The Abyss of Madness
I saw a 19 year-old woman many years ago, hospitalized, who refused to speak except to say that there were four children living in her bedroom. According to her parents, she had been entirely normal, reportedly perfectly delightful in fact, until just a few weeks before, but now she was in prolonged silence. The psychiatrist assigned to her gave her a diagnosis of schizophrenia, and she was begun on a course of antipsychotic medications. Her behavior remained the same: long stretches of silence, very occasionally interrupted by short statements that four children were in her room. She would not describe the children, explain their origin, or otherwise engage in any further communication on the matter. When asked if she believed the children were real, actual human beings, a look passed across her face of confusion and dismay. The doctor, after a period of weeks, recommended shock therapy, and a course of 12 electroconvulsive treatments then took place. Following these, she spoke just once to say there were now no children in her bedroom; otherwise the reign of silence continued. Finally she was discharged and her family took her home. We never saw her again. But I was haunted by what had occurred and always wondered about what happened to the young woman and what her behavior could have meant. So I thought I might ask my friend Dr. E if he could shed light on the matter. Our discussion, presented below, evolved into a long journey into the nature of madness.
PART I
G.A. So, Dr. E., what do you think of the case of the young woman who said she had children living in her room with her?
Dr. E. It is difficult to offer much of an idea given the limitations of the clinical material, G.A., but I can generate a thought or two if you insist.
G.A. And maybe you can branch out and talk to me about the problem of madness altogether, since I know you have spent a lifetime studying this problem.
Dr. E. What stands out in your little story are five items: first, that she was, according to her parents, a “perfectly delightful” child prior to this transformation in her behavior; second, that the primary change was one of lapsing into silence; third, the sporadic statements regarding there being four children sharing her bedroom; fourth, her apparent confusion in response to being asked about whether she believed the children were real; and fifth, following ECT, her report that the children were no longer present in her bedroom.
Let us suppose that the perfectly delightful girl her parents knew her to be was the product of a surrender, rooted in very early experiences of great power, a deep-ranging accommodation in which she brought herself into compliance with agendas as to who she was and should be, transmitted to her by her mother and father. The identity that developed would then be one taken over from preexisting images they supplied, rather than from her emergent agency and spontaneous intentionality. The sudden disappearance of that delightful girl would thus be comprehensible as an act of rejecting the false self, of fighting back against the enslaving tie to the maternal and/or paternal agenda, and therefore an effort to rescue possibilities of her own being from annihilation. I would interpret the silence as a negation of her compliance, wherein the whole field of speech has been co-opted by the conforming trends of her personality and the only way to oppose them is to stop talking. She stops speaking, however, but not quite completely. The one little statement that remains is about the four children living in her bedroom. Let us assume that this bedroom is a room of her own, a space within which whatever exists or remains of her authentic possibilities can live and survive. Why are there four? Air, earth, fire, and water come to mind – the fundamental elements of the universe. I have read that the quaternity is a symbol of wholeness. Here though one sees not wholeness but fragmentation, a collection of children rather than one coherent personality. Authenticity in the context of extreme pathological accommodation is at best a fragmentary, evanescent sort of thing, scarcely organized at all, lacking in the capacity to endure or coalesce. And yet this is what remains of the young woman’s soul: four children, living in a room of her (their) own.
From a perspective valuing such authenticity, this young woman’s breakdown into silence and delusion might better be considered an attempted breakthrough: to a life that, perhaps for the very first time, would actually belong to her. But such a possibility could not become actual without someone there to recognize and give it such a meaning, without a Thou to perceive the I trying to assemble itself out of its fragmentary possibilities.
Then we come to the so-called treatment of this young woman: medications, followed by electricity. The effect of these interventions was finally reflected in her statement that there were no children in the bedroom. This outcome must be considered a tragedy, a sign of great and perhaps enduring damage having been done to this young person’s chance to somehow pull herself together and have a life that could belong to her.
I was interested also in the apparent bewilderment she seemed to express when asked a question about whether she regarded the children as real. Of course the reason such a question would be asked pertains to the issue of her reality testing, the question as to whether she is in contact with all that her doctors consider true and real. From her point of view, the question would have to be enormously confusing, for it is her need above all that the children be real. In fact the reason she concretized the fragmentary state of her soul into the image of actually living children is precisely that she could not at her center sustain any sense that she was an actually existing, alive, real person. But she is perfectly smart, and could see that her psychiatrist would react to any idea that the children were real as a sign of her serious mental illness, perhaps necessitating further drastic medical interventions. So: to say that the children were not real would be to embrace annihilation; but to claim that they were real would be to accept a pathologizing diagnosis and damaging medical intrusions. She was confused for the simple reason that there is no viable journey possible between this Scylla and this Charybdis.
This is a very sad story, and I hope that she arrived in some better situation once her parents took her away from the institution. I would like to think they found a setting for her in which she could perhaps follow an artistic pathway. The journey of creativity is very often one that supports a person’s sense of being real. It even occurs to me that one could look at her descent into silence and what her psychiatrist saw as delusion as a piece of performance art, affirming her being and expressing to the world an indomitable life spirit within her. It would be extremely interesting to follow what might have happened had her analyst/psychiatrist taken such an attitude toward her so-called symptoms. I suspect she would have found him to be someone she could talk to.
G.A. Okay, but to continue the discussion, tell me more of your thinking on madness, insanity, psychosis, and all related things. Would you consider this young woman in my example to be suffering from madness? What is madness, anyway?
Dr. E. I don’t much use the term “madness,” and I never use the conventional psychiatric diagnostic terms. If you force the question upon me, I suppose I could say a thing or two. I would definitely consider the story of the young woman to be a tale of madness.
G.A. So what is madness?
Dr. E. Madness is the abyss.
G.A. Is that all you have to say about it?
Dr. E. That says it all, but if you want me to say something else, G.A., ask some more questions.
G.A. Define the term “abyss.”
Dr. E. A bottomless void.
G.A. So if someone goes mad, is it correct to say that person falls into a bottomless void?
Dr. E. Yes – infinitely and forever.
G.A. Why do you say infinitely and forever?
Dr. E. Because it is a limitless falling, a plunging into absolute annihilation. There are no halfway measures in this territory – it is all the way or nothing. And when one falls, one falls away from being itself, into utter nonbeing.
G.A. What though is your view of psychiatry’s understanding of madness, of the diagnostic system with its differentiations and classifications, with its view of the various forms of madness as disorders and diseases?
Dr. E. The ever-proliferating systems of nomenclature in psychiatry are among the field’s most serious embarassments, and nowhere as disturbingly as in the efforts that have been made in the study of madness. The notion of an orderly system that arranges and distinguishes this form and that form of infinite falling, nice little categories of a chaos that is beyond imagining and describing, is preposterous. It is human to try to bring order into disorder, but it is also human to be preposterous. The diagnostic systems are actually laughable, and I am ashamed to belong to a field capable of such things. But I am not terribly interested in a formal critique of the diagnostic viewpoint – at this point in my life I have better things to do.
G.A. Are you telling me that madness is not a mental illness?
Dr. E. Madness is the abyss. The abyss is not an illness, it is an experience. It is the experience of utter annihilation. Calling it a disease and distinguishing its forms, arranging its manifestations in carefully assembled lists and charts, creating scientific-sounding pseudo-explanations for it – all of these are highly problematic and I think they occur because of the terror.
G.A. What terror?
Dr. E. The terror of madness itself, which is the anxiety that one may fall into nonbeing. What is the matter with you, G.A.? The answers to your questions are obvious.
G.A. But tell me your further thoughts on the terror of madness, and its consequences.
Dr. E. The abyss lies on or just beyond the horizon of every person’s world, and there is nothing more frightening. Even death does not hold a terror for us comparable to the one associated with the abyss. Our minds can generate meanings and images of our deaths: we can picture the world surviving us, and we can identify with those that come later or otherwise immortalize ourselves through our works. We can rage against the dying of the light, and we can look forward to reunions with lost loved ones. We can think about the meaninglessness of human existence and its finiteness. We can be relieved that all our sorrows will soon be over. We can even admire ourselves for being the only creatures in existence, as far as we know, who perceive their own wretched destiny to be extinguished. The abyss of madness offers no such possibilities: it is the end of all possible responses and meanings, the erasure of a world in which there is anything coherent to respond to, the melting away of anyone to engage in a response. It is much more scary than death, and this is proven by the fact that people in annihilation fear – the terror of madness – so often commit suicide rather than continue with it. Death is a piece of cake compared to the abyss.
