Culture, Digested: Mental Illness is not a Metaphor

The Best Minds, Freddie deBoer, and schizophrenia influencers

So for the last several years, I have been working on a book. The last two years specifically were very research intensive, so books that weren’t related to the topic or books I was hired to review got sidelined. I kept amassing books, though. In that silly optimism of, I will definitely be done with this project at some point and have the opportunity to think about other things! The stacks continued to grow. They are everywhere.

I’m making my way through them in a very random manner, and now I’m going to complain about a book that everyone else finished talking about a year ago: Jonathan Rosen’s The Best Minds. It was billed as the story of Michael Laudor, a man who was once heralded as an advocate and spokesperson for the mentally ill — he graduated Yale law school after a hospitalization for schizophrenia and worked mostly on issues related to mental illness and institutionalization — until he murdered his pregnant girlfriend in a state of psychosis.

It’s the type of book that tends to get a lot of coverage because a lot of people have opinions and angles they want to work on the so called “mental health crisis” we are having in America. I’ve started to see an increase in content I can only describe as schizophrenia influencers, people who claim to have schizophrenia who film themselves having episodes (responding to hallucinations, etc) and narrate their experiences in TikTok videos. I say “claim” because, after the whole contagious Tourette’s thing of a couple years back, it has become impossible to distinguish between real displays of illness and feigned or even just conversion disorder.

People who have a specific idea about mental illness — whether it’s a social construct, whether it’s a normal response to oppression, whether we should bring back involuntary treatment — jump on these books and stories in the news to further their agenda, and all of them are annoying.

Louise Bourgeois

But really what it is is a “old man yells about a world he no longer recognizes” kind of thing, in a way that is exhausting. He blames feminism for destabilizing the family unit, he blames postmodernism for destabilizing “truth.” He blames people like Felix Guattari for theorizing social causes of mental illness and turning our understanding of it from a health problem to a social problem. All of these things, he suggests, have made people vulnerable to mental illness, while also interfering with our ability to treat disorders like schizophrenia as a health crisis. He writes:

At some point it became impossible to ignore the way a metaphorical version of mental illness had been institutionalized in academic life at the same moment that people who suffered from actual psychotic disorders were being released from hospitals and forgotten, as if the university and the asylum had organized a sort of exchange program.

This is something Freddie deBoer advances in his review of the book. DeBoer has, for a long time now, had a recurring clash with the whole “madness is just a sane response to an insane world” crowd. You would think, from reading his work on the subject, that this is the ideological position of the people running our health care system. But it’s really just some guys online.

When there is an act of violence that involves someone who is mentally ill, specifically schizophrenic, many people rush to social media to assure others that the mentally ill are not more likely to commit acts of violence than those who are not. They argue with people who yell for the involuntary institutionalization of the mentally ill and try to point to social causes for illness to help reduce stigma. This is compounded by the leftists who went to grad school (so…. all of them?) and read Capitalism and Schizophrenia and Madness and Civilization, who pick up on the anti-psychiatry movement and understand the whole mental illness industry as a form of social control.

There are variations on this — for a while within feminist circles madness was very hot, a form of political protest against patriarchy. This was a major quibble I had with Kate Zambreno’s Heroines, which tried to paint Lucia Joyce as a genius instead of an ill girl who apparently kept trying to set her clothes on fire, and films like Augustine, that portray the French hysterics as aspirational cool girls. (Jessica Almereyda wrote about this for our Friday Feature this past week.)

The power that these anti-psychiatry people have, though, gets vastly overstated, mostly because of their disproportional presence on social media and in academia. The guy on twitter saying depression is a natural response to a depressing world is not writing policy. DeBoer claims that Rosen has published a “damning indictment of the magical thinking that has ruined contemporary mental healthcare.” This is a recurring theme in deBoer’s Substack, with his general “I didn’t leave the left, the left left me” shtick.

“Magical thinking” has not ruined contemporary mental healthcare. What ruined mental health care is the fact that America got rid of institutions where the mentally ill were housed away from the public in favor of “community based care,” but then decided not to build or fund any community based care. DeBoer and Rosen both know this — they write about the process of deinstitutionalization and the absence of community backup. Instead, the government decided disability benefits and medication that has dubious results in longterm studies would be enough. “Money had replaced community mental healthcare the way medication had replaced state hospitals.”

And yet still, Rosen rails against the people who see mental illness as a social construct again and again. In stories like these, the blame for the difficulty the patient is going through is blamed on medical noncompliance. The man profiled keeps going off the medication, and when he does, he sometimes becomes violent although it’s unclear if the violence is due to his diagnosed schizoaffective disorder or medication withdrawal. His parents can’t house him because they are scared of him, so he ends up in motels or tents. There are very few resources for someone who has a family member in crisis, the only options seem to be, a) let this person reside with you despite the fact that he has attacked you in the past, b) let them deteriorate while living on the streets, or c) try to force them into temporary and inadequate treatment in prison or an involuntary hold until they are inevitably released.

But the reason why he’s not taking his medication is not because someone on Twitter told him his disorder is a social construct, nor is it because a French philosopher single handedly convinced Western nations to close their institutions. It’s because the drugs have debilitating side effects, their efficacy is questionable, and people in unstable environments have difficulty participating in their treatment regimen. It’s because America has a profit-focused health care system, and residential treatment centers are run with very little oversight despite accusations of rampant abuse. It’s because group homes and halfway houses are underfunded hellholes that also impossible to get into because of waiting lists and a shortage of quality caregivers. It’s because mental health centers have been disappearing, particularly in rural areas, for decades now, it’s because medication is seen as a cure-all rather than part of an array of options including quality talk therapy and nutrition and community support.

This is not what Rosen wants to write about, though. Nor does he want to write about the history of sterilizing the unfit, the torture performed in institutions, or the way lobotomies were used to enforce social conformity. He doesn’t want to write about how America doesn’t care about anyone but the very rich, or how we’ve allowed our health care system to decay. He just wants to be mad at feminists and queer theorists and sociologists who have tried to point out that it is often the most vulnerable and oppressed who carry the weight of a sick society, and that drugging or hurting them into compliance doesn’t solve the larger problem.

Nor does anyone really want to read about this collapse because there is no easy fix (just arrest the scary man on the subway and get him out of my sight), and your average person cares a thousand percent more about the person harmed or frightened by someone mentally ill in public than the mentally ill themselves. Doing culture war against leftists who read Foucault or conservatives who want everyone put in prison is much more fun.

Recommended:

• The Financial Times have launched a podcast series called “The Retreat,” about meditation cults and the scam of mindfulness. Only one episode has been released, but so far it’s good.

• Wendy Brown’s new book is very good. There’s an interview here.

• I liked Our Psychiatric Future, imperfect as it is.

• I’m glad we have every emotion every person could possibly feel labeled, categorized, and diagnosed. Limerence! Different from a crush, different from parasocial attachment, different from obsessive fixation, or, just different enough to justify a TedTalk about it. No one can get health care, but at least we have articles like these so the young can diagnose themselves on social media.