What Is X?

What Is Mental Health? | Danielle Carr

October 21, 2021 Justin E.H. Smith | The Point Magazine, with guest Danielle Carr Season 1 Episode 4
What Is Mental Health? | Danielle Carr
What Is X?
More Info
What Is X?
What Is Mental Health? | Danielle Carr
Oct 21, 2021 Season 1 Episode 4
Justin E.H. Smith | The Point Magazine, with guest Danielle Carr
Since the mid-twentieth century, there has been an ongoing quarrel over the definition of mental health: Are disorders like depression, OCD, or schizophrenia biologically determined or are they socially constructed?

In this episode of “What Is X?,” Justin E. H. Smith talks to Danielle Carr about the history of psychiatry and the politics of madness, from 1930s asylums and the DSM to the antipsychiatry movement and Elon Musk’s newest hobby: neural implants. They discuss the big business of mental health in our therapeutic society—evident in the popularity of mental wellness apps, the proliferation of SSRIs, and Silicon Valley's fascination with brain chemistry. But could the extent and prevalence of everyday unhappiness point to problems that medicine and technology can't solve? Do they call for changing the social conditions that contribute to these feelings of loneliness and immiseration? “Mental health,” Carr argues, “is a terrain of struggle over the question of what human flourishing is and how to achieve it.” Does Justin agree?

Show Notes Transcript
Since the mid-twentieth century, there has been an ongoing quarrel over the definition of mental health: Are disorders like depression, OCD, or schizophrenia biologically determined or are they socially constructed?

In this episode of “What Is X?,” Justin E. H. Smith talks to Danielle Carr about the history of psychiatry and the politics of madness, from 1930s asylums and the DSM to the antipsychiatry movement and Elon Musk’s newest hobby: neural implants. They discuss the big business of mental health in our therapeutic society—evident in the popularity of mental wellness apps, the proliferation of SSRIs, and Silicon Valley's fascination with brain chemistry. But could the extent and prevalence of everyday unhappiness point to problems that medicine and technology can't solve? Do they call for changing the social conditions that contribute to these feelings of loneliness and immiseration? “Mental health,” Carr argues, “is a terrain of struggle over the question of what human flourishing is and how to achieve it.” Does Justin agree?

Justin E.H. Smith  [00:04]
Hello, and welcome to a new episode of “What Is X?” I’m your regular host, Justin E.H. Smith. This is a podcast of The Point magazine. Regular listeners will know the rules: On each episode I have a guest who's eminent in a given field and we discussed the central question of that field, a question of the form “What is X?”—in a manner vaguely reminiscent of the Socratic dialogues, in which Socrates sought with an interlocutor to arrive at a shared definition of a particularly difficult concept. Sometimes Socrates and his mates arrived at agreement. Sometimes they arrived at disagreement, and sometimes they ended up in aporia, which is Greek for something like “dead end.” So each episode we try to see which one of those is most appropriate for the concept at hand. Today I am talking with Danielle Carr, who is working on a Ph.D. dissertation on the history and politics of neural implants. Danielle and I are going to be pursuing a shared definition of mental health. The question today is: What is mental health? So welcome, Danielle.

Danielle Carr  [01:49]
Thanks so much. It's wonderful to be here.

Justin E.H. Smith  [01:51]
You know, as I've mentioned to you earlier, I know your work principally from a few very lucid pieces I read of yours in the media over the past few years, an article in Jacobin magazine in 2018, on mental health and a more recent 2020 article in the Baffler on neural implants and, in particular on Elon Musk's adventure in, I believe, the Neuralink project, in which not long ago, he paraded some pigs out on a stage claiming that he had successfully implanted chips in their brains that control their behavior and their emotions. And you provide a pretty rigorous, and to my mind knockdown critique of some of the pretenses of Elon Musk's spectacle, and also of the history behind what he was doing. And I think we're going to have plenty of occasion today to unfold this critique in the course of pursuing a common understanding of mental health. But first, maybe before we talk about that article, I wanted to see if you could summarize for us what the link between these two topics is—that is, the link between the 2018 piece on mental health in general, on the historical and political conditioning of our idea of what mental health is, on the one hand, and on the other hand, the history of behavior and emotion modifying neural implants.