G.A. This is once again getting interesting Dr. E., so would you continue with these ideas?
Dr. E. I am not sure where you want me to go, G.A., but I will give you the reflections that come to mind.
I don’t want to get into the details, but I think the reason so many in our society want to think of madness as a brain disease and as arising from organic predispositions is that such ideas soothe the terror of the abyss. One must find some explanation for the extreme claims people in the highest offices of psychiatry make in this connection, because the science to support those claims is not strong, nor will it ever be. The abyss is a potential inhering in every human life, and the dream of psychiatry is to pin down a tangible source or cause for this potential, and once this is successful, so goes the thinking, some intervention will become possible to eliminate it. It is a dream never to be fulfilled. We are stuck with the abyss as an irreducible possibility of our lives, and we would be better off to understand that. Psychiatry here reminds me of the person who has actually fallen into the abyss and then gone on to develop the idea that there is an influencing machine sending persecutory rays into his body and mind. You see, if there is such a machine somewhere, operated by one’s enemies, a hope is held out that this machine can be found, turned off and finally destroyed, and one’s malicious adversaries can then be brought to justice and disposed of. The biological sources of the so-called psychoses are influencing machines, located in the molecular structures of who we are, and once these tiny machines are detected, we can turn them off, modify them, maybe breed them out of the human race. We as doctors can also reassure ourselves that our own organic constitutions do not include the predispositions, the little molecular machines twisted into our DNA, and we are therefore protected from the abyss. Guess what? The abyss is with all of us as a human possibility, forevermore, and so we will never be safe from it.
G.A. You seem to be saying that everyone, all of us, are forever on the threshold of madness – am I hearing you right?
Dr. E. I said no such thing. I said the abyss is a universal possibility, which is not the same thing as saying we all are always on its threshold. Sometimes G.A. you seem kind of lame.
Most of us spend our lives in a stability and sanity that does not bring us, subjectively speaking, to the doorway to madness. Our sense of our own existence and security is steady, in fact is such a given of our lives that we never really think about it. That does not mean, however, that the sanity we enjoy in our cozy little worlds cannot be taken from us. It can, because we all are capable of falling into the abyss. Something might happen and then the center cannot hold.
G.A. What are some of the things that might happen that push a person across the threshold?
Dr. E. Maybe what happens in the fall into the abyss is that the sustaining events of our lives cease to occur. Sometimes people fall not because the bad happens, but rather because the good stops happening. Sanity is sustained by the network of validating, affirming connections that exist in a person’s life, connections to other beings. If those links fail, one falls. The beings on whom one relies include, obviously, other people, sometimes animals, often beings known only through memory and creative imagination. In many instances it is the connection to God that protects a person against madness. Strip any person of his or her sustaining links to others, and that person falls. No one is immune, because madness is a possibility of every human life.
G.A. If a link to God shields some people from the abyss, why is it that the symptoms of madness so often circle around special relationships to God, delusions sometimes even of being God?
Dr. E. To speak of symptoms, G.A., is to return to a medical and diagnostic viewpoint, and it is not helpful in our task of discovering the human meanings in what is expressed to us. Please spare me. Generally people claiming to be God or to have a unique connection to the Almighty are resurrecting a sustaining tie that has been shattered. The so-called delusion recreates a bond to someone lifegiving, and thus becomes comprehensible as an attempt to climb back out of the abyss. The signs and symptoms that psychiatry likes to arrange in its orderly diagnostic systems are pretty much efforts to return to sanity from madness. For example, I once worked with a 7 year-old girl who heard God’s voice speaking to her. She was so occupied with her conversations with the Creator that she was neglecting her schoolwork and ceasing to relate to her family members. I found out what had happened. She had been enmeshed to an extreme degree with her mother in her early years, adopting a role of comforting and soothing which helped the mother keep her emotional balance in a marriage that was full of strife. But then the mother became pregnant and had a hospitalization lasting months because of extreme complications of the pregnancy and a very difficult birth. The child was left with her father, to whom she turned then to replace the missing closeness with her beloved mother. Everything went well for the initial weeks, although there was great anxiety as to whether the mother was going to survive and recover. But then the father, evidently, felt sexually deprived by his wife’s absence, and a period followed of molestation eventually culminating in full sexual intercourse with his daughter. The father, who had begun to replace the missing mother, in the sexual acts destroyed himself as anyone this child could rely on. She was eventually able to tell me, in her doll play, how the whole world “went wobbly” after the father’s intrusions began, which was her way of saying she had begun to fall into the abyss. But the crisis of wobbliness was eventually made to recede by the appearance of a new active relationship in the child’s mind: one to God in Heaven. Her celestial father replaced her earthly one and the stability of her world became resurrected. Her visible behavior became strangely incomprehensible to those around her, but inwardly she was finding her way. I worked with this child for two or three years, and she became less reliant on God and seemed to be doing well. Twenty years later she earned a doctorate in theology, which I thought was interesting. Why should she not devote her life to the one who saved her sanity? Do you see, G.A., how the madness in this case did not lie in the symptoms that were shown? The so-called symptoms in fact were the sanity returning to her world, or trying to. People who have stumbled into the abyss do all kinds of things to bring stability and substantiality back to their worlds, and it is a tragedy of my field that these efforts are confused and conflated with the madness itself. This is also seen in your case of the young woman who said children were living in her bedroom. Those children, I suggested, may well have symbolized what remained of her psychological health.
I need a break, G.A., you are tiring me out. Come back tomorrow please.
PART II
G.A. Good morning, Dr. E.! I want to hear all your further thoughts on madness, its origins, its nature, its treatment. Use what time and energy you have to give us an outline of your understanding of this whole territory of human existence.
Dr. E. All right, I will give you what I can, but we would need years to do it right, and I don’t have years left at this point, my friend. Of course to speak of “treatment” brings one back to the purely medical viewpoint, and very often this exacerbates the madness from which a person is suffering. One of the greatest challenges presented to those who have fallen into the abyss is the pervasive view in psychiatry that there is a disease process taking place within them. What a person in the grip of annihilation needs, above all else, is someone’s understanding of the horror, which will include a human response assisting in the journey back to some sort of psychological survival. A person undergoing an experience of the total meltdown of the universe, when told that his or her suffering stems from a mental illness, will generally feel confused, invalidated, and undermined. Because there are no resources to fight against such a view, its power will petrify subjectivity and deepen the fall into the abyss
G.A. What exactly is meant by the words petrify subjectivity, and why would whatever is referred to here deepen someone’s fall into the abyss of nonbeing?
Dr. E. Because objectifying psychiatric diagnosis is the antithesis of validation and mirroring. It leaves one with an attribution, offered up by a person invested with enormous authority, that can invade and usurp a person’s sense of selfhood, that can operate like a nuclear tipped torpedo exploding in one’s brain. Imagine the situation of a young man in the midst of a fall into the abyss, who has the misfortune to become incarcerated in an institution typical of the ones we have today in America. Perhaps the patient’s doctor, directly or indirectly, communicates the view that he is suffering from “the brain disease” known as schizophrenia. The annihilating impact of such a view then becomes symbolized in the patient’s communications that vicious, destructive voices are speaking to him over invisible wires and saying repeatedly that he should die. In this way a vicious spiral is brought into being, wherein the operation of the medical model injures the patient, whose reactions to the injury in turn reconfirm the correctness of the diagnosis. Around and around we go, and this is generally the situation of madness in America.
G.A. But is it not diagnosis to identify someone as having fallen into the abyss? This is what you said madness is. The words are different, but is it not so that here too we have a classification and a locating of the patient as a member of that particular class?
Dr. E. That question is pathetic, G.A., so think about it, would you? Obviously to note that the particular experiences someone is having involve a fall into nonbeing involves a distinguishing and a knowing, and to that extent, etymologically speaking, one could say it is a diagnosis. But the word ‘diagnosis’ has been absorbed into an objectifying, medical language game, interlocking with all manner of terms and concepts about disease processes, biological roots, treatment possibilities. So I would not want to use the term to describe one’s apprehension that someone has fallen out of the world. Also, my response will be a very different one based on this apprehension – certainly I am not going to tell the patient he is a schizophrenic. I am also not going to say he is mad.
G.A. But you said he was mad, by your own definitions!
