Mental Illness is More Than Dysfunction

DARWINIAN MEDICINE? –

Nov. 14, 2022 – The first name that came to my mind was Sigmund Freud. To me, his most important idea wasn’t the Oedipus complex (which nobody believes in anyway), infant sexuality, or the death drive. Rather, it was the idea, which drove his life’s work, that each form of what he called ‘madness’ has a special function, just like fever or calluses.

Specifically, he saw that its goal is to help us satisfy unconscious wishes – but in a disguised form. According to him, a young woman’s compulsive need to arrange and rearrange the pillows on her bed lets her symbolically fulfil her unconscious wish to sleep with her father, but in such a way that she never becomes aware of its real meaning. Freud was adamant that, often enough, the conditions we label ‘pathologies’ are actually the expression of an unconscious goal. Early psychoanalysts such as Frieda Fromm-Reichmann and Harry Stack Sullivan attempted to apply this perspective to treating schizophrenia.

Don’t get me wrong. Freud was mistaken about a lot of things (including about the pillow-arranging woman who likely had no such unconscious wishes, but was probably using compulsions to try to contain her anxiety). My point is that Freud insisted that mental disorders as diverse as hysteria, compulsive behaviour and delusions were purposeful, not pathological.