The Marin Headlands, Northern California

I Somewhere in the Marin Headlands.  3AM, Sunday August 8^th

I have blisters on both forefeet. The big toe on my left foot is bruised and sore. My stomach is aching. I feel nauseous to the verge of vomiting.  I am light-headed. When I bend to the ground, I almost lose my balance and fall as I stand up again. The night air is soundless but for my own groans. It is so dark under the dense fog cover that when we turn off our headlamps in an attempt to spot the lamps of other runners on the trail snaking down the hill behind us, it is hard to discern any difference in texture between the obscured hills and the obsidian sky. “You remember coming down a wide fire trail like this on one of the earlier loops?” my pacer asks, in an effort to regain our bearings. “It didn’t have this many turns,” I say. We keep jogging downhill. I see no course markings. I want to believe that this section of the course is badly marked, because the other interpretation of the evidence would be too hard to take. We keep running, pushing the pace a little, as if increased velocity has a higher chance of extricating us from the reality of our disorientation rather than getting us more lost, faster. I have been running for over 20 hours and 80 miles. The trail winds further downhill. I spot two eucalyptus trees standing either side of the trail. I have seen these trees before. There is no use trying to delude myself anymore that the Marincello trail somehow mysteriously got longer and windier and stripped of its course markings and other runners in the nighttime. “Is this the Bobcat trail?” I wonder out loud. Half a mile later we reach a sign that says: Bobcat Trail. We have run off course down a steep three mile hill. We know the route back to the course. And my level of exhaustion is not yet so intense that I feel physically unable to continue. But at this darkest hour of the night, after losing our way, I am starting to doubt the purpose of putting myself through such intense demands. Why am I enduring so much hardship to complete such an absurdly literal challenge as run 100 miles when there are so many other worthy and less self-centered endeavors I could otherwise be pursuing? I am too tired to know the answer, even to think about the question. The only answerable question that presents itself is whether to take the first step back up the Bobcat trail…

II Prologue

In The Dark Glow of the Mountains, Werner Herzog’s 1984 documentary about Reinhold Messner, the first climber to ascend all fourteen of the Earth’s peaks over eight thousand meters, Messner compares his relationship to the mountains with a painter’s connection to a canvas: climbing is a creative act, says Messner, in which the line of his ascent remains etched not only in his memory of the climb, but somehow even upon the mountain itself, even if — unlike the painter’s brush — his crampons and ice axe leave no visible trace on the rock and ice of the peak. Messner’s vision of his adventures as a melding of the outer, physical world with the inner, mental world has many parallels in other cultures (eg. the Muslim pilgrimage to Mecca, the Buddhist ritual circumambulation of Mount Kailash, medieval Christian journeys to the Holy Land.) The indigenous people of the Australian continent believe that their land is enmeshed by a network of energy currents, the Songlines, representing the paths across which the original creative spirits of the universe travelled as they sang the rocks, plants and animals of the world into existence, and that they are able to navigate vast areas of land through retracing the steps of these primordial trajectories while repeating the words of the correct songs in the appropriate sequence, thus connecting them from one location to the next and from the reality of the present fleeting conscious moment to the timeless domain of the “Dreamtime” in which the spirits created (and continue to create) the natural world.

Upon that natural world we have now overlaid the artifice of civilization. It has brought us antibiotics, comfortable shelters and plentiful food (well, for some of us). But if civilization’s objectives were solely to provide reliable satisfaction of basic material requirements – the lower tiers of Abraham Maslow’s Hierarchy of Needs – there would be no Twitter, no KFC DoubleDown.  As humans we are different from Ayer’s Rock and kangaroos because we have consciousness. Once we have satisfied our needs for food and shelter, unlike kangaroos we face the existential question of what to do with this peerless capacity of awareness.  Distract ourselves from loneliness, the knowledge of time’s inexorable forward march and the certainty of death, or what? In lives of deadlines, dishes, laundry and bills, how do we step outside the immediate stresses of daily life to confront the bigger questions?  There are meditation retreats. There is art.  And throughout history there have been pilgrimages — vehicles through which we return to a simpler mode of existence (moving forward, eating, drinking) – and allowing the microcosm of the journey to become a lens through the meaning of our life’s macrocosm can reveal itself. An ultramarathon is perhaps a secular version of this ancient form, connecting our bodies to the land; the present reality of the race to the journeys of ancestors stretching back to the earliest origins of the human race, meshing the outer physical challenge of miles and hills with the inner contemplation of past, present and future; of how I got here, where I’m going, and what really matters.

A hundred miles is so far that it feels like several distinct experiences consecutively aligned, rather than a single contiguous event –  a phenomenon, indeed, not unlike a lifetime, comprised of several interlocking although developmentally singular phases, as Jaques famously describes human life’s arc in Shakespeare’s As You Like It[1]. Erik Erikson built upon the well-established psychological idea of development as a progression of stages by proposing that it continues throughout the lifespan (rather than concluding at the end of physical maturation in adulthood) with a unique theme and growth objective for each stage. And so, loosely adapting Erikson’s model of psychosocial development, the “lifetime” of my hundred mile ultramarathon could be said to have unfolded in the following six phases[2]…

III A Life in a Hundred Miles

(i) Infancy (Miles 0-3)

There were several moments in the two weeks prior to the race when I wondered if I was really ready for such an extreme mental and physical challenge; and also whether the race was even going to happen.  Fatherhood to a four year-old daughter and a two month-old son was wonderful but tiring. I had produced dark brown urine after three training runs, leading me to wonder if my muscles had started to break down from months of progressively demanding exertion in a dangerous condition known as rhabdomyolysis. When my doctor’s blood work and urinalysis fortunately revealed normal liver and kidney function, I earned a medical green light to proceed with the race. But what race?  Even eight days before the scheduled start, the organizers hadn’t posted the course map or list of entrants. The internet rumor mill spun anxious speculation of insuperable logistical snafus; I feared cancellation. I woke every morning exhausted and aching. After finally allowing myself to rest in the last week’s pre-race taper, was I healing, or breaking down? Erikson defines the question of the infant’s developmental task as “trust versus mistrust” (will Mom and Dad feed me and love me, or will I be abandoned and die?) As sixty runners assemble at the Headlands Hundred start line in the gray foggy dawn on Rodeo Beach on Saturday August 7^th, a parallel question of trust starts to characterize my thinking. After months of preparation, my pre-race self now gives birth to an infant hundred-miler, forced to trust in my “parent” that I have done everything necessary to survive the long trail ahead…

I take in the scene. The race field (so small it feels more like a running club’s weekly group outing than an organized race) is roughly 75 percent male and 15 percent female. Most runners appear to be in their thirties and forties, although the group’s demographic span extends to one lady only a year shy of seventy. One younger, fast-looking male runner is shirtless despite the low-50 degree overcast, windy weather. There is a man who has packed extendable trekking poles, which he intends to use on this course in training for the Tor Des Geants, a 200 mile race in the Italian Alps in September. Sarah, one of two race directors, calls us to the start line.  I hear a countdown from five to one. At the stroke of 7AM we set off jogging and then hiking the first 800 foot climb of the 20,000 feet of vertical ascent that awaits us.

(ii) Childhood (Miles 3-10)

The shirtless leader is long gone, presumably miles ahead. I have set a very conservative early pace, hiking all the uphills to conserve energy for the inevitable rigors of the race’s later stages. I am running and chatting with Matt Schmidt, a fellow first time hundred miler and also a father of two, with whom I have shared several training runs, including a 30 mile outing in the Headlands six weeks ago. I am acutely aware of my energy level and degree of exertion. I do not feel as fresh and peppy as I would like to be. Matt and I have not planned to run together necessarily, but it seems to be working out that way – though, even at this fledgling phase, he seems more inclined than I do to immediately pick up the pace from hiking back to running at the crest of the ascents. Our conversation darts in free associative tangents across past races, future races, training, speculation about what we will experience in the latter half of the race as we enter the terra incognita beyond the furthest distance we have ever run (50 miles in my case; 62 miles in Matt’s), and thence from running topics (quickly exhausted: there really isn’t that much to say) to current affairs — the global financial crisis, the impact of that crisis on our relationship to debt — eventually leading me via further associative hops to reminisce about Edward Marks, my wife’s late stepfather, a humanitarian who lived through the Great Depression, an experience of chronic material deprivation so startling it inspired a lifelong habit of frugality stringent to the extent that his refrigerator shelf once stocked a half-eaten sandwich saved from an airline meal weeks earlier. Erikson defines the question of the child’s developmental task as “industry versus inferiority,” meaning that the child starts to measure his self-worth against the expectations of parents and other significant adults (am I successful or worthless?)  Ed is sadly not here to offer his kind gentlemanly blessing, but my own parents have given encouraging words via email before the race, in an echo of their cheers at the finish line when I won the 80 yard dash as a ten year-old at primary school in England, the only race I have ever won, a race in which through the Dreamtime pilgrimage of the ultramarathon the line of the Coastal trail down to Muir Beach intersects with my childhood former self’s sprint to the 80 yard finish line.

