What causes madness? Hamlet, who studied at the University of Wittenberg before ensuing unpleasantness in Denmark, was clearly unsettled and melancholic (“O that this too too sullied flesh would melt”) before his father’s ghost beckoned him across the ramparts of Castle Elsinor. The usual reading of Shakespeare’s play attributes Hamlet’s depression to his father’s death and his mother’s too-prompt remarriage. But what if Hamlet had been primed for descent into mental anguish by his discovery back at Wittenberg that he was free to invent himself? That the strictures of traditional religion were uncertain at best and possibly mere illusions? That the ultimate authority in his life as a prince, surrounded by privilege but with few corresponding obligations, was just himself? What if Wittenberg U. had assailed his medieval mind with the dizzying prospect that life is really an improvisation and his identity a matter of choice?
Hamlet—the play, not just the character—has been a touchstone for many theories of mental disturbance, though perhaps most famously Freud’s exposition of the Oedipus complex. It is thus not surprising that Liah Greenfeld, University Professor of Sociology, Political Science, and Anthropology at Boston University, devotes some attention to Hamlet’s madness in her extraordinary new book. Mind, Modernity, Madness (she omits the conjunction—an asyndeton for symmetry’s sake) argues that schizophrenia and manic-depressive illness are not just modern labels for age-old maladies, but also distinctly modern ailments. There was a time when they did not exist and there are many places where they still do not exist. Their absence from the historical and ethnographic record isn’t for a lack of diagnosis or description. To the contrary, people in other eras and places made perfectly good descriptions of the forms of insanity they saw around them. They just didn’t encounter what we usually mean by schizophrenia and manic-depressive illness.
This is a breathtakingly large claim and one that will probably be an insurmountable obstacle for some readers. The easy retort to Greenfeld from those who will be disinclined to engage her book on its merits, is that different cultures, of course, overlay the symptoms of mental diseases with their own rubrics, but surface appearances aside, the basic etiology of “madness”—schizophrenia and manic-depressive illness—is the same everywhere. These are organic diseases of unknown or poorly understood origin, but ultimately they are malfunctions of the gray matter, not historically contingent phenomena.
The reduction of madness to brain biology covered by a veneer of culturally contingent expression is a scientific dogma of our time, and to a fair extent it is the popular understanding as well. We know that mental illness responds somewhat to pharmaceutical treatment and some of its patterns can be imaged on MRIs. To suggest that biology may not be both the deepest root and the adequate explanation is to tilt against some imposingly established windmills. But Greenfeld has a case to argue and she argues it extremely well.
Her case is essentially that the liberation from the constraints of a fixed social order is an unbearable strain on some individuals who descend into madness as a result of the incapacity of their minds to create a sense of “self” that can operate within the ambiguities and contradictions of modern life.
This is a simplification of Greenfeld’s complicated hypothesis, but it will do for a start. Mind, Modernity, Madness deserves attention partly because of the usual circumstances it presents: a major scholar has published a major book with a major university press, but one which departs dramatically from prevailing academic views. Will “normal science” à la Thomas Kuhn simply ignore her? Most bids to transform a field of study from a radically divergent perspective fall by the wayside. In 2002, Stephen Wolfram published A New Kind of Science arguing that cellular automata are the key to understanding complexity in nature. The book sold well and Wolfram has numerous followers, but it hasn’t exactly sparked a revolutionary change in science. Not every bid to be the next Copernicus or Darwin succeeds, nor would we wish novel hypotheses to sweep without opposition to acclimation. The academy needs time to sift challenging departures from orthodoxy.
