Not too long ago I finished reading Making Sense of Madness by Jim Geekie and John Read. A central idea in the book was that “madness,” or “schizophrenia” are “essentially contested concepts” which means that like other terms such as “beauty” we can expect that there will always be controversy about their meaning, that different groups will see the meaning differently, etc.
This led me to think about how when a person is in the states we call madness, just about everything can become an “essentially contested concept” – the nature of self, of the world, of good and evil, of the meaning of words or a glance or anything at all. Or at other times, a person will accept the most incredible ideas without contesting them in the least. What’s that about? I thought I would share my thoughts.
I have heard more than one person say that they traced to origins of their psychosis to a time period when they were “asking too many questions at the same time.” And yet, we also know from research that a common behavior in psychosis is asking too few questions, of jumping to conclusions off very little evidence, and then holding onto those conclusions without allowing them to be questioned. How could “asking too many questions” and “questioning too little” both be a part of what we call psychosis, or madness?
In brain research, it is known that adolescence and young adulthood is a time when the number of connections in the brain is “pruned” or dramatically cut back. There is some evidence to suggest that in the brains of people headed for psychosis, this pruning is much greater than normal. Brain researchers often make this sound like it is some kind of strictly physical or biological process, but another possibility is that is just the way the process of “questioning things,” a process which is part of growing up, looks if you watch it inside the brain. We form lots of associations while we are children, but then have to question them in order to form our own identity and point of view. (Breaking associations is also, I’m sure, in some ways a dissociative process.)
From some perspectives, those who question what they learn more deeply have an advantage, because they are more likely to discover a truly independent point of view. On the other hand, the risk is that a person who questions more undermines the foundation of learning that the person grew up with, and becomes more uncertain than the person is willing to tolerate.
How, exactly, do we know that the world as we know it is not some kind of dream, from which we might wake up at any moment into an entirely different sort of world? How do we know that those who seem friendly might not be appearing so just so they can later betray us in some horrible way? Children turn to their caretakers to get reassurance that such things can’t be so, but as we grow up, we must find our own basis for judgment – and sometimes such a basis is difficult to find, especially for those who question previous “knowledge” too intensely.
The process of questioning is often more intense for young people who have grown up experiencing major interpersonal stress, trauma, and betrayal. Their world has been less reliable, and so any sense of direction is less certain. On the other hand, uncertainty is even harder to tolerate for those who know just how dangerous the world can be; they may feel unable to rest till they can have some certainty regarding what is happening.
When people feel they can’t tolerate uncertainty, they are likely to attempt to resolve the uncertainty by jumping to conclusions, and identifying with radical views. So what we see are cases where people flip from being what seems to them to be too uncertain, to being what seems to us to be too certain – too certain that the mafia is spying on them, that God is speaking to them or that the CIA has an implant in their brain. The person may now be afraid to question those beliefs, for fear of becoming, again, too lost in uncertainty.
Professionals themselves are often afraid of uncertainty, since they feel their claim to professional expertise would be undermined by being uncertain. Also, people in general are upset by the way “mad” people point out that all of our beliefs are in some respects questionable – it is often much more comfortable to see one’s cultural assumptions as necessarily true. These factors often lead professionals and others to clash with the “mad” person, or to dismiss the “mad” point of view as completely wrong. This only results in further alienating the “mad” person, or leaving that person feeling disqualified from any right to create his or her own independent view of the world, in other words, hopelessly “mentally ill.”
The route to recovery is often found when the helper instead is willing to acknowledge uncertainty themselves, which allows the “mad” person to first see the helper model being uncertain in a safe way, which then might be followed by a relationship where both learn to be uncertain together. Out of that process and that sort of relationship, the “mad” person can develop his or her own way of understanding what has happened, which is both independent and yet more related to the world of others.