One of the hardest aspects of living with schizoaffective disorder is the stigma associated with mental illness. The stigma makes the experience of living with mental illness doubly hard, because a person living with schizoaffective disorder, for example, already has much to deal with by way of symptoms of the illness, whether these be in the prodrome phase, or during one’s life living with the illness, and stigma on top of these symptoms can make for a double kind of entrapment. For we are stuck with our symptoms, and yet cannot talk about them satisfactorily, because the amount of societal shame attached to the illness. Stigma comes from the notion of a mark made by a sharp instrument, and it is not farfetched to say that people living with mental illness, including myself, often feel marked. Like the “A” sewn on the clothing of Hester Prynne, we are seemingly forced to move through the world in a demoralized light.
A question that then inevitably comes up is, How do we fight stigma? How do we change these conditions under which mental illness is perceived, so that those living with schizophrenia, or schizoaffective, or bipolar, or a depressive disorder, or a personality disorder, are not doubly condemned to living with the illness and living with the illness in silence? What does change look like, feel like? Does change happen only when we find something truer to our self-image? When we speak of change, what is it that we are referring to; or, what is the matter of change? How do we change how we perceive?
These are not easy questions to answer, but I have personally found some answers to these questions in the work of four thinkers associated with pragmatism - William James (1842-1910), John Dewey (1859-1952), Richard Rorty (1931-2007), and, more tangentially, Martha Nussbaum. What I want to do in this essay is weave together some of the work and thought of these profound American thinkers, in order to show how we might change our perceptions of mental illness, and in doing so fight stigma. I’m going to argue that changing our perception of mental illness means changing our morals, if by morals we mean habits and customs. We change our morals when we experience an inward trouble in our beliefs. One way we start this trouble is by “redescribing,” to use Rorty’s term, unfamiliar people in a different light - in this case, people living with mental illness.
Let me now back up and give a general overview of pragmatism, and relate how this tradition interacts with the topic of mental illness in a fruitful way. Pragmatism means that the most important aspect of our thought and ideas is the practical consequence of them in our actual lives. As James argued, pragmatism is a method for thinking. It views ideas in terms of their cash value, in terms of how they make an actual difference in the lives of people, and therefore in the world. There is therefore in pragmatism a kind of impatience with abstraction for the sake of abstraction, unless this abstraction is put to service for the lives of people and the world. Pragmatism as a philosophical tradition was founded by Charles Saunders Pierce (1839-1914), who wrote in a famous essay, “How to Make Our Ideas Clear” that “there is no distinction of meaning so fine as to consist in anything but a possible difference in practice.” Or, in the words of James from Pragmatism: A New Name for Some Old Ways of Thinking, “Whenever a dispute is serious, we ought to be able to show some practical difference that must follow from one side or the other’s being right.” (25) Because pragmatism emphasizes consequences rather than absolutes, the philosophical method “appears less as a solution, then, than as a program for more work, and more particularly as an indication of the ways in which existing realities may be changed.” (James’s italics, 28)
If pragmatism serves as an indication of how things might be changed, what is the nature of that indication? Perhaps we can start with a maxim from Pierce - the “sole motive of thought is to produce belief.” Why? Because beliefs, according to Pierce, are rules of action that produce habits, and habits produce customs, and customs produce morals. We can then say, extending Pierce’s maxim, that to fight stigma, our habits need to change. But why are habits so important, and how do they change? Dewey discusses habit in a fascinating way in the first section of Human Nature and Conduct. There, we learn that a frequent critique of moral theory is that “to derive moral standards from social customs is to evacuate the latter of all authority.” (1066, The Collected Works of John Dewey) We want to think that our morality is derived from our standards, but in reality it is derived from our beliefs and customs, which is to say, our habits. This is a radical insight, because we want to think that our morals come from a source that is not human, like God. But here Dewey argues that our morals rather come from the human community and the habits that are formed, like sedimentation of rock, over time.
After Dewey makes this point, he makes a further point, via analogy, that introduces the notion of how change happens to habit. Dewey compares the formation of morality - about principles deriving from customs, and not the other way around - to the formation of a language:
Men did not intend language; they did not have social objects constantly in view when they began to talk, nor did they have grammatical and phonetic principles before them by which to regulate their efforts at communication. These things come after the fact and because of it. Language grew out of unintelligent babblings, instinctive motions called gestures, and the pressure of circumstance. But nevertheless language once called into existence is language and operates as language. (1066)
We want to think that we are rational creatures who intend what happens to us. We want to think that we created language, or that we create our habits. But much of life involves processes of change and contingency, and the process by which language was developed is no different. Rorty says this better when he writes, “someone like Galileo, Yeats, or Hegel (a ‘poet’ in my wide sense of the term - the sense of ‘one who makes things new’) is typically unable to make clear exactly what it is that he wants to do before developing the language in which he succeeds in doing it.” (Contingency, irony and solidarity, 12-13) Something happens - the formation of language, the writing of a poem, the painting of a picture - and then we explain it in various ways. But the explanations are always retrospective. They cannot totally capture the strangeness and contingency that went into the thing that happened. The strangeness is the habit, let’s say, and the explanation is the moral standard.
