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[This is a gorgeous essay. I hate to excerpt it at all. -Ed.]

More on Andrew Solomon

I’m a fan of Freud. Despite a lot of funny ideas, his investment in self-awareness – and his method of attaining it, free association – makes him a crucial figure in the enlightenment of our species. Nonetheless, we live in dark times. I’m not a pessimist about nature, but I don’t believe in the progressive arc of history. As Freud himself asserts, human beings have to work to improve themselves. I take this to be true writ large. Without a vast, shared commitment to better our world, we will doom ourselves to horrors old and new. And a sentiment of shared commitment seems to be waning.

As always, though, bad news spells opportunity. In times of darkness, great minds usually arise to challenge the status quo; Freud himself is an example of this. Surprisingly, then, Freud’s philosophy is at the heart of the most scathing critique of modern society I have seen in some time: Adam Curtis’ The Century of the Self.

Curtis doesn’t take issue with Freud’s ideas directly. He attacks them for their consequences. If you have any interest in Freud whatsoever, you MUST watch this documentary. Here is Curtis in his own words:

I don’t say there was a conspiracy but that consumerism had an ideology just as much as fascism or communism did. It was another way of managing the masses in an age of mass democracy. People like [Edward] Bernays were the first architects of that. And the model they used was fundamentally the pessimistic Freudian view that we are just emotional, irrational creatures and nothing more…

Bernays [Freud's nephew] provided the ideas that were used by the US government, big business, and the CIA to develop techniques to manage and control the minds of the American people. But this was not a cynical exercise in manipulation. Those in power believed that the only way to make democracy work and create a stable society was to repress the savage barbarism that the psychoanalysts told them lurked just under the surface of normal American life…

What happened was that a group of psychoanalysts took what Bernays had begun and invented a whole range of techniques to get inside and manage the unconscious mind of the consumer. By the early 50s the ideas of psychoanalysis had penetrated deep into American life. The psychoanalysts themselves became rich and powerful and had many famous politicians, writers and show business celebrities as patients. And, as their ideas took hold, a new elite began to emerge — in politics, social planning, and the business world. What linked them was the assumption that the masses were fundamentally irrational. The way to manage a free market democracy, like America, was to use their psychological understanding to control this irrationality in the interests of everyone.

This may sound a bit marxist for your tastes, with its powerful elite controlling the minds of many. But Curtis is really the opposite of a conspiracy theorist – he’s interested in the consequences of good intentions. With an eye and ear for breathtaking historical detail, he illustrates how Freud’s followers undermine the notion of public good.

It’s safe to assume Freud would be horrified by Curtis’ picture. Freud meant to demystify the unconscious, as a way of freeing us from pain and misery. But his savviest disciples proved to be master manipulators. More shillers than healers, they used Freud’s theories to toy with the unconscious instead.

Curtis’ history is beyond shocking, if only because none of it is secret. He weaves together a grand narrative that seems utterly obvious and yet painfully fresh. Yes, it is true: Freud is the great uncle of public relations, the grandaddy of consumer culture. Watch The Century of the Self and you’ll be convinced.

Part One: Happiness Machines

Part Two: The Engineering of Consent

Part Three: There Is a Policeman Inside All Our Heads He Must Be Destroyed

Part Four: Eight People Sipping Wine in Kettering

I mention this in light of an ongoing debate: what is the best approach to mental illness?  This question has plenty of stock answers – too many, perhaps. When we boil down a complex issue to just two sides, it helps us to digest subsequent arguments. Making a simplified choice at the start of a debate (pro or con?) gives us a footing for grey area. But human beings don’t like grey area right off the bat.

Unfortunately, mental illness is grey area. In its most extreme forms it may not be – everyone agrees that John Hinckley was a sick man – but extreme forms of illness are just that; they’re rare. Most of the time, mental disorder expresses itself within a vast spectrum of behaviors that we can and do normalize. Sadness, emptiness, anxiety, fear, compulsion: these aren’t just symptoms.

