Review Article Isolation and Madness
A review of Anthony Storr's Book "Solitude".
Anthony Storr's book "Solitude" (HarperCollins 1994) is, for me, alternately stimulating and annoying. The ideas in his book, rearranged only slightly, provide an almost perfect analysis of the cause of madness and an explanation of much of its contents.
The original title of Storr's book was "The School of Genius" and his aim in writing it was to challenge the implicit assumption, so common in therapy, that success in relationships is the only key to happiness. Creativity and achievement can also provide satisfaction in life - and creativity often requires isolation from the distraction entailed in close human involvement. He shows that the capacity to be alone is valuable in a variety of circumstances - when it helps people to get in touch with their deepest feelings, in coming to terms with grief and loss; in sorting out their ideas and in the changing of attitudes. In a series of short biographies of artists, musicians, authors, philosophers, he shows that without long periods of isolation their achievements could scarcely have been possible. In many of these biographies there is a repeated pattern of miserable, lonely and/or persecuted childhoods of people who then made no intimate human relationship (but who were often regarded with affection by friends, not to mention the audiences of their work). It was through their work that these people found their salvation, repaired some of the hurt, found satisfaction in their achievement and creativity.
But solitude is not always to be regarded positively. The chapter on "Enforced Isolation" is prefaced by a quote from Francis Bacon. "The worse solitude is to be destitute of sincere friendship". In this chapter Storr analyses the effects of solitude in conditions of solitary confinement, the psychological torture of political dissidents, sensory deprivation and the like. In these cases the mental breakdowns that result are no different, though Storr does not say it, from the symptoms of schizophrenia - namely hallucinations, confusion, extreme anxiety, a lack of care about personal appearance and habits.
In this context phenomenon like hallucination become only too clear - cut off from external sensory stimuli there are only internal mental contents in the mind. "During waking hours, the brain only functions efficiently if perceptual stimuli from the external world is being received. Our relationship to the environment and our understanding of it depend on the information we gain through our senses. When asleep, our perceptions of the external world are greatly reduced, although significant sounds, like those of a child, may still arouse us. We enter the fantastic world of dreams; an hallucinatory, subjective world which is not dependent on memory in the here and now, but which is governed by our previous experience, by our wishes, our fears and our hopes. " (pp49-50). Of course in conditions of persecution the wishes, fears and hopes are likely to have an intensity of a horrific character and in so far as they are connected to the past they will be connected to childhood terrors of being very vulnerable. The dream/hallucinatory process will be regressive because, as Storr relates in an earlier chapter, dreams can be understood as a means in which an emotionally significant effect in the past is related to a recent emotionally significant effect, matching past and present experience (pp24-25). (This closely parallels my own thinking in my article "Madness and Its Causative Contexts" in Changes: An International Journal of Psychology and Psychotherapy, June 1995).
What is also interesting in this analysis is who survives and who does not. Storr quotes Bruno Bettleheim's experience of a concentration camp "that the prisoners who gave up and died were those who had abandoned any attempt at personal autonomy; who acquiesced in their captors' aim of dehumanising and exercising total control over them" (p49).
But what has all this to do with manic or schizophrenic psychosis? Most people who have developed severe 'mental illness' have not previously been imprisoned, politically persecuted or subjected to sensory deprivation experiments. To me it seems obvious that solitude and sensory deprivation can occur in a host of other circumstances. In the family for example. It seems absurd to say that solitude and sensory deprivation can occur within a family - but not if you are the family black sheep constantly under pressure not to do this and to keep out of that. Psychiatrists Leff and Vaughan have made the basis of their Family Management Aproach for Schizophrenia an observation that in families with "schizohrenic" offspring the relationships tend to demonstrate "High Expressed Emotion". Also that parents tend to be over critical and over involved and their is a high amount of hostility around. They refuse to see this as an underlying cause because they want to hang onto their medical ideology that schizophrenia is genetically based - which gives the status and power to their profession with its long medical training. But what kind of a relationship is it where there is a large amount of hostility, where parents are over-involved and over-critical? Is this not really using different words to describe a situation where someone has 'lost their autonomy' to others, where they are not allowed to be their own person and hence not allowed to develop their own personality. Might it not mean being stuck in the same family routines, the same family ideas with any attempts to escape leading to the same old rows again and again until breakdown occurs when a young person gets terrified that they will never develop a life of their own, be allowed to have a mind of their own. Wouldn't this also count as the most profound solitude and a daily sensory deprivation? What happens if one can never do what one wants? One suffers what becomes akin to sensory deprivation - one cannot find the stimulation of new relationships nor pursue new interests. As I would put it one can be "institutionalised by one's own family". One would be imprisoned by one's own family and one's bedroom would become an isolation cell.