Notice that neither Rorty nor Dewey are saying that change is impossible. But they are saying that contingency plays a central role in the formation of habits, just as it plays a central role in the formation of language. But if contingency does play such a central role in the formation of habit, how do we change ourselves? How do we fight stigma, if we cannot ourselves change, or if change is solely some blind process? What role in this equation does agency play? There is a great passage in Pragmatism where James explores this question, and in doing so lays some of our anxieties about the possibility of change to rest. He writes,
The observable process which Schiller and Dewey particularly singled out for generalization is the familiar one by which any individual settles into new opinions. The individual has a stock of old opinions already, but he meets a new experience that puts them to a strain. Somebody contradicts them; or in a reflective moment he discovers that they contradict each other; or he hears of facts with which they are incompatible; or desires arise in him which they cease to satisfy. The result is an inward trouble to which his mind till then had been a stranger, and from which he seeks to escape by modifying his previous mass of opinions. He saves as much of it as he can, for in this matter of belief we are all extreme conservatives. So he tries to change first this opinion, and then that (for they resist change very variously), until at last some new idea comes up which he can graft upon the ancient stock with a minimum of disturbance of the latter, some idea that mediates between the stock and the new experience and runs them into one another most felicitously and expediently. (James’s italics, Pragmatism, 31)
This is change at an individual level. The person experiences an “inward trouble,” a kind of cognitive dissonance, which forces her to re-evaluate her opinions and beliefs in the light of this new experience or fact. Let’s say this inward trouble is brought upon by seeking a great work of art about schizophrenia, say - a film like Ingmar Bergman’s Through a Glass Darkly, Lodge Kerrigan’s Clean, Shaven, Susan Smiley’s Out of the Shadow, or Frederick Wiseman’s Titicut Follies. How do we accommodate the vexing nature of these films, their intensity of vision, catastrophe, violence, and suffering? How do we then weave these narratives into our understanding of mental illness? How do we make sense of ambivalence, the way in which madness breaks certain taboos, or get in touch honestly with the tragedy of mental illness?
Rorty argued that it was through narrative that we could see familiar people in an unfamiliar light, and in doing so have our habits changed. In “Feminism and Pragmatism,” he writes, in the context of women in law, “Feminists are trying to get people to feel indifference or satisfaction where they once recoiled, and revulsion and rage where they once felt indifference or resignation.” (The Rorty Reader, 332) At a different moment, in Contingency, irony and solidarity, he writes - to my mind quite movingly - that
In my utopia, human solidarity would be seen not as a fact to be recognized by clearing away “prejudice” or burrowing down to previously hidden depths but, rather, as a goal to be achieved. It is to be achieved not by inquiry but by imagination, the imaginative ability to see strange people as fellow sufferers. Solidarity is not discovered by reflection but created. It is created by increasing our sensitivity to the particular details of the pain and humiliation of other, unfamiliar sorts of people. Such increased sensitivity makes it more difficult to marginalize people different from ourselves by thinking, “They do not feel it as we would,” or “There must always be suffering, so why not let them suffer?”…
This process of coming to see other human beings as “one of us” rather than as “them” is a matter of detailed description of what unfamiliar people are like and of redescription of what we ourselves are like. This is a task not for theory but for genres such as ethnography, the journalists’s report, the comic book, the docudrama, and especially, the novel. (xvi)
When people see films like the one mentioned above, or read novels about people living with mental illness, or an article by Louis Sass, they see what it is like to live with a mental illness, and are then able to find more room in their head for seeing such people as "fellow sufferers." They can see how the illness affects people’s agency - how it steals it, and how this thing that steals agency is completely contingent and therefore even more baffling, horrific, and infuriating. It is a nightmare to find that one’s agency has become curtailed because of a contingent factor outside of one's control. This means that we cannot blame ourselves for living with mental illness, since, like the formation of language, or the writing of a novel, mental illness happens, and it is only after, to a certain extent, that we search for reasons why, though this search can often be futile or unsatisfying. My own paternal grandmother had schizophrenia, and I repair to this fact often to explain my own experience with schizoaffective disorder. But this fact cannot cover the entire ground of my illness, even if it serves as a kind of oasis. The truth is that, because illness happens to one, mental illness is a direct confrontation with contingency. Or, to put it another way, living with mental illness instantiates a kind of relationship between one’s morality and disaster in the form of tragedy. Tragedy is also the byproduct - not entirely, but somewhat - of contingency. Tragedies can be prevented, but to a large extend mental illness cannot be prevented, because it happens outside of our control.
When I speak about tragedy, I do not mean to exclude the notion of tragedy in the sense of a play, and Nussbaum has written quite incisively about the role that tragedy plays in our conceptions, and therefore our beliefs. In The Fragility of Goodness: Luck and Ethics in Greek Tragedy and Philosophy, she writes,
A tragedy does not display the dilemmas of its characters as pre-articulated; it shows them searching for the morally salient; and it forces us, as interpreters, to be similarly active. Interpreting a tragedy is a messier, less determinate, more mysterious matter than assessing a philosophical example; and even when the work has once been interpreted, it remains unexhausted, subject to reassessment, in a way that the example does not. To invite such material into the center of an ethical inquiry concerning these problems of practical reason is, then, to add to its content a picture of reason’s procedures and problems that could not readily be conveyed in some other form. (Nussbaum, 14)
If we replace “tragedy” in the above paragraph with “mental illness,” we see that mental illness is also never “pre-articulated”; and those stricken with mental illness, like those stricken by other tragedies, are forced to search for answers about something that does not fit easily in our conventional concepts or categories. Tragedy is a word, but it is also a moan; in fact, the etymology of tragedy comes from “song,” and therefore to a certain extent something that is not entirely cognitive but more affective in nature. What's strange and hard about mental illness is how to make sense of it, how to think about it, and in some very real way, how to come to - not accept it, but somehow live with it, in the same sense of living with a tragedy. In this sense, people living with mental illness and doing their best - "coping," to use a word often employed by Rorty - are teaching us one example of what it means to live an ethical life in the midst of tragedy.
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