Greenfeld’s book bears a certain kinship to Durkheim’s Suicide (1897), which demonstrated that what looks like a supremely individualistic act—the taking of one’s own life—falls into clear social patterns. Durkheim’s master concept was “anomie,” the condition of profound disorientation that afflicts those who lose their social bearings. Greenfeld builds on this concept with a wealth of transdisciplinary detail from history, anthropology, neuroscience, psychology, and psychiatry. Anomie may arise in any culture, but the endemic form of anomie in the West, developing at the point at which individuals found themselves blasted loose from the old order, was madness:
In England, madness was spreading quickly throughout the sixteenth century, by the end of it being considered—as we learn from Hamlet—a special mark of English society.1
At first, madness “affected almost exclusively the elites—people who actually enjoyed the dignity, the liberty, and choice implied in the national consciousness” (4), but it spread downward as the liberty of national identity propagated throughout society.
Greenfeld sees the conditions that fostered the emergence of madness as connected to “nationalism,” by which she means something fairly different from Fourth of July celebrations or Tea Party rallies, mad as these may seem to some people. Nationalism is the term Greenfeld gives to the social order in which the impersonal state emerged as the political authority over a territory conceived as a whole. “It is a form of consciousness,” she writes, one that is “essentially secular,” and treats all of its members as fundamentally equal and participating in “popular sovereignty” (2). With nationalism comes an “open system of stratification,” i.e., the possibility of people sinking or rising from the station into which they were born, the ideal of sustained economic growth, and a growing conception of individual liberty. This is an understanding of nationalism that Greenfeld developed in three earlier volumes: Nationalism: Five Roads to Modernity (1992), The Spirit of Capitalism: Nationalism and Economic Growth (2001), and Nationalism and the Mind (2006).
The particular purchase this idea of nationalism has in Mind, Modernity, Madness is that it gives Greenfeld a way to distinguish the distinct forms of volition the modern West more or less invented. Madness, in her view, is a disease of the will, a kind of incapacitation of the individual’s ability to connect coherent thought with purposive action. “Nationalism” in the sense I just sketched adds “greatly to the human emotional repertoire” (3). It licenses new forms of aspiration and romantic longing, but it also ushers in new possibilities of suffering. We can strive for higher social status, and indeed we may be expected so to strive, but the right to reach also “makes the formation of individual identity problematic” (4).
This could simply lead to dissatisfaction and ordinary unhappiness among those whose aspirational identities fall short of the realities of their lives. And that’s what generally happens. But we humans may not really be that well-suited to this demand for perpetual self-invention and a surprisingly large percentage of modern Westerners lose the ability to participate in the “collective consciousness” of our culture.
“The malformation of the mind,” in this sense, “becomes a mark of nations” (28)—not just an individual pathology. It involves the “dissolution of the self as agency” (27), and the various forms of madness—schizophrenia, unipoplar depression, and depression with mania—represent various ways in which human will can be impaired.
Hamlet, of course, exemplifies enfeebled will. He rails against himself for his inability to act, but always finds the apt excuse to defer again. Greenfeld’s Hamlet is not the one favored by some critics in which he feigns madness as a tactical diversion. Even the truly mad presumably can feign madness or feign to themselves that their madness is feigned, but Hamlet is feigning nothing when he talks himself out of ending his “sea of troubles” in his most famous soliloquy: “Thus the native hue of resolution / is sicklied o’er with the pale cast of thought.”
Greenfeld’s theory bears enough superficial resemblance to the social constructionism advanced by Michel Foucault that it is important to draw the distinction. Most famously in Folie et déraison (1961; published in English as Madness and Civilization in 1964), Foucault argued that bourgeois society in the age of the Enlightenment took to locking up people who were mentally erratic. This was an act of enforcing external social order on a wide range of hapless individuals who, before that time, society had accommodated in other ways. Foucault, in other words, viewed diagnosis and treatment as socially constructed, but not madness, which he considered indistinct from the spectrum of mental disorders that have existed from time immemorial. Greenfeld, by contrast, sees madness as real and as having come into existence in response to particular social conditions. It might be best to say that for Greenfeld madness is not socially constructed at all. It is, rather, culturally contingent. Modern culture has within it the capacity to drive some people literally mad.