(iii) Adolescence (Miles 10-20)

Knee: This hurts.

Ego: No it doesn’t – not really. Just ignore it. The pain will go away.

Knee: Ow. Yes, it really hurts.

Ego: But this is mile fifteen. You can’t possibly hurt this early. Or at least if you do – please tell me this is nothing serious, okay?  Because this is MILE FIFTEEN.

These two opposing voices form my inner dialogue as I chase Matt along the SCA and Coastal trails through a series of sharp switchbacks down to the Golden Gate Bridge, only fifteen percent of the race behind me: the statistically equivalent experience in a regular 26.2 mile marathon would be to start feeling leg pain before I got to the mile four marker. Erikson defined the question of adolescence as the tension between “identity versus role confusion.” It is unsettling to accept – perhaps I cannot yet accept – that I am feeling little shocks of pain on the right side of my right kneecap so early in a race. Stopping to stretch out my quadriceps muscle relieves the pain for a while. The pain only flares on the downhills. But there is 20,000 feet of downhill in this race! And with each descent, the knee pain resurges a little more powerfully. Surely the twinge can only deteriorate over the next 85 miles into intolerable agony I will be powerless to transcend? At first I am reluctant even to mention my concern to Matt: naming the problem means accepting it is real. When I do mention it he graciously stops to let me stretch. I take some acetaminophen to mask the pain (ibuprofen might reduce any inflammation more effectively, but I am wary of taking that drug because it has been known to increase the risk of rhabdomyolysis in ultras.) I keep moving, and keep stopping to stretch my quads on the descents: I have no choice but to keep moving, and adapt to changing circumstances. On the spectrum of “identity crises”, this shift from the carefree early miles of my race’s “childhood” phase to the surprise-onset self-doubt of knee pain at mile 15 is trivial in comparison with the family disruption and depression that characterized my actual adolescence. Back then, running was the (re)discovery which game me a physical and emotional escape route from the pain of a troubled home: a new identity, purely of my own design, that marked health, strength, freedom, and a sense of communion with nature. Right now, knee pain is hardly a crisis, but in order to conserve my knees for the long trail ahead, I try to let go of any identification with the idea of a pace I thought should have easily been sustainable this early in the race. I tell Matt he should go ahead without me if he wants to.

(iv) Young Adulthood (Miles 20-50)

I continue running with Matt through the end of the first of the course’s four 25 mile loops. I am immensely grateful for the cool weather – the dense cloud cover has not lifted, and even as we run through the middle of the day the temperature does not feel like it exceeds the mid-60s Farenheit, with perhaps a mild increase in humidity. At the start/finish of the loop, I had expected to see Vivian, but she is stuck in traffic. My friend Shelby is there, though, smiling and cheering. I grab a few snacks from the aid station and we head out on the second loop, traveling counter-clockwise this time (the loop’s direction reverses each time). Half a mile down the road I find Vivian, Esther and baby Moss standing by our car at the side of the road. I give them sweaty kisses. Esther gives me a card she has made. It says, “I Love You.” I fold up the card and put it in the back pocket of my shorts, thinking it might help speed me on my way. Midway through this second loop Matt and I finally agree to go our separate ways as I struggle down a steep section of the Coastal trail towards Muir Beach. A lady in the Muir Beach parking lot asks me, “Are you guys running all the way up that hill?”  She points towards the Coastal trail.  I state my goal.  She is either impressed or bemused – I can’t tell.

At the Muir Beach aid station I drink some coke and pull out my iPod for the first time in the race. After five hours of running without music, the combined jolt of the coke’s sugar and caffeine with the pounding trance music in my iPod earbuds inspires a sudden rush of energy that propels me in an almost effortless power hike back up the Coastal trail,  and then running at what feels close to 7:30/mile pace or faster down past the dramatic cliffs of Pirate’s Cove, via Tennessee Valley, where I am thrilled to find Vivian and Moss waiting for me (Esther is napping in the car). “I can’t believe how much fun this is!” Vivian says. My friend and fellow PacWest runner Diane Perun is also there to meet me at the Tennessee Valley aid station. I am amazed how much of a mental boost I get from the support of family and friends – I feel as if they are with me along the way. Erikson defined the developmental task of young adulthood as the tension between intimacy and isolation – the challenge of establishing a long-term relationship, without which we face life alone – but in this race, although I am now running solo with Matt running strongly ahead of me, the support of my family and friends feels very intimate; I am enveloped in their warmth and encouragement even when running alone these past few miles. As I head onwards in a swift hike/run rhythm through to the end of the second loop, my knee pain completely disappears. Erikson defines “young adulthood” ending at the age of 34, but as I bound into the aid station at mile 50 (in 9:50) I am still very much feeling still within the race’s “youthful” phase. Eric Pacenta, my pacer for the third loop (miles 50-75), says he is surprised to see me reach mile 50 so quickly, which only bolsters my renewed sense of confidence.

(v) Middle Adulthood (Miles 50-75)

Eric encourages me to change my shoes and socks as we pass through Tennessee Valley again early in the third loop. I feel like I have new feet. He also encourages me to eat a slice of pizza. It tastes ridiculously good. Soon the day is ending. Hikers and mountain bikers become sparser until we run alone on the trail. As the light fades, we run past a young woman volunteer from the race organization marking trail intersections with glow sticks. By 9PM the daylight is gone and the fog begun to thicken. We turn on our headlamps. The pink and green florescence of the glow sticks marking the intersections in the foggy dark is reminiscent of a similar scene I have encountered many times in Nevada’s Black Rock Desert in the dust storm-enveloped nights of the Burning Man festival. That mental association with an alternate reality, combined with the carbohydrate boost from a steadily metabolized pizza slice, inspires a mood of euphoria, almost to the extent of heedless disregard for the necessity of still restricting myself to a sustainable pace, a mere 65 miles into the race. Sudden intense wind gusts on the Coastal trail overlooking the fog-shrouded Golden Gate Bridge intensify an aura of enchantment; I find myself tap dancing down rocky gullies illuminated by my headlamp, accelerating over some flat and downhill sections to what feels like sub-7:00/mile pace, just because it feels good.  Erikson defined the developmental task of middle age as the struggle between “generativity” versus “stagnation” – that is, the question of whether we are capable of producing anything of genuine value to society in our most potentially productive years; as I surge downhill to an aid station beneath the Golden Gate Bridge, a line of lights on the Embarcadero across the Bay refracting through their shroud of fog like the battlements of a distant fairy citadel,  I could not feel more marvelously energized. I grab some food and head back the way we came. “Do you think we might catch up with Matt?” I ask Eric. “You will catch up with Matt,” says Eric. “But don’t think about it. Just keep going.” It is wise counsel – Matt will manage to sustain his sprightly pace all the way to the finish line, securing third place, in 21:18. Around mile 70, my wave of energy crests and breaks, and then I start feeling tired and nauseous.

(vi) Old Age (Miles 75-100)

“Nausea is masked hunger,” Eric says. “Try eating a gel.” The prospect of eating turns my stomach, but I decide to trust my pacer. Eric has paced a friend over the last 35 miles of the Western States, a storied 100 mile race in the Sierra, in addition to completing several 50 mile ultramarathons himself. I force down a packet of carbohydrate gel; within minutes, my fatigue and nausea have subsided.  We reach the end of loop three and meet Rajeev Patel, my pacer for the last 25 miles of the race. I say goodbye to Eric and hike down the road with Rajeev.  In my now deteriorating state, Rajeev’s big-hearted and voluble temperament feels like a human energy gel. I find myself pitifully incapable of reciprocating the generosity of his laughter and story-telling. Rajeev recounts a detailed narrative of his introduction to running in the 1980s; his early experience of ultramarathons; of managing to prevail for 38 hours through driving sleet in the mountainous Coyote Two Moon 100 mile race in Ojai, California; of dropping out of a 250 mile race England at mile 183 after experiencing a distressing perceptual distortion in which the earth appeared to be shaking and tilting beneath him; of the persistent anatomical sleuth work he conducted in order to diagnose and treat his injured Achilles tendon and related spinal nerve problem, thereby leading him to acquire an ever-widening repertoire of diagnostic tools to support the many recreational runners with whom he now works as a coach; of his plan next year to run the inaugural South Downs Way 100 mile race in England, which finishes in Winchester, where coincidentally I grew up; of the Urdu poet Ghalib, and of his own poetry, much of it penned on an ultramarathon theme. I respond to this conversational generosity with intermittent grunts and an occasional “uh, huh” or “oh”, the uncontrollable rudeness of my exhaustion-borne paucity of response leading me at times to feel not unlike an irascible aging parent submitting reluctantly to the care of his long-suffering adult progeny.

