Arne Dietrich - The Mythconception of the Mad Genius

Vincent van Gogh, Isaac Newton, Wolfgang Amadeus Mozart, Ludwig van Beethoven, Edgar Allan Poe, Franz Kafka, Robert Schumann, Michelangelo, Virginia Wolf, Richard Strauss, Leo Tolstoy, John Keats, John Nash, and Ernest Hemingway, just to name a few. All of these great artists and thinkers suffered from some form of affective disorder (usually thought to be bipolar), alcoholism, psychosis, or were just plain weird (eccentric is probably a kinder word).

If we added in more recent creatives with mental illness, such as Kurt Cobain (deceased), Elliott Smith (deceased), Stephen Fry, Jim Morrison (deceased), Allen Ginsberg, Janis Joplin (deceased), Kristin Hersh, Syd Barrett (deceased), Brain Wilson, Ray Davies, Jim Carrey, Ian Curtis (deceased), Sylvia Plath (deceased), and the lest could go on and on. Those listed as deceased died from causes related to their mental illness, directly or indirectly.

Kristin Hersh (of Throwing Muses fame, as well as her amazing solo work) is a popular example of a gifted, perhaps "genius," musician whose mental illness shaped her work.

Here are the lyrics to a song she wrote 10 years before recording it because she was unable to play it "without throwing up." Notice there are no stanza breaks, bridges, or chorus - this is probably what it feels like to be manic - and it almost feels like she sings it in one breath. It's not surprising then that 1984 was the year she was first diagnosed with schizophrenia (later changed to bipolar).

The letter

September 29, 1984 Dear so and so
Gather me up because I'm lost
Or I'm back where I started from
I'm crawling on the floor Rolling on the ground
I might cry I won't go home
So here's the story
I am turning up in circles
And I'm spinning on my knuckles
Don't forget that there are circles left undone
And very close to me
Forgive me Comfort me
I'm crawling on the floor Rolling on the ground
There's a blanket wrapped around my head
I'm moving in a line that's shaped like this
I'm holding in my breath I have a room
Can you tell if I am lying
Don't forget that I'm living inside
The space where walls and floor meet
There's a box inside my chest
An animal stuffed with my frustration
Can you hear me?
Don't forget that I'm alone when you're away
You make me act like other people do
Forgive me Comfort me You comfort me
You make me die I'm gonna cry I won't go home
Don't kill the god of sadness
Just don't let her get you down
See that man inside that book I read
Can't handle his own head
So what the hell am I supposed to do?
I'd like to know how he died
My hands are shaking Don't you love me anymore
I only need a person, keep my shoulders
Stand around lie down
Move your hand above the floor
Gather me up because I'm lost
Or I'm back where I started from
I'm crawling on the ground Rolling on the floor
I'm gonna cry You look for me
Love Kristin, P.S. keep them coming

This is what it sounds like, notice how the tempo and voice change:


Hersh had this to say about her mental illness (she has talked about hearing voices and described music as something she has "almost no control over, like well-rehearsed Tourette's"), from an interview in The Guardian.

"I feel like music is real and bipolar disorder is not any longer," she says. "I hated the connection between mental illness and art. I couldn't stand that you had to be sick in order to create beauty, or confused to create truth. It made no sense. It was a huge relief to be essentially cured."

We accept without questioning that mental illness and creativity are intimately linked, and there is some genetic evidence that there is a real connection (see here [bipolar]). Other researchers have found slightly higher rates of some neuroses (here [particularly in writers]), although that connection is tenuous.

Perhaps at the most extreme end of the spectrum, in those we might consider true geniuses, there is a greater tendency toward psychological challenges. But in general there is very little real correlation, let alone causation, between creativity and insanity.

In the article below, Arne Dietrich dispels that "mythconception."


Full Citation: 
Dietrich A. (2014, Feb 26). The mythconception of the mad genius. Frontiers in Psychology: Psychopathology; 5:79. doi: 10.3389/fpsyg.2014.00079

The mythconception of the mad genius

Arne Dietrich
Department of Psychology, American University of Beirut, Beirut, Lebanon

Take troubled Vincent van Gogh, famed 19th century painter who suffered from bipolar disorder, cut off part of his left ear, and eventually committed suicide. Or Isaac Newton, eccentric 17th century physicist, general headcase, and judging from his leviathan superego, a candidate for making the diagnostic criteria of at least half a dozen psychological disorders. No sooner do we contemplate this aberrant pair, a whole army of mad geniuses springs to mind led by such illustrious figures as autistic Wolfgang Amadeus, depressed Ludwig van, or tortured Edgar Allan. Like Franz Kafka, Robert Schumann, Michelangelo, Virginia Wolf, Richard Strauss, John Nash, or Ernest Hemingway, they were all, at some point in their lives, anguished, tormented, alcoholic, angst-ridden, manic, outright psychotic, or just plain weird. Add the mind-boggling savant syndrome, throw in a quote from a venerable ancient Greek for good measure—say, Aristotle: “No great mind has ever existed without a touch of madness”—and we have the making of mythconception (for more details, see Rothenberg, 1990; Schlesinger, 2009, 2012; Simonton, in press).

