A New Way to Be Mad

The phenomenon is not as rare as one might think: healthy people deliberately setting out to rid themselves of one or more of their limbs, with or without a surgeon's help. Why do pathologies sometimes arise as if from nowhere? Can the mere description of a condition make it contagious?
Ecological Niches

One of the novels that occasionally pop up on devotee and wannabe book lists is Katherine Dunn's Geek Love (1989), the story of a carnival family conceived through the ingenuity of Al and Lil Binewski. Lil, the family matriarch, has ingested pesticides, radioactive materials, and a variety of drugs in order to produce children who are special: Iphigenia and Electra, piano-playing conjoined twins; Olympia, the bald albino hunchback dwarf who narrates the story; Chick, who has telekinetic powers; and Arturo the Aqua Boy, who was born with flippers instead of arms and legs. Arty, the undisputed star of the carnival, swims and frolics in an aquarium and then preaches dark, enigmatic sermons to his assembled admirers. "If I had arms and legs and hair like everybody else, do you think I'd be happy? I would not!" he shouts to his audience. "Because then I'd worry did somebody love me! I'd have to look outside myself to find out what to think of myself!"

Arty's charisma eventually propels him into the leadership of an Arturan Cult, whose members tithe parts of their body in order to become more like him. His assistant, a rogue surgeon by the name of Dr. Phyllis, amputates the digits and limbs of enthusiastic Arturans. Off come toes and fingers, then hands and feet, and finally, as converts approach ecstatic completeness, all four limbs in their entirety. "Can you be happy with the movies and the ads and the clothes in the stores and the doctors and the eyes as you walk down the street all telling you there is something wrong with you?" Arty asks a blubbering fat woman in the audience, like a preacher making an altar call. "No. You can't. You cannot be happy. Because, you poor darling baby, you believe them...." Soon his caravan is trailed by thousands of armless and legless disciples, living in tents, begging for food, waiting patiently for another turn in the operating room with Dr. Phyllis.

Geek Love is an odd choice for a devotee or wannabe reading list. It is brutal in its mockery of amputee wannabes. Yet it makes sense of a darker side of American life that often goes unexplored in the mainstream media. The media generally treat the desire for body modification either as the well-worn terrain of fashion slaves and social strivers, who buy cosmetic surgery in an endless quest for beauty and perpetual youth, or as something bizarre and unexplainable, like genital mutilation or masochistic fetishes. Geek Love makes the desire for amputation plausible by setting it against the bland, cheery aesthetic of mainstream American beauty. Geek Love may mock amputee wannabes, but it does not mock them for their poor taste. The aesthetic sensibility of Geek Love comes straight out of a carnival sideshow. Its heroes are not "norms," as ordinary Americans are called in the book, but the freaks of the Binewski Carnival Fabulon. "We are masterpieces," Olympia says when asked if she would like to be a norm. "Why would I want to change us into assembly-line items? The only way you people can tell each other apart is by your clothes."

Geek Love may help us understand the cultural context that produces conditions like apotemnophilia. Why do certain psychopathologies arise, seemingly out of nowhere, in certain societies and during certain historical periods, and then disappear just as suddenly? Why did young men in late-nineteenth-century France begin lapsing into a fugue state, wandering the continent with no memory of their past, coming to themselves months later in Moscow or Algiers with no idea how they got there? What was it about America in the 1970s and 1980s that made it possible for thousands of Americans and their therapists to come to believe that two, ten, even dozens of personalities could be living in the same head? One does not have to imagine a cunning cult leader to envision alarming numbers of desperate people asking to have their limbs removed. One has only to imagine the right set of historical and cultural conditions.

So, at any rate, suggests the philosopher and historian of science Ian Hacking, who in a series of strikingly innovative books and articles has attempted to explain just how "transient mental illnesses" such as the fugue state and multiple-personality disorder arise. A transient mental illness is by no means an imaginary mental illness, though in what ways it is real (or "real," as the social constructionists would have it) is a matter for philosophical debate. A transient mental illness is a mental illness that is limited to a certain time and place. It finds an ecological niche, as Hacking puts it—an idea that helps to explain how it thrives. In the same way that the idea of an ecological niche helps to explain why the polar bear is adapted to the Arctic ecosystem, or the chigger to the South Carolina woods, Hacking's ecological niches help to explain the conditions that made it possible for multiple-personality disorder to flourish in late-twentieth-century America and the fugue state to flourish in nineteenth-century Bordeaux. If the niche disappears, the mental illness disappears along with it.

Hacking does not intend to rule out other kinds of causal mechanisms, such as traumatic events in childhood and neurobiological processes. His point is that a single causal mechanism isn't sufficient to explain psychiatric disorders, especially those contained within the boundaries of particular cultural contexts or historical periods. Even schizophrenia, which looks very much like a brain disease, has changed its form, outlines, and presentation from one culture or historical period to the next. The concept of a niche is a way to make sense of these changes. Hacking asks, What makes it possible, in a particular time and place, for this to be a way to be mad?

Hacking's books Rewriting the Soul (1995) and Mad Travelers (1998) are about "dissociative" disorders, or what used to be called hysteria. He has argued, I think very persuasively, that psychiatrists and other clinicians helped to create the epidemics of fugue in nineteenth-century Europe and multiple-personality disorder in late-twentieth-century America simply by the way they viewed the disorders—by the kinds of questions they asked patients, the treatments they used, the diagnostic categories available to them at the time, and the way these patients fit within those categories. He points out, for example, that the multiple-personality-disorder epidemic rode on the shoulders of a perceived epidemic of child abuse, which began to emerge in the 1960s and which was thought to be part of the cause of multiple-personality disorder. Multiple personalities were a result of childhood trauma; child abuse is a form of trauma; it seemed to make sense that if there were an epidemic of child abuse, we would see more and more multiples.

Crucial to the way this worked is what Hacking calls the "looping effect," by which he means how a classification affects the thing being classified. Unlike objects, people are conscious of the way they are classified, and they alter their behavior and self-conceptions in response to their classification. Look at the concept of "genius," Hacking says, and the way it affected the behavior of people in the Romantic period who thought of themselves as geniuses. Look also at the way in which their behavior in turn affected the concept of genius. This is a looping effect. In the 1970s, he argues, therapists started asking patients they thought might be multiples if they had been abused as children, and patients in therapy began remembering episodes of abuse (some of which may not have actually occurred). These memories reinforced the diagnosis of multiple-personality disorder, and once they were categorized as multiples, some patients began behaving as multiples are expected to behave. Not intentionally, of course, but the category "multiple-personality disorder" gave them a new way to be mad.

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Carl Elliott teaches at the Center for Bioethics at the University of Minnesota. He is the author of A Philosophical Disease (1998) and a co-editor of The Last Physician: Walker Percy and the Moral Life of Medicine (1999).

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