Dr. E. Sometimes G.A. I wonder if there is any point in talking to you. You seem so full of questions that if we reflect even briefly on them disclose their utter emptiness. The reason I do not tell someone he or she is mad has to do with how that will likely be heard, what the term ‘madness’ would even mean to someone in an annihilation state. What I would want to do is communicate that I was listening, that I was understanding at least some part of what was being told to me, that I was prepared to do whatever would be necessary to be of help. I would always also try to express all of this in a language that would be likely to be understood in the spirit I intended.
G.A. I am not as stupid as you think Dr. E., and my questions are the ones many people might raise, and there is a chance if you answer them that your understanding might actually begin to reach people otherwise not in touch with these things. Stop being so grumpy!
So let’s be specific and concrete. Imagine a patient who comes to you, and who speaks of his or her destruction. The person expresses a sense of complete personal obliteration. What do you say? How might you respond?
Dr. E. Again obviously, G.A., it will depend on exactly what is said and how it is said, on my understanding of the unique situation of this particular person at this particular moment. There are no general formulas here. I could possibly give an example or two. Suppose a young woman tells me, as someone once did, that she is having hallucinatory visions of a most terrifying kind. She reports being swept away, through space, then physically shrinking and being drawn into the bloodstream of her mother’s body. She is then tumbling helplessly within the coursing blood, trying not to drown, and her face and finally her whole body begin flaking away and dissolving. The vision culminates in a terrifying sense of disappearing altogether, having become indistinguishable from the blood. Again and again this vision came to her, sometimes it being other family members’ bloodstreams into which she dissolved. She cried when she told me of these experiences, and begged me to tell her what was happening.
G.A. Okay, so what did you do? What does one say to someone undergoing such a scary experience? This does seem like the abyss, in that there is a dissolving away of this woman’s face and body and whole identity in the annihilating blood.
Dr. E. I did not tell her she was schizophrenic. I did not tell her she was mad.
I let her telling and retelling of the hallucinations flow over me like a waterfall. A thought then came into my mind, which I decided to speak - for better or for worse. I said to the patient, calling her by her first name:
“Sarah, is it possible that your whole family is nothing but a bunch of bloodsucking vampires?”
G.A. So what happened then?
Dr. E. Sarah was silent for ten or twenty seconds, and then said that no one had ever said anything like that to her before. This was the first conversation I had with this patient, the first of a great, great many. The hallucinations vanished, never to return.
G.A. And? What transpired then? Surely the patient wasn’t cured by this single interpretation.
Dr. E. I won’t complain about your use of the word “cure,” G.A. The hallucinatory visions subsided, permanently, and the story of her life began to emerge. It was a story of extreme trauma and enmeshment, and she needed a great many years to tell it fully.
G.A. You make it sound easy. Like all there is to it is that you caught on to the symbolism of an hallucination, and then listened to a long story.
Dr. E. It was not easy; it was arduous. It required many years. She did well though.
G.A. The story raises some questions. Why did the question posed to her about the family members being vampires cause her hallucination to vanish? Can hallucinations generally be disposed of through such interpretation? Why was she having the hallucination in the first place?
Dr. E. One thing at a time, G.A. The hallucinations vanished because the metaphor they contained had been understood and validated, because there was a new relationship to someone with whom the truth could be spoken. She did come from a family of vampires. But she had never known this as anything that was real to her – in fact, the appearance of the hallucination could be considered a spontaneous and quite profound improvement in her situation, because it contained a reality never before seen. Of course she needed someone to understand what was being expressed; otherwise it would just have been something strange interfering with her functioning. Had it been labeled and treated as a symptom of psychosis, I would imagine her situation would have grown even worse. I don’t know if hallucinations in general can be handled so readily; but I do know that they often contain symbolic metaphors, sometimes expressing the very heart of the matter of what has gone awry in a person’s life. It is obvious that our patients will do better if someone is available to understand these things than if there is not.
G.A. Continue, please.
Dr. E. Another case that comes to mind in a similar connection is that of Daniel Paul Schreber, the German jurist whose Memoirs of My Nervous Illness were analyzed famously by Sigmund Freud. Schreber said, to put it in its simplest terms, that he was the victim of a vast and deadly persecution, organized against him by God with the collusion of his own psychiatrist. His writings about this are highly elaborated, almost elegant equivalents to my patient’s report of her hallucination of being dissolved into the bloodstreams of her relatives.
G.A. So tell us, Dr.E., what you would have done with Daniel Paul Schreber? Would it have been possible to interpret his many hallucinations and delusions? And would they then have disappeared as was the case with your patient?
Dr. E. Let us imagine what one could have done with Schreber, and how he then might have responded himself. Of course the first thing would be to really try to hear what he was saying, and I mean all that he was saying, at different levels of meaning. I would listen to him as he told me of the conspiracy that had been directed against him. I would listen closely as he spoke of the horrifying unmanning to which he was being subjected by his psychiatrist and God, the final goal of which was to transform him body and soul into a woman and bring the process of soul murder to its terrible conclusion.. I would listen attentively to his descriptions of the divine rays coming down from heaven and playing on his mind and body, and of the diabolical miracles taking place within him as a result of this supernatural activity. I would focus on his descriptions of the people surrounding him in the asylum as fleeting improvised men, simulacra apparently existing only for his benefit
G.A. But what happens then? You listen to his descriptions of his delusions and hallucinations, but then what? What do you say, how do you act? What help could there be for a man like Schreber?
Dr. E. The task of listening is more involved than you seem to have taken in, G.A. Not only would I sit with him as he spoke, and carefully read over the manuscripts on which he worked; I would want to hear what he was saying and perhaps give him a sense of being listened to that he had never encountered before. Schreber may well have been a man that no one had ever listened to, at least not at the level of the deepest core of what he experienced. Do you, G.A., know what it is like never to have been listened to? To have been raised in an empathic vacuum, or worse, a setting that closes out all one might authentically feel and then authors and reauthors one’s experience according to the design of alien agendas? A family life that lays down layer upon layer of disqualification and invalidation, insisting all the while on total compliance? I see this man’s background in such terms.
G.A. But how do you accomplish that level of listening?
Dr. E. As in the case of the patient who was swept into her relatives’ bloodstreams, I would let what is said flow over me like a waterfall and see what images and understandings begin to emerge. I picture listening to Schreber tell of God deforming and transforming his body, of the miracles and the rays, of the soul murder being carried out. I would try not to hear any of this as delusion; nor, if there were voices speaking to him, would I think of them as hallucinations. The concepts of delusion and hallucination arise because we are hypnotized by what we think of as the externally real, and once the fascination sets in, we cannot hear what is said to us without judging its degree of concordance with that external reality. It is possible though to set such thoughts aside and listen to what is being said in and for itself.
G.A. Okay, Dr. E. So there you are, with a waterfall of Schreber’s words pouring over you – tell me what ideas and understandings begin to appear for you then.
Dr.E. I see a child locked in a power struggle with a parent – there is evidence that it was his father - a struggle for existence itself. The idea of unmanning and being made into a woman is a stripping away of what makes this male child who he is. It converts him from someone who has a right to his own existence, who is in possession of his own masculine power to act and think, into a woman, which in this historical context probably means a passive vessel of pure receptivity and cooperativeness. This is another way of picturing the fall into the abyss, the erasure of one’s very soul. The child to whom all of this has happened and is happening is telling his story in the so-called delusions and hallucinations, and if that story is heard, that might make all the difference for Schreber. I would want to let him know that I was listening, and that he was succeeding in making me hear what he was trying to say. I would also want to emphasize how I saw that his Memoirs constitute a kind of resurrection of his soul, a reclaiming of the life that had been stolen away from him.
G.A. What about the so-called fleeting improvised men Schreber said he witnessed around him? How would that fit into the ideas you are offering?
Dr. E. If other people in Schreber’s world are construed as a swirling of temporarily assembled appearances, then others are reduced to arbitrary beings having no real substance of their own. This amounts to the ultimate triumph of the will: the whole human world becomes subject to Schreber’s subjectivity - in a way he becomes the only being who is real, an epistemological tyrant with absolute power over the very existence of all other beings. This is a reversal of his original predicament, in which Schreber the child is fashioned into a contraption that materializes his father’s fantasy of the perfect child. So the original improvised man was none other than Daniel Paul Schreber.
