Does insanity exist outside the subjective viewpoint of a given society?

October 2, 2008 11:03 AM

Does insanity exist, outside the subjective viewpoint of a given society?

Imagine a man who takes to walking around naked in the streets talking aloud to God and insisting he was getting answers through the wind. If here were to do this every day out in public for all to see, society would label him insane. If that same man lived on an island where walking naked through the streets and talking to God was a common activity, he would not be labeled insane as he would be a normal part of that population. He might be labeled insane if he didn't behave in this manner while within that society.

Thus, insanity is a label hung on individual beliefs and actions and based strictly on the environmental and social norms of a given society and not inherent within the person in any way. Placing said individual in another environment more accepting of their behaviour and beliefs renders the definition meaningless as a descriptive term. This would apply to viewpoints both outside the society the individual is in, and from within a persons own experience.

Due to the relativity of it's definition, "insanity" as an objective term within ones own experience, does not exist.

Does this make any sense?

posted by datter to Society & Culture (47 answers total)

I don't think this question is conclusively answerable, but for a brilliant (and kinda hilarious) example of the social construction of insanity, see the Rosenhan experiments.
posted by game warden to the events rhino at 11:12 AM on October 2, 2008 [3 favorites]

What if you claimed there were giant pink bunnies all around me? I don't see any bunnies. No one else I ask sees any bunnies. Therefore, you are insane.

I don't think this reasoning depends on societal norms.
posted by demiurge at 11:12 AM on October 2, 2008

It makes sense in that I understand what you are trying to argue for. It's almost certainly wrong as an analysis of insanity, but sure it successfully conveys meaning.
posted by oddman at 11:14 AM on October 2, 2008

If this person were to endanger themselves - say either not covering themselves in freezing weather thus causing themselves to become ill, or walking on cut glass. This is indicative of someone who cannot differentiate between self care and self harm. The norm being self care. Who said so? Consensus.

Or regarding others - perhaps society is not open to viewing someone's naked body - and that is an infringement on their rights to live in a civilized society - that is the law of the land - by not adhering to the law, disregarding the feelings and rights of others, this would be considered anti-social behavior, coupled with raving - *talking to God* - this could constitute as being out of one's mind - i.e. insane.
posted by watercarrier at 11:18 AM on October 2, 2008

Of course, you could always construct a society in which any type of insanity isn't called insanity but treated as a special gift. The problem is that some of these societies would be untenable. Think of a society that considered pyromania as a special gift to be encouraged.
posted by demiurge at 11:21 AM on October 2, 2008 [1 favorite]

You are going to want to read Foucault on this question. And then you're going to want to read the people that disagree with Foucault.

This is well-trod ground in certain circles and there's disagreement (there always is) but Foucault's Madness and Civilization is going to be your best starting point for researching this.
posted by stet at 11:23 AM on October 2, 2008 [8 favorites]

Usually the litmus test is whether they can be functional in life, generally that means holding down a job, not attempting suicide, not attempting random murders, not crying randomly, dont piss themselves, etc. Having delusional beliefs isnt in itself a sign of mental illness. Humanity is incredibly delusion, see the history of religion and the supernatural.

Absolutely is this objective. Also, its worth noting that you just dont label someone insane. Its not just yes or no. They suffer from mental illness, which in most cases temporary or treatable. There are many forms of mental illness and mood disorders, many of which produce no delusions.

Honestly, I think you have a "hollywood" picture of mental illness. Like, the nice guy who talks to god but is actually an okay fellow. Severe delusions usually dont manifest this way. There are guys who shout and scream at god and who are much angrier than any anger youve experienced in your life. They harm themselves and others and usually end up killing themselves. They lead sad lives of homelessness and pain. Its obvious they are ill. Pissing yourself while crying and screaming at god isnt subjective moralism, its serious illness.

Praying is talking to god, yet nobody gets put into a home for that. I think your assumptions are wrong and your question is leading and flawed.
posted by damn dirty ape at 11:28 AM on October 2, 2008 [9 favorites]

I see where you want to go with this, but it's wrong. The definition of insanity has more to do with the mental state of the person involved than it does with the outward manifestation of said mental state. Your statement assumes that we can't know what goes on inside anyone's head.

Let's assume those people walking around in the street naked talking to God were doing so because it's how their culture socializes. The insane person who does this is not insane because he isn't "normal". He's insane because his mind cannot function in society. If you were to drop him down in the midst of the naked mumbling culture, they'd label him insane because he wouldn't connect with them. They'd be making social cues, and the guy wouldn't respond or he'd respond inappropriately.


