Making Minds and Madness: From Hysteria to DepressionRichard Balon, MD
Wayne State University, Detroit, MI, USA
By Mikkel Borch-Jacobsen; Cambridge, United Kingdom; Cambridge University Press; 2009; ISBN 978-0-521-71688-8; pp 266; $45 (paperback); $108 (hardcover).
Psychiatry and theories of mental illness have been subject to criticism and various interpretations and misinterpretations for a long time. The newest contribution to this collection is Making Minds and Madness: From Hysteria to Depression, written by Mikkel Borch-Jacobsen, a professor of French and comparative literature at the University of Washington. Considering that I was interested in comparative literature eons ago and that I liked books by other nonpsychiatrists such as Jeffrey Moussaieff Masson1 and Tanya Luhrmann,2 I was interested in another lay person’s view of psychiatry and mental illness. These treatises can be insightful, educational,2 provocative, and thought provoking.1
Making Minds and Madness consists of an introduction and 13 chapters organized into 4 parts: “Micro-histories of trauma”; “Fragments of a theory of generalized artifact”; “The Freudian century”; and “Market psychiatry.” The chapters with catchy titles basically are the author’s essays translated from French (except for the postscript to chapter 2) and were previously presented or published elsewhere. Part I contains 3 chapters: “How to predict the past: From trauma to repression”; “Neurotica: Freud and the seduction theory”; and “A black box named ‘Sybil.’” As the author writes in the acknowledgements, these 3 chapters trace the emergence and spread of the notions of “psychic trauma,” “dissociation,” and “repression” to highlight their historical, contingent, and ultimately artifactual nature (p vii). “History is used to critique claims to psychological universality and ahistoricity” (p vii). In the first chapter, the author suggests that during any exploration of psychic trauma we cannot be sure we are not facing a pseudo-causality (p 20). In a complicated manner, the author also suggests that in many—if not all—traumas “we witness here the birth of a true psychiatric myth, fated to a grand future: the patient is entirely ignorant of the trauma that caused his symptoms” (p 30). The author concludes this chapter by stating that what began as Jean-Martin Charcot’s speculation became an irresistible, self-propagating machine and a powerful cultural myth (p 32). The second chapter continues the criticism of Sigmund Freud, his theory of seduction, and psychoanalysis. The author states that “If Freud must be criticized, it is not because he refused to trust his patients’ word, but because he extorted confessions from them that corresponded to his expectations and refused to acknowledge this when he realized it” (p 38). Borch-Jacobsen also claims that Freud’s self-proclaimed discoveries (eg, the Oedipus complex) “are arbitrary constructions designed to explain away his patients’ stories of incest and perversion while simultaneously excusing the method that provoked them” (p 55). In this chapter’s conclusion, the author proposes that “Debunking psychoanalysis’s false claims is not enough. What we need to understand is how it creates the reality it purports to describe” (p 57). The last chapter of part I is a skillful criticism of multiple personality disorder (MPD) and careful debunking of the famous “Sybil” case (as the author points out, most of this account was fabricated for supposedly cynical motives [p 90]). The chapter is filled with many other critical bon mots about psychiatry and psychoanalysis, such as “Psychiatric syndromes such as MPD are always negotiated between several actors” (p 71).
The second part again consists of 3 chapters—“What made Albert run?” “The Bernheim effect”; and “Simulating the unconscious”—in which the author continues his critique of psychoanalysis. The author states that this section focuses on the core of his argument, “the co-production of psychic artifacts: people react in complex ways to ideas and to expectations about them, so that psychological and psychiatric theories inevitably influence and mold the ‘psychic reality’ they claim to describe” (p viii). He reminds us that “mental illnesses change from one place and time to another, undergo mutations, disappear, and reappear” (p 104), and “Very few mental illnesses can be confidently called fixed or ahistoric.” In the chapter discussing the “Bernheim effect” (regarding suggestion and suggestibility), the author exclaims, “There is no spontaneity, no more in the analyst’s office than in the laboratory of the experimental psychologist” (p 123). In the chapter on hypnosis, the author states, “The rules of the analytic game demand that patients should know why they love their analyst, why they have Oedipal dreams or fantasies of castration” (p 130).
The titles of the 3 chapters of the third part—“Is psychoanalysis a fairy-tale?” “Interprefactions: Freud’s legendary science”; and “Portrait of the psychoanalyst as a chameleon”—illustrate further critiques of psychoanalysis, its concepts, and Freud. We read that “Freud’s dream theory had multiple predecessors” (p 161)—one may ask, so what?—and “The Freud legend is not simply a propaganda tool or an external rhetorical garment…. The legend is an integral part of Freudian theory, in fact it functions as an epistemic immunization absolutely essential to countering the criticisms that were leveled at it.” The reader finally reads that psychoanalysts are basically chameleons and calls psychoanalysis a “zero theory” (p ix).
The final part consists of 4 chapters—“Science of madness, madness of science”; “The great depression”; “Psychotherapy today”; and “Therapy users and disease mongers.” These chapters, as the author writes, deal with the rise of biological psychiatry and its consequences (p ix). Borch-Jacobsen claims that “The psychopharmacological revolution, which was supposed to liberate the mentally ill and return them to a relatively normal life, has ended up, in a perverse paradox, creating a population of homeless people, drifters, and prisoners, just as in the days before the creation of psychiatry.” One should rather ask whether was it just the psychopharmacology revolution or was it also creating community health centers, closing hospitals for budgetary reasons, and other interventions? In the chapter on depression, after a critique comes the revelation that modern depression is not a myth or illusion and depressives’ distress is real, however depression was fabricated, constructed, produced, invented by the biomedical industry. The chapter on psychotherapy concludes with a recommendation that “It is time for psychotherapy to stop fancying itself as a medication of the mind or as a science of the subject, and finally accept itself for what it has become, for better and for worse: a modern politics of the self and of happiness” (p 218). I hope that by considering these citations, readers get a good idea of what this book is about and how it is written.
The book is fairly scholarly, with exhaustive notes and references, but this is the most positive statement I can make about it, although I liked the chapter on Sybil. The text is a bit difficult to read at times, but that would be a minor flaw. The main problem is the outright hostile attitude toward psychiatry and psychoanalysis. One wonders why psychiatry—out of all disciplines in medicine—is attracting so much negative attention from lay people. I also wonder why a professor of comparative literature and French spends most of his energy writing about psychoanalysis. His criticism is mostly theoretical, in contrast to the frequently cited book by T. Luhrmann,2 who spent time in the field studying her subject from all angles. The content of Making Minds and Madness is far from clinical. Regarding the author’s criticism of psychiatry, nobody doubts that psychopathology changes with time. The brain is our tool to interact with society and the environment. Therefore, it responds to “the present time” differently than it did in the past, and no one standard response is possible. Regarding the critique of psychoanalysis, I do not see anything new. Repeated autopsies do not yield much after a while. I do not know who is the intended audience for this volume—certainly it is not clinicians and definitely not psychoanalysts. I doubt that students of comparative literature would appreciate it. I wonder whether some historians and antipsychiatry cognoscenti or Christian Scientists would appreciate it.
- Masson JM. The assault on truth: Freud’s suppression of the seduction theory. New York, NY: Farrar Straus & Giroux; 1984.
- Luhrmann TM. Of two minds: an anthropologist looks at American psychiatry. New York, NY: Alfred A. Knopf; 2000.
Annals of Clinical Psychiatry ©2010 American Academy of Clinical Psychiatrists