I think of a contrast here: another patient regarding; whose treatment I consulted some years ago believed she had been kidnapped into the Truman Show, i.e., that her every act and even her every thought was being broadcast across our country for the entertainment of the population. Her life had thus become a television show and she had been stripped of her own autonomy and substance. Here we have the sovereign power of the Other, in whose gaze the whole of one’s being has become absorbed. She had come to feel she resided exclusively in the mass perception of the American people. Schreber is the reverse: he thought that the masses of people resided solely in his own perception, that they were little more than figments of his imagination, transitory little entities assembled to entertain or otherwise preoccupy him. And yet, still and all, Schreber was himself, in the beginning, a fleeting improvised child.
G.A. You make it sound so easy. How do you let him know you are hearing the story of his life?
Dr. E. It is never easy. To really listen to someone, anyone, to hear the depth of what he or she may have felt, to work one’s way into realms of experience perhaps never before perceived by anyone and therefore never articulated – all of this is as hard a task as one may undertake. Maybe I would try to listen to him and tell him I was doing so by sitting with him, day after day, month after month, year after year if need be. I know I would never say to him he was mentally ill. I certainly would not inform him of his diagnosis of dementia praecox or schizophrenia. Those communications could only deepen his fall into the abyss. I am quite sure his psychiatrist, someone he considered his mortal enemy, spoke to him in precisely such a way, and contributed greatly to his destruction. I might even tell Schreber that he was among the sanest people I had ever met, because I knew he was a man who spoke the truth.
You may not believe this G.A., but it is possible that Schreber would be able to see in my eyes and on my face the recognition and acknowledgment he was seeking, and that nothing more would be needed. Often the simple presence of another human being who is actually listening to the story that is being told is all that is required. Schreber was utterly brilliant, with a sensitive understanding of other people and a penetrating intellect. If someone were really paying attention, it would not be lost upon him.
I am getting tired again, G.A. I will give you one more chance tomorrow.
G.A. See you then old friend.
Part III
G.A. Good morning again my friend! Please tell me more about your understanding of madness.
Dr. E. You have to give me some direction, G.A.
G.A. Okay – how about the causes of madness? What is it really that happens that pushes someone over the edge?
Dr. E. If we approach madness as a human experience, then we would seek an answer to this question in human terms. What are the circumstances under which madness occurs? I already gave a partial answer to this, in the idea of a failure of the sustaining matrix of relationships to others that our sanity is based upon.
G.A. That sounds like an environmentalism casting the person as passive victim Dr. E. Is it not true that sometimes people choose madness, or at least make certain choices that then eventuate in what you describe as the fall into the abyss?
Dr. E. It is not a crude environmentalism, G.A., and you have been talking to me long enough to know better than to interpret what I am saying in such a way. Are you voicing other people’s questions again, my friend, or is it just that you aren’t thinking clearly? Did someone hit you with the stupid stick this morning?
G.A. I want you to spell out the ideas more fully, so please do that and stop complaining old man..
Dr. E. I will not engage in a debate about environmentalism. A failure in the sustaining ties one has to others is not external or environmental, and it is not internal or mental. Forget about all that dualism. It is something that happens subjectively, something felt, lived, endured by the person in whose life the madness erupts. That is the beginning, the middle, and the end. No one ‘chooses’ madness, and no one ‘chooses’ something that leads to madness. In fact the abyss includes the dissolution of choice itself, of all basis in self-experience for agentic action of any kind. It arises out of the utterly disastrous situations in which we find ourselves. Obviously we have a role in creating our situations, favorable or unfavorable. But thinking about the origin of madness requires a different mindset altogether, one that highlights the specific sequence of events occurring in the subjective field of the person’s experience.
G.A. Okay, but lay out such a sequence, and provide another example.
Dr. E. How about this one: imagine a young man, a brilliant physicist and mathematician, someone whose thinking was beyond the minds of his contemporaries in most respects. Imagine further that this man never learned how to relate closely and sensitively with other people, in part because of his exceptional scientific talents and preoccupying interests. He remained, nevertheless, very vulnerable to others’ reactions and opinions, and felt searing shame and humiliation when his socially awkward ways led others to think he was strange and to withdraw from him. In the extreme if someone treated him with hostility and contempt he actually begins to fragment, and avoided such terrible experiences by keeping almost entirely to himself.
Now picture this man, still in his youth but already working at a high level as a physicist, availing himself of the one experience that shored up his otherwise crumbling selfhood: exposing himself to other young men in a public urinal. Here he was, a brilliant scientist, letting it all hang out in the restroom of a public park. Now envision the police arriving, arresting him for indecency, and then communicating with his employer and colleagues about the crime he had been caught committing. Disaster upon disaster, catastrophe on catastrophe - - soon he is fired from his position at a pretigious science institute because of what was seen as unforgivable, intolerable moral depravity.
The story is not over. Our friend, the mathematician/physicist incomparable, experienced all this as the worst attack on his personal selfhood that had ever occurred: one defining him, seemingly irrevocably, as a sex pervert. An explosion took place in the center of his being, one in which all sense of coherent, cohesive identity was blown to pieces and all that was left was a need for unification. Time passed. Terrible, unspeakable agonies occurred. Then, as if brought to him on a magic carpet, an idea appeared that promised to solve everything. His destiny was to achieve the unified field theory, that structure of mathematical and physical concepts that will finally bring Einstein’s theory of relativity together with the theory of quantum mechanics. Over the next years he pours himself into the search for the equations that will help the macroscopic universe make contact with microscopic phenomena in the quantum domain, a theory that will unify gravity with the electromagnetic and other forces of nature. Anticipating glory , he celebrated in advance the lecture he would give upon receiving the Nobel Prize. Thereby, in fantasy, he pulled the fragments together, and displayed a shining coherence for all the world to see. The humiliated, devastated, annihilated soul thus moved toward its own redemption.
One minor problem: the scientific problem he has set out to solve is just too hard. Even though he was brilliant, unifying gravity and electromagnetism required something he was unable to provide, and this no matter how hard he tried. Working late into the night, night after night, month after month, nothing comes forward to bring the division together. Thousands of pages of equations were written down as all his efforts accelerated in the face of frustration and failure.
A vision finally supervened in the midst of this desperate activity: the world itself had become fractured and fragmented into isolated, often warring nations. Our friend now saw his future in even more glorious terms: to bring together the world itself, to heal the divisions that have torn it apart, to establish a unifying world government and usher in everlasting human peace. In this quest he appointed himself Emperor of the Earth whose sovereign rule would establish a human utopia. Guiding messages and confirmations of his destiny were received, telepathically, from advanced civilizations in other galaxies. At this point he actually traveled to various foreign capitals and tried to establish contact with the governing authorities so that his unifying dream could be fulfilled. His behavior now having become disruptive of the routines of ordinary life, however, the police were called and he was incarcerated in a psychiatric asylum. A very sad story.
G.A. So what is the point of this story Dr.E.?
Dr. E. You asked for an example of the sequence of events that lead to madness, and I just gave it to you. How can you ask what is the point? Sometimes, G.A., I just feel like beating you over the head! I know I am an old curmudgeon, but age has its privileges – one of these is the right to tell fools who they are!
G.A. Dr. E., it doesn’t bother me that you call me a fool. Nor do I have an exclusive right to that title; even an old, experienced, well-seasoned gentleman like you might have some ability in the fool department.
Dr. E. Okay, G.A., I will suffer with your insufferable ways. Ask some more questions, my foolish friend.
G.A. What is your understanding of his receiving messages from beyond? And what finally happened to him?
Dr. E. Think about it G.A. He was trying to put the shattered world back together, but the human environment was attacking him, imprisoning him and declaring him crazy. No man is an island, and so an intergalactic Thou crystallized, an Other to support and sustain his efforts to reintegrate and climb back out of the abyss. Here again we see how the struggle to regain one’s footing, to reestablish one’s very being, becomes confused with an illness everyone thinks one is suffering from. Eventually the aliens on whom he tried to draw turned persecutory, which pretty much always happens in such cases. It is simply too hard to sustain a positive vision in the face of so much violence having occurred.
He was subjected to a psychiatric catastrophe, including involuntary incarceration, intrusive, powerful medications, and insulin and electroshock therapy. He was also told that he was mentally ill – specifically, that he was a schizophrenic. This did not help, in that it repeated and exacerbated the other things that had occurred to make him feel terrible about himself. The so-called treatment added to the fragmentation and deepened the fall into the abyss.