I'll grant that "insanity" is a loose and not very helpful word, but this is why psychology doesn't really use that word. Here, I take it to mean someone who has some form of psychosis. There are a lot more mental disorders out there, but they aren't called insanity for a reason.

I suggest you take some time to really understand what insanity is rather than theorize about it. Go volunteer at a psychiatric crisis center and observe the people that come in for help.
posted by Axle at 11:28 AM on October 2, 2008 [4 favorites]

check out Foucault's "Madness and Civilization" for an in-depth discussion of how perception of actions by society can be labelled.

yes, a lot of things exist as subjective terms by society. If by "exist", you mean "can be put in a test tube", then no, madness doesn't exist. However, a person's behavior certainly has measurable effects on the way a person is treated; there's a guy who hangs out by Madison sq park who constantly talks and growls to himself, and people literally swerve to avoid walking near him.
posted by dubold at 11:28 AM on October 2, 2008

oops, stet beat me to it.
posted by dubold at 11:29 AM on October 2, 2008

If youre looking for an argument, you'll get one. No one is denying that society, especially in the past, has treated many people unfairly. Homosexuality was seen as mental illness until fairly recently. People burned witches with the full blessing of society and state.

Your question is just too loaded and too leading. Obviously society colors all, but to dismiss all categories of mental illness as being a social construct is throwing the baby out with the bath water.

From your followup its pretty obvious you have not spend any significant time with seriously mentally ill people. There are volunteering opportunities for you do this if you like.
posted by damn dirty ape at 11:33 AM on October 2, 2008

Somebody said it, I can't remember who, but it's stuck with me.

Perception is whatever one can person can agree on.
Love is whatever two people can agree on.
Community is whatever three people can agree on.
Society is whatever four people can agree on.
Five people have never fully agree on anything. This is culture, the argument that never ends (and it's fun).

No mention of sanity but I suspect it falls somewhere between perception and everything else.
posted by philip-random at 11:39 AM on October 2, 2008 [3 favorites]

Also, many mentally people know they are ill. They hate it. They wish they could be better. Your hollywood ideas of mentally ill people just having fun delusions is ridiculous. Its sad to hear "There's something wrong me but I dont know what." Lucidity comes and goes, but they certainly do know they are hurting and things are not right.
posted by damn dirty ape at 11:42 AM on October 2, 2008 [4 favorites]

Many thanks to damn dirty ape for pointing out, in a constructive and intelligent way, that this question is loaded with prejudice. Mental illness is illness, not viewpoint. Prejudice and bigotry, of course, are rooted in viewpoint.
posted by MinPin at 11:44 AM on October 2, 2008

I'll second and third most of what everyone is saying here, and add that there's very specific diagnostic criteria for mental disorders, as outlined in the DSM-IV.
posted by TurkishGolds at 12:00 PM on October 2, 2008

There is a whole movement predicated on the idea that insanity is a social construct (And that the construct is used to control and marganilize others.) Here is a link to the wiki for Antipsychiatry. http://en.wikipedia.org/wiki/Antipsychiatry (I'm sorry, I still cannot get links to work on AskMe.)

One thing to think about is that the IDEA of insanity, as far as I know, is universal. There is always someone that others in a society can point to and say "that person ain't right."
posted by thebrokedown at 12:07 PM on October 2, 2008

Ditto what others have said regarding the simplistic view of insanity. All of the extreme forms of mental illness I've seen involve a deep unhappiness and often an urgent desire to 'not be this way'. Unhappiness translates quite well across societies, and I'm pretty sure that voices telling you that you're worthless and should kill yourself would be equally damaging to an NYC cabbie and a Kalahari tribesman.
posted by mattholomew at 12:08 PM on October 2, 2008

It can be a bit of both. It's quite reasonble to talk about the ways in which cultures use terms like mental illness and insanity to marginalize people whose behavior falls outside of the norm, while at the same time, noting that some forms of mental illness do appear to be caused by physical disorders that cause great suffering.
posted by KirkJobSluder at 12:11 PM on October 2, 2008

Response by poster: Please understand I in no way mean to denigrate what it means to suffer from a mental illness. I'm not completely lacking in experience with people suffering like this, and I realize how hard it can be to know you aren't well somehow, and to not be able to really do anything about it.

I am exploring this admittedly generalized definition of insanity (as a term) for a paper I'm writing. I wanted to hit the points of labels, and societal judgment of same with relation to this term more than make any judgments about the people who deal issues like these.

One reasoning behind the outside labeling of a (generalized) condition as a definition/label comes from the historical solution of putting "insane" people in asylums. Within such an environment, does the persons level of sanity change in relation to those around him? Not from the viewpoint of the people who run it, as they are a part of the society that put them in there... but rather from the viewpoint of the others within said asylum. Would a pyromaniac (as someone mentioned above) put in a place full of other pyromaniacs find acceptance and understanding he might not have found elsewhere? Within that group would he still be labeled as he was, or would they accept him differently because they share a problem norm?

