A Cultural Approach to Emotional Disorders

Psychological and Aesthetic Interpretations

E. Deidre Pribram

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9781138018297
• eBook ISBN: 9781317700654
• Edition: 1
• Topic: Psychology
• Subtopic: Emotions in Psychology
• Index: Psychology

In her latest contribution to the growing field of emotion studies, Deidre Pribram makes a compelling argument for why culturalist approaches to the study of emotional "disorders" continue to be eschewed, even as the sociocultural and historical study of mental illness flourishes. The author ties this phenomenon to a tension between two fundamentally different approaches to emotion: an individualist approach, which regards emotions as the property of the individual, whether biologically or psychologically, and a culturalist approach, which regards emotions as collective, social processes with distinctive histories and meanings that work to produce particularized subjects. While she links a strong preference for the individualist construct in Western culture to the rise of the psychological and psychiatric disciplines at the turn of the twentieth century, Pribram also engages with a diverse set of case studies tied to psychological and aesthetic discourses on emotions. These range from Van Gogh's status as emotionally disordered to the public, emotional aesthetics of 19th century melodrama to the diagnostic categories of the DSMs and the fear of "globalizing" emotional disorders in the 21st century. This genuinely interdisciplinary approach makes for a text with potential application in a wide range of disciplines within cultural studies, including sociocultural and historical analysis of psychiatry and psychology, gender theory, subject and identity theory, popular culture studies, and history and theory of the arts.

1 Madness and Mental Illness

Taking up a culturalist perspective on emotional disorders entails asking why as a society, from professional and theoretical quarters as well as in popular conceptions, we care so much about madness and mental illness. Why has attempting to account for ‘disordered experience’ troubled us historically and contemporarily, and what does it indicate about ‘ordered existence’? Moyn observes that, “the history of the self is in some sense the history of the psyche” (316). This has been the case since the nineteenth century, at any rate. Over the last two centuries, the work of various Western bodies of knowledge, pivotally including the psy fields, has created the psyche and its bearer, the psychic subject. Moyn’s point is that assembling a history of the self also must involve a history of the entities responsible “for theorizing it and caring for it” (322). Ultimately, endeavoring to make sense of the modern self is inseparable from the organizations and systems that have conceptualized it into existence or that maintain and nurture it.

To this end, a number of contemporary theorists, including Michel Foucault as well as Marcel Gauchet and Gladys Swain, have devoted attention to the nineteenth century institution of the asylum, which temporally coincides with the development of the psychic self, precisely because they believe the asylum to be paradigmatic of the contours of the subject within modernity (Weymans 41– 42). As we shall see, however, they arrive at quite different conclusions about the qualities of modern subjectivity as constituted by the asylum, among other institutions. Yet, what they each make evident is how madness and mental illness dovetail with issues of modernity’s self, subject, or individual.

Although speaking specifically about what is at stake when addressing schizophrenia, Rod Lucas takes up terms that I believe apply to mental illness more generally. Considering schizophrenia, he explains, focuses “attention on the bounds of community and the existential limits of what it is to be human” (148). A cultural exploration of mental illness operates at two simultaneous levels. First, it points to what and whom belong within society, as shared communities of humans, and what and whom lie outside or beyond those parameters. Second, it makes apparent that which, at any historical moment, it means to be a human individual. Again, who counts and who does not as a fully functional, successfully performing person. My goal is to ‘get at’ some of the cultural locations, purposes, and operations of emotions by means of the historically and contextually changing normal/abnormal divide of functional versus dysfunctional emotionality. Emotional disorders indicate what is acceptable within or must exist outside given communities, as well as in what configurations emotions signal whole, intact, stable persons or personalities. The emotional parameters of psy are a useful means of approaching historically and culturally specific alignments of the human being, including particular modes of subjectivity and explicit manifestations of emotional experience.

Accordingly, I am interested in exploring how emotions fit into the making of the psyche and the modern self, that is, the psychic subject. Through psychopathology, I investigate some of the ways emotions have been enveloped, or gone missing, in the history of psychology/psychiatry and, as a result, in the history of the modern self. Although this chapter, and significant portions of the book overall, address the psy-disciplines, they are far from the only fields that need to be taken into account in order to provide an adequate rendering of the place of emotions and emotional disorders in the make-up of the modern self. To this end, elsewhere I turn to other cultural arenas, most notably aesthetics, in order to offer such an alternative account. In fact, much of my exploration concerns the limitations of the psy and aesthetic fields, as currently construed, towards an appreciation of the complex significance emotions and emotional disorders hold for our contemporary lives. Emotions, I believe, are far more constitutive of personhood, social relations, and cultural existence than much current theoretical attention acknowledges.

