Insanity is a phenomenon recognized by humanity since the beginning of the history of the mankind. Different societies used various methods of the treatment of insanity based on their beliefs about its nature. The analysis of different approaches to insanity, its treatment, and the institutions created for people suffering from mental disorder reveals that the psychiatry has overcome many wrong beliefs and faulty methodologies during the last three centuries. The analysis of the real experience of persons struggling for overcoming mental illness shows that modern psychiatry should strive for further improvement to provide the adequate treatment based on the recovery of their body and soul rather than on making the people suffering from different manifestations of insanity to adjust to social norms.
Insanity is mostly regarded as a collective name for mental deviations, which make the person unable to function as a member of society and control his/her actions. It is characterized by irrational behavioral patterns and mental instability. As a non-scientific term, insanity is not used in medical practice but, in fact, is considered a term that unifies all mental disorders presenting a significant danger to person’s ability to lead a normal life. The attitudes to insanity have changed throughout human history and numerous approaches to defining its nature and presentations have evolved. Careful analysis of the biological and the Freudian approaches to insanity helps to understand its nature better and track the changes in its definitions during the last two centuries.
The main constituent of insanity considered vital by all of the approaches is the person’s inability to control his/her psychological state and actions properly because of the abnormal perception of the external world (Freud Dream Psychology par. 4). Such a disability leads to the person’s dependence because she/he cannot perform daily activities or does so in a destructive way. Insanity can result in passiveness and a lack of willingness to interact with the society that results in the patient’s isolation, or it can produce aggressiveness and violent behavior that pose a threat to everyone around the patient. Another typical symptom of insanity is an inability to perceive the world accurately, resulting in inappropriate attitude and judgments. This can lead to irrational behavioral patterns characterized by the persistent repetition of certain traumatic actions called “repetition compulsion” (Freud Beyond the Pleasure Principle par. 3).
As a collective name for mental disorders, insanity presents a serious challenge for scientists in terms of defining its nature and causes. However, certain approaches try to explain what leads to insanity and determine the conditions necessary for its development. The Freudian approach based on psychoanalytic theory and the biological or neurological approach based on scientific theory deserve special attention as they reveal two dominant views on the nature of mental disorders.
The biological approach to insanity is also called neurological, as it relies on the claim that mental disorders are caused by the structure of the brain leading to deviations in its functioning. This approach relies on neurophysiology and studying the functioning of nervous system. The Biological approach excludes the possibility of causes of mental disorders that do not have an organic or physical nature. While the Freudian approach considers studying human mind the key to investigating insanity, the biological approach regards the proper functioning of the brain as the main factor affecting mental health.
Some studies support the biological approach, as certain differences in brain structures, such as gray matter loss in a network of brain regions, are present in various mental disorders, such as schizophrenia and depression (Goldman par. 2). That makes a group of scientists consider the identification of biological causes of insanity a key to managing mental disorders. However, there are no mental disorders cured by drugs. There are some that can be chemically managed, but drugs fail to make the people suffering from mental disorders no longer depressed, manic-depressive, or schizophrenic. Therefore, considering insanity having purely organic nature appears to be not well-grounded.
George Didi-Huberman’s book Charcot and the Photographic Iconography of the Salpetriere serves as an example of studying insanity from the biological perspective. Charcot’s work was based on the assumption that insanity is caused by common abnormalities in brain structure. Charcot, as a founder of neurology, was focused on physiological manifestations of insanity and objectified the body of the patients. His approach to examination and treatment of the patients was based on the leading role of the physician, who did not pay much attention to the subject’s narrative (Didi-Huberman 24). Such approach is brightly illustrated by the case of “Charming Augustine,” whose repetitive recalls of a rape scene did not attract the attention of physicians who were focused on her body postures (Didi-Huberman 115).
The collection of such data helped Charcot to understand the symptomatic of mental disorders and structure the knowledge about their common signs. Such knowledge helped the neurologist to master the art of diagnosing, which was considered the key to successful treatment. Charcot considered the manifestations natural consequences of biological deviation, did not pay much attention to the psychological aspect of the suffering of the objects of his photographs, and was searching for “ever-shifting kind of neurophysiological lesion in the cortex” (Didi-Huberman 24). Didi-Huberman criticizes Charcot’s methods and claims that the institution was structured as a “bribe” forcing the patients to demonstrate certain behaviors to avoid being placed under worth conditions (Didi-Huberman 170). However, Freud found Charcot one of the most prominent figures in psychiatry, as the observations in Salpetriere inspired him for creating the foundations of psychoanalysis.
