Lunacy or mental illness? A conversation with Mike Jay
🖋 Matei Iagher


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In the past two decades, Mike Jay has written seven books, edited four more, and penned dozens of articles and reviews. Widely regarded as an authority on the cultural history of intoxicants, Jay has also written about the history of madness, as well as a book-length foray into the world of Colonel Edward Despard, who was executed for treason and attempted regicide at the beginning of the 19<sup>th</sup> century. His latest book, tentatively titled <em>Mescaline: A Cultural History of the First Psychedelic</em>,<em> </em>is scheduled to be published in May 2019 by Yale University Press.
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I met Mike Jay in the lobby of the Wellcome building – a large and recently refurbished affair, complete with tourists, security guard, a metal sculpture of a de-sexed human figure hanging upside down from the ceiling, a noisy, jam-packed café morphing into a bookstore on one end, and a dizzying spiral staircase on the other. The Wellcome Museum is where Jay curated his latest exhibition Bedlam: The Asylum and Beyond, which was accompanied by a volume (This Way Madness Lies) that offers a birds-eye view of the history of psychiatry in the last 400 years.
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Physically, Jay cuts a striking figure. At over six feet, with the frame of a retired rugby player, a shiny head, and a densely patterned colourful shirt, he was hard to miss across the middling crowd of afternoon visitors at the Wellcome. When I saw him, he was greeting a diminutive bookseller and getting ready to sign a few copies of his books. ‘Apparently, it helps to sell them,’ he told me. I waited for him to get his coat and we walked across the street to a quieter location, a whitewashed café. We sat at opposite sides of a round table, and I began fumbling with my list of questions and my phone (now doubling as a voice recorder).
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[Matei Iagher] <em>I was wondering if you could tell me a little bit about your intellectual biography – with a view towards how you became interested in the history of psychiatry.</em>
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[Mike Jay] I did a degree in philosophy at Cambridge. By the time I was done with that, I was totally sick of the intellectual life and never wanted to read another book in my life ever again. So I went into film making. I made films, TV, and music videos. For most of my twenties, I worked in different capacities: editing, researching and directing – but I carried on writing, because I enjoy it. And I started writing about drugs. Nobody else was doing that at the time. People were afraid of being arrested. They asked me: ‘Aren’t you scared? The police will have your name on some list somewhere. You can’t do this!’ I found the field was open territory, because – by and large – druggies don’t have the patience for historical research, and academics did not want to get their hands dirty. There were great stories there that nobody had touched. My first books were in that area, and I found that, even though I considered myself a generalist with no academic specialism, drugs was a special subject. It gave me a license to rove across the divide between art and science, and across everything from psychology to art to ethnography to history. Having written about the history of drugs, I broadened out and started writing about the 18<sup>th</sup> century, and revolutionary politics. I would have happily continued writing biographies of 18<sup>th</sup> century natural philosophers, but people kept coming back for stuff on drugs. So that’s how it became a specialism. Still, I think the way I approach it is much broader than most specialists. It’s an excuse for me to be a generalist, with a particular lens, or frame.
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[MI] <em>In This Way Madness Lies, you provide a general history of psychiatry from the 17<sup>th</sup> century to the present, centered around Bedlam – the famous psychiatric hospital in London. How did this come about, and why Bedlam?</em>
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I had drawn on the Bethlem archives for a previous book. It struck me that they were a great resource for telling the history of psychiatry for this long period. My interest was also spurred by having friends with f. I found that this was a subject that nobody really understands – of course there is a huge body of professional expertise, but there are much wider questions that remain unanswered. As soon as you start to look historically at madness, you see the extent to which it is socially constructed, or at least a response to changing norms and attitudes. It’s a huge subject, and focusing on Bethlem was a way of containing the story. I was also struck by the fact that it has had three physical buildings, which roughly correspond to what you might call different eras: the madhouse, the asylum, and the mental hospital – the 18<sup>th</sup>, the 19<sup>th</sup>, and the 20<sup>th</sup> centuries. I felt that would work well as an exhibition, so I proposed it to the Wellcome. I also wanted to focus on the patients’ perspective, and wondered if one could make a history out of them. So I brought the patients’ perspectives in dialogue with the institution.