Writers must by now have spilled gallons of ink over the purported link between creativity and madness filling shelves of books and articles (e.g., Post, 1994; Kaufman, 2005; Koh, 2006). Such tales from the insanity zone are nuggets of pure gold for the true believer in the unlock-your-infinite-creative-potential movement. What if we could just open “the doors of perception?” What would we have lost had Prozac turned Nietzsche into a regular bloke? Sadly, there is no sign that this kettle is going off the boil anytime soon. Hollywood can't get enough of it. Nor does the TED Conference, the new home of international meme laundering. The narrative of the troubled genius just strikes all the right chords for coverage in the tweet-sized attention span of modern news reporting. Not even the BBC can resist, having featured a headline last year reading: “Creativity ‘closely entwined with mental illness”’ (Kyaga et al., 2011; Roberts, 2012). Such frenzied enthusiasm and a few flag-waving generalization might be forgiven among those untouched by the purifying powers of statistical reasoning, but one would expect more professional scrutiny in the rarefied air of peer-reviewed psychology journals. Far from it. Even in the academic ether do respectable people, even those of the highest scientific standing, regularly rise to levels of speculation that can safely be called imprudent (see, for instance, Jamison, 1993).

So what, then, is the link? Is there indeed just a thin line separating insanity from genius? The best place to start looking for an answer, one would think, is the scientific literature—if that is the right phrase to use here. I say this because one quickly discovers, while perusing this literature, that there does not seem to be any scientific data on the matter. The entire thesis of the highly-gifted mentally ill rests entirely on an unholy marriage of case reports and anecdotal storytelling (see for instance, Jamison, 1993 or Post, 1994). It is not uncommon, for instance, to read articles galloping through so many esoteric live episodes, irrelevant factoids, and so much delicious gossip (did you know that the reclusive William Cavendish insisted on having a chicken roasting at all hours of the day?), that the validity of the link is all but a foregone conclusion. But it is one thing to be enchanted by folklore, it is quite another to turn a blind eye to lethal doses of selective data reporting.

Like no other field of psychology, the study of creativity is beset with nebulous concepts, combustible propositions and myopic theorizing, to say nothing of all the vacuous fluff out there. The fog enshrouding this particular Potemkin village is nevertheless easy to lift. We need only to drill into some basic numbers on mental illness that continue to be enthusiastically ignored—incidence and prevalence data, to be precise—take the wraps off an astonishing medley of cognitive biases—base rate fallacy, availability heuristic, illusionary correlations and the like—and unpack a few question-begging definitions of creativity.

As every undergraduate student knows, to establish a positive correlation between event A and some other event B, you need to collect baseline data on the frequency of both events. According to the (World Health Organization, 2013), mental illness, unlike genius, is by no means a rare phenomenon. Mood disorders, such as the various forms of bipolar and depressive disorders, occur in about 10% of the population. This amounts to hundreds of millions of people! Similar prevalence rates exist for anxiety disorders, which makes for a few more—wait for it—hundreds of millions of people! There is somewhat less suffering from schizophrenia, substance abuse disorder, the different kinds of personality disorders and autism, but enough to add several tens of millions more. The Centers for Disease Control and Prevention (2001) estimated in 2001—when the world's population stood at 6.2 billion, or about a billion less than today—that there were some 450,000,000 people living in poor mental health. The lifetime incidence of people making at least a single visit to the mind's Pre-Hell is said to be significantly over 50%.

What do these staggering numbers mean? In the somber land of regression curves, they tell us that we can spare ourselves the trouble of determining the frequency of eminence in the population. For, irrespective of how we define creativity, let alone genius, this number must be less—vastly less. The simple truth of the matter is that the VAST majority of creative people are not mentally ill and, more importantly, the VAST majority of those suffering from psychopathology are not geniuses. Seen in this light, the claim that creativity and insanity somehow go together sounds more like densely ignorant nonsense, the stunted idea of someone who spent too many hours in a hot tub.

It isn‘t my goal here to make a case for the opposite claim, but, by all evidence, it is hard to escape that conclusion. By the looks of these numbers, I would wager good money that the link between mental illness and genius is negative. To be exact: extremely negative. This isn’t to say that there might be something to it, perhaps if the data is parsed differently (see Simonton, in press), but this link, unqualified as in the BBC headline above, is wrong—outright! This would seems to hold not only for psychopathology tout court, but also for each psychological disorder alone, as well as, to restrict things further to severe cases of a given disorder or to specific types of creativity (Waddell, 1998). That this fact has been almost universally overlooked, like one would a tic, is as crazy as it is amazing.

Most psychology undergraduate students, if they are reasonably attentive, would recognize the mad-genius howler as a textbook case of the base rate fallacy (Kahneman and Tversky, 1973). This common statistical sin, also known as base rate neglect, concerns the tendency to focus on specific information and ignore generic, baseline information, even when—and here is the rub—the latter is presented. Thus, people greatly underestimate the probability of a genius being totally sane and greatly overestimate the probability of an individual with mental illness being creative. The fact is that a very large proportion of creative people have no pathological symptoms (Simonton, 2005, in press). Incidentally, the same reference point neglect occurs for insanity and violence (Stuart, 2003). This link, too, is strongly negative, despite the perception we get from the media.

