Mad Knowledge

Somewhere in amongst all that growing up a sense of identity has been forged. Events beat the malleable self on the anvil of the genetic and cultural mix. Those events just keep on coming– refining and tempering throughout life. A sense of self is one of those concepts, like mind, that take fright and fly away when focused on. We probably don’t dwell very often on the nature of our selves, although bookshelves groaning under the weight of ‘self-help’ volumes might suggest otherwise, but we do know how we feel when we are ignored or recognized. Crucially, how we react to both criticism, praise or circumstance can build or diminish confidence in the person we are becoming. Insights into that process are best provided by fiction writers from the Ancient Greeks, Chaucer, Shakespeare to Jane Austin, Tolstoy and many from the 20th and 21stcentury rather than the quasi-medical discipline of psychology and its antonym psychiatry. Thus, by way of offering an answer to one of my questions about the usefulness of knowledge, a brief look at a history of how madness is viewed and treated follows.

I realise questioning the validity of an entire academic discipline does sound just a touch arrogant. Please indulge my explanation. It seems to me that the rigorous and persistent study of human biology has over the years revealed an increasing complexity in the ways the physical body functions both endogenously and with the environment. The application of this scientifically accumulated knowledge has undoubtedly decreased morbidity of whole populations. This uncontroversial statement goes part way to answering my question about knowledge. However, the same lifesaving results cannot be said about knowledge derived from studying the mind. Despite the advances in untangling the relationship between neuroscience and pharmacology the brain still resides behind a locked door. It is the least understood organ. Even if every last electrochemical process in the neuronal universe was revealed the resultant knowledge would contribute little to understanding emotional distress we suffer from time to time.

The phrase ‘mental illness’ or ‘mental health’ stem from a long etiological history. The metaphor that best encapsulates that history is the pendulum. Even in Ancient Greece it swung from mental abnormality being caused by intervention by the gods or demons to an early version of the medical model with Hippocrates’ humours in the brain being out of balance. Then it swung back during the Ecclesiastical state of the Middle Ages. Instead of antiquarian intervention by gods, the mad were possessed by Satan, Jews or heretics. (On Religious and Psychiatric Atheism: The Success of Epicurus, the Failure of Thomas Szasz, Michael Fontaine, Aug.26th 2014)

Fast forward to a post Scientific, Age of Reason, Enlightenment influenced Europe, the insane, having been incarcerated for the amusement of the gentry, at least now had the opportunity to roam around in the ample grounds of mental asylums. So that by late 19th century, the pendulum had swung back to Hippocrates only this time humours have been replaced by diseases of the central nervous system. This process leads to the German Physician Emil Kraepelin (1856 – 1927) formulating a syndrome ‘dementia praecox’ a label which later became ‘schizophrenia’ whose causes were completely organic. (A Social History of Madness, Roy Porter,1987) The consequences of this return to chemistry which Foucault labelled the construction of the ‘psychiatric patient’ or a shift from madness to ‘psychiatric pathology’, meant that anything uttered by the mad was ignored as symptomatic gibberish and justified their incarceration in ever larger numbers. (Porter,1987) In order to legitimate psychiatry as a medical discipline “…a shameful series of pseudoscientific rationales {were used} to justify the use of inhumane, and often barbaric treatment protocols such as insulin coma therapy, lobotomy, shock therapy, and most recently, the prescribing of antipsychotics…” (The Science and Pseudoscience of Mental Health Podcast, Sharna Olfman, Sept. 27th 2018, MIA)