Danielle Carr  [03:49]
Definitely. Well, first of all, thanks so much for having me on. It's a pleasure to be here. So I guess this is a somewhat good way into precisely the question that's at stake here. So just to explain a little bit about my research and like, you know, why you should pay any attention to what I have to say on this topic. I have done ethnographic and historical work on the development of intra-cerebral brain implants, as they've been developed since the 1930s. And the development of neural implants, from the earliest twentieth century to the present. That story has everything to do with not only the emergence of the data economy, by which everything that we do, every text we send, every movement we make is rendered into data that can be capitalized upon, but also with the establishment and enshrinement of certain understandings of what adjustment is, what normal is. And so I guess I'll just talk a little bit about the the 2018 piece, which was based on historical work that I did at the Rockefeller Foundation archives, the Rockefeller Foundation was an incredibly important institution in creating the discourse of mental health. And so prior to the turn of the twentieth century, there were of course, asylums for people who were severely mentally ill, or deranged. But there was not really active scientific treatment for these people. And the Rockefeller Foundation inaugurated the discipline of psychiatry as a medical profession. And what's interesting is that the enormous amounts of money that were poured into the creation of this discipline were first of all, directly culled from, right, Standard Oil's, like a monopoly on—so there's a very direct correlation between capital accumulation and establishment of this discipline, and so on. Surprisingly, there were a lot of assumptions that were built into this discipline that reflected particular political priorities. And so the discipline of psychiatry was essentially crafted with a technocratic vision in mind, which is the attunement of the individual to a certain norm, through the idea of adjustment. So psychological health is adjustment to a harmonious social goal and finding one's place within that. And so what I tried to do in the 2018 piece was to problematize a little bit the terms of the discourse, that it has been handed to us, which is that mental health is completely biological and to try to show its ideological conflicts. And that obviously carries through to the present moment, in which we find ourselves, where Elon Musk, who is you know, best understood as being totally in lockstep with the data monopolists that rule the economy right now, is saying that he's got a neural implant that can cure everything from blindness to depression. And obviously, these neural implants are hugely data productive. And the idea that that mental illness is a biological reality, in the sort of unreconstructed way, does have, obviously, a lot of ideological roots. So, that's what I'm trying to get at.

Justin E.H. Smith  [07:39]
So I think if I could try to summarize your point about the Elon Musk, in a few words, and you'll tell me if I have this wrong, it's that he is operating under the pretense that the implant is going to deliver something to our brain. But the real purpose of this project is what the brain is going to deliver to the implant and then be harvested for economic purposes. Is that right?

Danielle Carr  [08:15]
I mean, that's certainly—that's, like, one way of describing it. Now, having done a lot of ethnographic work with neural implant development, you know, I think it's difficult—like, the science is very much out on whether or not it works for certain applications. So Deep Brain Stimulation is the most common form of neural implant. And that works pretty well for movement disorders, because it's very easy to localize where a tremor is coming from, and it's like the gold—you know, DBS, Deep Brain Stimulation is the gold-standard treatment for movement disorders. But when it comes to these more socially constructed concepts, like depression, or anxiety, or sadness, or any of those things, obviously, the idea that there's a place we can zap in the brain is pretty bonkers. And like, the science is just very much out. Like, there are there are a huge number of types of depression, right? The DSM, the Diagnostic and Statistical Manual, which really gained hegemony in the field in 1980 with its with its third publication, is essentially a group's diagnosis together on the basis of common symptoms, but there's no guarantee that common symptoms indicate a shared pathophysiology. So, to cite one instance, you know, someone who's experiencing grief looks a lot like someone who is depressed, right? And so it's—I think it's a question of what do we mean by these technologies working, right? There's working in the sense of doing what what Elon Musk, et al., say they're going to do, but there's also like, What's their real economic function? Right? And I do think in that sense, working might be harvesting enormous amounts of data.

