STATE POWER, and the psychiatric pressure to accept reality
I wish to talk about the psychiatric pressure to accept reality. It is the pressure—under threat of being declared crazy—to accept a certain claim or claims about reality as Reality.
This pressure dominates us. And it may be abused by the State. Hence, free and democratic citizens of the present and future West—in order to preserve their freedoms—must first understand the psychiatric pressure to accept reality.
I hope to say one or two useful things about it here. But first I must convey a sense for how this pressure affects behavior. And for that I will call in Solomon Asch.
An insight from Solomon Asch’s conformity experiments
Solomon Asch was one of the truly profound social psychologists. He did many great and clever things. One of them, very famous, was his investigation of this cognitive adaptation that I have, utterly mindless (and sometimes infuriating), which makes me want to align my behaviors, ideas, thoughts, beliefs, etc. to those that most everyone around me is already broadcasting.
You have this cognitive adaptation too—it’s a human thing. In academic social science we call it the conformist bias.
As you’ve probably heard, experimental social psychologists are often, and in a very real sense, conmen. They employ fake props and even trained actors playing entirely fictional roles to suck the experimental subject into a managed reality that will serve the purposes of the investigation. This conning of experimental subjects is inevitably humorous (one can imagine the fun psychologists have). But in purely scientific terms, the advantage of reality management is that one may carefully design the precise social stimulus to which the experimental subject must respond. Asch generously availed himself of this advantage in order to study the conformist bias.
To understand his experiment, adopt the subjective outlook of the naïve experimental subject.
There you are, happily about, almost whistling to yourself as you go, and you enter into Asch’s lab to participate in an experiment that, you were told, is about visual perception. Upon entering, you find already in the room seven other subjects like you. Smiling placidly to yourself, you take the remaining seat, which is in the second-to-last position.
The experimenter takes two big cards and puts them side by side on an easel. Both cards have large vertical lines printed on them. The card on the left has just one line: the reference line; the other card has three lines labeled A, B, and C, of different lengths. You are told that you must identify which of the three lines—A, B, or C—is equal in length to the reference line.
Any idiot can solve this problem, as you can plainly see. One of those three lines is quite obviously the right answer and the two others are not even close. Does that surprise you? Certainly not. This stupidly obvious exercise must just be the warm-up, you say to yourself. Life is so good—you are smiling still.
Each subject must answer in turn, and you are second-to-last. The other subjects answer aloud, in order. Each answers correctly. Then you do the same. Another pair of cards is set on the easel, with a new set of lines. Equally easy. Ho hum. Probably another warm-up.
But then, on the next stimulus, which is just as stupidly easy as the previous two, the first subject answers ‘A’ when the correct answer is obviously ‘B.’
What? The second does the same: ‘A.’ And then the third, fourth, fifth, sixth: ‘A,’ ‘A,’ ‘A,’ ‘A.’ Now it’s your turn. What do you do?
“Your eyes give you a clear answer to the experimenter’s simple question: ‘B’ is obviously right. But all of those people said ‘A.’ There is something wrong here; either you can’t see, or you misunderstood the instructions, or something else is going on. Maybe they got the instructions wrong: maybe they can’t see. But how likely is that? After all, they all gave the same wrong answer. And what a fool you’ll be if you answer ‘B’ and ‘A’ is the right answer. They’ll probably laugh at you… Will you go along, or let on that you are a fool?”1
Of course, unbeknownst to you, the other seven are not real experimental subjects like you but confederates of the experimenter, playing entirely scripted roles. And the experiment is not really to see whether people can match a line.
The real point of Asch’s experiment was to produce the mental torture that my former colleague at UPENN Psychology, the late John Sabini, so effectively represented above. Asch wanted to know if people would, under such torment, publicly deny reality in order to avoid looking deviant.
You already know what Asch found. Though their eyes could plainly see that ‘B’ was the right answer, quite a few people went along with the majority and said ‘A.’
It is exactly as in Hans Christian Andersen’s tale, The Emperor’s New Clothes, where people praise the naked emperor’s supposed new vestments because everybody is afraid to let on that they can’t see them (the clothes are supposedly invisible to fools). That story is a classic precisely because it captures something profoundly human.