Mental Illness

At present, the most influential historio-cultural account of madness and mental illness is Michel Foucault’s The History of Madness, which was preceded by his Mental Illness and Psychology. The sequencing of these works is significant if we wish to track the development of Foucault’s thinking on mental illness and, more broadly, the location of emotional disorders in the madness/mental illness edifices he constructs. The History of Madness was initially published in 1961; Mental Illness and Psychology first appeared in 1954 (under the title, Mental Illness and Personality). In 1962, Mental Illness and Psychology was republished, with a marginally altered Part I but with a substantially rewritten Part II. So while Part I, “The Psychological Dimensions of Mental Illness,” reflects Foucault’s thinking prior to The History of Madness, Part II, “Madness and Culture,” is entirely shaped by the ‘later’ work. Indeed, Dreyfus calls Part II of Mental Illness and Psychology a “stunning” summary of The History of Madness (xxvii).¹

Dreyfus explains the difference between Part I and Part II of the 1962, revised Mental Illness and Psychology in the following manner: “Foucault thus switches from an account of the social conditions that cause mental illness to the cultural conditions that lead us to treat madness as mental illness” (viii–ix; italics in original). In attempting an analysis of the cultural positioning of emotions and emotional disorders, value exists in exploring the distinctions Foucault draws between ‘mental illness’ (maladie mentale) and ‘madness’ (folie). Why does he switch from one term to the other and, in doing so, what evocations of meaning are called up or denied between one expression and the other? In particular, the more Foucault discusses madness rather than mental illness, the less he refers to emotions. One issue, then, concerns the degree to which Foucault constitutes reason as his foundational ground, to the exclusion of emotionality.

In Part I of Mental Illness and Psychology, Foucault outlines the hierarchy of mental illnesses, in ascending order from mildest to most severe, “as they are detailed in the psychoanalytic tradition” (31). First are the neuroses, which damage “only the affective complexes” of the personality. Second comes paranoia, which influences an individual’s “emotional structure” but only as an exaggeration of personality; “there is as yet no damage to the lucidity, the order, or the cohesion of the mental basis.” The third level he refers to as dream states in which “perceptual control and the coherence of reasoning have disappeared,” resulting in illusions, hallucinations, and false recognitions. The fourth ranking falls to manic and melancholic states which exhibit both somatic symptoms and “emotional outbursts”: despair for the melancholic and “euphoric agitation” for the manic. Fifth are schizophrenic states in which “thinking has disintegrated and proceeds in isolated fragments.” This level is marked by hallucinations, verbal incoherency, and “sudden affective interruptions.” Sixth and last is dementia in which state “there is no longer a personality, only a living being” (26–27).

Foucault’s intention, of course, is to critique the psychiatric literature. His initial objection rests in what he perceives as the mistaken attempt to liken psychological illness with physiological ones. Because ‘personality’ cannot be divided into singular or discrete functions in a manner similar to the organic body, the two cannot be considered conceptually or pragmatically equivalent. Psychiatry having done so, as in the six levels he outlines of increasing severity of mental illness from neuroses to dementia, resulted only in “a qualitative appreciation that opened the way to every kind of confusion” (12). Categories of mental illness are qualitative conveniences that enable us to speak about varying pathological phenomena, but do not reference clear-cut, separable biological entities. Such categorization represents simply “the concrete forms that psychology has managed to attribute to” mental illness (13). In other words, the taxonomy he outlines belongs to historical, not organic, fact. However, as long as we understand the descriptions he provides as historical rather than physiologically natural traits, at this stage in his thinking Foucault does not take exception to the specific, dominant symptomatic features of mental illness in the West. My interest in the hierarchy of mental illness he outlines is the degree to which Foucault recognizes “psychological personality” as a formation of emotional elements, as well as cognitive and somatic characteristics (12).