In the absence of moonlight or stars, under the dense fog, the terrain is barely visible even under both our headlamps. We miss a turning from the road connecting the start/finish at Rodeo Beach to the trailhead, and find ourselves backtracking in search of glow sticks marking the way. My nausea returns. “Do you like milk, Jason?” says Rajeev. “I hate milk,” I reply, almost amplifying my distaste, now really falling into the role of Care Recipient Expressing Unresolved Anger at Rapidly Diminishing Physical Capability through Hostility to Selfless Carer. “What about chocolate milk?” says Rajeev. “I guess I’ll give it a try.” The chocolate milk slips down easily and my nausea dissipates. On a climb around ten miles into this final loop, my right ankle starts aching intensely. Rajeev requests the exact location of the ache, correctly diagnoses the cause as a swollen foot, and prescribes a loosening of my shoe laces — a remedy that works in seconds. After seventeen hours of running, at a point when my body and mind are experiencing unprecedented stresses, I am now willing to surrender my decision-making capacity to a guide who has successfully navigated these psychological and physiological challenges many times before.

Soon we are heading down the Marincello trail – or what turns out to be the Bobcat trail – and now the challenge of the race truly becomes as much mental as physical. After losing, and then regaining, our way back on the course, I start facing in microcosm the equivalent of the developmental task Erikson defined as the central objective of old age: the challenge of retaining a sense of psychic integrity against the threat of despair. I do not doubt the possibility of finishing, but question the purpose of the event itself, even of running ever again. After an hour of this soul-searching trudge we reach the Tennessee Valley aid station, drink more chocolate milk, and then hike through what proves to be the absolute emotional nadir of the entire venture for me, between miles 88-92, between three and five in the morning. In my exhausted and sleep-deprived state, I trip and fall on a tiny undulation on pebble-strewn trail downhill towards Muir Beach. “Pinch yourself in the face three times, and shout!” Rajeev instructs. Once again the advice is effective. Rajeev then tells me that at this pace, I will not be likely to finish the race in less than 24 hours (an early goal). “Your body has done all this work for you, and now it is saying, ‘this is what we can do now’, and you must accept that,” says Rajeev.  The remark’s wisdom is undeniable: the reality of the work now at hand – simply moving forward, step by step – is so self-evidently unsusceptible to ego-driven designs on a faster pace, so nakedly worthy of gratitude purely for itself (I can still walk!) that acceptance of my depleted capacities involves no ambivalence or second-guessing: I am doing what I can now and it is enough.

“Jason, do me a favor,” says Rajeev. “Shuffle your feet like this.” He jostles forward. I gently shuffle my feet and soon we are jogging again, down past Pirate’s Cove, hiking up the steps. He breaks into a beautiful old Hindi song. After a final climb up Wolf Ridge, we reach a stretch of asphalt. Rajeev shows me a way of running in a snake-like series of curves that makes it possible to exert the sides of my thighs rather than my now-spent quadriceps muscles. We begin the final jog that will take up the last couple of miles to the finish line. “I couldn’t have done this without you,” I tell Rajeev. “Thank you – but this is your achievement. You had the courage, you overcame the obstacles. It was you. I helped you, Eric helped you, Vivian helped you, and you should thank everyone when you finish, but then you should celebrate yourself.” As the finish line looms into view, deserted but for the race director and a handful of volunteers, I spot Vivian, Esther and Moss in the parking lot. I tell Rajeev I have seen them. “Don’t hold back on your emotions,” says Rajeev. I am already crying.

Joyous and relieved at the finish line with Vivian, Esther and Moss (center, under towel)

IV Dreamtime

I left a line of several thousand footprints on the trails of the Marin Headlands during the 25 hours and 35 minutes of my first 100 mile ultramarathon on August 7-8.  At the same time, the experience itself imprinted a line in my heart and mind that binds me to those hills and to the people that supported me along the way: Vivian, Esther, Moss, Eric, Rajeev, Diane, Matt, Caren, Matt’s parents, Shelby, the race directors and volunteers and all my fellow runners, and all those friends and family members who have been so supportive and encouraging in the six months I have prepared for this adventure. I was never alone, even during the few miles when I ran solo; we did it together. The footprints and even the memories of this specific run will fade, just as the Headlands themselves will gradually erode, but the hidden trails through which we remain interconnected as people with each other and with the natural world await our perpetual rediscovery. Thank you for that connection.

[2] The idea of framing a 100 mile ultramarathon as a microcosm of a lifetime is not original to me: I discovered a reference to this idea in a quotation from an elite female ultramarathoner. I have been unable to trace the reference; I seem to remember the author was either Anne Trason or Pam Reed. I will revise any future versions of this article with the correct source citation, should I manage to discover it.

In his recent novel The Castle in the Forest, Norman Mailer invokes the Devil in the genesis of young Adolf Hitler’s nascent psychopathology; in Hannibal Rising, Thomas Harris’s recent prequel to his serial killer series, the author cites Nazi atrocities as pivotal in young Lector’s upbringing. By contrast with these demonic early traumata, we find in Chip Frederick’s biography a young man who likes Nascar and pressing his trousers neatly, and who gets depressed when left alone.

In October 2003, Frederick found himself responsible for 400 prisoners in a facility in Camp Vigilant, one of four compounds in the Abu Ghraib prison in Iraq – a step up from the 100 prisoners he had supervised back home, but one with which he could initially cope. However, shortly after President George W. Bush announced “Mission Accomplished,” instead of the compliant and joyful Iraqi citizenry of which Bush administration pre-war propaganda had confidently prophesied, with the country rapidly disintegrating into insurgent violence, the number of detainees under Frederick’s watch had tripled by December 2003. With no special training for this new assignment, under no supervision, Frederick worked the 12-hour night shift for forty nights straight. When he wasn’t working, he slept in a prison cell. He describes his working conditions to Stanford psychologist and author Philip Zimbardo thus:

I couldn’t find supplies to keep the facilities clean. The plumbing was bad. Shit was backed up in the Porta-Potties. There was trash and mold everywhere…. It was nasty in there. There were human body parts in the facility…. There was a pack of wild dogs running around [still present from the days when those executed by Saddam were buried in part of the prison and wild dogs would dig up their remains.] You know I was so mentally drained when I got off in the morning, all I wanted to do is sleep.

One night near the end of October, Frederick attached electrodes to the left hand of Satar Jabar, the Iraqi prisoner whose hooded spectral image was to become the iconic representation of Abu Ghraib’s atrocious descent into hell. Under Frederick’s watch, prison guards watched or directly participated in the torture or humiliation of numerous prisoners.

Frederick, who feared the disapproval of his peers for not fitting in, had been driven into barbarism. As with Adolf Eichmann, famously psychopathologised by Hannah Arendt in 1963 in her seminal work Eichmann in Jerusalem: A Report on the Banality of Evil, no sulphur and brimstone announced the metamorphosis of Ivan Frederick from Joe Normal to Lucifer: demonic acts appear, in both cases, to have emerged from the minds of “normal” men.

How does this happen? For Zimbardo, who went on to testify as an expert witness in Frederick’s defense at his military trial, Frederick was strongly influenced by “situational pressures” that determined the scope of his actions. As opposed to the classic “bad apple” argument advanced by then U.S Secretary of Defense Donald Rumsfeld – that is, putting the blame for the atrocity at the feet of individual rogue soldiers – Zimbardo argued that Frederick’s mental processes and behaviors were heavily influenced by the dehumanizing conditions of Abu Ghraib and the explicit disavowal of human rights made by Frederick’s military and civilian superiors, all the way up the chain of command to Rumsfeld and Bush themselves. Zimbardo quotes a Human Rights Watch investigation citing evidence that Rumsfeld explicitly authorized torture at Abu Ghraib.

Thus, Frederick was not so much a “bad apple,” as one apple in a “bad barrel”: the whole system was rotten, Zimbardo argues in The Lucifer Effect. Like the professor’s pioneering 1971 investigation into the social psychology of evil — the so-called Stanford Prison Experiment (in which a simulated prison quickly descended into sadism) — Frederick’s personal moral intuitions had been corrupted by social forces. The judge at Frederick’s trial rejected Zimbardo’s mitigating arguments, sentencing the accused to eight years in prison, forfeiture of pay, a dishonorable discharge and a reduction in rank to private. (To apotheosize Sergeant Frederick’s Sophoclean descent from suburban normality to felon, his wife subsequently divorced him.) But where justice has so far failed to deliver equitable punishments to all parties responsible (in Zimbardo’s opinion) for Abu Ghraib, Zimbardo calls for an international prosecution of the broader criminal case. As parties directly complicit in the Abu Ghrab atrocity, Rumsfeld and Bush deserve to be charged with crimes against humanity, Zimbardo argues (a forthcoming website set up by Zimbardo will allow readers to vote on the guilt or innocence of President Bush and other top administration officials on war crimes charges).