A great deal can and must be said about the implications of Asch’s investigation of the conformist bias, and I will do that in another piece. Here, I am interested in what one of Asch’s critical—that is, real—subjects said in the debriefing, after it was explained to him that his fellow ‘subjects’ had in fact been confederates of the experimenter, helping set up the con: “I thought so,” said the subject, meaning that, for one second, he considered the hypothesis that he was getting conned, that everyone around him was acting and pretending for his benefit, “but wondered if I had paranoid tendencies.”2 Preferring not to be insane, he chased that hypothesis away.
This is interesting. The subject witnessed an extreme behavior and in order to explain it he produced an extreme hypothesis: that everyone around him was cooperating in the creation of a fake reality intended only for him. Yet the mere presence of that hypothesis in his head—though it was, in fact, the right hypothesis!—made this subject doubt his own sanity.
No doubt we can sympathize with him. Any radical test of reality has that ‘going crazy’ feel to it, and we have a horror of that. That feeling is what I call the psychiatric pressure to accept reality.
The psychiatric pressure to accept reality is a coercive force, diffusely felt, that results from certain institutional realities anchored in the role of professional psychiatry in modern nation-states. I’ll now make a first stab at describing that.
Professional incentives articulate with institutional structure
Psychiatrists are interested chiefly in what goes wrong. And the more things go wrong, the more opportunities they have for academic study, career building, and income growth. Psychiatrists therefore have a perverse incentive to narrow ‘normal’ and expand ‘sick,’ which they can do because the institutional order empowers them to define these concepts.
In other words, psychiatrists are wont to pathologize us—to declare many of the things we do as abnormal or unhealthy, requiring a correction or ‘cure’—because in this manner they can more effectively grow their own income and power. Since psychiatric diagnoses are famously nebulous and always on some continuum, the line demarcating ‘sick’ from ‘normal’ can easily be made to slide.
Psychiatrists hardly need to be consciously evil for this to happen. They just need to be like most of us: ordinary humans who enjoy having more money and power. If we grant just two things:
that psychiatrists enjoy being recognized as ‘experts’ who tell others how their minds malfunction and how to fix them; and
that psychiatrists like money,
then a perverse incentive follows to expand the frontiers of ‘sick’ at the expense of ‘normal.’
And because psychiatrists are cultural creatures, born and raised in particular societies, they will tend to consider as ‘mental illness’ those performances that contradict what is locally normative, as has been the case since the 19th c. beginnings of psychiatry with Charcot and Freud.
Now, since psychiatrists, in modern States, are licensed to declare someone insane (that’s the professional psychiatrist’s special and official power), psychiatric discourse is an interesting target for authoritarians in the power elite who are looking for excuses and arguments to increase social control over the citizens.
Such authoritarians want certain thought patterns and behaviors to become coercively normative. To get deviations from such thought patterns and behaviors officially declared ‘insane,’ they’ll create structural incentives to bring diagnoses of insanity in agreement with their political interests, taking advantage of the psychiatric bias to reduce ‘normal.’ By thus wielding manipulated diagnoses of ‘insanity,’ the power elite can discursively marginalize political dissidents and, at the limit, imprison them.
The classificatory and regulatory environment that has been created by the articulation of psychiatry with the coercive powers of the State has produced a situation nebulously analogous to heretical fear of the Inquisition. For this pressure is always latently present and hangs over our heads like a sword of Damocles. Whether we understand these structural linkages as clearly as I have sought to lay them out here, or merely feel intuitively the implicit threat of being considered ‘crazy,’ we all silently worry about this.
Thus, even when our own eyes seem loudly to demand that we question the locally normative reality construct, we feel an enormous pressure to accept it. We cultivate a studied docility towards this reality construct in order adaptively to disinvite potentially dangerous negative judgments on our sanity.
I’ll now try to flesh this out some more.
The insanity of psychiatrists
For psychiatrists the term ‘insanity,’ historically, has a strong semantic attachment to psychosis, wherein a person has trouble separating fantasy from reality. A diagnosis must answer the question: Can this person accurately perceive reality?