Finally, he took matters into his own hands. Ceasing to speak of his mission to unify the planet and the inspiring messages from space, he focused his efforts on giving his doctors what they wanted to see: a man who was oriented to his surroundings, in contact with the externally real, intent on resuming a normal life. He was still getting his messages and inwardly had not given up on destiny; but he was teaching himself not to speak about it, and not even to think about it all very much. His doctors, in turn, stopped telling him he was crazy. Finally he was pronounced dramatically improved and released from his long captivity. He subsequently worked on the periphery of his former field, and I understand did well for many years.
G.A. So how is it then that this story of madness came about as a result of the failure of sustaining human relationships?
Dr. E. What? The story is about that from first to last! I am going to hit you!
THWACK!
G.A. That will be enough for today, Dr. E. When I come back, I will be wearing a helmet.
PART I
G.A. So, Dr. E., what do you think of the case of the young woman who said she had children living in her room with her?
Dr. E. It is difficult to offer much of an idea given the limitations of the clinical material, G.A., but I can generate a thought or two if you insist.
G.A. And maybe you can branch out and talk to me about the problem of madness altogether, since I know you have spent a lifetime studying this problem.
Dr. E. What stands out in your little story are five items: first, that she was, according to her parents, a “perfectly delightful” child prior to this transformation in her behavior; second, that the primary change was one of lapsing into silence; third, the sporadic statements regarding there being four children sharing her bedroom; fourth, her apparent confusion in response to being asked about whether she believed the children were real; and fifth, following ECT, her report that the children were no longer present in her bedroom.
Let us suppose that the perfectly delightful girl her parents knew her to be was the product of a surrender, rooted in very early experiences of great power, a deep-ranging accommodation in which she brought herself into compliance with agendas as to who she was and should be, transmitted to her by her mother and father. The identity that developed would then be one taken over from preexisting images they supplied, rather than from her emergent agency and spontaneous intentionality. The sudden disappearance of that delightful girl would thus be comprehensible as an act of rejecting the false self, of fighting back against the enslaving tie to the maternal and/or paternal agenda, and therefore an effort to rescue possibilities of her own being from annihilation. I would interpret the silence as a negation of her compliance, wherein the whole field of speech has been co-opted by the conforming trends of her personality and the only way to oppose them is to stop talking. She stops speaking, however, but not quite completely. The one little statement that remains is about the four children living in her bedroom. Let us assume that this bedroom is a room of her own, a space within which whatever exists or remains of her authentic possibilities can live and survive. Why are there four? Air, earth, fire, and water come to mind – the fundamental elements of the universe. I have read that the quaternity is a symbol of wholeness. Here though one sees not wholeness but fragmentation, a collection of children rather than one coherent personality. Authenticity in the context of extreme pathological accommodation is at best a fragmentary, evanescent sort of thing, scarcely organized at all, lacking in the capacity to endure or coalesce. And yet this is what remains of the young woman’s soul: four children, living in a room of her (their) own.
From a perspective valuing such authenticity, this young woman’s breakdown into silence and delusion might better be considered an attempted breakthrough: to a life that, perhaps for the very first time, would actually belong to her. But such a possibility could not become actual without someone there to recognize and give it such a meaning, without a Thou to perceive the I trying to assemble itself out of its fragmentary possibilities.
Then we come to the so-called treatment of this young woman: medications, followed by electricity. The effect of these interventions was finally reflected in her statement that there were no children in the bedroom. This outcome must be considered a tragedy, a sign of great and perhaps enduring damage having been done to this young person’s chance to somehow pull herself together and have a life that could belong to her.
I was interested also in the apparent bewilderment she seemed to express when asked a question about whether she regarded the children as real. Of course the reason such a question would be asked pertains to the issue of her reality testing, the question as to whether she is in contact with all that her doctors consider true and real. From her point of view, the question would have to be enormously confusing, for it is her need above all that the children be real. In fact the reason she concretized the fragmentary state of her soul into the image of actually living children is precisely that she could not at her center sustain any sense that she was an actually existing, alive, real person. But she is perfectly smart, and could see that her psychiatrist would react to any idea that the children were real as a sign of her serious mental illness, perhaps necessitating further drastic medical interventions. So: to say that the children were not real would be to embrace annihilation; but to claim that they were real would be to accept a pathologizing diagnosis and damaging medical intrusions. She was confused for the simple reason that there is no viable journey possible between this Scylla and this Charybdis.
This is a very sad story, and I hope that she arrived in some better situation once her parents took her away from the institution. I would like to think they found a setting for her in which she could perhaps follow an artistic pathway. The journey of creativity is very often one that supports a person’s sense of being real. It even occurs to me that one could look at her descent into silence and what her psychiatrist saw as delusion as a piece of performance art, affirming her being and expressing to the world an indomitable life spirit within her. It would be extremely interesting to follow what might have happened had her analyst/psychiatrist taken such an attitude toward her so-called symptoms. I suspect she would have found him to be someone she could talk to.
G.A. Okay, but to continue the discussion, tell me more of your thinking on madness, insanity, psychosis, and all related things. Would you consider this young woman in my example to be suffering from madness? What is madness, anyway?
Dr. E. I don’t much use the term “madness,” and I never use the conventional psychiatric diagnostic terms. If you force the question upon me, I suppose I could say a thing or two. I would definitely consider the story of the young woman to be a tale of madness.
G.A. So what is madness?
Dr. E. Madness is the abyss.
G.A. Is that all you have to say about it?
Dr. E. That says it all, but if you want me to say something else, G.A., ask some more questions.
G.A. Define the term “abyss.”
Dr. E. A bottomless void.
G.A. So if someone goes mad, is it correct to say that person falls into a bottomless void?
Dr. E. Yes – infinitely and forever.
G.A. Why do you say infinitely and forever?
Dr. E. Because it is a limitless falling, a plunging into absolute annihilation. There are no halfway measures in this territory – it is all the way or nothing. And when one falls, one falls away from being itself, into utter nonbeing.
G.A. What though is your view of psychiatry’s understanding of madness, of the diagnostic system with its differentiations and classifications, with its view of the various forms of madness as disorders and diseases?
Dr. E. The ever-proliferating systems of nomenclature in psychiatry are among the field’s most serious embarassments, and nowhere as disturbingly as in the efforts that have been made in the study of madness. The notion of an orderly system that arranges and distinguishes this form and that form of infinite falling, nice little categories of a chaos that is beyond imagining and describing, is preposterous. It is human to try to bring order into disorder, but it is also human to be preposterous. The diagnostic systems are actually laughable, and I am ashamed to belong to a field capable of such things. But I am not terribly interested in a formal critique of the diagnostic viewpoint – at this point in my life I have better things to do.
G.A. Are you telling me that madness is not a mental illness?
Dr. E. Madness is the abyss. The abyss is not an illness, it is an experience. It is the experience of utter annihilation. Calling it a disease and distinguishing its forms, arranging its manifestations in carefully assembled lists and charts, creating scientific-sounding pseudo-explanations for it – all of these are highly problematic and I think they occur because of the terror.
G.A. What terror?
Dr. E. The terror of madness itself, which is the anxiety that one may fall into nonbeing. What is the matter with you, G.A.? The answers to your questions are obvious.
G.A. But tell me your further thoughts on the terror of madness, and its consequences.
Dr. E. The abyss lies on or just beyond the horizon of every person’s world, and there is nothing more frightening. Even death does not hold a terror for us comparable to the one associated with the abyss. Our minds can generate meanings and images of our deaths: we can picture the world surviving us, and we can identify with those that come later or otherwise immortalize ourselves through our works. We can rage against the dying of the light, and we can look forward to reunions with lost loved ones. We can think about the meaninglessness of human existence and its finiteness. We can be relieved that all our sorrows will soon be over. We can even admire ourselves for being the only creatures in existence, as far as we know, who perceive their own wretched destiny to be extinguished. The abyss of madness offers no such possibilities: it is the end of all possible responses and meanings, the erasure of a world in which there is anything coherent to respond to, the melting away of anyone to engage in a response. It is much more scary than death, and this is proven by the fact that people in annihilation fear – the terror of madness – so often commit suicide rather than continue with it. Death is a piece of cake compared to the abyss.
G.A. This is once again getting interesting Dr. E., so would you continue with these ideas?
Dr. E. I am not sure where you want me to go, G.A., but I will give you the reflections that come to mind.
