Under what circumstances does a person have a dilemma and cannot effectively defend himself?
In the first half of the 20th century, many Americans who lost their fertility and even their lives as a result of the Eugenic Movement, as well as the unfortunate who died under the Nazi "euthanasia" operation, probably told us:
In cases of being accused of being mentally ill.
At the beginning of the 20th century, the rising eugenics movement in the United States began to be supported by clinicians and researchers.
At the Kansas Free Exposition in 1929, the winning families of the "Healthier Families" competition stood outside the Eugenics Building. Image credit: Cold Spring Harbor Laboratory
Since psychosis is seen as a heritable factor, it is possible to pass on so-called inferior genes to the next generation. As a result, professionals began to consider stopping the spread of bad inherited genes by cutting off the fertility of patients.
As a result, between 1907 and 1937, 32 states in the United States passed the Forced Sterilization Act, which sterilized people diagnosed with severe mental illness.
When searching for the root cause of psychosis, American psychiatrist Henry Cotton proposed a "theory of lesion infection".
The theory is that the main cause of psychosis is that the toxic side effects of bacterial infections are transferred to the brain.
Therefore, in order to reduce the probability of infection and prevent metastasis, he began to extract teeth from patients, remove tonsils, colons and even spleens, often resulting in lifelong disability or death of patients.
However, he was not punished in any way, and those diagnosed with mental illness simply did not have any social resources and capacity to sue him.
This method of "eugenic sterilization" in the United States was implemented by the Nazis in a more extreme way in the 1930s. Around 300,000 Germans have lost their fertility due to being diagnosed with "mental retardation", "schizophrenia" or "epilepsy".
The Nazis intensified, and between the second half of 1939 and 1941, 200,000 people were euthanized by the Nazis in the name of mentally ill people. Among them were genuine schizophrenia, people with physical disabilities, antisocial actors arrested by the SS, unemployed vagrants and so-called "inferior race" people.
In September 1939, Hitler signed up for "euthanasia". Image source: Wikipedia
Later, this action proved to be a "testing ground" for the elimination of social dissidents, "inferior races" such as Jews, and certain groups of people with "mental defects" who did not conform to eugenics theory.
After the end of World War II, the Nazi atrocities against mentally ill people spread back to the United States, and the medical community, led by all walks of life, was so shocked that they had to re-evaluate the causes of psychiatry and psychosis.
However, this revaluation plan seems to have come a little late.
By the 1950s, the number of patients in all psychiatric hospitals in the United States had exceeded 500,000, an all-time high.
Moreover, even after the improvement of psychiatric diagnosis, the psychoanalytic theory of "self, self, and superego" gradually parallels with the research of "neuromediators, dopamine pathways, NMDA receptors" in traditional medicine, and some patients diagnosed with mental illness no longer need to be operated on, but receive psychological counseling and drug treatment, but it is still difficult to accurately assess whether a person really has mental illness.
This point was proved by the American psychologist David Rosenhan through the famous "Rosenhan Experiment".
In the 1960s and 1970s, along with 7 other normal people disguised as mentally ill patients, he conducted experiments in 12 hospitals with different qualifications in different regions and qualifications in the United States. As a result, almost all of them were diagnosed with psychosis.
David Rosenhan (1929–2012), professor of psychology at Stanford University, is best known for the "Rosenhan Experiment" that challenged the validity of psychiatric diagnostics. Image credit: Stanford University
Such a situation has undoubtedly aroused widespread doubts about the ability of society to diagnose modern psychiatric diseases.
Since these mentally healthy people have been diagnosed with psychosis, does that mean that there have been many similar misdiagnoses in the past?
Do patients in psychiatric hospitals really have psychosis?
Even a professionally trained medical worker or psychoanalyst cannot give the right answer, so who can define who is normal and who is mentally ill?
If it is not possible to make an accurate distinction, is the situation of the Nazis, who achieved the elimination of some people by indiscriminately fastening the hat of mental illness, still going on in unknown places?
However, regarding the "Rosenhan Experiment", after the American journalist Susannah Cahalan collected the relevant information, he found that Rosenhan actually forged some materials for the results of the experiment, and some volunteers even made them up.
