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The Myth of Mental Illness Redux

By Michael Guy Thompson

 

In the following remarks I want to say something about the problem I have with the conventional meaning of the word psychopathology, or as we typically encounter this term in the media, “mental illness.” The two most prominent psychiatrists who cast doubt on this concept were R. D. Laing and Thomas Szasz, each of whom achieved remarkable notoriety for their respective views on this topic in the 1960s and 1970s. Each remains an iconic figure in the field of psychiatry. In The Politics of Experience, for example, published in 1967, Laing questioned whether schizophrenia, the form of psychopathology he was most identified with, even exists. Yet many of the people Laing saw in psychotherapy suffered terribly, and sought his help to relieve them of the most incredible anguish. So what, exactly, was Laing relieving them of, if not a psychopathological condition? Surely, if there is such a bona fide activity as psychotherapy, then there must be some condition, or state of mind, however we come to label it, that the therapeutic process presumes to relieve. What else is the one person, the so-called patient, paying the other person, the so-called therapist, for?

Thomas Szasz, the author of The Myth of Mental Illness, published in 1960, built his career around the notion that mental illness is nothing more than a myth, that there is no such thing as an “illness” of the mind, and that psychiatrists have orchestrated a hoax by claiming they are treating patients for mental illnesses that don’t exist. Laing also rejected the concept of psychopathology, but took a more nuanced, less polemical approach to the problem than Szasz. Whereas Szasz argued that the entire structure of psychiatry, including its psychological derivative, psychotherapy, should be abolished, Laing argued that however flawed psychiatry is, we still need it, or something like it, to help those people who want someone to relieve them of their unremitting distress, but not necessarily in the way that psychiatry typically helps them. Though this distinction is not an easy one to appreciate, I hope to bring some clarity to the problem.

Let’s begin with the term itself. The word psychopathology derives from the medical term pathology, which comes from the Greek pathos, meaning suffering. The term was also used by the Greeks to connote passions, or feelings more generally. The first psychotherapists were physicians and the term psychiatry, which was only coined in the nineteenth-century, became the medical specialty of doctors whose mandate was to treat the psyche or the soul, or as we say nowadays, the mind. Both Laing and Szasz argued that psychiatrists, and for the most part psychoanalysts, have misunderstood the kind of suffering that people labeled schizophrenic are experiencing. They also believed that psychiatric nomenclature does little to help us understand the phenomena so labeled. If what psychiatrists believe they are treating is not, in fact, schizophrenia, or any medical or psychopathological condition, then what is it they are treating, if anything? And why do we, whether psychiatrists, psychologists, or lay psychotherapists still refer to the conversations we conduct with our patients as treatment, or its derivative, “psychotherapy?”

In order to ponder these questions I want to explore further whether the conversations we enjoy with our patients, though not specifically medical in nature, may nonetheless be termed a form of “therapy.” The subtitle Laing assigned to The Divided Self was “an existential study in sanity and madness.” It was not an existential study in psychopathology. Why this distinction? Are madness and psychopathology not the same thing? To answer this, I want to take a look at what Laing set out to accomplish in The Divided Self, why he calls it an existential study, specifically, and how this now-classic work laid the foundation for what would eventually evolve into anti-psychiatry.

As Laing says in the preface, the book is “a study of schizoid and schizophrenic persons,” and its basic goal “is to make madness, and the process of going mad, comprehensible.” At the outset, the diagnostic language Laing employs is readily familiar to every psychiatrist and psychoanalyst who works with this population. Terms such as psychotic, schizoid, schizophrenic, paranoid – all standard nosological entities with which therapists the world over are familiar – proliferate throughout this book. He is speaking their language, so to speak, but the meaning he is assigning to these terms is anything but ordinary. Laing explains he has never been especially skillful in recognizing the diagnostic categories that are standard in every psychiatric diagnostic manual in the world, including the Diagnostic and Statistical Manual (DSM) that is the bible to the mental health industry in America. Laing had trouble recognizing the subtle nuances that are supposed to distinguish, for example, the various types of schizophrenia, of which there are many, or even what distinguishes them from other forms of psychosis, including paranoia, or bipolar disorder (which used to be called manic-depressive disorder), or dementia.

