Richard Noll

The fanfare surrounding the publication of DSM-5 presents the manual as psychiatry's bible, a diagnostic decree that clinicians rely on and abide by. Such reception highlights the deficiency of public understanding of mental disorders and their treatment. Last week we asked Liah Greenfeld what she'd most want to convey to the public to help correct that misunderstanding, and below, Richard Noll, author of American Madness: The Rise and Fall of Dementia Praecox, takes on the same question. -----"The public here believe in drugs and consider prescription as the aim and end of medical skill," complained Swiss-émigré neurologist Adolf Meyer in August 1894, "whereas in Germany and in many other places, the people regard the drugs as quite as great an affliction as the disease itself." The same is true today. Indeed, since the publication of DSM-III in 1980, even more so.

This is a Japanese translation of a JSPS Fellowship address delivered in June 2018 at the University of Shiga Prefecture in Hikone, Japan.

It was published in Kikan Minzokugaku (Ethnographic Quarterly), a publication of the National Museum of Ethnology (MINPAKU) in Osaka, Japan in the Winter 2019 (No. 167) issue, pp. 86-95.

Individual humans have always reported experiences of “real” encounters with supernatural agents or travel to other worlds. These beings and other worlds are invisible to others. However, such claims based on individual subjective experience are often regarded as evidence that such invisible agents and worlds really do exist. Relationships with invisible agents and worlds can be established and maintained through learning how to repeat such experiences. Using the past 35 years of research in the Cognitive Science of Religion as our foundation, a cross-cultural practice known as “mental imagery cultivation” (Noll) or “inner sense cultivation” (Luhrmann) will be explored as a technology for maintaining “reflective beliefs” derived from culture that reinforce the “hyperreality” of such invisible agents and worlds. Examples will be presented from shamanism, Tibetan Buddhism, Western European ritual magic, C.G. Jung’s analytical psychology, “renewalist” Protestant Christians in the United States (who make up 23% of the US population), and recently declassified U.S. government documents about its secret “remote viewing” program (1970s to 1990s) and similar secret programs in China.

Some limitations of ‘category work’ in the history of psychiatry are illustrated via the example of attempts within US alienism and psychiatry since 1889 to identify psychosis and its prodromes. A slowly evolving acceptance of the need for specifiable biological disease concepts, distinct diagnostic categories and defined boundaries of the ‘before and after’ of psychosis among some elite physicians challenged widespread vernacular methods of diagnosis expressed as intuition, feelings or scent as well as local practices of creating novel placeholder terms ‘as needed’ or using question marks to express liminality or confusion. When ‘error of diagnosis’ emerged as a concern circa 1909, the professional transformation of this ‘scientific self of subjectivity’ of the psychiatrist into a ‘scientific self of objectivity’ eventually resulted in the turn to numerical judgments based on rating scales for psychotic symptoms. However, rating scales do not ‘count’ anything at all and exist as instruments of liminality between subjective clinical opinion and the affection of objectivity that quantification symbolizes.

Some limitations of “category work” in the history of psychiatry are illustrated via the example of attempts within US alienism and psychiatry after 1889 to identify psychosis and its prodromes. A slowly evolving acceptance of the need for specifiable biological disease concepts, distinct diagnostic categories and defined boundaries of the “before and after” of psychosis among some elite physicians challenged widespread vernacular methods of diagnosis expressed as intuition, feelings or scent as well as local practices of creating novel placeholder terms “as needed” or using question marks to express liminality or confusion. When “error of diagnosis” emerged as a concern circa 1909, the professional transformation of this “scientific self of subjectivity” of the psychiatrist into a “scientific self of objectivity” eventually resulted in the turn to quantifiable judgments based on rating scales for psychotic symptoms. However, rating scales do not “count” anything at all and exist as instruments of liminality between subjective clinical opinion and the affection of objectivity that quantification symbolizes.

Keywords

Schizophrenia, dementia praecox, psychosis prodromes, praecox feeling, psychiatric rating scales.

ABSTRACT:
Psychiatry is one of the oldest specialty professions in medicine, arising after 1800 in small communities of European, British, and American physicians who were physically, socially, and professionally isolated in asylums for the care and management of persons suffering from severe disturbances of thought, emotion, and behavior (“insanity”). In the twentieth century psychiatry turned its attention to milder psychiatric conditions (e.g.,“neurosis” or “neurasthenia”) in the general population, changing its mission and treatment methods. Competing views of mental disorder as biologically specifiable categories of disease (promoted by Emil Kraepelin), as dimensional psychosocial “reactions” (Adolf Meyer), or as mental mechanisms of personality (Sigmund Freud) have not been resolved by biomedical, psychological, or statistical methods.

This paper provides background information about the shamanism of the Tungus-speaking peoples in northeast China, particularly the Oroqen. It describes in detail the life, initiatory illnesses, training and healing practices of the last living Oroqen shaman who practiced this craft prior to the communist Chinese abolishment of such "superstitions" in the region just south of the Amur River in June or July 1952. Over three anguishing nights, hundreds of Oroqen participated in dusk to dawn rituals and begged the spirits to go away. Public, overt shamanistic healing rituals ended at that point.

