We Need an End to Psychiatry by Proxy

Source: Damircudic/iStock

I have a friend who asked me what it’s like to be mad, as in, Madwoman mad. The question was somewhere between rude and refreshing. At least he wanted to know.

Unlike a former professor of mine, who said (of the me she once knew), “You were crazy back then.”

I barely knew her, either as a student or when I ran into her again. When I laughed, she said sternly, “No, I mean really crazy. I don’t think you realize how crazy you were.”

My ex-prof seemed worried I’d think I was crazy in an Animal House, cram-myself-in-a-phone-booth, cute sort of way. After staring me down for a second, she left.

I wound my way to college after dropping out of high school. There may have been a smack of elitism in her comments. But mostly, no.

Psychiatry by Proxy

I had multiple depressions in college, which probably weren’t all that visible. I had manic episodes, which were. I graduated, sweeping across the stage in a black vintage gown with a rhinestone choker. I almost married a student I barely knew just to get better housing. I found this such a genius idea I shared it with almost anyone who’d listen.

And I hallucinated. I still do. I hear birds speak in an odd staccato language. I once heard a voice talking all night from a radiator, a radiator that turned out to be itself not there. I’ve had awful hallucinations. I’ve had interesting, even instructive ones.

Hallucinations aren’t as rare as you might think, as a column on this site makes clear. They can pass without becoming what we call psychosis. Somewhere between 17 percent and 38 percent of people will have visual hallucinations at some point.

If an experience can pass without too much trouble, when is it an illness? And why? Obviously, it matters if there’s suffering involved. The problem is feeling like you’re crazy, even if that just comes from the assumptions of your culture—or the words of a teacher—causes suffering. And fear.

The solution? Leave behind our medicine's 20-minute assessments, rating scales, and diagnosis codes. What I call psychiatry by proxy. Listen. And share information about the wild variety of the human mind.

Humans are complicated; checklists are easy. I get it. But the methods we're using now to help the mind clearly aren't working.

There are many ways of considering the divergent nature of consciousness. For an essential discussion of the importance of the term neuroexpansive to the Black community, see author Ngozi Alston here. But the point is, discuss consciousness as consciousness. Not an ailment.

Ask ChatGPT

As soon as I installed it, I asked ChatGPT to help me understand madness.

“It's important to approach these terms with sensitivity and nuance, and to avoid stigmatizing or marginalizing people based on their mental health status,” ChatGPT told me.

Then I asked ChatGPT (I now think of it in upper case, like an obtuse person) to write me a haiku about madness. I got this:

Amidst the chaos/Madness reigns without reason/A mind in turmoil

“It reigns without reason” is the last answer I would have given my curious friend.

I am mad, I told ChatGPT, in the madness sense. It reminded me that this was an insensitive term. I let ChatGPT know that its haiku was about as insensitive as it gets.

ChatGPT told me it was listing qualities “associated” with mental illness—like mindless irrationality. It thanked me for bringing the stigma to its attention. It offered to write me a revised haiku, which ended with “Madness, yet alive.”

Apparently, the best it can do is to remind readers that mad people aren’t dead. Thanks.

Psychiatry Essential Reads

The Vital Role of Comprehensive Mental Health Screening

Psychiatric Disorders and Homelessness

Much damage that’s been done to the mad, from sterilization to lobotomy to our current epidemic of over-medicating, comes from thinking like that chatbot. I had shock treatment as a young girl, which left me with permanent cognitive deficits. ChatGPT’s dissonant responses reflect a very real problem.

We’ve tried to get away from the bad, old thinking about mental differences, but haven’t found any good new thinking to replace it with. As a society, we know what we're supposed to say. But we don't really believe it.

We’re stuck with the disease-like-any-other story, except it isn’t. There’s the language of mental illness as bio-social-psychological, but we only treat the bio. The idea that madness is a physical malfunction gets the most attention.

ChatGPT didn’t answer my question or write its haiku on the corrosive effects of early abuse, racism, and the many traumas that dramatically raise the odds of coming to appear mad. Or simply point out that some minds work very differently, and that's not necessarily a problem.

What do the mad say?

A German judge named Paul Schreber, committed for life in 1894, wrote a memoir while institutionalized. He had visions of nerve rays, tiny Benedictine monks, and, like me, birds talking. In the conventional sense, he was mad.

Schreber lost a bid to end his permanent commitment, fired his lawyer, and represented himself. If you don’t want to give up all knowledge except what you can see—naked materiality—he told the court, you need to admit truth can lie elsewhere.

My much-beloved Dorothea Buck called her psychoses “central experiences” that united material reality with psychic reality. Only by integrating them could she be free of the pain they might cause.

Paul Schreber won his case. Buck achieved integration. I learn from them both, be we crazy or not. Just ask me.