The process of psychoanalysis is one that acknowledges the darkness. Freud may not have succeeded in finding a way into the dark unconscious, but he certainly knew it was there. What our modern age did, however, was grow to suppose that everything was bathed in the light of reason. The great fault of the Enlightenment was to make us believe that we were entirely enlightened. In our eagerness to believe we could shine a light on everything, we committed a fundamental act of adult Stupid. We repressed the unconscious darkness in which every conscious life begins.

  If we are to entertain this Freudian view of Enlightenment history, we can see how what was once just seen as the darkness of uncontrolled human emotion now becomes the opposite of reason. You are no longer emotional or mad or a prophet or a demon. You are just unreasonable. And the way we treat unreason is with reason.

  Freud wanted to treat patients with some crazy techniques. Dream interpretation; word association; an analysis of ‘slips’ or mistakes. Psychoanalysis doesn’t believe that mental illness is the opposite of reason. Rather, it’s the thing that reason leaves behind and fails to acknowledge. Of course, you might still think this idea of the unconscious as an actual thing is a crock. But you might acknowledge that it is also a very powerful crock in terms of explaining mental illness. There are few of us who can say we understand our own behaviour fully. There are fewer still who can say they understand the behaviour of the world. Unless we actually stop believing that we are all completely rational enlightened beings in full command of all our actions and nations, there really is no hope for our journey out of Stupid. And perhaps there is no hope for treating the large numbers of people who feel real and keen pain. If there is no moment where we say that psychiatry simply does not know, then the suffering we call ‘anxiety’ and ‘depressive’ disorders are bound to continue.

  We can do better as an organised species that acknowledges its own Stupid and so can psychiatry. It is the perverse hope that we will think more ably in the future than we do right now that prompts me—and other more qualified people—to ask questions of the branch of medicine that defines reasonable and unreasonable behaviour in the present. As we’ve said about a thousand times elsewhere in this book, it is crucial for us to examine the idea of ‘progress’ if we want to stop being so stupid. We tend to assume that things are just getting better. Come on. Lots of things are absolute shit and one of them is the fact that a large number of people having, like Willy Loman, perfectly logical reactions to life are being treated with drugs.

  Psychiatry won’t admit it, but the psychiatric view of science is actually mystic and dark. A great deal of science is not at all mystic. A great deal of science happens entirely in that well-lit garrison. But psychiatry is not science. There are no blood tests for psychiatric disorders. There are no brain scans. No pathology has yet been found. All we have is a checklist of symptoms as evidence for depression, ADHD or binge eating disorder. We have a checklist of symptoms and some drugs littering the streets of an unconscious city now growing more uniformly fucked thanks to the idea it knows how to organise itself.

  Concern about job loss, the death of one’s child or physical dismemberment can all be diagnosed as depression. Actually, grief can now be diagnosed as depression, too. I remember reading that in the news and wondering to myself if, perhaps, love would also one day become a mental illness.

  This will almost certainly be the case. There is ‘an involuntary interpersonal state that involves intrusive, obsessive, and compulsive thoughts, feelings, and behaviours that are contingent on perceived emotional reciprocation from the object of interest’ identified by psychiatry (Albert Wakin & Duyen B. Vo, 2011 The Wakin–Vo I.D.R. Model of Limerence). One is no longer ‘love sick’. One has come down with something called ‘Limerence’. This involuntary and frequent affection is pretty much what I feel for my partner.

  One can easily suppose in such a rational and illuminated century where even talk shows shed ‘light’ on the darkest corners of the psyche that psychiatry has progressed. I began to suspect that this may not be the case when, in 2008, my ninety-seven-year-old grandmother, who was widowed, in pain and about to die, was prescribed an antidepressant. A young doctor called her ‘depressed’. As if death wasn’t already sufficiently medicalised.

  I’m hardly the only one shocked by psychiatry’s irrationally rational authority. Some of the twentieth century’s most respected voices in psychiatric medicine have denounced a system that can no longer make room for the sadness of death. There are guys who, quite literally, wrote the book on madness who now find it mad; we’ll meet them in a minute. First, let’s look at that book; it’s one where normal sadness is rewritten to become depression.

  The most influential document in psychiatry today was not written by Freud; a difficult voice muffled for its insistence that the world had something to do with the darkness of individuals and that an unconscious mind governs so much of this individual will. It is The Diagnostic and Statistical Manual of Mental Disorders, or the DSM, a book that turns much non-normative behaviour into a series of symptoms that come together to give us diseases. The DSM, first published in 1952 and currently in its fifth revision, is both the major funding source and the raison d’être of the American Psychiatric Association. In it, you’ll find all the mental and mood disorders for which we can be treated and a few for which we cannot. There are some diseases-by-committee so dumb and made up that even psychiatry can’t be bothered to invent a way to fix them. Honestly, read it. Some of the diseases look like they were put in there for kicks or on a dare. Among my favourites in the new edition of the DSM is binge eating disorder (BED). It is basically like very mild bulimia without the throwing up and it has, like so many of the disorders in the book do, pretty generous criteria. To wit: eat to excess more than twelve times in three months and feel a bit bad about it. So if, like me, you have eaten a pizza on your own once a week, possibly in your underwear, and felt a bit crap about how fast you rammed it into your greedy pie-hole, congratulations: you’re not just a lazy pig who has fallen into a bad habit because things have been shitty lately and/or you like pizza; you’re mentally ill.

  Actually, in researching this chapter—surely a ‘rational’ act—I have shown symptoms consistent with BED. I ate an imperial pound of Cadbury Dairy Milk Marvellous Creations Jelly Popping Candy Beanies when I was trying to understand Foucault’s account of madness and I ate a whole barbecued chicken while I was reading just one chapter of Freud’s Civilisation and its Discontents. When Freud compared my conscious mind to a garrison in the city of the id, I thought I felt bad because I knew that most of humanity represses most of itself most of the time. Now I know it was because I ate an entire bird while I was alone in my underpants. I also ate the parson’s nose. I am not even going to tell you what I ate when I was reading the newest revisions to the DSM. Let’s just say that I should probably be in sectioned care for greedy lunatics.

  Thanks, psychiatry. Thanks for turning my erratic eating habits into unreason. Thanks for BED, which turns ‘eating even when
feeling full’ into something that can be medicated with Topmirate, an appetite suppressant, or with antidepressant drugs. Let’s not think about talking it through. Let’s not say that overeating is a normal response to a culture that encourages it or, worst of all, just fun.

  We should make brief mention of the influence of pharmaceutical companies on DSM revisions. Certainly, this topic is widely discussed by psychiatrists. There are a few blockbusters on the subject, including David Healy’s Let Them Eat Prozac: The unhealthy relationship between the pharmaceutical industry and depression. There is a wealth of study on economic rationalism and how it plays its part in creating ‘mental illness’ that is, in fact, just a reaction to life. You can read many compelling arguments against the business of a psychiatry that would create a ‘disorder’ like BED in order to medicate it. But my argument is more about how the idea of reason is used to make us ill.

  There are many reasons why one might overeat, not the least of which is that consumption itself is seen by so many of us as an antidote to the despair of the everyday. I mean, this despair is produced and then milked as surely as psychiatric illnesses are invented and then medicated. Listen, for example, to the music played at any major supermarket chain. It will be Coldplay, U2, Snow Patrol, REM. Mournful music played in the key of minor consumption. Even if psychiatry has dispensed with the idea of the unconscious mind, marketers still know how to work it.