Liah Greenfeld's Blog

The May 2013 issue of The British Journal of General Practice contains an editorial “Depression as a culture-bound syndrome: implications for primary care” by Dr. Christopher Dowrick, Professor of Primary Medical Care at the Institute of Psychology, Health, and Society of the University of Liverpool. Dr. Dowrick claims that depression “fulfills the criteria for a culture-bound syndrome,” i.e. , one of the “’illnesses’, limited to specific societies or culture areas, composed of localized diagnostic categories,” like, for instance ataque de nervios in Latin America. In the case of depression the culture area affected is “westernized societies.” Putting the word “illness,” when applied to culture-bound syndromes into quotation marks indicates that Dr. Dowrick does not consider such syndromes real illnesses; it follows that depression--a culture-bound syndrome of westernized societies--is also not a real illness. Dr. Dowrick further argues that depression as a diagnostic category cannot be seen as “a universal, transcultural concept,” because it has no validity and utility, and it does not have validity and utility, because “there is no sound evidence for a discrete pathophysiological basis” for depression. I find myself in absolute agreement with Dr. Dowrick’s two specific statements above (that depression is a culture-bound syndrome of westernized societies, and that there is no discrete pathophysiological basis for this diagnostic category), and yet completely disagree with the implication that depression is not a real disease.

It is important to remember what a disease, or illness, in general, is. Both terms clearly focus on the personal, subjective experience of suffering: dis-ease as opposed to ease, illness as opposed to wellness. So does the word “pathology,” which derives from the Greek for “suffering” (pathos) and Greek for “knowledge” or “understanding” (logos). Thus pathology = understanding of suffering. Even health professionals, whose task is to alleviate suffering, first of all, often forget this, and think that “pathology” refers not to the understanding of the patient’s suffering, but to an objective morbid condition underlying it, and also equate “disease” and “illness” with such objective morbid condition. Moreover, they also believe that such objective morbid condition is necessarily material, i.e., biological. As a result, the absence of “a discrete pathophysiological basis” for depression can lead Dr. Dowrick to the conclusion that depression is not a real illness, but a category, invented for commercial and professional reasons of pharmaceutical companies and medical practitioners who want to get paid for services rendered, which was developed on the basis of “an ethic of happiness, within which aberrations from the norm are assumed to indicate illness.” But, as my previous post [The Real Trouble With DSM-5] argued, mental diseases are likely to be caused by culture, rather than biology, because the mind, or the mental process, while occurring in the brain, is mostly processing intakes from the cultural, symbolic environment, in which it is unlike digestion or breathing, which process intakes from the material, physical and organic, environment. There is an objective underlying condition for the disease (i.e., the suffering) of depression, but this condition is cultural: it is the cultural condition of anomie, caused by the openness of modern Western societies and the bewildering multiplicity of choices for possible self-definition they offer their members [see The Modern Mental Disease]. Depression is, indeed, a culture-bound syndrome and at the same time it is a terrible disease, which cannot and should not be equated with low or bad mood, sadness, or any other “aberration from the norm of happiness”: it differs from these normal mental states symptomatically in the intensity of suffering experienced, in its character (such as resistance to distraction and other symptoms of the paralysis of the will, expressed among other things in the characteristic lack of motivation), and in its functional effects. An occasionally sad person is not dysfunctional, a depressed one is--depression destroys relationships and renders one incapable of performing one’s duties, it is as real and serious a handicap as any physical one. Neither should depression be seen as an exaggeration of normal mental states, differing from them only quantitatively, or equated with normal reactions to particularly traumatic life events, such as bereavement. (Indeed, Dr. Dowrick, like many other critics, justly castigates DSM-5 for including in the depressive diagnosis grief lasting more than two weeks--as if it were normal, in either statistical or medical sense of the word, to fully adjust to the loss of a close family member in two weeks!) One of the central characteristics of depression--and an exacerbating factor of the suffering it causes--is precisely its lack of connection to specific life events. As anyone who has experienced depression or observed closely persons suffering from depression knows, this absence of an external cause often leads the suffering individual to suspect oneself of madness. The most characteristic feature of severe depression, expressive of the intensity of suffering associated with it, is suicidal thinking. Twenty percent of people suffering from depression eventually commit suicide, which makes it one of the deadliest diseases today. It would be quite irresponsible of a health professional to let the lack of a “discrete pathophysiological basis” obscure this.

Because depression is a real disease, severe and often lethal, it requires the attention of a health professional. Because the causes of depression are cultural, it stands to reason that methods used for the treatment of physical diseases won’t be successful in its treatment. This does not mean that medications won’t have any effect. Pharmaceutical substances are powerful agents, just like alcohol or recreational drugs, and will influence the chemical balance in the brain, sometimes wreaking havoc in it and sometimes alleviating some of the symptoms. But even when the effects of medications are positive, they won’t address the cause of the disease. That’s why, so far, depression has no cure. It is a recurrent, or chronic, illness. Dr. Dowrick suggests that the primary physician serve as a spiritual advisor of sorts to the patient who comes to the clinic with such a mental complaint, talk to such a patient about life problems, ask about the patient’s “physical, psychological, and social circumstances…propose ideas for change… offer hope of an alternative.” But this, while a reflection of kindness and sympathy, is similar to treating cancer with cold compresses, the medication being physical like the disease, unlikely to cause any damage, but also totally irrelevant. Depression has an objective cause; to cure the disease, the therapy, just like in cancer, must focus on this objective cause and neutralize it. In depression, unlike in cancer, this objective cause is cultural. In the case of cancer, a responsible primary physician will refer the patient to an oncologist. In the case of depression, the physician must refer the patient to a specialist who understands the cultural causes of this awful disease and can treat it. There are no such specialists today. Psychiatry must recognize the cultural causes of depression and make cultural expertise an essential element of its therapeutic arsenal. Depression is a culture-bound syndrome. It is also a terrible real disease. It can be cured. But we must at last open our eyes to its cultural causation.