Storr does not develop the argument in this direction. But isolation and sensory deprivation is not only imposed overtly and explicitly through unjust legal processes. For many people isolation and sensory deprivation is the stuff of everyday life - they are sensorily deprived because they have no money for consumer purchases, they are sensorily deprived because they have no work, or their work of the most mind numbing and repetitive tedium; they are sensorily deprived because they live stacked in rectangular environments of grey concrete, peeled paint and glass and surrounded by grass; they are sensorily deprived because they are frightened to go out at night lest they get mugged by those who, in order to find at least some excitement and adventure, rob their neighbours at knifepoint.
I recall in 1984 visiting someone who had been an inmate like myself in his new flat. He had just received a grant to paint it. He also had two chairs, a Baby Belling Cooker, one saucepan, a plate and a cassette recorder. He had one tape which he played over and over again. He ate fish and chips and painted his flat white. Not, of course, quite so much sensory deprivation as in a sensory deprivation experiment - but then a sensory deprivation experiment lasts at most a few hours. This was what this person had to look forward to for the rest of his life. If I recall correctly Wittgenstein was famous because he once lived in a virtually empty room painted white but then, as Storr shows, he found his salvation in intellectual production, in creative abstraction. My acquaintance was no Wittgenstein. Storr is at pains to show that isolation, solitude can be survived by people who are able to find satisfaction in creativity and he occasionally remembers to mention ordinary humans finding satisfaction in solitary pursuits like fishing and gardening. But gardening requires resources of garden space, is not easy in the modern world without a car to take you to a garden centre, while fishing requires at least the cost of a bus ride and of a rod, line and licence.
Once we begin to relate mental health to the existence of manageable stimulation, personal autonomy and creativity while relating mental illness to deprivation and powerlessness (lack of autonomy) then big cracks begin to appear in the imposing facade of medical psychiatry.
Satisfaction in work and creativity - or when you are stifled at work....
If the stock in trade of therapists and psychiatrists concentrates largely on family and emotional relationships, rather than creativity and work, this is largely because there is, or is assumed to be, a common point of reference here which therapists share with their patients. We all share the experience of childhood, we all mostly have some kind of relationships. However the work we do, and the work settings, are however often very different.
Storr refers to the lives of well known artists, philosophers and scientists whose work he finds interesting. He makes the reasonable assertion that these artists philosophers and scientists will have found satisfaction in their work. He does not explore the experience of people who are stifled in their work or those who can get no work. He only mentions 'the hobbies and work' of ordinary people in passing. Yet if creativity is so importance to psychiatric health then it follows that psychiatric pathology might arise out of work circumstances - a road Storr does not go down, preferring instead to concentrate on the world of those people who have been 'successful'. If we do go down this road we might find psychiatric symptoms because the creativity of ordinary people might be stifled at work, that they might experience a lack of autonomy there. However that is an analysis that might involve difficult problems of upsetting employers and powerful vested interests.
In those rare occasions when research about humdrum work and mental ill health has been done the evidence supports the idea that what matters most of all is scope to use one's creativity and be autonomous in the labour process. ( Kornhauser, "A Mental Health of the Industrial Worker: A Detroit Study" New York, Wiley 1965). Unskilled machine paced repetitive work on the production line can be bad for your mental health. Doing the same thing minute after minute, hour after hour, month after month, and year after year and having no authority to do otherwise can be experienced as a form of sensory deprivation whose only relief is in the relationships with work mates. Of course, if you have work mates you are not isolated, but if you are rejected by them, or you become at odds with others though your work, then psychiatric injury may indeed ensue.
