Mind and madness

I once asked my uncle, a psychoanalyst, whether he could say that people had free will from a scientific, medical perspective.  He answered like a doctor rather than a philosopher:  “Some do.”

The virtues of freedom presuppose a clear mind.  Morality requires the ability to choose one action over another.  Those who suffer confusion, who are paralyzed by fear or fantasy, escape moral judgment and become patients to be treated by doctors like my uncle.

It is worth recalling that this distinction appeared in relatively recent times, and is a product of modern science.  In Europe and elsewhere, bizarre behavior was often condemned as possession or witchcraft, and suitably punished.  Otherwise, lunatics were treated like animals.

Michel Foucault made psychiatry the first target in his global attack on the Enlightenment.  For Foucault, the science of mind was a kind of license to cage, an ideological veil thrown over a brutal exercise of power — the mass imprisonment of those judged insane.  The Enlightenment worship of reason encouraged and justified a holocaust of the unreasonable, argued Foucault.  This began a lifelong, largely successful assault on the concept of reason as a universally accessible faculty.

Foucault was introduced to the English-speaking world by R.D. Laing, who believed that capitalist society was insane and schizophrenics enjoyed a kind of meta-sanity, something one could proclaim to an admiring public only in the wild-eyed Sixties.  Since then, Foucault’s ideas have become the orthodoxy in the academic West.

It is fascinating, almost shocking, to realize that the original translation of the History of Madness lacked all footnotes, and was severely abridged from the French original.  Clearly, Foucault’s influence was a matter of zeitgeist rather than scholarly persuasion.  Verdict first, trial later:  many academics and students in the Sixties wished to believe Foucault’s arguments, which tore at the fabric of a world they loathed and wished to overthrow.

This excellent Times Online essay by Andrew Scull examines Foucault’s scholarship in light of the newly published footnotes.  It turns out the French historian was selective and out of date in his use of sources.  In consequence, he was wrong about the facts — wrong about the numbers of confined madmen in Europe, for example, which never amounted to more than a fraction of the mentally ill population.

Wrong, too, about the practice of charging money for sensation-seekers in Bedlam asylum — never happened.  Foucault’s central claim, that the age of reason was an age of confinement, was never more than an ideological posture, even if the ideology proved delightful to professors in the humanities jealous of the prestige of science.

To witness insanity is to have no doubt about its character:  quite literally demoralizing.  The insane have lost their freedom of action, and can no longer be considered moral agents.  They must inspire compassion rather than judgment.  The causes of their behavior, we now know, are biochemical imbalances.  Neither society nor parents are in any sense complicit in the condition:  in this regard, both Freud and Laing were dead ends.  Oedipus and Marx explain nothing about insanity, and lead nowhere in the search for a cure.

Because the causes of mental illness are biochemical, they can be treated chemically.  Many such treatments are remarkably successful today, even if sometimes we aren’t sure why.  Again, to witness the chemically-induced reintegration of a once-shattered personality is to come close to the miraculous.  A slave to confusion regains the dignity of a moral agent.

But it isn’t a miracle:  the framework is that of modern science, of applied medicine, and anyone who wishes to “liberate” the insane from reason must demonstrate how any other path will lead to the same moral dignity — to the same freedom from madness.

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