Justin E.H. Smith  [10:11]
Now, you've kind of—not exactly—kept your cards close to your chest here. You've said what you think mental health is, though you did so en passant, I think, as if we could, as if we could take it for granted when you said, disorders of the sort we find in the DSM are socially constructed. And I wanted to pause there for at least a moment to allow you to spell out what exactly you mean by that. And whether that is something you would describe as an antirealist commitment, or whether there's a way of holding on to real ontological commitment to such diagnoses as depression, while also at the same time recognizing their historical embeddedness and the role of ideology in producing them.

Danielle Carr  [11:18]
Yeah, I mean, I think that is in some ways the question, so I'm glad we're getting to it. And I think that one way into this—to lay my cards further on the table—is to is to say, okay, like, what is it that we mean by ideology? Right? And I was recently reading Althusser's book about ideology and science, and he provides a really wonderful definition. I hope you don't mind if I read. And he says, "An ideological proposition is one that well, it is a symptom of the reality other than that of which it speaks is a false proposition to the extent that it concerns the object of which it speaks." So in much the same way that, for instance, the psychoanalytic symptom is an index of some truth—even if the hysteric, what the hysteric is telling you is not true, the hysteric is telling you something that is true. That's how Althusser says ideology operates. And I think we're in a moment, especially with the pandemic and climate change, where what was once a rather robust critique of ideology and science that was present on the left from you know, it's particularly in the 1970s—we've dialed it back a little bit, right? Because, because suddenly, like, the science seems to be on our side, or at least there's reading of the science that is on our side. And I think that I, I just, I urge caution in in abandoning the ideological critique of science, because we commit precisely the same naturalistic fallacy as, you know, our enemies on the right who say that, of course, like, the nuclear family is biologically oriented or that race correlates with violence or something like that, when we when we think, Oh, like, the science is on our side. Well, the science is not necessarily on our side, right? There are multiple forms of interest operating in science. So like, for instance, Philip Mirowski, makes this point, which is that, you know, the science is not open and shut on our side about climate change, there are a lot of technical solutions to climate change that don't involve redistribution and deprivatization that will be hugely lucrative for capital. And so that's where I, that's where I come from, on the question of ideology. And so when we talk about, "Is mental illness real or not?”, I think one of the first mistakes of—and you know, this is like, you can see it play out historically and be like, yes, indeed, that did not work—was for instance, the antipsychiatry movement.

Justin E.H. Smith  [13:53]
Right, I was going to ask you about that.

Danielle Carr  [13:55]
Right. And the critique of psychiatry that kind of became—a certain strain of it that became prevalent in the in the New Left movement against psychiatry, was not just a critique of the institutions in which medical treatment was being presented as being totalitarian or misogynistic or racist, all of which were true. But to say that there's no such thing as mental illness. In fact, the politics of madness is like, it's good, actually. Or it's completely discursively conducted. And that's not the right answer, either, right. There are—there is such a thing as the body and there there are definitely extreme, you know, cases of psychosis or or extreme cases of maladaptive affect, that are biologically mediated. What I'm talking about is, first of all, the medicalization of things—of everyday life, and which was a key part of the of establishing psychiatry in the early twentieth century. Adolf Meyer and the early psychiatrists were very explicit that what they wanted to do was to apply psychiatry not only to cases of like florid psychosis but for the problems of everyday life, for everyday life and normal people to be psychiatry's ambit. This had everything to do with selling the discipline to funders, like the Rockefeller Foundation, right? So there's that, and there's also the way that causality is mediated through these diagnostic categories, which have the effect of individualizing affect and and stripping affect of its context. And I think, like, we're in a moment where there's a—the causes of widespread immiseration have, like, never being more obvious. And so I think we're in a very good moment to make this critique. But we're also in a moment where like widespread immiseration is being hugely capitalized upon. Like, the mental health apps, that market is currently valued at $920.9 million in 2020. Right? So I think we're at a moment where we need to really take back the terrain of enforcing an ideological critique.

Justin E.H. Smith  [16:17]
It's highly paradoxical, then, isn't it, that—or not paradoxical, but maybe absurd, that it's people who are directly connected to the production of these conditions of immiseration, who are also setting themselves up as the ones offering the solution. Is that is that part of your critique?

Danielle Carr  [16:44]
Well, I mean, I think that it's like: What could be more expected? I mean, you know, this has everything to do with what we mean when we talk about, about hegemony, right, which is the convincing society through inaugurating civil institutions, like universities, like medical institutions, that it is within everyone's interest to go along with certain areas that, in fact, serve only one small group of people?