To those who were interested in helping, thank you for the helpful feedback, it's much appreciated. To the rest... well, thanks anyway.
posted by datter at 12:12 PM on October 2, 2008

Thus, insanity is a label hung on individual beliefs and actions and based strictly on the environmental and social norms of a given society and not inherent within the person in any way.

No, in all human societies - and even humans raised by wolves (so to speak), humans respond to their environment. Your example of identical behaviours misses this - just because the two examples are superficially doing the same actions, does not mean they are really doing the same things because their underlying causes are different - behaviour has a close relationship with environment and context. A transplanted islander who did these things in a city would not be considered insane, s/he would be considered foreign and in need of schooling.

As to your question, some forms of insanity show up on even today's brain scans as clearly as a large facial deformity would appear in person. So at what point do you consider that a bodily organ is objectively malfunctioning? When the person cannot survive? When the person has difficulty with basic human functioning? It is very difficult to take the position that insanity does not exist, or only exists subjectively.

For a clear-cut example, let's skip the congenital insanities and look at mad cow disease. You can see it eating the brain tissue over time. You can see the insanity that directly results. There is nothing subjective about it.
posted by -harlequin- at 12:17 PM on October 2, 2008 [1 favorite]

Alzheimer's is another interesting specific case -- I'm sure there are cultures that have all kinds of elaborate mythology built around it and why it happens, but there are boatloads of scientific evidence to show that it is a real physiological disease. Sure, some cultures may have varying levels of understanding of it and ability to deal with it, but it is a real, verifiable illness -- again as harlequin says, there's nothing subjective about it.
posted by mattholomew at 12:24 PM on October 2, 2008

In which case I'll second the Rosenhan experiments, and also suggest One Flew Over the Cuckoo's Nest.
posted by Axle at 12:26 PM on October 2, 2008

Best answer: This thread is riddled with confusion because most people here aren't defining their terms. This leads Bob and Tim to THINK they're both talking about apples. In fact, Tim is talking about apples while Bob is talking about oranges.

I'm going to attack the problem via an analogy. "Insanity" is a loaded term, so I'm going to talk about physical injuries instead of mental ones (though, as a non-dualist, I don't really think there's a difference).

Does a bodily injury exist, outside the subjective viewpoint of a given society?

Okay, let's deal with a few issues:

1. Is there such a thing as bodily damage? Well, we've already loaded the question by using the word "damage." When is something damaged? When is a clock damaged? When it ceases to tell time or to tell time correctly*. Why does that make it "damaged"? Because it's not doing what it's supposed to do? Who decided what it's supposed to do? WE do. That is, most people are brought up to expect clocks to tell time. When they don't, those people call the clocks "damaged." So we're definitely talking about a label applied due to cultural expectations and norms.

(*Notice that many people never get further than this. Are there people who are objectively mentally ill. "Yes! Objectively, because their minds aren't working properly." People who "reason" this way aren't defining what they mean by "aren't working properly" or stating how that can be anything other than a culturally-based understanding.)

2. Is there a way that MOST bodies work, and is it possible for a single body to deviate from that norm? I would say yes. Things get a little fuzzy, because every body is somewhat unique. But one can make predictions about bodies in general and find specific cases in which those predictions -- that generally are correct -- don't hold up.

For instance: most leg bones are solid with no breaks; a few do have breaks. So we have a standard and some deviations from that standard. Unless you want to accept really low-level issues, like whether or not the physical universe exists, we can say that standards and deviations are facts.

If we define healthy as the standard (in other words, all healthy means is a model that yields predictable outcomes) and sick as non-standard (the predictions yield false results), then there are definitely healthy people and sick people. It gets trickier when we add VALUE-based statements into the mix, e.g. health is good/desirable; illness is bad/undesirable.

3. Okay, so there are standard bodies and bodies that deviate from those standards. Is there ANY way one can make a value judgment about this without a cultural reference? For instance, without applying culture, can we say that standard bodies are good and deviants are bad (e.g. solid bones are good; broken bones are bad)?

Here, we have to be very careful what we mean by "culture." I think there's been a lot of confusion around this word in this thread.