The inherent “greyness” of illness makes it a difficult topic. We can reduce it to black and white, but that never does justice to our cause. Take, for example, this recent bit of news:

The level of Americans’ prejudice and discrimination toward people with serious mental illness or substance abuse problems didn’t change over 10 years, a new study has found… [Sociologist Bernice Pescosolido] and her colleagues compared the attitudes of people in 1996 and 2006. During this period, there was a major push to make Americans more aware of the genetic and medical explanations for conditions such as depression, schizophrenia and substance abuse… People who believed that mental illness and substance abuse had neurobiological causes were more likely to be in favor of providing treatment. But these people were no less likely to stigmatize patients with mental illness or substance abuse problems. [my emphasis]

First of all, this is progress. If more people support treatment, that’s a huge plus. Nonetheless, these researchers sound disappointed: “It’s time to stand back and rethink our approach,” said Pescosolido.

Really, guys? Obviously doctors are going to take a medical approach. But I’m a bit astonished that doctors, of all people – the ones who have the most direct experience with illness in all its various forms – think that purely medical explanations are going to satisfy us. Yes, it is absolutely crucial for people to understand illness as a medical problem. As I’ve written in the past, classifying something as a “mental illness” is just a way of acknowledging that treatment exists. But reducing these woes to brain chemistry in order to make illness more approachable?  It’s almost comic. I’m not suggesting that brain chemistry is too complicated for the average person (the fundamentals are easy to grasp, actually). It’s deeper than that. No one wants to think of their emotional life, no matter how unbalanced, as chemical soup.

First of all, this robs us of agency; it suggests a lack of free will. Second of all, it’s an obvious over-simplification. It’s not a distillation of the issue; it’s reductionist. (From a recent post: “It is time… to wonder deeply in and about our gifts, rather than reduce ourselves to primitive urges and selfish genes.”)  Everyone feels in their bones the reach of illness, that illness itself is wrapped up with fundamental things. Even if mental disorder is “just” errant neurons, we know from experience that our psychological development is a feedback loop – that our thoughts, feelings and actions inform our future selves (i.e., our neuronal development). By definition, sufferers can’t control their illness, but invariably they will make decisions that affect its course.

What does this have to do with stigma?  Everything. The premise of my efforts here and elsewhere is that stigma makes illness more difficult to bear – and that whatever exacerbates mental illness is actually part of it. Mental illness is simply too amorphous, too expansive and too rich to reduce to molecular biology alone. People may not articulate this in my way, but this argument is at the heart of a lot blowback against a medicalized view of mental suffering. People do believe, and they want to believe, that when it comes to mental illness, everything matters – not just science.

I’m inclined to agree. Part of my discussion with the students this summer included a brief lesson in neurology, showing them how SSRIs actually work in the brain. This is an essential piece of my attack on stigma, but it’s just a piece. I spent much more time talking about the stigma itself: how it arises, why it’s damaging, and how to combat it. I also talked to them about life in general, and in particular feelings of failure and/or hopelessness: how to recognize them, how to address them, and why they’re okay – why they’re essentially, actually, to a life well-lived. This can be abstract stuff. Brain chemistry is more concrete. But if we don’t acknowledge that our attitudes matter, then why change them?

Here’s a passage from her scathing critique of Freud, whom she obviously admires yet nonetheless finds hyped (bear with me):

If there is one thing that Freud asserts consistently… it is just this–that the mind is not to be trusted. Freud’s self is encapsulated, engrossed by an interior drama of which it cannot be consciously aware–unless instructed in self-awareness by means of psychoanalysis. That is to say, the center of emotional experience, the source of motive and inhibition, is inaccessible to the self as experience [my emphasis]…

If this conclusion was shocking to Jung, it is, nevertheless, a Freudian understanding of a state of things very widely attested to, an understanding that saw a painfully achieved equilibrium [Freud's civilization and its discontents] where others saw decline and dissolution [the Nazi's Jewish problem], that saw in unrest the inescapable fate that is individual and collective human nature [again, Freud's view] rather than corruption, evil, and subversion, which were taken to be alien or Jewish in their sources.

Why a vision of man and society so specific to an extraordinary historical circumstance should have been universalized as for many years it was is an interesting question… Considered aright, his metapsychology might be seen as the testimony of a singular observer to the emotional stresses of life in a fracturing civilization. It might be seen as a gloss on the fact that grand theories of human nature, however magisterial, can be based only on encounters with the world in circumstances that are always exceptional because the factors in play are always too novel, numerous, and volatile to permit generalization.

