Modernity, mental illness and the crisis of meaning
Author: Marc Roberts RMN RNT DipHE BA(Hons) PGCE PGCRM MA PhD
Published paper available on request or at:
Roberts, M. (2007) Modernity, mental illness and the crisis of meaning. Journal of
Psychiatric and Mental Health Nursing 14, 277-281.
Western civilisation has, over its relatively recent past, undergone dramatic, unparalleled changes. The historical period in which these changes have occurred is commonly referred to as ‘modernity’, and although modernity has had profound repercussions on all aspects of people’s lives what has received less attention in the nursing literature is how modernity has influenced, and continues to influence, the mental health of modern men and women. In an attempt to address this, the following paper, drawing on the work of Szasz, Nietzsche and Frankl, seeks to present an accessible introduction to one of the most salient features of modernity; namely, the erosion of those traditions that gave life a meaning or a purpose, and that provided people with ready answers to the problem of how they ought to live. The paper will then introduce some of the possible consequences of this on the mental health of modern men and women, as well as providing preliminary suggestions as to how mental health nursing might respond. In doing so, the paper also seeks to stimulate further discussion and research into how modernity has influenced, and continues to influence, the mental health of modern men and women, and how psychiatric and mental health nursing might respond.
Keywords: philosophy, psychotherapy, religion
Western civilisation has, over its relatively recent past, undergone unparalleled changes (see, e.g. West 1997, pp. 7-16). The historical period in which these changes have occurred is commonly referred to as ‘modernity’, and while the precise historical parameters of this period - and indeed whether we have entered a new ‘post-modern’ period - are the subject of much discussion (see, e.g. Harvey 1990; Lyotard, 1997), modernity can be understood, broadly speaking, as that unique form of civilization that emerged in Europe and North America over the last several centuries, whereby human beings progressively gained a scientific understanding, and technological control, over their environment and progressively developed ‘rational’ forms of social organization (see, e.g. Havel 1996; Cahoone 1997; Weber 2001; Roberts 2005). However, while modernity has had profound repercussions on all aspects of people’s lives (see, e.g. Berman 1983; Giddens 2002), what has received less attention in the nursing literature is how modernity has influenced, and continues to influence, the mental health of modern men and women. In an attempt to address this, this paper seeks to present an accessible introduction to one of the most salient features of modernity; namely, the erosion of those traditions that gave life a meaning or a purpose and that provided people with ready answers to the problem of how they ought to live. The paper will then introduce some of the possible consequences of this on the mental health of modern men and women, as well as providing preliminary suggestions as to how mental health nursing might respond. In order to do this, it will draw on the work of the so-called ‘anti-psychiatrist’ Thomas Szasz (1983) - specifically The Myth of Mental Illness, the nineteenth century German philosopher Friedrich Nietzsche (1974) - specifically The Gay Science, and the work of the psychiatrist, and founder of ‘logotherapy’, Viktor E. Frankl – specifically Man’s Search for Meaning (2004).
Szasz and the myth of mental illness
The guiding question that Szasz (1983) asks in The Myth of Mental Illness is: ‘Is there such a thing as mental illness?’(p. 12). He begins his response by suggesting that ‘the concept of illness, whether bodily or mental, implies deviation from some clearly defined norm’ (Szasz 1983, p. 15). Thus, in the case of physical illness this norm is said to be ‘the structural and functional integrity of the human body’ (Szasz 1983 p. 15), whereas the attribution of mental illness is said to be based on a judged ‘deviance’ from certain ‘psychosocial, ethical, or legal norms’ (Szasz 1983, p. 17). What is important to note about these two types of ‘norms’ is the implication that, in the case of physical illness, the norm and the deviation from that norm is, as it were, a matter of ‘value free, objective facts’, whereas in the case of mental illness, the norm and the deviation from that norm is a matter of ‘value-laden, subjective judgements’. This is to say that although psychiatry strives to present itself as somehow ‘value-free’, ‘impartial’ and ‘objective’ (Szasz 1983, pp. 17-20), as continuous with the natural sciences (Fulford 2000), the attribution of mental illness demands a value judgement in which an ‘observer’ makes ‘a covert comparison between the patient’s ideas, concepts, or beliefs and those of the observer and the society in which they live’ (p. 14). Accordingly, Szasz (1983) suggests that the psychiatrist ‘cannot, and does not, stand part from the person he observes, as the pathologist can and often does’ (p. 19); rather, the psychiatrist is, as it were, a ‘participant observer’ in so far as the psychosocial, ethical and legal norms of ‘society at large’ are active, participatory factors in the psychiatrist’s observations and in the judgements about who is ‘mentally ill’.
