Neil Gong
Icarus Project Internship
Brad Lewis/ Sascha Scatter
December 18, 2006

Mad Science/ Mad Pride for Those from the Dark Side:
Turning Bill Nye into a Mad Ally
A Primer on Sociological Theory and Madness

In 1972 the sociologist David Rosenhan conducted 2 major studies on the validity of psychiatric diagnosis, published as “On Being Sane in Insane Places.”  In it 8 healthy experimenters went to a psych ward complaining of hearing voices.  Upon entrance they proceeded to act as normally as possible, and claim that the voices had stopped.  Once labeled schizophrenic or bipolar, however, all of their behavior became considered pathological.  For instance, one researcher/patient’s note taking was regarded as an unhealthy compulsive “writing behavior.”  Each claim to one’s sanity was disregarded.  The average stay for the researcher/patients was 19 days, with some there as long as 52.  The next study occurred at a major psychiatric hospital that considered its diagnostic procedures fool proof.  Rosenhan agreed to send a few pseudo-patients through their doors over a three month period.  Out of 193 patients, the hospital concluded 41 were imposters, and suspected another 42 despite the fact that Rosenhan actually sent no pseudo-patients to the hospital.  The publication of this research created much controversy in the psychiatric world.
One response was to agree that psychiatry was too lax, and to make diagnosis more scientific.  This attitude can be seen in the highly codified DSM IV.  The “new psychiatry” is one of increased neuroscience research and medication use, and a move away from the soft humanities practices like psychoanalysis.  Though many psychiatrists accepted the social science critique of diagnostic procedures, they clearly missed out on what the sociologists were saying.  It was not simply that diagnosis needed to be refined.  Instead, the sociological research points to the complexity of how language and labels filter our perceptions of the world.  Sociological labeling theory argues that the labels placed on individuals affect their behavior profoundly, as well as the reception of that behavior.  In criminology, for instance, many studies have found youth offenders labeled “deviant” return to crime in higher rates than those not so labeled.  It is the result of a self-fulfilling prophecy, meaning that a false definition of a situation can elicit behavior that makes the originally false definition come true.  This is taken from the Thomas theorem, which states “if men define situations as real, they are real in their consequences.”  In the Rosenhan case, this can be seen in a healthy researcher’s diagnosis as schizophrenic.  Though the pseudo-patient may not be suffering, the consequences produced are much the same as if he or she had been.  The hospital staff’s refusal to see anything but pathology and schizophrenia led to a closing of their own critical minds.  For the pseudo-patient, a long enough stay with constant reinforcement of schizophrenic expectations might be enough to produce behavior similar to schizophrenia. 
Bio-psychiatrists have attacked this mode of thinking repeatedly.  They argue that mental illness is a clearly documented, empirically verifiable fact.  Since the symptoms exist prior to labeling, the disease is there with or without social definitions.  This is, unfortunately, where the dialog tends to stop between sociologists and bio-psychiatrists.  Many in the mental health field regard sociologists to be working against science and the best interest of patients who need to be diagnosed.  This is symptomatic of the larger “science wars” occurring in academia today. 
 Perhaps the biggest leap for a scientist is accepting multiple truths.  The important thing here is to recognize that the critique isn’t simply about neuroscience being right or wrong.  It is about seeing the multiple, coinciding realities to every situation.  Yes, “symptoms” may be there, but they only gain resonance when humans add meaning to them.  Meeting someone with a different perception of reality can have many different interpretations.  To pathologize this person as crazy is certainly one interpretation, but it is not necessarily the best, most accurate, or only “true” one.  Take for instance, the experience of hearing voices.  Some cultures believe that a person hearing voices is having a shamanistic experience.  Indeed, this person might become a spiritual leader.  Using the lens of bio-psychiatry, we could go into that other culture and spot what looks to be textbook DSM schizophrenia.  On the other hand, using the lens of shamanism, we could go into a mental hospital and find a group of people in touch with the divine.   Now it may seem obvious to bio-psychiatrist that all shaman are really schizophrenics, and that the cultures they live in simply haven’t been exposed to modern mental diagnostic procedures.  The other way of looking at this, however, is to understand that truth is unstable and is intimately shaped by the language we use.  There may be an experience that the “schizophrenic” or “shaman” has, but as human beings we can only describe that experience by imbuing it with language and subjective meaning.  There is no objective acquisition of it.  The meaning we choose to give it creates consequences that will affect the life of the “schizophrenic” or “shaman.” Returning to self-fulfilling prophecy theory, the person hearing voices can be made to experience each way of life through the very labeling and social reinforcement of terms like shamanism or schizophrenia.  This is to say that the experience of and reaction to shamanism and schizophrenia are socially constructed. 
This does not mean, however, that schizophrenia and shamanism do not exist.  To call these lived identities socially constructed labels does not mean that the frameworks don’t explain some peoples’ lives quite well.  Instead, it means that each is one way of mediating the reality people experience.  When we recognize something as a construction we are reminded that it is one of many possible ways to understand the world, and that the seemingly “bare facts” can only be understood through these different mediations. Mental illness is one way of understanding a set of symptoms, but there is nothing inherently ill about those symptoms.  They might be understood as creating dysfunction, but under whose definition of functioning?  The social context of a person’s life determines whether hearing voices is better understood as illness or divinity. 
In diagnosis medical and psychological practitioners hold an important tool for shaping the consequences of a patient’s life.  The power of the self-fulfilling prophecy in labeling should not be underestimated.  This is more than simply the placebo effect, in that a diagnosis such as schizophrenia or shamanism has the power to completely reorganize a person’s life, sense of self, and future.  The next generation of doctors and psych experts will have a role in shaping whether the mental health industry continues down a purely scientific path, or if it opens itself up to other forms of knowledge.  Though the science wars rage on, some questions to consider include: What are the manifold consequences of a diagnostic label in a person’s life, beyond that of “curing” a sickness?  What are the political implications of a mental health system that can only see difference in terms of pathology?  Is the scientific desire to “know” the “truth” of a person’s psychic condition more important than the desire to care for that person?  Upon which criteria do we define a baseline “health” across varying cultures and times?  These and others are important questions that cannot be answered satisfactorily in the scientific world alone.
To provide one more example, the Icarus Project has changed the definition of madness from “illness” to a “dangerous gift.” Again, the scientific skeptic might argue that this is just wishful thinking for the crazies, who want to believe they are special.  But upon closer examination we must understand that the truth of calling them “crazies” is manifested in that labeling.  Calling them dangerously gifted can take on its own kind of truth, and the consequences of that name are far different, and for some people, perhaps better.  As one leader from Icarus has said, a person can certainly take their meds because they are sick.  They can alternatively take their meds because they are a superhero learning to control their powers.  Though this is something of a comical statement, it reflects the power framing has on a situation.  The work this social activist has done throughout his life was made possible by dangerous gifts.  Had he remained convinced he was ill, his options would have been far more limited.  What the next generation of mental health professionals needs to do is focus more on empowering and caring for those suffering psychically than chase after an illusory “truth” to their condition.  This does not mean a turn away from science, but an embracing of other forms of knowledge that will hopefully result in a mental health industry prepared to deal with people in all of their complexity.