Justin E.H. Smith  [17:15]
Right, right. So it shouldn't be surprising, in fact. Tell me a little bit more about antipsychiatry as a movement, because I think there's a kind of demotic common sense that I hear a lot, particularly from students who haven't thought that much about the question of psychiatry, might not know what antipsychiatry is, but are able to produce such insights. And I'm sure you've heard this and thought about—as that in other cultures, schizophrenics are shamans—is that kind of explanation of legacy of the antipsychiatry movement? Does it contain, in spite of its banality, a certain kind of value as an explanation, that there are cultural settings in which mental illness might not be experienced as mental illness?

Danielle Carr  [18:11]
So this is kind of—there are two strains, two general movements of thought that we're describing here. One—the sort of schizophrenics are shamans one—I think  would fall more under the line of what's often called "psychological anthropology," which really started having its heyday in the American academy in the 1960s. And, you know, that has a tradition of looking at how, how not only how other cultures treat or categorize mental illness, but also kind of problematizes by default, you know, American diagnostic systems. That was not so—that was not so much a part of the antipsychiatry project, which was a very historically situated project that really congealed in the late 1960s. I think it's a fascinating moment historically, and discursively, because it united such strange bedfellows. Right? You had kind of like, May '68ers on the same team as American libertarians in this peculiar kind of, like, Californian ideology moment, right? And so the antipsychiatry movement, I think, was defined by an anti-institutionalism. And there had been movements throughout the twentieth century to better conditions in psychiatric treatment. Perhaps the most notable of which, which plays into what we were discussing earlier, was led by a man named Clifford Beers you know, very bright guy who suffered a nervous breakdown in, I want to say like 1915, and you know finds himself—upper middle-class guy—finds himself in just, like, these horrible conditions in an asylum. And once he gets out, he writes this memoir called "A Mind that Found Itself" and establishes the National Committee for Mental Hygiene. Now, the National Committee for Mental Hygiene was specifically oriented to bettering the conditions of people who found themselves in these asylum. But the Rockefeller Foundation essentially funds and in so doing coopts this movement and makes it about applying psychiatry to the problems of everyday life. But throughout the twentieth century, there have been multiple movements to better the conditions of people in these institutions. And the antipsychiatry movement was a particular iteration of that that was also connected to the sort of like post—the critique of Stalinism, the critique of Nazism and the critique of total institutions that was going on throughout the 1950s—to say psychiatry is a part of a system of societal oppression that institutionalizes certain forms of normalization. And so there were a lot of projects that that were aiming to just totally abolish psychiatric institutions. And, you know, it's interesting, because, like, one of the reasons that the antipsychiatry movement died out was that the American right could not have been more thrilled to defund public health.

Justin E.H. Smith  [21:53]
Yeah, I think I recall hearing probably something probably apocryphal about Reagan, when he was governor of California, having a staffer who had recently read Foucault on the birth of the clinic and "Madness and Civilization," and was happy to advise the governor about the discursive production of mental illness as a pretext for turning mentally ill people out on the street. I mean, this is again, probably apocryphal, but whether or not it's real, it gives us a kind of exemplum of the strange convergence between this very sixties spirited human liberation philosophy on the one hand, and the birth of austerity in the service of the political right on the other hand.

Danielle Carr  [22:48]
Right, and it's like, this is like, could you ask for a better example of the "it's all constructed" critique going wrong than this? I think it's like—it feels a lot like you know, like Latour—Bruno Latour—being like, okay, but not about climate science, like dialing it, dialing the social construction party back a little bit. But yeah, I mean, this was used as a pretext, basically, to empty asylums in the name of integrating care more into communities. And unfortunately, like they did the first thing and then never quite got around to doing the second. It's interesting in many cases, these former asylums were directly repurposed into prisons, right?