None of these terms is laid in stone. In fact, they are constantly changing and undergo revision in every new edition of the DSM, currently in its fifth edition. So what is Laing saying here? Is he suggesting that he is too stupid to understand the complexity of these entities? I don’t think so. Rather, he is proposing that because there is no agreement in the psychiatric community as to how to recognize such symptoms and the mental illness they are purported to classify, it is impossible to take them literally, or even seriously. No two psychotherapists or psychiatrists agree on how to diagnose a person, and given the never ending revisions to these categories, currently numbering in the hundreds, practitioners often change their own minds as to how to recognize what it is they are supposed to be diagnosing and treating. This is hardly the science it is purported to be.

What did Laing conclude from this disarray in categorization? That there is no such thing as mental illness, or psychopathology, so no wonder there is no agreement as to what it is. When a doctor sets out to diagnose a typical medical illness, he customarily looks for physical symptoms in his patient. The color or tone of one’s skin, dilation of the pupils, body temperature, and so on may indicate an abnormality. Additional tests may be administered that examine the blood or urine, and if that fails to provide conclusive results, perhaps x-rays, CAT scans, EKG’s, heart stress tests, biopsies, mammograms or prostrate exams – all ways of examining the chemistry or interior of the body – may be utilized in order to hone in on what is malfunctioning. For so-called psychiatric symptoms, however, such tests will be of virtually no use, because no one has ever been able to locate any of the symptoms of psychopathology inside or on the surface of the body. Even an examination of the brain, now the darling of neuropsychiatry and neuropsychoanalysts, has yet to locate the presence of any form of mental or emotional disturbance that we can label a mental illness. (Organic conditions such as Alzheimer’s or drug-induced psychosis are not labeled “mental illness.”)

Instead, what we are able to examine is the behavior of the person being diagnosed, whether, for example that person is suffering from delusions or hallucinations, confusion, disorganization, incoherent speech, withdrawal, flights of fancy, or depression, anxiety, dissociation or maladaptation, or perhaps a persistently elevated, expansive, or irritable mood, and so on. This list is hardly inclusive, but what all such symptoms have in common is that they signify experiences that everyone has, at one time or another, some more than others, some less. Even delusions and hallucinations, the gold standard for schizophrenia, are common in dreams, and not that uncommon when we are awake. Yet most people who exhibit or experience these so-called symptoms are never subjected to a formal diagnosis or treated for them. So why is it that some people are and some people are not? Why are some people deemed crazy and others sane, when they exhibit the same symptoms?

The principal mode of treating psychotic conditions today is not psychotherapy, but medication. Medication is typically prescribed for a medical illness or condition, so why is it prescribed for mental illnesses that do not really exist? How is it that drugs are used to treat people who do not suffer from a medical condition? There is nothing about drugs, inherently, that possess medicinal properties, though some do. Drugs were around a long time before they were adopted by medicine, and most of the drugs we use today are not the kind you need a prescription for. Alcohol, marijuana, opium and its derivatives, coffee, sugar, tea, tobacco are only some of the traditional mind-altering drugs that nearly all cultures throughout history have employed. For what? To reduce our anxieties, and perhaps the tedium of an unsatisfying life or a stressful occurrence. There is nothing wrong with this. Drugs are used to enhance our lives, though some in desperation err in believing they can obliterate our problems. We call them “addicts.” What distinguishes these drugs from the kind promoted by psychiatry is that street drugs are used episodically, when the need arises, usually prompted by anxiety. Prescription drugs, such as Prozac, Paxil, Zoloft,, Wellbutrin, Thorazine, Haldol, Abilify, Lithium, Adderall, or Xanax are employed variously for depression, psychosis, bipolar disorder, attention deficit disorder, or anxiety and are ingested daily in order to remain in the nervous system continuously. Whereas street drugs are ingested in response to anxiety or boredom, prescribed drugs are ingested to prevent such feelings from arising, or to keep them in check.

What all these drugs share in common, whether prescribed or recreational, is not that they are treating a medical condition, but that they are capable of altering our states of consciousness, depending on the state of consciousness we wish to alter, and whether it is distressing. We like to say that alcoholics are self-medicating their depression or anxiety, but in fact they are not “medicating” anything. They are simply using a drug to mitigate their suffering whenever they feel they cannot handle it. Again, there is nothing wrong with this, nothing immoral or sick about it. We all draw the line somewhere. Some of us are able to handle a lot more anxiety than the next person, and some of us are pretty astute at solving our problems before they get out of hand. We don’t know why some people manage the stress and strain of everyday life more ably than others, but whatever the root cause or causes might be, we are nonetheless left with a choice when confronted with these feelings: we can either examine why life is making us so anxious and try to do something about it, or we can render ourselves senseless with drugs. What do we gain by calling these problems forms of mental illness? I don’t think you have to ponder that question for very long in order to arrive at the obvious answer. There is a drug industry that makes enormous amounts of money selling this product to an unwary public who don’t know any better.

