Psychology has always interested me because it is one of the last great mental frontiers of our time. Occluded with the haze of recognition, parts of our understanding of the human mind remain, in a blind sort of way, out of reach of our objective consciousness. It is less that we know so little and more that our 'knowing' is subject to the wills of our own psychology in a way that does not allow for self-reflexivity the way studying the life sciences, medicine or engineering does. Can we never 'truly' know the processes of depression or anxiety, insomnia or addiction given they are simply experiences of human excess and amplification? How can a team of researchers transcend their own faint brushes with any of these mental afflictions in order to understand them in an absolute way? Anthropologists have long been interested in these subjective and intersubjective dilemmas and indeed, I can't think of a better discipline to takle this last great frontier of human knowledge. I recently did a book review for Elizabeth Anne Davis's Bad Souls: Madness and Responsibility in Modern Greece. Touching on subjects of patient responsibility and the moral accountability all sentient beings carry, Davis brought to light the ethical gray area of holding those with severe mental illness responsible for themselves in the same ways other patients, with illnesses like type II diabetes or cancer are. If we agree that mental illness has strong genetic causative factors and that it is a 'real' illness like any other (although this dispute rages on), then how and in what ways can we hold the mentally ill accountable for their behaviors and thoughts? From Davis's account, it is clear the 'helpless' model of severe mental illness does not hold, at least in modern Greece's psychiatric reform era. Our own psychiatric reform in the U.S. did not do a particularly stellar job of understanding the experience of mental illness and patients here too were scooted off into the community for 'community-based' care and autonomous patienthood, even though it is clear some could not assume the degree of responsibility expected, hence homelessness and incarceration are sometimes where these most severe patients fall. In a political milieu with a cleaner logic of mental illness, a more accommodating model of treatment would be implimented and these kinds of patients would not suffer on the streets or at the hands of the judicial system. But it remains, mental illness is not a true cognate of any other 'physical' or somatic illness. It is not like cancer, diabetes or HIV/AIDS. It cannot be cured in an absolute sense, is not transmitted from person to person and, despite mountains of effort, is not simply manageable. All three of these caveats place undue burden on the sufferer themselves while casting away social and political responsibilities. Perhaps it is the spirit of inclusion that drives so many institutions and organizations to frame mental illness as just another physical problem of biology, genes and chemistry. These key words pepper research articles and materials from the National Institute of Mental Health, the World Health Organization and various other health organizations. Davis's ethnography shows us, however, that adhering to this model of mental illness as a physical illness and therefore subject to the power and control of the human hand can be problematic and at times can bind patients so tightly to typical disease models of recovery that their condition worsens under the expectations. Neither is mental illness as ephemerally located as previously thought, in Freud's era of the ego, superego and id. Mental illness must find its place in the middle of these two extremes, between pure biology and pure psyche. The responsibility and accountability Greece's psychiatric reform held over the mentally ill in Bad Souls did little to heal and rehabilitate the most severe of patients, those who need the most support and care. Unfortunately, their needs go beyond the assumption that all people have the ability to recover and further a responsibility to keep trying, no matter how severe the case. Just as cancer patients are not held responsible for their blood cell counts, mentally ill patients lack the direct influential link to their neurological misfirings. This dilemma enclosed upon the patients in Davis's book, leaving them in a therapeutic standstill for years; the state provided what care the reform legislation recommended and the rest was 'up to them' to take responsibility for their conditions. While the disconnect here is clear, how to remedy this is uncertain.
Pamawaluukt is a Umatilla (Confederated Tribes of the Umatilla Indian Reservation) term for "each person raising himself up".
References:
2012 Davis, Elizabeth Anne
Bad Souls: Madness and Responsibility in Modern Greece. Duke UP.