This can be a scientific question, in principle, provided we have rigorous methods by which to propose—and test!—models of reality. Unfortunately, this evaluation is often muddied by the social values of psychiatrists, so that the terms ‘sanity’ and ‘insanity,’ in psychiatric discourse, have acquired the following connotations:
As a token example, consider a paper contributed to Schizophrenia Bulletin and titled ‘The Spectrum of Sanity and Insanity’ (2010). The author, himself a schizophrenic, explains that during a schizophrenic break (an example of psychosis) “one moves between the spectrum of sanity and insanity and is gradually pulled from the clear light of reason to that of madness.” His “insane thoughts” at first “seemed normal and plausible,” to him, “if only a bit more creative,” but “eventually … [they] lost all bases in reality.”3 (All emphases are mine.)
To tie the term ‘sanity’ to the allegedly associated terms ‘normal,’ ‘reason,’ and ‘plausible’ in this manner creates unsolvable problems. For isn’t a scientist abnormal who proposes a paradigm shift—a radical change—that in fact improves our model of reality? Won’t he initially be perceived as unreasonable and his claims as implausible? Yet he is not insane. Neither—mind you—are scientists automatically insane who deviate from the norm with worse models of reality (riddled with illogic and poor evidence). Most of them are just wrong.
And consider: Can’t insanity itself become normal? As psychologist Erich Fromm wrote in The Sane Society:
“It is naively assumed that the fact that the majority of people share certain ideas or feelings proves the validity of these ideas and feelings. Nothing is further from the truth. Consensual validation as such has no bearing whatsoever on reason or mental health. Just as there is a ‘folie à deux’ there is a ‘folie à millions.’ The fact that millions of people share the same vices does not make these vices virtues, the fact that they share so many errors does not make the errors to be truths, and the fact that millions of people share the same forms of mental pathology does not make these people sane.”4
Fromm was thinking about the Germans under the Nazis, of course. The Sane Society, published in 1955, was the sequel to his Escape from Freedom, wherein, with the insanity-is-normal Third Reich still fresh in memory, he discussed the question of totalitarianism.
Would that psychiatrists had heeded Fromm! They did the opposite.
In the dominant psychiatric way of thinking and speaking, the generally normal—as established by consensual validation and psychiatric fiat—are automatically ‘the sane.’ Abnormal people, therefore, must be ‘mentally ill.’ Yes, and they must have a physical disease of the brain (a ‘chemical imbalance’). This latter allegation—so convenient to the Big-Pharma pill makers who promise to ‘restore’ the ‘chemical balance’—is one that psychiatrists are heavily invested in, because the words ‘brain’ and ‘chemical’ have the power, quite magically, to confer on their work the social prestige of medical science.
The modern State collaborates with this medical conceit of psychiatry, as its highest representatives loudly insist that ‘mental illness’—understood as a physical disease of the brain—is supposedly a real thing. In the United States, for example,
“In 1999, President William J. Clinton declared: ‘Mental illness can be accurately diagnosed, successfully treated, just as physical illness.’ Tipper Gore, President Clinton’s mental health adviser, stated: ‘One of the most widely believed and most damaging myths is that mental illness is not a physical disease. Nothing could be further from the truth.’ … A White House Fact Sheet on Myths and Facts about Mental Illness asserted: ‘Research in the last decade proves that mental illnesses are diagnosable disorders of the brain.’ In 2007, Joseph Biden … declared: ‘Addiction is a neurobiological disease—not a lifestyle choice—and it’s about time we start treating it as such.’ … At the same time, Biden introduced to the Senate a bill titled the Recognizing Addiction as a Disease Act. The legislation called for renaming the National Institute on Drug Abuse as the ‘National Institute on Diseases of Addiction,’ and the National Institute on Alcohol Abuse and Alcoholism as the ‘National Institute on Alcohol Disorders and Health.’ In 2008, Congress required insurance companies to provide people with mental illnesses ‘the same access to affordable coverage as those with physical illnesses.’ ”5
To all this, a vehement opposing voice has been expressed, most eloquently in The Myth of Mental Illness. It is the voice of psychiatrist Thomas Szasz, who became a historian and sociologist of psychiatry and a philosopher of science and democracy.
