The first line that struck me of Hacking’s chapter, that brought me back to many discussions with friends, was: “…mental illnesses, more neurotic than psychotic and we wonder which of them are affectations, cultural artifacts, clinician-enhanced, or copycat syndromes, and which ones are…real”. He mentions several syndromes, PMS, ADHD—I wrote a paper, looking at the etiology of ADHD, iatrogenesis, the ‘epidemic’ in the US versus the rarity of the condition in France, our overmedicalizing what may just be natural behavior—this caused quite heated discussions in the class, as you may imagine. (BTW, Ritalin, methylphenidate, is a stimulant, pretty much Speed for kids, not a steroid—I dare say I would rather give my kid some steroids than this).

Hacking makes a good point that we are somewhat voyeuristic when it comes to mental illness. It pervades our literature and popular culture. A “kooky” woman who swings between moods could be branded as having multiple personalities, which will inevitably bring about a “Sybil” reference (although the woman the book was based on admitted her disorder was faked), Woody Allen has made a career off of his neuroses, we are fascinated with antisocial behavior (the train wreck that is Kanye West comes to mind). When people self-destruct due to their own errors in judgement, mental illness can be a convenient crutch (hello, sex addiction!—a REAL thing, but not in the way it happens all too often to our politicians).

Hacking questions “what counts as evidence that a psychotic disorder is legitimate, natural, real, an entity in its own right?” The issue is with how we try to fit diagnosis of a psychiatric disorder into the box of the medical model used for diagnosing physical disease. The symptoms of psychiatric disorder are behavioral. You can’t fake clogged arteries, we can test for that…but what about personality disorders and depression? Also, could the bombardment of images, ads for psychiatric drugs, news reports on the prevalence of depression, anxiety, adult ADHD, bring about a type of “intern’s syndrome” (the phenomenon of medical students believing they have fallen ill with the diseases they are studying)? Is it our overzealous healthcare? It is true that social awkwardness can now sometimes be dx as Asperger’s, a disorder on the high functioning end of autism spectrum (but we would NEVER deny that autism is very real and very serious—but Asperger’s??). We have lamps in the GC to help us with our seasonal affective disorder. Fugue, like multiple personality disorder after Sybil was published, had a surge in diagnosis rates—were we just more enlightened, now knowing what to call these groups of symptoms? It seems that Hacking, while recognizing that some severe psychiatric disorders like schizophrenia, are real—fugue may be a bit too “convenient” of a disorder, especially as manifested in Albert, the “clean” traveler, who always seemed to lose his ID papers.

The Casey novel was a nicely written dramatization of fugue—but I feel like I missed a resolution. I’m not sure if I was expecting the wrong outcome. I suppose I’m incapable of reading for reading’s sake? (My scientist mentors have beaten this out of me, ha ha ha!)