Did Freud Ever Do This? A Reflection on the Epidemic of Crazy

May 24, 2016
Elliott B. Martin Jr, MD
Volume 33, Issue 5

“Hey, man, why is the world so crazy these days?”

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“Years ago it meant something to be crazy; now everyone’s crazy.”

Charles Manson1

I recalled these words during a recent episode at work in which a surgical colleague suddenly threw his hands in the air, folded his arms, and asked me point-blank, “Hey, man, why is the world so crazy these days?”

It was an honest question, and the complex, though incomplete, answer I had in my head, one I have been formulating for years-Western society has fundamentally evolved from a repressive 19th- and early 20th-century climate of hysteria-neuroses to a latter-day fragmented-identity climate of narcissism-borderline-came out instead as a butchered line from another, albeit fictional, psychopath, Norman Bates, “Hey, we all go a little crazy . . . sometimes” (Psycho, Universal Studios film; 1960).

Both Manson, in California, and Bates, on film, have been subjected to old-fashioned “moral treatment” for their “madness”: isolation from polite society. But this seems out of step with the National Institute of Mental Health’s fairly newly adopted classification of “crazy” as essentially biological.2 Indeed, every time I read the updated Research Domain Criteria (RDoC) manifestos I cannot help but recall the infamous bio-behavioral “re-programming” of the protagonist, Alex, in Stanley Kubrick’s 1971 film version of Anthony Burgess’ dystopian A Clockwork Orange. For those unfamiliar with the sequence, the “ultraviolent” nature of this delinquent youth is “cured” with an experimental biological “treatment”: subjecting him forcibly to watching hours of rough-cut violent imagery, set to Beethoven’s Ninth Symphony, while some unspecified emetic drug is injected into his veins. Afterward even the thought of violence causes horrific visceral reactions in Alex, thereby molding his behavior very much against his will, but allowing him re-entry to polite society.

 

Rise of antihumanism and antipsychiatry

These now antique examples-Manson, Bates, and Alex-are almost mundane relative to far more grotesque and recent examples of dime-store pornography and violence of reality television and television news. But I choose them for their contemporary timing with the rise of antihumanism and antipsychiatry. In other words, in the 1960s and 1970s psychiatry, represented as Freudian psychoanalysis, was forced, like Alex, like any passive film watcher, into a reactionary reactive position by the sudden, media-driven, physical appearance of the “id” as frank, if random, reality.

Indeed, even the Marquis de Sade’s gut-numbing catalogue of relentlessly horrific perversions, 120 Days of Sodom, was released as a feature film as early as 1975. Closer to home, if no less gruesome, the evening news grew more and more graphic, and cable television emerged as the lewd alternative to the sanitized networks. The British television comedy troupe, Monty Python, perhaps described best the increasingly rapid, fragmented experience of now rampant screen-viewing with their pithy segue from one non-sequitur to another, “And now for something completely different. . . .”

Not far removed from Sade, or Monty Python, French postmodern historian, Jean Baudrillard, described the cultural fallout of the 1960s and 1970s, the “orgy,” as he unmincingly referred to it in his 1990 The Transparency of Evil, as the remnants of a Western society so desperate for euphemisms as to have created a nearly perfectly synthetic state3; that is, a “hyper-real” state utterly devoid of depth, of any complex meaning. Baudrillard describes one’s relationship with the world of the 1980s and 1990s as devoid of any meaningful “object relations.” Rather, the world is a thrown-together pastiche, a superficial collage, of the objects themselves. There is a wonderful iteration of this 2-dimensionality in a 1999 episode of the contemporaneous animated television series, Family Guy (“I Never Met the Dead Man” [season 2, episode 2]. Fox Television, April 11, 1999). In it, the lead character, Peter Griffin, overcomes his own worsening agoraphobia by placing a cut-out box, or simulated television, over his head. This “cures” him, allowing him to re-connect 2-dimensionally with the world outside his living room.

