Myths of Madness

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Book Review

Myths of Madness

New Facts for Old Fallacies

The Macmillan Company

New York, 1964 (hardcover)

by Don D. Jackson, M.D.

reviewed by

Douglas A. Smith

While I was browsing in a store where used books are sold I was intrigued by the

title of this book: " Myths of Madness. " Seeing it was published in 1964 - 38

years ago - the thought occurred to me it might not be relevant now in the year

2002. I couldn't have been more wrong. Myths of Madness is as relevant today

as when it was published.

 

 

The author, Don D. Jackson, M.D., graduated from Stanford Medical School and was

an Assistant Professor of Psychiatry there. There is a web site about his

career (http://www.mri.org/dondjackson). The authors of the web site call him

" A Founding Father of Family Therapy " and say he was named one of the top ten

psychiatrists in America shortly before his death in 1968. Myths of Madness was

his second book, his first being The Etiology of Schizophrenia. Many years ago

a friend of mine recommended another of Dr. Jackson's books, The Mirages of

Marriage, co-authored with William J. Lederer, a book that remains popular

today. A biographical note on the dust cover of Myths of Madness says Dr.

Jackson was a fellow of the Academy of Psychoanalysis. A pattern I have noticed

is psychiatrists who have had psychoanalytic training not only oppose biological

psychiatry but, like Dr. Jackson, demonstrate a vastly greater understanding of

human psychology than other psychiatrists.

 

 

Myths of Madness is mostly a critique of biological theories of mental illness,

particularly genetic or hereditary theories. In this book Dr. Jackson argues

that " as the evidence accumulates, the hereditary theory [of mental illness]

seems to lose ground " (p. 147) but that " diagnosis by heredity continues despite

lack of evidence " (p. 60). This of course is still true now in 2002. Dr.

Jackson says that even in his time " most physicians [d] to the theory

of organic causation " and says " No amount of learned writing in the journals has

yet altered their basic position, in spite of their superficial knowledge " (p.

151). He rejects the term mental " illness " and instead uses the term mental

" disorder " which to him had a different meaning. He says when he wrote the book

there was a " new awareness among psychiatrists and other behavioral scientists

that their patients are not sick in the usual medical meaning of the word " (p.

4). He points out that " Mental disorders cannot be diagnosed by such anatomical

or chemical means as urinanalysis or blood pressure or X rays " (p. 4), a

statement that is as true today as when he wrote it 38 years ago. He says " The

fathers of modern psychiatry were, in the main, medical men " and that " This

situation led not only to using medical terms but to classifying mental

disorders like physical diseases, and the problems created by this

understandable but mistaken technique still plague the profession " (pp. 5-6).

Because of the rise of biological psychiatry in recent years, this is more true

today than it was in 1964 when Myths of Madness was published. Dr. Jackson says

" I am arguing here that the case for the inheritance of mental disorder has been

overstated, misstated, and badly applied, and this theory has worked to the

detriment of the mental patient in his relations with the law, medicine, and

even the public at large " (p. 11). He acknowledges, as he must, that he

" cannot...prove that heredity has absolutely no connection with mental disorder "

(p. 11). Heredity does indirectly contribute to what are thought of as mental

disorders or illnesses, because people do inherit what they are physically, and

people who are born with genes that make them short or ugly or with less

intellectual capacity than others are more likely to encounter frustration when

trying to get their needs met, such as getting and keeping a good job or winning

the love of an attractive member of the opposite sex. The truth of this was

dramatically illustrated to me when I went to an " Alternatives " conference in

Columbus, Ohio in 1993 at which an estimated 2,000 ex-mental patients attended:

The number of us with physical abnormalities and physical disabilities was

striking. Nowhere before had I seen such a large percentage of people in

wheelchairs. Physically disabled or unattractive people are more likely than

others to have difficulty getting their needs met, and as psychiatrist William

Glasser said in his book Reality Therapy (Harper & Row, New York, 1965, pp.

5-6), " ...everyone who needs psychiatric treatment suffers from one basic

inadequacy: he is unable to fulfill his needs. ... whatever the symptom, it

disappears when the person's needs are successfully fulfilled. " This sort of

understanding eludes today's biologically oriented psychiatrists, who instead

believe in unproved biological theories of so-called mental illness. Biological

psychiatry today is a regression from what in the past was a more widespread and

more accurate understanding of what is called mental illness or disorder.

 

 

Despite being a strong proponent of the " nurture " or environment side of the

nature-nurture or heredity versus environment debate, Dr. Jackson acknowledges

the influence of biology in the development of human intelligence. He refers to

studies showing there is a closer correlation between adopted children's

intelligence and that of their biological parents than their adoptive parents

even if they move to their adoptive home in their first few months of life. He

cites a study showing that on average the intelligence of children whose mothers

took " vitamin supplements during the latter part of pregnancy was significantly

higher than those whose mothers had received inert control tablets " (pp. 19-20).

However, he discounts the importance of intelligence in creativity, saying

" there seems to be no direct relationship between creativity and a high

intelligence quotient as measured by the usual tests. Creativity may be found

among the low scorers as well as the high, and a 'genius' may be quite as

lacking in this important quality as his academically untalented neighbor. "

However, he says, family environment greatly affects creativity: " Statistically,

certain family characteristics were found to be associated with creative

performance in the children - a family that encouraged expression without

domination, accepted regression...parents who showed a lack of dependency on

each other or on the family as a means of reinforcing the parents' own status.

Actually, among those children who rated high in creativity, no family deviated

markedly from this pattern. In addition, " he says, " the characteristic pattern

showed parents who had rather well-defined personalities and who were able to

express emotions and emotional material, both toward each other and toward the

child " (p. 21).

