Last week I talked about the value of exploring and explaining historical developments where ideas are not quite as powerful as is commonly assumed. Lest this make anyone nervous – this is the intellectual history blog after all, right? – this week I’ll balance it out a bit by looking at an arena where, it appears, ideas are not only very important, but their importance is also chronically underappreciated. For if we take the subject of intellectual history to be that which deals with the “ideational stuff,” then the history of mental illness, it turns out, is so rich a place to look at that I’m going to have struggle to keep this post down to a readable length.
It has previously been discussed on this blog whether or not the particular ways in which we “go mad” ought to be a subject matter for intellectual historians, to which I reply of course. In particular, an article by Ethan Watters in the Times, written almost four years ago, greatly shaped my thinking on this matter. I read this article when it was published, and it has become, for me, one of those narrative milestones where it is impossible for me to contemplate a particular subject without referring back to my own memory of the moment I finally “got it” in a new and thrilling way. That article was called “The Americanization of Mental Illness.”
Briefly put, the argument of the article is that while mental illness is indeed a physical occurrence related to what is happening in the brain, the way we interpret its effects is so heavily influenced by cultural and social norms that it has drastic consequences not only for how we explain the symptoms, but the way individuals actually experience them. This means, in effect, that ideas can actually shape what forms the illness itself takes, and also greatly impacts the manner in which patients recover and the chances they have of doing so.
And increasingly, the world is experiencing mental illness through the eyes of the West. In some cases, this can become incredibly specific. For instance, cases of anorexia in Hong Kong, which had been relatively rare, used to commonly be experienced by patients as being rooted in an aversion to the feeling of being full. A sensational news story, however, educated the public about the fat-phobic version of anorexia so common in the US, and before long, cases of anorexia where patients reported fears of weight gain as their central concern increased rapidly.
The broader concepts through which Westerners understand mental illness have been spreading abroad as well, and this has wrought some unintended consequences. It has long been assumed, for example, that viewing mental illness as exactly that – a medical illness like any other, rather than a spiritual or social disorder – would help reduce stigma against sufferers and increase the likelihood of empathy for them. Recent research, however, suggests that this is not the case – even in the West, understanding mental illness as a disease, rather than the result of some kind of exterior trauma, appears to reduce empathy for patients rather than increase it.
Moreover, the assumption that a clinical conception should increase empathy appears to be related to that ever-important pillar of Western culture, individualism. Mental illness, in the Western narrative, is rarely a social condition; it is an experience contained in the individual mind, and as such, has something to say about that person and only that person. Given this constraint, it is not surprising that advocates of the mentally ill in the West prefer the less malicious version of this assumption, pushing for the idea of disease over the alternative view that the mentally ill are somehow corrupt or vice ridden.
Which got to me thinking about a different, more ostensibly positive manifestation of viewing mental illness through individualistic lens – the extremely popular trope of the tortured genius. A few months ago, The Chronicle of Higher Education ran a piece detailing the controversy surrounding the supposed link between mental illness and genius. Indeed, Americans are very familiar with the character of the brilliant madman (or woman), perhaps captured most effectively (and crudely) by films such as A Beautiful Mind and Proof.
Yet while I was reading the Chronicle article, I noticed how discussions of “crazy creativity” tend to cluster around particular conditions more than others. Schizophrenia, bipolar disorder and depression are the favorites, and tales of genius by way of insanity almost always involve one of these conditions. Much less common are characters who have exceptional insight due to obsessive compulsive disorder, hypochondria, or generalized anxiety disorder. When these characters do appear, they are usually portrayed as more batty or eccentric rather than brilliant or profoundly troubled. Sure, it seems like an unpleasant inconvenience for Jack Nicholson’s character in As Good As It Getsto have to skip over all the cracks in the sidewalk, and yes, he is a writer; but his affliction plays more as quirky than tortured, and he composes formulaic romantic novels, not epic tomes of literature.
Why the different tone? My first guess is that anxiety disorders interfere with an easy narrative that connects mental illness to genius. The expression of these particular conditions is, vulgarly put, not as sexy as schizophrenia or bipolar disorder. Consider one recent exploration of OCD in popular media, Lena Dunham’s laudable incorporation of her own personal experience into a few episodes of her TV show Girls. It’s rather more difficult to frame an overwhelming need to do things in eights in a way that implies it is inextricably bound up with some sort of profound insight about the nature of the universe or the human condition. And indeed, that’s precisely what Dunham is trying not to do – in one of the episodes dealing with her character’s OCD, her anxiety actually prevents her from completing a work of creativity, rather than spurring it on.
One possible exception to this tendency might be Martin Scorcese’s depiction of Howard Hughes (played by Leonardo DiCaprio) in The Aviator. Hughes isn’t really presented as a genius in the clichéd sense, but he certainly is presented as a “visionary,” which seems to operate as the equivalent of a genius in the business world. Additionally, however, Scorcese makes sure to clearly connect Hughes’ mental health condition to a narrative that makes further sense out of his affliction, as the film begins and ends in flashbacks to childhood memories of Hughes being sanitized by his germaphobe mother, who instills in him the belief that he is never safe.
