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Are mental disorders physical or ethical?

One of the things that has happened in our culture over the last 300 years is the shift from theology to morality to psychiatry. Conditions that were once deemed vices are now considered diseases. Gluttony has become obesity. Despair has become depression. Lust has become sex addiction.

A few ornery voices on the right, like Theodore Dalrymple, Peter Hitchens and Frank Furedi (he’s on the right, isn’t he?), complain about the rise of the discourse of disease and therapy, and the gradual disappearance of the idea of moral responsibility. Recently, Dalrymple and Hitchens fulminated against Russell Brand’s contention that drug addiction is a disease, insisting instead that it’s a vice, and a crime.

Most of us probably sympathised more with Brand, just as most of us probably agreed with that cartoon doing the rounds a few weeks ago, ‘what if physical illnesses were treated like mental illnesses’. Labeling things like depression or alcoholism ‘vices’ seems medievaly cruel and heartless. Many people are now genuinely offended by the idea of the individual as an autonomous free agent, which they see as an invention of neo-liberalism.

This fundamental cultural shift comes from the rise of materialism since the Scientific Revolution, and the growing popularity of the idea that, as Julian Offray de La Mettrie put it, man is a machine. If the machine starts doing strange things like gorging on chocolate or killing people, that is a mechanical malfunction rather than a moral choice, and should be treated accordingly, with drugs or behavioural modification.

So which view is right? Are mental disorders physical, or ethical?

I think that, paradoxically, both views are right. Humans are machines, determined by our genes, our neural chemistry and our environment. But we also have the capacity to make moral choices, and should be held accountable for our moral mistakes. Ignore either side of this polarity, and you fall into error – either the error of thinking man is entirely a machine without any free will, or thinking man is a completely free agent without any limits on his rationality and choice.

The paradox of humanity is that we are both caused physical objects, and also moral subjects with a limited capacity for transcendence. That small capacity for transcendence means that, unlike every other animal, we can re-programme ourselves. Our personalities are not set in stone. We can use our rational consciousness to choose a direction in life. And that rational consciousness means we can also be held accountable for our actions, rather than treated like helpless children or dogs.

With regard to mental disorders, this means they are best understood as both causally determined, but also involving ethical errors about the best way to flourish. The gambler, the drug addict, the food-gorger, the social phobic, even the depressive, are not simply the victims of physical malfunctions. They are the makers of ethical errors. They may have inherited these ethical errors from their parents, their genes or their culture, but they have the sovereign human capacity to change these errors.

The Greek philosophers understood that bio-psychology and ethics are not two separate departments. They understood that mental disorders like anxiety are both diseases and vices or moral errors. They are diseases of our reason, diseases of our moral capacity to choose a wise course in life. And the cure for this disease is philosophy,  by which they meant psychology + ethics + economics + politics + theology.

Today, at the apex of the materialist worldview, we are beginning to return to the ancients’ wisdom that humans do have self-control and the capacity for moral reasoning, and that these things are important for helping us escape problems like obesity or addiction.

The most scientifically credible treatments for depression, anxiety and many other mental disorders is Cognitive Behavioural Therapy (CBT), which was inspired by Greek philosophy, and 12 Step programmes like Alcoholics Anonymous, which grew out of Protestant Christianity. Neither CBT nor AA use the old language of sin or vice or moral blame, but they both insist our ability to recover from mental disorders depends on our reasoning and moral choice (as well as help from a Higher Power, in the case of AA).

Neither CBT or AA are glibly optimistic about our ability to change ourselves. Both recognise the terrifying power of mental disorders  to wrap themselves around us like a parasite, to lie to us and utterly transform our personality. They also recognise that, in some cases like dementia or schizophrenia, our biology may destroy our capacity to reason. But they also recognise our stubborn human capacity for transcendence and re-birth.

Our capacity for transcendence is just a capacity, and Aristotle insisted it can be ruined by our environment, by a particularly poor or abusive childhood for example (although the Stoics would have argued that even abused slaves like Epictetus can show extraordinary moral courage). And our moral capacity is also bounded by the power of habits. Decisions harden into habits, habits harden into personality traits, personality traits harden into biographies. Character, as Heraclitus put it, is destiny.

I know from personal experience how poor life-decisions gather momentum until they become overpowering and chronic mental disorders. When I was a teenager, I did lots of drugs, and ended up traumatizing myself. Poor life-choice. The trauma hit me at university, and led to me becoming increasingly socially phobic. Bit by bit, what started as a free choice not to go to a party hardened into an involuntary compulsion – I would be terrified at the thought of going to a party.

At that time, I was addicted to the I-Ching, the ancient Taoist book of divination. I constantly asked it questions to try and work out what was happening to me. I often got hexagram number 29 – K’An, The Abysmal – as a reply. The second line of it tells us:

Repetition of the Abysmal.
In the abyss one falls into a pit.