One of the crushing aspects of unemployment is enforced isolation. Many people seek to divert themselves in the early period of unemployment by habitat creation - they renovate their houses. Nest building or habitat creation is the form of expression of the creativity of many people but it is heavily dependent on skills, confidence and money. It is difficult to motivate oneself to these things without support and others. If one is short of support, money, confidence and money then staying at home may be every bit as isolating as a prison cell. Boredom is just another name for the onset of sensory deprivation. Chronic boredom can lead to day dreaming and then to madness. (I found this when I did community development work briefly in East Germany in 1996. Shortly after re-unification huge numbers of people were unemployed at home in neighbourhoods that had not been designed as anything else than dormitories with no community activities. Most previous leisure and communities activities had also been organised before by the work place and these too had collapsed. A great many people were in serious psychological difficulties because they were staying at home in their monotonous concrete bunker flats doing nothing with no sense of what their future might be - even though, at that time, their unemployment pay was quite generous quite a lot of people became very disturbed. Allotment gardening is a major passtime in East Germany and these gardens probably saved the sanity of many people...)
The imagination as a retreat from unhappiness
Storr writes of the works of imagination created by authors" Various types of deprivation in early life may make it difficult for those who suffer them to achieve intimate attachments. But the development of an imaginary world can sometimes serve as a retreat from unhappiness, a compensation from loss, and a basis for later creative achievement" (p 107). My additional point to this would be to ask: what if the imaginary world is not written down but takes the form of day dreaming unattached to any action - might it also not form the basis for a psychiatric diagnosis? Isn't the difference mainly one about how far a person is able to write, how well they are able to martial their fantasies for an audience and in the process having a much more definite sense that they are fantasies. What is the difference between thinking in metaphors and writing poetry anyway? They both work by a choice of words which evoke emotionally associative thinking.
Storr quotes figures which show that very many writers have been given a diagnosis and feels the need to repeat the usual psychiatric shibboleth about the cause for this being in their genetic make up. The evidence for this is claimed to be that so many of the relatives of these writers were also 'emotionally disturbed'. Why should this be evidence? A large part of his book is about how young people can be damaged emotionally by emotionally damaged parents, other relatives and older siblings. When this very same idea is turned into statistics it magically becomes evidence of the genetic inheritability of mental health problems. (One wonders what Darwin would have said about these people whose genes disturbs their interpersonal functioning so profoundly. Surely in this very fact would be the reason the supposed "schizophrenic genetic make up" would die out - for in so far as it inhibits emotional relating surely it also inhibits sexual and reproductive bonding. While we can have no problem understanding how emotional disturbance might be recreated in parts of populations by the ebb and flow of human fortunes and tragedy and then passed across several generations it is a bit difficult to understand how the 'schizophrenic and manic depressive genes' didn't die out a long time ago.)
We should apply Occam's Razor to Storr's repeated theoretical appeal to genetics. As Bertrand Russell expressed the philosophical maxim of the 14th century Franciscan William of Occam "If everything in some science can be interpreted without assuming this or that hypothetical entity there is no ground for assuming it." Storr provides a perfectly adequate framework for explaining all the symptoms of madness without recourse to genes and there is no justification to reach for this theoretical entity.
The real role of genetic theories is to legitimise continued medical control of the responses to madness. It avoids close questioning about the lives of ordinary people. It enables the dominant response to distress to be a tranquilising one and holds in check social criticism. Occam's ideas were part of a slow process that helped separate philosophy from theology. For centuries new ideas had to be compatible with belief - which had to match the interests of that most powerful of institutions- the church. In our own age ideas about distress must be made consistent with medical thinking because medical thinking enables the power structures of society to blame their victims.
Outcasts and outsiders
Creative thinkers, and this Storr does not dwell on, may challenge received orthodoxies and are not only isolated but outcast and persecuted for doing so. Their emotional disturbance may reflect their scapegoating. It is interesting in this regard that the mental health services are no more likely to be friendly than anyone else when it comes to heretics. People who are desperately hurt at the break with their former colleagues find that their hurt is used as evidence of their own mental instability - which confirms how often psychiatric symptoms, an expression of powerlessness, are used as evidence to discredit and invalidate their critically different view. As Storr shows Jung struggled to retain his sanity when he broke with Freudian orthodoxy. One has only to read the desperately hurt way in which Alice Miller writes at the rejection of her ideas, or the hysterical scapegoating of Laing and Cooper by the psychiatric establishment.
