The writer Will Self came to talk at a conference I organised in November 2010. Here is a transcript of a conversation we had. I started off by asking him about the Quantity Theory of Insanity, which was one of his first published works.
SG: What was the inspiration for your short story the Quantity Theory of Insanity?
WS: Well, it’s a long time ago…
SG: Eighteen years ago?
WS: The story was written in 1990, more like twenty years ago. All sorts of things came together in that story, but the most significant things were an exposure to the psychiatric ward at the Royal Free hospital in the 1980s. At that time one of the consultants there was the father of somebody I’d been to school with. When I was growing up there was a psychiatrist who lived in the house behind ours and her son had a flamboyant psychotic breakdown when I was in my teens. And I grew up around – this was the Hampstead Garden Surburb – the fringes of mental health professionals of various sorts and kinds and so had an awareness of the wider culture surrounding that.
It struck me as an interesting conceit, that a lot of – but I‘m thinking more of another story in the collection called Ward 9 in which a ward in the hospital – it’s called ‘Health hospital’ in the books, but it’s based on the Royal Free hospital – in which a psychiatric ward in the hospital is full of the children of mental health professionals. That relates to the Quantity of Insanity which in a way is an aggressive synthesis of RD Laing and Milton Freedman.
There’s a classic study of suicide in Sweden, that some people have said seemed to conform to some of the outlines of the Quantity theory of insanity although I hadn’t read it and I didn’t know about it when I wrote the story. The Quantity theory of insanity states that there’s only a given quantity of mental ill health to go around or a given quantity of sanity in any given society or societal group at any given time. So if you palliate one group of mentally ill people inevitably a different mental illness will crop or up or maybe the same one in a different cohort of the population.
My inspiration for that was more Milton Friedman’s work on the classical quantity theory of money, which was something that was very much in the air at that time because monetarism was one of the keystones of the second Thatcher government. So it was a kind of unholy miscegenation between economics and some of the more radical theories about mental health propagated by some of the 1960s anti-psychiatrists. So that was the intellectual and personal background to the story.
SG: I got the feeling reading the story that you’d actually done quite a lot of reading on how psychiatric research is conducted. Is that something you picked up by osmosis?
WS: Yes I picked it up by osmosis. I certainly knew how a scientific trial is conducted and my closest friend at school went on to become a psychiatrist and is now a consultant. He’s helped me with my stuff over the years. And I’m reasonably well read on some of the literature but not exhaustively, because one doesn’t as a layperson.
SG: The interested difference between our viewpoints is that we’re very directed in terms of what we read about psychiatry and we’re moulded by our profession, whereas you as an outsider looking in, but nevertheless an interested one, would have a different viewpoint and be freer to come to your own conclusions
WS: A bit is not the right qualifier there! It’s not only the psychiatric profession that is guilty of a degree of professional closure, not only in terms of what it’s allowed to treat but also in the sense of mental closure. All other professions are engaged in the kind of canalization and a certain blinkered view of what it is they do.
The advantage of being a novelist is that we’re interested in everything, so by definition we shouldn’t be blinkered in that way. And I think that psychiatry is increasingly interesting because of various things that have happened in our society over the twentieth century, the way in which we have come to regard mental ill health and the increasing specialization and pathologization of certain kinds of conduct and that’s what got me interested in it from the get-go.
I studied philosophy in university and I come to psychiatry from Nietzsche rather than from medicine.
SG: It’s interested you should say that because generally speaking a psychiatrist doesn’t read much philosophy. It’s often a very medical role of identifying symptoms, putting them into symptom clusters and then moving onto treatments. Your view of psychiatry is quite different in that it’s very much from first principles.
WS: Yes, I was reading an account written by two doctors about a mental hospital in north London. They make the observation – this is a book written in the 70’s – that in that era a psychiatrist wouldn’t physically examine a patient. My impression is this still often happens. The psychiatrist, although qualified as a medical doctor, has moved into psychiatry to stop laying on hands.