Take a minute to think about these four scenarios:

a. we discover that some groups of people dislike broken bones and always try to mend them. Other groups of people think broken bones are useful or desirable. If this was the case, would we (would YOU) call this a "cultural difference"?

b. we discover that in all groups of people, throughout history, broken bones have been considered bad. But we can imagine a group of people who thinks otherwise. They may not exist, but they COULD exist. Assuming this, would you consider "broken bones are bad" to be a cultural statement?

c. we discover that humans are genetically incapable of liking broken bones. Given a creature with human DNA, that creature will inevitably think broken bones are bad. Is there any way that it still makes sense to call "broken bones are bad" a value judgment? Does the term "value judgment" make sense when there aren't alternatives?

d. what about cases that MOSTLY fall into one of the above categories? For instance, what if almost all humans are genetically programmed to hate broken bones but a few people -- with genetic mutations -- like them. Does it make any sense to say that the majority is right and the minority wrong? Do the words right and wrong have any meaning aside from majority-based norms?

Let's say that everyone agrees that, having surveyed all cultures, past and present, MOST people within those cultures dislike broken bones.

Bob: Saying "broken bones are bad" is true, because almost everyone (throughout history) has hated them.

Tim: Saying "broken bones are bad" is false, because SOME people like them.

Who is right? Who is wrong? I would say that neither is right or wrong. They're talking apples and oranges. Specifically, Bob is (implicitly) defining "bad" as "what most people dislike." Whereas Tim will only accept as bad what ALL people dislike. This is the sort of confusing we're seeing in this thread.

My feeling is that ultimately you're right -- that "illness" is a value judgment -- and it's within the realm of my imagination to envision a culture could have a different value judgment.

But in many cases, you won't be able to find such a culture. For instance, though there are cultural differences when it comes to acceptance of violence, I don't think you'll find any human culture that has ever valued serial killers. That's not to say that being anti-serial killer isn't culturally based. It's to say that fearing serials killers is a trait of all cultures.

(It's important to remember that "culture" is not the opposite of "genetic." Culture is malleable but it's not infinitely malleable.)

There are some "illnesses" -- such as homosexuality -- that are accepted in some cultures and rejected (as illnesses) in other cultures. I think you're looking for a clean, decisive answer. In the workaday world, I doubt you're going to find one. Some "illnesses" are likely to wax and wane (in terms of how we label them). Mostly, these involve traits that -- while some may think of them as illnesses -- don't stop people from generally functioning in society. A gay man can hold down a job just as well as a straight man. In most cases, the same is true for someone who has Aspergers. This is often not the case with untreated Schizophrenia, Depression or Bipolar disorder.

Finally, I think you should ask yourself "Why do I care?" I'm not suggesting that you shouldn't care. I'm suggesting that if you can narrow this down to a more specific issue, you might get better answers. For instance...

"I have X trait. It doesn't bother me, but people keep saying it's an illness. That bugs me."

If this is the case, think about whether or not getting an answer in this thread will really improve things for you. I doubt it would go over well to say, "Oh yeah, you're wrong. It's not an illness! Calling it one is just a cultural label! And here's the proof..." If you said that to me, I'd respond, "Okay, you're right. It's a cultural label. And, as a member of the culture that applies that label, I'm going to see to it that you're locked up for your own good."

If this is purely academic interest, I suspect you're unlikely to resolve anything unless you someone (how?) compel everyone to define their terms. You may, of course, learn all sorts of useful things about related issues, such as whether or not we treat mentally-ill people with respect, but that's not your specific question.
posted by grumblebee at 12:30 PM on October 2, 2008 [13 favorites]

Best answer: I'm not sure if this will make sense, but I think it's possible that "mental illness" as it is commonly understood is a social construct and that people diagnosed with mental illnesses are genuinely suffering and experience a pattern of distorted emotions/thinking/behavior. It's interesting to note that the diagnostic criteria for mental illnesses sometimes explicitly refer to social norms, or one's ability to be productive (as if only individuals can be dysfunctional and not societies). As someone else noted above, an excellent point to consider is the fact that homosexuality was once considered to be a mental illness, and there was also drapetomia, the "disease" which caused slaves to run away. I'd be more inclined to believe that the people who owned slaves were emotionally dysfunctional. It's essential to remember that psychiatry has a history as an institution supporting oppressive status quos and reinforcing problematic social norms.

At the same time, I do think that other comments pointing out that you're not really thinking about the more painful, less flashy experiences such as depression are right. I've struggled with depression and it's definitely real. At the same time, calling it an "illness" implies that it has a biological cause when, for me, it seems to have a lot more to do with growing up queer in seriously homophobic spaces.

If you want to read more along the lines of what you're thinking, I'd recommend The Politics of Experience by R.D. Laing, and The Myth of Mental Illness by Thomas Szasz.
posted by overglow at 12:31 PM on October 2, 2008 [4 favorites]

In which case I'll second the Rosenhan experiments, and also suggest One Flew Over the Cuckoo's Nest.