The silence of Salpetriere patients became the basis for Freud’s reflections on the role of encouraging the patient to speak and using the collected information for psychoanalysis. Besides, while Charcot considered hypnosis a neurological phenomenon, Freud regarded it as a psychological one. Freud used Salpetriere experience to develop a wholly new approach to insanity. Ironically, though considered one of Charcot’s biggest admirers, Freud gave a start to the approach that opposed most of Charcot’s beliefs and assumptions.
Krafft-Ebbing is considered another great contributor to the development of the biological approach. In his “Text-Book of Insanity, Based on Clinical Observations for Practitioners and Students of Medicine”, the psychiatrist emphasized the role of hereditary factor and neuropathic constitution in promoting the development of psychiatric illnesses: “Next to hereditary predisposition, the most important predisposing factor in the individual is that peculiar condition of the nervous system that has been called neuropathic” (Krafft-Ebbing Text-Book of Insanity 163). Though the psychiatrist recognized the role of external factors, such as parental influence and “defective education,” in the development of psychiatric deviations, he considered studying neurological factors the main keys to understanding the nature of such illnesses (Krafft-Ebbing Text-Book of Insanity 164).
Freud, on the opposite, considered childhood “a primaeval period which is already a part of the individual existence” playing the crucial role in the development of the one’s psyche and regarded psychological factors as the primary causes of psychiatric deviations (Freud Three Essays on the Theory of Sexuality 173). Besides, sexual deviations, considered by Freud consequences of negative childhood experiences, are regarded by the biological camp as the results of abnormal brain functioning. Krafft-Ebing expressed his views in fundamental work “Psychopathia Sexualis” and demonstrated that sexual deviations, such as homosexuality, are the consequences of biological abnormalities experienced by the organism at different stages of its development (Krafft-Ebing Psychopathia Sexualis 295).
Freud, on the contrary, regarded homosexuality as a purely psychological deviation related to the unconscious (Freud Letter to an American Mother 787). He claimed that the nature of inversion cannot be explained “by the hypothesis that it is innate” (Freud Three Essays on the Theory of Sexuality 140). Kraft-Ebing’s and Freud’s views on sexual deviations illustrate the differences between the biological and the Freudian approach to insanity.
The Freudian approach to insanity is based on psychoanalytic theory developed by the famous neurologist in the late 19th century. Freud moved from trying to understand mechanical malfunctions in the brain to exploring the mind. He defined specific features of mind as the cornerstones of mental deviations leading to insanity. Freud’s theory is based on the belief that the key to different characteristics of a person’s mental development depends on the unconscious. This portion of the human mind is hidden from a person due to its “innermost nature” but significantly influences his/her behaviors and mental health (Freud The Interpretation of Dreams 613). Freud emphasized the significant role of childhood experience and sexual drives and considered them the main drivers of any personality (Freud Fragment of an Analysis 115).
Therefore, curing mental deviations was supposed to be done with the help of psychoanalysis, which would reveal the original problem hidden in the unconscious and allow the tension surrounding it be released, thus ending the deviant behavior and ideation. According to the Freudian approach, the key to successful treatment lies in making the unconscious side of the mind conscious. Freud believed that as hidden thoughts lead to mental deviations, their unveiling through interpretation of dreams, which he called “the royal road to a knowledge of the unconscious activities of the mind,” can be the basis of effective therapy (Freud The Interpretation of Dreams 608). The Freudian approach to mental disorders reveals that the main constituents of insanity include mental deviation caused by traumatizing experience and leading to the unconscious development of irrational motivations related to sexual issues resulting in certain behavioral patterns.