[Originally published on Psychology Today]

Mind, Modernity, Madness: The Impact of Culture on Human Experience

Let us take a little break from the discussion of the historical development of modern emotions and modern mental disease—that is, of the modern mind-—pursued in the previous posts of this blog, and instead focus on the present. May 22 is the official publication date of the much-talked-about DSM-5, a significant day for all who are in any way concerned with mental health, patients as well as professionals who are trying to help them, and therefore for many in the Psychology Today community. The manual has been subject to severe criticism for months preceding its publication; it appears that hardly anyone has a good word to say about it, the time and effort spent in its preparation seems to have been largely wasted. The poor baby is likely to be dead on arrival, stillborn, its own family having turned away, unwilling to embrace it. Just a week ago the mighty NIMH all but completely renounced it.

But why is it such a disappointment? And who or what is to blame for the problems with DSM-5? The answer to the first question, I would say, lies not in anything DSM-5 contributes to the previous versions of the manual (whether in terms of additions or subtractions), but in what it does not change in them at all. The answer lies in that it does not solve the fundamental problem of psychiatry and psychology, i.e., does not provide them with the understanding of the human mental process—tthe mind—healthy or ill. This is, obviously, not a problem which the DSM-5 creates, or which was created by any of the preceding versions of this document. It is the problem at the core of the psychiatric/psychological/mental health establishment in its entirety-—both its research and its clinical branches, and including in the first place its central, most powerful, and richest institution, NIMH.

According to the prepublication materials, the essence of the new DSM consists in the modifications it introduces in the extensive psychiatric nosology, specifically adding diagnostic categories to diseases of unknown biological origin and uncertain etiology. But the real problem lies much deeper—in the understanding of such diseases itself; it is the problem with the old, fundamental, and universally accepted diagnostic categories of thought disorder vs. affective disorders, or schizophrenia vs. manic and unipolar depression, on which all the other diagnostic categories of mental illness of unknown etiology, new and not so new, are based. DSM’s approach is similar to attempting to salvage a house, falling apart because built on an unsound foundation, by adding to it a fresh coat of paint and new shutters. What is needed, in contrast, is to dismantle the structure, establish a sound foundation, and then rebuild the house on top of it.

DSM-5, and DSM in general, is just an expression of the increasing confusion in the mental health community (including both researchers and clinicians, and both psychiatry and psychology with their neuroscience contingents) in regard to the nature of the human mental processes—or the mind-—altogether. Before this confusion is cleared, none of the problems with the DSM and the resulting mental health practice can be resolved. And the criticism of the DSM should in all fairness apply also to its critics and judges, such as the NIMH.

Despite its nearly exclusive biological focus and the equation of the mind and the brain, the source of the mental health professions’ misunderstanding of the mind lies in their deviation from the norm in biology. Psychiatry and psychology consider the human individual as their subject. Biology, in distinction, studies the organic world. The most important causal factor in biology is the environment in which organisms find themselves (think of natural selection) and no specialization in this mighty science, among the sub-disciplines of which neuropsychiatry and neuropsychology, at least, would like to range themselves, would limit itself to the study of a form of life in isolation from the environment. Consider, for example, medical (i.e., applied biological) specializations such as gastroenterology or pulmonology: is it possible to imagine a physician who would be unaware that the process of digestion is necessarily affected by the nature and quantity of food the stomach digests, or the process of breathing by the nature and quantity of the air inhaled? No, because this is what our organs do: they process intakes from the environment, and these intakes have at least as much to do with our health and illness as the structure and physiology of the organs which process them. Yet, we forget this when it comes to the brain and mental processing—the mind.

The environment of the human brain is far more complex than that of the stomach and lungs, or than the environment of the brains of other animals. Most of its intakes come not from the organic and physical world, but, instead, from the world of meanings and symbolic systems which convey them, that is, culture. If digestion can be defined as what happens to food in, and what food does to, the stomach, the mind, by analogy, can be conceptualized as what happens to culture in, and what culture does to, the (human) brain. It is very likely that most mental diseases (just like most gastrointestinal or pulmonary ones) come from the intake of the processing organ, rather than from the organ itself, i.e., it is likely that they are caused by culture. Mental health professions pay no attention to it, and no revision of the DSM will make them improve their ability to help the mentally ill.

To solve the problem of the psychiatric/psychological/mental health establishment, which the DSM has failed to do (thereby disappointing its closest associates), one has to start by questioning and analyzing the fundamental diagnostic categories used by this establishment, consider them against the existing clinical, neurobiological, genetic, and epidemiological evidence, and-—most important—bring into the mix the never-before-considered cultural data. It is likely that on this basis one would reach the conclusion I have arrived at, that the two (schizophrenia and manic-depressive illness) or even three (schizophrenia, manic depression, and unipolar depression) discreet diseases are better conceptualized—and therefore treated—as the same disease, with one (and cultural) cause, which expresses itself differently depending on the circumstances in which this cause becomes operative. Psychiatric epidemiologists, at least, have long suspected that “the black box of culture” is an important contributing factor in these diseases. However, as the phrase indicates, they lack the means to understand or even examine its contribution. Let us unpack the “black box” and add a missing yet essential dimension to the diagnostic tool-kit, which the new DSM, like the old ones, disregards.

