Industrial and organization psychology

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Topic 9 – Mental illness, madness and creativity

MGMT341 – Industrial and Organizational Psychology

Summary of topic 9

Occupational stress is a relationship between workers and their environment that cannot be understood outside of that relationship

This is particularly evident in the case of Repetitive Strain Injury which, in the absence of medical signs, is best analysed as a communication, not as a medical condition caused by inadequate working conditions

The value of understanding the context of communications is also revealed when looking into such issues as mental illness, madness and creativity

Topic 9: Agenda

The myth of mental illness

What is normal?

Creative madness

Psychoanalysis and psychiatry

The rise of Freud’s ideas has been paralleled in the 20th century by that of psychiatry (the origins of which are more ancient, however)

Both disciplines share similar objectives (mental balance for psychoanalysis, mental health for psychiatry) and are based on similar central notions

The mind

The existence of ‘mental problems’ (neuroses for psycho-analysis, mental illnesses/disorders for psychiatry) which they seek to cure or at least mitigate

They differ in the means they use to reach these objectives

Psychiatry seeks to study and treat mental disorders from a medical (i.e. physiological) perspective

Psychoanalysis pursues similar objectives but through purely verbal means (psychoanalytic discussions)

Neurosis and psychosis

Psychiatric illnesses used to be classified in two kinds, neurosis and psychoses

Neurotics are people mildly affected, behaving sometimes strangely (possibly consciously but uncontrollably) but on the whole rather normally

Neurotics often report feeling miserable in social settings

Psychotics are people behaving in very bizarre ways, so much so that they can be a danger to others or to themselves

Psychotics often hold incoherent conversations and seem to have lost contact with reality yet are not completely blind to their physical environment

These terms (of Freudian origins) are rarely used nowadays; the American Psychiatric Association now classifies mental disorders as ‘mild’ or ‘severe’ to mark the difference from psychoanalysis

The term ‘psychosis’ is still used by some psychiatrists when speaking of very severe cases, however

Mental illness or disorder

The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5, published in May 2013) admits that

“although decades of scientific effort have gone into developing […] diagnostic criteria sets […] no definition can capture all aspects of all disorders” (p. 19)

Yet defines a mental disorder as a

“syndrome characterised by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.” (p. 20)

Schizophrenia is the flagship case, but in the DSM are listed diseases like anorexia and excess eating, addictions to substances or gambling, hyperactive children (ADHD), cross-dressing, sleep walking…

Therapy is sought in terms of psychotherapy (verbal or behavioural), medication, electroshocks or even surgery (illegal in some countries) for extremely severe cases

Hospitalisation is generally voluntary but can also be involuntary

Thomas Szasz (1920-2012)

Thomas Szasz was an Hungary-born, USA-educated psychiatrist and academic

In 1961, Szasz published in The Myth of Mental Illness most of the views for which he is (in)famous today

Szasz’s critique of psychiatry is a radical one: he argued that the notion of mental illness is devoid of meaning and that modern psychiatry is a misguided effort

Szasz’s main arguments

A disease or illness is a malfunctioning or a problem in the structure of an organ (or group of organs)

The mind is not an organ, it is not a thing: I mind (the step, the baby) but I have no mind

What is called ‘mind’ is the dialogue within

The ‘mind’ is the way people talk, including to themselves (thinking)

‘Mind’ is a social, moral and linguistic concept, not a scientific or medical one

The mind therefore cannot be sick or ill (only organs can); there cannot be any ‘mental illness’

‘Mental illness’ is not something a person has, but is something that a person does

Minds can be ‘sick’ only in the sense that economies or jokes can be ‘sick’: ‘mental illness’ is a metaphor for unusual, inadequate or inacceptable behaviour

If there is no mental illness, there can be neither treatment nor cure

People may change their behaviour with or without psychiatric intervention

If psychiatric, intervention is called ‘treatment’ and its effect, if in a direction that is socially approved is called ‘recovery’

