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The Condition of MadnessReview - The Condition of Madness
by Brian Grant
University Press of America, 1999
Review by Glenn Branch
Dec 18th 1999 (Volume 3, Issue 50)

The Condition of Madness is the work of Brian Grant, Associate Professor of Philosophy at the University of Calgary. As the title suggests, Grant is concerned with madness; as his profession suggests, he is concerned with it qua philosopher. Philosophy is foremost only in the lengthy final chapter, however; the first three chapters—roughly half of the book—are generally historical or expository in nature. In none of the chapters, however, is there anything worthwhile. Unformed, tedious, and shoddy, The Condition of Madness is unlikely to be of interest to anyone, especially at its exorbitant price—$32.50 in paperback, $54.00 in hardback. I cannot think of any reason to recommend it.

Grant begins the first chapter—"The Pioneers—From Freud to Pharmacology and California"—with the unexceptionable observation that "[t]o come to terms with psychiatry, we need to look first of all at its past" (p. 1). Unfortunately, the ensuing sketch of the history of psychiatry is quite unsatisfactory. He begins, arbitrarily (as he acknowledges), with Freud, to whose work he devotes thirteen pages, concentrating on The Interpretation of Dreams. The discussion is strangely uneven, lurching between uncontroversial points about Freud’s life and recondite, often dogmatic, claims about his theory of the unconscious. Although Grant is critical of Freud’s theory of the unconscious, he reaches the startling conclusion that it is right in certain cases: "All that is really needed here is for there to be one convincing case. One case in all of Freud’s writings—or those of anyone else, for that matter—that is described in Freudian and convincing terms. I don’t see how anyone who has read Freud could possibly deny it. The only question then is for just how many cases of madness and neurosis does this sort of account seem right. This is the question of whether we all—or all of the mad or neurotic—have a Ucs" (p. 11—throughout the chapter, Grant insists, pointlessly, on referring to the unconscious as the Ucs). Here Grant is properly wary of Freud’s penchant for overgeneralization but apparently oblivious to Freud’s tendency to distort his case studies (as documented in, e.g., Malcolm Macmillan’s definitive critique Freud Evaluated: The Completed Arc). It is at once ironic and suggestive that Grant fails to identify what he considers to be the canonical Freudian case.

Although Freud was hardly the last in the psychodynamic tradition, it is not until the third chapter that Grant says anything about his successors. Instead, after the discussion of Freud, he turns his attention to the pharmacological tradition, which he identifies as beginning with Freud’s contemporary Emil Kraepelin. He perfunctorily reviews the various treatments used, now and in the past, for various mental disorders—not all of which are pharmacological, e.g., prefrontal lobotomy and electroconvulsive therapy (the currently preferred term for what Grant refers to as electroshock therapy and what slang cheerfully calls Edison Medicine). Although there is nothing particularly objectionable in his discussion here, there is also nothing that is unavailable in any decent encyclopedia. The remainder of the chapter is devoted to "California"—not the state as such but the state of mind exemplified by practitioners of Scientology, Cocounseling, est, Esalen, Primal Therapy, Transcendental Meditation, and the like—culminating, unilluminatingly, with a page-long list of self-help titles. Grant’s treatment of the self-help movement is resolutely superficial and ahistorical. His lack of sympathy for the movement is so profound that he fails to provide any intelligent criticism of it; Wendy Kaminer’s discussion in I’m Dysfunctional, You’re Dysfunctional, on which he acknowledges relying, is far superior in depth and insight. It is amusing that Grant is critical of the credulous devotees of the self-help movement when he himself is rather credulous, not only about Freud, but also about telepathy (see p. 107).