[Originally published on Psychology today]



Mind, Modernity, Madness: The Impact of Culture on Human Experience

Modern humans—that is, people who live in societies such as ours, democratic, prosperous, relatively secure, and offering its members numerous life-choices, people like you and me, in other words—are different from humans who lived or live in other types of societies. We experience life differently from them: perceive reality differently and feel emotions that other humans did not have.

Human experience was revolutionized in the 16th century England. In the previous posts we have already discussed such new emotions as ambition, love, happiness, and their connection to the new form of consciousness, which came to be called “nationalism” and formed the cultural framework of modernity. Nationalism implied a special image of society as a sovereign community of equal members (a “nation”) and of reality in general. In its original, English, form it was essentially democratic. As it spread, it carried the seeds of democracy everywhere. Considering a living community sovereign (the source of all laws), it implicitly but drastically reduced the relevance of God and, even when combined with religion and presented in a religious idiom, which happened often, was to all intents and purposes secular. It was dramatically different, in other words, from the fundamentally religious, hierarchical consciousness which it replaced, and it shaped the way we live today. Among other things, the new consciousness made the human individual one’s own maker: it implied we had the choice to decide what we want to be; it dramatically increased the value of human life, encouraging us to realize it to the fullest extent—in other words, it gave us dignity and freedom. The society built on its premises of equality and popular sovereignty was an open society, in which the individual had the right to define one’s own identity, a society which made one’s identity one’s own business. It is not coincidental that the new emotions discussed in previous posts, which emerged when the English society was redefined as a “nation,” were in some way connected to the individual’s ability to define oneself and that the two great modern passions—ambition and love—in fact answered a new need which this ability created: the need for help in identity-formation.

Unfortunately all these benefits of nationalism—the dignity, freedom, and equality, both empowering and encouraging the individual to choose what to be – did not come unaccompanied by costs, and for all the enrichment of our life experience contributed by love and happiness, these costs would be impossible to disregard. The liberty to define oneself has made the formation of the individual identity problematic. A member of a nation cannot learn who or what s/he is from the environment, as would an individual growing up in an essentially religious and rigidly stratified, non-egalitarian order, where everyone’s position and behavior are defined by birth and divine providence. Beyond the very general category of nationality, a modern individual must decide what s/he is and should do, and thus construct one’s identity oneself. Modern culture cannot provide individuals within it with consistent guidance, with which other cultures provide its members. By providing inconsistent guidance (for we are inevitably guided by our cultural environment), it in fact actively disorients us. Such cultural insufficiency is called anomie. Already over a century ago, it was recognized as the most dangerous problem of modernity. For many people, the necessity to construct one’s identity, to choose what to make of oneself, became an unbearable burden.

At the same time as the English society was redefined as a nation, and ambition, happiness, and love made their first appearances among our emotions, a special variety of mental illness, different from a multitude of mental illnesses known since antiquity, was first observed. It expressed itself in degrees of mental impairment, derangement, and dysfunction, the common symptoms of which were social maladjustment (chronic discomfort in one’s environment) and chronic discomfort (dis-ease) with one’s self, the sense of self oscillating between self-loathing and megalomania and in rare cases deteriorating into the terrifying experience of a complete loss of self. Some of the signs of the new disorder were similar to the symptoms of familiar mental abnormalities. In particular, the new illness, like some previously known conditions, would express itself in abnormal affect—extreme excitement and paralyzing sadness. But, in distinction to the known conditions in which these symptoms were temporary, in the new ailment they were chronic and recurrent. The essence of the new disorder, however, was its delusionary quality, that is the inability to distinguish between the inner world and the outside, which specifically disturbed the experience of self, confusing one regarding one’s identity, making one dissatisfied with, and/or insecure it, it, splitting one’s self in an inner conflict, even dissolving it altogether into the environment. Sixteenth-century English phrases such as “losing one’s mind,” “going out of one’s mind,” and “not being oneself” captured this disturbed experience, which expressed itself in out-of-control behaviors (that is, behaviors out of one’s control, out of the control of the self), and, as a result, in maladjustment and functional incapacitation.

None of the terms in the extensive medical vocabulary of the time (which included numerous categories of mental diseases) applied to the new mental illness; neither could it be treated with the means with which the previously known mental illnesses were treated. It required a new term—and was called “madness.” It also called into being the first hospital in the sense in which we understand the word (the famous Bedlam), the first medical specialization, eventually named “psychiatry,” and special legislation regarding the “mad.” It is this clearly bipolar and delusional disease which would be three centuries later classified as distinct syndromes of schizophrenia and affective (depressive and manic-depressive) disorders.