Dora’s case can illustrate the specifics of the Freudian approach in practice. The case describes the specifics of diagnosis and treatment of hysteria in the patient Ida Bauer. Hysteria was studied by Freud from the perspective of his approach to the analyzing unconscious. He referred to the sexual etiology of hysteria and regarded hysterical symptoms as the consequence of inappropriate sexual desire repressed at an early age (Romano 20). Though the treatment of the patient failed and the lady refused to continue it, Freud considered the case a vital part of the arguments proving the rightness of his theories (Romano 21). Analysis of the case demonstrate how the Freudian approach to insanity was used in practice – instead of using traditional methods of curing hysteria, the psychoanalyst tried to uncover the unconscious part of Dora’s mind through the exploration of her experience and interpreting the dreams as referring to her sexual life (Romano 96). The example of Dora’s case illustrates the unique features of Freudian approach to mental disorders.
The Freudian approach to insanity has not only shifted the face of modern psychiatry and psychology but has also influenced the legal procedures related to insanity defense of the crime suspects. Leopold and Loeb’s case became the first trial, in which the Freudian approach replaced the biological one. This trial is explicitly described and analyzed in Simon Baatz’s book “For the Thrill of It: Leopold, Loeb, and the Murder that Shocked Chicago”. The author reveals the specifics of the crime committed by two young fellows and describes the process of their defense in details. Though the killers fully confessed to prosecutors, their defender Clarence Darrow attempted to use the Freudian approach to insanity to acquit the criminals and avoid capital punishment (Baatz 278). The defense encountered the alienists who adopted the Freudian approach to demonstrate that the causes of the murder were related to the subconscious motives of the killers who could not be considered mentally healthy due to the severe impact of childhood on their psyche.
The alienists found the roots of the crime in the emotional inability of the young people to control their actions caused by oppressive governesses experienced in the childhood and analyzed the sexual perversions of the killers in details. Such approach to insanity defense opposed the traditional methods of psychiatry used for diagnosing the mental health of the criminals (Baatz 278). Though the court rejected such approach, and the killers were not sentenced to death due to their young age and the unwillingness of the court to “make an addition” to the number of minors “put to death by legal process” rather than due to the alienists’ defense, the trial deserved a huge attention and became crucial to popularizing the Freudian ideas and the basics of psychoanalysis (Baatz 402). Leopold and Loeb’s case played a crucial role in demonstrating the benefits of the Freudian approach based on analyzing the subconscious motives to a wide public.
The idea of psychoanalytic investigation extended from the theory of humanism, which supported the process of challenging and verifying personal self as the way of measuring one’s emotional health (Lye 3). Thus, the basic practices of dreams interpretation, as well as sexuality, personal desires analysis, and mental disorders identification, were put in the focus of psychoanalytic description. The major theorist of the discipline is the Austrian psychologist, Sigmund Freud, who developed a doctrine of mental distinctions and human behaviors being the follow-ups of unconscious desires.
Sigmund Freud’s idea of psychological impulses as the reactions to subconscious wishes earned a wide popularity not only through its originality but the extension of the first public clinics. Thus, the scandalous psychologist became the first doctor, who launched a program of founding the primary free-access clinics. The project evolved in Austria, in the first part of the 20th century and the British and Hungarian medical institutions rapidly overtook the practice. The public services, which provided free-of-charge psychological treatment, became social in character, for they embraced a form of the democracy establishment and gave birth to multilevel social services throughout the world (Danto 9). The techniques and practices that were applied in the first psychiatry clinics included the methods of direct observation and discussions mostly. However, some traditional treatment elements were still present in the program of psychoanalytic examination.
When one regards the practices of psychiatric treatment, the cruel practices of lobotomy, cold and hot water exposure, and some other physical tortures are often recounted. The approaches of bodily treatment of mental disorders stem from the 20thcentury. The following overview of the major aggressive approaches to human psychology provides a consisted notion of the psychoanalysis background.
Lobotomy
The practice of lobotomy was initially employed as an effective response to prolonged depressions, schizophrenia, and some other severe mental illnesses. The treatment technique first evolved in Portugal. It was developed by a neurologist, Egas Moniz, who deduced that gaining direct access to the human brain through drilling holes in a skull might improve the intellectual stability of a person. From that time on, the method was spread throughout multiple European and American clinics. Today, lobotomy is not used as a psychiatric treatment practice since it was acknowledged that the technique poses some threat to human life. In 1967 an American patient died directly during the session of lobotomy, consequently the practice was discarded by the World Health Organization (Tartakovsky 12).