The fall of psychoanalysis

In such a simulated world, increasingly incapable of the thoughtfulness to respond to it in a deliberate and meaningfully therapeutic way, with patients increasingly “(falling) apart on the couch,” psychoanalysis certainly faltered.4 In a 2-dimensional world filled with a much more vast array of grotesqueries than the pure violence of war and torture that initially destroyed the early postmodernists’ faith in reason, the mind itself fundamentally changed. In 1992, just prior to the advent of the Internet, Carl Bernstein put it this way: “For the first time the weird and the stupid and the coarse are becoming our cultural norm, even our cultural ideal.”5

What had given the id its mystical force after all, at the crossroads of Victorian sensibility, fin de siècle decadence, and the horrifying discovery of germs, was its unspeakable nature. Similar to the play of shadow and silence in early horror cinema, to the play of the revealed and unrevealed in gothic literature, the id was the Lovecraftian “lurker at the threshold.” With the rise of cinema, television, the Internet, the id became ubiquitous, and to the point, as noted, of cartoon-kitsch. There is not an image to be imagined that cannot be called forth instantly from the Internet. There is not a fantasy too dark, too repulsive, too unimaginable for the solutionist magic of the Silicon and San Fernando Valleys. For psychoanalysts the question then became: how can symbols exist in a world without the “id”? Conversely, this loss of personal metaphor unleashed the biologic psychiatrists, and psychopharmacology-existing well before the end of the century-re-emerged in a media explosion. The expanding-contracting DSM reflects this perfectly: a catalogue of 2-dimensional snapshots, stills, or pop-ups, of deviance without context.

 

The well-nurtured id

The id has since found itself well-nurtured within the politics of economic de-regulation of the 1990s and early 2000s. Corporate narcissism, arm in arm with increasingly spectacular Hollywood histrionics that have set a stage where the slightest perception of trauma is unbearable and intolerable, has gained a prominent place in the collective awareness. Wealth, too, has entered the cyber-realm, created and destroyed with a keystroke, and the corporate psychopath has gained rock star status.6 Logic has been utterly devoured in what has become an id-iotic world, and how could there not be an epidemic of crazy? The instinctual defense against the raging id, after all, is to run away, to hide, to self-preserve, to self-negate.

Depression is the second most debilitating illness in the world.4,7 While debatable, depression can certainly be conceptualized as pathological self-absorption.8 Anorectics are quite literally self-absorbed. Psychosis, marked by excessive paranoia or hallucinations, leads to excessive defense of the self. Anxiety is all about self-preservation.

Autism is especially interesting, increasing in prevalence every year, by definition a disorder of self-absorption. According to all available media outlets, we are already living in an “epidemic of autism.” Prior to the work of Drs Leo Kanner and Hans Asperger in the 1940s, autism was virtually unknown; now the estimated prevalence is anywhere from 1 in 110, to 1 in 68. Historically, this increase corresponds with the rise of the media, with the establishment of Baudrillard’s 2-dimensional hyper-reality.

The more recent explosive numbers correspond with the development of the Internet, social media, and the mass surrogation of children. (Rather than orphanages, there is day care and/or the arms of hired strangers, with a corresponding, if ironic, Western cultural de-valuation of boys, with a rate of diagnosis now typically 4 times that of girls).9 Autism also parallels the cultural educational shift from efforts to develop readers to developing “users.”10 In socio-biologic terms, autism appears to be a hyper-rapidly selected-for trait.

An intense relationship with the self

Indeed, the experience of reality in the 2010s, for many, is an intense relationship with the self, a little insular world of one’s union with one’s electronic devices, with one’s music. This is the borderline emptiness transformed into an aesthetic/fetishistic experience, transformed into a dyadic relationship not necessarily with fellow humans but allowing for the substitution of things, of commodities. Selfies, headphones, meditation. Mass availability of drugs, pornography, and weapons. An aggressive anonymity that allows for “virtually” anything, and despite the thousand or so appropriately superficial pages of the current DSM, a thousand more could not possibly cover it all. This narcissism/autism at its core may be a desire to return to the womb, to attain a state of, if not pleasure, then not suffering, a state of quasi-dissolution, of an eternal life equivalent to the repeated airing of a television rerun.