One Flew... is a fictional novel. From the information you provided on the Rosenhan experiments, the conclusions drawn sound suspect at best. You could easily perform a similar experiment in which you asked a number of doctors to diagnose somebody who verifiably has cancer, and a portion of them would miss it. Does that mean that cancer is a social construct?
posted by mattholomew at 12:33 PM on October 2, 2008

Would a pyromaniac (as someone mentioned above) put in a place full of other pyromaniacs find acceptance and understanding he might not have found elsewhere? Within that group would he still be labeled as he was, or would they accept him differently because they share a problem norm?

The problem here is, we don't differentiate so finely like that. We don't have one separate asylum for the one kind of disorder and another separate asylum for this other kind, and etc. And even if we did, not every pyromaniac is a pyromaniac for the same reasons. We honestly know feck-all about how the healthy brain works, and we similarly know feck-all about how the unhealthy brain works -- what little we know boils down to "well, these various random different kinds of behaviour patterns are problematic" and "sometimes, if you give the guy who thinks he's a tree this particular medicine, it helps. Unless it doesn't. Give it a shot."

So it's not like you put Pyromaniac Sid in an asylum and he finds ten other pyromaniacs and they all hang out and say "cool, someone like us!" It's more like, Pyromaniac Sid ends up in an asylum with Kent, the guy who thinks he's dead, and LuEllen, who thinks that everyone around her gets periodically kidapped and replaced with their clones, and Nick who's on suicide watch...maybe you'll have another pyromaniac in there (we'll call him Luther), but even here, Sid's a pyromaniac because he thinks God is commanding personally, but Luther's a pyromaniac because it happens to be a sexual fetish. So it's possible that even in the asylums you can have one person look at another person and say "okay, you're just not right, dude."
posted by EmpressCallipygos at 1:01 PM on October 2, 2008

mattholomew:
From the information you provided on the Rosenhan experiments, the conclusions drawn sound suspect at best. You could easily perform a similar experiment in which you asked a number of doctors to diagnose somebody who verifiably has cancer, and a portion of them would miss it. Does that mean that cancer is a social construct?

For the record, it wasn't I who provided information on the Rosenhan experiments. As for One Flew Over, I mentioned it because the OP has already said that they're not looking for a scientific viewpoint.

I am exploring this admittedly generalized definition of insanity (as a term) for a paper I'm writing. I wanted to hit the points of labels, and societal judgment of same with relation to this term more than make any judgments about the people who deal issues like these.

One Flew Over the Cuckoo's Nest is an exploration of societal judgements of people, be they "insane" or not. Since we're not talking science here, I fail to see how it isn't relevant.
posted by Axle at 1:02 PM on October 2, 2008

Axle:

I understand your point, and sorry if I offended. I would agree with you that One Flew is a good reference for a non-scientific view of how the mentally ill are treated.
posted by mattholomew at 1:12 PM on October 2, 2008

Does insanity exist, outside the subjective viewpoint of a given society?

Here's another related question: do humans and rocks exist, outside the subjective viewpoint of a given society?

If I hold a rock in my hand, do you think of me and the rock as one object or two? Let's say you think of the rock and me as two objects. Are we OBJECTIVELY two objects or is that just a cultural understanding?

In my view, it's impossible to REALLY answer your question without bogging down into issues like this (e.g. what we mean by objectivity; what sorts of thing are objective; whether anything can every be completely objective). We can talk around the issue in fuzzy ways or we can talk about related issues, but we can't really zero in on your issue unless we're willing to get into some deep shit.
posted by grumblebee at 1:15 PM on October 2, 2008

The answer to the OP's question is "yes". But the verification of "yes" is very complicated, involving possibilities over time and calculating long-term outcomes and the statistical interactions between humans, their environments, and their ability to reproduce.
posted by sandking at 1:34 PM on October 2, 2008

Also, many mentally people know they are ill. They hate it. They wish they could be better.

As a person gifted with bipolar awesomeness, I'd concur with this. Whether or not depression classifies as 'insanity', I'm not sure, but a full-blown manic episode certainly does - voices, delusions of grandeur, the whole schizotypal works.

And one could argue that it's all in the definition, and that if one were placed in an island where everybody thought they were Jesus reincarnated, then that would be great & normal & fine, and that's true in a shallow, Foucaldian sense of "hey, it's all defined by the power-knowledge of the socio-medical discourse etc" but that ignores the fact that during those states you are not the person you normally are, and at least some of the time you have the lucidity to realise it. When back to normal, you can clearly recognise how awry your thoughts were.