But it doesn't end there. This error in thinking is so extensive and the opportunities for flummoxing so abundant that this matter is sure to continue to generate more heat than light. It is a disarming reflection of our reluctance, or inability, to think statistically that we just can't seem to snap, crackle, pop out of it. What makes our intuition misfire by such a wide margin? Seeing the world through our own warped force field is standard operating procedure of course. Psychologists have long accepted the sobering fact that our mind comes with a whole stack of cognitive biases preloaded and preinstalled. Without getting too technical about it, the one doing most of the dopamine squirting here bears the inauspiciously label “availability heuristic.” It is a mental shortcut that estimates the likelihood or frequency of an event by the ease with which a specific instance of it comes to mind. So when you think about the creativity-madness link, the odd behaviors of Michael Jackson are more likely to guide you than the 99% media-invisible normals.

The availability heuristic as a cognitive mechanism was first proposed and demonstrated by Kahneman and Tversky (1973). In a now classic experiment, they asked people to judge the likelihoods of an English word either starting with the letter K or having a K as its third letter. With people more readily thinking of kitchen, kennel or kickboxing than ankle, Eskimo or acknowledge, their participants overestimated the number of words starting with a K and underestimated those with a K in third position. An English text, however, has about three times as many words with a third-place K; they are just not as available in memory.

What's more, the availability heuristic also causes illusionary correlations, for the same reason. This leads to the perception of a non-existent relationship between two events simply because they occurred together at some point in the past (Chapman, 1967). Alternatively, this false impression can also arise from the way people incorrectly integrate contingency information (Perales and Shanks, 2007). Naturally enough, the more vivid the pairing, the more people tend to enduringly conflate the events and overestimate the frequency of their co-occurrence, and thus their causal relationship. The loopy logic then comes full circle with the confirmation bias, the tendency people have of confirming their existing beliefs. Cases that substantiate the belief, and ambiguous information that can be tweaked that way, strengthens the imaginary connection, while cases that violate or disconfirm it are ignored. Consider this rather typical finding from Redelmeier and Tversky (1996), who asked arthritis patients to track the weather over 15 months and judge to what extent their condition was related to it. While the correlation was actually zero, virtually all were certain that their level of pain depended on the weather. We have here a knockdown one-two punch then. The availability heuristic serves as the seed for the illusionary correlation between madness and genius, and the confirmation bias supplies the fertilizer that nourishes it.

I could go on and on. In fact, I think I will. Pulling conceptual rabbits out of metaphysical thin air is routine business in creativity research. Open any source, academic or otherwise, and you will find the concept of creativity linked to, say, low arousal, defocused attention, right brains, unconscious processes, lateral thinking, or altered states of consciousness, to name but a few popular themes, when common sense alone tells you that their opposites are also sources of creative thinking (Dietrich, 2007). Consider, for instance, a study by Kyaga and colleagues (2011) that searched the database of Swedish registries for the insanely gifted, as it were. The real humdinger of the study was the operational definition of creativity. They found mental illness to be more common in people holding “creative occupations“—artists, writers, and scientists—compared to the evidently insipid army of accountants and auditors. Not only would this be news to engineers in Silicon Valley, but also the authors ask us to accept that writers and graphic designers are—by definitional fiat—creative. This is nuts. For the record, this study is the one that led to the BBC headline quoted earlier.

All of this would seem to suggest that some serious scientific work needs to be done on the matter. In addition to controlling for cognitive biases, measurement and analytic issues can also contribute to a false assessment of the creativity-madness link (Simonton, in press). Until such time, I take my inspiration form the humanistic perspective and prefer to think, just like Abraham Maslow and Carl Rogers did, that creativity is associated with mental health. Standing tall at the top of the hierarchy of needs, creative imagination and expression is the hallmark of a well-adjusted, self-actualizing, fully functioning person.

References

Centers for Disease Control and Prevention. (CDC). (2001). Available online at: http://www.cdc.gov/mentalhealth/basics/burden.htm.

Chapman, L. J. (1967). Illusionary correlations in observational report. J. Verb. Learn. 6, 151–155. doi: 10.1016/S0022-5371(67)80066-5 CrossRef Full Text

Dietrich, A. (2007). Who is afraid of a cognitive neuroscience of creativity? Methods 42, 22–27. doi: 10.1016/j.ymeth.2006.12.00. CrossRef Full Text

Jamison, K. R. (1993). Touched with Fire: Manic-Depressive Illness and the Artistic Temperament. New York, NY: Free Press.

Kahneman, D., and Tversky, A. (1973). On the psychology of prediction. Psychol. Rev. 80, 237–251. doi: 10.1037/h0034747 CrossRef Full Text

Kaufman, J. C. (2005). The door that leads into madness: eastern european poets and mental illness. Creat. Res. J. 17, 99–103. doi: 10.1207/s15326934crj1701_8 CrossRef Full Text

Koh, C. (2006). Reviewing the link between creativity and madness: a postmodern perspective. Educ. Res. Rev. 1, 213–221.

