“You have to go on and be crazy. Craziness is like heaven.”
― Jimmy Hendrix
Have you ever thought about what a diagnosis is? We believe a diagnosis contains an explanation of the cause so that when you’re diagnosed “with” something you know what it is. In addition, one also hopes to learn how to remove it. We diagnose problems, situations, and illnesses, and it’s the same in each case. The diagnosis is an explanation.
In medicine we take this for granted, even though most medical diagnoses often don’t tell us what it is or how it got there or, often, how to get rid of it. Still, for the most part, we have faith, do what’s prescribed, and accord healing powers to the doctor if we get better.
There are many different types of medical situations and, for the chronic ones, if we get better, it’s usually not through the powers of medical intervention but through our ability to heal ourselves. That is to say, in those cases the diagnosis might be irrelevant.
Then we come to mental health, and for some strange reason we no longer have “it” but we now are “it.” Presumably, this change from carrying to being reflects a new type of condition. Now, the thing we’ve got has literally gone to our brain. And since we equate the brain with the mind and with us, the affliction now is us rather than just being attached to us.
I know many people diagnosed as mentally ill who don’t appear much different from anyone else on the surface. They reveal differences under the surface; but then, under the surface, so do most people. In fact, by any comprehensive standard that I know—given that mental illness is something one is rather than something one has—all people are mentally ill in some regard. Few people are perfect. I consider most people disturbed. It’s normal.
There are books filled with medical diagnoses with mechanical, genetic, chemical, neurological, nutritional, and cellular explanations for each. There are few books with mental health diagnoses. You cannot just “discover” a mental illness. You might be the first to name some condition, but until it’s put in the Diagnostic and Statistical Manual of Mental Disorders, or one of the few similar tomes, it’s not “real.”
To add to the confusion, with each new edition of these manuals new real illnesses are introduced and old real illnesses are combined, redefined, renamed, or erased. In fact, in many of the DSM’s newer editions, the definition of mental illness itself is redefined.
“There is no point driving yourself mad trying to stop yourself going mad. You might as well give in and save your sanity for later.” — Douglas Adams
Symptoms and Behaviors
The confusion that I’m pointing to is an illusion. The truth and the key to the puzzle is that “mental illness” is a misnomer. It used to be that mental illnesses were believed to have mechanical causes and so were labeled in the same way as physical illnesses. It was thought that it was only a matter of time before various mental illnesses would be understood and cured and that equating them with physical illness was justified. But that is no longer the case.
The Diagnostic Manual, the DSM, is really a dictionary. It serves to define terms and presentations and to set similar conditions in juxtaposition. In this way people have a language to describe what clients present. It’s diagnostic in the taxonomic sense, not the pathogenic sense.
While some would dispute the blanket statement that all mental illness is a matter of terminology, the role of diagnosis in mental illness no longer makes any pretense of assigning cause. Because of this, we should really reappraise the mental health endeavor. We’re no longer trying to cure anything, because the labels we assign to mental conditions are not attached to “things.” This being the case, how can one identify oneself with these conditions? One does not say “I am indigestion,” or “I am pain,” so why do we say, “I am depressed,” or “I am delusional”?
Consider statements of our capacities. It has become a habit to identify ourselves with what we do. We say “I am a runner,” or “I am a doctor,” or something else we would like to identify with, as in “I am pretty,” or “I am smart.” But if we are too insistent, inconsistent, or incoherent while actually believing ourselves, we’re considered mentally unstable. So we say “we are” this or that, but we’re not supposed to take it too seriously. This all strikes me as a misuse of language. It perpetuates the basic misunderstandings of I-ness, being-ness, and what we’re trying to accomplish.
Do you really think you know who you are? Of course not. You are a charade. You don’t know if you’re smart or dumb, pretty or ugly, smart or stupid. “It’s relative,” you might explain, but that’s not why you don’t know. These standards are constantly abused, misused, ignored, distorted, and misunderstood. In fact, in many cases, they’re simply meaningless terms that we use to justify what we already believe.
At the root of it, these are symptoms. “I am smart,” or “I am delusional,” or “I am ill,” is a symptom relating to one’s self-image. You may be something, but what you are is not what you know yourself to be. Similarly, if you “are” sick, then you’d be lucky if you knew much about it. Being aware that you feel sick tells you as much about the cause as the smell of day-old garbage.
This is why we get along with knowing so little about our symptoms: for the most part, they mean whatever we feel they mean. Very rarely do we test or fully explore the attributes of our sanity, and when we do we keep our cards close to our chest.
