This post is quite interesting and challenging. I am going to write a longer reflection on it, because I think it merits a longer response, but that'll take me a week or so (I'm slow). For now a few observations.
It has never been clear (to me) how important it is, for Garson, that there be some sort of purpose-like element in his story. Two candidates for serving that role appear in your account – the ‘subpersonal’ (“My subconscious self is sending me a message”) and evolutionary adaptationism (“mental breakdowns are an evolutionary adaptation”). Garson also mentions those. (A third makes several appearances in Garson’s historical examples, Divine intention.)
Perhaps the idea of ‘madness as strategy’ is more compelling if we get rid of the apparent felt need to tie it to purpose. (Yes, the word ‘strategy’ invites this connection.) Perhaps function is a better concept, not function as in “what is this thing *meant* to do?” but function as in “how does this thing work?” I will suggest (without further discussion, here) that thinking in this way transforms the analogy between mental breakdowns and car accidents.
Adopting this shift from purpose to function (if it is a shift), the contrast to ‘madness as dysfunction’ would still stand. The car accident isn’t a matter of the world functioning incorrectly. That’s how the world functions – when poor decisions are made, car crashes can happen. We have far less clear and general understanding of the analogous antecedent in the case of mental breakdowns, but perhaps the proponents in the two cases that you mention have correctly identified antecedents in their own particular cases.
It’s also important, in fairness to Garson, to remember that he does not think that one or the other of his models is exclusively true. He thinks they are both true. So yes, it would seem that for Garson the depression is a kind of dysfunction. It’s just that at the same time, it can be understood as a kind of strategy, or, as one might put it in light of above, the world functioning as it does. (That’s my spin, not necessarily Garson’s but maybe his.)
There’s a lot more to be said, here, and thanks for giving food for thought. I’m now resisting the temptation to say quite a lot! (I’ll give in to it later...)
Zsuzsanna Chappell and I wrote a little about this in our forthcoming (very soon now! I'm doing the proofs) research encyclopedia chapter on Philosophy of Madness. We suggest that the terms "dysfunction vs function" are better than design or strategy vs dysfunction, and makes a comparison with asthma and fever.
Quoting our chapter:
"When an asthmatic person’s bronchi close up, the person suffers from a breathing dysfunction. They need help to have their breathing restored. Fever, on the other hand, is a more complicated matter. Fever can be damaging in itself if it becomes too high or persists for too long, but in infectious diseases it also serves a function; the fever helps to slow down pathogenic reproduction. Similarly, scholars and physicians have discussed whether, e.g., psychotic states might serve as an escape mechanism from an intolerable situation. Garson later suggests that insofar as Madness is a strategy, it is not a medical matter, but as the fever analogy shows, this conclusion need not follow. The ‘escape psychotic’ may still suffer and need help. Nevertheless, a fever-like Madness which serves a function may call for different approaches than an asthma-like Madness that is completely pathological."
I have reflected on this a great deal. There were points in my own story when I thought I had to go through everything to make transformation possible, but I no longer think that's true.
I think there are two very reasonable ways of looking at this: enactivism, where mental illness is seen as an operationally closed system in the extreme end or as an overly rigid system on the lighter end of the spectrum, and Dabrowski's theory of positive disintegration.
From the enactivist perspective, crises are shocks to the systems that can potentially lead to shifts in function and structure. The outcomes are dependent on the interplay between the context and the system (organism). I think what allows transformation to occur is removal of the factors that kept the processes and the system on a fixed trajectory, but without so much perturbation that the system is destroyed (that's kind of like what happens in decompensation and total decompensation means death).
Dabrowski was writing before Varela et al, but it's fairly similar. He saw mental illness and symptoms as opportunities for change which needed to be engaged, not treated away. Disintegration (of the personality) can be followed by reintegration (at a higher level) and that's what transformation is.