Foucault’s principle objection to Janet’s and Freud’s schemas (the psychoanalytic tradition) does not reside in symptomology but, rather, with their attributions of origin or cause. He describes their explanations as “psychological evolution” because they position the purported causes of mental illness in regression to either archaic social states or to infancy, which he describes as “serial determinism” (30, 45). The notion that mental illness is a retreat to more ‘primitive’ stages of human social interactions or a relapse to earlier childhood states, he calls “myth” (24). In place of evolutionary theories of human social or libidinal development and regression, in sequentially increasing stages of severity, he offers up his version of “psychological history” (30). In Part I of Mental Illness, in the mid-1950s and under the influence of phenomenological psychiatry (Lanzoni; Dreyfus), Foucault speaks in terms of the specificity of the individual morbid personality wherein a patient experiences internal affective contradictions as a direct response to encountered, irresolvable social conflicts in the world within which he or she exists. The ill person is responding to a “present situation” in which pathological behavior occurs as “a compromise between two contradictory tendencies” that the surrounding social world produces (36, 38). These are the social causes of mental illness that Dreyfus refers to versus the cultural approach of Part II that, in contrast, works to explain why we treat madness as mental illness.

In Part I, mental illness occurs as a reaction to externalized situations that the neurotic or psychotic responds to in two ways. First, he or she internalizes the social conflict as personal experience; second, the affected person moves to derealize some portion of the ‘normal’ world because the conflict cannot be resolved or solved (39, 35). Normal conflict is understood as ambiguity embedded in a given social situation, while pathological conflict becomes accepted as contradiction within one’s very existence, the latter of which Foucault refers to as ‘experience.’ “The patient’s psychological history is constituted as a set of significative acts that erect defense mechanisms against the ambivalence of affective contradictions” (42). For Foucault, at this stage in his thinking, important aspects of mental illness as experience take place in terms of affective life, in particular, as affective conflict.

Affective contradictions are felt, by those who suffer them, as insurmountable anxiety. In an effort to combat or diminish such intense anxiety, mentally ill persons create a morbid world for themselves that they experience alongside the ‘normal’ world, but which embody a private community of meanings. This morbid world is the erected defense mechanism that Foucault refers to in the quote above. While these morbid defenses appear as pathological to others, they embody logical meaning to the person who is mentally ill (40–41, 19). It is because the morbid behaviors have meanings for the patient that Foucault can call symptoms of mental illness simultaneously pathological and significative (42, 55, 19). However, attempted remediation of socially-derived conflicts through the establishment of pathological behaviors, lodged in a personalized morbid existence, inevitably fails because it is based on a misapprehension of the problem (as individual not social) and, as such, ends only in ongoing or even increased anxiety that leads, in turn, to further pathology.

Although Foucault attributes the cause of mental illness to affective contradictions, within the framework of phenomenological psychology, he depicts the morbid world constructed by the mentally ill in terms of rational, cognitive faculties. In analyzing what distinguishes the morbid world “from the world constituted by the normal man,” Foucault pinpoints four qualities (55). First, potential exists for “a major disturbance in temporality,” in which the past, present, and future take on alternative configurations (51). Second, space may lose its cohesion so that objects and relations appear either more distant or more oppressively immediate. Third, relations with the social and cultural ‘normal’ world are distorted to the effect that the person may feel isolated or persecuted. Finally, the mentally ill may come to experience their own bodies in distorted ways that diverge from common perception. In all these ways, morbid existence abandons the normal world “by losing the significations of the world … being unable to possess its meanings,” to be replaced for the mentally ill by a world of their own making that is, simultaneously, pathological yet logical to those experiencing it (56).

On the one hand, then, in the earlier phase of Foucault’s thoughts as exemplified in Part I, he follows psychiatric tradition that views mental illness as manifested in somatic, affective, and cognitive symptoms. Mania, for example, “involves motor agitation, a euphoric or choleric mood, a psychic exaltation characterized by verbigeration, rapidity of the associations, and the flight of ideas” (4). For its part, depression “takes the form of motor inertia against the background of a mood of sadness, accompanied by a psychic slowing down” (5). Schizophrenia involves “a disorder in the normal coherence of the associations” as well as “a breakdown of affective contact with the environment” (6). On the other hand, although Foucault considers somatic and affective symptoms as well as cognitive characteristics in his earlier writing, the terms ‘psychic’ or ‘psychological’ refer most specifically to issues of cognition or reason. Thus, as noted above, a difficulty in concentration or focused thought associated with depression becomes “a psychic slowing down.” Similarly, paranoia is accompanied by “psychological hyperactivity” or delusions, while dementia is “the total disorganization of psychological life,” in which the personality sinks into “incoherence” (5). In Part I then, the notion of psychic or psychological is already most equivalent to rational thought while physiological and emotional symptoms are of a different order. Indeed, in describing dementia as the state “in which there is no longer a personality, only a living being,” he equates rationality or lucidity with personhood itself. Although dementia entails disintegration in cognitive faculties, the person continues to exist as a physical and feeling being. But for Foucault, even at this early stage in his writings, physical and emotional existence without cognitive abilities is to live without subjectivity. An affective life does not in and of itself qualify as personhood; therefore, loss of emotional equilibrium without cognitive deficiency does not impair constituted personhood. That is to say, affect is a less crucial component of personhood than an accompanying symptom of its demise. Psyche or mind, then, is most closely associated with rational thought that, in turn, is indispensable for subjectivity.