I don’t want to get into the details, but I think the reason so many in our society want to think of madness as a brain disease and as arising from organic predispositions is that such ideas soothe the terror of the abyss. One must find some explanation for the extreme claims people in the highest offices of psychiatry make in this connection, because the science to support those claims is not strong, nor will it ever be. The abyss is a potential inhering in every human life, and the dream of psychiatry is to pin down a tangible source or cause for this potential, and once this is successful, so goes the thinking, some intervention will become possible to eliminate it. It is a dream never to be fulfilled. We are stuck with the abyss as an irreducible possibility of our lives, and we would be better off to understand that. Psychiatry here reminds me of the person who has actually fallen into the abyss and then gone on to develop the idea that there is an influencing machine sending persecutory rays into his body and mind. You see, if there is such a machine somewhere, operated by one’s enemies, a hope is held out that this machine can be found, turned off and finally destroyed, and one’s malicious adversaries can then be brought to justice and disposed of. The biological sources of the so-called psychoses are influencing machines, located in the molecular structures of who we are, and once these tiny machines are detected, we can turn them off, modify them, maybe breed them out of the human race. We as doctors can also reassure ourselves that our own organic constitutions do not include the predispositions, the little molecular machines twisted into our DNA, and we are therefore protected from the abyss. Guess what? The abyss is with all of us as a human possibility, forevermore, and so we will never be safe from it.
G.A. You seem to be saying that everyone, all of us, are forever on the threshold of madness – am I hearing you right?
Dr. E. I said no such thing. I said the abyss is a universal possibility, which is not the same thing as saying we all are always on its threshold. Sometimes G.A. you seem kind of lame.
Most of us spend our lives in a stability and sanity that does not bring us, subjectively speaking, to the doorway to madness. Our sense of our own existence and security is steady, in fact is such a given of our lives that we never really think about it. That does not mean, however, that the sanity we enjoy in our cozy little worlds cannot be taken from us. It can, because we all are capable of falling into the abyss. Something might happen and then the center cannot hold.
G.A. What are some of the things that might happen that push a person across the threshold?
Dr. E. Maybe what happens in the fall into the abyss is that the sustaining events of our lives cease to occur. Sometimes people fall not because the bad happens, but rather because the good stops happening. Sanity is sustained by the network of validating, affirming connections that exist in a person’s life, connections to other beings. If those links fail, one falls. The beings on whom one relies include, obviously, other people, sometimes animals, often beings known only through memory and creative imagination. In many instances it is the connection to God that protects a person against madness. Strip any person of his or her sustaining links to others, and that person falls. No one is immune, because madness is a possibility of every human life.
G.A. If a link to God shields some people from the abyss, why is it that the symptoms of madness so often circle around special relationships to God, delusions sometimes even of being God?
Dr. E. To speak of symptoms, G.A., is to return to a medical and diagnostic viewpoint, and it is not helpful in our task of discovering the human meanings in what is expressed to us. Please spare me. Generally people claiming to be God or to have a unique connection to the Almighty are resurrecting a sustaining tie that has been shattered. The so-called delusion recreates a bond to someone lifegiving, and thus becomes comprehensible as an attempt to climb back out of the abyss. The signs and symptoms that psychiatry likes to arrange in its orderly diagnostic systems are pretty much efforts to return to sanity from madness. For example, I once worked with a 7 year-old girl who heard God’s voice speaking to her. She was so occupied with her conversations with the Creator that she was neglecting her schoolwork and ceasing to relate to her family members. I found out what had happened. She had been enmeshed to an extreme degree with her mother in her early years, adopting a role of comforting and soothing which helped the mother keep her emotional balance in a marriage that was full of strife. But then the mother became pregnant and had a hospitalization lasting months because of extreme complications of the pregnancy and a very difficult birth. The child was left with her father, to whom she turned then to replace the missing closeness with her beloved mother. Everything went well for the initial weeks, although there was great anxiety as to whether the mother was going to survive and recover. But then the father, evidently, felt sexually deprived by his wife’s absence, and a period followed of molestation eventually culminating in full sexual intercourse with his daughter. The father, who had begun to replace the missing mother, in the sexual acts destroyed himself as anyone this child could rely on. She was eventually able to tell me, in her doll play, how the whole world “went wobbly” after the father’s intrusions began, which was her way of saying she had begun to fall into the abyss. But the crisis of wobbliness was eventually made to recede by the appearance of a new active relationship in the child’s mind: one to God in Heaven. Her celestial father replaced her earthly one and the stability of her world became resurrected. Her visible behavior became strangely incomprehensible to those around her, but inwardly she was finding her way. I worked with this child for two or three years, and she became less reliant on God and seemed to be doing well. Twenty years later she earned a doctorate in theology, which I thought was interesting. Why should she not devote her life to the one who saved her sanity? Do you see, G.A., how the madness in this case did not lie in the symptoms that were shown? The so-called symptoms in fact were the sanity returning to her world, or trying to. People who have stumbled into the abyss do all kinds of things to bring stability and substantiality back to their worlds, and it is a tragedy of my field that these efforts are confused and conflated with the madness itself. This is also seen in your case of the young woman who said children were living in her bedroom. Those children, I suggested, may well have symbolized what remained of her psychological health.
I need a break, G.A., you are tiring me out. Come back tomorrow please.
PART II
G.A. Good morning, Dr. E.! I want to hear all your further thoughts on madness, its origins, its nature, its treatment. Use what time and energy you have to give us an outline of your understanding of this whole territory of human existence.
Dr. E. All right, I will give you what I can, but we would need years to do it right, and I don’t have years left at this point, my friend. Of course to speak of “treatment” brings one back to the purely medical viewpoint, and very often this exacerbates the madness from which a person is suffering. One of the greatest challenges presented to those who have fallen into the abyss is the pervasive view in psychiatry that there is a disease process taking place within them. What a person in the grip of annihilation needs, above all else, is someone’s understanding of the horror, which will include a human response assisting in the journey back to some sort of psychological survival. A person undergoing an experience of the total meltdown of the universe, when told that his or her suffering stems from a mental illness, will generally feel confused, invalidated, and undermined. Because there are no resources to fight against such a view, its power will petrify subjectivity and deepen the fall into the abyss
G.A. What exactly is meant by the words petrify subjectivity, and why would whatever is referred to here deepen someone’s fall into the abyss of nonbeing?
Dr. E. Because objectifying psychiatric diagnosis is the antithesis of validation and mirroring. It leaves one with an attribution, offered up by a person invested with enormous authority, that can invade and usurp a person’s sense of selfhood, that can operate like a nuclear tipped torpedo exploding in one’s brain. Imagine the situation of a young man in the midst of a fall into the abyss, who has the misfortune to become incarcerated in an institution typical of the ones we have today in America. Perhaps the patient’s doctor, directly or indirectly, communicates the view that he is suffering from “the brain disease” known as schizophrenia. The annihilating impact of such a view then becomes symbolized in the patient’s communications that vicious, destructive voices are speaking to him over invisible wires and saying repeatedly that he should die. In this way a vicious spiral is brought into being, wherein the operation of the medical model injures the patient, whose reactions to the injury in turn reconfirm the correctness of the diagnosis. Around and around we go, and this is generally the situation of madness in America.
G.A. But is it not diagnosis to identify someone as having fallen into the abyss? This is what you said madness is. The words are different, but is it not so that here too we have a classification and a locating of the patient as a member of that particular class?
Dr. E. That question is pathetic, G.A., so think about it, would you? Obviously to note that the particular experiences someone is having involve a fall into nonbeing involves a distinguishing and a knowing, and to that extent, etymologically speaking, one could say it is a diagnosis. But the word ‘diagnosis’ has been absorbed into an objectifying, medical language game, interlocking with all manner of terms and concepts about disease processes, biological roots, treatment possibilities. So I would not want to use the term to describe one’s apprehension that someone has fallen out of the world. Also, my response will be a very different one based on this apprehension – certainly I am not going to tell the patient he is a schizophrenic. I am also not going to say he is mad.
G.A. But you said he was mad, by your own definitions!
Dr. E. Sometimes G.A. I wonder if there is any point in talking to you. You seem so full of questions that if we reflect even briefly on them disclose their utter emptiness. The reason I do not tell someone he or she is mad has to do with how that will likely be heard, what the term ‘madness’ would even mean to someone in an annihilation state. What I would want to do is communicate that I was listening, that I was understanding at least some part of what was being told to me, that I was prepared to do whatever would be necessary to be of help. I would always also try to express all of this in a language that would be likely to be understood in the spirit I intended.
G.A. I am not as stupid as you think Dr. E., and my questions are the ones many people might raise, and there is a chance if you answer them that your understanding might actually begin to reach people otherwise not in touch with these things. Stop being so grumpy!