We shall follow the history of this modern disease and analyze it in the following posts.Mind, Modernity, Madness: The Impact of Culture on Human Experience

In the last post [Modern Emotions and Perennial Drives: Love and Sex], I argued that the modern concept of love as an identity-affirming emotion, the way to one’s true self, and the supreme expression of the self, changed the cultural significance (that is, our attitude to) of sex, elevating it far above the base drive, legitimate only in marriage for the purpose of procreation and even then considered sinful within the framework of Christian morality which was dominant in our, Western, civilization throughout the last fifteen centuries of its pre-modern existence. Love became the greatest modern passion, it was presented from the outset--in Romeo and Juliet--as sexual love between a man and a woman, and the involvement of sex in it purified sex and added to it an important spiritual dimension. The essence of the modern ideal of love, and of love-relationship, however, has always remained its identity-affirming power, the fact that it offered the most direct route to finding oneself and, therefore, to meaning in life and happiness [see Modern Emotions: Happiness].

So long as this was the essence of the emotional bond in a relationship, the relationship could diverge from the ideal-typical image of love and still be recognized and characterized as love. The most obvious diversion was the understanding that love was possible between persons of the same sex. Such love relationships could be both sexual and not sexual (though in the United States, as noted in the last post, they would most probably be sexual). It is quite possible, for instance, that the insistence on the homosexual couples’ right to marry--at a time when the institution of marriage loses support among heterosexual population--has as its goal precisely this recognition on the part of society at large. Given that we consider only love marriage as truly legitimate (which is, incidentally, the reason for our divorce rates), giving homosexual couples’ the right to marry necessarily amounts to the public acknowledgment of their relationships as love.

But love has extended farther than homosexual couples from the original modern idea of it as a sexual relationship between a man and a woman: it extended to relationships that are not sexual at all. It is only since the 16th century that love in the sense of identity-affirming emotional bond, filling one’s life with meaning, could be found--and sought--in the relationships of parents and children. This may seem counterintuitive, especially in regard to mother-child relationships, given what we know about the bonds between mothers and their young in the animal kingdom. Surely, human motherly love derives from the same instinctual (natural) source! But both comparative zoology and comparative history contradict this assumption. Even the most devoted animal mothers chase their offspring away, when the job of raising them up to maturity, genetically determined, indeed, is completed--think of cheetas, leopards, bears. As to history, it is enough to consider the past of Western societies. Before the 16th century, when the contemporary concept of love emerged, children were commanded to honor their mother and their father and owed their parents the duty of obedience and respect to the end of their days. The parents owed their children nothing: the Ten Commandments include no mention of parental duties. Certainly, sometimes profound affection tied generations living in the same household. But it was dependent on class, with the top families in the social hierarchy entrusting the upbringing of their children, from the moment of birth, to various servitors, and hardly having any but the most formal relations with them at all. Very often, moreover, affection could not go deep: women were constantly pregnant, infant and child mortality was extremely high, both physical and psychological investment in a particular child had to be kept at a minimum. But even were all this not so, affection (a secondary emotion--see Are Human Emotions Universal?) cannot be equated with love as we understand it today-- a much more complex tertiary, culturally produced emotion, which affirms the ideal identity of the individual and helps him or her to find meaning in life.

From the 16th century on, many a woman would find true love--and herself--only in motherhood and the love of a child. This, far more than anything else, explains why modern society places children on such a pedestal. Children too, especially before they reach the age when they can search self-affirmation outside of home, become very dependent on the parent’s love in the formation of their identity (I shall explain in a later post why they were not so dependent in pre-modern societies). This may explain the paradox that it is precisely in our time, when parents--especially mothers--are much more emotionally (and otherwise) invested in their children than ever before, that children have so many complaints against their parents (especially mothers, perhaps): just see the posts on problems with mothers in the days around Mother’s Day in Psychology Today. We expect from our parents much more and, obviously, have many more reasons for disappointment and frustration.

But the deep need for finding meaning in one’s life--the reason for being on this earth at this time--and for the affirmation of self leads us to expand the concept of identity-affirming love even further and include in it dumb creatures, our pets. Our concept of pets and the idea of dog as a man’s best friend derive directly from the search for self-definition. Most modern languages do not have a special category for pets within the general designation of domestic animals. Derived from a Scottish and North English agricultural term for a lamb or kid taken into the house and brought up by hand, the word “pet” was, in Scotland, first applied metaphorically in early 16th century to spoiled children and then to animals, such as monkeys or peacocks, kept for entertainment or home adornment, rather than a utilitarian purpose such as hunting mice and protection. In England, the word “pet” soon became a term of endearment. The first instance of its application to a dog, cited by Oxford English Dictionary, happened in 1710 in connection to “amorous passions.”

It is our need for self-affirming love that led us to see a fellow being, a soul-mate, in a creature with a tail and four paws--a dog or a cat, and the many of you who have owned one know precisely what I am talking about and how powerful the emotion is and how it fills one’s life. This emotion--this variety of love--has also been unfamiliar to people in pre-modern societies, just like “romantic” love, identity-affirming parental love, happiness, and ambition, already discussed in these posts. What connects all of them is that each has a role--and helps--in the construction of our personal identities. In the next post I shall explain why the need for such help arose and what was the source for this expansion in the range and change in the character of our emotional life.Mind, Modernity, Madness: The Impact of Culture on Human Experience

If you ever wondered, love--the identity-affirming one we all desire--is not dependent on sex and can well thrive without it. Love, as already Shakespeare said (and Shakespeare--see Modern Emotions: Love--was the expert on the subject) is a marriage of minds, after all, and the bodily element in it is at most secondary. Of course, the experience of that love we are discussing here is essentially erotic in the sense that the emotion is ecstatic and self-transcendent--finding that perfect understanding (the understanding that allows one to understand and accept oneself) in another person implies virtually merging with the other person in one’s innermost self, making the other person an essential, vital part of one’s identity. And this self-transcendence, merging of the minds, is naturally felt as a physical longing, a desire to become physically one--expressed as sexual desire. But sex, in this case, is an expression of love, not the other way around, and love can have numerous other expressions, it does not necessitate sex under all circumstances.