Importantly, Szasz (1983) suggests that the ‘transgression’ of psychosocial, ethical and legal norms is not a consequence of ‘illness’, but of the attempt to confront and to tackle what he refers to as ‘problems in living’ (p. 20). This is to say that the variegated phenomena that are currently identified as ‘mental illnesses’ should be removed from the category of ‘illness’ altogether in so far as they are not the consequence of some ‘objective’, intra-personal ‘disease entity’, the consequence of ‘diseases of the brain’ (Kendell 1996), but are instead ‘the expressions of man’s struggle with the problem of how he should live’ (Szasz 1983, p. 21). In particular, Szasz (1983) suggests that ‘human relations at all levels’ are ‘fraught with stress, strain, and disharmony’ (p. 20) and, as the result of ‘conflicting human needs, aspirations and values’ (p. 21), they leave ‘Man’ pondering: ‘What should he do with himself? For what should he live?’ (p. 23). Therefore, rather than a ‘real’ entity, Szasz (1983) suggests that the concept of mental illness is a ‘disguise’ (p. 21), ‘social tranquillizer’ or ‘myth’ (p. 2) that is employed to obscure the ‘problems in living’ that people confront. It is important to note that by claiming that mental illness is a myth, Szasz (1983) is not suggesting that the variegated phenomena that are currently identified as mental illnesses do not exist (p. 23); rather, he is claiming that such phenomena is a consequence of the attempt to confront and to tackle the problem of how to live, and that to identify such phenomena as a ‘disease’ or an ‘illness’ is to hide the very real problems in living that people face.
Although Szasz (1983) suggests that human beings are inherently ‘afflicted’ by problems in living (p. 20), a more sophisticated reading suggests that problems in living, or at least their intensification, are the result of relatively recent events that have occurred within, and have irrevocably transformed, the whole of Western civilisation itself. Thus, somewhat enigmatically, Szasz (1983) suggests that by ‘problems in living’ he is referring to ‘that explosive chain reaction that began with man’s fall from divine grace by partaking of the fruit of the tree of knowledge’ (pp. 21-22). By doing so, Szasz (1983) can be understood as alluding to the emergence of that period in the history of Western civilisation that is commonly referred to as ‘modernity’ whereby, broadly speaking, human beings began to increase their understanding of themselves and the world in which they live; he suggests, however, that an important consequence of this is ‘an ever larger burden of understanding’ (p. 22). This is to say that with increasing understanding of themselves and the world, along with the concomitant challenge and erosion of the theological world view, modern men and women are gaining a growing awareness that they are free to direct their own lives and must take responsibility for how they do so. We are, as Sartre (1996) memorably asserted, ‘condemned to be free’ (p. 439), ‘condemned’ to ‘shoulder’ the ‘burden’ of our freedom and the responsibility for how we use it; accordingly, Szasz (1983) dismisses any attempt to alleviate this ‘burden’ by ‘taking refuge in an outmoded theological view of man’ because, he suggests, the only ‘rational’ manner in which to address the problem of how to live is through ‘more understanding, and appropriate action based on such understanding’ (p. 22).
Nietzsche and the death of God
Perhaps more than any other, it was Friedrich Nietzsche (1974) who explored the impact and the implications of modernity upon the lives of modern men and women, encapsulated within his now infamous proclamation that: ‘God is dead’ (p. 181). It is important to note, however, that Nietzsche’s work has always elicited conflicting responses, and his aphoristic and often highly dramatic discursive style has meant that his work has been subject to a variety of interpretations, uses and even damaging misuses (Kaufmann 1974, pp. 3-9); accordingly, what Nietzsche means by proclaiming that ‘God is dead’ has been, and continues to be, the subject of varying consideration, discussion and disagreement (see, e.g. Schacht 1992; Deleuze 2002; Pearson 2005). For the purposes of this paper, however, it is enough to suggest that by proclaiming that God is dead, Nietzsche (1974) was proposing that Western civilisation was undergoing one of its most profound historical and cultural events; namely, the demise of the belief in the existence of God (p. 279). In particular, he was suggesting that human beings, by virtue of their own enquires, investigations and reflections upon themselves and the world, have irrevocably discredited the theological, Judeo-Christian world-view, that human beings themselves have ‘killed God’. Thus, in a memorable, aphoristic passage, Nietzsche (1974) has his protagonist, ‘the madman’, run into a crowded market place and cry: “Whither is God?” to which he replies: “I will tell you. We have killed him – you and I. All of us are his murders…God is dead. God remains dead. And we have killed him” (p. 181).