The nurses, who did not cope with separate highly disturbed or aggressive patients, initially employed the usage of isolation as a treatment technique. Since the time of psychiatric clinics existence, the experts faced the problem of extensive cruelty or rage, which was demonstrated by the clients. Therefore, they used to close the patients in separate rooms so that to give them a chance to calm down. It was noticed that the practice was quite helpful, for the desolated revealed relative submission after the session of separation. Consequently, isolation became a full-value treatment technique. At the end of the 20th century, however, it was certified by the psychological investigations that solitude does not allow people to cope with their problems. In contrast, it only stiffens their desires, which can evolve in the further mental complications, and so the practice was forbidden (“Isolation of Patients in Protected Rooms during Psychiatric Treatment” 5).
The history of shock therapy in psychiatry began in the first decade of the 20th century and stemmed from the idea of convulsions being the effective treatment of such illness as apathy. Since the convulsions can be evoked by the electroshock therapy or insulin-imposed coma, the shock-based approach to recovery was developed. The method functioned for 70 years and was widely spread throughout multiple clinical settings (Shorter and Healy 10). With the course of time, the approach became employed as a tool for manipulation and patients subdue, which posed some dangers to human health. Consequently, the theorists of psychoanalysis eradicated the practice.
The earliest types of psychotherapies take their roots from the 17th century. In this context, one usually regards the practices of various physical exposures and modifications, which were interpreted as the reactions to intellectual disabilities. For instance, the first psychologists were used to applying hydrotherapy as a producer of multiple bodily reactions. Since the human organism provides certain impulses in response to high and low temperatures, water was often heated or frozen (“Restoring Perspective: Life and Treatment at London Asylum” 1). Moreover, the doctors made an extensive use of holdovers in the 17th century. This method targeted depression treatment and implied brain stimulation through the application of different physical materials.
The reviewed methods of psychiatric treatment provide a picture of psychoanalysis functioning in the first part of the 19th century. According to the estimation, the variety of therapies was based on some bodily reactions analysis. In the aftermath of the study, it may be concluded that the application of the mentioned techniques is based on vain assumptions and can pose a considerate threat to human health.
Though the approaches to understanding the nature of insanity and defining the most appropriate way of treating the patients suffering from mental deviations have experienced significant changes throughout the past several centuries, the important role of medical institutions created for the continuous treatment of mentally-ill people has been recognized by most prominent figures in psychiatry. The history of the creation of the institutions serving for people suffering from insanity illustrates how the attitudes to the asylum for such people changed in the course of time.
The notion of an asylum which would serve specifically as a shelter for mentally retarded individuals first appeared in England in the 18th century. Historians of mental illness argue that humanitarian progress allowed the doctors of the 18th century to distinguish a new form of a disease that revealed itself in a form of lunacy or irrational behavior. Lunacy was not, however, a disease disconnected from its social context. according to the theory of social control, the ruling class of England created madhouses to show the laboring classes the real nature of mental recovery and discard the beliefs of religious remedy, which existed among the citizens at that time. In this way, wealthy Anglicans established a new form of social manipulation. Other historians claim that the introduction of asylums was a direct consequence of the Industrial revolution and a new economy of private entrepreneurship. Private madhouses became a significant source of profit. “Madhouses and mad-doctors arose from the same soil that generated demand for general practitioners, dancing masters, man-midwives, face painters, drawing tutors…” (MacKenzie 12).
Madhouses flourished in the 19th century, when they benefited from a theory that said beautiful surroundings were the key to mental recovery. Greek architecture featuring high ceilings, large windows, airy rooms, and carefully landscaped grounds became the model for asylums and an opportunity for architects to demonstrate their skills. These asylums were exceptionally beautiful and equally expensive, and their luxury raised ire among many of the working class who struggled to survive in horrific slums while wealthy lunatics relaxed in resort-like settings. In fact, most of the people who worked in the madhouses could not have afforded to stay in one, which demonstrated the socioeconomic disparities in access to mental health care.
Thus, the psychologists came to the conclusion that madness could arise on two grounds. First, it was a direct consequence of multiple physical injuries. Second, it evolved from childhood traumas and repeated right abuses.When the poor were admitted to asylums, much as when they were admitted to private hospitals, it was as a form of charity and on an unequal basis. Indigent patients were housed in lesser quarters and denied access to many of the entertainments and benefits offered (Yanni 9).