The second chapter of The Condition of Madness—"The Cynics"—is devoted to Thomas Szasz and R. D. Laing, whom Grant takes to deny, in their separate ways, the existence of madness altogether. The title of the chapter is misleading. Cynics about psychiatry would, by definition, be suspicious of the motives of psychiatrists, thinking them not to be as altruistic or disinterested as they purport to be. Grant’s discussion, however, focuses on Szasz’s and Laing’s doubts about the epistemological legitimacy of psychiatry: for the purpose at hand, then, the two are not cynics but skeptics. Szasz and Laing are hardly the only skeptics in the area, but Grant concentrates on them on the grounds that they "have dominated the ‘anti-psychiatry’ movement over the last thirty years or so" (p. 35), which, if arguable, is at any rate not implausible. Now, faced with the sort of complicated epistemological controversy initiated by Szasz, Laing, and their crowd, the philosopher is supposed at least to clarify the debate. (Clarifying the debate is of course compatible with engaging in it as well; think of Philip Kitcher and Robert Pennock writing on creationism, or Adolf Grünbaum and Frank Cioffi [reviewed in Metapsychology July 1999] writing on Freud, or J. L. Mackie and Anthony Flew writing on theism.) Grant fails here, primarily because his presentation of the positions of his adversaries tends to be simplistic, uncharitable, and even distorted. Doubtless the antipsychiatry movement is seriously in need of careful philosophical examination, but Grant’s attempt is neither thorough nor judicious.

Grant graces his discussion of Szasz’s criticism of psychiatry with three pages of disparagement of Ayn Rand, whose novels, political writings, and philosophical work he deplores.  As it happens, I wholeheartedly share his aversion to Rand, but why the festival of excoriation? Glancing through the indexes of several of Szasz’s books, I found no reference to Rand.  Yet Grant declares that "the single indisputable and pervasive influence [of Rand on Szasz] lies in morality and social policy.  It’s there in the harping on, in every conceivable context, about ‘freedom’, ‘liberty’, and ‘autonomy’" (p. 38).  It is hard to take Grant’s detection of the fine Russian hand of Ayn Rand at work here seriously; by his capacious criterion, anyone on the political spectrum who evinces concern for freedom, from Barry Goldwater to Emma Goldman, ought to count among her admirers.  Grant later writes, "The only direct evidence I have for the link between Szasz and Ayn Rand is that he has for years been a Contributing Editor of Reason, the official voice of the Libertarian party of which Ayn Rand is the intellectual guru" (p. 58, n. 3).  I took the trouble to check with Reason’s Director of Public Affairs, who stated that Reason is not affiliated with the Libertarian Party, that contributing editors and staff members of Reason are not required to be either members of the Libertarian Party or admirers of Ayn Rand, and that Rand herself disowned, and threatened to sue, Reason in the early 1970s.  Grant’s cavalier way with the facts here fails to inspire confidence in the reliability of his scholarship.

The third chapter—"The Believers"—concentrates on what Grant takes to be the beliefs of "those who make a living out of madness" (p. 63—who’s the cynic now?), starting with the taxonomy of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, i.e., DSM IV. As readers of Metapsychology are aware, criticisms of DSM IV and its ancestors abound. (Two recent book-length critiques, which I have not read, are Herb Kutchins and Stuart Kirk’s Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders and Paula Caplan’s They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal.) Probably the central complaint is that the DSM emphasizes descriptive consensus at the cost of ignoring the question of etiological validity; as Paul McHugh and Phillip Slaveney complained in 1983, "reliability, and not validity, is the goal of the DSM" (The Perspectives of Psychiatry, p. 32). Without citing any of his fellow critics, Grant echoes the complaint: "reliability—a sort of coherence notion of consensus among diagnosticians—is much more highly prized than validity" (p. 64). Nevertheless, in the following twenty pages of discussion of DSM IV’s taxonomy, and in the reprise in the fourth chapter, his specific criticisms are conspicuously not based on etiology. The point here is not that Grant’s criticisms are worthless—they vary in worth: some seem cogent, some seem captious, some seem confused—but that they are a priori, retrospective, and without the evidential resources to produce any suggestions for improvement. Turning from taxonomy to therapy, Grant reviews various sorts of "talking cures" for the remainder of the chapter, finally asserting, without citing any evidence, that "the above therapies, if and when they are at all plausible, usually owe a large debt to psychoanalysis" (p. 89)—i.e., in accordance with his prior stipulation, to "broadly Freudian views" (p. 40). Which Freudian views exactly? He fails to say.