In the sense of possessing greater gravity, cognitive symptoms are of a higher order than affective and somatic ones. This is evident in Foucault’s definition of psychoses versus neuroses.² Psychoses affect the personality “as a whole,” including disordered thinking and “a disturbance in conscious control” along with an “alteration of the affective life and mood” (8). Neuroses, in contrast, affect “only a part of the personality” because “the flow of thought remains structurally intact” as does the patient’s “critical lucidity” (8). In his description of psychoses and neuroses, we see a similar hierarchy to Foucault’s borrowed taxonomy of ascending genres of mental illness in which the mildest forms of neuroses and paranoia concern only “the affective complexes” or “emotional structure.” However, levels three, five, and six (dream states, schizophrenia, and dementia, respectively) interfere with “the coherence of reasoning.” The flow in this ascending pattern of severity of illness is disrupted solely by mania and depression (level four), which are classified by predominantly affective symptoms, yet are positioned at a stage of greater severity than the initial phase (three) of loss of rational coherence. We can see that, in a number of ways, emotional disorders represent a ‘problem’ or ‘disruption’ in psychiatry’s taxonomy, leading “to every kind of confusion” (12).

In describing the more severe forms of pathology as “a loss of consciousness,” resulting in a style of “total incoherence,” Foucault prioritizes rational deficiency over emotional suffering as the most devastating attribute associated with mental illness (17). In doing so, he is far from alone. A longstanding, still currently applied tradition refers to psychoses as ‘serious,’ ‘severe,’ ‘major,’ or ‘acute’ mental illness, while neuroses or the contemporary mood and anxiety disorders are regarded as ‘minor,’ ‘milder,’ ‘less severe’ forms of mental distress (MacDonald 10; Dallaire et al. 147; Palmer 117; Bentall 7, 94; Horwitz 50–51, 208). Yet it remains difficult to imagine more serious or severe repercussions than the suicide, self-injury, or intense pain that often accompany emotional disorders.

For Foucault at this stage, if the reality of the mentally ill person is not necessarily logical or coherent, it is, at any rate, meaningful in that the behaviors and ideas taken up are filled with significance for the person experiencing them. Therefore, he notes that the difference between the doctor and the patient is not the distinction between knowledge (understanding of illness) and ignorance (incomprehension of illness) (46). The patient is aware that something separates him or her “from the world and the consciousness of others” (47). Instead, the distance between doctor and patient is that of medical expertise versus experience, in which experience is consciousness “from within the illness,” manifested in terms of how the patient feels and expresses the illness (47).

Out of Madness

In “Madness and Culture,” Part II of Mental Illness and Psychology, Foucault relies on the term ‘madness’ to a far greater degree, while mental illness refers to a specific development in the history of madness, beginning in the nineteenth century. At the same time, references to emotional and physiological phenomena are notably reduced. Foucault partly acknowledges this, stating that he has “purposely not referred to the physiological and anatomicopathological problems concerning mental illness” (86). And of course, he would go on in future work to devote much attention to the body, particularly as the locus of disciplinary power and, therefore, pivotal to the establishment of certain modern forms of subjectivity. Emotions in Part II, however, are referenced only in passing and without explanation for their disappearance.

Part II comprises more familiar Foucaultian arguments on mental illness, a result of the influence of History of Madness.³ In this section, the shift Dreyfus describes as moving from “the social conditions that cause mental...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Introduction
• 1 Madness and Mental Illness
• 2 The Psychological Self
• 3 The Artist as Mad Genius
• 4 Personality Disorders, Biopsychiatry, and the Problem of Social Identity
• 5 Neuroscience and Other Narratives of Emotional Disorders
• Works Cited
• Index