So it seems that when presented with a character that suffers from a serious mental illness, popular depictions of that individual tend to lean in, or combine, one of two directions – either the person is a genius, or they have been traumatized by an event in their past. If neither option is available, the tone shifts noticeably, and the illness is no longer quite so serious – the character is a somewhat endearing grumpy old man who hates to take pills, or an eccentric (and often Jewish; another whole can of worms to unpack) cosmopolitan – think Woody Allen – that seems like he is just performing another Seinfeld routine. The disease itself has to be trivialized, has to be turned into something merely decoratively unusual, rather than substantially disruptive. Indeed, this tendency has even seeped into popular speech – how many people casually joke, while they are cleaning their kitchen or washing their hands, “I am so OCD,” when in reality they are nothing of the sort?
So full-scale, serious suffering is less common in depictions of anxiety disorders – and this is due, I would like to suggest, because the specter of entirely arbitrary, meaningless mental anguish is a horrifying concept for Westerners to grapple with. I imagine it is terrifying for most people, actually, but it seems to be particularly tricky for Westerners, who cherish the idea that we are masters of the castles that are our minds, able to fend off any interference with our equilibrium by some combination of reason and sheer determination. Absent creative brilliance, a story of emotional trauma will do just as well to lend some sense to why, for example, Howard Hughes would lock himself in a film studio for weeks on end and never leave. But the expressions of anxiety disorders often resist either solution; they are mindlessly, and maddeningly, arbitrary and inexplicable.
And as the research discussed in Watter’s article suggests, the consequences of not having a story can be considerable. For if someone who struggles with a psychological condition explains it in terms of a personal trauma, it appears that others are less likely to view them as somewhat subhuman or stigmatized. On the other hand, if the only explanation the individual provides for their condition is that they have a medical condition – nothing more, nothing less – others are more likely to respond negatively. This has come as a surprise to some, but a moment’s thought makes it seems so self-evident; of course human beings have an easier time relating to others if we are given a story that makes sense, a story we can imagine ourselves in as well. We are, after all, story-telling creatures that tend to deal with the unknown and the irrational precisely by finding a way to make sense of it all through a narrative.
But here we run into an ethical dilemma. What if a mentally ill person does not want to have her illness understood as either a product of trauma or a connection to some kind of higher intellectual plane? Indeed, as Watters points out, thinking of mental illness as only and exactly that – a disease like any other – is the approach preferred by many patient-advocacy groups. And in light of how popular culture often depicts mental illness, it is not too hard to see why – in addition to the more aggressively negative depictions, how would you feel if, say, as a sufferer of schizophrenia, you watched a film that romanticized your condition by implying that it was also some kind of gift, a wormhole of sorts into a Platonic realm of perfect forms?
Yet the belief that a medical understanding of mental illness would lead inevitably to a reduced stigma appears to be, at the least, not so straightforward; so what do we do when the desired self-understanding of a mentally ill person actually clashes with the explanation more likely to give them a sympathetic response from the broader society? I have no idea, for as compelling as the desire for a story might be – and I imagine there are many other viewpoints and data to bring to bear on this question, and my presentation here has been greatly limited – how can you possibly instruct individuals on how to represent and understand their own experiences? I can’t imagine being able, myself, to perform such aggressive condescension.
So, after a long post of many speculations, I’ll leave you with that conundrum.
Post-script: As I was finishing up this post, I stumbled on this article by Daniel Smith on the very problematic stereotypes surrounding Jews and anxiety – turns out, he argues something close to the opposite of what I argue here, that anxiety is in fact correlated, in the minds of some at least, with higher intelligence. Well, so much for my thesis, because when I looked at it in this slightly different angle, I found myself convinced.
Yet I think my observations can still stand next to his; the anxiety of the anxious, I would suggest, is usually depicted as a part of a person’s personality, but not the central front piece. Which might be all to the good – we are not our fears and worries, right? – but I think is also a part of this trivialization of anxiety disorders that I talked about. Although the average anxiety sufferer might be regarded as a nerd, she’s only above average in intelligence, rather than hitting genius level. So the mental illness aspect doesn’t get quite the romantic focus that other depictions of mental illness – such as those that focus on bipolar disorder or schizophrenia – tend to exhibit.
 I highly recommended pursuing the comments section to this article, which is full of thoughtful speculations about how while there might indeed be a connection, it might be due to entirely different dynamics than is usually assumed by the simple madness = brilliance idea.
 Of course, the very association of mental illness with sexiness – the sexiness that comes attached to the genius – is itself exhibit A for what is hugely problematic with these depictions of such conditions. Those who suffer from the diseases themselves are unlikely to report, I am guessing, that at least it has helped them out enormously in the sexiness department of life.
 See this Daniel Smith article and my corresponding post-script for more on this.
 The “sheer determination” strategy, of course, providing the inspirational narrative resolution of A Beautiful Mind, a movie so rich with problematic depictions of schizophrenia that another entire post could be written on it.