Meanwhile post Scientific, Age of Reason, Enlightenment influenced Europe, the insane, having been incarcerated for the amusement of the gentry, at least now had the opportunity to roam around in the ample grounds of mental asylums. So that by late 19th century, the pendulum had swung back to Hippocrates only this time humours have been replaced by diseases of the central nervous system. This process leads to the German Physician Emil Kraepelin (1856 – 1927) formulating a syndrome ‘dementia praecox’ a label which later became ‘schizophrenia’ whose causes were completely organic. (A Social History of Madness, Roy Porter,1987) The consequences of this return to chemistry which Foucault labelled the construction of the ‘psychiatric patient’ or a shift from madness to ‘psychiatric pathology’, meant that anything uttered by the mad was ignored as symptomatic gibberish and justified their incarceration in ever larger numbers. (Porter,1987) In order to legitimate psychiatry as a medical discipline “…a shameful series of pseudoscientific rationales {were used} to justify the use of inhumane, and often barbaric treatment protocols such as insulin coma therapy, lobotomy, shock therapy, and most recently, the prescribing of antipsychotics…” (The Science and Pseudoscience of Mental Health Podcast, Sharna Olfman, Sept. 27th 2018, MIA)

While broadly agreeing with Kelmenson’s de-coupling abnormal behaviour from the disease model, there are occasions when some sort of drastic intervention is called for. In my case, after passing out post declaiming with messianic fervour to a bunch of my relatives perhaps a dose of smelling salts was not quite enough. Whether my catatonia justified the use of ECT I’ll never know but given that I did recover from an acute hypomanic nervous breakdown I have to conclude it worked. However, I’m not convinced the neuroleptic tranquillizers used to treat my ‘paranoid schizophrenia’ were necessary. Sure, they speeded up the diminution of the florid symptoms, but I had already had my alternative reality punctured by Tom on one occasion and my parents on another while in Ashford Remand. I don’t think it’s too much of a stretch to imagine I would have slowly come to accept that not everyone I didn’t know were Arab spies. Recovery might have been possible simply with enough reciprocal trust and empathy built up slowly in a setting such as Longrove. But then that would have taken too long for parents who were used to outsourcing emotional support. As Alwine said “It’s marvellous what those drugs can do these days!”

As this is supposed to be a critique of knowledge as it pertains to the vexed relationship between the abnormal and the normal mind and body, how has treatment of schizophrenia progressed in the last 50 years? According to Simon McCarthy-Jones, (Assoc Prof in clinical Psychology and Neuropsychology, Trinity College, Dublin. 2017) “…the proportion of people {diagnosed schizophrenic} who recover hasn’t increased over time.” The answer, the good professor proposes, is to hasten the end of the label schizophrenia.

Questions such as ‘who is Tom? Who is Alwine? What was Longrove and why Arabs? will be answered when I post chapters from my memoire. So stay tuned… Oh yes, that “growing sense of identity” I referred to relates to my early 20s.

Bretton Woods to Nixon

To explain what Nixon did to shock global finance it is first necessary to understand the significance of Bretton Woods. In 1944 there were still at least 5 major battles in two theatres to be won before the end of the war but armistice in the Allies’ favour was expected. It was a measure of the determination to put in place a global economic system, which would prevent future wars that it was convened even as war still raged. Remarkably, this ambitious international agreement was negotiated and ratified in 22 days.

One can imagine a delegate from France, say, whose family lived in Cherbourg, Rouen or Amiens, struggling to concentrate on nutting out the articles of the Fund in a committee or plenary session when you knew your parents would be on the front line of invading allies and Germans retreating.

If you were a delegate from Europe you probably flew in to New York then you would have been driven East on highway 95 to New Haven and then north on 91 for 300 kilometers where you turned right and drove through Bath, Lisbon, Littleton, Bethlehem and Carroll till your tires crunched on the driveway of the massive Mount Washington Hotel in Bretton Woods in the state of New Hampshire. Place names reflecting their British, French, Portuguese and Palestinian heritage. This off the beaten track venue was chosen because it was probably the closest big enough place to New York that only had one access road, so it was easier to secure and also picturesquely situated beneath mountains. Probably as a casualty of the 1929 stock market crash the hotel closed down in 1930 so had to be extensively renovated for the 730 delegates from 44 countries arriving in July 14 years later. As Shirley Boskey recalled in 1957 only “…some of the faucets produced clear water, but not all of the time, a failing for which the free Coca Cola dispensers on the veranda did not fully compensate.”