So much for the thesis. How does Greenfeld substantiate such an audacious departure from established views? Her book proceeds in three large tranches: philosophical, psychological, and historical. In the philosophical section, Greenfeld presents herself as someone who takes “the mind” seriously, not as epiphenomenal or reducible to neuronal biology. Most of what the mind does is process symbols, and symbols for the most part derive from the surrounding culture. “We have abundant empirical evidence for the existence of the mind” (36), but “an empirical, scientific study of the mind” (37) has lagged due to some a priori assumptions among scientists. Greenfeld launches her work from the “interim conclusion” that science is “as dogmatic as any other system of beliefs” (40) but is in the grip of an illusion that it has escaped its own dogmatism.
I won’t attempt to recount the rungs on the ladder that lead from that to the idea that “culture” is paramount in shaping not only what we think but how “mind” itself is organized (and sometimes dis-organized). Culture and mind, as Greenfeld has it, are “not simply intimately related” (70). They are “the same process occurring on two levels” (65). This leads her into a discussion of neurobiology including of the cognitive, intellectual, and emotive animals who present the baseline of mental processing without the complications of a “cultured mind” (85). This holds surprises, as, for example, in the discovery that “rats easily surpass us in simple Aristotelian logic” (83). For Greenfeld, the largest lesson of the comparison is that we humans contrast to animals in having to adapt to a “genetically undetermined” reality (84), the society of fellow humans. To this end, we “construct culture” (84).
The second section, dealing with the psychology of madness, takes the reader deep into the symptomatology, classification, and analysis of madness. Greenfeld’s thesis gains considerable credibility from the precise accounts by physicians of their observations of schizophrenics and those in the grip of manic depression, as well as some profoundly moving firsthand descriptions by the afflicted in moments of lucidity. In its earliest stage, the prodrome of schizophrenia, for example, the sufferer focuses with abnormal attention on the outside world and often has a “truth-taking stare” in which “anxiety intermixes with exhilaration,” (171–72).
Greenfeld quotes the experimental psychologist Louis Sass on the “intellectual acuity” of schizophrenia (118):
Generally the person has a sense of having lost contact with things, or with everything having undergone some subtle, all-encompassing change. Reality seems to be unveiled as never before, and the visual world looks peculiar and eerie—weirdly beautiful, tantalizingly significant, or perhaps horrifying in some insidious but ineffable way. Fascinated by this vision, the patient often stares intently at the world.2
And she quotes a patient who described her madness not as an “illness” but as finding herself in “a country, opposed to Reality, where reigned an implacable light, blinding, leaving no place for shadow; an immense space without boundary, limitless, flat; a mineral, lunar country, cold as the wastes of North Pole” (173). People there “turn weirdly about, they make gestures, movements without sense; they are phantoms whirling on an infinite plane” (173). To her, “Madness was finding oneself permanently in an all-embracing Unreality” (173). It is a state of being in which the thinking will has vanished and both the visual and verbal worlds have been reduced to meaninglessness.
This is just one stage of one kind of madness, but it fits extraordinarily well with Greenfeld’s idea that madness consists of the radical disruption of cultural schema The sufferer is acutely aware of the strangeness of things and words that have been stripped of cultural significance. This stage of schizophrenia, however, doesn’t last. It is typically followed by “apophany,” in which meaning rushes back in huge excess. Suddenly everything is endowed with excess meaning. The sufferer has an “abnormal awareness of meaningfulness” to a degree that is “intolerable,” “exhausting,” and language fails to keep up (176–77).
There are certainly many ways to construe such symptoms, but Greenfeld has offered what, at a minimum, can be taken as a plausible interpretation. A mind bereft of the ordinary function of “culture,” to give due and proportional meaning to the purposive aspect of things, tumbles into an abyss—first of no meaning and then into a desperate but out-of-control attempt to paint meaning back into the picture.