Kyaga, S., Lichtenstein, P., Boman, M., Hultman, C., Långström, N., and Landén, M. (2011). Creativity and mental disorder: family study of 300 000 people with severe mental disorder. Br. J. Psychiatry 199, 373–379. doi: 10.1192/bjp.bp.110.085316 Pubmed Abstract | Pubmed Full Text | CrossRef Full Text

Perales, J. C., and Shanks, D. R. (2007). Models of covariation-based causal judgment: a review and synthesis. Psychon. Bull. Rev. 14, 577–596. doi: 10.3758/BF03196807 Pubmed Abstract | Pubmed Full Text | CrossRef Full Text

Post, F. (1994). Creativity and psychopathology: a study of 291 world-famous men. Br. J. Psychiatry 165, 22–34. Pubmed Abstract | Pubmed Full Text

Redelmeier, D. A., and Tversky, A. (1996). On the belief that arthritis pain is related to the weather. Proc. Natl. Acad. Sci. U.S.A. 93, 2895–2896.  Pubmed Abstract | Pubmed Full Text

Roberts, M. (2012). Creativity ‘closely entwined with mental illness’. Available online at: http://www.bbc.co.uk/news/health-19959565. 16 October 2012.

Rothenberg, A. (1990). Creativity and Madness: New Findings and Old Stereotypes. Baltimore, MD: Johns Hopkins University Press.

Schlesinger, J. (2009). Creative mythconceptions: a closer look at the evidence for the “Mad Genius” hypothesis. Psychol. Aesthet. Creativity Arts 3, 62–72. doi: 10.1037/a0013975 CrossRef Full Text

Schlesinger, J. (2012). The Insanity Hoax: Exposing the Myth of the Mad Genius. New York, NY: Shrinktunes Media.

Simonton, D. K. (2005). Are genius and madness related? Contemporary answers to an ancient question. Psychiatry Times 22, 7.

Simonton, D. K. (in press). More method in the mad-genius controversy: A historiometric study of 204 historic creators. Psychol. Aesthet. Creativity Arts.

Stuart, H. (2003). Violence and mental illness: an overview. World Psychiatry 2, 121–124.

Waddell, C. (1998). Creativity and mental illness: is there a link? Can. J. Psychiatry 43, 166–173. Pubmed Abstract | Pubmed Full Text

World Health Organization. (WHO) (2013). Available online at: http://www.who.int/mental_health/management/schizophrenia/en/.

Mad or Bad - Thomas Szasz

Thomas Szasz first presented his attack on the legal usage of the term "mental illness" in a 1958 Columbia Law Review article. He argued that mental illness has no more bearing on a person's guilt than possession by the devil.

In 1961, Szasz testified before a United States Senate committee, arguing that the use of mental hospitals to incarcerate people defined as insane violated the general assumptions of patient-and-doctor relationships and turned the doctor into a warden and a keeper of a prison. (1)

(1) Summarized from Wikipedia.

The article is long, but very interesting - here are the first two sections, which largely serve as an introduction.

Mad, or Bad?

Even in the decade of dissent, Thomas Szasz stood alone when he attacked the concept of madness from the political right

by Holly Case

Stir crazy: Jack Nicholson in the 1975 film of Ken Kesey's book One Flew Over the Cuckoo's Nest.
Photo by Rex

Holly Case is associate professor of history at Cornell University and the author of Between States: The Transylvanian Question and the European Idea during the Second World War (2009).


In 1961, a young psychiatrist initiated a one-man insurgency against his own profession. ‘Psychiatry is conventionally defined as a medical specialty concerned with the diagnosis and treatment of mental diseases,’ he wrote. ‘I submit that this definition, which is still widely accepted, places psychiatry in the company of alchemy and astrology and commits it to the category of pseudoscience. The reason for this is that there is no such thing as “mental illness”.’

Fifty years after his book The Myth of Mental Illness: Foundations of a Theory of Personal Conduct first ventured this uncompromising view, its author Thomas Szasz visited Cornell University in upstate New York. He was there to speak to an audience of students, many of them coerced or bribed by their professors to attend, plus a few local lawyers and psychiatrists. His subject was ‘The Insanity Defence: The Case for Abolition’. The talk started late because a man in a wheelchair was being positioned near the front of the lecture hall. Szasz greeted him enthusiastically; the audience would later learn that he was Ronald Leifer, a psychiatrist who had been denied tenure at the Upstate Medical Center at Syracuse in 1966 for defending Szasz and his iconoclastic ideas against practically the whole of the psychiatric profession.

When it finally started, the lecture was heavily anecdotal and lasted barely half an hour. The 91-year-old psychiatrist spoke in a quiet voice and with a thick Hungarian accent. Students shifted in their seats. Then came the Q&A. Although the subject was the insanity defence, the audience was more interested in Szasz’s assertion that there was no such thing as mental illness. ‘What about schizophrenia?’ ‘How can you be a practising psychiatrist if you don’t believe in mental illness?’