So far, so grimly familiar: homo sapiens may lie somewhere halfway between ape and angel, but the vicious half of the human psyche seems tragically irrepressible despite quantum leaps forward in our material and technological capacities, the evolution of morality failing to keep pace with the advance of guns and steel. By this logic, only so many missile defense shields and Jack Bauer-style torture interrogations can stave off inevitable atrocity and apocalypse, or as Bertrand Russell put it:

There lies before us, if we choose, continual progress in happiness, knowledge, and wisdom. Shall we, instead, choose death, because we cannot forget our quarrels? We appeal as human beings to human beings: Remember your humanity, and forget the rest. If you can do so, the way lies open to a new Paradise; if you cannot, there lies before you the risk of universal death.

Yet the optimism nestled in Russell’s scary proposal is the inviolability of free will. (Was St. Augustine on to something, after all, with his doctrine of the felix culpa, or “fortunate fault” – the idea that humanity’s propensity for wrong-doing is the pre-requisite of our freedom of consciousness?) In a much criticized work, The Blank Slate, Harvard psychologist Steven Pinker argues that nature almost invariably wins out over nuture and that hardwired (mainly brutish) behavioral tendencies will always out. But such Hobbesian socio-biological yarns purportedly demonstrating the mighty clout of the selfish gene in rendering evil unavoidable ignore the striking counter-evidence of humanity’s better half. Evolutionary models sometimes go further and argue that even altruism or heroism are genetically determined as the result of “group selection,” but this logic quickly collapses into a Just So story, neatly subsuming all irksome counter-evidence in an ever-ballooning explanatory circle. Conclusive proof of genetic determinism notwithstanding, we are faced with a humanity perhaps mired in the gutter but still looking at the stars – a commingling of meat and mystery.

If so, the question then becomes: will good yet triumph over evil, and if so how? If evil is a choice rather than a biological destiny – if atrocity and war are perhaps theoretically eradicable in the same way that civilization consigned female infanticide and slavery to the historical dustbin – what are the likely candidate strategies for making sure we avoid an eternal return of our species’ bloodiest blunders?

First, we will need to answer Joel Surnow, creator or hit television drama series 24. As The New Yorker reports of the show’s classic approach to the ethical conundrum of whether torture is ever morally justifiable:

Terrorists are poised to set off nuclear bombs or bioweapons, or in some other way annihilate entire cities. The twisting story line forces Bauer [the protagonist] and his colleagues to make a series of grim choices that pit liberty against security. Frequently, the dilemma is stark: a resistant suspect can either be accorded due process—allowing a terrorist plot to proceed—or be tortured in pursuit of a lead. Bauer invariably chooses coercion. With unnerving efficiency, suspects are beaten, suffocated, electrocuted, drugged, assaulted with knives, or more exotically abused; almost without fail, these suspects divulge critical secrets.

While the “ticking time bomb” scenario frequently depicted by the show may be fanciful, and the efficacy of torture as an intelligence-gathering tool questionable (according to the U.S. Army, quoted in the New Yorker piece), a post-911 urgency highlights fault-lines in the classic utilitarian defense of violence in regard to the ethics of torture and the attendant debate about the nature of wartime “evil.” Early in The Lucifer Effect, Zimbardo defines evil thus:

Evil consists in intentionally behaving in ways that harm, abuse, demean, dehumanize, or destroy innocent others – or using one’s authority and system power to encourage or permit others to do so on your behalf.

Interviewed by phone and email for this article, Zimbardo conceded that the word “innocent” applied to “others” in this definition raises the problematic issue of defining “guilt” or “innocence” in relation to those victimized by the perpetrators of evil. Asked about the U.S. atomic bombings of Hiroshima and Nagasaki in 1945, Zimbardo uncategorically classes the Hiroshima bombing as evil and the Nagasaki bombing as “doubly evil” (the latter thus because it was really the first act of the Cold War, rather than the last act of WWII: at least 70,000 people burned as a message to Joseph Stalin). Zimbardo’s insistence on the absolute moral wrongness of the bombings stands in brave defiance to the common defense that the bombs “saved lives” by preventing a U.S. invasion of the Japanese mainland. However, since the “innocence” reference of his definition might lead some readers to wonder if there are indeed hypothetical cases in which victims are not innocent and whose treatment, however painful, could not therefore be construed as “evil” (this, after all, is the Hiroshima defense, the Abu Ghraib defense, the Dick Cheney defense) – I press Zimbardo for a redefinition. He offers the following:

Evil is the exercise of power to intentionally harm (psychologically), hurt (physically) or destroy (mortally or physically) other people.

To this definition, Zimbardo adds a striking coda that speaks beyond the phenomenon of evil itself to its seductive societal and psychic allure:

Our fascination with evil is less from its consequences than from its demonstration of power and dominance to control people, animals or the environment, and is greater the more creative and unique it is, more raw and absolute.

If this coda is accurate, does Hollywood mythologize the Zodiac killer or John Wayne Gacy because they symbolize an enviably extreme concentration of power and dominance? Some theorists have argued that psychopaths lack a Theory of Mind – an intuitive understanding that you think and feel pretty much just like I do – and that this deficit is possibly related to the activity (or lack thereof) in cells of the orbitofrontal cortex called mirror neurons that contribute to the simulation of internal experience in other human beings. Hence the psychopath, perhaps lacking this critical simulacrum of the sentient Other, feels no pain when he induces it in his victim, and can thus dominate his prey with unconscionable liberty. By contrast, a compassionate person experiences a neighbor’s suffering as partly her own, because at the neuronal level she mirrors this suffering. (In Deconstructing the Psychiatric Bible, I showed how neuropsychonalysis is now replacing “single skull” neurology with an interpersonal and interpsychic model of development and psychopathology; I will be excited to find out more about mirror neurons and their role in this model.) If so, what happens to the Sergeant Fredericks and Adolph Eichmanns of the world once they’ve been lured to the Dark Side: how and why do the mirror neurons stop reflecting the pain outside?

One answer to this question may lie in the unlikely form of How to Build A Universe That Doesn’t Fall Apart Two Days Later, a 1978 speech by science fiction novelist Philip Kindred Dick, an author whose cultural and philosophical influence has grown to near-cultic proportions since his death four years thereafter – a popular blossoming in recent times arguably driven by a gradual convergence between the real world of post-911 existential paranoia and the spooky Gnostic ruminations of the writer’s imaginative terrain. Creator of the novels A Scanner Darkly and Minority Report (both now movies) and the short story on which the film Bladerunner is based, Dick used his fiction to explore the nature of reality and the question of what it means to be “authentically human,” this latter issue proving especially perplexing for the literary psychonaut, since he believed that reality is multiple, often hidden from plain sight, and distorted by powerful elites for malign purposes.

For Dick, the cosmos resembles a colossal prison experiment designed to no apparent purpose by an invisible hand: “some of us are prisoners, and some of us are guards,” as Bob Dylan sang. That the prison is simulated does not diminish its power (as the subjects of Zimbardo’s 1971 Stanford experiment discovered). However, to realize the prison’s simulated nature is to illuminate the artificer’s hand, and thus potentially to shift the shape of the simulation. “The mind is its own place and in itself, can make a Heaven of Hell, a Hell of Heaven,” wrote Milton in Paradise Lost. But are there limits to such solipsistic grandiosity? Yes, we must ultimately face the constraints of Reality, defined by Dick as follows: “Reality is that which, when you stop believing in it, doesn’t go away.” (Hopefully, President Bush is not real). But within these limits of the Real, there’s a great deal of creative freedom. To be authentic is to resist the seduction of groupthink, to endure the aloneness that Chip Frederick could not tolerate and without which his Baptist principles meant zero. Dick writes:

The authentic human being is one of us who instinctively knows what he should not do, and, in addition, he will balk at doing it. He will refuse to do it, even if this brings down dread consequences to him and to those whom he loves. This, to me, is the ultimately heroic trait of ordinary people; they say no to the tyrant and they calmly take the consequences of this resistance. Their deeds may be small, and almost always unnoticed, unmarked by history. Their names are not remembered, nor did these authentic humans expect their names to be remembered. I see their authenticity in an odd way: not in their willingness to perform great heroic deeds but in their quiet refusals. In essence, they cannot be compelled to be what they are not.

Zimbardo retired from lecturing at Stanford this week. He also announced that, after a distinguished career investigating the horrible things that people do to each other, in this era of “extraordinary renditions” and terrorist dirty bomb plots he is now more interested in a corresponding topic which Dick would admire: the nature of heroic acts, big and small.