As Jeffrey Masson has argued in his book "Against Therapy". "When we read almost any modern autobiography, we see that what was most painful was living in a reality that others did not see or would not acknowledge or did not care about." This makes it possible that at least some of the reason that madness and genius sometimes go together is not to do with emotional damage from childhood but rejection by one's peers. It might be because one is 'ahead of one's time' and one might be ignored because one's ideas or works are too threatening or frightening to an intellectual, cultural, political or economic establishment. Storr's heroes are mostly people who were not only immensely creative but whose creativity was recognised in their own lifetime. Van Gogh, for example, was not so lucky and a part of his craziness may well have been because he was not so lucky. He went crazy, for the first time when his hoped for relationship with Gaugin broke down, at the same time that his brother married - leaving him feeling very isolated and alone. Storr's heroes are not all conformists, to be sure, but they do not challenge the fundamentals of their age - like Luther did for example, a man who not only challenged the fundamental of catholic belief but 'suffered' from what would today be described as psychiatric symptons.
Madness in life transition crises
It is ironic that Store should give us perfectly simple ways of understanding madness - or he would do if he were to follow through. For example he writes (p35) "Suppose that I become dissatisfied with my habitual self, or feel that there are areas of experience or self understanding which I cannot reach. One way of exploring these is to remove myself from present surroundings and see what emerges. This is not without its dangers. Any form of new organisation or integration within the mind has to be preceded by some degree of disorganisation. No one can tell, until he has experienced it, whether or not this necessary disruption of former pattern will be succeeded by something better".
Indeed. A more succinct description of how madness might arise as a transitional crisis in life could not be imagined. Sometimes the new surroundings and new setting are not better. This is particularly where we fail to make an adequate re-orientation to our new setting with its new habits. If the attitude of everyone around someone (in an institutionalising family, just as in an institutionalising asylum) has always been that they cannot be allowed near new environments and new activities (because of the self fulfilling prophecy of them not being adequate to cope), if there is great resistance to their moves for change, then the disorganisation (i.e. their inability to re-orientate) - will be that much the greater.
I suspect that to Storr the norm of life is essentially comfortable. He has an idea of an "ideally balanced person who might be expected to find the meaning of his life in interpersonal relationships and in his interests". Some chaps, however, have a rather rough time on the relationship front but that's OK because "mankind would be infinitely the poorer if such men of genius were unable to flourish, and we must therefore consider that their traits of personality, as well as their high intelligence, are biologically adaptive."
Psychotic mechanisms underlyng ordinary emotional life
To a psychiatrist who believes in the genetic shibboleths of his profesion there is presumably no greater compliment than to be "biologically adaptive". What on earth this means, however, is difficult to say - after all how are socially isolated people 'biologically adaptive' if they do not reproduce? Perhaps, however, it is that the discontent of these people move Western civilisation forward (or at least move forward the conversations in Oxford common rooms). For "It is always the dissatisfied who triumph. Western man has treated with appalling cruelty the aborigines of Australia, the Indians of both North and South America, the inhabitants of Africa and India, and many other groups. But given the restless inventiveness of the West, displacement of traditional groups of men is probably inevitable, even when segregation and extermination have not been deliberately employed. Discontent, therefore, may be considered adaptive because it encourages the use of the imagination, and thus spurs men on to further conquests and an ever increasing mastery of the environment. " (p64).
Empires, whether political, business or intellectual are not made by conformists - they are made by those colourful characters remembered by the Oxford intellectuals with indulgence because, although they are often such cads, indeed are not beyond a bit of genocide, they spur us on to further conquests and mastery of the enviornment......