Justin E.H. Smith  [23:36]
Another kind of total institution. You are interested—well, first of all, a brief comment about Bruno Latour, and this might be getting us off topic, but you seem particularly interested in the peculiar polarity reversal that seems to be at work when we look at ideas about social construction in general and mental illness is a good example. And since—what is it—his 2004 article in Critical Inquiry Latour has indeed been worried about the responsibility critique, as has borne for bringing about a general attitude that, in a sense, we are capable of generating and maintaining our own truths as we wish, and doing this it was discovered is something that is possible for people of any political stripe. Right? And so Latour kind of freaked out about that. Lorraine Daston as well has confessed to that there is at least some responsibility on quote unquote, "our side" for the production of such such monstrosities as the Creation Science Museum of Kentucky and things like that. So is this something you're worried about? Is this difficult terrain to navigate? What lessons do you have some what, you know, some years now down the line from that moment of awakening that I see as happening in the early 2000s, whereas the 1990s I recall, as being a time of just full bore, unworried theorizing?

Danielle Carr  [25:32]
Yeah, it's like, in so many ways, it's like I was born in 1990. It's like, the '90s, like, seemed like, you know, what a time to have been alive, right? Because, like, you have the kind of End of History, like, consensus in place, and it's like, well, we can like galaxy-brain ourselves pretty scot free, right? Because like, nobody's listening to us, right? Like, we're in English departments so, like, who cares?

Justin E.H. Smith  [26:00]
Yeah. Right.

Danielle Carr  [26:00]
And so, yeah, I do think that it really exemplifies the—both the opportunity and the danger of the moment that we're in right now. And I think one way to get into this is: there's been a lot of talk about Luddism, and is a left politics of technology or science just Luddism? Like: Smash the 5G, we don't want data collection, we make some of this science just, indeed, stop happening. And it's a question I think about a lot because I think that that plays into some of the same impulses that were animating, for instance, the anticipatory movement, right? And I think that what we need to move into is to understand that science is not something that has an inherent politics that are going to be inevitably transacted through it—right? There multiple political valences of science and technology projects. And so, obviously, care for people who are suffering, mentally is something that we want to be doing, right? And the question is: How? So, you know, for instance, like, when we think about Medicare for All, which is one of the points that I—one of my big axes that I'm always grinding is that Medicare for All, if successfully implemented, is not simply going to be the system of American health care remaining intact, structurally, and then the state picks up the tab, right? Because the entire—capitalism has been baked—in profit making is baked into what we even conceive of as a medical problem in the first place. Right? And so and so Medicare for All, sure, but then also like, you know, investments in social housing, investments in green spaces, and so on. And de-—taking some of these things that have been folded into health care out of that domain is going to be a project. The left is going to have to deal with it, I hope, if we start winning.

Justin E.H. Smith  [28:08]
Yeah. That's so interesting. But at the same time, if I can challenge you a little bit, that sounds to me, like an opening for this tendency towards hypermedicalization of all of human social reality that I think you're also a bit worried about, right? Like I see, for example, the physician's recommendation that you wear your seatbelt. And of course, if you need to have your skull put back together because you've been in a car accident with no seatbelt on, that's a medical matter. And at the same time, it doesn't quite seem to me that putting on your seatbelt is a medical matter, right. And similarly, I mean, I'm going to confess to you that the period I know best is prior to 1800. And I'm looking at a time in which the idea of what medicine is is undergoing radical change. But still, for the most part, it means things like, you know, getting leeches, you know, bloodletting, maybe even getting a haircut. And so, all of this makes me think that the—I mean, this is probably the case for any science or even for any human techne, so to speak, the bounds of the discipline of medicine are extreme fluid, and kind of always up for grabs, but do you really want to think about a future, more just medicine that extends even further into social reality in general to kind of maximize human thriving? Or do you want it to be somewhat closer to the bloodletting side of the continuum? You see the question?