I'd spent a decade in therapy and on countless medications, had gone through multiple points of inflexion that could have served as catalysts for change before the moment that lifted the dissociative veil, yet these only led to deeper and deeper decompensation and reduced ability to function. Why? It wasn't because I didn't want to heal or wasn't trying. I'd always been incredibly driven to heal, and even when all I was consciously doing was fixing and trying to function better, I was unconsciously exposing myself to material to confront my past (like the time I spent a year writing psych reports on PTSD while not being able to even use the word trauma in relation to myself). The conditions and context simply weren't there, and the people in my life were harmful. It was only when I removed myself from everything and everyone and had reclaimed enough of myself that I was able to hold the ridiculous amount of trauma in conscious awareness, and recovery and integration are ongoing processes. From the outside, it doesn't look like "progress" or "growth" or even "healing" are occurring, especially when I look at slices in time and don't see the wider and deeper picture. You have to go down to come up, but that doesn't mean you need to go down all the way to the depths of hell, especially because you might not make it back up.
I think there is a gentler way to go into and out of our inner dimensions that don't involve quite so much trauma. I do believe that most people are driven towards greater health and integration, it's just that the actions they're taking are ineffectual and their context is disabling or harmful. A crisis comes along and can clear the path so to speak, but the crisis itself is not the driver of transformation.
Awais: I hope you read this essay by Ackerman. It gives a far more detailed description of his experience with depression and recovery. He learned to practice a kind pf cognitive therapy on himself in which he came to realize that he couldn't live a life with a single goal but that his human nature demanded respect for a variety of goals. This essay is referenced in one of responses to his X post.
This is excellent. The thing that I've never understood about Garson's account - although I confess that I've not read everything he's written - and I guess it would be a bit of a shocker if a philosopher hadn't dealt with the following obvious objection as part of his 'strategy' account, so perhaps it's futile of me to comment without further reading! - is that I couldn't see how his theory made the distinction you mention. Sure a depressive episode could be a wake-up call. It could, in a purely metaphorical way, "tell us" that our life was confounded in ways we hadn't got our head around. But the fact is that depression actually doesn't "tell us" this even in the still-somewhat-metaphorical way that, say, foot pain tells us to remove the scorpion from our foot, hunger tells us to eat, loneliness (supposedly) tells us to go see our friends. It mainly tells us that we are worthless, that our future is hopeless, etc. Whereas if we could read the apt behaviour off the state, then we'd not think "I am hopeless" but instead "my situation sucks". We need to bring our self-reflective capacities to bear on it, and so prima facie at least it does look rather more like the wake up call that the heart attack offers the obese person. Now perhaps it is said that the function, the strategy, is working at a much more primitive biological level - rather like the things that Jordan Peterson used to say about lobsters. (IIRC, something like: if you're kinda a weedy loser of a lobster, you're not gonna get any lobster love any time soon, so your low serotonin will now help you not be fruitlessly motivated to play the risky games of lobster derring do, and so you'll not waste energy or even get killed on the mating fields.) But at this level, depression seems very clearly to not promote reproductive fitness in individuals, and even if it was once adaptive, it now seems mainly bunk. And alongside the fact that the existential angle you mention - the fact that we can reflect on our poor health or clumsy accidental overdose or suicide attempt or generalised anxiety and, with the benefit of psychological nous, think 'yep, I better change things up' - clearly ascribes no *intrinsic* function to the putative illness, it seems hard to me to know how to motivate the function claim in any way that ought to invite us to change up our understanding of the nature of mental illness.
On Kemptrup's nice comment: "“Sometimes the pt and analyst/therapist explore things similar to what gets described in science as “underdetermination of theory by evidence” wherein two or more explanations equally fit with the available case history, facts about the pt. And the pt can BENEFIT from understanding that he can be understood in more than one way, and humility is felt as a virtue, which opens up possibilities for new ways of thinking, acting, and feeling. Often, a sign of health in a patient is that they start to understand themselves pluralistically, through multiple lenses. “I suppose one way to think about what I did is this, but another is this. I don’t really know which is true at the moment.”": There are I think two ways to understand this, although the last sentence does rather push it toward one of them. On one reading of it, the different understandings aren't in competition. An 'understanding' here is like a picture, a metaphor, a perfectly legitimate in itself way of organising data. On the other reading, an understanding is more like a theory; it's something which further information could falsity. The bucolic jigsaw puzzle I'm now doing: this shape here on the left could easily be part of a milk maid's bonnet - but then, as I pick out further pieces, iI see that it ACTUALLY is the rear end of a chicken. My first thought was simply WRONG. The former seems to me to map onto the kind of "understanding" we get with the wake-up-call idea. The latter seems to me to fit the kind of "understanding" that evolved functions are supposed to offer us.
