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Pauline Lerner

Sanity: A follow up to Emily Grossman's blog

April 6, 2007 at 6:37 AM

I just read Emily Grossman’s blog on sanity and found it very moving and thought-provoking. I started to write the following as a comment, but, since it is so long, I’m writing it as a separate blog.

Sanity is so hard to define because it is personally and culturally determined. Psychiatrists have attempted to objectify diagnoses with tests, notably DSM-IV. According to the results of these tests, upper middle class white males are the group with the lowest incidence of mental illness. Who wrote the tests and made the definitions? Upper middle class white males, of course. In one famous experiment, psychiatrists in different parts of the US were shown films of people who might be considered crazy and asked to decide whether or not they were. Psychiatrists on the West Coast were more likely to accept as normal certain behaviors that psychiatrists on the East Coast considered crazy. I don’t know what decisions the Alaskan psychiatrists made. In other studies, American psychiatrists and European psychiatrists tended to differ in their diagnoses.

I think a good way to look at the issue is: Is this person a danger to himself or others? Unfortunately, the answer would be "yes" for an awful lot of people. Alcoholics and people on the verge of committing domestic violence are good examples, and there are plenty of such people. Yet legally, nothing can be done until after violence has been committed, and, even then, many of the perpetrators are not punished, rehabilitated, or prevented from committing more violent crimes. If you consider emotional abuse, the picture is even scarier. All parents, teachers, sweethearts, spouses, family members, and even close friends hold enormous power over other people. Consider this: we all have more power over other people than we are generally aware of. Fortunately, the human spirit is amazingly strong and resilient, and most people survive some degree of emotional abuse without becoming very destructive of others. A more subtle question is: What about people who are on the verge of injuring themselves physically? I know people who have attempted suicide one or more times, people who have threatened suicide, people who have family members who have committed suicide, and people who have intervened to save other people trying to commit suicide. An even more subtle question is: What about people who are injuring themselves seriously mentally? A large proportion of the population does this at least some of the time. How can we recognize trouble before it happens and intervene to help?

The questions are multiple and important, and the answers are, sadly, elusive.

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