Since asylums depended on wealthy patients to survive and psychiatrists often held posts at madhouses while simultaneously seeing private patients, private physicians became an excellent means of recruiting mental patients. Any wealthy person—especially woman—deemed emotionally sensitive or socially inappropriate could be sent to the asylum to protect her from the world’s stresses. Family arguments, refusals to accept an arranged marriage, homosexual inclinations or relationships, and many other private problems were labeled as symptoms of insanity and became the rationale for admitting someone to the madhouse. Since asylums were generally far from cities to protect patients from urban stressors, visits from family and friends were difficult if not impossible.
Mackenzie argues that this allowed asylum physicians and staff to engage in abuses and neglect that would not otherwise have been possible. (MacKenzie, 67) Yanni demonstrates that the mythology behind the theory of locating asylums in a rural paradise so that the mentally ill could return to sanity by communing with nature. In fact, patients were not allowed to spend time outside without staff supervision, and since staff were not thrilled by the prospect of being alone in a field with a large group of lunatics, they rarely allowed the patients to spend much time outside. (Yanni 123) Thus, the tradition of insane treatment in the 19th century was based on fraud and health commercialization.
The creation of mental hospitals simultaneously encouraged the growth of the field of psychiatry. Thus, the first specialists in the sphere were either the owners of the madhouses or the workers of such institutions since they had a chance to track the improvements or downfalls in the patients’ mental health. In the USA, the science was called asylum medicine since the major investigations were conducted inside the institutions. Due to the elevated social rankings of madhouse treatment, the profession of a psychiatrist gained instant popularity among the young professionals and quickly surpassed other specializations. Different theories were offered to explain mental illness, largely based in neurology. Psychiatrists contended that the mentally ill possessed highly sensitive nervous systems that staggered under the constant stimuli of modern life. The only cure for overly stimulated nerves was a rest in a calm, beautiful place that could return the nerves to a state of rest. This theory supported the creation of the beautiful asylums that proliferated in the 19th century and provided the landscape in which the next stage of psychiatry emerged.
The twentieth century was marked by the evolvement of new attitudes to the nature of insanity and its treatment. As discussed above, the psychiatry has become more focused on the psychological side of insanity and the methods of psychoanalysis. However, the role of mental institutions has not decreased. Some of the real experiences of being treated in mental hospitals described in literary works illustrate the drawbacks of the system of healthcare related to treating the patients of people with mental deviations.
In her 1997 novel The Last Time I Wore a Dress, Daphne Scholinski comes up with the autobiographical account of her years, spent in mental institutions during the eighties, due to having been diagnosed with the ‘gender identity disorder’ – the condition that was extrapolated by the character’s juvenile delinquency and by her emotional discomfort with being a female. According to Scholinski, it was not only that the psychiatric treatment she used to receive did not do her any good, but that it has in fact facilitated even further the author’s abnormal ways – this appears to be the novel’s main idea.
To substantiate the soundness of this idea, Scholinski exposes readers to her memories of being endowed with the sense of lessened self-worth by psychiatrists, who according to the author tended to mistreat her, in order to feel better about themselves: “Everybody feels weird, and everybody is trying to tiptoe around and make you think they’re not” (75). Thus, The Last Time I Wore a Dress can be referred as the actual indictment of the way in which America’s system of psychiatric care used to operate a few decades ago. At least, this is how the author would like her novel to be perceived by readers – the fact that that the novel in question features some rather graphic accounts of psychiatric patients being subjected to theelectroshock therapies supports the validity of this suggestion.
Marya Hornbacher’s 1999 autobiographical novel (memoir) Wasted: A Memoir of Anorexia and Bulimia is essentially about the incapacitating effects of eating disorders (anorexia and bulimia) on the author’s ability to lead a productive life. In it, the author expounds on her memories of having been provided with different medicinal treatments, as the mean to lessen the severity of these effects. The main idea, promoted throughout the novel, is that due to being affiliated with the ego-centric/individualistic values, the American healthcare system continues to remain utterly arrogant of the needs of people, affected by eating disorders – something that resulted in putting Hornbacher on the path of becoming a socially alienated individual. Another important idea, explored in the novel, is that contrary to what many people assume, eating disorders are not ‘physiological’ but rather ‘mental’. The author refers to them in terms of a “sinister, malevolent and predatory mental construct” (Hornbacher 5).