That's the way I'd look at whether or not insanity / mental illness exists - not as a question of how society or medicine define it against behavioural norms, but as a question of how the person themselves would define their state*, in contrast to their normal stable self, or the generally rational self that they lived in for much of their lives.

*assuming they could, eg with treatment or in moments of lucidity.
posted by UbuRoivas at 1:48 PM on October 2, 2008

Thomas Szasz, who wrote "The Myth Of Mental Illness," would also be interesting for you to read. He believes mental illness is a societal construct.
posted by Punctual at 2:01 PM on October 2, 2008

Overglow already mentioned Szasz; my bad.
posted by Punctual at 2:03 PM on October 2, 2008

I think you could argue that what modern western psychology calls insanity exists in every culture. How a particular culture defines and relates to that state will vary from culture to culture. The obvious example is someone who claims to be a direct representative of God or a god. In modern western psychology we say that person is schizoid and has delusions of grandeur, in ancient Greece that person might be made an Oracle. Even today we have people in high office who claim to talk to God.

The real question is whether absolute sanity exists, in any universal sense. People certainly believe in it, but no one can prove that they are absolutely sane. Sanity is usually seen as a goal, which can't really be arrived at, but to even establish a universal definition is basically impossible. A sane Christian is insane by definition to an atheist, and vice a versa.
posted by doctor_negative at 2:31 PM on October 2, 2008

Alzheimer's is another interesting specific case [...] there are boatloads of scientific evidence to show that it is a real physiological disease. [...] as harlequin says, there's nothing subjective about it.

Another avenue you could explore in your paper is the opposite of this. Where does having a hobby and poor self-discipline end and addiction to "world of warcraft" begin? Where is the line between youthful exuberance and attention deficit disorder?
posted by Mike1024 at 2:43 PM on October 2, 2008

Best answer: First off, I think grumblebee's answer is brilliant.

The nature of human language is such that the vast majority of concepts are ill-defined creatures with very, very fuzzy borders. Ask twenty different people to draw the lines between a pebble, a stone, a rock and a boulder and you'll end up with twenty different ways of conceptually chopping up the world. But there's enough overlap in those ways of classifying things that we can actually communicate. We can construct an "average" of all those different way of classifying, and that average is what we point to when talking about the meaning of the words pebble, stone, rock and boulder in the context of those twenty people.

That idealized classification certainly depends on subjective viewpoints of those twenty people. It's not too hard to think of another system in which the concept of a pebble doesn't exist ("oh, you mean a really small stone?"). The concept of a pebble doesn't exist outside of a certain subjective way of chopping up the world. But pebbles, as we understand them, do exist. No getting around that, and the evidence is plentiful.

My point is that by even appealing to the concept of "illness" at all, you have already bought into a system that normalizes and "averages" the functioning and behavior of the body and mind. You have already legitimized the notion that "health" and "illness" are coherent, distinct concepts. And that means you agree that there is some dividing line between illness and health, even if that line is vague and fuzzy.

Where that line is depends on a given society, yes, because the concepts behind the words only have meaning because of that society. Different societies and/or language communities draw the line in different places, and with different degrees of fuzziness -- kind of like two different English speakers that differ about the difference between a stone and a pebble. ("A pebble is smaller than a quail's egg!" "No, a pebble is smaller than a Raisinette!") But just because the line is drawn differently and subjectively doesn't mean that the concepts the lines define are incoherent or invalid. Pebbles exist.

So, does illness "exist" in an objective, universal sense, the way pebbles do? That depends on whether or not the illness/health categorization system exists across most cultures and languages. I think it does, although of course I have no way of knowing with any sort of certainty. But I've seen zero evidence that any human culture simply doesn't believe in illness as a concept.

So yes, insanity exists, it exists objectively, it's part of the way we as humans cut up the world into coherent concepts. Now whether or not a specific action or state is considered symptomatic of illness depends entirely on the culture -- just like the categorization of any observable phenomenon. But the concept, the categorization system that defines illness, is as real as rocks and pebbles and boulders.
posted by DLWM at 2:49 PM on October 2, 2008 [1 favorite]

Best answer: I am exploring this admittedly generalized definition of insanity (as a term) for a paper I'm writing.

Be very careful if your goal in this paper is to claim that psychology does not take culture into account, or that its ability to diagnose is rendered null and void when cultural differences are added to the equation.

I took Sociology Of Mental Illness one term, and the prof loved making this claim. She'd deliver passionate lectures on it. The sociology students were enthralled; the psychology students annoyed. Her favourite example was that of a tribal shaman, who gets ritualistically intoxicated and converses with trees, transplanted to a western metropolis. She argued that he'd be found insane in 'here', while his behaviour was normal in his home culture.