If Dick is to be believed, perhaps there is hope for humanity and grist for Zimbardo in the next generation:

The power of spurious realities battering at us today— these deliberately manufactured fakes never penetrate to the heart of true human beings. I watch the children watching TV and at first I am afraid of what they are being taught, and then I realize, They can’t be corrupted or destroyed. They watch, they listen, they understand, and, then, where and when it is necessary, they reject. There is something enormously powerful in a child’s ability to withstand the fraudulent. A child has the clearest eye, the steadiest hand. The hucksters, the promoters, are appealing for the allegiance of these small people in vain. True, the cereal companies may be able to market huge quantities of junk breakfasts; the hamburger and hot dog chains may sell endless numbers of unreal fast-food items to the children, but the deep heart beats firmly, unreached and unreasoned with. A child of today can detect a lie quicker than the wisest adult of two decades ago. When I want to know what is true, I ask my children. They do not ask me; I turn to them.

“Blank slate” romanticism? Maybe. But let’s not forget that Theory of Mind – our mirroring, compassionate capacity – apparently emerges in toddlerhood, and that arguably the roots of good and evil may well lie there, too. Let’s also remember the fate of Adam in Book XI of Milton’s Paradise Lost: after his ejection from Eden for eating the apple from the Tree of Knowledge, Adam is transported by the Archangel Michael to a high hill, from which he observes a seemingly infinite succession of future progeny corrupted by his first taste of evil, of which Michael remarks:

Adam, now ope thine eyes, and first behold
The effects which thy original crime hath wrought
In some to spring from thee, who never touched
The excepted Tree, nor with the Snake conspired,
Nor sinned thy sin, yet from that sin derive
Corruption to bring forth more violent deeds.

Milton gives Adam and Eve the power to resist the Snake and put an end to violent deeds in the future: “The world was all before them,” reads the poem’s last stanza. So, if Zimbardo and not Lucifer triumphs, maybe the world really won’t fall apart in the next two days after all…

Welcome to NEUROTRANSMISSION: a blog on the meaning of madness. Let me explain why this topic fascinates me. As a teenager, I thought my mother was “mad.” The few friends to whom I confessed this description often replied, light-heartedly, that their mothers, too, were “mad.” The word “madness”, amongst fifteen year-old English schoolboys in the mid-1980s, had something of the resonance of “madcap”, or “zany” – amidst the oppressive conformity of Thatcherite Britain, it was almost a badge of pride. My friend Sean called himself “mad” to denote the crude delight he felt in eating a Snickers bar with his mouth wide open. Madness was the name of a popular band. But I had the feeling, in respect of my mother, that the madness I perceived in her was of an altogether distinct and distressing variety. Madness was my mother talking to herself; refusing to keep a bin in the house; screaming. Madness was her wide brown eyes staring straight through me as if I was not there; commissioning a professional wedding photographer to take a series of portraits of her posed in our back garden in a second-hand wedding dress; trying to smash my brother in the head with a metal clock. I sometimes fantasized that a white-coated doctor would come to our house and take her away in a straight-jacket, pronounce her “psychotic” or “schizophrenic”, feed her pills, and return her to the “normal” loving mother I remembered from my earlier childhood – but this never happened, and her madness went undiagnosed.

As I became an adult, I developed an interest in psychology and broadened my knowledge of clinical language. At first, this knowledge appeared to cast the inchoate misery of my adolescence in the comforting certainties of medical science. I soon discovered a book published by the American Psychiatric Association (APA) called the Diagnostic and Statistical Manual of Mental Disorders (DSM), which defined several hundred “mental disorders” in terms of their associated mental and behavioral characteristics. Confusingly, my mother did not seem to fit neatly into any of the categories, displaying features bridging psychosis, schizophrenia, and many of the so-called “personality disorders.” Further reading told me, however, that multiple diagnoses were not uncommon. So I decided that my mother likely had “Narcissistic Personality Disorder” with psychotic or schizotypal features. I wrote a memoir thus labeling her, feeling a duty, as a writer, to enlist the most accurate words I could find for the woman I remembered. Accuracy, as I then understood it, meant an aspiration to scientific objectivity. And the DSM, I assumed, was scientific. While I clarified in the memoir that, in contrast to the DSM labels, I actually preferred my father’s mythical explanation for what had occurred to my mother (he said, following Celtic folklore, that her soul had been abducted by the faeries and replaced with an evil spirit), I nonetheless deferred to the DSM as the repository of empiricism’s best account of the dark abyss of madness.

It was only after finishing my memoir that I began to study the DSM more closely. In the latter part of the six years it took me to write the book, I had experienced recurrent episodes of severe anxiety, profound hopelessness, and a pervasive obsession with the worthlessness of my existence, symptoms that both reflected the post-traumatic shadow of my mother’s quixotically abusive personality and partly formed the subject of the book. My psychiatrist gave me the diagnosis initially of “Generalized Anxiety Disorder” and then, as I became more distressed, “Major Depressive Disorder,” although he made clear that he did not take diagnostic categories very seriously, viewing them as a practical exigency for the purposes of medical insurance reimbursement (for which a DSM diagnosis is typically a pre-requisite), not an inviolable feature of biological reality. I was prescribed Paxil, Celexa, Lithium, Buspar, Klonopin, Trazodone, Effexor, Seroquel and Abilify, received psychotherapy, cognitive behavioral therapy, and a host of alternative treatments not covered by my medical plan (including, at my most desperate and vulnerable, a shamanic exorcism of my mother’s spirit), and my symptoms eventually faded. The modus operandi governing my treatment was a trial-and-error sequence of psychotropic interventions coupled with talk therapy. Whether my eventual recovery can be taken as corroboration for the effectiveness of selective serotonin reuptake inhibitors boosted by atypical anti-psychotics, or simply evidence that, given enough time, even the grimmest depression will resolve all by itself, I am no position to comment. In any case, recovering from my “dark night of the soul” (as theologian Thomas Moore poetically recasts the modern western clinical nomenclature of depression), I consoled myself with a stack of cheery self-help books with titles such as “There is Nothing Wrong With You” (Cherie Huber) before delving more deeply into the literature of madness. Since my own unhappiness had felt related to my mother’s condition, I hoped to find an answer to the mystery of her unusual behavior, and thereby feel a sense of closure in relation to my memory of her. Imagining that my own sanity lay in defining her madness, I began a journey that would take me to the frontiers of neuroscience and psychiatry. Ultimately, in attempting to define “madness”, I would be forced to reckon with the conundrum of what constitutes psychological health and the nature of the western Self. And ultimately I would need to understand my deep-seated need to find a psychopathological label for my mother, and the associated scope and limitations of western psychiatry’s classification of human thought and feeling.

The Head Doctors
Medical explanations for the vicissitudes of human behavior stretch back to antiquity, if not earlier. The ancient Greek physician Hippocrates categorized dispositional abnormalities in terms of the unseen operations of four internal substances, or “humors” (black bile, yellow bile, blood, and phlegm), a concept whose legacy lives on today in the notion of a “phlegmatic” personality (and arguably even underpins the popular idea that mental disorders are caused by “chemical imbalances” in the brain.) By the middle ages, materialism had been overtaken in the west by a harshly judgmental theological paradigm in which marginal or transgressive beliefs and behaviors were reified as the workings of Satan; “witches” were burnt to death or drowned. But in the wake of the Enlightenment, the zeitgeist again recast madness in materialist terms, as essentially a malfunction of Reason. Significant advances in medical science, such as Leeuwenhoek’s discovery of microscopic organisms, the subsequent emergence via Koch and Pasteur of the “germ” theory of disease, and the development of the hospital, then compounded a widespread understanding of sickness as rooted in mechanistic terms.

A countervailing paradigm, sprung from ancient eastern religious notions of the “soul,” then resurfaced in post-Enlightenment terms in the shape of G.W Leibniz’s insistence that consciousness was not reducible to the mechanical operations of its biological substrate. While philosophers throughout Europe then continued to analyze the idea of mind as a phenomenon whose quality of reflexive self-awareness rendered it categorically distinct from the material world, their peers in medicine initiated the period described by French sociologist Michel Foucault as “the Great Confinement,” in which vast numbers of “madmen” (and women) were detained against their will in institutions such as the Hopital General in Paris and London’s Bethlem Royal Hospital. Madness to early modern medicine was thus a sickness no less rooted in hidden physical agents than leprosy, and hence no less imperiling the healthy population unless the mad were locked behind stone walls. Yet western thought’s ambivalent stance on its predominant theory of the mind (and thus of madness) remained split between consciousness conceived as an epiphenomenon of grey matter, and mind regarded as a substance unto itself, at minimum a special sort of matter or at most a hologram of some sacred totality.

