“Men are so necessarily Mad, that not to be Mad would be itself a form of Madness”

There’s an article here about ‘Mad Pride’, a group of people diagnosed with mental illnesses (couldn’t decide whether to put scare quotes round that…) who advocate personal freedom in deciding whether and what medications to take and treatments to receive. There’s a very long discussion about it in comments here. (The title is a quote from, I believe, Blaise Pascal)

I am broadly sympathetic to ‘mad pride’, ‘anti-psychiatry’, and related movements, but it would be disingenuous of me to act as though I had a confidence and settled opinion that I lack, so I won’t offer a definitive position. What I will offer is a few observations that may help to navigate.

So the first thing is: let’s take the most commonly used argument for forcible treatment, which is that some mentally ill people are dangerous to themselves or to others, and thus it’s irresponsible to not treat them. Now, probability of violence against others is statistically correlated with a number of features: most obviously, being young, and being male.

So I ask – would we consider it acceptable to place serious limits on the freedom and bodily autonomy of young men? Limits which might in some cases be not hyperbolically described as ‘stealing X years of their lives’? Of course, the number of non-violent young men is much larger than the number of dangerous ones. But then, it’s also only a minority of mentally ill people who harm others, and methods of identifying them are not very reliable. Maybe the ratios are different, depending on who we put in what category, but wouldn’t a difference of degree only justify a difference in the degree of denial-of-freedom?

Perhaps some people have no problem locking away young men. It would neatly reverse the pattern of women being more reluctant to go outside on their own that has dominated history. But it seems unlikely. So what’s the difference? One possibly difference is that mentally ill people aren’t capable of making rational decisions (and young men, supposedly, are). It’s not clear that that’s relevant, though, if the issue is simply to protect people. And why think that this is the entire reason for a difference in intuitions, rather than the fact that as a society, we are used to taking the point of view of young men, but not of mentally ill people?

The second observation is that it’s quite possible there might be a general cognitive bias against freedom: when freedom is restricted, the goals aimed at are quite clear and concrete, while the benefits of freedom are always somewhat intangible. This may lead us to under-value them.

The third point is that we should avoid a distortion from our gaze only having one direction – onto mentally ill people. As we scrutinise them we see all their imperfections and the frequency of their folly and irrational decisions. But an unrealistic picture of the medical profession may be festering behind us – we should scrutinise doctors as well, and consider their imperfections, the frequency of their folly and irrational decisions. It would not be entirely false to say that their authority in this field comes from a body of reliable methods and knowledge which they happily admit they do not yet have.

The fourth observation is related: when someone is locked up, we don’t see either how well they would have coped/recovered, or how disastrously they would had exploded. So we have to deal with this systematic flaw in the data.

The fifth and final observation that occurs to me is simply the relationship of this to drug criminalisation. On the one hand people are being forced to take dangerous drugs against their will, on the other hand their being prevented from taking dangerous drugs against their will. And there is a certain shared idea: that altered consciousness must, by being altered, have been distorted.

Perhaps many people both support forcible treatment and oppose drugs legalisation without this idea, but at least some rely on it – any change in one’s mental state that is a product of taking a drug or having an ‘illness’ can only be a diminution of rationality, a blurring and not a clearing of perception. It can’t just be rational in a different way, or even in some respects clearer (that’s not to deny of course that there are many undeniable reductions in rationality – but let’s not rush to absolutes).

Ironically, of course, this typically co-exists with the idea that ‘medical’ drugs will make you ‘saner’, rather than, say, offering you a different sort of madness to cancel out the (more inconvenient) one you have. It also sits uneasily with the fact that we routinely change the levels of various chemicals in our body every day, by exercise, diet, etc. If ‘chemical’ always mean ‘delusional’ then it’s not clear how a chemical brain can be anything but deluded.

The ‘Icaristas’ in the above-linked article talk about ‘exploring’ treatments and medications and finding ones that work. That is, they invert the epistemic focus: rather than sane professionals seeking to understand the mad, the mad seek to understand themselves. Such a focus is not a million miles away from the idea of drug use as a sort of self-exploration: how does my brain work when I give it a bit of this. Perhaps familiarity with a greater range of states might aid in recognising and describing pathological ones.

Of course there is clearly such a thing as drug ‘abuse’, just as there is abuse of alcohol, and even of Facebook. And the motive for such abuse is liable to be greater among the more distressed. It’s never easy to let people decide things for themselves, it’s just that it’s often too easy to declare that ‘we’ (that grand mythological figure) should decide for them.

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