These are only some of the questions that Laing raised in The Divided Self, but he never arrived at a conclusive answer as to how to solve to them. In matters of the mind, the act of diagnosis can just as often be a political as medical ceremonial. I don’t believe we will ever succeed in understanding such phenomena as long as we persist in looking at people from an alienating, and alienated, point of view. It is the way that we look at each other, the way that psychiatrists and psychoanalysts typically see a patient when they look at him or her, that is the crux of the problem. The reason Laing called The Divided Self an existential study instead of, say, a psychiatric, or psychoanalytic, or even psychological study is because the existential lens is a supremely personal way of looking at people, a person to person manner of regarding others and recognizing them, as Harry Stack Sullivan once said, as more human than otherwise. This is another way of saying that the person, or patient I am “treating,” is not literally a sick person, but a person like me. And it is the fact that my patient is just like me that allows me to understand and empathize with him in the first place.

Laing began writing The Divided Self while still working at a mental hospital in Glasgow, when he was just in his twenties. It doesn’t sound like he had an opportunity to do much psychotherapy there, but he did have lots of time to hang out with the patients under his charge, all of them diagnosed as schizophrenic. Instead of looking for symptoms of recognizable forms of psychopathology, Laing sought to simply talk to his patients, as he was fond of saying, “man to man,” and to listen to what they had to tell him. What he heard was nothing short of amazing. They told him stories about their life, their belief systems and experiences, the things that worried them and the things they thought about, day in and day out, just like any sane person would. The thing that I remember standing out for me when I first read this book was that I felt he was talking to me. This, from what I have subsequently gathered from others, was not an unusual reaction. It is this reaction that has made this book the classic that it is.

Instead of trying to determine what makes “us” – the sane ones - so different from “them” – the ones who are crazy – Laing sought to explore what we share in common. Laing used the term schizoid – quite common in Britain but only marginally employed in the U. S. – to depict a state of affairs that lies at the heart of every person labeled schizophrenic, as well as many who are not so schizophrenic, in fact all of us to varying degrees. The common thread is this: that the person so labeled, in his or her personal experience, suffers from a peculiar problem in his relationships with others: he cannot tolerate getting too close to other people, and at the same time cannot tolerate being alone.

This is a terrible dilemma to be burdened with. Most of us either hate to be alone and throw ourselves into the social milieu with others (Jung would have called them extroverts) or we cannot bear social situations and opt instead to spend most of our time by ourselves. These more introverted, private individuals may be gifted writers or artists or scientists or deep sea divers who are well suited to their relative isolation, whereas the extroverts among us make excellent politicians or salesmen or actors or any number of other callings that entail contact with other people. In other words, we tend to incline in one direction or the other, and either may be a perfectly viable way of existing and living a happy, contented life. The person who is schizoid, however, doesn’t excel at either. He cannot tolerate isolation, nor can he get genuinely close to others. He is caught in a vise, a kind of hell, that is rife with unrelenting anxiety, what Laing calls ontological insecurity, because simply existing is a serious and persistent problem for him. In speaking of a person this way we are not really diagnosing him, we are simply describing what it is like to be him.

When I first read this I couldn’t help but wonder how many of us are really all that comfortable being alone, and how many of us are truly that taken with our relationships with others, which is to say, free from anxiety. Isn’t this a problem, for example, that psychotherapists typically share in their work with their patients? Psychotherapy is a fabricated relationship whose purpose is to achieve uncommon intimacy with another person, while placing extraordinary constraints on it, conducted by two people who, relatively speaking, have problems with getting close to others. Isn’t this rather like the lame leading the blind? Laing didn’t think so, but he was acutely aware of the paradox, of how wounded a person must be to want to spend all of his professional time in the company of people who are obsessed with their problems!

Laing was not the first to recognize this paradox. Nor was he the first to accuse psychiatrists of employing means of helping others that are for the most part ineffectual. For that Sigmund Freud would have to be credited, arguably the first anti-psychiatrist. Freud was a neurologist, not a psychiatrist, and he was scathing in his commentary about the psychiatrists of his day who, Freud believed, knew nothing about why their patients suffered, nor how to help them. Freud believed that people develop symptoms of hysteria and other neuroses because they have been traumatized by unrequited love in their childhoods. He was the first to recognize the powerful effect that our parents, in fact all our social relationships, have on us, how our capacity to love is also the source of our greatest sorrows. Freud was also the first to recognize that our craving for love is both unremitting and insatiable, no matter how much we get, and that we are most vulnerable when at the mercy of the person we love.