Writing in 1887, Nietzsche (1974) suggested that the recognition of the ‘death of God’, and certainly the full implications of this event, would elude many people; as he made clear: ‘The event itself is far too great, too distant, too remote from the multitudes capacity for comprehension…Much less may one suppose that many people know as yet what this event really means’ (p. 279). However, Nietzsche (1974) suggested that its repercussions would, given time, affect more and more people so that, at least initially, we would begin to experience a profound ‘instability’ and ‘disorientation’, and we would do so because the belief in God, and the Judeo-Christian world view generally, had so greatly influenced the conception of ourselves and others, the values that we hold and the morality that we espouse, the meaning we believe our lives to have and the direction we believe our lives ought to take (p. 279). This theological world view prevented, or to a large degree mitigated, what Szasz refers to as problems in living because it provided ready answers to the problem of how life ought to be lived and what its overall meaning and purpose was, and faith in the existence of God gave the reassurance that the validity of that form of life had, as it were, a ‘divine guarantee’. With the demise of this faith in God, however, the form of life that was built upon it begins to disintegrate (Nietzsche 1974, p. 279), and so, as Nietzsche (1968) forewarned, ‘we have to pay for having been Christians for two thousand years: we are losing the center of gravity by virtue of which we have lived; we are lost for a while’ (p. 20).
With the death of God, the ‘ruin’ of the Judeo-Christian interpretation of the world and the loss of meaning and guidance that it gave to people’s lives, Nietzsche (1974) suggests that human beings are faced with a terrifying question; namely: ‘Has existence any meaning at all?’ (p. 308). For Nietzsche (1974), it will take time and courage for people to confront and ‘honestly’ attempt to tackle this most profound of questions; indeed, he makes it clear that: ‘It will require a few centuries before this question can even be heard completely and in its full depth’ (p. 308). However, Nietzsche (1968) suggested that the initial response to it would be one of despair, whereby people would: “rebound from ‘God is truth’ to the fanatical faith ‘All is false’” (p. 7); this is to say that the Judeo-Christian world view has so deeply influenced Western people’s lives that its loss will entail the belief, the nihilistic belief, that everything is lost. Set to become the defining characteristic of our age (Nietzsche 1968, p. 3), Nietzsche (1968) suggests that nihilism is that condition wherein what were previously ‘the highest values devalue themselves’, a state in which life lacks any aim, purpose or meaning and, more generally still, a state in which ‘“why?” finds no answer’ (p. 9). Therefore, one of Western civilisation’s most significant events, the death of God engenders the most profound cultural, sociological and psychological repercussions, leaving many facing an ‘existential crisis’, a crisis in discerning a meaning or purpose for their existence and struggling to tackle the problems in living that this engenders; indeed, elucidating Nietzsche’s (1974) famous passage on the death of God entitled: ‘The Madman’ (p. 181), Kaufman (1974) ominously suggested that ‘to have lost God means madness; and when mankind will discover that it has lost God, universal madness will break out’ (p. 97).
Frankl and the search for meaning
One notable figure who has attempted to respond to ‘existential crisis’, and whose work can therefore assist mental health nursing to consider how it might respond to the psychological manifestations of the nihilism that the death of God engenders, is Viktor E. Frankl. For Frankl (2004), the traditions that provided existence with a meaning and with ready answers as to how we should live are now ‘rapidly diminishing’, leaving an ‘existential vacuum’ in their wake and the sense that life no longer has a meaning or purpose (2004 p. 111); as he makes clear: ‘The existential vacuum which is the mass neurosis of the present can be described as a private and personal form of nihilism’ (p. 131). Moreover, he suggests that this existential vacuum, this nihilism, has many varied and far reaching consequences for modern men and women, and many will respond by simply doing what other people do, while others will do what they are told to do – ‘conformism’ and ‘totalitarianism’ respectively (Frankl 2004, p. 111). In addition, we can suggest that others will cling more passionately to what has been lost, becoming more ‘fundamental’ in their religious convictions, while yet others will adopt ‘new’, quasi-religious beliefs, such as those of ‘New Age Spiritualism’ (see, e.g. Simmel 2000, p. 293). Importantly, much of the phenomena that is referred to as ‘mental illness’ is, for Frankl (2004), best understood as the varied expression of how modern men and women are struggling to confront the ‘existential vacuum’, and thus the nihilism, of their age; as he makes clear: ‘Such widespread phenomena as depression, aggression and addiction are not understandable unless we recognise the existential vacuum underlying them’ (Frankl 2004, p. 112).
