Politics & Policy

Shrink-Think after Tucson

The modern mental-health disciplines have done much good. But they have forgotten much of what used to keep the psychic peace.

In the aftermath of Tucson, many have pointed to the need for more state intervention in the treatment of those suffering from grave mental illness. Although there may be merit in having government do more to police the mentally ill — to identify those who may pose a threat, to require them to submit to treatment, and in some cases to confine them — such an approach is not the whole answer to the problem of psychotic violence, and it has drawbacks of its own.

It is true that, had Jared Lee Loughner been compelled to undergo treatment for mental illness, the Tucson horror might have been averted. But it is easy to overrate the potential effectiveness of enforcement mechanisms that would rely largely on a mental-health industry plagued by its fair share of pseudo-science.

Mental-health professionals have yet to develop reliable tests for mental illness; the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is a study in over-inclusive definition. Consider the DSM-IV criteria for the “Schizotypal Personality Disorder.” These include “odd thinking and speech . . . vague, circumstantial, metaphorical, overelaborate, or stereotyped” (a criterion that might have caught Proust and Ruskin in its net) and “behavior or appearance that is odd, eccentric, or peculiar” (a standard that puts Lady Gaga outside the pale).

The DSM-IV criteria for “Narcissistic Personality Disorder” include a “pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy,” and a “grandiose sense of self-importance,” infirmities that characterize perhaps half the Senate. The first question in one schizophrenia screening test — “I see and hear things that others cannot see or hear.  Not at all   Just a little   Somewhat   All the time” — would have perplexed G. B. Shaw and the Kennedy brothers, with their predilection for the “vision thing.” Search for an adequate definition of paranoid schizophrenia that would definitely exclude, say, the prophet Isaiah, and you will search in vain.

Pseudo-science is a dangerous thing where the evaluation of mental heath is concerned because it can so easily be abused, as Richard Hofstadter demonstrated when he maintained that the “contemporary right wing” suffered from a paranoid disorder, and as Theodor Adorno and others showed when they argued that conservatives are afflicted by an “authoritarian personality” syndrome.

True, the danger that a mental-health police supervised by state or federal authorities will politicize insanity is at present remote. But slopes are slippery where bureaucrats are busy. Should there ever be a Federal Bureau for Sanity, with the power to administer mental patdowns, one can only hope that there will be safeguards.

It is true that, in spite of ambiguous definitions, there is considerable consensus about what constitutes serious or “certifiable” mental deterioration. Jared Lee Loughner would seem by any reasonable standard to be sick. But although some forms of psychotic violence might be prevented if people like Loughner were brought under the aegis of a reinvigorated enforcement regime, such a solution will do little to impede other forms of violent lunacy. Acts of psychopathic violence will continue to be committed by those who are able to conceal their lunacy, as Ted Bundy did.

The other difficulty with the policing solution is that it overlooks the deeper causes of psychotic violence. The psycho as we know him appears to be a comparatively new phenomenon. Of course it may be that there only seem to have been fewer violent psychotics in the past because the most seriously unbalanced people were dispatched to asylums before they went berserk. (Yet pre-modern asylums housed comparatively few inmates; the Priory of Saint Mary of Bethlehem, better known as Bedlam, had only six patients at the beginning of the 15th century.) It is also possible that psychopathology merely seems to have been less prevalent in the old days on account of poor record-keeping, or because certain crimes were ascribed to witches or demons. Still, I do not think we can exclude the possibility that the older communities possessed methods of identifying, and helping, marginal characters that were in some respects superior to our own.

A number of studies suggest that “the outcome for people diagnosed with schizophrenia in non-Western countries is on average better . . . than for people in the West. Many clinicians and researchers suspect [that] relative levels of social connectedness and acceptance [explain] the difference.” It may be that the West has lost some of its once highly developed (and non-statist) protocols for fostering “connectedness,” and that it has been too quick to dismiss as archaic methods of pastoral care that in the past played a part in keeping the psychic peace. (I have written about this here, here, and here.) E. M. Forster’s mantra, “Only connect,” was always a little simple, but the art of social or communal connection seems to have become more difficult in the modern West — as Tocqueville predicted that it would, and as Putnam shows that it has.

Not only are we likely to exaggerate the effectiveness of modern mental hygiene, we are apt to put too much faith in the remedial powers of the hygienic priest and explainer, the shrink, who, though he has a mass of clinical data in hand, is as helpless before the great mysteries of the mind as the witch doctor of old. The reformation of the psycho Raskolnikov in Dostoevsky’s book was not achieved by a superior mental-health regime, nor was Jean Valjean, the hero of Hugo’s novel, restored by a course of “assisted outpatient treatment.”

If we had a little more patience with the past than we do, we could better see that the mental-health disciplines, if they have done much good, have resulted in the shunting aside of quite valuable techniques of dealing with those who linger in the borderlands between sanity and insanity — as well as with those who suffer from the minor forms of mental pathology, such as the sadness the medieval West knew as acedia and we, with a flourish of pseudo-scientific élan, call “major depressive disorder.”

Can the best of the older methods of pastoral care, now disdained as wildly primitive, be recovered, and adapted to the conditions of “these our unimaginative days”? Perhaps not; but conservatives (who are called to vindicate what is valuable in the tradition) should not dismiss the possibility out of hand.

— Michael Knox Beran is a contributing editor of City Journal and the author, most recently, of Pathology of the Elites: How the Arrogant Classes Plan to Run Your Life.

Michael Knox Beran — Mr. Beran is a lawyer and writer. His book WASPs: The Splendors and Miseries of an American Aristocracy is to be published this year.


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