I think one of the most confusing aspects of mental illness is that the experience of symptoms can distort how we think about our illness, and in so doing, we leave certain understandings of illness related to sociality for a thinking about illness that lodges symptoms inside a "private mind." In a way, the language of the DSM encourages these kinds of conceptualizations, since there is little to no mention of sociality or intersubjectivity in the DSM, but rather only a strict and austere listing of symptoms. This listing of symptoms, while potentially useful for a clinician, who needs somehow to apply over time a diagnosis, and therefore needs certain basic elements to work with in order to see clearly at all what the patient is struggling with, still registers a kind of falsehood in existence, which is to say, that mental illness is a "private experience," a ghost in the machine.
What I'm suggesting is that the language of the DSM works in tandem with the person suffering mental illness to form an idea about illness that is not realistic or tethered to the ground of our actual existence. And this idea goes something like: meaning is private, is not objective or social. It is possible, so mental illness says and thinks, to turn your back on the social world. In psychosis, for example, when someone is experiencing forms of animism, the sense is that they are privy to a world that most people are not privy to. An intuition of this sort would then naturally lead to a form of thinking that posits the problem with and in the social world, rather than the person suffering with the illness. This is horribly problematic, because not only is the patient suffering from symptoms of the illness, but their ability to interpret the meaning of their illness is also impaired.
I think the language of the DSM encourages these false forms of interpretation, on the part of both patients and clinicians, because the DSM, in its austerity, suggests a form of thinking that does not rely on context. We are not given thick descriptions in the DSM, for example, though we are in novels and memoirs, which can help us think more clearly about the ramifications and realities of living with illness, and provide insight in what mental illness feels like, looks like, is like. But I think the most pernicious form of thinking that comes both from the patient suffering mental illness and the DSM - the idea that illness is not social, that, because it is a set of private symptoms, consequently means that it only happens within the closed theater of the private mind - is a dangerous Cartesian legacy that we need to jettison if we are thinking with any robustness, clarity, and honesty about what it means to be ill.
What does it mean to be ill? Let me use a metaphor from John Dewey. He writes (and we can substitute "psychotic" for "introspectionist") in Experience and Nature,
When the introspectionist thinks he has withdrawn into a wholly private realm of events disparate in kind from other events, made out of mental stuff, he is only turning his attention to his own soliloquy. And soliloquy is the product and reflex of converse with others; social communication not an effect of soliloquy. (170)
The problem is that someone with a schizophrenia-spectrum illness, for example, is seeing things that other people are not seeing. Therefore, it seems logical to conclude, with Descartes, that the only thing they can be certain of is their own thinking. But this is exactly where we go wrong, because thinking, like discourse, is a product of the social world, and not the other way around. This is why Dewey, later in the same essay, writes "It is heresy to conceve meanings to be private, a property of ghostly psychic existences." (189) The soliloquy is only possible because of the background of social practices, even if the soliloquy believes otherwise.
What I want to argue, then, is how we interpret our illness is as important as the illness itself. I do not mean to say that if we think differently about our illness, the symptoms will go away. I do mean to say that our recovery is contingent in many ways on how we think about our illness, in how we contextualize it, in how we understand it. There are consequences to our conceptualizations, ends to the means by which we think about things. And when we imagine, or conceive of mental illness as a ghost in the machine, or in Dewey's words as "ghostly psychic existences," rather than as forms of subjectivism run amok, then we immediately draw a boundary between the self and the world, or mind and world, or mind and body. And these dualisms only reinforce the illness we are attempting to cure, because delusions and insanities are wrenchings away from the intersubjective, and from the objectivity of meaning, into forms of private fancy cut off from the social.
What do I mean by "objectivity of meaning"? Dewey writes, "Meanings are objective because they are modes of natural interaction." Later he writes,
Alternatives are too narrowly conceived. Because meanings and essences are not states of mind, because they are as independent of immediate sensation and imagery as are physical things, and because nevertheless they are not physical things, it is assumed that they are a peculiar kind of thing, termed metaphysical, or "logical" in a style which separates logic from nature. But there are any other things which are neither physical nor psychical existences, and which are demonstrably dependent upon human association and interaction. (196)
Dewey goes on to suggest that we think of traffic laws in this light, for example. A traffic law is not a state of mind, and it is independent of immediate sensation and imagery as are physical things, yet it is not a physical thing. Laws are good examples of this. So are customs and norms. Mental illness is a breakdown in norms, just as much as it is a breakdown in whatever the medical model of illness stipulates the error to be happening in the brain. The benefit, the consequences, of talking about mental illness as a breakdown in norms, is that we view the self not as isolated and divided, but as operating within, and formed by, a thick context of relationalities, norms, customs, habits and interactions. There is something objective about these norms, something we can't quite see over, something that shapes us just as much as we shape them. And when we contextualize madness in the context of the nomos, we see that madness is not a separate existence, but, in Dewey's terms, always "of, from, toward, situations and things." (238)
Robert Brandom, in his Spinoza Lectures, entitled Pragmatism and Idealism Rorty and Hegel on Representation and Reality, puts this notion of the nomos in a helpful light, when he writes, "Merely natural creatures are bound by rules in the form of laws of nature. Discursive beings are bound by rules they bind themselves by: concepts they apply, which are rules determining what they have thereby made themselves responsible to and for. Their normative statuses (responsibilities, commitments) are instituted by their attitudes of undertaking or acknowledging those commitments." (pp. 30-31) The concepts we use provide us with rules that make us responsible to and for things. Concepts, like traffic laws, are not states of mind, nor are they physical things. There is something objective about the conceptual world that holds us responsible for our commitments. In such a context, of norms, concepts, rules, and statuses, we can then see psychosis as a social and imaginative illness, a kind of false freedom, that claims an authority it does not have, and is unintentionally committed to a way of perceiving that binds it to forms of solipsism that undercut the reality of the subject's actual position. This actual position is social, through and through. And it is against, or through, or within this sociality that we must think about psychosis.
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