People who seek psychotherapy, Thomas Szasz argues, have “problems with living,” that is, with their adaptation to society. Such problems are real and a therapist may help. But getting therapy is not fundamentally different from seeking the advice of your rabbi, priest, or guru (psychotherapists may have more relevant expertise, but the sufferer’s motivation is similar). These are social, not medical problems: “[so-called] mental illnesses are not, and cannot be, brain diseases,” Szasz flatly declares.6 He will not negotiate this point.
But he is bolder still. He claims that “contemporary ‘biological’ psychiatrists” have already “tacitly recognized” the truth of his polemic, because—whatever they may otherwise loudly express—whenever a condition is shown to be caused by a documented pathology of brain tissue “it ceases to be classified as a mental disorder and is reclassified as a bodily disease.” Conversely,
“in the persistent absence of such evidence [of tissue pathology], a mental disorder becomes a nondisease. That is how one type of mental illness, neurosyphilis, became a brain disease, while another type, homosexuality, became reclassified as a nondisease.”7
But in fact—and here lies the crux of it—homosexuality was not reclassified as a nondisease just from the simple failure to find brain-tissue pathologies; there was also, from the days of Freud to the present, a cultural change. In his time,
“by couching his observations and interventions in the language of medicine and pseudo-medicine, Freud made it appear as if he were morally detached or neutral. … [Yet] he not only speculated about the nature of homosexuality, but he also deplored it as a ‘perversion.’ ”8
Wasn’t Freud turning a social value into a medical diagnosis? He was. That’s obvious from how, when values changed, psychiatrists became embarrassed to say that homosexuality was a disease and simply stopped.
But we must ask: What happens when the relevant value hasn’t changed, and hence no similar social pressure is exerted on psychiatrists? Well, then they go right along imposing by fiat the category ‘medically abnormal’ on run-of-the-mill human variation, calling whatever they like a ‘mental illness’ or a ‘personality disorder,’ and pretending—despite no evidence of tissue pathology—that these are brain diseases.
Or, alternatively, a change of values allows psychiatrists to take people previously pathologized—for their documented disconnection from objective reality—and reinterpret them as healthy people expressing a minority identity.
This is a tremendous power!
Now, consider the personality diagnosis most relevant to a person’s relationship with reality:
Paranoid personality disorder (PPD)—when does it apply?
WebMD confesses that “The exact cause of PPD is not known.”9 This amounts to saying that no tissue pathology is yet understood to produce it. One cannot do a lab test on a blood sample or find it on an MRI. How to diagnose? Since, as WebMD also concedes, “we all have [paranoid] thoughts like this from time to time,”10 and since some of these thoughts may in some contexts be entirely reasonable (for example, if you are a critical subject in Solomon Asch’s experiment!), one must decide whether a given person’s paranoid thoughts are, well, beyond normal.
But ‘normal’ is a criterion that, for these purposes, psychiatrists have the professional power radically to narrow. Indeed, WebMD explains that ‘paranoia’ is included in “ ‘Cluster A’ personality disorders, which involve odd or eccentric ways of thinking.”11
Odd or eccentric—this is a scientific standard?
Aren’t “odd or eccentric ways of thinking,” as mentioned earlier, obligatory for scientists who in fact improve our models of reality? And won’t diagnoses of insanity (okay, ‘mental illness’), if this standard is adopted, be more forthcoming from psychiatrists who are painfully dull and conventional hyper-conformists?
You can see the problem. How to solve it? By looking for other signs of behavioral abnormality in the possibly pathologically paranoid patient?
Nope—that won’t do. Because people with pronounced social oddities or eccentricities can be free of all fantastical ideation and may possess, moreover, a competent grasp of evidence and causality (again, many outstanding scientists come to mind). No, Fromm was right: “Consensual validation as such”—a socially derived (or psychiatrically imposed) standard of ‘normal’—“has no bearing whatsoever on reason or mental health.”
To identify a genuine paranoid pathology one must find the sufferer to be disconnected from reality. But no such disconnection can be identified by reference only to the patient’s assertions and to the (American) psychiatrist’s Diagnostic and Statistical Manual—even if that manual is assumed to be scientifically reasonable. Why? Because one must also know what reality is, and that ain’t in the manual!