In 2009, Kaharan was diagnosed with schizophrenia due to sudden symptoms such as nervous disorders and visual hallucinations. However, the psychiatric diagnosis and treatment not only did not cure her disease, but made the symptoms more and more serious. Later, she was found to have a rare form of autoimmune encephalitis, rather than a mental illness. This unusual experience made her start to think about the diagnostic criteria for mental illness, and after in-depth study of the history of mental illness, she wrote the book "Normal People in Mental Hospitals". Author: [Beauty] Suzanne Kahalan Translator: Zhao Xiaorui Publisher: CITIC Publishing Group Publication date: 2021
But at the same time, she also pointed out that although there were some problems in the experimental process, it can be confirmed through various historical sources that the phenomenon described by Rosenhan is real and has been happening. She also quoted a line from the movie "Flying Over the Madhouse" to express her attitude:
"But it's true, even if it didn't happen."
Narrated by the narrator Bromden, this phrase also appears at the beginning of the original novel Flying Over the Madhouse.
The novel's author, Ken Kesey, wants to remind the reader that the ongoing narrative is not entirely reliable, but is filtered through the characters from the subjective point of view of the narrator, especially if the character is a mental hospital patient. So don't simply think of it as a truth.
However, both the novel, published in 1963, or the 1975 adaptation of the same name, are still classic texts that are often used as examples when discussing and analyzing mental illness today. Because, after being read and analyzed by countless people, it is believed that they largely reflect the reality of the situation and the plight of the mentally ill.
The protagonist, Murphy, as a normal person, is sent to a mental hospital to escape forced labor in prison and pretend to be mentally abnormal. After being admitted to the hospital, he asked to watch the television broadcast of the baseball game, led the patients out to sea to fish, challenged the hospital's various management systems, and was obstructed by the head nurse, which caused the hospital a headache.
But in the process, the patients' spirits are lifted. The hospital went from being lifeless at first to being alive.
Stills from the movie "Flying Over the Madhouse". Image source: Douban
Although most of them are different from the "normal" as the average person understands, or delirious, or crazy, or suddenly sick, their joy is real when watching the ball and going to sea. Especially at the end of the film, when the tall Indian "Chief" breaks the window and escapes the hospital, the other patients hear the movement and get up from the bed to cheer him in various ways. And these are all profoundly manifested:
The insane mental patient, who is essentially or no different from a normal person, is a person as an individual.
However, due to the development of human reason, people imprison irrationality in the name of pure reason, use "normal" to exclude "abnormal", use reason to exclude madness, and reason suppress irrationality to "silence".
The French philosopher Foucault discussed this in detail in his book Madness and Civilization.
The French critic Roland Barthes commented on the book: "This work is a purges and questioning of knowledge. It returns a fragment of "nature" to history, transforms madness, that is, what treats us as a medical phenomenon into a civilized phenomenon." Author: [French] Michel Foucault Translators: Liu Beicheng, Yang Yuannian Publisher: Life, Reading, and New Knowledge Triptych Bookstore Publication date: 2019
In the 17th century, philosophers represented by Descartes began to promote and promote reason. He excludes madness from thought, believing that a thinker can never be insane. Along with this trend of thought, the confinement and exclusion of madness in social practice, which concretizes madness, also begins to be strengthened.
Prior to this, in the older years, of course, mental problems also existed, and people also took some measures against the madman. But the significance of these measures is different from that after Descartes.
In the Neolithic Age, there was a "ring drilling technique". At that time, the ancients often believed that people were crazy because there were demons or ghosts lurking in their bodies, and as long as a hole was drilled in the skull of a mad person and released evil spirits, they could complete the treatment and restore calm.
In ancient Greece, the ancient Greeks believed that people went crazy because they made mistakes that caused the gods to be angry or retaliate. This view was later accepted by Judaism and Christianity, and when one lost faith or became proud, "God will punish you with madness."
By the time of the Renaissance, the mind began to be liberated, and people's perceptions of madness changed dramatically, gradually emerging as an everyday or aesthetic phenomenon:
"The controversy between man and madness is a dramatic debate in which man is confronted with all the mysterious forces of this world; the experience of madness is shrouded in images: the primitive fall of man and the will of God, the bestiality and its various transfigurations, and all the magical secrets of knowledge."
In other words, the madman is not necessarily ostracized at this time, but "in every respect, madness fascinates", mainly for two reasons:
First, madness is related to knowledge.
At that time, many people thought that most of the knowledgeable and rational people could grasp it partially and one-sidedly. A madman or a fool, on the other hand, may have a full range of knowledge.
This was reflected in some important works of the time, such as Don Quixote and Hamlet. Among them, the madman, who often mocks people with a crazy gesture, is actually a prophet, who can tell the truth in one word, and remove the fog that the intellectuals who are addicted to the old paper pile and useless arguments cannot see.