 

 

Dr. Jackson's chapter titled " A Salk Vaccine for the Mind? " is so good I've been

tempted to make a photostatic copy of it and send it to a psychiatric resident

(a physician in training to be a psychiatrist) with whom I've had an exchange of

letters. In this chapter Dr. Jackson does point-by-point refutations of various

biological, particularly genetic, theories of mental illness that were

supposedly verified but were later disproved and discarded, revealing that the

futile efforts to prove the existence of biological causes of mental illness

were as commonplace four decades ago as they are today. He closes this chapter

with these words: " Don't believe everything you read. No tranquilizer affects a

schizophrenic as insulin affects a diabetic " (p. 77). What Dr. Jackson refers

to as a tranquilizer is the same as what today is often (misleadingly) called an

" anti-psychotic " drug.

 

 

Dr. Jackson gives two particularly damning examples disproving the ridiculous

concept of " milieu therapy " as applied to the supposedly therapeutic environment

of a mental hospital - and illustrating the value of the idea as a justification

for abandoning psychiatry and instead letting people recover from the emotional

consequences of their problems in the context of normal human society. The

first of these involved mental hospital patients in Stockholm, Sweden who were

" allowed to summer on the Italian Riviera " to see if the change from the

environment of the mental hospital where they had spent much of their lives

might be helpful. One result was of 50 patients in the experiment, " 8 patients

with hebephrenia, paranoia, or catatonia, all hospitalized more than fifteen

years, were permanently discharged " (pp. 97-98). All they needed to " recover "

from their supposed mental illness was escaping the depressing and limiting, one

might say anti-therapeutic, environment of a mental hospital. The other

experiment involved normal men who were kept in an isolation chamber to observe

what changes in their electroencephalograms (EEGs) might occur. The result was

" each man showed a progressive decrease in the number of waves in the alpha

range ... This decrease lasted for some time after the men left the isolation

chamber, and in each case the EEG was abnormal a week later. ... these three

experimental subjects are important primarily because EEG changes have so often

been reported in hospitalized schizophrenics. No one has ever considered that

these changes might be the result of the hospital environment rather than

something inherent in the biological structure of the mentally disturbed " (pp.

98- 99). He says a mental patient " is taught the patient's role, deprived of

his possessions, his contacts with the outside, and his previous ego-enhancing

activities; in fact, he may eventually be deprived of his identity. It is not

surprising, therefore, to find slight biochemical differences between mental

patients and medical students " used as control subjects (p. 157). Dr. Jackson

charges that " the patient in the state hospital who looks, acts, and talks in a

strange way may be largely the product of the social isolation and the peculiar

milieu in which he lives " (p. 160).

 

 

There is no doubt most members of the National Alliance for the Mentally Ill

(NAMI) would hate this book. Not only does Dr. Jackson demolish NAMI's

cherished biological and genetic theories of mental illness that allow the

family members of so-called mentally ill people who compose the bulk of NAMI's

membership to proclaim they are in no way to blame for their so-called mentally

ill family member's problems. He goes further and shows how " family situations

cause mental disturbances. [italics in original] In other words, father,

mother, brothers, and sisters, if any, behave in such a way that one member of

the family, either in an attempt to satisfy their needs and meet their demands

or as a result of total inability to do so, is forced into the abnormal behavior

that we call mental disorder. This member is singled out as 'sick' and sent to

the doctor, to be diagnosed as neurotic, manic-depressive, schizophrenic, or

whatever. Actually, however, the behavior of the entire family must be, and

must have been, abnormal in order to bring about the situation; in a sense, the

family is 'sick'. ... One of the most rewarding occurrences in family therapy

is the discovery of a piece of family interaction or behavior that explains one

of the patient's symptoms. In this sense, schizophrenia and schizophrenic

symptoms are adaptive behavior. ... These parents and others like them are not

deceitful or mean; they simply act out in a pattern in which they and the

patient are hopelessly caught. ... as a treatment method, the analysis and

modification of such family behavior produces results " (pp. 105 & 127-128). Dr.

Jackson says " after one has worked with families, it is difficult, for many

reasons, to accept the hereditary hypothesis of severe mental disorders. ...

On the other hand, meeting a truly nurturing and healthy family is a truly

impressive experience, and it is difficult to imagine what kind of hereditary

handicap this kind of family could not overcome. That biological equipment is

but a small part of living has been proved by Helen Keller and her magnificent

and patient teacher. There is no reason to imagine, for example, that a child

born with a 'sensitive nervous system' (if indeed one can be) could not be

protected during his formative years by parents who accepted their

responsibilities and were truly able to give " (pp. 154-155). As I quote these

words I can see and hear the anger seethe from a typical NAMI member who might

read them whose mantra is " mental illness is biological and genetic and is no

one's fault. "

 

 

In this book Dr. Jackson laments " the situation that occurs every day in the

office of the psychiatrist who believes that mental disorders are primarily

organic, and therefore that pills are the most reliable agents. Like the

believer in heredity, he leaves his patient alone and untreated in large areas

of his disturbed world " (p. 152).

 

 

On the next-to-last page of his book Dr. Jackson says " actually we have no

standard of 'normal' to use as a yardstick " (p. 168). I especially like the

final paragraph of the last chapter of the book (p. 169), which I will also make

the final words of this book review:

 

On that day when it is generally recognized that " normality " is a myth,

that mankind does not divide into sane and insane, that mental disorder is not

an intractable unalterable ogre unrelated to ordinary human nature, we will look

with more optimism toward the future. We will recognize that man is

fantastically adaptable (especially when he is given adequate opportunities) and

that most people contribute something to the world. We will know that men and

women, strangers or neighbors, are not " less normal " or " more inferior " than we

are - just different.

 

 

 

 

 

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