Here we have it. In an age characterised by ecological destruction and repeated genocides, Storr, who is also supposed to be an authority on human destructiveness and violence, holds up as an ideal being "spurred on to further conquests and the mastery of nature". One of Storr's favourite words in 'adaptive' and his association of 'adaptation' with 'mastery' and 'conquests says a lot. To Storr it is "regrettable" but "inevitable" that traditional societies have to give way before "western society". Yet when he describes these societies as remaining unchanged for centuries what he is writing about can be expressed as a measure of a cultures "sustainability" - which is just what our western civilisation is not. l,
In a culture in which respected members of the psychological and psychiaric establishment like Storr uphold conquest and mastery as a matter of course it is no surprise that we end up with psychiatrists like Radovan Karaticz. To the world of Storr civilisation and the society he lives in are to be accepted and hence the need for "adaption". He does concede there might be something ominous to be found in the writings of Melanie Klein but does not explore this in any great depth. Were he to do so he would start to recognise that if the psychiatric establishment of a society take for granted that conquest and incredible cruelty is to be regretted, but is probably inevitable, then it is hardly surprising that one will also found paranoia, hostility and emotional disturbance as culturally pervasive phenomenon.Indeed once one begins to look at society in a more critical way madness and pychological turmoil can come to be seen as a structurally inevitable feature. People are not going to be emotionally healthy and 'in touch with their feelings', as therapists say they would like them to be, when structures of social authority so commonly want them to love and respect their oppressors ('their betters'), to hold back their anger (in front of their 'superiors'), to ignore their fear (for the good of the regiment), to choke back frustration and stress (in the interests of productivity and competitiveness).
Storr writes that Klein's "belief that 'psychotic' mechanisms underlie and affect the emotional attitudes of 'normal' people is convincing ..For example it is only if we accept the existence of a latent paranoid potential lurking in the recesses of the normal mind that we can explain the mass delusions which led to the persecution of witches and the Nazi slaughter of the Jews". (pl00-101). This latent paranoid potential does not come to be there by accident. It is there when and after children come to experience for the first time those authority structures of civilisation that are later taken for granted. The paranoid/psychotic phase is the phase when vulnerable infants learn to their horror and terror that, to the normal 'civilised mind' 'adaptive' means to be bent on 'conquest' and 'mastery'.
In her book "The Continuum Concept" (Penguin, 1986) Jean Liedloff, who lived with Stone Age Indians in the Venezuelan Rain Forest provides compelling evidence that the absence of strong authority structures, the gentler and more responsive forms of child rearing, the community organisation which allows for personal autonomy does not include those elements. Relations between people are regulated to pleasure and to minimise tension. Such communities are also adapted to their environment. Actually the society Storr describes is not 'adaptive' - we have an environmental crisis precisely because it is exploitative and oppressive, precisely because of those ordinary attitudes displayed by Storr. A Hopi Indian once told Jung that white people were mad because they thought with their heads and not with their hearts. If you think with your head you mental framework is one of calculation and you ignore the common feelings that you share with other people. It is the mind-set of those bent on the accumulation of wealth and power at the expense of other people. Looked at in historical perspective this mind-set could destroy humanity. It is served by technologies of fuel based power generation, large scale production, transport, communications and weaponry which together make it possible for those in economic and political power centres to separate themselves from the negative experiences and costs of their actions. These negative effects are felt by other people in other places (unemployment, impoverishment, pollution, desertification etc). This is pushing our ordinary world towards ecological disaster. To live in an age and society characterised by mass paranoias (patriotism, racism, sexism, mentalism etc) when we have the technology of nuclear weapons is very alarming. Many people who have mental health problems are terrified, during their insanities, of these issues and can see quite clearly the trends to social disintegration. It is quite wrong to see their terror viewpoint as inappropriate and it is wrong to consider their madness is somehow a deviation from a norm of ordinariness, happiness and mass mental health. The mad person who proclaims that the whole world is insane, is, unfortunately, largely correct.
A thinking person can only recover their mental health in the process of changing society. A strategy for mental health is a strategy for society.
Brian Davey
June 1995
Afterword. I sent a copy of this to Anthony Storr who replied saying he agreed with many of the points that had made but, without going into any detail, expressing his scepticism of Jean Liedloff's work about Yeaquana Indians.
© BRIAN DAVEY