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Sometimes, I think Jack Nicholson was the worst thing that ever happened to mental illness. In One Flew Over the Cuckoo's Nest, he played an anti-social rebel who took refuge in a loony bin, where he rallied the oppressed inmates to revolt against the tyrannical Nurse Ratched (who symbolized the rigid authoritarian forces of society). He was punished, of course. They tied him down and tortured him with electroshock, which turned him into a compliant vegetable.
The movie, one of the biggest hits of the seventies, reinforced the widespread belief of everybody under 30 that the people who ran the world (Richard Nixon, our parents) were the crazy ones, and the protesters, the rebels, the Merry Pranksters, and the nonconformists (i.e., us) were the sane ones. Society was mad, not Jack.
This week's Globe and Mail series has given much attention to the stigma of mental illness. But the romanticizing of it has done a lot of damage, too. Thirty years ago, the people who flocked to see Jack Nicholson fervently believed that mind-warping substances such as dope and psychedelics threw open the gates to perception. We devoured the work of R. D. Laing (who argued that mental illness is a perfectly understandable reaction to the conditions of modern life) and Thomas Szasz (who argued that involuntary hospitalization of the mentally ill is a crime against humanity). We idolized Virginia Woolf, Sylvia Plath and other exalted sufferers, convinced that madness and great art were two sides of the same coin. We also knew that mental institutions were full of sadists, who shocked and lobotomized their victims into submission.
Soon after came the great wave of deinstitutionalization. In the name of progress and humanity, the big old buildings were shut down across North America. The mentally ill would be better off in the community, it was thought, perhaps in small group homes. But they were never built, and those freed but tortured souls were left to fend for themselves on the streets. Madness had come to Yonge and Bloor in Toronto, and it wasn't very romantic after all.
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Today, mental illness has been acknowledged as a major cause of homelessness. On the streets, the dazed, the addicted and the witless are prone to disease and predation. Such is our compassion that we have made it all but impossible to hospitalize a mentally ill person against his will, or keep him in a safe place if he wants to leave, or give him treatment he doesn't want. People in the grip of severe mental illness are seldom capable of making informed decisions. But the pendulum of human rights has swung so far the other way that involuntary treatment has become unthinkable.
The advent of modern psychopharmacology has been a boon for a many of these souls (so long as they take their meds, a big problem when you're living on the streets). It is also a godsend for millions of the ordinary walking wounded - people who suffer lifelong depression, bipolar disorder, obsessive-compulsive disorder, postpartum depression and what used to be called nervous breakdowns. But today, the once-fashionable fear and loathing of mental institutions has morphed into a fear and loathing of Big Pharma. The anti-psychiatric narrative is essentially the same, only this time it's drugs that are being used to enforce conformity to social norms.
Why have we turned into Prozac Nation? Because it's in capitalism's interest to produce happy, perky, well-adjusted workers and consumers! A variation of this theme is that, in our instant-gratification society, people are no longer willing to tolerate ordinary, garden-variety unhappiness. Another variation is that people's feelings of numbness and distress are a perfectly natural reaction to our individualistic, disconnected society.
On the flip side is the charge that these drugs, although grossly overprescribed, really don't do much good at all. They're hardly better than placebos. Big Pharma has driven the demand with its relentless marketing campaigns, and bought off the medical and psychiatric establishment with billions in research dollars. "It's well known that, if effective at all, antidepressants are barely better than sugar pills," says Gordon Warme, a leading psychiatric critic.
Curiously, he himself is a psychiatrist who taught for decades at the University of Toronto. "Madness," he says, "is another way of life, another way of being human." I'm wondering whether he ever had a depressive episode so severe he didn't get out of bed for a week. My guess is not.
Although Big Pharma has plenty to answer for, the impact on human suffering of modern psychotherapeutic drugs is hard to overstate. I have loved ones who, without them, would not be able to hold a job, live on their own, or stop thinking incessantly about decomposing bodies. Without medication, they'd probably be street people, or dead. I have friends who would not have their marriages, families, careers or the ordinary, garden-variety happiness that makes it worth getting up in the morning. Perhaps sugar pills would have worked for them, but I don't think so. Then there are the one or two people I knew who committed suicide, shattering their families forever. I sometimes wonder if the right medication would have saved them, because cognitive therapy certainly didn't. Or maybe folks such as Dr. Warme would say that killing yourself is just another way of being human.
I no longer think, as I did when I was young, that mental illness is romantic or that suffering is necessary to produce great art. Today, I think that talk therapy alone doesn't always work - you might as well expect talk to heal a broken leg. I think pills for mood disorders are at least as great a blessing as pills for high blood pressure, or shots for diabetes. I even know of people who've been eased of their tremendous suffering by - listen up, Jack! - electroshock therapy. Yes, it's made a comeback. It doesn't hurt or turn you into a vegetable. And it works.