…Freud tried to bring the assumptions of rationalism to bear on the myths and frenzies that were carrying Europe toward catastrophe. In the event, he brought to bear not reason but rationalization, treating the Europe of his time as timeless and normative [my emphasis], and therefore, in its fractious way, stable. Notably, he attempted to redefine the unconscious, a concept then broadly associated with primitive racial and national identity, making it instead a force in a universal yet radically interior dynamic of self. Granting the perils of delusion, fear, denial, and all the other excesses to which the mind is prone, this severely narrow construction of the mind, suspicious of every impulse and motive that does not seem to express the few but potent urges of the primitive self, bear the mark of its time. Yet… it continues to hold its place among the great, sad, epochal insights that we say have made us modern.

Uhm, whoa. I’m not going to try and unpack this whole passage. While I find it pretty convincing (more on that in a moment), I do think there are some holes in her argument. First of all, Freud didn’t conceive of everyone as a patient. Yes, he devised a universal theory of unconscious conflict; and yes, he broadened the scope of psychiatric treatment immensely. Nonetheless, I don’t think Freud insisted that man “cannot be consciously aware” of himself without psychoanalysis. After all, how would Freud have arisen if that were true? Freud’s genius, and his lasting contribution, is his method, free association. His narratives of psychological conflict (the Oedipal conflict, penis envy) may go in and out of style, but folks will be sitting on couches forevermore.

Freud may seem obsessed with the negative influence of the unconscious mind. But first and foremost he was a doctor, and not in the academic sense. He was treating disease (or pain at least). Should it be so shocking that he sees conflict everywhere? That he is skeptical of self-treatment? Certainly his time and culture influenced his thinking – but his roster of subjects (i.e., patients in distress) may have influenced him just as much. Freud studied hysterics, not Buddhist monks.

My other gripe with Robinson’s passage is her suggestion that Freud’s time, and by extension any time, is utterly unique. Specifically, she seems miffed that Freud commands so much respect these days. But doesn’t it make sense that we should pay such close attention to Freud? If one agrees with Robinson, as I do, that Freud’s theories attempt to extrapolate from from a particular time and place – that they seek to explain and contain the anxieties surrounding the “myths and frenzies that were carrying Europe toward catastrophe” – then wouldn’t we be wise to listen to him intently? The world agrees: the horrors of WWII are too horrifying to repeat. Is it so odd that we’ve lionized Freud under these circumstances? Perhaps his perspective is tainted, but Freud’s relevance may persist for this very reason. In other words, the horrors of WWII have tainted us. How could we not fear our worst tendencies after Naziism? To undermine Freud’s theories as the “testimony of a singular observer” indicates, in my mind, a lack of shared anxiety with Freud, a lack of anxiety about our own capabilities. Like it or not, this anxiety may be the defining feature of modern life – and with good reason. We have proven ourselves capable of unimaginable cruelty and annihilation. Of course each moment in time is unique, but some are more unique than others; or as Mark Twain put it: “All generalizations are false, including this one.”

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Having said all that, Marilynne Robinson’s mission feels plenty apt, and I’m wholly on board with her. In short, she wants to lift us up. “I believe it is only prudent to make a very high estimate of human nature,” she writes, “first of all in order to contain the worst impulses of human nature, and then to liberate its best impulses.” Our contemporary urge to commemorate the Holocaust, and our appreciation of Freud, dawns from a desire to curb our worst impulses, to be sure. Robinson, however, is far more focused on liberating our best impulses. In broad terms, she takes issue with what she calls “parascientific” literature, a “genre of social or political theory or anthropology” that, “using the science of its moment” and with a “characteristic certainty,” reduces human nature to a set of primordial first principles and, from there, claims to settle life’s deepest questions. (Why is blood thicker than water? Genes. Why am I depressed? A chemical imbalance.)

Scientists are inclined to conquer mystery, not revel in it; the pleasure, for them, comes in finding things out (to borrow from Richard Feynman’s famous title). Parascientific arguments go beyond this. They debase alternative modes of inquiry, especially those with an inward, subjective bent. (Ironically, Freud gets plenty of flack for his subjective methods.) Robinson finds these arguments both grandiose and soul-deadening.