Thanks for posting this. I had been wondering about the transformatory effect of mental crises. In my case, a handful of episodes of depression, mania and psychosis packed in a five year period. Somehow this period changed me into a slightly different person. More outspoken, less anxious and afraid, more sociable. Less stress-sensitive also (knock on wood). I sometimes wonder whether this has to do with the opportunity (especially in mania and psychosis) to experiment with new behaviour, and to engage with otherwise unreachable unconscious fears and trauma. Or would all this personality-development just be a lucky side-effect of lithium treatment, quenching lifelong subclinical dysthymia?
The "Antidepressant Effect of Lithium" involves increasing gray matter volume in the anterior cingulate cortex, which regulates emotions. In my view, your transformation is a synergy: the lithium provided the biological floor, while the crisis provided the psychological "reset" needed for growth.
The "Doxastic Shear Pin" hypothesis suggests that delusions might function like mechanical fuses, breaking under pressure to prevent a total brain "engine" failure. In my view, honoring a patient's personal narrative is the most potent clinical tool for lasting recovery.
What these stories capture isn’t that madness is secretly wise, but that collapse can reintroduce constraint when a life has become uncorrectable by normal feedback. A psychiatric crisis can sometimes function like a hard stop, an interruption that forces reality back into alignment when softer feedback have failed. The danger is mistaking the interruption for the design, rather than seeing it as an extreme and costly way a system regains limits after too much drift.
Beautiful and thoughtful, I hope all clinicians recognise this dynamic. I know in the ADHD clinic, where treatment efficacy is much higher than gen psych meds, I take care to warn my high functioning patients that using meds punitively, to "fix" productivity on an exhausted baseline will cause meds not to work, they need to stop, look for inner calm first, and then think about who they are and what might work for them in their lives. Pig parent/angry exhausted child narratives often explain this space well. Thanks so much
A good friend’s daughter, diagnosed with Bipolar disorder and medicated, died Monday of a Fentanyl overdose. She couldn’t bear being alone and needed to get out from under her paralyzing need for comfort and validation.
I do believe medication harmed her.
I also had suicidal depression for decades that has now lifted through a process of deep analysis of my life and priorities, as well as my upbringing and the effect of my parents.
There are clearly biochemical and physical causes for severe psychological states (lesions, etc.) but I believe it is right to ask whether the nature of the world itself can make certain brain types and states unstable - not internally, but with reference to the society and the norms of economic life.
I suppose the way I think of psychiatric events like this is that they're a "strategy" for increasing variance, where the underlying cause is that one's subconscious believes that the current situation is untenable, that if things go on for much longer along their modeled trajectory that everything ends in blood and death, and that therefore something needs to change Now. So they smash a bunch of panic buttons in the brain in an attempt to "rescue" themselves from that fate.
Thing is, in the modern day the subconscious is often catastrophically wrong about the facts on the ground. An amount of stress that used to indicate that you were weeks away from starvation no longer means anything close to that for most people in the developed world. So that wild swing isn't as useful anymore. It was always a destabilizing gamble to be taking, and these days the material upside is much smaller (you probably weren't going to die anyway) and the material downside is much bigger (but now you can lose your job!)
And yet the emotional distress remains pretty relevant right? Even if you're alive, you might not feel that you have a life worth living. Of course most of the physical actions and real-life choices that will fix that suffer from notably impaired execution in "mental health crisis" type states. But in a world where you start out with significantly less than perfect information about the cause of your problems, sometimes the key to something better is simply to realize that there are any solutions at all.