Which the commentary explains as:

By growing used to what is dangerous, a man can easily allow it to become part of him. He is familiar with it and grows used to evil. With this he has lost the right way, and misfortune is the natural result.

Things get away from us. The state of vice or sin can be compared to the episode of The Simpsons, when Homer is standing on a skateboard at the top of a hill, overlooking a canyon. All it takes is a small push at the beginning – one bad life-choice or unlucky life-event – and things quickly gather momentum, until you are hurtling towards the abyss and it’s very difficult to get off the skateboard.

We always have the choice to get off the skateboard, but it gets harder and harder, partly because it takes humility to admit we are heading in the wrong direction and we need help to change. Our egos love to delude ourselves that everything is alright, like the optimist who jumps off a building and says, as he passes each floor, ‘so far so good’.

The unfortunate consequence of our nature as moral subjects is that people have to choose to get off the skateboard. Loved ones can’t make them do it. As the joke puts it, ‘how many psychotherapists does it take to change a light-bulb? One, but the light-bulb must want to change.’

Often, when I do philosophy talks, I meet mothers whose teenage or young adult children are deeply depressed, but who won’t do anything to get better. They are heading for the abyss. The poor mothers often wear brave smiles, but you can see how destroyed they are inside. And they don’t know what they should do, they say that their boy (it’s usually a boy) just won’t try anything to get better and gets furious with them if they try to make them.

It makes me think that fundamental to recovery from mental illness is some survival mechanism kicking in. People need a moment of epiphany, when they wake up from the automatic cycle of self-destruction, and think ‘my God, I’m killing myself’. They need to stop blaming their mother or father or genes or God for their shitty life, and think, ‘I’ve got to do something’. And when that self-preservation kicks in and they take responsibility for their beliefs and habits, they might have a chance of getting better. But they need that moment of insight and that sudden urge to survive.

Drugs may well be a part of that recovery. But a lot of the therapeutic power of pharmaceuticals may well be placebo (just as an addict praying to a Higher Power may be placebo). What is really helping us recover is the realisation ‘shit, here comes the abyss, it’s time to change direction’. It may not be your fault you’re heading for the abyss, it might have been your shitty childhood that gave you the first push down the hill, but ultimately it’s your choice whether to get off the skateboard or not.

Russell Brand realizes, I think, this paradox. He says addiction is a disease, but a spiritual disease. We make bad life-choices or suffer traumatic life-events, and then things get their own momentum. The treatment for such diseases involves lots of love, sympathy, and perhaps pharmacology. But Peter Hitchens is right too – it also involves individuals making better and wiser moral choices.

Scrubbing up religion to make it fit for polite society

I had the pleasure of meeting Jonathan Haidt on Monday at the RSA. Haidt, as you all know, wrote The Happiness Hypothesis, which really inspired me. I gave him a copy of my new book, so if you see it in a bin near the Strand, it’s yours! Haidt’s own new book is called The Righteous Mind: Why Good People are Divided by Religion and Politics.

It’s a very interesting and quite ideas-packed book. A lot of ‘intelligent non-fiction’, particularly in psychology, can be easily boiled down to a 10-minute TED talk (indeed many books should have stayed as TED talks), but Haidt’s book – shock horror! – has more than one idea in it. It talks about the emotions beneath different political ideologies, how our brains generate sacred values, and how religions help societies to cohere and bond.

It’s this last idea that Haidt discusses in his very slick TED talk on religion and ecstasy (I love the animated slides – it’s lecture-as-movie-experience). His talk begins with William James, and a brief look at revelatory ecstatic experiences – those moments where, as Haidt puts it, a door seems to open in our heads, and we are suddenly lifted from the profane to the sacred. Haidt talks about how such revelatory experiences can involuntarily happen to us (we are seized by forces, as the young Wordsworth feels himself to be), or we can voluntarily engineer them by taking psychedelic drugs, as shamans did (or do).

Then Haidt moves, quite rapidly, to a social or Durkheimian explanation of religion. Sacred values, he says, give societies something to cohere around, to coalesce around. They help us bond, and help our societies endure and resist external shocks. He shows us the fascinating work by the anthropologists Richard Sosis and Eric Bressler, who studied American communes in the 19th century, and found that the religious communes which demanded a lot more from their members survived far longer than the secular communes which demanded less (see the graph below).

So, and this is Haidt’s main point, perhaps there’s an evolutionary purpose to religions. Perhaps they evolved at a certain period in human evolution, around 10,000 years ago, to help human tribes to cohere and cooperate, making them more adaptive and resilient. They are the product, he suggests, of ‘group selection’ – apparently a rather controversial idea in biology. You can be an atheist, as he is, and still have respect for the sacred and its socially adaptive function. ‘

And you don’t need the supernatural for a sense of the sacred’, he insists. ‘You could get it from your country, or from nature.’ Well, maybe, though I’d suggest if people get really worked up about their country, there’s probably a bit of the supernatural mixed in – think of how American nationalism is often mixed in with a sense of manifest destiny.