One student asked him: ‘Are you trying to say we all have different brains?’ The lecturer seemed unsteady on his feet. ‘Yes,’ he replied, ‘we do.’ Another student put it to him that we might be determined by our neurological make-up. ‘I think you and I have different brains,’ Szasz replied. That got a laugh from the audience. It was clear that being the only one in the room with a brain like his was part of his persona; being contrarian was his way of being right. Throughout his career, even friendly co-optation irked him. When scholars started associating him with the anti-psychiatry movement, he wrote a book entitled Antipsychiatry: Quackery Squared (2009).

Szasz liked to present himself as a dissident. And yet, when he began dynamiting the foundations of psychiatry in the 1960s, rebellion was in vogue, and he seemed very much a man of his time. Along with so many other radicals of the decade of dissent who got half of what they wished for, he has largely been forgotten, his troubling declarations defused by decades over which he worked as an academic and a practising psychiatrist.

After the talk at Cornell, he confided over a stiff drink that he generally did not give talks anymore. ‘I’m too old,’ he told me. ‘Plus, not many people know I’m still alive.’ Indeed, not long after our conversation, Szasz died, last fall. But did his ideas die with him? On the contrary, it might be that the world has only recently come around to his way of thinking.

Near Szasz’s school in Budapest there stood a statue of Ignaz Semmelweis, a Hungarian obstetrician who found posthumous fame as a 19th-century martyr of science. To Szasz, the sickly and discontented young son of a Jewish businessman, Semmelweis became something of a hero. The late doctor’s claim to fame had been the discovery that it was possible to practically eliminate the often-fatal ‘childbed fever’ common among new mothers in hospitals if doctors simply washed their hands before assisting with childbirth — especially if they had just been performing autopsies. When his findings became more widely known in the 1840s, he expected a revolution in hospital hygiene. It didn’t come, and Semmelweis grew increasingly outspoken and hostile towards doctors who refused to acknowledge his discovery. Vitriolic academic exchanges ensued, and he was eventually lured to a mental hospital where his opponents had arranged for his incarceration. He was beaten severely and put in a straitjacket. He died within two weeks. Echoing Voltaire, Szasz recalled the doctor’s tragic life in an autobiographical sketch in 2004:

It taught me, at an early age, the lesson that it can be dangerous to be wrong, but, to be right, when society regards the majority’s falsehood as truth, could be fatal. This principle is especially true with respect to false truths that form an important part of an entire society’s belief system. In the past, such basic false truths were religious in nature. In the modern world, they are medical and political in nature.

Szasz was still a teenager when his Jewish family left Hungary, and just preparing for college when they settled in the US in 1938. He later confessed that his knowledge of America prior to his arrival was sketchy, and largely based on reading The Adventures of Tom Sawyer (1876) by Mark Twain. He had heard the ‘usual tales’ about ‘the land of movies, money, and the mistreatment of blacks’. When he enrolled in the University of Cincinnati in the winter of 1939, he discovered that discrimination against Jews, ‘not to mention blacks and women’, was ‘perhaps even more intense’ than it had been in Hungary.

Though he earned a degree in medicine, Szasz was much more interested in politics and philosophy. He chose training in psychoanalysis in Chicago, then a centre of the psychoanalytic craze, over a career as a medical doctor. Demonstrating textbook psychoanalytic ambivalence, he was simultaneously attracted and repelled by the prevailing image of psychoanalysts as the elect. In the same autobiographical sketch from 2004, published as part of the collection Szasz Under Fire: The Psychiatric Abolitionist Faces his Critics, edited by Jeffrey Schaler, he recalls:

The analysts passionately believed that they were treating real diseases, never voiced objections against psychiatric coercions, and believed that criminals were mentally ill and ought to be treated, not punished. These beliefs were an integral part of their self-perception as members of an avant-garde of scientific, liberal intellectuals.

His fellow psychoanalysts, with their ‘left-liberal “progressive” prejudices’, fanatically denounced Republicans as ‘either fascists or sick or both’. As a practising psychoanalyst, an academic psychiatrist (with tenure) and a staunch Republican, Szasz felt he belonged to an embattled minority, an elect of a different sort. It was the ideal position from which to deliver his dissident strike.

It came in 1961 with the publication of The Myth of Mental Illness, wherein Szasz asserted that psychiatry, unlike medicine, could demonstrate no physical basis for the ‘diseases’ it identified and ‘treated’.

‘To speak of elevated blood pressure and hypertension,’ he wrote, ‘of sugar in the urine and diabetes, all as “organic symptoms”, and to place them in the same category as hysterical pains and paralyses is a misuse of language; it is nonsensical.’ Masquerading as scientists, psychiatrists abused scientific concepts and deluded their patients.

Worse still, they acted as henchmen for society and state. ‘[T]herapeutic interventions have two faces,’ Szasz wrote; ‘one is to heal the sick, the other is to control the wicked’. Yet the standard for wickedness is always subjective and variable, and so the psychiatrist inherited from the Inquisition the task of quarantining society’s dangerous elements. It was not a coincidence that, even decades after the word ‘psychiatrist’ entered English in 1890, practitioners were often called ‘alienists’, derived from the French aliéné, meaning both ‘alienated’ and ‘insane’. First, Szasz wrote, it was ‘God and the priests’ who kept the unruly in check. Then came ‘the totalitarian leader and his apologists’, along with ‘Freud and the psychoanalysts’.