Now in theory this is the sort of insight that therapy is supposed give you. Unfortunately as we know a lot of the therapists do it badly. And if you don't luck out into a good one, you're left to get bailed out psychologically by an absolute disaster. This cancer relapse I'm going through has done wonders for my mood! Factually it should not work that way. But sometimes that's how it goes.
The "Evolutionary Mismatch Theory" explains why our nervous system reacts to a lost job like a predator attack. In my view, your cancer paradox is a "clarity event"; it simplifies your hierarchy of needs, silencing the noise of modern social performance.
I would hesitate to compare simply losing a job to a predator attack. Being fired in an aggressive manner, that I could see, but just the loss of the position without a "shock" of perceived violence I would guess tends to activate different instincts than an unfriendly encounter with a tiger. More the ones that were once adaptive in managing one's status in a tight knit community you couldn't afford to leave.
It's been observed that historically certain groups that made their homes in particularly resource thin areas would sometimes retract support from "underperforming" members-a death sentence in the harsh conditions they lived in. Even now in a less deadly era it's quite evident that many people will treat you much worse if they decide that you aren't doing enough for their liking.
Not feeling like you contribute to society is not the same as actually not contributing to society. Losing a job doesn't actually make you some kind of leech upon humanity. But I do think there is something very real about the idea that it could be bad to be seen as a burden. And to this day there are some people out there who are prepared to express a truly virulent hatred of the unemployed.
Then again, I could easily be wrong about that side of things. I haven't had much experience after all. One of the little plot twists I get to hit people with over the internet is that I'm 20 years old right now. The cancer I'm dealing with currently is a late relapse of a late manifestation of a kind of leukemia that most often affects toddlers.
So I don't know much about what it's like to lose a "proper job" because I never had one. What I do know is what it's like to absolutely flame out of middle school after falling ill with tragedy disease, and then later be treated with contempt by The System for my high-school dropout ways.
It's interesting moving through life being seen through such contrasting lenses. Pitiful to some, resented by others. (Sometimes both at the same time, which can lead to strange conversations.) The people who resent me for some perceived inherent laziness are obviously wrong. Comically so. Exhibit one in the case against: The length of this comment.
What might be less obvious from the outside is that the people who feel pity for me can be corrosive in their own right. Because the thing I've found tends to happen when someone feels that pity isn't that they offer me help. Instead, disturbingly often, they offer me permission to give up.
Now certainly many people need that permission. I've seen how destructive real perfectionism can be. Constantly punishing ones self for failing to meet an impossible standard is. Not exactly a good time.
And also, damn! Can a guy not have goals? I swear you get diagnosed with one scary sounding condition and all of a sudden people act like you can't do anything. Can't even want anything. "Oh you should really focus on your health!"
Yeah ok sure! I'll do that. I'll take all my meds, make it to all my appointments, prepare and eat a nutritionally balanced diet, and get a full night's sleep every night I can. After that I'll have 12 or so hours left in my day, with which I can do other stuff.
But then somehow it's completely unreasonable for me to invest a fraction of that time towards cleaning the kitchen. I'm pushing myself too hard, loading the dishwasher at a sedate pace. This goal I set for myself where I try to put the clean dishes in roughly the same place every time, why it's nonsense! Perfectionism run amok! Much better to simply shove them wherever and then have a harder time finding them later.
I presume it's self-evident why I'm not much of a fan of this strain of defeatism. It's kind of unnerving to be honest. You finally manage to dig yourself out of a pit of depression, only to find that everyone else thinks you should get right back in. That can't be right!
Now I do think the broader concept of a "clarity event" as you present it still fits my experience pretty well. In the midst of these hard times I've found precious truths! But maybe this wasn't quite the way you thought it'd gone eh? I hope not. It's much more fun that way.
Awais,
This post is quite interesting and challenging. I am going to write a longer reflection on it, because I think it merits a longer response, but that'll take me a week or so (I'm slow). For now a few observations.