One of our big assignments was a presentation. I borrowed a copy of the DSM from one of my psych profs and plunked it down on the lectern. I quoted from the exclusion criteria related to the hallucinations she'd always describe. Said exclusion criteria were along the lines of (I don't have a DSM handy, or I'd find them for you):

Hallucinations attributable to intoxication should not be taken as indicative of an Axis I disorder.

Hallucinations attributable to cultural or religious practices, if viewed as normative within the culture or religion, should not be taken as indicative of an Axis I disorder.

The shaman would not be found 'insane', regardless of his physical location. The psychology students applauded; the sociology students grumbled. I got an A.
posted by CKmtl at 3:29 PM on October 2, 2008 [3 favorites]

I have little to add except that the latest Cat and Girl comic strip, titled Hysteria, deals with this very issue.
posted by Kattullus at 3:32 PM on October 2, 2008 [1 favorite]

Best answer: I am not a medical professional, I'm not a psychiatrist, and I've never suffered from anything remotely close to a mental illness other than--maybe--some mild situational depression (if that is even a diagnosis...but maybe this is related to the question at hand). However, I worked as an "mental health worker" for six months (all I could stand, I was disgusted by the administration and had to leave...not to mention seriously stressed out by hanging out with schizophrenics all the time) in a small mental institution in Brookline, MA. I think it has since closed. I worked in the 'admissions unit,' which was basically where everyone went other than those who went right to the elderly, women's or substance abuse units. So we'd get all the schizophrenics going through a psychotic episode, the bi-polars suffering from their manic phase, the addicts a bit too out of control for the substance abuse unit, borderline personality disorder folks acting out and no longer able to function within their outpatient programs, acutely OCD people who no longer could deal with simple things like changing their pants, and some people who were just cycling through the system because that was their entire world and didn't really know how to live outside of it (and who usually had one or more diagnoses out of the DSM-IV, of course, not to diminish their mental illnesses). And more that I'm not remembering.

I don't get the sense the original poster was trying to be hurtful. I think folks should cut the OP some slack. In fact, in my opinion I think that the original poster has hit the nail on the head (insanity is very much created, filtered and distorted by how our society perceives insane people), while at the same time I'd be the last person to say that mental illness does not exist after seeing the pain and suffering that it causes those who suffer from it as well as their families and loved ones. Let me explain.

While I'm sure there are many better mental health clinics in the country, after talking to a number of psychiatrists I was given the idea that this one was fairly typical. But, perhaps this isn't the case. Anyways, what I perceived was that, to a large degree, we have no idea what mental illness is. A lot of things are lumped together under the heading of "mental illness" just because we don't know how the hell to deal with them (including things that we didn't know how to deal with culturally, like how homosexuality used to be a diagnosis as people have pointed out).

The DSM-IV, it seems to me, is akin to the maps you see of the world from the days before it was completely explored, complete with pictures of strange, terrifying monsters and the bottom of Africa chopped off (or whatever...I'm not a historian...doh). One psychiatrist once said to me that the current state of medication to treat schizophrenia was like "hitting a thumbtack with a sledgehammer." It became clear to me that many "crazy" people could not find a baseline for functioning successfully either on their medication or off--but many would go off their medication, wind up in our admissions unit, get their medication assigned again, and head back out (schizophrenics and severely bi-polar folks, especially). I would occasionally see these people on the street in Boston and remember the time I helped pinned them down with the other orderlies when they were attacking another patient and some doc or nurse gave them a shot of thorazine...that was always a strange feeling. But I digress...

Anyways, point being, while it's clear mental illness exists, it seems obvious to me that we really know so little about it, why it happens, and how we need to treat people in our society who have mental illnesses. It was clear to me also that many of the conditions of our society--while not causing these illnesses--exacerbated the symptoms of people suffering from mental illness. It also seemed like certain illnesses were more "real" to me than others--which I know is incredibly presumptuous and may seem inconsiderate, but I mean that more in the sense that some illnesses were more provoked by external causes and some were more obviously biological in nature (of course there is nothing "fake" about the PTSD caused by abusive relationships or a traumatic childhood).

