Mind, Modernity, Madness: The Impact of Culture on Human Experience
by Liah Greenfeld

Reviewed by Catherine McKenna

In his 1897 book Le Suicide, Emile Durkheim defines the concept of ‘anomie’ as ‘man’s activity’s lacking regulation and his consequent sufferings’. Durkheim asserts that, ‘in anomic suicide, society’s influence is lacking in the basically individual passions, thus leaving them without a check-rein.’ For Durkheim, individuals in society need a moral structure in order to limit their desire. It is free-running desire, or limitless aspiration, which leads to anomie. Events such as economic disasters disrupt the usual moral structure(s) which govern the limits within which individuals in a society may aspire, leading to anomie. Greater still is the structural influence of (de-regulated) industry, whose boundless markets and endless drive towards growth lead to ubiquitous anomie; ‘There, the state of crisis and anomy is constant and, so to speak, normal. From top to bottom of the ladder, greed is aroused without knowing where to find ultimate foothold. Nothing can calm it, since its goal is far beyond all it can attain.’

Liah Greenfeld’s new study of the influence of culture on schizophrenia and manic depression, Mind, Modernity, Madness: The Impact of Culture on Human Experience, has Durkheim’s concept of anomie at its centre. Greenfeld describes anomie as a ‘cultural insufficiency – the inability of a culture to provide individuals within it with consistent guidance.’ This lack of guidance, for Greenfield, leads to difficulties in identity formation and mental functioning. Greenfeld sees this phenomenon of anomie as a significant causal factor in the illnesses of schizophrenia and manic depression. But whereas Durkheim examines specific cultural causes of anomie (deregulation of industry, economic disaster etc.), Greenfeld’s approach focuses instead on the influence of nationalism.

Although it is not made explicit in the title, Greenfeld’s concept of nationalism is the central facet of the book, and indeed of Greenfeld’s entire body of work, (Mind, Modernity, Madness is, in fact, the third in a trilogy on the theme of Nationalism). Mind, Modernity, Madness’s basic thesis is that ‘anomie’ is the result of the uniquely modern phenomenon of nationalism, defined in the book as consisting of the three principles of ‘secularism, egalitarianism, and popular sovereignty’. These principles, it is argued, bring into being the idea(l) of the ‘individual in control of his or her destiny… the ultimate authority in deciding on one’s priorities.’ Indeed, Greenfeld’s discussion of the linguistic history of the term ‘madness,’ the documentation of the creation of a new medical vocabulary, provides a significant challenge to any claims that these illnesses, as we currently understand them, were in existence before the rise of nationalism. Greenfeld argues persuasively that this was a new, previously non-existent affliction, for which new medical terminology, institutions, organisations and journals would be created.

Mind, Modernity, Madness displays an astonishing level of research. In the last section of the book, the historical section, Greenfeld takes as a case study the emergence of ‘madness’ as an illness in 16th century England – a time coinciding with the emergence of nationalism and transformation of society following the War of the Roses – and the subsequent spread of ‘madness’ to Ireland and France as nationalism took hold in these countries. Particularly persuasive is the evidence Greenfeld puts forth of the lack of ‘madness’ in France during its early days in England, despite the French knowledge of the ‘English malady. ’ Provocatively, Greenfeld documents the French eagerness to ape the English by building their own asylums, which then stood empty until nationalism began to take hold. Not only does Mind, Modernity, Madness cover the historical development of the “science” and treatment of schizophrenia and manic depression from England in the 16th Century, through France, Germany, Russia and America into the present, but it also gives a thorough and fascinating overview of the current state of scientific studies of these illnesses. Greenfeld further supports her theory with analysis of evidence of the significantly lower incidences of the illnesses of schizophrenia and manic depression in countries where nationalism has not taken hold.

Greenfeld turns to America, and the history of schizophrenia and manic depression from its inception to the present day, towards the end of her work. America is for her a special case, a ‘country which was born with national consciousness (though not defined at first as a separate nation) and madness already present’. There are incidences of ‘madness’ documented in the historical record in America from as early as 1752. Thus ‘madness exists in, and has existed since the inception, of the United States’. Finally, the issue of whether anomic illnesses have been and are on the increase is the central concern of the final section of the book. In particular, Greenfeld looks to demonstrate the increase of these illnesses in line with the spread of the principles implied in nationalism to large groups of the population whose access to such freedoms had previously been denied (women or the descendents of slaves, for example). This provides Greenfeld with the opportunity to examine the difficulties surrounding statistical evidence in relation to these illnesses, with early mistakes in evidentiary recordings leading to the mistrust of statistics, and subsequent refusals to acknowledge the increase of these illnesses.

Greenfeld’s book persuasively demonstrates the lack of consensus in the scientific community and beyond, over the causes, treatment and prevalence of schizophrenia and manic depression, both in America and worldwide. As this review is being prepared a new edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, is being released in the United States to some controversy. Liah Greenfeld’s call for a broader understanding of the role of culture in the growth of the illnesses of schizophrenia and manic depression seems perfectly timed to join the debate over the balance between science and culture in the diagnosis and treatment of these complex illnesses.