If you say then “I’m interested in first principles”, I’m not just interested in looking at sets of symptoms and getting them to conform or not conform to pathologies. I’m interested in what psychiatry is in the wider sense. What it is that psychiatrists are doing and how they relate to the other healing professions and how they relate to society’s expectation of itself. Society’s own self regard.
WS: He’s still very active.
SG: How was your meeting with him?
WS: it was a long time ago, seventeen years ago. I wrote to him. He had a book out called Our right to drugs and I went and interviewed him for the Times in Syracuse where he was attached to the medical centre there. I’d read the Myth of mental illness before that and others of his books and was interested in him as a sort of Hungarian/Viennese/ American version of Ronnie Laing. With the Myth of Mental illness perhaps standing in some relation to The Divided Self.
I wrote in my latest book (Walking to Hollywood) about meeting Szasz. If you’re interested in my thinking about psychiatry over the years a lot that it is worked into this book. It’s a fictionalized memoir so some of it’s fictionalized and some of it is not. The meeting with Szasz is a mixture of fiction and fact.
SG: Does he appear in that book as a character?
WS: He does. I’ve always had a character Zac Busner. He appeared initially in the Quantity Theory and he’s in a lot of my books. He’s a psychiatrist and he is the most consistent fictional character in my work overall. He’s like a sort of practical philosopher he has a shape shifting quality, I suppose to express my view of the psychiatric profession as being our equivalent in secular society of a priesthood. He has a shape shifting and hieratic character to stand for these different things. Sometimes he seems more based on the neurologist Oliver Sacks and sometimes he appears more like Ronnie Laing.
SG: Why do you equate Psychiatrists with priests? A lot of people equate GPs with vicars, why do you see psychiatrists as more in this vein?
WS: I think because in a sense Freudianism has been so successful in the West. It really has, what’s interesting is that even psychiatrists who feel themselves to come from a hard scientific background, and feel themselves to have no truck with the ‘talking cures’, nonetheless are unable to evade Freudianism in all sorts of ways and are unable to evade the presumption that there is a sliding scale between relatively minor neurotic symptoms and major psychoses. And that means that psychiatrists stand – whether they acknowledge it themselves and whether people collectively acknowledge it- at the threshold between happiness and sadness and between sanity and madness, between the particular and quotidian and the transcendent. This is a priestly role. You might say that a GP occupies a ‘vicar function’ and but I’m thinking more of the old religion, in terms of priests who manage the transition from the phenomenal to the numinal.
SG: Almost as if we stand at the gateway, saying “you’re normal, but you’re supernatural”. And we hold the key to that.
WS: Yes, whilst neurosis is in some ways rejected and stigmatized, in many other ways it’s embraced. We have a culture of ‘compliant neurosis’. These two readings which are sometimes directly contrary to one another are quite present in our culture. In some ways psychosis is revered. It’s our version of ecstasy. There are all forms of experience that either are genuinely psychotic or verge on the psychosis. They are revealing.
SG: One last question, if you had one piece of advice to psychiatrists what would this be?
WS: I’m very concerned about the prescription of SSRIs to everyone in our society. It’s just the latest, pill fad. They occupy the same role as baribituates did in the 1950s or benzodiazepines did in the 1960’s and 1970’s or tricyclics did in the 1980s and into the 1990s. But I see so many people who are suffering from long-term SSRI use for all sorts of reasons. Because of the very fact that they work on what used to be considered ‘exogenous depression’ – in other words they work to alleviate the subjective experience of unhappiness which should be felt – that they represent a very dangerous evolution in neuro-pharmacology.
I don’t actually think that psychiatrists are usually responsible for writing too many prescriptions for SSRIs, I think that GPs are more to blame. If I were a member of the psychiatric profession I would make it an imperative to open a conversation in society about the use of these drugs.