To see what I mean, suppose that someone reports being haunted by the hypothesis that a secret organization has taken control of political power, or reports the perception of being in mortal personal danger from agents of that presumed organization. Or suppose that someone believes that everyone in a social psychology lab was colluding to suck him into a fake reality. If psychiatrists already consider such reports as symptoms of the pathologically ‘abnormal,’ the inquiry is circular. There is no inquiry. But it ain’t paranoia if they’re really out to get you, as an old saying wisely points out. Proper diagnosis therefore requires an investigation of the world—not just the patient. That, however, is something that no psychiatrist usually attempts.
An entertaining parable of these problems is Richard Donner’s Conspiracy Theory (written by Brian Helgeland). The film’s fictional story is built around a historically documented case of US-government conspiracy: the CIA ‘mind-control’ program, as they called it, officially codenamed ‘Project MK-Ultra’ and first exposed in the 1975 Church-Committee hearings in the US Senate.
The film is careful to construct its main character, Jerry Fletcher (Mel Gibson), as the type of person whom a psychiatrist would be tempted to diagnose as ‘insane.’ His style of speech, stutter, and sometimes wild eye movements are “odd or eccentric.” The same may be said for his thoughts: he believes that a malevolent secret organization is out to get him. And he defends, moreover, very nonstandard theories of political causality. Except that reality turns out to match Fletcher’s claims rather precisely. He is not mad. The diagnosis of insanity, however, is entirely convenient for the powerful people who wish to control Fletcher (the bad guy is an MK-Ultra psychiatrist).
This film parable makes clear that, to an immoral State that conspires in secret—via its intelligence services—to undermine and abolish the rights and liberties of the citizens, as the CIA infamously did in the MK-Ultra case, it is utterly convenient to have psychiatrists define ‘conspiracy theory’ as evidence of a mental pathology. Citizens who dispute and denounce the government’s official ‘reality’ may be declared insane, drugged, and incarcerated.
It is hardly necessary for all or even most psychiatrists to collude consciously with the intelligence services for this to come about. If ‘polite society’—the institutionally and culturally dominant socioeconomic cohort of the university-trained, to which psychiatrists belong—are raised to believe that ‘conspiracy theory’ is utter nonsense that only uneducated ‘rednecks’ will consider, then psychiatrists will do what they tend to do generally with deviations from local normativity: they’ll diagnose those who suspect nefarious secret activities of the powerful as ‘mentally ill’: paranoid.
The psychiatric power of the State
The film Conspiracy Theory embodies the problem that Szasz identifies: “when this role [‘mentally ill’] is imposed on a person against his will,” he writes, “it serves the interests of those who define him as mentally ill. … it is ascribed in the hope of social control” (emphases mine).12
Yes, and the social control achieved extends beyond the person so diagnosed. Here lies the penetrating power of Szasz’s analysis. For whatever we may think of this legal circumstance, we all know that State-empowered psychiatrists do indeed cart people off to be incarcerated, and so we all silently dread that we might seem crazy to others. That latent diagnostic threat, like a sword over our heads, coerces conformity and docility with the locally dominant reality consensus.
This, Szasz argues, invoking (perhaps unintentionally) echoes of Michel Foucault’s Madness and Civilization, is the creeping reincarnation of Medieval totalitarianism in modern form.
“Formerly, when Church and State were allied, people accepted theological justifications for state-sanctioned coercion. Today, when Medicine and the State are allied, people accept therapeutic justifications for state-sanctioned coercion. This is how, some two hundred years ago, psychiatry became an arm of the coercive apparatus of the state. And this is why today all of medicine threatens to become transformed from personal therapy into political tyranny.”13
(In light of our recent COVID experience, which included a sweeping attack against our citizen rights and liberties using the medical profession as a cudgel, I want to say that Szasz was prophetic. Sadly, however, he didn’t need to be, for this had all happened before: the United States government used professional doctors and psychologists to impose political tyranny, to great effect, during the heyday of the eugenics movement, when Szasz was a child.)
Now consider, with Szasz, the evolutionary process: the adaptations of would-be totalitarians to changing political conditions, how they have substituted, over the centuries, one institution (the Church) with another (psychiatry) but preserving the function.