Regardless of what other people think, we’ll likely retain our self-image. If you feel unloved, you will never feel loved by being loved, and if you do feel loved, you will never feel hated by being hated. “All you need is love,” sang The Beatles, and everyone believes them.
“The extreme limit of wisdom, that’s what the public calls madness.” — Jean Cocteau
I work with someone who protests they’re not delusional. They are hoping, I suspect, that by recognizing this I’ll think better of them. Once that introduction is out of the way, they solicit my endorsement of their delusional-sounding stories. I tell them, “Yeah, that sounds delusional, but that doesn’t mean it’s wrong.”
It’s unclear what delusional means. There’s a long slope of inference and implication that leads to the shores of delusion, and even once we’ve arrived it’s possible to wade out pretty far before reality floats away in scattered pieces.
Fully delusional means you act in response to an imagined reality that fails to respond properly and conflicts with the reality of others. The problem with this definition is that all reality is imagined, and just because you can elicit the response you intend does not mean you’re thinking normally.
Don Quixote wasn’t said to be delusional because he tilted at windmills but because he thought they were giants. That wasn’t true. He knew the windmills were windmills, but he said they were giants magically changed into windmills. Was he delusional because he believed in magic? No, everyone believes in some form of magic and much of it makes little more sense than his windmill story. Don Quixote was delusional because he did weird things based on unusually strange explanations.
I tell my friend, “Don’t worry too much about being delusional. Just because your theories are largely false doesn’t mean they’re all wrong. When you behave suspiciously toward suspicious people, it’s easy for them to slip further into that perception of you. It’s easy to make yourself into a perceived adversary. At that point, your initial paranoia starts to become justified.”
What’s happening in my friend’s case is a combination of misunderstood cues, weak social skills, and a river of personal fears. The problem is not one of delusions, it’s one of failing to understand the meaning of them. The delusions are a repetitive nightmare from which my friend cannot awake.
“Anybody remotely interesting is mad, in some way or another.” — Doctor Who
Let’s Get Real
People have all kinds of ideas in their heads, and acting on most of them would qualify a person as delusional. That doesn’t mean these ideas are wrong; they’re just likely untrue, unwise, and unproductive. It’s knowing how to assign a probability to one’s expectation that distinguishes accurate prediction, by which we distinguish truth from delusion.
This leaves a huge grey area, and most of what we do lies within it. Most of what we do is based on illusion, and many of these illusions are destructive, such as what we think of other people and of ourselves.
For some people, delusion erupts into daily life in the form of depression. For others, it’s a nagging irritation as disruptive as living above a dance hall. This characterizes many of my sleep-deprived clients. It’s as if there is some internal alarm clock they cannot shut off. They may not hear menacing voices, but they have destructive ideation. I have it, too, we all do; but if we’re “normal” we keep our boats upright even through the rough water.
I don’t know about you, but if the water’s too calm I get bored. I guess I’m an adventure hound. If I’m not engaged in some difficult and important puzzle, then I couldn’t be bothered. I don’t have a lot of fun; I’m not generally happy, I’m sorry to say, but I’m always doing something I think is important. This qualifies me as being kind of crazy. I’d rather have good company and stimulating companionship but I can’t find it, and it’s not for lack of trying.
If I were not outgoing and personable, I’d qualify as a sociopath, and I may be one, except that I act normal and I don’t blame others for my troubles. If I did, there’d be hell to pay, and many people do blame others for their problems or see other people as a threat. And while most individuals don’t wage war on other individuals, they do cause trouble for others, and they will wage wars collectively.
“Sometimes the dim veil between sanity and insanity is perception.” — Luis Marques
On the Bright Side
Is there a bright side to delusion? Success, stability, security, wealth, happiness, fame, family, and good community do exist, sometimes. At least, so it appears.
How about creativity, invention, whimsy, and good cheer? These are all products of our imagination and exist in our imagination. Why is it that in some cases we insist on dwelling on the negative, the low self-esteem, and those that ill-treat us? Should we be fostering better environments by homesteading in paradise, or should we be fighting a war in the jungles of our dark thoughts? I would like to do the former, but I find the jungle more interesting. Jungles are wonderful places.
Most of those who come to me are in the same quandary. They’re looking for a new path, new ideas, or a new mind. It’s a jigsaw puzzle, and sometimes all it takes is finding the right piece in order to create a raft of new possibilities.
I read business books that seem like paeans to positive delusion. Rationalism veers into delusion when it treats people as logical agents acting in their own best interests. Blue Ocean Strategy, a hugely popular management guide from two world-class academics, is one of these.