Partially, this explains why, as it appears from the novel, the author’s exposure to the conventional therapies for treating bulimia and anorexia, did not prove beneficial in the long run. Quite to the contrary – Hornbacher contemplates the idea that it was namely due to these therapies that, as time went on, the sheer acuteness of her existential angst continued to increase. Thus, just as it is the case with Scholinski’s novel, Wasted: A Memoir of Anorexia and Bulimia can be best referred to as a literary piece that helps readers to grow increasingly aware that eliminating unpleasant symptoms in patients, as such that has the value of a ‘thing in itself’, can be no longer considered the legitimate objective of healthcare in the West.
In her 1995 memoir An Unquiet Mind: A Memoir of Moods and Madness, Kay Redfield Jamison presents readers with her personal life-account of having struggled with the mental condition of manic-depressive disorder, while advancing the idea that it is rather inappropriate to assume that individuals, affected by this disorder, are not able to attain social prominence, by definition (Jamison holds Ph.D. in psychiatry). According to the author, even though the socially observable extrapolations of the concerned disorder do lead many people to assume that the affected individuals are ‘mad’, this is far from being the actual case – Jamison’s career serves as the best proof, in this respect. In fact, the memoir’s actual aim was to show that the reason why this disorder is considered strongly incapacitating is that even today the etiology of this mental condition remains largely unclear.
This is the reason why, throughout the memoir’s entirety, Jamison never ceases to stress the importance of understanding that, within the context of a particular person developing the condition in question, the genetic factors are being just as imperative as the environmental ones. Moreover, Jamison strives hard to convince readers that it is not only that people should not be ashamed of their manic-depressive condition, but that they may, in fact, benefit from it, because being affected by this disorder naturally prompts individuals to indulge in analytical thinking. All that matters, in this respect, is to ensure that one’s manic anxieties are being properly channeled – hence, the author’s comparison of the concerned mental state to fire, which “by its nature, both creates and destroys” (Jamison 123). It is understood, of course, that Jamison’s outlook on the discursive significance of manic-depressive disorder is rather unconventional, but this is what contributes to the objective value of An Unquiet Mind: A Memoir of Moods and Madness even further.
There can be only a few doubts that the summarized earlier literary works do interrelate in a variety of different ways. The most notable of them has to do with the fact that these works are essentially about the effects of one’s mental/neurological inadequacy on his or her ability to enjoy life to the fullest. There is, however, even more to it – the writing agenda of Scholinski, Hornbacher and Jamison appears to have been concerned with these writers’ intention to educate readers about the commonly overlooked societal consequences of being diagnosed with a particular mental/neurological disorder. In addition, we can mention the fact that the autobiographical novels in question radiate the strongly defined spirit of tolerance – according to all three authors, there is no rationale in deeming the behavioral ‘strangeness’, on the part of those affected by mental/neurological disorders, as the most obvious indication of their lessened social worth.
Finally, regardless of whether the mentioned authors deliberately strived it to be the case or not, but the reading of their literary accounts about one’s struggle with mental and neurological issues, will naturally encourage readers to wonder about whether the euro-centric paradigm of Western healthcare, as we know it, can be considered consistent with the realities of modern living. After all, given the authors’ negative experiences of having been subjected to the conventional psychiatric therapies, it will be thoroughly appropriate to assume that all three literary pieces advance the idea that the time has come for the psychiatric interventions to serve the purpose of providing patients with the chance of ‘holistic’ (concerned with body and soul) recovery, rather than merely the purpose of helping them to conform to the society’s ways. This alone qualifies the discussed autobiographical novels to be recommended for reading by just about anyone.
The analysis of the approaches to insanity and its treatment during the last several centuries demonstrates that psychiatry appears to have become more human and patient-centered. However, the analysis of the history of the institutions for mentally ill people and the methodology employed by them reveals the flaws in modern psychiatry. Personal experience of the writer whose books were analyzed shows that the approach to treating mental disorders should be focused on ensuring the benefits for the patients instead of focusing on benefiting the society.