Signs and symptoms: illness and role-playing

Sign	Symptom	Patient	Example
Yes	Yes	Yes	Patient with symptomatic illness (‘normal’ patient)
Yes	Yes	No	Non-patient with symptomatic illness (‘stoic’ or ‘hardy’ individual)
Yes	No	Yes	Patient with asymptomatic illness (detected through a routine visit)
Yes	No	No	Non-patient with asymptomatic illness (previous case before detection)
No	Yes	Yes	Patient with symptoms but no detectable illness (‘mentally ill’ people)
No	Yes	No	Non-patient with symptoms but no signs
No	No	Yes	Patient with no detectable illness (individual declared ill for no medical reason)
No	No	No	Healthy person

A medical sign is “an objective indication of some medical fact or characteristic […] detected by a physician during a physical examination of a patient.” (Wikipedia)

A symptom is “a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality. A symptom is subjective, observed by the patient and not measured.” (Wikipedia)

Szasz: cui bono?

Who benefits?

The State (control of socially deviant individuals)

Families of difficult individuals

Psychiatrists

The pharmaceutical industry

Patients themselves: life is a task which can defeat you

Video here

Consequences of Szsaz’s arguments

Psychiatric diagnoses are stigmatising labels, phrased to resemble medical diagnoses and applied to persons whose behaviour annoys or offends others

Those who suffer from and complain of their own behaviour are usually called ‘neurotic’; those whose behaviour makes other suffer and about whom others complain are usually called ‘psychotic’

Psychiatry medicalises moral problems (problems in living); ‘right’ and ‘wrong’ behaviour become ‘healthy’ and ‘sick’ person

Insofar as Occupational Health and Safety legislation and practices are based on therapeutic paternalism (implemented by law in the name of employees’ well-being without asking their input), they represent a significant step toward what Szasz called the ‘Therapeutic State’

Szasz: a critique?

Even though Szasz’s arguments have attracted loud and intense criticism, no convincing counter-argument has been offered to date

His critics do not seem to grasp the full weight of his arguments or appear to remain insensitive to logic

A very common accusation is that Szasz ignored or denied the suffering or ‘social non-functioning’ of psychiatric patients

Even if true (Szasz can be described as a tough-minded libertarian), this finding does not bear on Szasz’s main thesis

Another common criticism is that he ignored the possibility of discovering one day biological causes for mental illnesses

Like it is the case for general paresis (tertiary syphilitic infection), caused by the organism spirochete on the nervous system

Szasz admitted this possibility, but insisted that such discovery will rely on biological signs and not merely on behavioural (moral) symptoms: one is healthy until proven otherwise

In any case, if a biological basis is found for a ‘mental illness’, then it is a physiological one; if ‘mental illness’ does not mean ‘bodily disease’, then how can a medical (i.e. bodily, physical) intervention be justified?

In defence of Szasz (1)

To date, no biological basis for any mental disorder has been identified

The often-mentioned ‘chemical unbalance in the brain’ has yet to be formally established within the general population

How to differentiate between the true genius and the socially maladapted on a biological basis?

How is it possible that a chemical unbalance in the brain translates into schizophrenia or depression and nothing else, like dizziness, abnormal blood pressure or temperature?

If I say ‘I am Napoleon’, there is no way to check the validity of this claim within my body (the answer is in my birth certificate)

That ‘mental illnesses’ (problems in living) run in families is unsurprising

If problems in living are the visible manifestations of inappropriate internal dialogues, if my parents face problems I am likely to face them too, since my parents taught me to speak (to myself)

Besides, if ‘mental disorder’ means ‘brain disease’, then the expression is redundant and misleading

Cf. CCHR video.

In defence of Szasz (2)

Psychiatric diagnoses are based exclusively on symptoms, i.e. on interpretations of behaviour made by the patient and / or the practitioner; these interpretations are subjective, framed by circumstances as well as heavily morally and culturally biased

Psychiatry has in fact little interest in seeing objective and biological tests being developed, for patients diagnosed thus would be automatically referred to another branch of medicine, i.e. they would be ‘lost’ to psychiatry

Treatment cannot be forced upon someone diagnosed with a ‘bodily disease’ (tautology); yet it can be upon someone diagnosed as ‘mentally ill’

Psychiatry is endowed with important powers, close to those of the Police or of the Justice system; these powers warrant scrutiny

Psychiatrists would be in a better position if they could define ‘normal behaviour’ and relate this reference to physiological (biological) data

There are serious reasons to believe that they will never be able to do this

What is normal behaviour? (1)

The question of what is normal behaviour has received various answers in the literature, none of which is very convincing

Normal is often defined in opposition to abnormal (in the sense of pathological), which is in turn equated to specific patterns of behaviour

Further analysis reveals that normal people behave in ways that are otherwise considered abnormal, but in less extreme ways: in other words, everyone is ‘sick’, but some are ‘sicker’ than others

The question becomes then: why are some people sicker than others? or again: what is the difference between a sick person who behaves normally and another who does not?