Here in America, we prefer materialistic interpretations of everything, which leads us to see all emotions as a function of our biological constitution, so love is usually understood as an essentially sexual feeling, as an expression of sexuality. We tend to equate “romance” and “romantic” with sex and sexual. As a result, sex acquires a far greater importance in our society, than it has in many other societies, and it leads many of us to mistake sex for love and therefore to have disappointing relationships or even become disillusioned in love altogether and settle for sexual attraction only. This is a peculiarity of the American culture; many other cultures would not even connect the primary emotion of sexual arousal to the tertiary emotion of love, whatever their specific concept of love (see Are Human Emotions Universal?).

The association of sex with the new—our--idea of love (as identity-affirming, revealing one’s true self, and making life meaningful) in the 16th century in England ennobled and purified sex, which was considered fundamentally sinful in the Christian worldview (it was the original sin, you will remember; because of our discovery of sexuality we were expelled from Paradise and became mortal), and legitimated it outside marriage where it was by necessity allowed (while making marriage itself, if loveless, illegitimate--nobody thought of making love a condition for marriage before). Yet, this association, which encourages the contemporary American to see sexual attraction as the source and foundation of love, was quite accidental for the English culture where our idea of love emerged. Shakespeare, the great love poet, had very little to say of sex that was good. Far from being the foundation of love, loveless sex (which he called “lust”) was revolting: it led to nausea, not to love. Consider this:

Th’expense of spirit in a waste of shame

Is lust in action; and till action, lust

Is perjur’d, murderous, bloody, full of blame,

Savage, extreme, rude, cruel, not to trust;

Employ’d no sooner, but despised straight;

Past reason hunted; and no sooner had,

Past reason hated, as a swallow’s bait,

On purpose laid to make the taker mad:

Mad in pursuit, and in possession so;

Had, having, and in quest to have, extreme;

A bliss in proof, -- and prov’d a very woe;

Before, a joy propos’d; behind, a dream:

All this the world well knows; yet none knows well

To shun the heaven that leads men to this hell.



So love, which we all today want and the ideal of which was first presented to us in Shakespeare’s Romeo and Juliet, is not a sexually driven emotion. It may be more akin to the exemplary male friendships of antiquity, which allowed one person to find his alter ego (his “other self”) in the other. For his reason, this ideal, identity-affirming love can be found not only in homosexual relationships, but in relationships in principal lacking any sexual dimension. It is on these that I shall focus in my next post. Mind, Modernity, Madness: The Impact of Culture on Human Experience

Surprise! Surprise! Love, too, in the sense we understand it now, is not a universal human emotion. Even today it is not universal: some cultures are familiar with it and some are not. And, historically, only the last five hundred years in human history have known it -- the same five hundred years that have known happiness, aspiration, and ambition. The first humans to fall in love also lived in the 16th century and were English. Today, of course, this most powerful feeling is familiar everywhere within the so-called "Western" civilization (which includes all societies based on monotheistic religion, i.e., Judaism, Christianity, and Islam) and it has penetrated into other civilizations as well. But it has spread from England, accompanying other experiences (such as ambition or happiness) which were at first specifically English, and reached other societies in translation from the English language. Love as we understand it, therefore, also does not spring from human "nature": it is essentially a cultural phenomenon.

We all feel that our lives would be incomplete without love, isn't this so? Many of us do not find it and suffer because of this. The search itself often becomes a source of suffering. But we all want love and are unwilling to give up. It seems unbelievable that there were times and there are still places, where people have never had this need and hardly would be able to understand why we make such a big deal about it. Yet, this is a historical fact: for most of human history love scarcely touched more than a couple of eccentric individuals here and there.

We also know precisely what it is we are looking for--we recognize love immediately when we meet it, we know when it is "the real thing" and when what we encounter is not "it" but an emotion that only bears a superficial resemblance to it. If we are mistaken, if we take for "real love" something that only appears as one, for "true love" something that is false, we can go mad, have a nervous breakdown. Indeed, such "disappointments in love" are among common causes of depression and even suicide. We all know what it is, and yet, it is so difficult to define.

Among other reasons, this difficulty has to do with the word "love," which (unlike “happiness”) is an old word that was commonly used before it acquired its modern meaning. In general, it referred to an ecstatic desire of any kind, which implied the experience of self-transcendence--this was, in fact, the original meaning of the word eros in Greek. Because of this general meaning, “love” could be used to express both the purely spiritual sentiment of Christian love and even the divine love of God itself (agape, caritas, eros of Christian theology) and the physical desire, libido, which the church considered essentially sinful--sexual lust. When the 16th century English concept of love--which is our concept--was added to these older meanings, this resulted in some confusion. You may remember Shakespeare’s sonnet, one of many in which he defines true love, but where he says, admitting to the multiplicity of meanings the word “love” allows:

Love is not love

Which alters when it alteration finds,

Or bends with the remover to remove:

O no; it is an ever fixed mark,

That looks on tempests, and is never shaken;…

Love alters not with [Time’s] brief hours and weeks,

But bears it out even to the edge of doom.