It has never been clear (to me) how important it is, for Garson, that there be some sort of purpose-like element in his story. Two candidates for serving that role appear in your account – the ‘subpersonal’ (“My subconscious self is sending me a message”) and evolutionary adaptationism (“mental breakdowns are an evolutionary adaptation”). Garson also mentions those. (A third makes several appearances in Garson’s historical examples, Divine intention.)
Perhaps the idea of ‘madness as strategy’ is more compelling if we get rid of the apparent felt need to tie it to purpose. (Yes, the word ‘strategy’ invites this connection.) Perhaps function is a better concept, not function as in “what is this thing *meant* to do?” but function as in “how does this thing work?” I will suggest (without further discussion, here) that thinking in this way transforms the analogy between mental breakdowns and car accidents.
Adopting this shift from purpose to function (if it is a shift), the contrast to ‘madness as dysfunction’ would still stand. The car accident isn’t a matter of the world functioning incorrectly. That’s how the world functions – when poor decisions are made, car crashes can happen. We have far less clear and general understanding of the analogous antecedent in the case of mental breakdowns, but perhaps the proponents in the two cases that you mention have correctly identified antecedents in their own particular cases.
It’s also important, in fairness to Garson, to remember that he does not think that one or the other of his models is exclusively true. He thinks they are both true. So yes, it would seem that for Garson the depression is a kind of dysfunction. It’s just that at the same time, it can be understood as a kind of strategy, or, as one might put it in light of above, the world functioning as it does. (That’s my spin, not necessarily Garson’s but maybe his.)
There’s a lot more to be said, here, and thanks for giving food for thought. I’m now resisting the temptation to say quite a lot! (I’ll give in to it later...)
Good comment, Michael.
Zsuzsanna Chappell and I wrote a little about this in our forthcoming (very soon now! I'm doing the proofs) research encyclopedia chapter on Philosophy of Madness. We suggest that the terms "dysfunction vs function" are better than design or strategy vs dysfunction, and makes a comparison with asthma and fever.
Quoting our chapter:
"When an asthmatic person’s bronchi close up, the person suffers from a breathing dysfunction. They need help to have their breathing restored. Fever, on the other hand, is a more complicated matter. Fever can be damaging in itself if it becomes too high or persists for too long, but in infectious diseases it also serves a function; the fever helps to slow down pathogenic reproduction. Similarly, scholars and physicians have discussed whether, e.g., psychotic states might serve as an escape mechanism from an intolerable situation. Garson later suggests that insofar as Madness is a strategy, it is not a medical matter, but as the fever analogy shows, this conclusion need not follow. The ‘escape psychotic’ may still suffer and need help. Nevertheless, a fever-like Madness which serves a function may call for different approaches than an asthma-like Madness that is completely pathological."
Boisen had this idea around 1946
I have reflected on this a great deal. There were points in my own story when I thought I had to go through everything to make transformation possible, but I no longer think that's true.
I think there are two very reasonable ways of looking at this: enactivism, where mental illness is seen as an operationally closed system in the extreme end or as an overly rigid system on the lighter end of the spectrum, and Dabrowski's theory of positive disintegration.
From the enactivist perspective, crises are shocks to the systems that can potentially lead to shifts in function and structure. The outcomes are dependent on the interplay between the context and the system (organism). I think what allows transformation to occur is removal of the factors that kept the processes and the system on a fixed trajectory, but without so much perturbation that the system is destroyed (that's kind of like what happens in decompensation and total decompensation means death).
Dabrowski was writing before Varela et al, but it's fairly similar. He saw mental illness and symptoms as opportunities for change which needed to be engaged, not treated away. Disintegration (of the personality) can be followed by reintegration (at a higher level) and that's what transformation is.