Danielle Carr  [30:22]
Yeah, I do see the question. It's funny because I would say that my, you know, my line is that we are going to have to demedicalize enormous parts of human flourishing, right, which means—and to be specific about that, what I mean is by medicalization, is the framing, not just discursively but as that is enacted through institutions and infrastructures and bureaucracies, right, of certain problems or entities as being the purview of medical personnel. And one of the reasons why this is important, other than the fact that it would work better, right, it worked better for people to have social housing where they're not having nervous breakdowns constantly that's bringing them to the ER, that's like, you know, causing enormous cost to the health-care system. Like, other than that, it one of the problems with the medicalization of everything is that overwhelmingly the psychiatric profession represents certain class interests because it is drawn from certain classes. Right? Since the Flexner Report, which was the 1910 restructuring of American medicine, that process of installing certain certifications, where you would have to be university-trained—and by the way, we don't accept universities with, like, overwhelmingly Black student populations, right? Medicine has been created as an overwhelmingly white, like, wealthy, at that time, predominantly male institution. And, you know, I don't think we need to get into, like, the question of the different ways that identity categories are working now. But, you know, like, I don't think necessarily that having more, like, wealthy white women in psychiatry is necessarily like the answer to the problem, right? And so putting these social problems in the hands of, essentially, technocrats from a certain class is I think, like not, that's not the answer.

Justin E.H. Smith  [32:27]
Right. So it's not further reach or overreach or hyperextension of the notion of the medical that you envision in the transformation of the health-care system but rather kind of seeing to it that certain things don't enter within the scope of medical experts at all.

Danielle Carr  [32:53]

Justin E.H. Smith  [32:53]
I may be getting us into a bit of hot water. But if we can go back to the DSM, and then I want to talk more about neural implants after that—the question of the ideological and historical embeddedness of diagnostic terms: How do we navigate the current reality in which increasingly people seem to be invoking diagnostic terms as part of their own conception of their own liberatory project, right? For example, PTSD. There's a huge amplification of appeals to this diagnosis, perhaps to the self-diagnosis as part of an argument about justice. Right? So, what do we do about that kind of use of what might be—I don't know, to someone like you who is attuned to the historical and ideological shaping of the way we talk about mental illness and about psychiatric diagnosis—what do we do about this usage of that kind of language?

Danielle Carr  [34:27]
It's such a good question, and it's something that I spend a lot of time thinking about. And I do think that you're right to point to the sort of overlap of what we might call a moral economy of trauma. That's a term from anthropologists Didier Fassin.

Justin E.H. Smith  [34:45]
Oh, yeah. Right.

Danielle Carr  [34:46]
And he wrote this wonderful book called Empire of Trauma. And the medicalized disease entity or pathology entity called "trauma." And I mean, this is sort of a maybe interesting institutional history point, but really the efflorescence of trauma studies and the generalization of the trauma concept came post-9/11 with the enormous increase in funding for projects studying PTSD, and as that kind of scientific cottage industry began to grow and and institutionalize itself, something called "complex PTSD" began to be studied. Of course, people have been looking at these questions of trauma for some time, like most notably Bessel Van der Kolk, who wrote a book that is, I think, currently at the top of the Times best-seller list called The Body Keeps the Score. But there's a generalization of the trauma concept to mean, kind of, just the plasticity of subjectivity in relation to chronic stress, aka what most of our lives look like right now, but particularly people who are poor and nonwhite and so on. And so we're really talking about two things here. One is the plasticity of the body that in response to acute stress, like getting fired at in Afghanistan, or chronic stress, like living as a single mother in the projects, this does introduce biochemical changes, like for instance, elevated cortisol, this produces changes in neural circuitry—like, for instance, hyper-coherence between the frontal lobe and the amygdala, which is a kind of dual, almond-shaped structure deep in the brain that activates around emotions like fear. And it produces things like hypersensitivity, and so on, or hyper-vigilance. And that's all real, right? And these are real things that are happening to people's real bodies. What I think we need to take care with is saying that just because it's happening to our bodies, that the solution is to go to psychiatrists or venture capitalists who are funding, like, mental-health apps for VR, right? Like, I was talking to a friend of mine who works in the MIT Media Lab just yesterday about a training that has been developed at UCL for people who are sexual harassers. And you put on a VR headset, and you are in the position of a woman getting sexually harassed by someone who was, like, a VR creation of you. Right? And so, I think that there's a danger in saying, well, we agree on the problem, which is that we are all in some sense, traumatized, and saying, Well, okay, I think I think that these particular people have the solution for it. That's one thing. But the other thing is, I think, the individualization of the trauma language, and I think we need to kind of pry open a way of talking about the collective conditions of things really sucking and life being increasingly hard that don't resort to an individualization of trauma where we need to just go talk to our shrink or take our medicines. And I think that—so I think that there is an exciting, like, left valence to the sort of emerging trauma language. But I think, you know—and we all know what we're talking about here, when people are mobilizing trauma for what are essentially individualistic ends, like, to score points in an argument or something like that—like, "Oh, I'm traumatized." That's precisely the sort of like, you know, maybe entrepreneurial use of the word or concept of trauma.