I’m inclined to agree. Science in the modern era argues for itself alone; it not only promotes its own findings – it promotes those findings as Truth. But Robinson reminds us how real science actually upends such confidence:

These phenomena [the discoveries of dark matter and energy] demonstrate, as physics and cosmology tend to do, that the strangeness of reality consistently exceeds the expectations of science, and that the assumptions of science, however tried and rational, are very inclined to encourage false expectations. As a notable example, no one expected to find that the expansion of the universe is accelerating, and that the rate of its acceleration is accelerating. It is a tribute to the brilliance of science that we know such things. And it is also an illustration of the fact that science… is not a final statement about reality but a highly fruitful mode of inquiry into it.

Robinson wants us to abandon our fetish for final statements, in order to reacquaint ourselves with inward contemplation – and ultimately “encourage an imagination of humankind large enough to acknowledge some small fragment of the mystery we are.” She blames the language of modern science, more than our epochal advancements in cruelty and suffering, for a lack of soul-searching and wonder over the miracle of our own being. Whichever the culprit, I relate to her yearning.

The 20th century, more than all others combined, reflects our staggering capacities for good and evil. Like a small boy who accidentally injures his father, the realization of our own power has scared us, and scarred us, deeply. Perhaps Freud’s genius was more attuned to our time than his own. His grand project – “turning hysterical misery into common unhappiness,” in his words – can be read as a kind of survival manual for a traumatized planet. Absence of Mind strikes me as an early step beyond this trauma, into a richer appraisal of who we are.

Human existence is an impossible mystery. “Something terrible and glorious befell us,” Robinson writes. It is time, she suggests, to wonder deeply in and about our gifts, rather than reduce ourselves to primitive urges and selfish genes. After all, what stops us from annihilating ourselves is exactly the opposite of the reductionist’s view: the intuition that we, and the world that gave rise to us, are too beautiful and mysterious to finish being.

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[I have a friend in medical school – a psychiatrist in training – who tells me that AA gets tremendous credit for being the most effective addiction recovery program in existence. This surprised me, because a) I didn't know that AA's success rate is the gold standard, and b) I thought that many of AA's strategies were at odds with certain classic, psycho-therapuetic mores. The latter appears to be true, although this article suggests a welcome shift in attitude. If AA offers the best chance for recovery, than psychotherapy should follow its lead. Therapists, say the authors, should break out of their comfort zones when the failure of addiction looms; the successful treatment of alcoholism may require more communion with patients than is commonly advised.

This makes a lot of sense to me. In my own treatment (not for addiction, admittedly), my therapist never shared her own stories. I knew next to nothing about her life, and I assumed it would stay that way. But in one instance, she shattered this well-established practice – it was shocking to both of us – by sharing an incredibly intimate story about a death in her family. I could see this made her nervous. Clearly she was going out on a limb, defying her own notion of "best practices." Yet her intuition paid off. Her story changed my life, not because it made me feel any closer to her, but because it made me feel closer to others (certain others at first, and then more generally). I went from feeling confused and frustrated to feeling sympathetic and forgiving.

She told me her story, she said later, in an attempt to give me facts that she never thought I'd get, i.e. I wanted explanations from people who couldn't give them to me. The revelation of her family's secret became a stand-in for the experience I'd been missing, both literally – she told me something I never thought I'd hear – and figuratively – her story gave shape to the actions of people in my own life. She drew a parallel, but she also broke a boundary. Both helped my treatment; I can't say which helped more. This is the art of psychotherapy: the acknowledgment that, despite an appropriately clinical approach, any rules-based system is bound to fall short in the face of us. -Ed.]

This pending law in Nebraska correlates abortion with mental weakness; it suggests that women who are pressured to have an abortion should be handled with kid gloves. First of all, women face all kinds of pressure from all sides at this juncture: lovers, friends, family, and even circumstances themselves. Making a choice under pressure doesn’t mean that it’s a bad choice. Most important choices in life are made this way. Second of all, if we’re honest about these pressures, then we can see this law for what it is: an attempt to use the stigma of mental illness against women considering abortion.

As you probably know from reading this blog, I’m all about de-stigmatizing mental illness. This stigma leads to suicide all the time – every day. It killed my sister, who took her own life before she was willing to take an anti-depressant (even after she filled a prescription). So the thought of using this stigma, reinforcing it, for political victory makes my blood boil. Whatever your position on abortion, we must do better than this law.