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[MI] <em>From the very beginning of the book, alongside Bedlam, you mention Geel in Belgium, which provides the counterpoint to the story—an antithesis—a place where a different kind of therapeutic regime was enacted, one where the mad where integrated into the community, taken in by peasant families and provided a more nurturing environment—one in which they worked alongside their adopted families, but also where they were allowed to still be a part of society, i.e. they weren't simply locked up. And the way I see it, the story that you tell is one where the Bedlam model eventually fails, and the Geel model gains ascendancy—particularly after World War II, in so-called 'therapeutic communities. 'Is this a fair description? And can you say a bit more about these two, let's call them, 'approaches to madness'?</em>
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They work well as counterpoints, because they were both founded at the same time, they both have religious founding myths, and they encapsulate different ideas, one of which is: sequestering the mad in a separate colony, and the other is integrating them into the social mainstream. It’s interesting to follow these two attitudes through history, because the heyday of the asylum – the late 19<sup>th</sup> century – was actually a time when Geel became integrated into the Belgian public mental health system. It’s technically declared a large colony – there’s a line on the map drawn around it. So at that point, you could either lock your crazy relative up in a grim asylum, or have them work out in the fields with the farmers in Geel. The dialogue between the two perspectives was interesting. If you go to Geel now, the family care system still exists, but there’s also a gleaming psychiatric hospital, which looks like anywhere else. Everybody is trying to meet in the middle now: to do as much as possible in the community, but with residential health care as a last resort. That is what makes Geel interesting. It considers, or at least has done so in the past, psychiatry not as the first port of call. They did not immediately frame madness as a medical problem with a medical solution. They framed it as a social problem, and if a social solution fails, there’s a medical framework. The opposition between Geel and Bethlem is a very fertile point to start thinking about where we are now in terms of framing madness.
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[MI] <em>The first sentence of the book reads: 'It may seem that mental illness has been with us forever, but it took root only around two hundred years ago and is a product of the Western world. Madness, by contrast, has been a part of every culture across the globe since the dawn of humanity.' You come back to this towards the end of the book, where you suggest that perhaps one consequence of the medicalization of madness is that recovery is always seen in very narrow terms—mental illness is something that you ideally would take a pill for. On the one hand, this doesn't tally up with how some of mad today see their plight, and on the other it's clear that the vast majority of medical therapeutic regimes have failed (completely or partially, whether it's the asylum, physical therapies, or drugs). So, should we do away with mental illness completely?</em>
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[MJ] I believe mental health has many dimensions. In some cases, it has a medical dimension, but it also has a spiritual dimension, a social dimension, a psychological dimension. There are lots of ways of looking at it. Mental illness sounds like the opposite of mental health, but actually there’s more to health and well-being than the absence of illness. The term ‘mental illness’ collapses all the other dimensions down and makes everything about the medical dimension. Mental illness frames the problem as a medical problem, and obviously there are a lot of mental illnesses that have a biomedical dimension (dementia for example); but there are many others where the biomedical cause is not so clear. In the end I believe there is no good collective noun for what we are talking about, because what we are talking about is millions of different conditions and experiences and ways of being in the world. The only thing they have in common is that they fall outside the lines of normality. But that is also problematic, because the sphere of the normal keeps shifting. I found all these terms like ‘mental illness’ or ‘madness’ problematic, because I think they are simplifications. Given the choice, I feel the term ‘madness’ is open to these other dimensions more than the term ‘mental illness’, which seems to be closed in by the medical frame.
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[MI] <em>And it has been reclaimed by proponents of the academic field of ‘mad studies’.</em>
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[MJ] It has. If you go back a hundred years, you can see that the term ‘mental illness’ was very progressive, because it opposed terms such as ‘lunacy’. The underlying message was: this is not your destiny; this is an illness just like any other. Anyone can have it, anybody can recover from it. But one hundred years on, I can see why people might want to self-identify as mad. There are more perspectives to choose from. Are you King Lear? Or Don Quixote? Are you Hamlet? It’s reductive to call these characters and ways of being ‘mentally ill’. There’s more to it than that.