 

Shirley Boskey 1917-1998

Who the hell was Shirley Boskey? You might wonder. She was smart, had a great sense of humour –­ rare in the world of international finance­­– and became the first woman director of the International Relations Department at the World Bank from 1975 – ’83. She characterized the difference in priorities between the Fund and the IRBD (International Bank of Reconstruction and Development) as “… the [Fund] being the spinach in the international diet and the bank as dessert…and as everyone knows, spinach comes before dessert.” Later in the same recollection she unpacked the euphemism used to describe the Articles of Agreement for the bank – “sufficiently flexible” as being a politer word than “vague”. A year earlier, 1956, yet another institution providing international finance was established. The Economist magazine announced the formation of the international Finance Corporation thus: “To IBRD – a son.” A gender challenged by Shirley who said, “It had kept people waiting since 1951…it would be engaged principally in spending money…And it had already changed its mind…” (Jonas Haralz, in The World Bank: Its First Half Century, Vol. 1, 1997) Shirley Boskey 1917-1998

The purpose of the conference was to learn from the mistakes of the Treaty of Versailles which was overly punitive to the vanquished and set-in train competitive devaluation of currencies which is believed to have fed the rise of Fascism, the stock market crash of 1929, world depression and war. The deliberations were premised on the notion that peace between nations is dependent on international cooperation and economic stability. Although Keynesian government intervention was seen as a good thing in the form of the welfare state, strong currency rules were set up so governments could NOT intervene. The primary instrument of monetary regulation they agreed upon was fixed exchange rates with the US dollar being the reserve currency which itself was pegged to gold. Even an economic neophyte like myself can conclude that a regulatory regime like that has got to reduce the opportunity for gambling with currencies and thus free up money for investing in actual things.

Dismantling of Bretton Woods– the World Bank, as it later became known, and IMF survived–involved the overturning of the fixed exchange rates pegged to the American dollar, which in turn was tied to gold, which ushered in an era of recessions and inflation. According to Lutz Kilian, writing for the Reserve bank of Australia in 2009, there is little consensus on the causal relationship between oil price rise, monetary policy and stagflation (high inflation, slow growth high unemployment) in the early 70s. Since that time, in the absence of ‘wage-rigidities’– the ‘fault’ of powerful labour unions but despite countless stock market crashes, banking crises and massive budget deficits there has not been high inflation which is a necessary ingredient of that uniquely 70s phenomenon: stagflation. The most telling graph, which encapsulates the uniqueness of that post war period, can be found in This Time is Different by Reinhart and Rogoff’s 2010 book detailing the similarities of financial crises over 800 years. The chart shows the number of countries having a banking crisis each year from 1800 to 2010. The graphic resembles Shard-like skyscrapers reaching ever higher as they move towards the year 2000 and the absence of any crises between 1945 and 1971 looks like the gap in the New York sky line where the Twin Towers used to be. Therefore, it has to be concluded the global financially regulated system of fixed exchange rates worked.

Another telling graph with two lines snaking off together from 1948 and remaining entwined until 1972 and then diverging until 2013, shows how productivity rose by 143% but wages by only 8.9 %. (G. White, Atlantic, Feb. 2015) Without going in a too granular analysis of the causes of Nixon pulling out of Bretton Woods, suffice to say the Keynesian approach to economic management was beginning to unravel. Eagerly anticipated by Milton Friedman – the darling of Thatcher, Reagan, Kohl, Hawke, Keating and just about everyone else in the OECD during the 80s. As early as 1962 he was advocating refloating exchange rates, but it was probably his winning the Nobel Prize for economics in ’76 that guaranteed his influence. Although, given Thatcher’s penchant for taking tea with Pinochet, it was more likely to be the shock therapy Friedman advised the Chilean ouster of Allende to deal with Chile’s economic crisis that so impressed the Iron Lady.