Of course, this is in the context of otherwise overwhelming distraction. An obscurely defined creativity may have fueled this desire to return to nothingness in the past, but this has become a sufficient, not necessary, condition. Creativity, in other words, used to be the means to the ends, whether these be fetish or masterpiece. But now the ends are readily available, once again as commodity.

The aesthetic experience-auto-erotic gaming, auto-erotic sex, auto-intoxication, auto-mutilation-can be easily had by all, is aggressively and utterly pursued by all, and the result is a fetish-saturated world, a world of highly personal-made-instantly-public “masterpieces,” so self-absorbed as to be on the verge of disappearance. Witness recent university-level reactions, endorsed by major media outlets, to wipe away, quite literally, an inconvenient, if “distracting,” history.11

“Craziness therefore,” I found myself finishing the conversation with my colleague, “may just be, as economists are fond of describing their own failed predictions, a rational response to an irrational world. Technology after all has evolved astronomically faster than the humanities, shattering the superego, fragmenting the ego, and creating a fetish of the id.” (Even Manson has maintained a certain innocence in the wake of his subsequent “image”: “The Charlie Manson that you’ve created, that’s not me. That’s only an illusion in your minds; it hasn’t got anything to do with me.”12

My poor surgical friend looked at me, shook his head, and muttered quite simply, “I am soooooo glad I went into surgery.”

Disclosures:

Dr Martin is a Pediatric and Adult Consultation-liaison Psychiatrist at the Newton-Wellesley Hospital in Newton, MA, and a Clinical Assistant Professor of Psychiatry at Tufts University School of Medicine in Boston. He reports no conflicts of interest concerning the subject matter of this article.

References:

1. Hedegaard E. Charles Manson Today. Rolling Stone. November 21, 2013. http://www.rollingstone.com/culture/news/charles-manson-today-the-final-confessions-of-a-psychopath-20131121. Accessed March 31, 2016.

2. Cuthbert BN, Insel TR. Toward the future of psychiatric diagnosis: the seven pillars of RDoC. BMC Med. 2013;11:126.

3. Wernick A. Baudrillard’s Remainder. 1993. http://www.ctheory.net/articles.aspx?id=233. Accessed March 31, 2016.

4. Stone MH. Psychotherapy of borderline patients in light of long-term follow-up. Bull Menninger Clin. 1987;51:231-247.

5. Good Reads. Carl Bernstein. http://www.goodreads.com/author/show/15445.Carl_Bernstein. Accessed March 31, 2016.

6. Babiak P, Hare RD. Snakes in Suits: When Psychopaths Go to Work. New York: Harper; 2006.

7. Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLOS Med. 2013;10:e1001547. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001547. Accessed March 31, 2016.

8. Ingram RE. Self-focused attention in clinical disorders: review and a conceptual model. Psychol Bull. 1990;107:156-176.

9. Sommers CH. The war against boys. The Atlantic.May 2000. http://www.TheAtlantic.com/issues/2000/05/sommers.htm. Accessed March 31, 2016.

10. Sloterdijk P. In the World Interior of Capital: Towards a Philosophical Theory of Globalization. Hoban W, trans. Cambridge, MA: Polity Press; 2013.

11. Fisher G. Princeton and the fight over Woodrow Wilson’s legacy. The New Yorker. November 25, 2015. http://www.newyorker.com/news/news-desk/princeton-and-the-fight-over-woodrow-wilsons-legacy. Accessed March 31, 2016.

12. Emmons N, ed. Manson in His Own Words. New York: Grove Press; 1986.