Blue Ocean Strategy reviews over one hundred unlikely success stories and concludes that the most profitable, secure path to success is to create a wildly unlikely, successful business. Their impressive research analyzes hundreds of improbable businesses to provide a careful outline of how to flush inspiration out of the bushes.
I feel these authors’ well-meaning business advice is delusional, and the mass acceptance of their optimistic formula is delusional as well. I’m happy to say that in the book’s expanded edition they’ve added a chapter exploring the failures of those who took this path.
On the topic of mass delusions, brittanica.com says this:
“Why is the myth of mass lemming suicide so widely believed? For one, it provides an irresistible metaphor for human behavior. Someone who blindly follows a crowd—maybe even toward catastrophe—is called a lemming. Over the past century, the myth has been invoked to express modern anxieties about how individuality could be submerged and destroyed by mass phenomena, such as political movements or consumer culture.”
… or business management books.
In this case, the delusion is believing there exists a low-risk path to innovation. This is delusional for the business person who, with notions of chivalry, sets off to slay the dragon… or the giants cum windmills, an economic soldier risking their life for pride, valor, glory, and wealth.
There is a real beneficiary here. Soldiers help countries secure assets in the way entrepreneurs help industries find solutions. Many die trying.
Do you want to be a huge success like Bill Gates? Do you have Asperger’s to start with? How about Steve Jobs? Are you an orphaned sociopath?
The most spiritually successful people I’ve known lived humble, minimal lives. The most materially successful people I’ve known are personally unattractive to me. Some were obviously unbalanced, others suspiciously so. I don’t think that you have to be crazy to be successful, but I do think that the most successful are at least a little bent.
“Insane people are always sure they are fine. It is only the sane people who are willing to admit they are crazy.” — Nora Ephron
I’m a truth-teller. I believe in it as a way of life. I don’t presume to know The Truth, or even be certain of the smaller truths, but if I can tell if something is a lie of consequence, I will expose it. Watch out for the Small Lies, they’re often bigger than they seem.
I accept the inconsequential lies, the unjustified presumptions, and the arbitrary protocol. Knowing where to draw the line is a combination of intuition, sensitivity, and discernment. You need to see where things are headed. Two tell-tale elements of Big Lies are a gut feeling of malintent, and evidence of personal injury or injurious intent.
I actually don’t believe in success as a goal. I don’t believe in happiness as a goal, either. I’m usually uncomfortable around socially extroverted, happy people. The few I’ve known well turned out not to be so happy.
I believe happiness and success are dispensable accessories to spiritual balance. You don’t need either, and their pursuit is a distraction. Maybe you’ll achieve them, or maybe you won’t. Happiness and success are not what is most important in life. There is no prescription that everyone can follow, short of introspection and personal work.
Introspection is necessary because much of what you need to know you don’t yet know. Much of what you need to know is hidden in your forgotten past, buried beneath the layers of your ego, habit, and necessity, or ingrained in the ignorances of your family, culture, and genetic predispositions. You need to dig for it.
The universal prescription for success is simple: do your work fearlessly. Make the project your reward and don’t be afraid of your delusions, just keep your balance.
“Be mad and tell us what is behind the veil of ‘sanity.’ The purpose of life is to bring us closer to those secrets, and madness is the only means.” — Khalil Gibran
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Lincoln, you write provocatively and it is interesting. You write from a distinct and very personal and highly intellectual perspective of your own. You write like an all knowing observer who is not actually walking along a usual life path.
You also portray an unscientific bias against Western Medicine; the word doctor means teacher; we know we cure few illnesses but we frequently guide people to their own healing. The significance of mental illness is that these patients are suffering! They are asking for whatever we have to make them feel and function better.
However, there is great sadness between the lines. I believe happiness is really important and that most deserve it. I wish everyone had such success in their own estimation that they were satisfied Or had the ability to change their chances.
Alas, like weight loss whilst not impossible, some things are very difficult.
Will likely be in Victoria early November.
Wonderful to hear from you, Rick! There is clarity within or between our disagreement. I do find medicine and science largely incompatible: there is almost no science in clinical medicine (almost, with the exception of the aim for repeatability which both share) and nothing almost clinical in science (almost, except for attention to “objectified” results). Also, having now said it in this post, I feel more certain that making happiness a goal is a mistake. Happiness is like money in that is is acquired (or chemically released) as a reward for achievement but, like money, making it a goal regardless of the nature of that achievement leads to disaster. Your comments are much appreciated.