Dr Thomas Szasz pictured at his 90th birthday seminar in London. Photo by Jenny photos

Read the whole article.

Upaya Dharma Podcasts - Maia Duerr: The Dharma of Finding Sanity in an Insane World

Excellent dharma talk from Maia Duerr, her first at Upaya - a very relevant talk on distinguishing mental health and illness in a world gone quite insane.

Maia Duerr: 05-09-2012: The Dharma of Finding Sanity in an Insane World

Speaker: Maia Duerr

Recorded: Wednesday May 9, 2012

EPISODE DESCRIPTION: In her debut Dharma talk here at Upaya, Maia shares her own personal experiences of working with people with mental illnesses and how many of the symptoms that are used to diagnose such conditions can vary from one culture to another, as well the reaction of the community towards these individuals. She challenges the audience to question what it means to be sane/ insane, and how to incorporate our own neurosis or personality disorders as a learning tool that leads us to more compassionate action and understanding.

TEACHER BIO: Maia is the Director of Community Outreach and Development at Upaya, and also directs Upaya’s Buddhist Chaplaincy Program. She sometimes serves on Upaya’s Engaged Buddhism faculty. She is an anthropologist, writer, and editor. From 2004-2008, Maia was based at the Buddhist Peace Fellowship where she served as executive director and senior editor of Turning Wheel magazine.

Maia has received lay ordination from Roshi Joan Halifax into the Order of Interbeing and the Zen Peacemaker Order. She is also a student in the Soto Zen lineage of Suzuki Roshi, and has lived and practiced at the San Francisco Zen Center where she received jukai from Victoria Shosan Austin in 2008.

From 2002-2004, Maia was the research director of the Center for Contemplative Mind in Society, in Northampton, Massachusetts, where she led a study on the use of meditation and other contemplative practices in secular settings. She is the author of a number of articles on this topic, including “The Contemplative Organization,” published in the February 2004 issue of the Journal of Organizational Change Management.

Maia is the author of a blog on socially engaged Buddhism called The Jizo Chronicles.

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Jared Loughner - Should He Be Forced to Take Meds?

This is a tough issue. If a person is not mentally competent to stand trial without drugs in his system, he does not, by default, meet the legal requirements for sanity at the time of his crime. On the other hand, he did seem to have some sense that what he had done was illegal, at least in more lucid moments, but is that the same thing as knowing right from wrong?

Legally, the issue comes down to this:

Should prosecutors wage a legal war to force Loughner to take medicines that will render him mentally “competent” to stand trial and possibly be sentenced to death? And should Clarke fight for him to live off meds with his paralyzing mental illness indefinitely in order to spare him a trial and keep him alive?

It's pretty obvious that the prosecutors want him on meds so that he can be convicted of murdering six people and the attempted murder of a dozen more, including Congresswoman Gabrielle Giffords.

What are the ethics of medicating someone who clearly is not sane (schizophrenic or not, and I think not) simply so that the State can convict and execute him?

The Daily Beast has a lengthy article on this issue.

Should He Be Forced to Take Meds?

A fierce court battle is raging over whether Jared Loughner, diagnosed as schizophrenic but not wishing to be medicated, should be restored to mental competency for an Arizona shooting trial—and face execution.

Written by Terry Greene Sterling
July 30, 2011

Nearly three months after he allegedly killed six people and injured Rep. Gabrielle Giffords and 12 others during a January shooting rampage in Tucson, Jared Lee Loughner sat in a Tucson courtroom, where his mental competency to stand trial was being evaluated. Gone were the shaved head and leering smile from his mug shot released after the shootings. Now Loughner wouldn’t stand out in a crowd—he’d grown a full head of brown hair, sideburns, and a goatee. He appeared benign.

And then, unexpectedly, he yelled at the judge: “Thank you for the free kill. She died in front of me. Your Cheesiness.”

The 22-year-old unemployed community-college dropout, who had just been diagnosed with schizophrenia, was later deemed mentally incompetent to stand trial. He was whisked back to a federal Bureau of Prisons medical facility in Springfield, Mo. Since then, he’s been at the center of a vicious court battle over whether he should be forced to take psychotropic medicines.

In the past few weeks, courts have ordered Loughner, who does not want to be medicated, to be put on meds, then taken off meds, then put on meds again, as lawyers prepare for yet another appellate-court hearing in late August over his forced medication.

The intense legal fight between Loughner’s defense team, led by star San Diego lawyer Judy Clarke, and federal prosecutors raises serious medical and ethical questions. Should prosecutors wage a legal war to force Loughner to take medicines that will render him mentally “competent” to stand trial and possibly be sentenced to death? And should Clarke fight for him to live off meds with his paralyzing mental illness indefinitely in order to spare him a trial and keep him alive?

Attorney Judy Clarke; inset: Jared Loughner, AP Photo

There’s no easy answer, Harvard Law professor Alan Dershowitz tells The Daily Beast, but clearly medications should not be “strategically advantageous,” either to prosecutors or to defense attorneys.