Justin E.H. Smith  [38:54]
Do you want to say more about this latent, left potential in the use of trauma language?

Danielle Carr  [39:04]
Yeah, so, I mean, I think that when we talk about trauma, one way to think about it as as the way that social conditions register in the body. And that's the basis of positivity, right? That's a shared—like, we all know what it feels like to be depressed from being in quarantine because the state refused to pay people to stay home. Right? And so I think that there is—there's a way of thinking about embodiment and the plasticity of the body in relation to shared environments that is the basis for collectivity.

Justin E.H. Smith  [39:46]
I gave the example of PTSD though I could have perhaps used other examples that are not connected to trauma—of, again, mobilizing of data and diagnostic terms to account for our condition and our bad fit with institutions or with the economy as a way of attempting to articulate what one perceives as an injustice. But my conviction or my suspicion is that this is less than ideal language for doing that. Right? Every time someone—again to get away from trauma—every time someone says that they can't take a test because they have ADHD or they need these or those special arrangements, this is perpetuating—is it not?—the account of things on which there's something wrong with that person's brain. Right? They came out wrong. And what I always want to do is reassure them that there's nothing wrong with their brain and that there's something liberating in discovering that. Right? Does that make sense?

Danielle Carr  [41:12]
Yeah, I mean, I think it's definitely—part of what we're talking about here is adjustment and normalization to unlivable conditions, right? So, for instance, the United States military is a huge funder of work on PTSD now, and partly that PTSD is a kind of cover story for putting enormous amounts of federal funds into the development of data, data-extracted technologies. Like, you know, DARPA is a big funder of neural implants. And the cover story there is: "it's for PTSD, aka it's good," right? And meanwhile, it's part of subsidizing a pipeline that ends up with Elon Musk and Neuralink. But I think also, when, you know, we think about the very real problem of veterans returning from a war where they have killed a large number of innocent people, it's not that their suffering doesn't matter, but that, you know, that that reaction is, in some ways, like registering something very real. And so when we think about, like, what treatment for that would look like, you know, I think that just making those symptoms go away is not necessarily, like, the right answer. Right? And this connects to your sort of question about, you know, the student who wants extra time on the test—which, like, by the way, I've never liked the carceral teacher. You know, like, dude, basically do whatever. Like, thanks so much for showing up.

Justin E.H. Smith  [42:45]
Oh yeah, of course. Of course, me too. You know, it's not—it's not that I tell them, no, you can't have extra time. In fact, I'm not allowed to tell them that. But I wouldn't even if I were allowed.

Danielle Carr  [42:54]
You're in the French system, that's right.

Justin E.H. Smith  [42:55]
Even in the French system at this point. But still, the fact that this is part of so many people's self-conceptions today seems to me to be not exactly part of the bending of the arc towards human liberation. [Laughs]

Danielle Carr  [43:17]
Yeah, it is interesting, the way that certain, certain diagnoses come to be a part of people's identity construction. And to take the example of depression for instance, this was the blooming of the term "depression" that really began in the Eighties but took off with the enormous advertising and selling of blockbuster drugs like Prozac, had everything to do with recruiting people into understanding the conditions of their life within this terminology. So there were, you know, questionnaires that you would get, or that would be on television where: "Do you have XYZ symptom? Well, talk to your doctor about Prozac." Right? And I think that there is something seductive in this—clearly, because it worked—with saying, because it's biological, first of all, you are experiencing something real and secondly, it's not your fault. And that, in many cases is true. What you are experiencing is real. And secondly, like, yeah, it's not you. But the way that these categories are constructed is often, their rhetorical effect is to make it their domain of one individual's body.