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[MI] <em>At one point in the book (p. 281) you write: 'Depression is a condition for which antidepressants offer relief, but by doing so they create more depression, shaping the distress generated by modern life into medical form.' If I understand you correctly, you're saying that the situation we're in now is one where supply is creating demand.</em>
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[MJ] If they did not work at all, nobody would take them. So it’s not all pure marketing. At the same time, if drugs do work, why is depression so much more prevalent these days? What I am suggesting is that when the first antidepressants came out, the producers almost did not bother to bring them on the market, because at that point depression was still considered melancholia, and the producers felt there would be no market for them. So I think once the idea of depression was activated, it spoke to a lot of people, for a lot of different reasons. If you have medication like antidepressants (and they do work at times) for people who feel terrible, then doctors will be looking out for something that might be diagnosed as depression. Now there is an antidepressant, there is something you can do about it. Once the broader population realizes there is such a thing as depression, and there are antidepressants, then they’re much more likely to shape what they are unhappy about in their life to the prescribed forms of illness.
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[MI] <em>Because you have a cure, and you also have a description that allows to frame your troubles somehow.</em>
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[MJ] Exactly. And you can now medicalise them in ways that remove blame. When you’re ill, it’s not your fault that you are lying on your sofa all day feeling miserable, or you cannot get out of bed in the morning, or your life is shit. I have a friend who is a recently retired psychiatrist. He was a locum psychiatrist all around Scotland and Northern Ireland. If he felt his patients could bear it, he would say to them: ‘Look, you do understand there’s nothing wrong with your brain or chemistry. You don’t actually need these pills. You know the problem is that your life is really unfulfilling and actually the answer is to get a new life somehow.’ Almost all patients went straight to my friend’s superior. They went to the doctor who would give them pills. People really want their malaise to be medical, and they want their problems to be curable.
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[MI] <em>Another issue that you do not mention in the book, but which I have to ask you about is the current resurgence of interest in drugs like MDMA or psilocybin for the treatment of a range of conditions (depression, anxiety, PTSD). How do you see the future of this kind of research?</em>
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[MJ] I think it is very popular because, as I suggest in the book, we are losing faith in traditional pharmaceuticals. The development of new antipsychotics and antidepressants is slowing down rapidly. I think people are realising we have hit the buffers of what we can do, given our current – very limited – understanding of the brain. I think people are looking for alternatives. I see a lot of people who have had transformational experiences with Ayahuasca, for instance. I think recovery narratives are of crucial importance here. Take this one for example: ‘At a time when I was mentally unwell, I went to the Amazon and met a shaman. During the trip, I was psychically dismembered, I saw the infinite, and I was put back together again.’ Now that is a great recovery narrative! It certainly beats: ‘I’ve been depressed, the doctor put me on pills, and then we decided to up the dosage a bit and now I feel OK.’ In the latter case, you are merely trapped in the story of your own brain chemistry defects. I think that psychedelic therapy in that sense is very powerful for people who are primed for it. However, giving powerful psychedelics to people with fragile mental health seems to me intrinsically problematic. I know it works, because I have seen it work spectacularly on people, but I must also admit that there are possibilities of it not working. When that happens, there is a risk that the next professional the patient sees will say: ‘The last guy gave you MDMA? In your condition? Have you sued him yet?’ I believe it has potential – particularly, I think it has potential for people who are primed for revelations through the psychedelic experience. But whether that is something that is going to thrive in contrast to clinical psychiatry or within it – that’s the question.
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[MI] <em>And you can’t really control it, if you are a psychiatrist. You don’t know what’s going to happen. It’s not something you can fully understand.</em>
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Yes, but I also think that – it’s kind of a double bind. When it works, it works because the therapist is great and they care and really believe in it. The only person I know who was given LSD during therapy, back in the old days, is my uncle. He had severe mental health issues in the 1960s. He was given LSD in a doctor’s surgery and was then left alone in a room on a plastic chair and told to think about his childhood. Those were possibly the worst eight hours of his life. I think when it works, it works because the therapist believes in it. So in a way, the most important thing is the therapy. It’s not unlike homeopathy. If the homeopathist believes in what he or she is doing, and is a warm and caring person who spends an hour with you a week, you’re going to feel better. So I think there is a dimension of that with psychedelics as well. Often the people who do it are inclined to think it is psychedelics that are doing the trick, when in fact it is the work of good therapists.
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[MI] A<em>nd they’ve got a good narrative.</em>
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[MJ] A very glamorous narrative.
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[MI] <em>So where did your uncle’s LSD experience happen?</em>
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[MJ] I guess it was in Harley Street somewhere
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[MI] <em>In London?</em>
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[MJ] Yeah. With a proper old-school Freudian analyst. It was the journey back to childhood, which in my uncle’s case was a place he’d never wanted to return to. That was the problem.
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