Madness, and What Passes for Civilization: The Way We Diagnose Now

Abstract

Abstract Two new books, one by a journalist and one by a historian, reveal enduring and novel paradoxes of mental illness and its treatment. The mentally ill are, perhaps by definition, people whose perception of reality departs from the consensual. Yet they often have uncanny insights that elude the healthy. Sometimes the mentally ill value aspects of their illness experience but also welcome the relief from symptoms that treatments can bring. The advent of psychopharmacology may have led to an over-reliance on drugs for some populations, while, at the same time, leaving people with less access to health care under-medicated. Mental illness is sometimes imagined as an affliction of the affluent, yet decades of social research has shown that it is more likely to impair the poor. Substantial evidence suggests reducing poverty would also reduce the incidence of many mental illnesses, yet this step is rarely a part of the relevant policy discussions. [Aviv suggests] that stories of mental illness follow a standard plot. . . . with an idyllic setting. . . . broken by the intrusion of illness. . . . [but] the poor are most likely to experience mental illnesses. . . . studies. . . . [show] that less poverty would mean less mental illness. . . . Yet little was ever done.