- Making Minds and Madness: From Hysteria to Depression
Mikkel Borch-Jacobsen’s new book, Making Minds and Madness: From Hysteria to Depression, is a multifaceted challenge to the claim that psychiatrically-defined illnesses, past and present, are objective entities, verifiable by scientific testing and treatable by universal therapies.
Borch-Jacobsen assumes the relativist’s stance, observing that no non-organic (i.e., tumoral, neurological, etc.) mental illness that has been presented by psychiatry as an objective clinical entity has yet proven itself to be universal and ahistorical. “If there really is a huge lesson to be learned from the history of psychiatry, it is the infinitely variable and fluctuating character of psychiatric illnesses” (2).
This outlook is familiar to medical anthropologists, transcultural psychiatrists, philosophers of science and others. Borch-Jacobsen’s aim, however, is not merely to add a historian’s voice to the existing body of criticism, but to unearth the knotty epistemological details of how psychiatry, [End Page 1101] and in particular psychoanalysis, has made its object. To accomplish this, one has to be not just a historian, but a sleuth, interrogator, and genealogist.
Borch-Jacobsen is undaunted by the challenge of demonstrating logical fallacies in arguments that have been accepted and lacquered over during the past century, and he is unremittingly skeptical of and ironic towards his quarry, most particularly Sigmund Freud. Borch-Jacobsen’s method is to trace back to the moment a psychological theory was born, and then sort out how the future unfolded as a consequence of the success of the theory. Those who still have a professional stake in supporting some aspect of the Freudian therapeutic tradition, or who participate in the ongoing hagiographic scholarship on Freud’s legacy, or even those stragglers in literature and anthropology who somehow continue to fancy Freud and to build off his ideas, might challenge themselves by reading the cold hard case made against Freud the scientist, philosopher, and psychoanalyst in this book.
Borch-Jacobsen’s theory of psychiatric entities (diagnoses and therapeutic concepts) derives from the history he unearths. Mental illness, he says, “is at least in part an idiom developed between the patient, the doctor, and the surrounding culture” (8). Thus the historian’s task must be to “show how both these objective theories [of psychiatrists] and this subjective experience [of patients] emerge from beliefs, preconceptions, and expectations that are shared, negotiated, and modified by both the theorist and his patient: madness is always a folie à deux, or rather a folie à plusieurs, the madness of several” (8). It is by means of a process he calls “interprefaction” that the analyst’s interpretations, hypotheses and constructions are transmuted into psychoanalytic data, even while its non-positivist origins are concealed.
He sets out to prove this assertion by interrogating central concepts in psychiatry, from psychic shocks to the unconscious, and by tracing back to the source point of several diagnoses to demonstrate how these were either co-invented by psychoanalysts and patients (or suggested to patients by their analysts) and made popular through bestselling books, patient advocacy groups, or the self-interested promotion of the therapeutic community itself.
Along the way, the theories of many of the major figures of nineteenth and early twentieth century psychotherapy are evaluated and compared, giving the reader a demystified view into the intellectual context from [End Page 1102] which certain ideas and individuals emerged victoriously from among their competitors. Case histories of now-defunct conditions such as hysteria and multiple personality disorder illuminate how, through a sort of rigged consensus involving therapists, patients, and the public, psychological conditions have been constructed.
This process is ongoing in the age of biopsychiatry and contemporary forms of psychotherapy. The last section of the book, entitled “Market psychiatry,” offers an informed summary of the interplay between private industry, professional psychiatry, regulatory science (placebo controlled trials) and the consuming public in the materialization of “the great depression.” Comparably to how psychoanalysis made its object, the author suggests, psychopharmacology also creates the psychological reality to which it is the solution.
“Depression…is nothing other...