So...I'm not sure exactly if I'm being clear. I guess what I'm trying to get at, fundamentally, is that this is a really tricky and unanswerable question! I think it is true that "insanity" doesn't really exist...just as it is completely clear to me that mental illness is real, and incredibly destructive.
posted by dubitable at 3:43 PM on October 2, 2008

Just to clarify further, I shouldn't have used the term "real" in describing mental illnesses--biological vs. environmental is a far better dichotomy. Although often there would be elements of both (which was part of the point of my post). In the end, I think this further goes to emphasize my point about how so much is lumped together under this big category of mental illness, but really these illnesses may have very little to do with each other, and could potentially be treated in very different ways...
posted by dubitable at 3:48 PM on October 2, 2008

Hallucination and delusion exist as empirically provable medical conditions (not saying every case is provable, saying provable conditions exist) regardless of social constructs. The fact that any given hallucination or delusion may be difficult to identify as such in the context of social beliefs has nothing whatsoever to do with whether or not the belief is genuinely symptomatic of mental illness. In other words - mental illness unquestionably exists regardless of subjective belief systems. Proving which is which in any particular instance, however, may not be cut-and-dry.
posted by It's Raining Florence Henderson at 4:30 PM on October 2, 2008

Best answer: Have you read "Going Sane" by Adam Phillips? It argues that there's a collective absence of a definitive definition of sanity, and illustrates the delicate balance between sanity and insanity. Another author I can recommend is psychologist R.D. Laing who argued that psychiatry can often be a form of brainwashing, and that the "normal" state is "too often a betrayal of our true potentialities." Also, you don't have to look any further than Nazism for examples of labels hung on individual beliefs and actions based strictly on environmental and social norms. I would argue that "insanity" is definitely subjective.
posted by elke at 4:35 PM on October 2, 2008

Appropriate (and expected) that Szasz would come up. Before my bipolar awesomeness first manifested itself (typically, this often happens mid-late 20s for some reason), I was dating a psychiatrist's daughter & reading a lot of Szasz & Foucault & trying to argue the "it's all just an arbitrary classification of people who happen to think differently to the norm" as if the whole concept of insanity / mental illness was just a perverse way that society chooses to persecute eccentrics.

She was the one who argued the "outside of one's normal self" line, saying "yeh, your argument's all well & good from an abstract perspective lacking in any actual experience of these things, but if you'd seen the same people talking to aliens in their heads one month, then back to relative normality on meds the next, thanking my mother for having returned them to themselves, you'd think again about your 'it's all a construct' attitude"
posted by UbuRoivas at 4:38 PM on October 2, 2008 [1 favorite]

(Marked Ubu's comment as a favorite. Wish I could do it again.)
posted by yclipse at 5:25 PM on October 2, 2008

Hallucination and delusion exist as empirically provable medical conditions (not saying every case is provable, saying provable conditions exist) regardless of social constructs.

as if the whole concept of insanity / mental illness was just a perverse way that society chooses to persecute eccentrics.

I'm slightly baffled by the insistence in this thread that if something's a "social construct" it can't be "empirically real" as well. To say that something is socially constructed is not at all to say that it is fake or imaginary.
posted by game warden to the events rhino at 10:12 PM on October 2, 2008

game warden to the events rhino - I think there's a strong tendency amongst the "Myth of Mental Illness" crowd & opponents of Big Pharma to take the line that there is absolutely no such thing as mental illness, and that it's entirely an invention, eg for the purposes of strengthening the medical profession or for selling more drugs to patients. Another variation is that there's a kind of methodological blindfold within psychiatry that forces existential issues into pseudo-scientific pigeonholes, or that the structure of medical discourse itself largely predetermines the outcome. This is roughly the Foucauldian view.

For example, you often hear that depression is a fiction, that people are just sad sometimes - as they have been throughout history - but now we have this arbitrary & artificial framework & label that doctors & patients alike (plus the general community) latch onto & use as if it's somehow a natural & essential feature of human nature. By pointing to vested interests & grey areas in the various diagnoses, they talk as if everything about our conception of mental illness is false.

I'd say that there are a set of underlying actual conditions, but that different cultures (now, and throughout history) may use different conceptual frameworks to interpret & speak about them. There's also the idea that one's own cultural frames of reference will to an extent inform exactly how a particular condition might manifest itself.

As an example, try digging up the post on the blue about Japanese advertisements for psychiatric medication - they're very different at times to the kinds of conditions depicted in the West. One partial explanation might be that the Asian concern with maintaining "face" could mean that paranoia plays itself out in different ways, eg instead of a vast government / illuminati conspiracy to spy on you because you're such an important & special western snowflake, instead there's a conspiracy to humiliate you by spreading rumours etc so that you lose face.
posted by UbuRoivas at 11:21 PM on October 2, 2008

I have nothing to add to this very interesting discussion except this:

David Foster Wallace once wrote, at greater length, that there's a reason we use the concept "well-adjusted" as the opposite of "mentally ill". Think about that. Our notions of mental illness are typically connected to how well we cohere socially. However, this is not universally true, given that some mental illnesses pretty obviously have biochemical ("real") bases.
posted by Mr. Justice at 5:10 PM on October 5, 2008