The characteristic of true love that Shakespeare stresses in this sonnet is its unchanging nature: it is one-in-a-lifetime passion. Admit it: this is what we all want, however difficult it proves for most of us to find. Those who argue that our desires are genetically, and therefore, evolutionarily determined, should consider that; it is far more likely that we share our genetic endowment with the clearly polygamous apes, than with species genetically remote from us, such as wolves, penguins, or swans, who mate for life. Yet, we long for a monogamous lifetime relationship.

There are, of course, other characteristics which distinguish love as we understand it today from other emotions (including those that could be called “love” in different times and cultures). And, again, Shakespeare was the first to point to them. For example, “true love” is a passion, that is, an authentic and free expression of one’s innermost self; in fact, it is the ultimate modern passion, the supreme movement of the human spirit. None of the earlier concepts of love included this element. [See the discussion of passion in Modern Emptions: Aspiration and Ambition]. As a passion, it is irrepressible, uncontrollable, free from extraneous compulsion, and oblivious of social norms. The definition of love as the ultimate passion (i.e., the most authentic expression of the self), it must be pointed out, changed the view of human nature. This was done in Romeo and Juliet, the story of ideal love, in which Shakespeare provided us with the clearest description of what the love that we now want is.

In short, love makes it possible for every one of us to find one’s proper place in the world and to define oneself. It leads one to the discovery of one’s true identity (we often say that we find true understanding in the loved one, someone who really understands us): one’s identity, one’s true self is found in another person, in what he or she sees in one. This other person, immediately recognized (thus true love is love at first sight), then is recognized as one’s destiny, the One, and finding love at once also becomes self-realization, giving meaning to life as a whole. It is this that we all want--not simply affection, or companionship, or sex. In fact, the relationship between the essence of love-experience, which is self-affirmation, and sex, which is usually connected to it, is quite complicated. I’m going to discuss it in the next post.Mind, Modernity, Madness: The Impact of Culture on Human Experience

Our Declaration of Independence includes the pursuit of happiness among the inalienable human rights, alongside life itself. It is so included because the founding fathers evidently assumed that such pursuit was a human universal of the most important, that human beings, in other words, have always and everywhere had the capacity for experiencing happiness and have been naturally drawn to it. The readers of this blog would, probably, agree with this assumption and it is quite likely that many would consider happiness the very purpose of human existence. And yet, this assumption is wrong. Happiness is a modern emotion. No one – no society, no language – had a concept of it before the 16th century, when the idea of happiness first appeared in England, and this means that it was inconceivable for people who lived before the 16th century and to those who lived outside of England even for some time after it. If it was inconceivable, it could hardly been experienced, and certainly could not be consciously desired and pursued. As to whether it could be felt, desired, and pursued unconsciously we cannot know, because for obvious reasons, we cannot have any evidence regarding this possibility.

The English word “happiness” was created in the 16th century. At that time it had no equivalent in any other language. The words in French, German, or Russian, with the help of which we translate it, specifically meant “good luck,” a concept that existed in English as well, the word for any kind of luck being “hap.” The idea of “good luck” itself went back to the pagan antiquity. From the eudemonia of the Ancient Greeks on, all the synonyms of it connoted the benevolence of fate. To experience good luck meant to be subject to such benevolence, to be “blessed.” Luck was an objective state, not an emotion. The Greek eudemonia, in fact, could not be experienced at all, one of its defining characteristics was an easy and honorable death, and it was impossible to say whether one was or was not subject to the benevolence of fate until one was dead.

Luck, good or bad, is completely outside of one’s control, therefore, one cannot blame oneself for not being lucky or take pride in one’s good luck. Jewish monotheism rejected the idea of luck, opposing to it a view of the world predicated on the concept of justice. Man became to a certain extent responsible for his own fate. Under the influence of Jewish monotheism, which began to spread sometime in the 6th century BCE, eudemonia was reinterpreted and could now be applied to actual experience. From our, modern, perspective, however, it was certainly not a happy experience. The word now referred to the acceptance of mortality. Because the task of philosophy was to prepare one for death, eudemonia became the goal of philosophy. Today, when we translate eudemonia as “happiness,” this leads to the misconception that happiness is the goal of philosophy. But, actually, the advice of the philosophy which pursued eudemonia was to live a life that, while free of actual suffering to the extent that was possible, would be so devoid of enjoyment that one would not regret leaving it when time comes – a sort of nirvana. Such life was considered the “good life,” and eudemonia became a name for it.

This interpretation was reinforced and at the same time further modified in the Christian thinking. “Good life” acquired the meaning of faith, in particular, the absolute faith in eternal life, which often sought to express itself actively. Therefore Christian felicity (a derivative from Latin for “luck” – felix, which we also wrongly translate as “happiness”) could be found in martyrdom, an especially painful death one chose to demonstrate how free of fear of death one was.