And although there’s a pressing need for the medical and legal professions to figure out how to “disincentivize” the use of medicine as a legal strategy, no one is doing much to fix the problem, notes Dershowitz. Some defendants can be so drugged up by psychotropic meds, he adds, that they exhibit a flat affect in the courtroom, persuading the jury to convict because the accused shows “no remorse.”

The purpose of medicating defendants, Dershowitz repeats, is to “heal, not give legal advantages.”

The purpose of medicating defendants, Dershowitz repeats, is to “heal, not give legal advantages.”

Prosecutors for the Loughner case declined to be interviewed for this story; Clarke did not return a phone call seeking comment.

Loughner was first forced to take Risperidone, a psychotropic drug used to treat schizophrenics, in mid-June, after he’d spent nearly six months in custody without medications.

In court records, prosecutors say it was necessary to give him Risperidone because he threw chairs, spat, swore, tried to disarm a video camera with a roll of wet toilet paper, and barricaded himself behind his bed to avoid a mental-health hearing.

Photos: Killer Smiles - The Happy Faces of Evil

Photos: The Happy Faces of Evil

Clarke, who is known for her compassion for her mentally ill clients as much as for her legal skills, in court records says other inmates have exhibited more bizarre behavior, such as hurling feces and urine at their jailers, without being forcibly medicated. Yet Loughner, who did neither, was considered a “danger to himself and others,” she says.

The defense attorney called the prosecutors’ “dangerousness” excuse an “end run”—prosecutors with a keen interest in restoring Loughner’s mental competency managed to get him on just the right meds without a so-called Wells hearing mandated by the Supreme Court. In such a hearing, forcible medication of a defendant is ordered only after a judge carefully weighs the prisoner’s constitutional rights against the government’s right to take a defendant to trial.

So far, though, the courts have mostly sided with prosecutors, who cited a different Supreme Court case that allows forced medication of prison inmates without judicial review if they are a danger to themselves or others.

Clarke had a brief victory when Loughner was taken off Risperidone by court order in early July.

But an appellate panel ordered him back on the drug after prison officials reported that he had deteriorated without the Risperidone. Prison officials said Loughner exhibited disturbing behavior that included constant weeping, feeling hopeless, expressing regret for the “circumstance that led to his arrest,” pacing so much he injured his ankle, “keeping his hands in his underwear and touching himself sexually,” and asking for a lethal injection.

Steve Pitt, a forensic psychiatrist based in Scottsdale, Ariz., says “starting and abruptly stopping” a psychotropic medication like Risperidone is generally “ill advised.”

In the Loughner case, he says, “when you have someone who is reportedly showing signs of clinical improvement while on medication and then deteriorates when off the medication, you don’t need to be a psychiatrist to know that he has benefited from the medication and needs to resume taking it.”

For doctors “to stand by and not do anything” as a patient “destabilizes” in a “clinical emergency,” says Richard J. Bonnie, the director of the Institute of Law, Psychiatry, & Public Policy at the University of Virginia, would be unethical. Bonnie, who opposes the death penalty in most cases, says it is entirely ethical for the prosecution to seek to restore a mentally ill defendant competent to stand trial. He also says a defense lawyer representing a seriously mentally ill patient often must work hard to establish trust, and establishing trust could include advocating for the client’s wish not to take medications.

Elizabeth Kelley, a Cleveland defense attorney who chairs a mental-health committee for the National Association of Criminal Defense Lawyers—of which Judy Clarke is a past president—says medicating someone against his will is not often appropriate. She calls forced medication of Loughner a “perversity” and a “way to perhaps execute him.”

Kelley doesn’t fault Clarke for asking the court to take away Loughner’s meds, because he never wanted to be medicated in the first place. And she wonders whether Loughner, whom she calls “profoundly mentally ill,” could ever truly be “restored” to competency to stand trial.

The only one who hasn’t weighed in on the matter, beyond expressing a wish not to be medicated, is Loughner himself, who sits in a Missouri prison cell. He’s on Risperidone now, but he may not be taking the drug for long. Clarke is preparing for an Aug. 31 Ninth Circuit Court of Appeals hearing on his forced medication. “She has a huge up-road battle,” says former federal prosecutor Kurt Altman, who has successfully prosecuted a federal death-penalty case.

“Her job,” he says, “is to keep Loughner off death row.”

Tags: Psychology, schizophrenia, murder, law, insanity, forced medication, Jared Loughner, The Daily Beast, Terry Greene Sterling, mental competency, Gabrielle Giffords, Judy Clarke, Alan Dershowitz, guilt, mental illness, Alan Dershowitz, ethics

Putting Hamlet on Trial in the 21st Century

Interesting idea - this would have been fun to participate in, especially when we read Hamlet back in college. It certainly would have been fun to watch. I'd have to question the impartiality of the reporter/narrator - events may have been misrepresented for dramatic impact.

From the LA Times Culture Monster blog.

To be sane or not to be sane? For Hamlet, a question still unanswered

February 1, 2011

A Southern California jury decided on Monday that Hamlet, prince of Denmark, was mentally sound at the time he allegedly stabbed royal adviser Polonius to death, and can be tried for murder.