This split persisted even into the ascendance of a certain Viennese neurologist, Sigmund Freud, who although speculating in his Project for a Scientific Psychology (1895) that all psychological phenomena would ultimately be understood in neurobiological terms, also made the paradoxical assertion that his work was, in fact, not really scientific at all. “Everybody thinks that I stand by the scientific character of my work,” Freud said in a 1934 interview with Giovanni Papini, “and that my principal scope lies in curing mental maladies. This is a terrible error that has prevailed for years and that I have been unable to set right. I am a scientist by necessity, and not by vocation. I am really by nature an artist…And of this there lies an irrefutable proof: which is that in all countries into which psychoanalysis has penetrated it has been better understood and applied by writers and artists than by doctors. My books, in fact, more resemble works of imagination than treatises on pathology.” Freud the writer of the imagination arguably survived in the therapeutic treatment, in classical psychoanalysis, of patient speech as a form of elliptical symbolic text, pregnant with hidden meanings whose exegesis the astute analyst was tasked to illuminate, but it was Freud the psychopathologist whose legacy was to prove more influential as the medical men co-opted the “germ” theory of disease for psychological purposes, and the “disease model” of modern scientific psychiatry was born.

In 1883, Emile Kraepelin, the German doctor generally credited with “discovering schizophrenia and manic depression,” published the first edition of his seminal Lehrbuch der Psychiatrie, a volume that by 1915 in its eighth edition had swollen to 2, 818 pages, purporting to establish for the mind sciences the type of classificatory system that Carl Linnaeus had created in zoology a century earlier. Echoing Kraepelin, the DSM, first published in 1952 as a slim volume and covering a modest 108 disorders, had undergone a similar lexical and nosological ballooning to over 300 disorders and 934 pages by its fourth edition of 1994. Accounting for such a radical expansion in the putative knowledge base supporting the science of the mind in four short decades, with the known ecology of mental disorder apparently proliferating like species of Amazonian butterflies, demands that we accept either a version of Moore’s Law applying to medical science (for which no evidence exists), or speculate that non-scientific forces were afoot: perhaps it was Freud the writer of the imagination, not Freud the doctor, whose legacy was holding sway after all, with “scientific” psychiatry propelled by some form of imaginative agency. And if the DSM is thus partly a speculative work, its purpose, assumptions and sub-textual implications are presumably susceptible to critical analysis like any text, however sacred…

The Good Book
The DSM is often described as the “psychiatric Bible,” and it is oddly instructive, in reflecting upon the manual’s fiftysomething year history, to contrast the APA’s influential publication with the compositional backstory of the Judaeo-Christian tradition’s long-venerated tome. Literal readers of both books tend to ignore their bases in the limits of individual human decision-making, and often prefer to quote from an idealized version of their iconic text that conforms to their own prejudices, rather than the real texts with all their irksome inconsistencies. For instance, when Beverly LaHaye, founder of Concerned Women for America (the Christian conservative group that in January criticized Mary Cheney, Dick Cheney’s openly gay daughter, for getting pregnant) commented in a 1987 interview with Ms magazine that “America is a nation based on Biblical principles,” the text to which she presumably referred was not a version including the Song of Solomon’s homage to sexual love; neither, presumably, does LaHaye find her midnight prayers to the Almighty restlessly disrupted by reports of the Gnostic “heresies,” such as the Alexandrian philosopher Valentinius’ foundation myth that a primordial ur-being known as the Demiurge created the universe by accident, or indeed any of the contentious and often bizarre scriptures that failed to make the cut when Bishop Cyril of Jerusalem presided over the synthesis of the first Christian Bible in the year 350.

For fundamentalists of any religious stripe, indeed, the hermeneutic controversies implicit for sophisticated readers in the three major monotheistic religions’ canonical texts are typically subsumed by faith in the works’ unmediated transmission of the word of God. Consequently, what the Ten Commandments and the Sermon on the Mount represent for sincere Christian believers, regardless of these textual discrepancies, is a prescription for living, and while the Good Book apparently falls silent on the questions of stem-cell research or Britney Spears’ vagina, Christian conservatives typically appear to presume that Christ Himself has spoken disapprovingly upon these matters. Such prejudicial posturing equally characterizes much of the psychiatric profession, which often pretends to speak from a vantage-point of ex cathedra infallibility when the objective evidence underlying their opinions is often ambiguous.

The early history of the DSM was no less constructed by committee than the early Christian Bible, and equally the result of internecine schisms, political horse-trading, and negotiation with outsider factions – the APA’s 1973 decision to cave to gay activist pressure and remove homosexuality from its list of mental illnesses being perhaps the most salient and notorious case in point. There, as in the case of “Post-Traumatic Stress Disorder” (included as a result of a committee vote, after pressure from Vietnam veterans), the “Religious or Spiritual Problem” code appended to DSM IV (after a campaign by psychoanalyst David Lukoff and colleagues), and the repositioning of “Pre-Menstrual Dysphoric Disorder” from the manual’s body text to an epigraph describing topics requiring “further study” (after pressure by Paula Caplan and other feminist psychologists), it is hard to avoid the suspicion that the purported “disorders” do not exist in the same way as “Mount Rushmore” or “chicken McNuggets” can be said to exist. Equally, the tired hypothesis that not existing in the same sense as “Mount Rushmore” perforce implies that the item in question, in this case mental illness, is therefore “socially constructed” – that is, purely subjective – would have provided little reassurance, for instance, to me during the suicidal phase of my own severe depression, when the unwelcome and unrelenting visitation by the “noonday demon” certainly did not feel like simply a matter of cultural convention.

But if “mental disorders” are neither fully “natural kinds” (to quote philosopher Ian Hacking’s term) nor fully “human kinds” – neither entirely independent of human observation for the ground of their being (like fish or forests) nor, at the other end of the epistemological spectrum, entirely dependent on human observation (like catwalk fashion or the dance of the Dow Jones index) – if “mental disorders” are perhaps more properly understood as fuzzy sets, constituted by a dizzying array of biological, psychological and social factors with wildly heterogeneous symptom patterns and prognoses, then it perhaps should come as no surprise that the DSM has emerged not as an unambiguous taxonomy of mental maladies but a hodge-podge of clinical supposition and heuristic compromise. In other words, we should fully expect the DSM, like the Christian Bible, to represent the fallible opinions of flesh-and-blood men and women (albeit, mostly men). If the Bible is not really the word of God, the DSM is not really the facts of madness. The difference is that one might imagine that “the facts of madness” could, at least in principle, be determined as a matter of empirical record for any and all to scrutinize (like the oblate-spheroidal shape of the Earth), whereas determining the reality of the “the word of God” is contrastingly only possible to the faithful. Madness is fact, God interpretation, or so popular wisdom might speculate.

But the enigma at the heart of madness is that the matter of interpretation is actually far more problematic than a literal reading of a Zyprexa advertisement would otherwise tend to suggest. Yet since we live in a surface-obsessed culture with an insatiable hunger for quick fixes for every ailment, an aversion to pain, and a narrow, Cartesian conception of the self, the predominant reading of the DSM is as an encyclopedia of mental diseases, with “bipolar disorder” presumed to exist in the same sense as “influenza” or “osteoarthritis.” Thus imagined as holy psychiatric writ, the DSM looms large amidst medical insurers, lawyers, mental health practitioners and patients as a lexicon of psychic suffering, cited and critiqued not only for what it actually says but also for the literal significance with which some of its readers rush to impart it, both positive and negative. Like the Bible, the DSM has inspired busy parallel industries of believers and apostates, and the manual has acquired, intentionally or otherwise, the appearance not merely of helpfully outlining some common psychological pitfalls for the benefit of the needy but of prescribing what it means to be “normal.” The APA never officially intended its manual to be read, like the Christian Bible, as a guide for living, but is it, I wonder, perhaps an unconscious implicit purpose precisely to this pedagogical effect that renders the book so divisive, so inflammatory? The DSM ostensibly defines disorder, not order – sickness, not health – but despite the absence of explicit guidelines for what constitutes the Good Life in 21st Century America, doesn’t the very categorization of illness effectively insinuate a corresponding paradigm of wellness, a model of “sanity” elliptically inscribed within the nomenclature of disease as its sub-textual shadow? In addition to the official DSM, it is hence this shadow DSM, the APA’s “Guide to the Good Life”, with whose hidden directions I become intrigued as I make my first foray into the “PsyComplex,” hoping to disentangle the visible book from its spectral twin, and learn the lessons of each as they relate to my mother’s madness and my own…

Extreme Overwhelm
Sometime in 1977, Harvard undergraduate David Oaks began to feel alienated and to find his extracurricular work as a social activist overwhelming. One day, after smoking cannabis, he entered an “altered state” in which he came to believe that his neighbor worked for the CIA and that his television was talking to him. He was variously diagnosed as “schizophrenic”, “bipolar”, and “psychotic”- terms which, to this day, he entirely refutes as applicable to his former experience, preferring the phrases “extreme overwhelm” or “crisis.” Oaks went on to found MindFreedom, an organization at the forefront of the psychiatric “survivor” movement. Experiences that one can be said to have “survived” are typically understood as dreadful – one survives cancer, a car wreck, a concentration camp – and by thus nuancing his movement’s self-definition in such graphically post-traumatic terms, Oaks is clearly not shrinking from a starkly antagonistic stance in relation to the APA and the DSM, it strikes me. But while it is clear that David Oaks has survived something, I am not ultimately sure whether that something was mental illness, malpractice at the hands of sub-standard clinicians, or some combination of the two, and wonder about the extent to which the pain of “extreme overwhelm” perhaps informs and colors his perception of the allegedly “fascistic” APA.