Haidt is certainly right that religions can bond societies together and help give them a collective sense of meaning, and that this can help them respond to shocks and threats. Others have also argued this recently – from the philosopher Charles Taylor to Robert Wright to Alain De Botton. At a time of riots and revolutions, it’s unsurprising that liberals suddenly start talking about how religions create social stability, as Edmund Burke and William Wilberforce did after the French Revolution.

But I think the Darwinian social function theory of religion leaves something out. It leaves out the phenomena that Haidt begins his TED talk with – the sheer strangeness of revelatory and ecstatic experiences. In such moments, humans feel invaded by external powers, filled with the holy spirit, possessed, overwhelmed. There is something extremely wild, psychotic even, about some religious phenomena, and I think both Haidt and De Botton, in their eagerness to rehabilitate religion for a polite secular bourgeois audience, leave some of that wildness out.

Haidt presents a nice evolutionary story: at a certain stage of evolution, humans came up with religion to help our tribes cohere. But the story is weirder than that. At a certain stage in evolution, humans became conscious, and felt bombarded by messages from gods and angels. We tripped into consciousness, and this must have been both an awesome and a completely terrifying experience. It seems to me that William James appreciated the savage rawness and weirdness of the revelatory experience. Haidt does to some extent, but not sufficiently. (That’s St Theresa on the right, by the way, getting slapped around by some angel. Take that Theresa!)

I put this to Haidt, and he began by saying that James was a depressive recluse, so was focused very much on the individual aspects of religious experience rather than the social. Fair enough, though a bit harsh on James. Haidt then suggested that homo sapiens believed the universe was full of spirits as a side-effect of evolving a theory of mind. It was very adaptive to be able to infer other humans’ intentions, and as a result, we started to infer intentions everywhere – the sky thunders because God is angry etc (this is a theory known as the Hyper-Active Agency Detection Device, which Jesse Bering ably explored in his book The God Instinct).

But, again, I don’t think this adequately explains revelatory experience. The experience of hearing voices, seeing visions, feeling suddenly filled with the holy spirit etc is simply far more powerful and immediate than inferring divine agency when you hear some thunder. It’s a feeling of being actively invaded and overpowered by an external agency. Such experiences can certainly be socially cohesive, but they can also be highly socially disturbing. They are weird, uncanny, abnormal, frightening. The people who experience them are, traditionally, weird, frightening figures, half in the tribe and half out of it (half in the profane world and half in the sacred, as Mircea Eliade put it in his study of shamanism). They might be revered by their tribe and followed. Or they might be executed for being demonically possessed.

Haidt emphasizes the social cohesion role of the sacred, and seems to suggest our Enlightenment cultures need a bit more of the sacred in our lives and societies. But the sacred is notoriously hard to manage, politically, as King Pentheus knew (he’s the hero of Euripides’ Bacchae, who tries to ban the ecstatic cult of Dionysus. He even tries to imprison Dionysus, but the god of ecstasy escapes and sends Pentheus into madness. He ends up getting ripped apart by the maenads). What I admire about ancient Athens in the fifth century BC is its ability to balance the rationalist with the irrational and daemonic: Socrates and Sophocles, two sides of the human personality balancing each other out. But our Enlightenment societies have far more difficulty in seeing any value in the ecstatic, the revelatory or the daemonic. It simply terrifies us. It’s too weird, too uncivic, too impolite.

The last generation to be genuinely OK with revelatory experiences was the civil war generation of Oliver Cromwell, the Quakers and John Milton. In some ways, you could read Milton’s Samson Agonistes as the swan-song for revelatory experience in western culture. Samson sits in jail, wondering why God isn’t sending him any more messages. Well – we’re all wondering that now Samson. Why aren’t we getting any messages? What’s up with our reception! After the prophetic violence of Milton’s generation, England settled down to a calmer and more polite culture that was very suspicious of religious ‘enthusiasm’. And with good reason: the ‘voice of God’ often told people to kill, as God tells Samson to do. Such experiences have to be controlled and even banished in a multicultural rational commercial society. (Check out this excellent video of Stanley Fish discussing the inherent weirdness and illiberal savagery of Samson Agonistes, by the way).

Soren Kierkegaard was right, I think, to insist on the strangeness and irrationality of religious experience in his 1842 book Fear and Trembling. Kierkegaard was surrounded by 19th century Deists and Hegelians trying to turn religion into something nice, polite, rational and civic (as Haidt and De Botton are trying to do today). And he responds, forget all that – religion is God telling Abraham to kill his son, and Abraham agreeing.