I'd spent a decade in therapy and on countless medications, had gone through multiple points of inflexion that could have served as catalysts for change before the moment that lifted the dissociative veil, yet these only led to deeper and deeper decompensation and reduced ability to function. Why? It wasn't because I didn't want to heal or wasn't trying. I'd always been incredibly driven to heal, and even when all I was consciously doing was fixing and trying to function better, I was unconsciously exposing myself to material to confront my past (like the time I spent a year writing psych reports on PTSD while not being able to even use the word trauma in relation to myself). The conditions and context simply weren't there, and the people in my life were harmful. It was only when I removed myself from everything and everyone and had reclaimed enough of myself that I was able to hold the ridiculous amount of trauma in conscious awareness, and recovery and integration are ongoing processes. From the outside, it doesn't look like "progress" or "growth" or even "healing" are occurring, especially when I look at slices in time and don't see the wider and deeper picture. You have to go down to come up, but that doesn't mean you need to go down all the way to the depths of hell, especially because you might not make it back up.
I think there is a gentler way to go into and out of our inner dimensions that don't involve quite so much trauma. I do believe that most people are driven towards greater health and integration, it's just that the actions they're taking are ineffectual and their context is disabling or harmful. A crisis comes along and can clear the path so to speak, but the crisis itself is not the driver of transformation.
This is a genuinely thought provoking article.
Awais: I hope you read this essay by Ackerman. It gives a far more detailed description of his experience with depression and recovery. He learned to practice a kind pf cognitive therapy on himself in which he came to realize that he couldn't live a life with a single goal but that his human nature demanded respect for a variety of goals. This essay is referenced in one of responses to his X post.
https://forum.effectivealtruism.org/posts/AjxqsDmhGiW9g8ju6/effective-altruism-in-the-garden-of-ends
This is excellent. The thing that I've never understood about Garson's account - although I confess that I've not read everything he's written - and I guess it would be a bit of a shocker if a philosopher hadn't dealt with the following obvious objection as part of his 'strategy' account, so perhaps it's futile of me to comment without further reading! - is that I couldn't see how his theory made the distinction you mention. Sure a depressive episode could be a wake-up call. It could, in a purely metaphorical way, "tell us" that our life was confounded in ways we hadn't got our head around. But the fact is that depression actually doesn't "tell us" this even in the still-somewhat-metaphorical way that, say, foot pain tells us to remove the scorpion from our foot, hunger tells us to eat, loneliness (supposedly) tells us to go see our friends. It mainly tells us that we are worthless, that our future is hopeless, etc. Whereas if we could read the apt behaviour off the state, then we'd not think "I am hopeless" but instead "my situation sucks". We need to bring our self-reflective capacities to bear on it, and so prima facie at least it does look rather more like the wake up call that the heart attack offers the obese person. Now perhaps it is said that the function, the strategy, is working at a much more primitive biological level - rather like the things that Jordan Peterson used to say about lobsters. (IIRC, something like: if you're kinda a weedy loser of a lobster, you're not gonna get any lobster love any time soon, so your low serotonin will now help you not be fruitlessly motivated to play the risky games of lobster derring do, and so you'll not waste energy or even get killed on the mating fields.) But at this level, depression seems very clearly to not promote reproductive fitness in individuals, and even if it was once adaptive, it now seems mainly bunk. And alongside the fact that the existential angle you mention - the fact that we can reflect on our poor health or clumsy accidental overdose or suicide attempt or generalised anxiety and, with the benefit of psychological nous, think 'yep, I better change things up' - clearly ascribes no *intrinsic* function to the putative illness, it seems hard to me to know how to motivate the function claim in any way that ought to invite us to change up our understanding of the nature of mental illness.