So let’s be specific and concrete. Imagine a patient who comes to you, and who speaks of his or her destruction. The person expresses a sense of complete personal obliteration. What do you say? How might you respond?
Dr. E. Again obviously, G.A., it will depend on exactly what is said and how it is said, on my understanding of the unique situation of this particular person at this particular moment. There are no general formulas here. I could possibly give an example or two. Suppose a young woman tells me, as someone once did, that she is having hallucinatory visions of a most terrifying kind. She reports being swept away, through space, then physically shrinking and being drawn into the bloodstream of her mother’s body. She is then tumbling helplessly within the coursing blood, trying not to drown, and her face and finally her whole body begin flaking away and dissolving. The vision culminates in a terrifying sense of disappearing altogether, having become indistinguishable from the blood. Again and again this vision came to her, sometimes it being other family members’ bloodstreams into which she dissolved. She cried when she told me of these experiences, and begged me to tell her what was happening.
G.A. Okay, so what did you do? What does one say to someone undergoing such a scary experience? This does seem like the abyss, in that there is a dissolving away of this woman’s face and body and whole identity in the annihilating blood.
Dr. E. I did not tell her she was schizophrenic. I did not tell her she was mad.
I let her telling and retelling of the hallucinations flow over me like a waterfall. A thought then came into my mind, which I decided to speak - for better or for worse. I said to the patient, calling her by her first name:
“Sarah, is it possible that your whole family is nothing but a bunch of bloodsucking vampires?”
G.A. So what happened then?
Dr. E. Sarah was silent for ten or twenty seconds, and then said that no one had ever said anything like that to her before. This was the first conversation I had with this patient, the first of a great, great many. The hallucinations vanished, never to return.
G.A. And? What transpired then? Surely the patient wasn’t cured by this single interpretation.
Dr. E. I won’t complain about your use of the word “cure,” G.A. The hallucinatory visions subsided, permanently, and the story of her life began to emerge. It was a story of extreme trauma and enmeshment, and she needed a great many years to tell it fully.
G.A. You make it sound easy. Like all there is to it is that you caught on to the symbolism of an hallucination, and then listened to a long story.
Dr. E. It was not easy; it was arduous. It required many years. She did well though.
G.A. The story raises some questions. Why did the question posed to her about the family members being vampires cause her hallucination to vanish? Can hallucinations generally be disposed of through such interpretation? Why was she having the hallucination in the first place?
Dr. E. One thing at a time, G.A. The hallucinations vanished because the metaphor they contained had been understood and validated, because there was a new relationship to someone with whom the truth could be spoken. She did come from a family of vampires. But she had never known this as anything that was real to her – in fact, the appearance of the hallucination could be considered a spontaneous and quite profound improvement in her situation, because it contained a reality never before seen. Of course she needed someone to understand what was being expressed; otherwise it would just have been something strange interfering with her functioning. Had it been labeled and treated as a symptom of psychosis, I would imagine her situation would have grown even worse. I don’t know if hallucinations in general can be handled so readily; but I do know that they often contain symbolic metaphors, sometimes expressing the very heart of the matter of what has gone awry in a person’s life. It is obvious that our patients will do better if someone is available to understand these things than if there is not.
G.A. Continue, please.
Dr. E. Another case that comes to mind in a similar connection is that of Daniel Paul Schreber, the German jurist whose Memoirs of My Nervous Illness were analyzed famously by Sigmund Freud. Schreber said, to put it in its simplest terms, that he was the victim of a vast and deadly persecution, organized against him by God with the collusion of his own psychiatrist. His writings about this are highly elaborated, almost elegant equivalents to my patient’s report of her hallucination of being dissolved into the bloodstreams of her relatives.
G.A. So tell us, Dr.E., what you would have done with Daniel Paul Schreber? Would it have been possible to interpret his many hallucinations and delusions? And would they then have disappeared as was the case with your patient?
Dr. E. Let us imagine what one could have done with Schreber, and how he then might have responded himself. Of course the first thing would be to really try to hear what he was saying, and I mean all that he was saying, at different levels of meaning. I would listen to him as he told me of the conspiracy that had been directed against him. I would listen closely as he spoke of the horrifying unmanning to which he was being subjected by his psychiatrist and God, the final goal of which was to transform him body and soul into a woman and bring the process of soul murder to its terrible conclusion.. I would listen attentively to his descriptions of the divine rays coming down from heaven and playing on his mind and body, and of the diabolical miracles taking place within him as a result of this supernatural activity. I would focus on his descriptions of the people surrounding him in the asylum as fleeting improvised men, simulacra apparently existing only for his benefit
G.A. But what happens then? You listen to his descriptions of his delusions and hallucinations, but then what? What do you say, how do you act? What help could there be for a man like Schreber?
Dr. E. The task of listening is more involved than you seem to have taken in, G.A. Not only would I sit with him as he spoke, and carefully read over the manuscripts on which he worked; I would want to hear what he was saying and perhaps give him a sense of being listened to that he had never encountered before. Schreber may well have been a man that no one had ever listened to, at least not at the level of the deepest core of what he experienced. Do you, G.A., know what it is like never to have been listened to? To have been raised in an empathic vacuum, or worse, a setting that closes out all one might authentically feel and then authors and reauthors one’s experience according to the design of alien agendas? A family life that lays down layer upon layer of disqualification and invalidation, insisting all the while on total compliance? I see this man’s background in such terms.
G.A. But how do you accomplish that level of listening?
Dr. E. As in the case of the patient who was swept into her relatives’ bloodstreams, I would let what is said flow over me like a waterfall and see what images and understandings begin to emerge. I picture listening to Schreber tell of God deforming and transforming his body, of the miracles and the rays, of the soul murder being carried out. I would try not to hear any of this as delusion; nor, if there were voices speaking to him, would I think of them as hallucinations. The concepts of delusion and hallucination arise because we are hypnotized by what we think of as the externally real, and once the fascination sets in, we cannot hear what is said to us without judging its degree of concordance with that external reality. It is possible though to set such thoughts aside and listen to what is being said in and for itself.
G.A. Okay, Dr. E. So there you are, with a waterfall of Schreber’s words pouring over you – tell me what ideas and understandings begin to appear for you then.
Dr.E. I see a child locked in a power struggle with a parent – there is evidence that it was his father - a struggle for existence itself. The idea of unmanning and being made into a woman is a stripping away of what makes this male child who he is. It converts him from someone who has a right to his own existence, who is in possession of his own masculine power to act and think, into a woman, which in this historical context probably means a passive vessel of pure receptivity and cooperativeness. This is another way of picturing the fall into the abyss, the erasure of one’s very soul. The child to whom all of this has happened and is happening is telling his story in the so-called delusions and hallucinations, and if that story is heard, that might make all the difference for Schreber. I would want to let him know that I was listening, and that he was succeeding in making me hear what he was trying to say. I would also want to emphasize how I saw that his Memoirs constitute a kind of resurrection of his soul, a reclaiming of the life that had been stolen away from him.
G.A. What about the so-called fleeting improvised men Schreber said he witnessed around him? How would that fit into the ideas you are offering?
Dr. E. If other people in Schreber’s world are construed as a swirling of temporarily assembled appearances, then others are reduced to arbitrary beings having no real substance of their own. This amounts to the ultimate triumph of the will: the whole human world becomes subject to Schreber’s subjectivity - in a way he becomes the only being who is real, an epistemological tyrant with absolute power over the very existence of all other beings. This is a reversal of his original predicament, in which Schreber the child is fashioned into a contraption that materializes his father’s fantasy of the perfect child. So the original improvised man was none other than Daniel Paul Schreber.
I think of a contrast here: another patient regarding; whose treatment I consulted some years ago believed she had been kidnapped into the Truman Show, i.e., that her every act and even her every thought was being broadcast across our country for the entertainment of the population. Her life had thus become a television show and she had been stripped of her own autonomy and substance. Here we have the sovereign power of the Other, in whose gaze the whole of one’s being has become absorbed. She had come to feel she resided exclusively in the mass perception of the American people. Schreber is the reverse: he thought that the masses of people resided solely in his own perception, that they were little more than figments of his imagination, transitory little entities assembled to entertain or otherwise preoccupy him. And yet, still and all, Schreber was himself, in the beginning, a fleeting improvised child.
G.A. You make it sound so easy. How do you let him know you are hearing the story of his life?