The third tranche of Mind, Modernity, Madness is Greenfeld’s attempt to construe madness as contingent to the rise of modern culture. This begins in sixteenth-century England, where it has seemed clear to many generations of historians that a key break with medieval culture took form, one that allowed individualism, secularization, and new kinds of ambition to emerge. Greenfeld’s most daring move is to propose that these are exactly the conditions that unhinged many people in a brand-new way.
Mental illness, of course, was already well-known. But in some sense, the sixteenth-century English created madness. Greenfeld finds warrant for the novelty of madness in sixteenth-century medical texts. “Bedlam madness,” named for the “only specialized mental asylum in the Western world,” seems pretty strong testimony (352). Greenfeld follows the progress of the disease from England to France, then Germany, and eventually all of Europe, and devotes her last chapter, “Madder Than Them All,” to American insanity. It isn’t a compliment.
As someone who has written a book on the cultural predicates of an emotional disorder (A Bee in the Mouth: Anger in America Now, 2006), I have some experience in observing the difficulty Americans have grappling with the notion that their internal emotional states owe anything to the surrounding culture. Nothing feels more immediate, personal, authentic, and compelling than our emotional excitements. To suggest that these states owe not a little but a great deal to the culture that invisibly informs our minds and shapes us as social beings comes across to many as preposterous. We are not robots. We feel what we feel. We’re free.
Greenfeld can add this hurdle to the formidable barrier of convincing the medical profession that it has been on the wrong scent for the last two hundred years in treating madness as a disease, whether of the psyche (Freud) or of the brain. In her favor is that Mind, Modernity, Madness is a beautifully readable book, capacious in its scholarship but entertainingly so. At points it is like Robert Burton’s The Anatomy of Melancholy, which early in the history of madness (it was published in 1621) ranged everywhere in search of an explanation for this “perturbation of the mind.” Greenfeld has some of Burton’s mirth—“A rat, of course, does not know that it makes a ‘transitive inference’” (87)—as well as his breadth of learning and love of literature, but she is a vastly better master of orderly argument. She mentions the loss of earlier insights, “drowned in the torrent of Burton’s relentless erudition” (401).
No one will drown in Mind, Modernity, Madness. It is more a voyage across a wide lake, ruffled by the wind, to a distant shore. It deals with a dark subject but is not gripped by that stealthy admiration of madness that sometimes creeps into contemporary accounts. After an extended reading of Kay Jamison’s memoir of her madness, An Unquiet Mind (1996), Greenfeld observes that it is “a very frightening book,” not as “moral judgment,” but because it is so accurate an account of a terrible affliction (306).
That affliction is growing in frequency in the United States. We are told by the psychiatric profession that more than 25 percent of the American population over age eighteen suffers from a “diagnosable mental disorder” each year and 6 percent of the population has a serious mental disorder.3 This rate is astonishingly higher than the one-in-a-thousand estimate of serious mental disorders worldwide.4 This discrepancy calls for a cultural explanation. Liah Greenfeld has offered one.
1 Liah Greenfeld, Mind, Modernity, Madness: The Impact of Culture on Human Experience (Cambridge, MA: Harvard University Press, 2013), 4. Further references to this work will be cited parenthetically within the text.
2 Louis Arnorsson Sass, Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought (Cambridge, MA: Harvard University Press, 1994), 43–44. Quoted by Greenfeld, Mind, Modernity, Madness, 172.
3 Ronald C. Kessler, Wai Tat Chiu, Olga Demler, and Ellen E. Walters, “Prevalence, Severity, and Comorbidity of Twelve-Month DSM-IV Disorders in the National Comorbidity Survey Replication” Archives of General Psychiatry 62, no. 6 (June 2005): 617–27.
4 E. Fuller Torrey, The Invisible Plague: The Rise of Mental Illness from 1750 to the Present (Piscataway, NJ: Rutgers University Press, 2001), 315. Cited by Greenfeld, Mind, Modernity, Madness, 20.