On the phone, Oaks thanks me several times for writing about the DSM, a “human rights” issue that he said has been “ignored” thus far by the media, and scarcely pauses in a forty five minute diatribe against North American psychiatry’s record of clinically and ethically dubious activities in the past few decades, from forced electroshock treatments and court-ordered psychotropic medications to the undue influence exercised upon the profession by profiteering pharmaceutical companies and the undemocratic, subjective nature of the DSM’s composition.

Now, let me be clear that I am in no doubt of the gravity of the evidence corroborating Oaks’ indignation in regard to certain activities of the APA. In April 2006, the Washington Post reported that of the 170 experts who contributed to DSM IV, more than half had ties to drug companies that sell psychiatric medications, including 100 percent of the experts who worked on mood disorders and psychotic disorders. How is the average person supposed to take his diagnosis seriously, when half the “experts” who came up with those diagnoses are on the Pharma payroll? As Oaks argues, the collusion between medicine and drug money renders the prospect that non-drug alternatives will be seriously considered by the psychiatric establishment far less likely. And, yes, there is the fundamental issue of the DSM’s problematic empirical validity. “It’s completely unscientific!” says Oaks. “Now, I’m not denying that there are people going through extreme distress, but the point of any crisis is that it can also lead to growth, and locking people up with the power of law on the basis of a scientifically dubious document is simply wrong.”

I ask Oaks what he thinks of the Church of Scientology, which, through an unassumingly named subdivision called the Citizen’s Commission on Human Rights (CCHR), has campaigned vigorously against the APA and psychiatry in general (an “industry of death”) on the grounds, inspired by maverick psychiatrist Thomas Szasz, that mental illness is a “myth.” (Possessing the status of “myth” does not, we should note, prevent Scientologists from believing in the idea that an extra-terrestrial dictator called Xenu brought billions of aliens to Earth 75 million years ago and blew them up in volcanoes with hydrogen bombs, but the religion expects a different standard of truth-telling of the psychiatric profession, apparently). Oaks replies that he thinks CCHR has “done some good work,” but insists that he is “pro-choice” rather than “anti-psychiatry,” and applauds “progressive” psychiatrists who allow patients to “chose their own diagnostic labels.”

If one assumes the validity of the disease model, this patient-centric model of psychiatry would be scandalously akin, in physical medicine, to permitting a brain cancer patient to believe he was actually only suffering from a headache. Oaks does not believe in the disease model, of course, but I feel that his preferred euphemistic alternatives (“overwhelm” etc.) sidestep the essential questions of whether madness exists, and if so in what forms and for what reason, and how, as a society, we might best respond to it. Even if it is meaningful to conflate every variety of psychological suffering, from severe anxiety to paranoid delusions to arachnophobia to dementia, under the single term “emotional distress,” what about the more fundamental questions of what is actually occurring for the sufferer, whether at the level of molecules and neurotransmitters or in his romantic and work life? Assuming that a suicidal crack addict is clinically distinct from a panic-prone investment banker, what words can we most effectively use to distinguish their definition and treatment, if the language of psychiatry is off limits? Surely it is not enough just to say that the addict and the banker are both “distressed.”

So, is even a bad DSM better than no DSM at all? And, even supposing that mental illnesses are not “natural kinds” like tigers or tuberculosis, is it really practical to imagine attempting to treat the vast panoply of “emotional distress” on a purely ad hominen basis, providing a customized therapy for everyone, without reference to some form of consensually-determined criteria? When he was not fulminating against the APA, Oaks concedes the problem.

Don’t Prolong Your Grief
“Let me stop you right there,” the APA public relations person curtly interrupts me, as I try to explain my interest in speaking to Dr. Michael First, editor of the DSM’s revised fourth version (DSM IV-TR) and the director of an APA group that is doing the ground-work for DSMV. “You know that DSMV isn’t coming out for several years?” she says, as if rapping me on the knuckles for not doing my homework. I explain that, yes, I am well aware from the APA’s website that DSMV is not scheduled for publication until 2011 at the earliest, but that I am nonetheless interested in examining the issues surrounding the potential future of psychiatric diagnosis that the lengthy DSMV composition process promises to examine. “Oh, in that case…” I never hear back from the PR person, but a few days later, Dr. First calls me. Now, the DSM has been the subject of intense flack for so long, and the APA equally such a longstanding target of animus, that my instinct as an interviewer is to spin the true scope of my interest as far as justifiable, short of lying, towards a semblance of the anodyne. So I do not mention David Oaks.

(And I certainly do not mention my mother. Dr. First has never met my mother. Possibly, she would like to meet him – she routinely sends letters and poems to Bill Clinton, Tony Blair, Queen Elizabeth II and other dignitaries, so an eminent American psychiatrist would not be out of place in her address book. But I do not plan on showing this article to my mother, or furnishing her with First’s email address, so this meeting is unlikely to occur, and First thus highly unlikely to ever know my mother outside the palimpsest of my own fallible recollections; inviting his comment on the topic therefore seems quite futile.)

I think it especially unwise to betray my interest in David Oaks and the “survivor” movement since such a confession, prior to my interview, would surely be equivalent, I speculate, to boasting of militant atheism prior to meeting the Pope. Better to get on First’s good side with some credulous noises about the “exciting prospects” for an “etiologically-based neurobiological and genetic psychiatry.” What I mean by those noises is my feigned credulity in the APA’s potential fulfillment, in DSMV, of Freud’s Project for a Scientific Psychology: the idea that science will soon propel psychiatry to the point where it can identify specific disease processes, even specific genes and neurological mechanisms, that are causally related to specific mental illnesses in the same way that the HIV virus causally relates to AIDS. If so, would Dr. First then be able to analyze my mother’s fMRI scan and identify the tell-tale malfunction that once led her to wake up my brother in the morning by spraying an aerosol deodorant in his face?

Perhaps I go too far with my fake credulity, because Dr. First is quickly at pains to dispel any delusion under which I may have been laboring that Freud’s Project is anywhere close to realization. “It’s very unlikely that we’ll see any sort of paradigm shift in DSMV,” says First. “The research base just isn’t there, yet, and I can’t imagine it appearing in the three years before we write the DSMV draft in 2010.” Even in the case of dementia, a hitherto clear-cut case where the evidence of neuronal “plaques” and “tangles” in post-mortem brain tissue samples was presumed to suggest a straightforward causal relationship between an organic diagnostic marker and an associated psychopathology (Alzheimer’s disease), the plot has recently thickened, and the plaque-tangle correlation no longer appears to represent a diagnostic “gold standard.” And in the far more ambiguous case of schizophrenia, the research is even less promising. (Paul Hammersley, a psychologist at the University of Manchester, England, has proposed abolishing the word “schizophrenia” altogether, because the “disease” denotes a hugely heterogeneous set of bizarre behaviors with no common etiology). Indeed, Dr. First seems to be striking such a tone of humility in the face of his profession’s patchy scientific research base that I begin to wonder why David Oaks and the “survivors” were still so angry with the APA. (Probably because neither First nor any of the other APA big cheeses have deigned to respond to MindFreedom’s emails; although, given Oaks’ militant tone, First’s disregard for the “human rights” activists who oppose him is hardly incomprehensible.)

We discuss the changes in DSMV and I try and establish whether the APA is shifting the manual onto new ground. First commits the APA to a stringent new conflict-of-interest policy to avoid repeating the embarrassment of the DSM IV drug company links scandal. He is going to insist on a “very high [research] threshold” for the inclusion of controversial new diagnoses such as Compulsive Shopping Disorder, to mitigate the timeworn allegation that the APA is responsible for the continued “medicalization” of what Thomas Szasz called “problems in living.” (There is a chance, though, that Prolonged Grief Disorder will make the cut in DSMV, apparently, putting the APA in the peculiar position of being authorized to determine exactly how long the grief-stricken are permitted to mourn before a shrink can pronounce them sick in the head). The DSM will remain a strictly “clinical document,” not a “statement of what mental health is” – even if, on my analysis, one cannot exist without the other.