[For a pdf of the complete book, see Researchgate.net] Each book is a reflection of its historical context. This book was an attempt to begin a discourse of "history from below" in Jung studies. It contains the first extensive archival material from the analysis diaries and letters of patients of C.G. Jung or his close associates during the critical post-Freud 1913 to 1930 period. Previously unpublished material from the diary of Constance Long (who inscribes letters from Jung in her diary, including a rather Gnostic one from Jung to her friend Joan Corrie), Fanny Bowditch Katz, Edith Rockfeller McCormick (daughter of John D. Rockefeller) and the McCormick family of Chicago, and Harvard psychologist Henry Murray and Christiana Morgan.

The author employs an autobiographical frame to address the concurrent rise of the satanic ritual abuse moral panic and claims of recovered memories of UFO abductions in the 1980s and 1990s. He highlights the influence of privileging subjective data over objective data as a source of scientific error that can lead to clinical, cultural and social movements that can potentially have adverse effects.

Conference paper for "Psychopathological Fringes: Historical and Social Science Perspectives on Category work in Psychiatry," Institute fur Geschichte der Medizin un Ethik in der Medizin, Charite, Universitatsmedizin Berlin, 13 February 2015.

ABSTRACT
The current fascination with “category work” and the negotiation, objectification and policing of the boundaries of diagnostic categories may be a reflection of presentist biases of historians of psychiatry that occlude subtle nuances of the medical cognition and practices of  past actors. Historians fawn over fringes: liminal phase changes such as the moving targets of thresholds, of dimensions that coagulate into categories and then dissolve again into novel continua, of relentless streams of hyper-reflexive nomenclature that bubble up and bury the bodies of patients.
The oscillating dialectic of figure/ground reversals provoked when contemplating the relationship of category to fringe is a mesmerizing one. Perhaps too mesmerizing. One difficulty for historians attempting to understand this relationship may stem from the implicit assumption that physicians of the past engaged in an explicit cognitive exercise at the point of diagnosis. Instead the practice may have been more akin to recognizing a melody or a scent. Another difficulty for historians may be the presentist assumption that physicians of the past shared our concern with “error.” Evidence suggests in fact that a century ago, at least in the United States, most did not. This was especially true for those devoted to the treatment of nervous and mental diseases.  If diagnostic error is not a concern, neither are sharply defined categories, or policed boundaries, or prodromes or fringes. It is left to historians to chase these phantoms.
Of all the modern medical specialties, psychiatry had (and continues to have) the greatest difficulty in not only accepting, but negotiating the conceptual boundaries of objective “error” and “medical certainty.” Using chronic psychosis and its prodromes as a thread, this paper explores the efforts of early 20th century US alienists and neurologists to adopt a moral economy of science based on the negation of subjectivity – and why this failed.

When Kraepelin's dementia praecox (1896) and Bleuler's schizophrenia (1908) were introduced as discrete natural disease entities, accurate differential diagnosis became a necessity for both clinical and research purposes. Objectivity, the containment of subjectivity, became a core value of the new scientific self of the psychiatrist. Focusing primarily on psychiatrists in the US in the early 20 th century, I will trace the evolution from a " scientific self of subjectivity " as a basis for diagnosing schizophrenia that relied on psychiatrists' " feelings " or bodily sensations provoked by a patient, to the development of " objective " symptom rating scales in the late 1920s and, in 1933, their linkage with factor analysis as a statistical tool for identifying invisible (latent) dimensions of structure behind the chaos of psychosis. Despite their hypothetical nature, researchers have tended to reify factors and occasionally invoke them as causative agents. I will argue that rating scales, which do not " count " anything at all and reside on the threshold of objectivity, and factor analysis, an exploratory but not a confirmatory statistical method, have been central to the dissolution of the schizophrenia concept. Reified factors of psychosis have replaced schizophrenia as objects in psychiatry. But a never-ending cycle of " deconstructing psychosis " into further hypothetical constructs that " exist " in a realm of Platonic pretensions outside the direct experience of the physician challenges claims of enhanced objectivity in diagnosis.

What is the Paranormal?
“The paranormal” is a comparative category that serves as a dumping ground for a wide variety of beliefs, experiences and claims that fall outside the normative boundaries of our culture’s notions of scientific reasoning and conventional religious doctrines. By default, both scientific and religious elites have left it to experimental psychology and psychiatry to try to make sense of these domains of human experience, and more than a century of such research has much to tell us about how to critically evaluate this material. However, psychology is not enough to grasp all of the dimensions of the paranormal. Therefore, as we develop our “tool kit” of critical thinking skills we will need to also approach this material from perspectives in philosophy, sociology, comparative religions, anthropology, history and investigative journalism. This course, then, will be multidisciplinary in its approach, with insights from psychological research providing the Ariadne’s thread to help us find our way through and out of this labyrinth. After all, we don’t really want to meet the Minotaur (or Mothman), now do we?