On Kemptrup's nice comment: "“Sometimes the pt and analyst/therapist explore things similar to what gets described in science as “underdetermination of theory by evidence” wherein two or more explanations equally fit with the available case history, facts about the pt. And the pt can BENEFIT from understanding that he can be understood in more than one way, and humility is felt as a virtue, which opens up possibilities for new ways of thinking, acting, and feeling. Often, a sign of health in a patient is that they start to understand themselves pluralistically, through multiple lenses. “I suppose one way to think about what I did is this, but another is this. I don’t really know which is true at the moment.”": There are I think two ways to understand this, although the last sentence does rather push it toward one of them. On one reading of it, the different understandings aren't in competition. An 'understanding' here is like a picture, a metaphor, a perfectly legitimate in itself way of organising data. On the other reading, an understanding is more like a theory; it's something which further information could falsity. The bucolic jigsaw puzzle I'm now doing: this shape here on the left could easily be part of a milk maid's bonnet - but then, as I pick out further pieces, iI see that it ACTUALLY is the rear end of a chicken. My first thought was simply WRONG. The former seems to me to map onto the kind of "understanding" we get with the wake-up-call idea. The latter seems to me to fit the kind of "understanding" that evolved functions are supposed to offer us.
Thanks for posting this. I had been wondering about the transformatory effect of mental crises. In my case, a handful of episodes of depression, mania and psychosis packed in a five year period. Somehow this period changed me into a slightly different person. More outspoken, less anxious and afraid, more sociable. Less stress-sensitive also (knock on wood). I sometimes wonder whether this has to do with the opportunity (especially in mania and psychosis) to experiment with new behaviour, and to engage with otherwise unreachable unconscious fears and trauma. Or would all this personality-development just be a lucky side-effect of lithium treatment, quenching lifelong subclinical dysthymia?
Any thoughts?
The "Antidepressant Effect of Lithium" involves increasing gray matter volume in the anterior cingulate cortex, which regulates emotions. In my view, your transformation is a synergy: the lithium provided the biological floor, while the crisis provided the psychological "reset" needed for growth.
The "Doxastic Shear Pin" hypothesis suggests that delusions might function like mechanical fuses, breaking under pressure to prevent a total brain "engine" failure. In my view, honoring a patient's personal narrative is the most potent clinical tool for lasting recovery.
What these stories capture isn’t that madness is secretly wise, but that collapse can reintroduce constraint when a life has become uncorrectable by normal feedback. A psychiatric crisis can sometimes function like a hard stop, an interruption that forces reality back into alignment when softer feedback have failed. The danger is mistaking the interruption for the design, rather than seeing it as an extreme and costly way a system regains limits after too much drift.
Beautiful and thoughtful, I hope all clinicians recognise this dynamic. I know in the ADHD clinic, where treatment efficacy is much higher than gen psych meds, I take care to warn my high functioning patients that using meds punitively, to "fix" productivity on an exhausted baseline will cause meds not to work, they need to stop, look for inner calm first, and then think about who they are and what might work for them in their lives. Pig parent/angry exhausted child narratives often explain this space well. Thanks so much
A good friend’s daughter, diagnosed with Bipolar disorder and medicated, died Monday of a Fentanyl overdose. She couldn’t bear being alone and needed to get out from under her paralyzing need for comfort and validation.
I do believe medication harmed her.
I also had suicidal depression for decades that has now lifted through a process of deep analysis of my life and priorities, as well as my upbringing and the effect of my parents.
There are clearly biochemical and physical causes for severe psychological states (lesions, etc.) but I believe it is right to ask whether the nature of the world itself can make certain brain types and states unstable - not internally, but with reference to the society and the norms of economic life.
I suppose the way I think of psychiatric events like this is that they're a "strategy" for increasing variance, where the underlying cause is that one's subconscious believes that the current situation is untenable, that if things go on for much longer along their modeled trajectory that everything ends in blood and death, and that therefore something needs to change Now. So they smash a bunch of panic buttons in the brain in an attempt to "rescue" themselves from that fate.
Thing is, in the modern day the subconscious is often catastrophically wrong about the facts on the ground. An amount of stress that used to indicate that you were weeks away from starvation no longer means anything close to that for most people in the developed world. So that wild swing isn't as useful anymore. It was always a destabilizing gamble to be taking, and these days the material upside is much smaller (you probably weren't going to die anyway) and the material downside is much bigger (but now you can lose your job!)
