Book Review
Myths of Madness
New Facts for Old FallaciesThe Macmillan Company
New York, 1964 (hardcover)by Don D. Jackson, M.D.
reviewed by
Douglas A. SmithWhile 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 subscribe[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.