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The movie Greenberg stars Ben Stiller as an introverted, volatile, self-obsessed jerk. Its ad campaign promotes Greenberg as a kind of “lovable loser,” a 40 year-old ne’er-do-well with the affected charm of a teenage cynic – i.e., someone we can relate to. Yet it’s not a fair portrait, exactly. Greenberg is far less likable than you’d expect.

At the start of the movie, we learn that Greenberg’s troubles run deep: he’s just been discharged from a hospital, but “not that kind of hospital,” his sister-in-law warns; “he had a nervous breakdown.” She’s warning Florence Marr, the family’s nanny (played by Greta Gerwig). With the household in Thailand, Florence doesn’t have much to do. But she’s asked to check in on Greenberg, who’s crashing at his brother’s house, just to make sure he doesn’t need anything. Greenberg exhibits the classic symptom of co-dependency in LA: he doesn’t drive.

Florence approaches Greenberg with a forced nonchalance, fluttering around him and avoiding eye contact. She’s quintessentially West Coast. Terrified of confrontation, eager to appear cool, she waits for Greenberg to make a move. And despite his palpable anxiety, he does.

Stiller plays Greenberg brilliantly. (The script, by director Noah Baumbach, gives him plenty to work with.) Greenberg looks so uncomfortable in his own skin that half the time he could be wondering where to put his hands. And his awful, mangy hairstyle suggests a person entirely at odds with the material world. A neurotic character like Greenberg is prone to be overacted, yet Stiller and Baumbach give us something real: a man not defined by his neuroses but genuinely beset by them. In an early sequence, Stiller approaches a swimming pool with a haunted, brazen look. ‘Oh no,’ I thought – ‘is he gonna hurt himself?’ But Greenberg attacks the pool instead, desperate to overcome his inner wuss. In seconds we realize that Greenberg can’t swim. The pool wins.

Rather too quickly, Florence falls for Greenberg. She seems to want an easy life, but what she really wants is to make a complicated life easier. She finds a foil in Greenberg. With her eagerness to smooth everything over, she drifts through the ugly circumstances of their relationship like a college intern. She sighs a lot. (Her brief character setup is a passive one night stand, suggesting that Greenberg is an unfortunate love interest in a long line of many.)

Am I making this sound like a horrible movie? Because it’s not. Florence and Greenberg are not admirable people. I shudder at the thought of being either’s parent. Greenberg, when he’s not grouching about trivial wrongs, can be shockingly nasty. And Florence laps it up like a hungry, lazy dog. So why should anyone go see this movie? It’s a tough question. The film, like the relationship, is not a pleasant experience. But to answer this question – Why watch this? – is to answer something else as well. Why put up with anyone?

I am not at all a masochistic moviegoer. More than most, I loathe directors who take advantage of an audience. But in Greenberg, Baumbach expertly toes the line. He fashions a character that is just shy of insufferable. Any more annoying, and we’d wind up hating the experience. Any more sweet, and Greenberg would become a stock character: the down-on-his-luck dude who finds redemption in love (yawn). In testing my limits as a moviegoer, Baumbach had me thinking about my limits as a friend. How much patience did I have for Greenberg? Would I have had more or less if he were a real person? Would I have considered someone like him at all?

This is the fundamental conundrum of mental illness. Often, if not all the time, mental illness is defined by how much it aggravates us. The more frustrating a condition for us, the more severe we judge it to be. So if we’re committed to helping the mentally anguished, what limits can we rightfully have? If a family member or friend has become intolerable, isn’t that more evidence of need? How do we balance our own lives and those of more turbulence? The answer to “Why put up with anyone?” brings us back to the Golden Rule. We put up with exasperating people because we know how easily we can become exasperating ourselves.

So is Greenberg mentally ill? Absolutely. Some may disagree, likely because Greenberg seems too “normal.” But that’s exactly the point. Psychiatric disorder in cinema tends toward the extreme: One Flew Over the Cuckoos Nest, A Beautiful Mind, The Aviator. Yet Greenberg presents the most vivid, honest portrait of illness I’ve ever seen on the big screen. Here’s a guy desperately trying to cope with the smallest niceties in life – and failing. When his best friend surprises him with a birthday cake in a restaurant, he storms out before yelling, “Sit on my dick!” The outbursts are painful to watch; they’re far from endearing. But you feel for the guy. Greenberg is a reminder of just how tough life can be.

