Tuesday, December 23, 2014

The Invention of Nostalgia

The Invention of Nostalgia
Lawrence Raab
Before 1688 nostalgia didn't exist
People felt sad and thought about home,
but in 1688 Johannes Hofer, a Swiss doctor,
made up the word. It wasn't what he himself
was feeling, but a malady he'd observed

in soldiers posted far from home.
Leeches and opium were the cure,
and if those failed, a return to the Alps.
Therefore: homesickness, nostalgia's symptom,
the way your stomach felt that first nitht

at summer camp, though if you cried
so hard you had to leave, later
you probably found yourself thinking,
They'd be swimming now, they'd be having lunch.
And you felt sad in a different way.

Imagine how many places you can't
go back to, how much it hurts
to want what's lost--all those days,
the ones that have left
their cloudy picture in your mind.

and the smell of certain rooms, the light
through trees at a certain hour, a time
before the first time you felt it,
like all the years before 1688
when no one had the right word to turn to.

Lawrence Raab is author, mostly recently of "Visible Signs: New and
Selected Poems"

Sunday, September 07, 2014

Erving Goffman's Asylums

While still in college and working as a volunteer at a 5,000 bed state hospital, I read Erving Goffman's Asylums. His descriptions of St. Elizabeth's Hospital matched what I was observing each Saturday afternoon during the 3 or 4 hours that I spent with a few of the 200 men housed on  a so-called Cottage Ward.  I  accepted Asylums as the gospel. Recently I read a short article titled "Erving Goffman's Asylums and Institutional Culture in the Mid-twentieth Century United States" by the historian Mathew Gambino, which takes a second look at Goffman's classic book. Gambino reviews materials, such as a patient edited newspaper, that were available to Goffman. Where Goffman saw indoctrination, Gambino hears the voices of patients. Even after more than fifty years he was able to locate statements by patients that suggested that they were quite active in shaping their lives at patients. Indeed, Gambino points out that for all the time Goffman spent as a participant-observer at St. Elizabeth's, he presented no interviews with patients. The difference in orientation between Goffman and Gambino suggests an evolution in our attitudes towards the mentally ill. While Goffman saw the patients  as victims, Gambino asks us to consider these patients as agents.  This does not suggest to me that we simply rewrite the history of asylum treatment in the United States. At the very least there is no way that I can erase my experiences with patients at a state hospital in the 1960s. It does suggest that when we write about the mentally ill  we should not forget that they are people struggling not only with their illnesses, but with the institutions that shape their lives. Gambino's article should be required reading in classrooms where students are asked to read Asylums.

Wednesday, July 30, 2014

The Weariness of the Self

The Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age
Alain Ehrenberg
(McGill-Queens University Press, 2009)

It appears that we live in the midst of an epidemic of an illness that we call Depression. Looking back to my training as a psychiatrist in the early 1970s, the diagnosis of Depression was usually limited to states that were so disabling that a person could not work, was at risk of suicide, often needed hospitalization and was usually treated with tricyclic antidepressants or ECT. There was a diagnosis of Neurotic Depression that was milder and was always treated with psychotherapy. Our current epidemic is usually explained by two factors: first, the Diagnostic and Statistical Manual of 1980 which eliminated Neurotic Depression and created a vaguely defined category called Major Depression and second, the advent of Prozac, an easy to take medication that was effective for a broad range of symptoms. 
Ehrenberg takes a different tack. He traces the history of depression focusing on two models. The conflict model, initiated by Freud, sees people as whole, but divided by conflict. Transgression and guilt are the forces that drive it, especially in France where Lacan's version of psychoanalysis is dominant and about which Ehrenberg is writing. The key term in the second model is deficiency. Following the social and cultural changes of the 1960s, he argues, transgression and guilt were no longer dominant concerns. She, and Ehrenberg is religious about using that pronoun, can do anything she wants. Now what matters is feeling inadequate, that is to say deficient. Depression is no longer about conflict and guilt, but about feeling inadequate and deficient. Medications like Prozac help with this by allowing people to feel more capable. Ehrenberg seems nostalgic for the old days when conflict reigned and psychoanalysis was popular. He seems to hold the view that feeling better because of a chemical effect is not authentic. Nonetheless, because he sees the changes as cultural, and social he does not make case for going back to the old days. 

What to make of a book like this. It was certainly confusing at times, especially because most of his references are to twentieth century French psychiatry about which I am not very familiar. The broad idealistic/Foucauldian perspective where cultures change without clearly marked material causes is hard to follow. Nonetheless, posing a contrast between a view of human nature centered on the idea of conflict and one centered on a notion of deficiency is quite refreshing. It isn't a matter of a biological/psychological dichotomy. Ehrenberg is clear psychotherapies, going back to Janet, can be based on a deficiency model. Indeed as I think about discussions of psychotherapy in recent years it seems to me that these were often based on the premise that the patient was somehow injured and in need of repair, not that 'she' was in conflict about how to live. The medications and the psychotherapies that we use are consistent with one another in how they view human nature. In this regard it seems to me that Ehrenberg is onto something and that this book was worth reading.

Wednesday, February 19, 2014

The Prisoner of Stress

Having seen Scott Stossel's book My Age of Anxiety” (Knopf) in a bookstore, I was interested in reading Louis Menand's review. Menand, as usual, goes beyond simply giving his opinion about the book under review. In this case he has written an interesting essay on the many meanings of anxiety. Is it an illness? Is it due to unconscious conflicts? Is it an existential condition? Is it due to stressors? None of the above or all of the above. Is it even 'somthing'? In the course of the review he sketches a brief history of our current ideas about and methods for treating anxiety. While he doesn't mention Andrea Tone's book The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers, I would suggest it as a good place to get a fuller description of this history.  

In the end Menand seems to take an agnostic position about theories of anxiety. His final word leaves room for both biology and psychology. He writes "As a species, we lucked out: natural selection gave us minds, and that freed us from the prison of biological determinism. We can put our genetic assets to positive account if and as we choose, and sometimes we have to try to do the same thing with our genetic deficits. " Not a bad approach to something we may not be able to avoid.