And yet the emotional distress remains pretty relevant right? Even if you're alive, you might not feel that you have a life worth living. Of course most of the physical actions and real-life choices that will fix that suffer from notably impaired execution in "mental health crisis" type states. But in a world where you start out with significantly less than perfect information about the cause of your problems, sometimes the key to something better is simply to realize that there are any solutions at all.
Now in theory this is the sort of insight that therapy is supposed give you. Unfortunately as we know a lot of the therapists do it badly. And if you don't luck out into a good one, you're left to get bailed out psychologically by an absolute disaster. This cancer relapse I'm going through has done wonders for my mood! Factually it should not work that way. But sometimes that's how it goes.
The "Evolutionary Mismatch Theory" explains why our nervous system reacts to a lost job like a predator attack. In my view, your cancer paradox is a "clarity event"; it simplifies your hierarchy of needs, silencing the noise of modern social performance.
I like the term “clarity event”!
I would hesitate to compare simply losing a job to a predator attack. Being fired in an aggressive manner, that I could see, but just the loss of the position without a "shock" of perceived violence I would guess tends to activate different instincts than an unfriendly encounter with a tiger. More the ones that were once adaptive in managing one's status in a tight knit community you couldn't afford to leave.
It's been observed that historically certain groups that made their homes in particularly resource thin areas would sometimes retract support from "underperforming" members-a death sentence in the harsh conditions they lived in. Even now in a less deadly era it's quite evident that many people will treat you much worse if they decide that you aren't doing enough for their liking.
Not feeling like you contribute to society is not the same as actually not contributing to society. Losing a job doesn't actually make you some kind of leech upon humanity. But I do think there is something very real about the idea that it could be bad to be seen as a burden. And to this day there are some people out there who are prepared to express a truly virulent hatred of the unemployed.
Then again, I could easily be wrong about that side of things. I haven't had much experience after all. One of the little plot twists I get to hit people with over the internet is that I'm 20 years old right now. The cancer I'm dealing with currently is a late relapse of a late manifestation of a kind of leukemia that most often affects toddlers.
So I don't know much about what it's like to lose a "proper job" because I never had one. What I do know is what it's like to absolutely flame out of middle school after falling ill with tragedy disease, and then later be treated with contempt by The System for my high-school dropout ways.
It's interesting moving through life being seen through such contrasting lenses. Pitiful to some, resented by others. (Sometimes both at the same time, which can lead to strange conversations.) The people who resent me for some perceived inherent laziness are obviously wrong. Comically so. Exhibit one in the case against: The length of this comment.
What might be less obvious from the outside is that the people who feel pity for me can be corrosive in their own right. Because the thing I've found tends to happen when someone feels that pity isn't that they offer me help. Instead, disturbingly often, they offer me permission to give up.
Now certainly many people need that permission. I've seen how destructive real perfectionism can be. Constantly punishing ones self for failing to meet an impossible standard is. Not exactly a good time.
And also, damn! Can a guy not have goals? I swear you get diagnosed with one scary sounding condition and all of a sudden people act like you can't do anything. Can't even want anything. "Oh you should really focus on your health!"
Yeah ok sure! I'll do that. I'll take all my meds, make it to all my appointments, prepare and eat a nutritionally balanced diet, and get a full night's sleep every night I can. After that I'll have 12 or so hours left in my day, with which I can do other stuff.
But then somehow it's completely unreasonable for me to invest a fraction of that time towards cleaning the kitchen. I'm pushing myself too hard, loading the dishwasher at a sedate pace. This goal I set for myself where I try to put the clean dishes in roughly the same place every time, why it's nonsense! Perfectionism run amok! Much better to simply shove them wherever and then have a harder time finding them later.
I presume it's self-evident why I'm not much of a fan of this strain of defeatism. It's kind of unnerving to be honest. You finally manage to dig yourself out of a pit of depression, only to find that everyone else thinks you should get right back in. That can't be right!
Now I do think the broader concept of a "clarity event" as you present it still fits my experience pretty well. In the midst of these hard times I've found precious truths! But maybe this wasn't quite the way you thought it'd gone eh? I hope not. It's much more fun that way.
-Crimson