Monday, September 19, 2011

Mental Health and "The Three Christs of Ypsilanti"

Dealing with mental illness is something that society does not do well. First, there is the arbitrariness in the definition. Psychiatrists have at their disposal a manual that details hundreds of different states of mind that can be interpreted as illness, but this is only an attempt to relieve the practitioner from the guilt associated with making arbitrary decisions. 

Given that an individual has crossed whatever boundary exists between sanity and insanity, what does one do about it? One can be assured with physical sicknesses that a broken bone is really broken, or that a fever is caused by a virus, but with mental illness we are left with a system little better than calling the local witch doctor to come and cast out the evil spirit that has invaded the friend or family member. The good "doctor" will generally pull out a handful of colored stones from a pouch, pick the appropriate color while mumbling an incantation, and order the "sick" person to swallow the colored object.

But what if the "sick" person denies their sickness? A person can refuse treatment for medical treatment for a physical ailment and have their decision honored—or even applauded. Refusing treatment for a mental illness can be deemed as confirmation of being mentally ill—and mentally incompetent to boot. We discussed earlier Rachel Aviv’s article in The New Yorker describing Linda Bishop’s struggle with her demon. She suffered intermittently from delusions, was diagnosed as schizophrenic, and was provided medication. She did not like who she became under the influence of the medication and for the rest of her life refused to take any. Aviv presents a moving tale of her life and ultimate demise. Bishop chose a lonely and slow death by hunger rather than submitting to medication and the loss of the person she saw herself to be.

Some might call Linda bishop a sick fool. Others might view her as a heroine in a tragic tale.

Jenny Diski addresses some of these same issues in an article in the London Review of Books. Diski has some first-hand experience with mental illness and the associated issues. She tells us that at the age of sixteen, and after spending time in a psychiatric hospital, she came across a book that highly influenced her and confirmed observations she had made about the "mentally ill." The book was The Three Christs of Ypsilanti by Milton Rokeach.

Rokeach was a social psychologist who received a grant to perform an extended study of three institutionalized patients at Ypsilanti State Hospital in Michigan.

"Rokeach specialised in belief systems: how it is that people develop and keep (or change) their beliefs according to their needs and the requirements of the social world they inhabit."

The particular study he was to embark on promised to be exceptionally interesting. He was to bring together three individuals who all claimed that they were Jesus Christ. How would the three men, who all claimed to be the same person/God, react when placed in extended contact with others making the same claim?

Diski makes it clear that this was not an attempt at treatment. They were to be experimented on to try to understand the strength of their delusions and to determine if they could be manipulated in such a way as to alter them. Rokeach is quoted in order to define his approach.

"Because it is not feasible to study such phenomena with normal people, it seemed reasonable to focus on delusional systems of belief in the hope that, in subjecting them to strain, there would be little to lose and, hopefully, a great deal to gain."

Diski takes delight in recounting how the "mentally ill" were clever enough to keep a step ahead of Rokeach and his ploys. They each had no trouble dealing with any potential conflict when confronted by two others claiming to be the same person they were. After all, when dealing with individuals who are confined to a mental hospital it is rather easy to conclude that they might be insane. They basically sidestepped the issue and got along rather well together.

She views Rokeach’s attempts at manipulation as unworthy of the doctor, pointing out that the assumption implicit in his approach was that because these people did not lead "normal" lives, their lives and feelings were his to toy with.

"The three Christs themselves, however, were of the certain opinion that they had something valuable to lose and made truly heroic efforts, each in his own way, to resist, as well as to explain to Rokeach and his team that their lives had considerable meaning for them. All of them....had a very clear understanding of what it was to be deluded, why it might be a useful option to choose over normality, and who did and didn’t have the right to interfere in their self-selected delusions."

In fact the three were so persistent and persuasive in defense of their delusions that

"....Rokeach deduced that ‘a psychotic is a psychotic only to the extent that he has to be’."

Rokeach may not have attained the results he anticipated, but he must have written an excellent book. Diski writes:

"In 1964, having spent some time myself in a psychiatric hospital, I read The Three Christs....which confirmed what I had seen in it. It has made me very wary of reading ‘case histories’, written about the disturbed by those who believe themselves to know better. It also seemed to me, aged 16, that The Three Christs of Ypsilanti contained everything there was to know about the world. That’s not the case of course, but if resources were short, I’d still be inclined to salvage this book as a way of explaining the terror of the human condition, and the astonishing fact that people battle for their rights and dignity in the face of that terror, in order to establish their place in the world, whatever they decide it has to be."

Diski seems to be telling us that people can have illusions not because their brain is damaged, but because that is the only way they have found to cope with the world. Interestingly, she points out that Rokeach ultimately came to a similar conclusion. His book was reissued in the 1980’s and he appended some afterthoughts.

"Rokeach reread the book with regret. There were, he says, four people with delusional beliefs, not three. He failed to take himself into account, and the three Christs, not cured themselves, had cured him of his ‘God-like delusion that I could change them by omnipotently and omnisciently arranging and rearranging their daily lives’. He came to realise that he had no right to play God and interfere, and was increasingly uncomfortable about the ethics of his experiment. ‘I was cured when I was able to leave them in peace...."

As for what he may have learned from his study:

"The best Rokeach can manage is the acknowledgment that psychosis ‘may sometimes represent the best terms a person can come to with life’."

When Rokeach first started his study it was common practice to physically administer the equivalent to a whack up-side-the-head in hopes of jolting the person’s brain back to normality. Much time has gone by, but the only thing that has changed is that the hopeful jolt is administered with drugs. Both approaches have the same null scientific backing.  Perhaps, when possible, we should just leave these people alone.

When I first read of Linda Bishop’s story I concluded there was a bit of the heroine in her tale. I expect Diski would concur. Thanks go to Jenny Diski for providing some desperately needed perspective and insight into these matters.

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