Conclusion: the question ‘what is normal?’ has been replaced by other questions which are at least as difficult to answer; no progress has been made

What is normal behaviour? (2)

Another answer is to propose that behavioural characteristics or traits are normally distributed and that the most frequent trait defines normality

Extreme deviations from the norm indicate pathology, or again abnormal simply means unusual

If this is the case, the extremely intelligent person is just as abnormal, or sick, than the extremely unintelligent one

Yet there are many cases where extreme behaviour is the norm (for instance, at one’s wedding, one is supposed to be very happy) or where normal behaviour is extreme (soldiers are supposed to kill enemies during battle)

Conclusion: the statistical approach to normality also fails

What is normal? (3)

Normality has also been defined as ‘good’ in a moral or legal sense

Behaving normally is then synonymous to doing ‘the right thing’

Problem: the definition of the right thing to do keeps changing across times and places

Headhunting (chopping and desiccating heads of people) is admired in some cultures, but is disapproved elsewhere

Slavery remained for centuries acceptable and expected, but is now banned and considered wrong

What is normal? Conclusions

There is no stable and consensual definition of what is normal behaviour

‘Normal’ simply means ‘expected or considered as reasonable by most people’ given the circumstances

‘Normality’ (sanity) is therefore a moral and cultural concept, not a medical one

Psychiatrists cannot ‘cure’ someone who misbehaves (behaves strangely)

“The madman is not the man who has lost his reason; the madman is the man who has lost everything except his reason.” (G. K. Chesterton)

If ‘normal’ means ‘expected’, then ‘abnormal’ means ‘unexpected’

It is enough to say something that goes against received expectations to be considered ‘abnormal’ or ‘mad’: those who held that the Earth was round, not flat, or that objects heavier than air could fly were considered as dangerous lunatics in their time

Creative madness

‘Genius is (indeed) next to madness’: there is no fundamental difference between the genius and the madman before what they say is put to empirical test

Both hold on to ideas which run against established beliefs, conventions or general expectations

The more what they advance departs from accepted wisdom and the more vocal they are in their claims, the less attention they are granted and the less likely a fair test of their ideas will be organised

Mainstream (scientific) psychologists are unable to tell the difference between the creative genius and the madman

They tend to label both ‘mentally ill’

As a result, there has been very few studies of creativity conducted by psychologists worth mentioning

The creative process

The history of arts and science shows that no one has a better chance of dying alone and in poverty than the authentic genius whose ideas will eventually revolutionise parts of society

When a new idea appears, it is usually first called stupid, then considered dangerous because going against the social order, then finally taken for granted because self-evident

Social critic and writer Arthur Koestler proposed an attractive account of the creative process; according to Koestler, to innovate, one must…

acquire a solid knowledge of a field, enough to understand its weaknesses and limitations but not to the point to be trapped in its dominating models and ways of thinking (so-called ‘experts’ are never inventors)

do not try to force a new idea into being but wait for it to ‘spring to mind’ while going about other matters

write down and investigate carefully the value of the new idea

“The more original a discovery, the more obvious it seems afterwards” (Arthur Koestler)

Madness and creativity

Creative people are people who appear to be able to free themselves from convention and apparent logic

They do not listen to people around them saying that something is impossible

They are not deterred by propositions like ‘if A then not B, if B then not A’ but try to reconcile A and B

If this is the case, then passion and rationality, logic and creativity cannot be reconciled, at least not at the same time

To be passionate about something means to be irrational about it

Creativity demands determination, courage and sometimes even sacrifice: swimming against the current is difficult, exhausting and often dangerous

Today, the risk of being called ‘mentally ill’ is very high when one tries to innovate

Creativity cannot be controlled, let alone commanded

‘Be creative!’ or ‘be yourself!’ are self-contradicting instructions

MGMT341

Questions?