Yet Freud was not interested in the kind of person Laing described in The Divided Self, because he didn’t believe a person who is schizoid or psychotic is capable of attaching himself to the psychotherapist who is treating him and, so, cannot be helped by him. Freud was correct in recognizing how vulnerable such people are, but mistaken in his conclusions about their capacity for attachment, and for therapy. It has been argued that Laing accomplished for the so-called schizophrenic what Freud accomplished for the neurotic: a way of establishing an intimate relationship with this person that, in fact, may serve as a vehicle for healing. In fact, the distinction between psychoses and neuroses is not a significant one; it is a matter of degrees. Freud was unhappy with the brutal manner in which the hysterics of his day, mostly women, were typically treated, and even less happy with the prevailing understanding of psychological suffering. Unlike psychiatrists, Freud did not believe in an us versus them mentality. He did not believe, for example, that some people are neurotic and that some people are not. He believed that everyone is neurotic to varying degrees and that neurosis is an aspect of our human condition. He also believed that neurotics may, on occasion, become psychotic if pushed far enough. So if everyone is neurotic but curing us of neurosis is not in the cards, what is psychotherapy good for?

Freud was never able to definitively answer this question, though he was confidant that it can help. If you read between the lines, you can’t help concluding that Freud viewed anxiety, and the more psychotic forms of alienation that Laing was so good at describing, as essential aspects of our human condition. So what we call “ill” versus “healthy,” or crazy versus sane is not all that black or white, but shades of grey. If all of us are neurotic, and on some occasions even psychotic, some more, some less than others, then all of us are healthy and sane, to varying gradations.

Freud’s invention of psychoanalysis was a huge step forward in treating people we think of as nuts or crazy as human beings like ourselves. But once it was embraced by psychiatrists, psychoanalysis became another weapon in their war on mental illness. Whereas psychiatrists had depersonalized the relationship between doctor and patient by pretending that it wasn’t the person, but rather his illness, that was being treated, psychoanalysts depersonalized the treatment relationship by insisting that it wasn’t the person or his body that was responsible, but his unconscious. Though psychoanalysis made extraordinary gains in humanizing the treatment relationship over prevailing psychiatric practices, both seem strangely incapable of formulating a genuinely symmetrical therapy relationship between equals. There have been notable exceptions to this, such as Laing, who stood proudly on the shoulders of other remarkable, humanistic practitioners such as Sullivan, Fromm-Reichmann, Winnicott, and other psychiatrists and psychoanalysts who advocated more personal way of “treating” their patients, not treating them for illnesses, but treating them like they would want to be treated themselves were they in a similar predicament.

This isn’t to say that Laing was advocating simply being nicer, or kinder to his patients, as though that alone was sufficient. Instead, his concern was with being more real, or authentic with them, more honest. That’s a lot harder than just being nice. This, he believed, could only happen if we stop objectifying our patients into diagnostic categories that only serve to alienate them from us. Perhaps the model that best exemplifies what Laing advocated is not a relationship between therapist and patient, or parent and child, but one between friends. After all, friends confide in each other, and confiding is an essential aspect of what therapy entails. In one of his more mischievous moments Laing even suggested that therapists might as well call themselves prostitutes, because what patients are buying is not treatment, per se, but a relationship with another person. Whether he thought of himself as a friend, or prostitute, to his patients, Laing didn’t have a problem with calling the people who paid to see him his “patients,” any more than he had problems with calling what they were doing “therapy,” both undeniably medical terms. But isn’t this contrary to what I have been saying about the myth of psychopathology?

Whatever problem Laing had with the institution of psychiatry, he never had a problem with being a doctor. He was proud of his medical training, and while such training is not necessary to practice psychotherapy, he thought is was as good a way as any to enter the field. After all, what all doctors share in common is that they want to help people. This is basically what therapists are trying to do. Laing was fond of pointing out that the word therapy is etymologically cognate with the term attention or attendant. In ancient Egypt a religious cult called the Therapeutae were literally attendants to the divine, so the term predates the subsequent medical appropriation of it by the Greeks. If we take the term literally, a therapist is simply a person who is attentive, or pays attention to the matter at hand, the suffering of his patient. Similarly, a patient is literally a person who patiently bears his suffering without complaint. The term doesn’t necessarily refer to someone in medical treatment because the kind of suffering is not specific to the term itself. Laing concluded that if you put these two terms together you get one person, the therapist, who attends and is attentive to the other person’s, the patient’s, suffering. To what end? Hopefully, such attention, with enough patience, good will, and most importantly, time, will lead to something: an end point where the patient no longer requires such attention and can get along perfectly well without it.