Frankl’s (2004) therapeutic response to those experiencing such phenomena, a practice that he refers to as logotherapy, is to ‘reorient’ the person to the meaning, or the purpose of their existence (p. 104). This is to say that a person is orientated to confront the question of the meaning of their existence, to explore this question and, ultimately, to provide a positive answer to this question (Frankl 2004, p. 108). Accordingly, the search to find a meaning or a purpose for one’s life is not to be understood as some ‘idle, academic curiosity’ that one engages in once supposedly ‘more urgent’ or ‘more fundamental’ needs have been met; rather, the striving to search for and to possess a meaning or a purpose for one’s life is said to be ‘the primary motivational force in man’ (Frankl 2004, p. 104). For Frankl (2004), if a person’s life lacks a meaning or a purpose, if a person does not have something to live for, then life’s strivings, struggles and projects become, ultimately, futile, and again, for Frankl (2000), ‘such phenomena as addiction, aggression, and depression are, in the final analysis, due to a sense of futility’ (p.140). However, with a meaning, life’s strivings, struggles and projects ‘make sense’, they become meaningful, and mental health nurses are well placed to attempt to reinstall meaning, purpose and hope into people’s lives (see, e.g. Moore 2005; Skaggs & Barron 2006). Indeed, stressing the importance of meaning or purpose for a person’s life, Frankl (2004) suggests that: ‘There is nothing in the world…that would so effectively help one to survive even the worst conditions as the knowledge that there is a meaning in one’s life’ (p.109).
Now, the manner in which logotherapy attempts to assist a person to address the question of the meaning of their existence - and thereby ameliorate the threat of nihilism and its various psychological manifestations - cannot be discussed in detail here. However, as a broad and insightful introduction, it is instructive to consider Allport’s (2004) account of how Frankl would assist his clients to make clear the implicit, and sometimes forgotten, actual or potential meaning or purpose of their existence (p. 7); so, for example, there might be the love of one’s children, a talent to be developed and used or ‘perhaps only lingering memories worth preserving’ (Allport 2004, p. 7). As this suggests, the answers a person gives to the question of the meaning of their existence will reflect the particularity of that person’s life (Frankl 2004, p. 113), and a person is free to decide what is, or what will be, the meaning or purpose of their existence, and how they will live. It is important to note, however, that a person’s life is ‘lived against the backdrop’, as it were, of wider ethical, legal, and psychosocial ‘horizons’ (see, e.g. Taylor 2003, pp. 31-41), and so the answer that a person gives to the question of the meaning of their existence can be measured against those horizons, and so it is against those horizons that a person will be called to account for what they do with their life. This is to say that a person must take responsibility for what they have deemed to be the meaning or purpose of their existence, and therefore how they address the on-going question, the on-going problem of how they ought to live; as Frankl (2004) concludes: ‘In a word, each man is questioned by life; and he can only answer to life by answering for his own life; to life he can only respond by being responsible’ (pp. 113-114)
Szasz, Nietzsche and Frankl all provide, in their own way, a ‘diagnosis’ of the state of contemporary, Western society and explore its implications upon the mental health of modern men and women. Characterised by expanding scientific understanding, and a concomitant erosion of the religiosity that gave life a meaning and a ready answer to the problem of how one ought to live, modernity leaves men and women susceptible to nihilism, and the variegated mental health problems that can arise as a consequence. If that ‘diagnosis’ and its implications are accepted then there exists an opportunity for mental health nurses to conduct further research into how modernity, and in particular ‘the death of God’, has influenced, and continues to influence, the sense of meaning or purpose in people’s lives, the implications of this for their mental health and how mental health nurses may ‘therapeutically’ respond. Moreover, if we take Frankl’s work as a productive point of departure, and understand a therapeutic response in terms of assisting people to find a meaning or a purpose in their lives, then there exists an increasing body of accessible work concerned with ‘the meaning of life’ that can serve mental health nurses as a ready resource (see, e.g. LeBon 2001; Marinoff 2004; Baggini 2005; Young 2005; Cottingham 2006) Finally, it presents mental health nurses with an opportunity to develop, as it were, a broader, more ‘philosophical’ perspective in which the aetiology, development and treatment of mental health problems are also viewed in the context of the shape and the direction of a person’s life as a whole, and as a life embedded within, and therefore shaped by, the unique particularities of our historical epoch.
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