Finally, in the lengthy fourth chapter—"The Anatomy of a Concept"—Grant proposes to examine the concept of madness philosophically, noting that "philosophers have not paid much attention to madness" (p. 96). True. Certainly philosophers ought to pay attention to madness, for, in light of the philosophical tendency to hyperintellectualize the mind, it is useful to ponder the idea of the faulty mind. But it is useful only insofar as the ponderer is competent, which is not the case with Grant, whose examination of the concept of madness, such as it is, fails to provide any philosophical insight whatsoever. On the mind–body problem, he fails by his own admission: "So what have we learned from this excursion through the major Isms in the philosophy of mind? What are we to retain, what can we take with us, in our thinking about the mad? Not much, it must be admitted" (p. 116). Moreover, the excursion itself is not sufficiently clear to be helpful to anyone unfamiliar with the philosophy of mind, while experts are bound to be appalled at its inaccuracies, especially in his discussion of supervenience. He cites the work of the doyen of supervenience, Jaegwon Kim, but did he read it? Grant is unable to phrase even the simplest claim correctly. Take, for example, his example in which "the table supervenes on its atomic representation" (p. 112). Ouch! It is not objects but properties (and sets of properties) that supervene; moreover, what the properties of the table supervene on is not any representation of atoms but the atoms—or rather the properties of the atoms—themselves. Furthermore, he fails to distinguish among the innumerable varieties of supervenience, which is ironic in light of his concern with taxonomy in psychology and in light of his endorsement (on p. 96) of Wittgenstein’s insistence on the philosophical importance of making distinctions. Finally, and damningly, Grant thinks that supervenience is among the candidate solutions to the mind–body problem, instead of what it is: one of the data to be explained by any candidate solution.

Other philosophical topics addressed in the fourth chapter are skepticism with regard to reason, introspection, the self, and freedom versus determinism. On none of these topics is Grant’s discussion clearly presented or carefully argued; the promised connection with the concept of madness is frequently obscure or invisible. The chapter culminates with his suggested definitions of madness, neurosis, personality disorder, mental disorder, and sanity, none of which appear to me to be insightful or interesting in the slightest. The definition of mental disorder, for example, reads, in full: "Any of the above [i.e., presumably, madness, neurosis, and personality disorder]. In a broader sense: Any disorder that directly affects or involves the mind" (p. 192). Oh. Is the audience that Grant envisions hopefully in his preface—"philosophers, psychiatrists, neurologists, psychologists, journalists, lawyers, witch-doctors of one school or another, sales managers, anthropologists, sociologists of course since they care about everything—and, insofar as this is possible, […] the mad themselves" (p. v)—likely to be impressed? Fat chance.

Grant’s prose in The Condition of Madness is breezy, undistinguished, and badly in need of the editorial pencil. Try parsing the second sentence of the first chapter: "So this is the history of, not a science and not really or just an art, but a field, certainly, or a discipline, an area where training, experience and expertise have a crucial place" (p. 1). His writing is also lamentably imprecise, which in a philosopher is a particularly grave failing. Worst of all, perhaps, is his indulgence in ponderous bouts of whimsy, as in the paragraph introducing his discussion of the self-help movement: "So hey, kick back, chill out. Get your head or your shit together, get in touch or connect with yourself. I mean, find your own space. Are you hearing me? Like be happy, be rich, be cool, be real, be an asshole. Be you or the very best you you can be. And have a nice one, a really nice one. You know?" (p. 24). How droll. Don’t quit your day job, Professor Grant.

Glenn Branch received his BA in philosophy from Brandeis University and is presently on leave from the PhD program in philosophy at UCLA. Among his philosophical interests are the philosophy of mind, evolutionary psychology, and the scientific status of psychoanalysis.

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