I think practically, sexual abuse victims need to hear loud and clear that what happened to you is what happens to most people. It was wrong and not your fault, and you should report the crime, and the perpetrator should be punished. I don’t think that sex abuse victims in most cases need years of therapy to get over the betrayal. What they need first and foremost is the straightforward truth: You are not alone, you have nothing to be ashamed of, it’s his fault, and this is a crime.

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[I sympathize with Susan Clancy's skepticism of universal narratives. But her claim that trauma from sexual abuse "almost never happens" is difficult to swallow. Yes, maybe young victims don't experience trauma right away. What should we expect? Of course kids don't understand sexual abuse. Of course it confuses them more than anything else. No child has the capacity to process complicated emotions immediately, if at all. But kids grow up. And when they come to understand, what then? Wouldn't we expect their confusion to turn to rage? At least some of the time? -Ed.]

We’ve built an impressive civilization around the primacy of individual agency. Our near-worship of human potential, and its attendants hard work and self-sacrifice, has given us everything from the light bulb to the internet. It is safe to say that in the last two-hundred years Americans have contributed more to the advancement of knowledge than most other people. We are a nation of hard workers hoping to become heroes. We persevere.

The ideology of individualism is a useful one, a beneficial one. But it’s not entirely true or always helpful. “Behind every good man is a good woman.” “It takes a village to raise a child.” These are aphorisms that pay lip service to the shortcomings of our individualist bent. And if this myth of personal agency – that if you look deep within yourself you can conquer anything – is not entirely true, then where exactly does this conviction clash with reality? Where does this belief system fail us the most? In the realm of mental illness.

A few days ago the New York Times ran a brilliant piece about how we’re exporting our “symptom repertoire” to the world, about how disparate cultures have begun to adopt our uniquely American expressions of mental anguish.

NOWHERE ARE THE limitations of Western ideas and treatments more evident than in the case of schizophrenia. Researchers have long sought to understand what may be the most perplexing finding in the cross-cultural study of mental illness: people with schizophrenia in developing countries appear to fare better over time than those living in industrialized nations…

Trying to unravel this mystery, the anthropologist Juli McGruder from the University of Puget Sound spent years in Zanzibar studying families of schizophrenics. Though the population is predominantly Muslim, Swahili spirit-possession beliefs are still prevalent in the archipelago and commonly evoked to explain the actions of anyone violating social norms — from a sister lashing out at her brother to someone beset by psychotic delusions.

McGruder found that far from being stigmatizing, these beliefs served certain useful functions. The beliefs prescribed a variety of socially accepted interventions and ministrations that kept the ill person bound to the family and kinship group. “Muslim and Swahili spirits are not exorcised in the Christian sense of casting out demons,” McGruder determined. “Rather they are coaxed with food and goods, feted with song and dance. They are placated, settled, reduced in malfeasance.” McGruder saw this approach in many small acts of kindness. She watched family members use saffron paste to write phrases from the Koran on the rims of drinking bowls so the ill person could literally imbibe the holy words. The spirit-possession beliefs had other unexpected benefits. Critically, the story allowed the person with schizophrenia a cleaner bill of health when the illness went into remission. An ill individual enjoying a time of relative mental health could, at least temporarily, retake his or her responsibilities in the kinship group. Since the illness was seen as the work of outside forces, it was understood as an affliction for the sufferer but not as an identity.

For McGruder, the point was not that these practices or beliefs were effective in curing schizophrenia. Rather, she said she believed that they indirectly helped control the course of the illness. Besides keeping the sick individual in the social group, the religious beliefs in Zanzibar also allowed for a type of calmness and acquiescence in the face of the illness that she had rarely witnessed in the West.

Mental illness is more of a crisis in America because we’re expected to take care of ourselves so completely. When we can’t – when our feelings overwhelm us to the point of breakdown – we have failed as individuals. And seeing illness as a personal failure doesn’t just suck; it’s a burden that can be fatal.

