Barry’s Blog # 377: Dionysus Looks at Mental Illness, Part Three of Seven

The ideal of growth makes us feel stunted; the ideal family makes us feel crazy…So long as the statistics of normalizing developmental psychology determine the standards against which the extraordinary complexities of a life are judged, deviations become deviants. – James Hillman

It is possible that poet Theodore Roethke romanticized suffering when he asked, “What is madness but nobility of soul at odds with circumstance?” Yet we can’t consider mental illness outside of its social, cultural, economic and political contexts. Psychologist Mary Watkins writes, “The symptom as it appears in the individual points us also toward the pathology of the world, of the culture.” Depression is not rare among non-Western people, but it increases when they move to America. Some claim that schizophrenia is more prevalent in cultures like ours that combine high rates of poverty with low senses of social belonging.

But America adds two other factors. The first is that our characteristic American expectation of positive emotions and life-experiences makes sadness more pathological here than elsewhere. Sociologist Christina Kotchemidova writes, “Since ‘cheerfulness’ and ‘depression’ are bound by opposition, the more one is normalized, the more negative the other will appear.”

She argues that twentieth century America took on cheerfulness as an identifying characteristic. The new consumer economy of the 1920s called for cheerful salespeople who’d be careful to avoid provoking vital customers. A powerful emotional deintensification process also began at that time. The American etiquette obliged “niceness,” which excluded strong emotionality. Railroads introduced “Smile School” in the thirties. Among the dozens of self-help cheerfulness manuals, Dale Carnegie’s How to Win Friends and Influence People (1936) sold over thirty million copies.

In the 1950s the media industry invented special devices such as the TV “laugh track” to induce cheerfulness. Eventually, politicians discovered cheerfulness. All Presidents since Ronald Reagan smile in their official portraits. The “smiley face” button sold over 50 million buttons at its peak in 1971.

The laugh-track has a specific purpose: keep people engaged, pleasantly entertained and therefore receptive to the commercials selling them things that they don’t need. The products in the commercials are meant to create emotional associations with the artificial cheerfulness stimulated by the laugh track. In other words, since the 1950s, television (and increasingly, films and later the internet) have mediated our emotions; they’ve been telling us what to think and feel.

Ronald Laing argued that the modern family functions “to repress Eros, to induce a false consciousness of security…to promote a respect for ‘respectability.’” To be respectable is to produce, and, in America, to look cheerful while doing it. Our obsession with feeling good (“pursuing happiness”) is enshrined as a fundamental principle of the consumer society.  Kotchemidova writes,

Our personal feelings are constantly encouraged or discouraged by the culture of emotions we have internalized, and any significant deviance from the societal emotional norms is perceived as emotional disorder that necessitates treatment.

She argues that Americans feel significant pressure to look cheerful in order to get a job. Once they are employed, putting on a ready-made smile is simply not enough. “Corporations expect their staff to actually feel good about the work they do in order to appear convincing to clients.”

Most advertising is in some sense selling happiness or relief from unhappiness. Despite all our “stuff,” however, our characteristic American individualism subverts social networks, making it difficult for those in emotional or spiritual crises to find containment except through drugs, religious literalism, political cults or madhouses. In a culture that remains Puritan at the core, Americans have commonly internalized the mad notion that our suffering is our own fault, and that others who appear to be happy are normal (in religious terms, “among the elect”). The cultural pressure to appear upbeat invalidates sadness, pathologizing it into depression. Thus, a person who feels sad may also feel guilty.

Or angry. Very angry. The second factor that American culture adds to the brew of madness is our radical individualism with its characteristic expectations of constant growth and social mobility. (For lengthy speculations about the myths of progress and growth in Chapter Nine of my book.) When our assumptions of social mobility are revealed as fiction, the hero encounters his opposite – the victim, or the loser – within himself, and we become what we really are (except for Nazi Germany), the most violent people in history. American crime and violence are natural by-products of our values, alternative means of social mobility in a society where “anything goes” in the pursuit of success. In “A Mythology of Bullets”, mythologist Glen Slater writes that “America has little imagination for loss and failure. It only knows how to move forward.”

We go ballistic when we can only imagine moving forward and that movement is blocked. Then guns become the purest expression of controlling one’s fate. As such, they are “the dark epitome of the self-made way of life.” We as a people may well dream bigger dreams than other peoples. With great possibilities, however, come great risks. Gaps between aspiration and reality – the lost dream – are also far higher here than anywhere else. When we don’t meet our expectations of success, when that gap gets too wide, violence often becomes the only option, the expression of a fantasy of ultimate individualism and control. In this sense, the Mafia is more American then Sicilian, and the lone, mass killer (almost all of whom have been white, middle class men with no criminal background) is an expression of social mobility gone bad.

Gun violence throws us back onto some of the basic questions posed by Dionysus: Why are convicted murderers not considered insane? Why do we punish criminals instead of rehabilitating them? We could also add: Is a depressed young man who massacres schoolchildren or Black churchgoers, or who drives his car into a crowd of BLM protesters evil or sick? Should he be punished or given compassionate treatment?

Depression has been defined as “disturbance of affect.” But “affect” is culturally determined. Positive expectations and assumptions of the right to the “pursuit of happiness” make feelings of sadness and despair more pathological in America than anywhere else. Feeling good has become no longer simply a right, but a duty. If we cannot accept normal depression, we may become ashamed and alienated from ourselves, we may well experience the rage that often lies below the depression, and in true American fashion, we may search for scapegoats to punish.

Depression, violence, a culture that cannot grieve and poor medical standards, meet Big Pharma. The gatekeepers who update the DSM comply with these prejudices, having reduced acceptable, “normal bereavement” from one year to two months. Psychiatrists administer drugs instead of psychotherapy in over seventy percent of patient visits. Frederick Crews writes,

Those stigmata, furthermore, are presented in a user-friendly checklist form that awards equal value to each symptom within a disorder’s entry. In Bingo style, for example, a patient who fits five out of the nine listed criteria for depression is tagged with the disorder. It is little wonder, then, that drug makers’ advertisements now urge consumers to spot their own defectiveness through reprinted DSM checklists and then to demand correction via the designated pills.

The percentage of patient visits to a psychiatrist involving any psychotherapy fell from 44% in 1996 to 29% in 2004. Bruce Levine argues that Psychiatry has increasingly replaced psychotherapy with “medication management,” which largely consists of symptom assessment and prescription updates. It typically takes 10 or 15 minutes and is scheduled every two to three months, rather than weekly, as is psychotherapy. Insurance companies favor medication management because it is so cheap, and drug companies favor it for obvious reasons. Psychiatrists themselves favor it because they can make far more money with it. Those who offer only medication management routinely make nearly triple the income as do those who provide mostly psychotherapy. And when drugs don’t work, some still prescribe electroshock for children. Madness is big business.

Read Part Four here.