The Magazine

Mental Health

In the post-Freudian world, it's a matter of opinion.

Nov 14, 2005, Vol. 11, No. 09 • By ALGIS VALIUNAS
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Going Sane

Maps of Happiness

by Adam Phillips

Fourth Estate, 245 pp., $24.95

PSYCHOANALYSIS, THE EXTRACTION OF buried psychic matter and its liberating exposure to the light of rational awareness--usually the painstaking work of years--is no longer the mainstay of psychiatry. Doctors offer it more as a technique of self-exploration for the moderately dissatisfied, and rarely present it any longer as the promise of salvation for the profoundly afflicted.

Salvation now lies in the latest psychopharmacology, coupled with talk therapy less protracted and less doctrinaire than the Freudian excavation and its side tunnels. Psychiatry tends to go deeper into the brain these days than it does into the mind, although at its most effective it cares for both. And the most debilitating mental illnesses--depression, schizophrenia, manic-depression, schizoaffective disorder (basically, schizophrenia plus manic-depression)--respond to treatment as never before.

Still, the genius of Freud has left a deep impression on our culture, so it is instructive to see what his most admired heirs are making of the psychoanalytic tradition today. In Going Sane: Maps of Happiness, the English psychoanalyst Adam Phillips, a prolific writer and general editor of the new Penguin translations of Freud, takes on the increasingly popular but still largely unexamined question of what mental health, as opposed to psychopathology, consists of. For Freud himself, mental health involved coming to terms with the civilizing constraints that marked the limits of a rather rueful happiness.

How far we still subscribe to the Freudian conception is a significant measure of our cultural sanity.

Phillips's book is, in large part, a fascinating exercise in the cultural etymology of sanity: With learning of an easy sweep, Phillips shows how the word's usage down the ages discloses society's understanding of itself. The original English meaning of the word, in the 17th century, was "health in body and mind." Samuel Johnson, in his monumental dictionary (1755), narrowed the definition to "soundness of mind."

That straitened definition, however, proved morally expansive. The 19th century ratified the Johnsonian view of soundness as connoting, in Phillips's words, "health and orthodoxy and harmony, and solid and well-established principles." Sanity acquired its current popular meaning as "the opposite of or antidote to madness," with madness embodying the oceanic perils threatening to swamp Victorian moral certainty.

Moral certainty proved a frail little craft, indeed, in the 20th century. Phillips sees psychiatry's break with traditional sanity in a group of renegade disciples of the analyst Melanie Klein. While conventional Kleinians were "averse to madness," which is an essential part of our nature and with which our lives are a ceaseless wrangle, the unorthodox Kleinians generally favored sanity but thought too much of it was a bad thing, confining and warping natural inclinations. The 1960s introduced blatant "anti psychiatry": The theoretician Michel Foucault and the practitioner R.D. Laing taught that "to be sane in a world like this was to be out of touch with reality," and they conspired at "the glamorization of madness--the promotion of madness as revelation, as political protest, as the higher sanity."

By the time Phillips was beginning his psychoanalytic training in the late 1970s, the anti psychiatric vogue had passed, but it did leave its mark. While Phillips is no anti psychiatrist, he does implicitly incorporate into his own description of sanity a moderate version of Laing's critique of normality as Freud understood it.

What the reader of such a book as Phillips's most wants to know is what sanity and happiness mean today. Anyone writing on this matter does so under the influence of the Third Force psychologist (neither Freudian nor behaviorist) A.H. Maslow (1908-1970), apostle of self-actualization, or becoming the best person one can be. No other idea of the past half-century has had so potent and widespread an effect on American culture. That effect has not exactly been for the best, as popularization operates like a sausage-grinder, and has mixed in with Maslow's intellectual choice cut the customary offal, gristle, and rodent hair. Maslow's exhortation to live nobly has thus been corrupted into the mewling prescription to accept yourself as you are, however nasty you may happen to be.