Religions certainly fulfill an important social role. But they also grow out of the fact that, as a species, we sometimes feel invaded and possessed by external forces. Religions make sense of such experiences and give them a structure and meaning. And perhaps they give us a way to tell the good messages from the bad ones – the pro-social from the anti-social. We could try and come up with an explanation for these experiences of receiving messages from beyond.

There are two possible explanations, it seems to me. Firstly, western science’s explanation: the feeling of being invaded by spiritual forces is a deluded by-product of human consciousness. I’m absolutely fine with that explanation. Secondly, perhaps there really are external beings ‘out there’ in the multi-verse, which communicate with humans and inhabit them. Perhaps some of them can be good for the host and their society, and others bad for them. Perhaps it’s all a question of letting the right one in.

I know such speculations are somewhat beyond the pale of polite rationalist Enlightenment discourse. Nonetheless, this is how humans have, for the last 10,000 years, understood their experiences of the daemonic (daemon means a messenger, and eudaimonia, by the way, means ‘having a good daemon within’ – tell that to the Office of National Statistics the next time they come round to measure your eudaimonia). It’s how most of the human species still understands such experiences. So I think it should be acceptable to at least entertain such a thesis, without being labelled insane.

That’s not to say that religions are all correct and true – they couldn’t be. But it would suggest that religions grow out of actual interactions with non-human intelligences. Such a theory doesn’t have to make any claims about the identity of these beings – if there is one God communicating with us, or many gods, or no gods at all, simply other intelligences, mortal or immortal, who can communicate with us through revelations. These are all possibilities. It simply suggests that the reason humans came to believe that other intelligences send them messages is because they actually do. I’m going to call this the animist theory of religions.

I certainly don’t mean to attack the Enlightenment and all its achievements, and to welcome in some sort of degenerative age of magic like that of late antiquity. I personally don’t like talk of ‘malevolent demons’, because it seems to me to open the door to all kinds of unhealthy superstitions (nicely illustrated by the famous ‘sleep of reason’ drawing, on the right). But I wonder if we should at least entertain the hypothesis that revelatory experiences genuinely are communications with other beings in the multiverse – some benevolent, some perhaps malevolent.

Skeptics, at this point, will charge me with being an utter loon, and will insist that science’s great achievement was to free us from all our spooky fears of being in what the astronomer Carl Sagan called a ‘demon-haunted world’. But Sagan himself thought higher beings might be trying to communicate with humans, and imagined such a possibility in his book and film, Contact. Aliens, angels – same same, but different?

Well, maybe speculations about where such messages come from are pointless, unprovable either way, and we should ask more pragmatically what people do with such experiences, to what social uses they put them, and how we can hold them to rational account (unlike Kierkegaard, I think we must hold revelations to rational account and try to make sense of them). But if you’ve had such experiences, as much of the population have, I’m sure one can’t help but wonder…where did that come from?


Here are some interesting other links for newsletter subscribers:

Here’s Angie Hobbs robustly defending philosophy’s ability to teach us how to live.

Here’s Mark Williamson of Action for Happiness talking about the ‘Sachs effect’ – or what Jeffrey Sachs’ support for national happiness measurements means for the ideology of happiness.

One thing that amuses me about happiness economists is that they tell us that constantly comparing ourselves to others makes us less happy, but their own international rankings of country happiness leads us to do just that. Here, for example, is a journalist in Malaysia worrying about his country being less happy than Singapore (but at least it’s happier than Thailand).

This chap from Nesta thinks the arts and humanities should be more willing to measure their impact scientifically. I’m fine with that, as long as social scientists are happy to express their theories through dance. Wait…they are happy to do that! Check out all the YouTube entries for ‘dance your PhD’, like this. OK you crazy scientists, we’ll try.Here’s an Economist piece on the drive to make academic journals open access.

Two pieces showing the harshness of our cultural and media attitudes to female celebrities’ bodies (and hence the harshness of our attitudes to women in general). First, the actress Ashley Judd responds to the media / internet abuse over her ‘puffy face’. And then, a nasty time-lapse video appears on YouTube showing Lindsay Lohan’s face ageing. The New Republic suggests it shows the corruption of celebrity. Well, maybe, I think it also shows how vicious we can be to women. Everyone has some bad photos of them, right? We don’t subject male celebrities to this sort of body-policing.

Ilona Boniwell, who teaches a masters in Positive Psychology at University of East London, is one of the people behind this Personal Well-Being Centre, which has devised a ‘well-being curriculum’ for schools, and which also does free (or very cheap) ‘psychology in the pub‘ sessions. Cool! I shall go to one to discuss my daemon obsession.

Finally, here’s my favourite philosopher, footballer Joey Barton, on Lucian Freud, trans-genderism, body-consciousness and other stuff. ‘I’m body-aware, not body-conscious’, sighs Joey. Do I see the beginning of a floppy wrist for football’s hard-man?

See you next week,