Happiness has nothing in common with the phenomena whose names are used to translate this utterly novel English experience into other languages. To start, it is a joyful and pleasant emotion. Of course, human beings, like animals, have always been familiar with the sensations of joy and pleasure. Happiness incorporates them but implies much more. Examine yourselves and you’ll recognize that the word refers to a lasting, profound, fully conscious feeling of satisfaction with one’s circumstances – the sense that one’s life fits one like a glove. This implies that one experiences existence as meaningful, feels there is a reason for being here and now, and that one has a firm and satisfactory identity. Above all, perhaps, happiness is experienced as an achievement. It is a conscious realization that one reaps the results of right choices.

It is an historical fact that for much of human history people could not be happy. This was not because the capacity for happiness did not exist, but because happiness the emotion did not exist. It was created at the dawn of modernity. In future posts I’ll discuss what exactly brought this new experience, so important in our emotional life today, into being. Perhaps the reader already begins to see what connects the modern emotions on which we focus: ambition, happiness, and love, together.

[Originally published on Psychology Today]
Mind, Modernity, Madness: The Impact of Culture on Human Experience

The claim of this post is that such characteristic emotions as ambition, happiness, and love as we understand it today, which form the very core and define the emotional experience of so many of us, are not universal, but specifically modern in the sense of being a creation of the modern culture; that members of pre-modern societies were unfamiliar with them, i.e., did not experience ambition, happiness, and love; and that even at present these emotions play only a minor role in the emotional life of billions of people living outside modern Western civilization. The sources of these three emotions, in other words, are to be sought not in human nature, but in modern culture.

The focus of this post is ambition, while the following two posts will be devoted, respectively, to happiness and love. Still later posts will explain what in modern culture called these emotions into being. (I’d like to remind the reader that this blog is continuous, i.e., it follows the agenda set in the first post, with each new post continuing the arguments of the preceding ones.)

Emotions which are central to our experience, that is, emotions which are shared across significant populations, rather than moving exceptional individuals, are necessarily conceptualized--captured in specific words or in concepts which use words earlier applied to other experiences with a new meaning. Emotional vocabularies of different languages, even from closely related cultures, usually cannot be fully translated one into another. For instance, there is no translation for the French word ennui--English language appropriates it as such, because no concept in English coveys its meaning perfectly. In English, the emotion to which ennui refers and which French people, apparently (as we can judge from the very existence of a word for it) experience on a regular basis, must be described in many words. (Per Oxford English Dictionary: “the feeling of mental weariness and dissatisfaction produced by want of occupation or by lack of interest in present surroundings or employments.” It is much less than depression and significantly more than boredom.) For us not only the word, but the experience itself is foreign.

In the 16th century, numerous new concepts and words entered the English language to capture emotional experiences which were new for people in England and for a long time after that remained foreign for others. “Aspiration,” first used by Shakespeare, was one such completely new word. It denoted, as we all know, a hopeful desire to become, to acquire an identity of, something better or higher than one is, or has, at the present moment. (One would “aspire” to become an athlete or a writer, but not a thief or a slave, for instance). The word for this new emotion reflected the nature of a physical sensation that accompanied it--filling one’s lungs with pure, delicious air. That is, consciousness of such “upward desire” alone was enough to produce this physical sensation. [See Are Human Emotions Universal?] “Aspiration” was tightly connected to another new word, “achievement,” and, in fact, always presupposed it. One could aspire only to something one hoped to get to on merit: for example, to become rich, but not to win the lottery. Both these words (and several others) fell within the semantic space--that is, an area of meaning and experience--of the individual’s capacity and expectation to improve one’s identity and social position, to gain dignity, by one’s own effort. This area of meaning and experience itself was new. A new semantic space could emerge only if a possibility for self-creation that did not exist before came into being. The new emotions, therefore, while physically expressed through the existing neurobiological mechanisms, were a result of history.

The governing emotion within the new cluster was ambition. “Ambition” was an old negative term. Before the 16th century it was included among vices such as pride and vainglory and referred to inordinate desire for honor. Now it became neutral and would be characterized as base or noble, a sin or a virtue, depending on whether or not it was an aspiration and what kind of achievement it presupposed. The essential quality of ambition as an emotion now became its intensity. It is in connection with ambition that the word “passion”--which before that time referred to suffering, as in “Passion on the Cross”--began to acquire its current meaning of intense, overpowering emotion, an authentic movement of one’s innermost self. Ambition eventually became one of the two central modern passions. Love was to become the other one.

[Originally published on Psychology Today]
Mind, Modernity, Madness: The Impact of Culture on Human Experience

It is widely believed that human emotions, from love to ambition to pride or desire for freedom, for instance, are hardwired into our brain and that, therefore, both their range and their nature are universal, shared by humanity as a whole. This belief is wrong and itself reflects the fundamental universalism of modern Western, particularly American, thought and its tendency to consider all human consciousness and behavior as a function of biology. Both comparative zoology and comparative history show that, above the limited range of emotions we share, as animals, with other animal species, what moves human beings and makes them suffer in one culture or society may be dramatically different from the emotions shaping the living experiences in another one.

Emotions, or feelings, as the name suggests, are experienced through physical sensations. In this they differ from other mental experiences, usually called “cognitive.” The part of sensations in an emotion allows us to place it into one of three categories: primary emotions, secondary emotions, and tertiary emotions. Primary emotions are experienced through specific sensations and represent the direct reaction of the organism to the stimuli of its physical environment. They include such experiences as pain and pleasure, fear, positive and negative excitement (joy and anxiety), hunger and satiation, and their biological function is to increase the individual organism’s survival. It is clear that these primary emotions are common to humans and other animals.