Second, madness is associated with lightness and pleasure.
Madness makes people "active and happy", "a common figure on the social picture, from the old-fashioned madness groups, from their festivals, gatherings and conversations, people appreciate a fresh and lively pleasure".
However, after the arrival of the classical era represented by Descartes, the construction of reason and order gradually silenced the cry of madness and relative freedom in the Renaissance.
René Descartes (1596 – 1650), French philosopher, mathematician, scientist, is widely regarded as one of the founders of modern philosophy and algebraic geometry.
In 1656, the General Hospital was established in Paris to house madmen and beggars whose spirits were different from those of most ordinary people.
Foucault saw this as a direct consequence of Descartes' rational instrument. This system, which has emerged since the 17th century, is a decisive moment in the history of the madman, which determines the perception and attitude of the latecomers towards the madman:
"Here, order is no longer free to encounter chaos, and reason does not have to try to make progress among those who will avoid it or try to reject it. Here, reason exercises absolute dominion through a prearranged victory over violent madness. ...... (Madness) obedience to reason, subject to moral precepts in the castle of confinement, living in the long darkness of the night."
However, at this time, between the mad person and the mentally ill, there can be no equivalence.
Madness in classical times was rarely associated with medicine, and madmen were not patients. The madness at this time is more like the embodiment of a beast, the product of the extreme degeneration of human reason, the extreme symbol of man's sin.
The madman, with his own madness, uses irrationality to carry out a futile struggle.
Normal, rational people, like beasts watching a zoo, observe them and use reason to supervise and distinguish between "them" and "us."
Bethlem Royal Hospital, a psychiatric hospital in London, was one of the first insane asylums in the world. Its nickname , Bedlam , meaning riot and chaos , represents a series of violent measures it has taken against insane people throughout its history. The hospital in 1739 is pictured.
During the Enlightenment of the 18th century, madness was finally no longer seen as a sin, but evolved into what we know today as psychosis.
But this conceptual change has not fundamentally changed the division of "them" and "us.".
The further development of reason made it perfect the classical way of using the material power of confinement to compete with irrationality and thus win victory, and developed the system of mental hospitals and care:
"The winner or loser has been decided in advance. The concrete circumstances in which madmen and rational people meet have predetermined irrational failures. The absence of coercive measures in the psychiatric hospitals of the 19th century did not mean that irrationality was liberated, but that madness had long since been subdued."
The psychiatric hospital was detached from the place of imprisonment and became a separate space. Psychiatry has a truly independent status. As the spokesman of science, the doctor stands on the commanding heights of reason, whether from social order or morality, has supreme authority, is determined to be an irrational mental patient, and has no room for resistance.
When a madman enters a mental hospital, he is not liberated, but completely destroyed.
They will always be in a state of silence and shame, becoming the eternal Other, objectified by civilized, rational and normal people. People as subjects don't listen to what crazy people say because they are "abnormal", their words are untrustworthy, irrational nonsense.
The work of the 18th-century printmaker William Hogarth, which is based on scenes from the Bedram Mental Hospital. Image source: ABC
And the source of power to define "normal" and "abnormal" is precisely the "order" that has been formed step by step by the approval of the majority of people in history. This kind of power is not natural, but is constructed by the majority, as Ge Zhaoguang, a professor at Fudan University, put it:
"In the real world, if the group of people we call the madmen have an absolute majority in numbers and have absolute power, they will call us so-called rational people crazy." 」
The order that most people agree to is constructed as the core social need, even the so-called "civilization.". Thus all those who form a society in accordance with the order are endowed with the greatest possible power in order to keep it running steadily, to imprison and isolate those who might disrupt it.
From this, we can understand that the social nature of contemporary mental illness is actually a so-called "civilizational" division of enemies and us.
The whole history of human mental illness is a history of the rationality of the majority, a history of the gradual imprisonment and exclusion of irrationality by reason.
There was not a deep gap between what we call normal and psychosis, but after the continuous construction and differentiation of power, madness gradually appeared, and then it was naturally placed in a mental hospital, as if it were naturally there.
But this is not the case, it is not really natural and detached.
Therefore, while people are intoxicated with reason and believe that it has brought about complete progress for humanity, we must also be alert to the "problematic and dubious aspects" of reason. After all, as Foucault asks at the end of Madness and Civilization:
"When rational people willfully persecute the madman according to the orders of reason, who is going crazy?"