Dr. E. It is never easy. To really listen to someone, anyone, to hear the depth of what he or she may have felt, to work one’s way into realms of experience perhaps never before perceived by anyone and therefore never articulated – all of this is as hard a task as one may undertake. Maybe I would try to listen to him and tell him I was doing so by sitting with him, day after day, month after month, year after year if need be. I know I would never say to him he was mentally ill. I certainly would not inform him of his diagnosis of dementia praecox or schizophrenia. Those communications could only deepen his fall into the abyss. I am quite sure his psychiatrist, someone he considered his mortal enemy, spoke to him in precisely such a way, and contributed greatly to his destruction. I might even tell Schreber that he was among the sanest people I had ever met, because I knew he was a man who spoke the truth.
You may not believe this G.A., but it is possible that Schreber would be able to see in my eyes and on my face the recognition and acknowledgment he was seeking, and that nothing more would be needed. Often the simple presence of another human being who is actually listening to the story that is being told is all that is required. Schreber was utterly brilliant, with a sensitive understanding of other people and a penetrating intellect. If someone were really paying attention, it would not be lost upon him.
I am getting tired again, G.A. I will give you one more chance tomorrow.
G.A. See you then old friend.
Part III
G.A. Good morning again my friend! Please tell me more about your understanding of madness.
Dr. E. You have to give me some direction, G.A.
G.A. Okay – how about the causes of madness? What is it really that happens that pushes someone over the edge?
Dr. E. If we approach madness as a human experience, then we would seek an answer to this question in human terms. What are the circumstances under which madness occurs? I already gave a partial answer to this, in the idea of a failure of the sustaining matrix of relationships to others that our sanity is based upon.
G.A. That sounds like an environmentalism casting the person as passive victim Dr. E. Is it not true that sometimes people choose madness, or at least make certain choices that then eventuate in what you describe as the fall into the abyss?
Dr. E. It is not a crude environmentalism, G.A., and you have been talking to me long enough to know better than to interpret what I am saying in such a way. Are you voicing other people’s questions again, my friend, or is it just that you aren’t thinking clearly? Did someone hit you with the stupid stick this morning?
G.A. I want you to spell out the ideas more fully, so please do that and stop complaining old man..
Dr. E. I will not engage in a debate about environmentalism. A failure in the sustaining ties one has to others is not external or environmental, and it is not internal or mental. Forget about all that dualism. It is something that happens subjectively, something felt, lived, endured by the person in whose life the madness erupts. That is the beginning, the middle, and the end. No one ‘chooses’ madness, and no one ‘chooses’ something that leads to madness. In fact the abyss includes the dissolution of choice itself, of all basis in self-experience for agentic action of any kind. It arises out of the utterly disastrous situations in which we find ourselves. Obviously we have a role in creating our situations, favorable or unfavorable. But thinking about the origin of madness requires a different mindset altogether, one that highlights the specific sequence of events occurring in the subjective field of the person’s experience.
G.A. Okay, but lay out such a sequence, and provide another example.
Dr. E. How about this one: imagine a young man, a brilliant physicist and mathematician, someone whose thinking was beyond the minds of his contemporaries in most respects. Imagine further that this man never learned how to relate closely and sensitively with other people, in part because of his exceptional scientific talents and preoccupying interests. He remained, nevertheless, very vulnerable to others’ reactions and opinions, and felt searing shame and humiliation when his socially awkward ways led others to think he was strange and to withdraw from him. In the extreme if someone treated him with hostility and contempt he actually begins to fragment, and avoided such terrible experiences by keeping almost entirely to himself.
Now picture this man, still in his youth but already working at a high level as a physicist, availing himself of the one experience that shored up his otherwise crumbling selfhood: exposing himself to other young men in a public urinal. Here he was, a brilliant scientist, letting it all hang out in the restroom of a public park. Now envision the police arriving, arresting him for indecency, and then communicating with his employer and colleagues about the crime he had been caught committing. Disaster upon disaster, catastrophe on catastrophe - - soon he is fired from his position at a pretigious science institute because of what was seen as unforgivable, intolerable moral depravity.
The story is not over. Our friend, the mathematician/physicist incomparable, experienced all this as the worst attack on his personal selfhood that had ever occurred: one defining him, seemingly irrevocably, as a sex pervert. An explosion took place in the center of his being, one in which all sense of coherent, cohesive identity was blown to pieces and all that was left was a need for unification. Time passed. Terrible, unspeakable agonies occurred. Then, as if brought to him on a magic carpet, an idea appeared that promised to solve everything. His destiny was to achieve the unified field theory, that structure of mathematical and physical concepts that will finally bring Einstein’s theory of relativity together with the theory of quantum mechanics. Over the next years he pours himself into the search for the equations that will help the macroscopic universe make contact with microscopic phenomena in the quantum domain, a theory that will unify gravity with the electromagnetic and other forces of nature. Anticipating glory , he celebrated in advance the lecture he would give upon receiving the Nobel Prize. Thereby, in fantasy, he pulled the fragments together, and displayed a shining coherence for all the world to see. The humiliated, devastated, annihilated soul thus moved toward its own redemption.
One minor problem: the scientific problem he has set out to solve is just too hard. Even though he was brilliant, unifying gravity and electromagnetism required something he was unable to provide, and this no matter how hard he tried. Working late into the night, night after night, month after month, nothing comes forward to bring the division together. Thousands of pages of equations were written down as all his efforts accelerated in the face of frustration and failure.
A vision finally supervened in the midst of this desperate activity: the world itself had become fractured and fragmented into isolated, often warring nations. Our friend now saw his future in even more glorious terms: to bring together the world itself, to heal the divisions that have torn it apart, to establish a unifying world government and usher in everlasting human peace. In this quest he appointed himself Emperor of the Earth whose sovereign rule would establish a human utopia. Guiding messages and confirmations of his destiny were received, telepathically, from advanced civilizations in other galaxies. At this point he actually traveled to various foreign capitals and tried to establish contact with the governing authorities so that his unifying dream could be fulfilled. His behavior now having become disruptive of the routines of ordinary life, however, the police were called and he was incarcerated in a psychiatric asylum. A very sad story.
G.A. So what is the point of this story Dr.E.?
Dr. E. You asked for an example of the sequence of events that lead to madness, and I just gave it to you. How can you ask what is the point? Sometimes, G.A., I just feel like beating you over the head! I know I am an old curmudgeon, but age has its privileges – one of these is the right to tell fools who they are!
G.A. Dr. E., it doesn’t bother me that you call me a fool. Nor do I have an exclusive right to that title; even an old, experienced, well-seasoned gentleman like you might have some ability in the fool department.
Dr. E. Okay, G.A., I will suffer with your insufferable ways. Ask some more questions, my foolish friend.
G.A. What is your understanding of his receiving messages from beyond? And what finally happened to him?
Dr. E. Think about it G.A. He was trying to put the shattered world back together, but the human environment was attacking him, imprisoning him and declaring him crazy. No man is an island, and so an intergalactic Thou crystallized, an Other to support and sustain his efforts to reintegrate and climb back out of the abyss. Here again we see how the struggle to regain one’s footing, to reestablish one’s very being, becomes confused with an illness everyone thinks one is suffering from. Eventually the aliens on whom he tried to draw turned persecutory, which pretty much always happens in such cases. It is simply too hard to sustain a positive vision in the face of so much violence having occurred.
He was subjected to a psychiatric catastrophe, including involuntary incarceration, intrusive, powerful medications, and insulin and electroshock therapy. He was also told that he was mentally ill – specifically, that he was a schizophrenic. This did not help, in that it repeated and exacerbated the other things that had occurred to make him feel terrible about himself. The so-called treatment added to the fragmentation and deepened the fall into the abyss.
Finally, he took matters into his own hands. Ceasing to speak of his mission to unify the planet and the inspiring messages from space, he focused his efforts on giving his doctors what they wanted to see: a man who was oriented to his surroundings, in contact with the externally real, intent on resuming a normal life. He was still getting his messages and inwardly had not given up on destiny; but he was teaching himself not to speak about it, and not even to think about it all very much. His doctors, in turn, stopped telling him he was crazy. Finally he was pronounced dramatically improved and released from his long captivity. He subsequently worked on the periphery of his former field, and I understand did well for many years.
G.A. So how is it then that this story of madness came about as a result of the failure of sustaining human relationships?
Dr. E. What? The story is about that from first to last! I am going to hit you!
THWACK!
G.A. That will be enough for today, Dr. E. When I come back, I will be wearing a helmet.