According to Michel Foucault, the philosopher, it was purely by accident that medical doctors became responsible for treating crazy people in the first place, in eighteen-century Europe. If fact, it was a very recent moment in history when mad people were deemed mentally ill. Historically, people who acted crazy were thought to be possessed, either by evil spirits or the gods. In the seventeenth century Europeans began to feel unsafe with the crazy people in their midst, who wandered the streets – not unlike the homeless people who wander about our cities – and began to confine them as a means of protection. Not surprisingly, such confinement made them even crazier and their jailors began chaining them to the walls of the Lunatic Asylums they had put them in. They soon developed diseases, which only escalated their problems further until the French physician, Philippe Pinel, was brought in to attend to their specifically medical maladies and observed that the way they were being treated was inhuman. Pinel argued they should instead be treated as sick people, in order to treat them more compassionately. It was then, according to Foucault, that mad people were for the first time in history deemed mentally ill.

This was a remarkable step forward in treating such people with sympathy who deserved to be helped, but it also initiated the slippery slope that occasioned the birth of psychiatry and, with it, the diagnostic universe we now live in. Laing was proud of being a physician but recognized that we now find ourselves in an historical quandary. Like the Europe that invented the Lunatic Asylum, our society feels the need to protect itself from crazy people, some of whom are undeniably dangerous and capable of savage violence, even murder, but most of them are harmless, even more vulnerable than you or me. If and when violence does erupt, someone has to make the call: Is the person in question crazy enough to lose, even temporarily, his constitutional rights and be confined to treatment– which is to say, “medication,” intended to render him senseless or worse, against his will? Whether we like it or not, that task has been assigned to psychiatrists, and it has given them enormous power over those members of society they deem dangerous, whether to themselves or others. Laing had no ready or easy solution to this problem, but believed that all of us is implicated in it.

In fact, Laing never formulated an overarching theory of psychopathology to replace the edifice that psychiatry and psychoanalysis have built. For the most part, his focus was on schizoid phenomena and schizophrenia, not as specific diagnostic entities but, like Freud’s conception of neurosis, as a metaphor for varieties of mental anguish that compromise our ability to develop a satisfying relationship with others, and with ourselves. As the subtitle of The Divided Self suggests, Laing was more comfortable thinking in terms of sanity and madness than psychopathology. But what does it mean to be crazy? And what does it mean to be sane?

These terms lack precise definition when compared, say, with the plethora of diagnostic categories in the DSM, because they are used colloquially, as a manner of speaking, so it is up to each of us, individually, to determine how to employ them. It seems to me that the essence of what it means to be crazy, in the way that term is ordinarily used, can be broken down into three components, the combination of which will tell us just how crazy a person is. The first concerns how a given person exercises his or her judgment; the second concerns how agitated that person may be; and the third concerns the lengths a given person will go to mitigate his anxiety.

Our use of judgment is probably the most critical of the three, because it determines how we make sense of things, including the situation we are facing at a given moment. The judgment of a person suffering a manic episode, for example, is said to be seriously compromised, but so is that of a person who suffers from acute paranoia or hallucinations. Our judgment is where we live, and there’s no escaping it, though we can improve it if – and only if – we have the presence of mind to realize that we cannot entirely trust it. Yet, who gets to decide whether a given person’s judgment is impaired or sound? If I judge that I need help in improving my judgment and take my plight to a therapist, can I trust the judgment of that therapist over my own judgment? I’m not going to get much out of therapy if I can’t trust his judgment, but who is to say that my therapist’s judgment is more sound than mine is? How can I make such a judgment if, say, I don’t trust my judgment? This is a problem, and one that makes therapy almost, but not quite, impossible.

A person’s judgment is for the most part a private affair. The person who is crazed is often in a state of agitation, which others can’t help but notice. It is this state than usually makes my judgments public, when, for example, I am about to leap off a tall building, or assault someone for no discernable reason. This is the prototypical image that we all have of the crazy person, who is acting crazy, and often in a manner that not only gets our attention, but scares us, because we don’t know what he is going to do next. Each of us has been crazed at some time or other, but the moment usually passes before any real harm has been committed. If it persists, that is a different matter, and things can quickly spiral out of our self-control. This is when I am most likely to be taken to a mental hospital, whether I want to go there or not.