When Church and State are joined, arbitrary power is maximized by taking the most common, necessary, and desired behaviors (e.g., sex) and calling them ‘sins.’ The same is done for almost any stray dissenting thought, calling it blasphemy or heresy. Only State-sanctioned torture and death may redeem such ‘sins,’ which, being naught but human nature, are inevitable, and place the entire population under suspicion. In this manner, the most troublesome can be picked off at will and turned into vivid examples for the rest: inquisition, witch hunts, burnings, forced conversions, etc.
When Medicine and State are joined, as in our modern world, the same functional result may be had by enlarging the category ‘mentally ill’ to encompass essentially everyone and treating even minor deviations from State-sponsored reality as evidence of a psychiatric disorder. Such disorders may require, at the limit, forcible hospitalization and drugging (to heal the patient from his politically deviant madness).
In this manner, the psychiatric pressure to accept reality, backed by State power, becomes a coercive tool to enforce the citizen’s obedience to officially sanctioned narratives.
But can this really happen in the modern West?
Allen Frances, another psychiatrist, points out that
“psychiatric diagnosis is now being abused for preventive detention of … peasants complaining about corruption in China and previously was an excuse to hospitalize political dissidents in the Soviet Union.”14
But what about, say, the United States?
As mentioned above, this sort of thing already happened in the United States during the heyday of the eugenics movement, though the key diagnosis which got dissidents incarcerated then was not ‘insanity’ but ‘mental retardation.’ Can something like that happen again today?
Given the political structure of the US and the dominant political grammar (liberal in the classical, European sense of respect for personal freedoms), no movement towards Chinese-style or Soviet-style abuses in psychiatry can happen in the US without some informal structural collusion that triangulates 1) professional psychiatrists (however conscious or unconscious of their role in this); 2) the largest pharmaceutical companies; and 3) the State. But I am hardly saying that this is unlikely.
If any such collusion is taking place, the symptoms of it should be evident in the Diagnostic and Statistical Manual (DSM). We should find the DSM squeezing ‘normal’ into such a narrow tightrope walk that almost anything we do becomes a diagnosable ‘mental illness,’ and we should find, on this distorted academic/professional process, the fingerprints of Big Pharma corruption.
In his book Saving Normal, psychiatrist Allen Frances—who was once called “the most powerful psychiatrist in America,” partly because he chaired the task group that edited the DSM-IV—levels precisely this charge: he claims that, massively corrupted by Big Pharma, the psychiatric profession has been squeezing ‘normal’ into extinction, making almost any one of us easily diagnosable as mentally ill. Allen Frances has ‘flipped’: now he is a whistleblower (from the top!).
I conclude the following from reading Frances: the psychiatric pressure to accept reality—the State’s official reality—has been increasingly hemming our thoughts and behavior from all sides. I look into his accusations next:
Sabini, J. (1992). Social Psychology. United Kingdom: Norton. (pp.22-23)
Asch, S. E. (1956). Studies of independence and conformity: I. A minority of one against a unanimous majority. Psychological monographs: General and applied, 70(9), 1. (p.29)
Reina, A. (2010). The spectrum of sanity and insanity. Schizophrenia Bulletin, 36(1), 3-8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800139/#
Fromm, Erich. (2013[1955]). The Sane Society. Open Road Media. Kindle Edition. (pp. 14-15)
Szasz, Thomas. (2011[1974). The Myth of Mental Illness. HarperCollins. Kindle Edition. (loc.56)
The Myth of Mental Illness (op. cit.) loc.303-330
The Myth of Mental Illness (op. cit.) loc.330
The Myth of Mental Illness (op. cit.) p.257
‘Paranoid Personality Disorder’; WebMD; 25 August 2022; Written by WebMD Editorial Contributors and medically Reviewed by Smitha Bhandari.
https://www.webmd.com/mental-health/paranoid-personality-disorder#1
‘Paranoia’; WebMD; 9 September 2021; Written by Paul Frysh, and Medically Reviewed by Jennifer Casarella, MD.
https://www.webmd.com/mental-health/why-paranoid#1
‘Paranoid Personality Disorder’ (op. cit)
The Myth of Mental Illness (op. cit.) p.188
The Myth of Mental Illness (op. cit.) loc.330
Frances, Allen. (2013). Saving Normal. William Morrow. Kindle Edition. (p.20)