My sister was a casualty. An incredibly bright and hard-working businesswoman, she prided herself on managing a very busy schedule. She wanted a lot from life, but more than anything else she wanted to be “a success:” she wanted to buy her own car, live in her own house, run her own company, and raise a family, too. Independence with a capital “I.” (She loathed expectations of femininity. When we were kids I told her that I’d never heard a girl fart. From then on, she made a point of doing so in my presence – loudly.) By any measure, she gained the life she craved. But when illness struck, she was horrified, not so much by her feelings, but by her inability to master them, her inability to take care of herself. She wanted desperately to be independent. And quite suddenly, she couldn’t be.

More from the Times article:

The course of a metastasizing cancer is unlikely to be changed by how we talk about it. With schizophrenia, however, symptoms are inevitably entangled in a person’s complex interactions with those around him or her. In fact, researchers have long documented how certain emotional reactions from family members correlate with higher relapse rates for people who have a diagnosis of schizophrenia. Collectively referred to as “high expressed emotion,” these reactions include criticism, hostility and emotional overinvolvement (like overprotectiveness or constant intrusiveness in the patient’s life). In one study, 67 percent of white American families with a schizophrenic family member were rated as “high EE.” (Among British families, 48 percent were high EE; among Mexican families the figure was 41 percent and for Indian families 23 percent.)

Does this high level of “expressed emotion” in the United States mean that we lack sympathy or the desire to care for our mentally ill? Quite the opposite. Relatives who were “high EE” were simply expressing a particularly American view of the self. They tended to believe that individuals are the captains of their own destiny and should be able to overcome their problems by force of personal will [my emphasis]. Their critical comments to the mentally ill person didn’t mean that these family members were cruel or uncaring; they were simply applying the same assumptions about human nature that they applied to themselves. They were reflecting an “approach to the world that is active, resourceful and that emphasizes personal accountability,” Prof. Jill M. Hooley of Harvard University concluded. “Far from high criticism reflecting something negative about the family members of patients with schizophrenia, high criticism (and hence high EE) was associated with a characteristic that is widely regarded as positive.”

Widely regarded as positive, that is, in the United States. Many traditional cultures regard the self in different terms — as inseparable from your role in your kinship group, intertwined with the story of your ancestry and permeable to the spirit world. What McGruder found in Zanzibar was that families often drew strength from this more connected and less isolating idea of human nature. Their ability to maintain a low level of expressed emotion relied on these beliefs. And that level of expressed emotion in turn may be key to improving the fortunes of the schizophrenia sufferer.

My sister killed herself in 1999, just before the new millennium. She would have turned 37 last week, on January 10th. I can think of no one more independent and more responsible than she. She constantly goaded me into pushing myself to do more. “No one else is going to do it for you,” she used to say.

This is the dark side of American Individualism: those in need of help are loathe to seek it. This concept of Expressed Emotion, or EE, doesn’t just apply to the community; it applies to the subject as well. If friends and family are highly critical – if they are unsupportive of a person in breakdown – it’s likely the person has internalized that kind of thinking. My sister was probably the most “EE” of anyone in the family. In other words, nobody was harder on her than herself. Not surprisingly, this had a lot to do with how determined she was to persevere.

She could have used a little humility. Can’t we all.

Those patients with schizophrenia who are more intelligent and better educated, for example, who perform better on measures of abstract reasoning, and who demonstrate greater insight into the nature of their illness, are more likely to kill themselves [my emphasis]. Patients who do well socially and academically when young and who then are hit by devastating illnesses such as schizophrenia or manic-depression seem particularly vulnerable.

In other words: smart, sociable, over-achivers can be just as suicidal as withdrawn folks once illness hits – and often times illness isn’t given much expression. Jamison goes on to stress that many people fool their peers expertly, despite the darkest of feelings. Here she is again, in the book’s prologue, writing of her own ordeal:

Because the privacy of my nightmare had been of my own designing, no one close to me had any real idea of the psychological company I had been keeping. The gap between private experience and its public expression was absolute; my persuasiveness to others was unimaginably terrifying.

The point is, we are terrible at judging “the kind of person who would do such a thing” – especially parents when it comes to their own children (understandably so). We need to shed the mindset that we can grasp suicide, that we can see it coming. We need to open ourselves up to surprise. Suicide is not the province of the preternaturally depressed. It is, in a sense, all around us.