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.

Phillips is certainly not so lofty in aspiration as Maslow, nor quite so flagrantly degenerate as Maslow's most baneful stepchildren. For Phillips, moral health appears to be an indispensable part of mental health. "Sanity means loving oneself in exactly the right way, or knowing exactly what it is about oneself that is worth loving." That is, proper self-love demands genuine self-knowledge, and reckoning one's moral worth is the basis of decent behavior toward others. Fundamental decency is, above all, a natural regard for others' inviolable singularity: "No sane kind person can accept a description of another person as in any sense true if that person themself [sic] does not accept it. The sane kind person believes that getting on with people (including oneself) is more important than knowing or understanding people." The sane person has a knack for drawing good people into his life precisely because he has no fixed notion of what goodness is.

To establish such an order of moral rank would constrict his searching and improvisatory nature; it might even get him killed for some insane reason. "The sane person would not think it worth dying for anybody's sentences [sic], including their [sic] own," he writes. Ethical prescription is a form of pontification and imperial self-aggrandizement; universal moral principles must be eradicated, and reverence for individual and cultural uniqueness inculcated: "No adult can know what's best for another adult; and, by the same token, no group or society can know what's best for another group or society."

In a sense, one cannot even really know what's best for oneself, unless it is to eliminate the need to know what's best; for one's strongest impulses and longings tend to conflict with each other, and one sprouts new impulses and longings all the time, so that the perpetual rediscovery of one's nature requires a sane person to make continual adjustments and accommodations. Indeed, to state that one is making a lifelong commitment to another person cannot be sane: "The only sane foregone conclusion about any relationship is that it is an experiment; and that exactly what it is an experiment in will never be clear to the participants. For the sane, so-called relationships could never be subject to contract."

What they are subject to is the endless search for novel pleasures--essential to sanity, within limits: "It would be part of the sane person's sanity to want new forms of pleasure in which neither one's kindness nor one's excitement are overly compromised." Sane sexuality, for example, includes the freedom "to pursue [one's] sexual inclinations not simply as long as they don't harm other people, but as long as they don't harm other people in ways that they don't want to be harmed." Sanity gladly comprises sado-masochism, provided one is kind about it.

In short, Phillips's ideal of sanity is a portrait of liberalism perfected circa 2005: Isaiah Berlin with nipple piercings. Where Phillips is moderate and sensible--at least as such qualities are understood today--his conclusions are of crushing banality; and where he is fashionable and preposterous, his conclusions are of crushing banality. His ideal, moreover, partakes of the liberal intellectual's usual incoherence. On the one hand, sanity requires true self-knowledge and moral judgment; on the other, you don't really need to know yourself, so long as you like yourself.

Yet self-knowledge is also somehow so important that it enjoys absolute moral authority even in those people who lack it entirely. The person who is blind to his own character, or lies to himself, nevertheless sees himself truly, as another person who might penetrate that self-deception and search him to the core does not. (This pretty well obliterates the traditional role of the analyst.) Like each individual, each group or society has its own way of knowing what's best for itself, so even if a particular society is founded on torture, rape, and mass murder--which manifestly offend against the right of a certain group in that society to decide what's best for itself--no other society can say that's wrong, or intervene to end the abominations. This is reasoning, or rather its travesty, plucked screaming from The Guardian's editorial page.

By etymology, psychiatry is the care of the soul. Phillips is not the sort of doctor to whom one's soul can be entrusted, whether it is mortal or immortal. His prescription for sanity even suggests that the social foundation of psychoanalysis is crumbling irreparably; the concept of normality has been so debased that psychoanalysts like Phillips accept the platitudes, confusions, and inanities defining the current culture at its worst as the ideal that their patients should strive to attain. Sanity like his makes neurosis look like the wise alternative.

The sad wisdom of Freud is a relic of a time and place that Phillips is glad to see gone. The replacement Phillips devises is pitiable, laughable, and lunatic.

Algis Valiunas is a writer in Florida.