Never mind that the (fictional) crime happened something like 400 years ago. And that most of the evidence was drawn from the poetic words of William Shakespeare.

Even in Shakespeare, it appears, there is no statute of limitations on murder.

The mock court took place more than an ocean and several generations away from Hamlet's home: the University of Southern California campus, where the Shakespeare Center of Los Angeles held the trial in a strange anachronism of centuries-old literature meeting the modern American legal system, and the event ended up hanging somewhere in the ether between the two.

The defendant (played by Graham Hamilton) looked spry and young for someone in his fourth century of life. The bailiff wore the tunic of an old-world guard, and the acronym of the DSM4 — the Diagnostic and Statistical Manual of Mental Disorders, the directory of mental ailments used by psychologists — was renamed the Danish Statistical Manual.

Hamlet was prosecuted by attorneys from Los Angeles, acting on behalf of the crown; he was defended by lawyers from Beverly Hills.

Supreme Court Justice Anthony M. Kennedy swapped his perch on the highest court in the land for a folding table draped in a black cloth. Clearly a Shakespeare enthusiast, he presided over the trial with a discerning eye, his hands folded in front of him and a halo of stage light ringing his head.

The jury was a collection of 12 (plus two alternates) that ranged from high school and college students to Academy Award-winning actress Helen Hunt.

Before them was a simple question that had long proved difficult to answer: What was the mental state of Hamlet in the time leading up the killing of Polonius? Or, as his defense attorney, Blair Berk, phrased it in her opening statements: “Is Hamlet to be sane or not to be sane at the time in question? That is the question.”

Berk contended he was not: Hamlet was struck by grief, after the death of his father, King Hamlet, while he was away at university. He became even more distraught when his mother, Gertrude, married her late husband’s brother, Claudius, soon after his death. It was said that the union came so swiftly that the meats from the funeral were still good for the wedding celebration. (On top of all that, Hamlet was bitten by a serpent too.)

The defense argued that Hamlet suffered from a "major depressive episode," or melancholia. He was, Berk said, a “still brilliant but decompensated man.”

The fatal stab to Polonuis was a "stroke of impulse,” she said. “Hamlet had tragically succumbed to a disease of the mind when he allegedly committed this crime.”

The prosecution agreed that Hamlet was, indeed, a brilliant man — that’s exactly why he’s claiming to be insane now. It was the method by which he tried to manipulated his way into the throne he thought was rightfully his, countered Danette Meyers, a prosecuting attorney (by day, she’s a veteran of the L.A. county district attorney’s office).

“He was not insane, he was grieving,” she said. “He was cunning, he was cold, he was calculating.” What he wanted, she added, was revenge.

Much of the debate concerned the symptoms of such a melancholia — loss of mirth, change in weight and so forth — and whether he appeared to have them. Also, the ghost of his father, of course, had a great deal of bearing: What meaning, if any, can be divined from a spirit seeming to pop up everywhere, according to Shakespeare’s documentation, yet only offer commands to his son?

All big hurdles for a jury to cross as they pondered his mental state. After the jury received its instructions and left to deliberate, a projector flickered on and a screen descended from above, providing a fourth wall, if you will, into a typically sequestered process.

The jurors batted around the question in a thoughtful and passionate conversation that never quite became contentious. One woman had a spacey look in her eyes. Another juror seemed to roll his eyes when someone made a comment that he must have thought was foolish.

A woman at the other end of the table cautioned not to hold the DSM4, a clinical manual cobbled together by psychologists, as some sort of sacrosanct text. And, she added: “Just because he’s pretending to be insane doesn’t mean he’s not insane.”

Hunt questioned the motives of Shakespeare. She wondered how many liberties Shakespeare took as a playwright in covering the events that purportedly transpired, as well as Hamlet’s mental state through it all. (As she spoke, she squinted her eyes, seeming to look through her fellow jurors, as if she wasn’t joining a discussion but having a soliloquy like ones that attorneys on both sides quoted so generously to make their case.)

Before the deliberations had wrapped, the screen coiled back into the ceiling, leaving a cliffhanger.

Because of the compacted nature of the evening, the jurors did not have to come to a unanimous decision. And they didn’t: 10 believed Hamlet to be sane, thus able to be held criminally culpable; two did not. Thirty-three minutes of deliberation, it appears, wasn’t enough time to answer a question of justice that has lingered for more than 400 years.

-- Rick Rojas

Top: Hamlet (Graham Hamilton), right, sits quietly as his attorneys Blair Berk and Richard G. Hirsch, have a discussion during "The Trial of Hamlet" at USC's Bovard Auditorium. Bottom, the judge presiding over Hamlet's trial was Supreme Court Justice Anthony M. Kennedy, who entered the courtroom as announced by crier J.B. Waterman, right. Credit: Christina House / For The Times

Tags: Hamlet, murder, trial, insanity, William Shakespeare, Supreme Court Justice, Anthony Kennedy, Polonius, Shakespeare, literature, Psychology, insanity, law, insanity defense, murder, LA Times, Culture Monster