The third way I may feel or appear crazed concerns what psychoanalysts call defenses, the mind-games I employ to mitigate my anxiety. This was the issue that Laing was most concerned with in The Divided Self, the so-called schizoid person. We see his defenses in the way he engages in social space. As we noted earlier, this is a person who cannot tolerate being isolated from or being intimate with others because either position makes him intolerably anxious, so he walks a tightrope between the two where he feels the least amount of anxiety, but still too much fear to navigate his relationships effectively. Much of what we do to cope with our anxieties does not appear crazy and does not feel crazy, and works for us, more or less. It is the most severe states of anxiety, the more psychotic variety epitomized by ontological insecurity, that are the most problematic and result in extreme measures to mitigate, such as catatonic withdrawal.

If these criteria offer a rough and ready means of discerning what it means for me, or you, to be in a crazy state, then what does it mean to be sane? It would more or less approximate the exact opposite of feeling crazy. Our judgment would be sound, relatively speaking; our use of defensive maneuvers would be minimal because we would bear our anxieties with relative indifference; and we would not be in a state of panic or agitation, but one of serenity, of feeling at peace with ourselves and the world. When we weigh the two, there are no crazy people, or sane people. Every single one of us goes from one state to the other in the course of our lives and sometimes in the course of a single day. By this definition, all of us have been crazy, no matter how sane we are most of the time, and will be tomorrow. If this were not so there would be no way for a psychotherapist to connect or empathize with a person who has been diagnosed, say, schizophrenic. We can only help people with problems we ourselves can relate to, and have experienced ourselves.

No one has ever developed an air tight etiological theory of what “causes” us to become neurotic, or psychotic, or just plain crazy, though most therapists favor the environmental thesis over the biological. Neither model is entirely satisfactory, so our mental states and what accounts for them are for the most part a mystery, and may always be. We may never know why this person is crazier than the next person, or why, in fact, all of us are crazy in some contexts and not so crazy in others. It seems that some people are capable of driving others crazy, but there are those who appear to be perfectly capable of becoming crazy by their own device. It appears that common deception is a problem, but difficult to recognize in the situation as it is lived. The bottom line, given the inherent ambiguity of the situation we find ourselves in, is to proceed cautiously, with a degree of humility in how we treat such people when we meet them.

Whenever Laing addressed this topic, whether in writing or in public, he often invoked the Golden Rule. How would you, if you lost your wits, fell apart with grief or consternation, want to be treated by those who have you at their mercy? When the shoe is on the other foot, shouldn’t you treat them the way you would like to be treated yourself? It is impossible to separate our thoughts about psychopathology from the work of psychotherapy. If I met a mad person on the street who was threatening me, I would defend myself without hesitation and, if need be, ask the police to confine him. But if he wandered into my consulting room, no matter how crazy he might be, and wanted my help, and was not trying to assault me, that is another matter. And that is the matter that concerns us all. How we come to meet another person in dire straights, whether we happen to be that person’s therapist, family, or friends, and how to treat that person in such a way that, in the name of the Hippocratic oath, we do no harm.

And what of today? One century after the birth of psychotherapy, are we more humane and compassionate in our treatment of those at our mercy? It is difficult to say. But one thing we cannot deny, our culture has become even more “medicalized” than at any time in history. The medical metaphor that Laing found more or less acceptable when explaining what he thought therapy is, has become increasingly literal. In California, we even have medical marijuana. Pot is not just a pleasing way of altering our consciousness, it has become medicine. When you smoke pot you are no longer getting high, you are medicating yourself for whatever ailment you are “treating.” You are no longer deemed a pot smoker, you are a “patient.” More and more, anything that pains us is a condition that can be treated. If you are caught having extra-marital affairs with a dozen women, you are no longer a philanderer. You have a sex addiction, which is a condition for which you can be treated, so you are not responsible. This seems to be the thing our culture is most concerned about, to escape responsibility for who we are and the mischief we get up to.

I think this trend in our culture creepy, because it implies that just about anything we do that might get us into trouble is simply a condition for which we bear no responsibility. Is this a sane way of proceeding? Is this what our capacity for judgment has come to? I will let you be the judge of that.