In essence, DSMV is going to be APA business-as-usual. The manual will almost certainly retain the controversial “categorical” model that defines mental disorders as discrete entities that a person either does or does not have (like a virus) as opposed to the “dimensional” approach (favored by many researchers) that presents psychological phenomena on a continuum with no arbitrary cut-offs between “normal” and “abnormal.” An exception might be in the area of “personality disorders,” where the categorical approach is so wildly at variance with both the research and clinical picture that “some element of dimensionality” will probably be adopted. So, First is neither arguing bullishly for the likely realization of the Freudian Project, nor is he conceding to the invalidity of the disease model and committing the APA to an earnest search for alternatives. Far too much is at stake, I assume, to abandon the disease model: think of all the labor needed to revise the insurance industry paperwork, the millions of dollars in APA publishing revenue, the billions of dollars in drug money…

In Oaks and First, I have met the psychiatric equivalents of both the Apostate and the Believer (although Oaks confessed to a smidgeon of belief, and First to an almost heretical degree of doubt) – but I am still no closer to understanding the nature of madness, whether it is a disease or not, and in any case how it can best be defined and treated. If Oaks is right, my mother was just “emotionally distressed” when she took me on a skiing holiday in Austria but refused to let me ski; if First is right, even if my mother still fits into a DSM category, my bizarre Alpine holiday wasn’t likely to be explicable by a brain scan, at least not any time soon. I decide I need to meet an Agnostic, a thinker sensitive to mental illness as both “natural kind” and “human kind,” to therapy as both psychopathology and imaginative dialog. Perhaps, I speculate, madness is explicable in this interzone where science meets Soul, and perhaps here I will find some answers not just about the nature of sickness but the meaning of mental wellness – clues to the “Guide to the Good Life” which First argues the DSM never purported to be and which Oaks and the “survivors” suspect is the APA’s hidden agenda (conscious or otherwise) in advancing a certain model of mental “disorder” and its implicit vision of “order.” Or perhaps I have simply been grieving my mother too long, should add Prolonged Grief to my list of troubles, and take the right pill to dispel my unhealthy fixation…

Mother, you had me…
If there could be said to be a single figure pioneering a new paradigm in the sciences of the mind that bridges the divide between the neurobiological determinism of the disease model and the fuzzier, subjective realm of psychoanalysis, it is Allan N. Schore, a professor on the clinical faculty of the Department of Psychiatry and Biobehavioral Sciences at the UCLA David Geffen School of Medicine. A pioneer of the nascent field of “neuropsychoanalysis,” Schore has integrated the research on neurobiology, neuroscience, psychiatry, psychoanalysis, developmental psychology, pediatrics, and trauma, serving on the editorial board of 28 journals in six scientific fields, in addition to running a private clinical practice. Schore’s work proceeds on the premise that the “single skull” view of the human psyche that has effectively served as the dominant framework for the western understanding of the mind (and mental illness) since Hippocrates is essentially incorrect. We have been looking for clues to the riddle of madness inside one head, when the answer really lies in the connections between two heads (or more).

In particular, the development of the mind (whether “healthy” or pathological) depends critically on the infant brain’s interrelationship with its primary caregiver. Between birth and the age of one year, the average brain expands in weight from 400 grams to 1000 grams, with much of this expansion contingent upon the nature of infant-mother interactions. In particular, the neurological mechanisms responsible for our emotional development depend on a consistent, loving interplay between mother and child. So far, so familiar, but the awe-inspiring features of Schore’s work is that he has shown how this understanding of the importance of effective parenting plays out at the neuronal level, and demonstrated empirically that “good enough” mothers actually create the neurological make-up of their children through unconscious intrapsychic processes.

The revolutionary impact of this new model is that it no longer makes sense to try and understand madness solely as a malfunction of a single brain. Instead, it is more accurate to think of madness as a disturbance in the interpersonal links between two brains, with its origins almost certainly located in the early mother-infant relationship. Early parental neglect or abuse develops a brain wired with the potential for later pathologies such as “Borderline Personality Disorder” (BPD). The good news is that the brain retains a degree of “plasticity” even into adult life, allowing therapists and other caring people to rewire the brain of the abused individual through empathic interactions. “This is why we have intimate relationships,” Schore tells me, “so one unconscious can homeostatically regulate another unconscious. The core of most human problems is emotion – one thinks of violence, for instance – and the development of qualities like empathy is critically related to attachment patterns in the early mother-infant relationship. But just as pathology can result from poor affect regulation by the mother of the infant, later psychotherapy can actually rewire those affective circuits in positive ways.” Schore is currently studying the fMRI scans of mother-infant pairs involving mothers with BPD in order to study the intergenerational transmission of BPD at a neurological level with an ultimate view towards developing new therapies to help people with BPD.

My mother was adopted at the age of one. I do not know why her biological parents, who were married and ultimately went on to have three more children, decided to give their first child away, or what kind of early interactions she had with her biological mother. I can imagine that the early separation was traumatic. Perhaps her sensitive infant limbic system never recovered from this primal blow. I can also imagine that her developing neo-cortex probably took quite a hit when her adopted mother left her alone by a primus stove one day and she badly burnt her face. The sense of betrayal she felt, aged eight, when she learnt through playground gossip, rather than from her mother, that she was adopted, must equally have made its presence distressingly manifest in her proliferating synapses. So, who can then say what was going on her head two decades later when she gave birth to me? Taking Schore’s work into account, I find myself wondering about the time, aged seven, when I stole some change from my mother to buy candy, and her subsequent reprimand was so severe I sobbed for hours unconsoled. Was the intolerable level of shame I experienced then in some sense an intergenerational echo from my mother’s own primal trauma? If Schore were to capture my mother’s brain in dialog with my own through a fMRI scan, would traces of our mother-infant shame still be partly visible even now, her abusive personality and my later depression mutually encoded in a common limbic injury? My desire to answer these questions is the ulterior motive behind my interview with Schore on the rapprochement between science and psychoanalysis.

But just as I had refrained from introducing my mother to Michael First, neither I do not burden Allan Schore with my personal story. Yet I feel clearer, having spoken to him and read his work, that a new way of understanding the mind and madness is emerging, a paradigm that straddles the gap between the crude determinism of the disease model and the loose subjectivism of the “survivors,” between the Freud of the Project and Freud the imaginative writer, between “natural kinds” and “human kinds.” His work, it strikes me, has suggestive parallels with the Buddhist teaching of “anatta” (“no-self”), the idea that the individual self can only be said to have existence in relation to other selves. In Buddhism, neither “madness” nor “sanity” has any ultimate reality; the point of living is not to achieve “sanity”, or indeed any quality in relation to the individual self, but to reduce the suffering of others. And while it is valuable to develop the means to help others in distress – let us imagine a DSM, free of stigma, purely conceived for practical purposes to guide treatment– a “mental disorder” is neither entirely solid nor entirely fluid. Madness is instead a “practical kind ” (to quote philosopher Peter Zachar’s term) – a useful map that does not pretend to the status of territory. Thus the important question, in relation to my mother’s strange personality and my later melancholia, is not which diagnostic category to put them in, but how their attendant pain can be eased, and how I can prevent their underlying cycle of intergenerational trauma from affecting my nine month-old daughter as she grows up.

According to Schore, my daughter’s brain and my own are unconsciously intertwined, just as my own behavior mirrors my mother’s imprint. Her developing brain cannot thrive outside of that fluid intertwining. (Perhaps, like a quantum state, her brain cannot even be said to exist outside of the brains that interact with her and consequently influence her?) A DSM that thus fails to recognize this sensitive interdependence of dual psyches, that reifies mental disorders as static disease entities, has not fundamentally advanced on the medieval paradigm in which psychoses were interpreted as the presence of evil spirits. A fundamentalist “psychiatric Bible” insists on “mental disorder” and the self as no less solid than Mount Rushmore; their implied vision of psychic “order” is a humdrum, etiolated vision of life with its eccentricities cauterized, a life in which Van Gogh and Virgina Woolfe would have zoned out on Haldol as teenagers; a vision of America populated by legions of obedient consumers, anxiously siloed from one another behind gray office cubical walls and a solitary myth of the “single skull” psyche. By contrast, an enlightened paradigm of psychological health starts from the assumption that the smallest sub-division of homo sapiens is not one person but two; that sanity and synapses are similar because they both depend on connection. I may still not have a satisfactory label for my mother’s madness, but I know that at some point the links between her and those closest to her were painfully disrupted. To be mad is to be alone. Sanity starts in the communion of one self with another. “Mother, you had me, but I never had you,” as Lennon sang. Time to hug my daughter.