We also share with other animals more complex, secondary emotions which lack a physical expression specific to them and are expressed through various combinations of physical sensations. These are emotions such as affection, which we see plainly in the species of birds (penguins, swans) and mammals (wolves) which mate for life and in the relations between mothers and their young among numerous species of mammals. Physically, affection is, most probably, expressed through sensations of pleasure and joyful excitement. Animals that are capable of affection are also capable of sorrow, which must express itself through similar neurobiological mechanisms as pain. This is what they feel when they lose, as often happens in the animal kingdom (think how many mothers lose their babies and vice versa) the object of their affection. One could add to these the feelings of sympathy and pity, on the one hand, and anger--outraged authority, which have been regularly observed in great apes and monkeys, as well as in social mammals such as wolves and lions. Secondary emotions also perform an obvious biological function: they strengthen the social order within the species and thus ensure the survival of the species. For this reason, like sensations, or primary emotions, which ensure the adaptation and survival of the individual organism, they indeed must be hardwired into the brain and produced genetically.

But this is not so with the great majority of our emotions, twice removed, so to speak, from their physical expression, which we don’t share with other animals. These tertiary emotions include common feelings, such as love, ambition, pride, self-respect, shame, guilt, inspiration, enthusiasm, sadness, awe, admiration, humility and humiliation, sense of justice and injustice, envy, malice, resentment, cruelty, hatred, and so on and so forth. It is not that other animals don’t have the capacity for these complex emotions: first, capacities can only be observed in realization, and therefore we do not know what capacities other animals have or don’t have; second, anyone who has lived with a dog knows that dogs --our pets--are capable of many of these feelings, for sure. We do not share tertiary emotions with other (wild) animals, even such closely related to our biological species as chimpanzees, precisely because they don’t have a biological function; they are not needed for physical survival, and so they are not hardwired into our bodies. They are produced culturally, and not genetically. The brain supports but does not provide for them. Saying that the great majority of human emotions are produced culturally implies that each one of them is a product of a specific culture, that is, an historical product. This means that the emotional experiences of people in different cultures are not the same and may even be very different. But emotional experience is a major part of our mental life, our mind. This, therefore, means that mental life associated with different cultures is likely to be different, i.e., that, while there is a specific brain structure that represents every human brain, there is no one human mind that can serve as the model of all minds. (This, among other things, further leads us to conclude that psychology must be cultural psychology.)

In the next post, I shall begin focusing on specific emotions, such as love, ambition, happiness, etc., which are central to modern existential experience.

[Originally published on Psychology Today]

Mind, Modernity, Madness: The Impact of Culture on Human Experience

In the 16th century, in England, several remarkable things happened:

Social mobility, inconceivable before, became legitimate and common;
The ideal of Romantic love between a man and a woman emerged and “true love,” as we understand it today, was added to the human emotional range;
The word “people,” which earlier referred to the lower classes, became synonymous with “nation,” which at the time had the meaning of “an elite”;
Numerous new words appeared, among them “aspiration,” “happiness,” and “madness”;
The English society, previously a society of hierarchically arranged orders of nobility, clergy, and laborers under the sovereignty of God and his Vicar in Rome, was redefined as a sovereign community of equals;
The nature of violent crime, personal and political, changed, with crime that was not rational in the sense of self-interested becoming much more common;
The attitude to pets, especially dogs and cats, changed, transforming these animals in many cases from living multi-purpose tools to our friends and soul-mates;
The pursuit of growth -- rather than survival, as was the case before – became the goal of the economy;
Mental diseases which were later to be named “schizophrenia,” “manic-depressive illness,” and “depression” were first observed, shifting the interest of the medical profession, in particular, from other, numerous, mental diseases that were known since the times of antiquity.

Were these things connected? And, if they were, what were the connections between them? These are the questions I shall be exploring in this blog.

In the course of these explorations we shall

Arrive at a new interpretation of mental diseases with uncertain organic basis, such as schizophrenia and affective disorders, and find their actual causes – sought by psychiatrists without success for the past two centuries;
Resolve the mind/body, or psychophysical, problem which Western philosophy has not been able to resolve in over two millennia, and define the mind;
Redefine what it means to be human, when human life begins, and where the difference between us and other animals lies;
Deepen our appreciation of Shakespeare and Darwin;
Learn to understand (and thus, at the very least, make the first step towards the ability to prevent) tragedies such as Newtown mass shooting and Boston Marathon bombing;
Acquire a new and surprising angle at modern poetry and detective fiction;
Reconsider the bases of psychology;
And prove the empirical reality of the soul.
Possibly, we’ll do more, but certainly no less. This is my promise to the readers of this blog and I invite them to hold me accountable, if any part of it remains unfulfilled.

I come to this online activity after thirty years of research, thinking, and teaching on the subject of modern culture, that is, of the culture of modern societies. It is impossible to understand modern culture without the comparison with other type of cultures, and it is unproductive to study any culture without attention to its relation to the individual mind. Thus, though a social scientist, not a psychologist, by training and profession, I have been led by my research itself to focus on psychology’s central topics, and by the results of this research to conclude that looking at these topics from the social science point of view has a lot to offer to those interested in them. It is a great pleasure for me, therefore, to join the Psychology Today blogging community.

[Originally published on Psychology Today]

Mind, Modernity, Madness: The Impact of Culture on Human Experience