Justin E.H. Smith  [44:50]
Right, right, right. So then this kind of gets us back to the question of social construction and how we want to understand social construction. I mentioned to you earlier that I'm an admirer of Ian Hacking’s work…

Danielle Carr  [45:07]
One of the greats.

Justin E.H. Smith  [45:08]
One of the greats. And you confirmed that this is good taste on my part—good judgment on my part, I should say…

Danielle Carr  [45:18]
He's also a wonderful writer, so taste as well.

Justin E.H. Smith  [45:20]
Right. Aesthetic and intellectual at once, right? But you know, I love the historical case studies of things like fugue syndrome that swept up a lot of young men in the era around World War I, when they would start walking in one direction, and they would wake up in a village in France. And the next thing knew they were in Istanbul and couldn't, couldn't tell you how they got there. But it turns out a walk in a fugue. And there are other such historical examples. In the 1970s, the proliferation of cases of multiple personality disorder that seemed directly connected to the film Carrie, right— that's what made it a cultural phenomenon. And you can take examples from earlier centuries, like St. Vitus’s dance in the Middle Ages. And you know, there there are many, many such examples. And Hacking's general line—that I tend to agree with, and that I that I think I have it right—is that you can easily accommodate these historical appearances, or these historical manifestations that differ from one century to the next within your understanding of reality, and you can treat them within a context that takes them seriously, that respects them, even if you are also committed to their eventual drifting off into some other manifestation. But doesn't that—and I guess this is my question, and this might be moving us a bit closer to the ultimate question of whether we agree or not—doesn't that present a particular trouble for someone like you whose job it is to be sensitive to these historical inflections? And doesn't that make it hard to accept at face value your contemporaries' talk—in the plural, that is: the talk of your contemporaries—about this or that 21st century equivalent of fugue syndrome or St. Vitus's dance?

Danielle Carr  [48:00]
Yeah. So, I mean, I have ongoing admiration for Ian Hacking, as I said, and I think that just, what I am trying to do, and I think what many of us working in, you know, critical scholarship on psychiatry are trying to do is to do like that plus Marxism. Right? Because what's really missing for me in Hacking is: sure things are constructed in what he calls a looping effect. And I'll come back to that in a second. But then there's not really a question of whose interest is served in particular cases. Right. And sometimes  that's fine. And, you know, I don't think that science is ideology all the way down. But there are currents within science, as in the rest of reality, in which certain interests are served. Right. And so, to come back, just briefly, to Ian Hacking's idea about: things are both real and they are really made up, right. That's the fundamental insight. And so, you know, one one good example of the kind of looping effect by which a conception like discourse comes to constitute reality to the same extent that reality constitutes discourse is, for instance, the way that symptoms come to be measured in psychiatric diagnosis. So people often think that the first antidepressant drug was called ???, which was invented in the early 1950s, and came to be used clinically, but actually as historian Nicolas Rasmussen has shown, the first drug to be marketed for depression-like symptoms were amphetamines—it was benzedrine—which were very widely used in the late 1920s and early 1930s. And one of the ways that this was sold was that there is something called anhedonia, or lack of pleasure. Anhedonia is treated by this drug, therefore, this drug must correspond to the disease entity, because it's curing that thing. And you begin to see that sort of looping effect. And another example of this might be, for instance, when you're designing functional magnetic resonance imaging, fMRI studies, which produced those, like, hot, you know, glossy, beautiful, colorful pictures of the brain where we're like, "Oh, we found the part of the brain that experiences x or is responsible for x?" Well, when you're designing the tasks that someone does in those scanner is one of the marks of a good test is that it makes a discrete region light up. That's a very publishable result, right? And if you makes the discrete region line up, and you think, "Oh, this is a good task," and then that task comes to be used as a proxy for more and more naturalistic conditions, so like, doing this test comes to be a standard for a variety of naturalistic things that you experience in daily life outside the scanner. And so, so there is a looping effect there. And what I'm trying to do is to say some of those loops are being bent in the interest of our enemies.

Justin E.H. Smith  [51:22]
Right, right, right. Yeah, Hacking does not have a sophisticated understanding of the—or let's say, the analysis of the economics behind these looping effects. You're right. I am I'm trying to draw towards a close but I did want to talk briefly a bit more about Neuralink and the history of neural implants, because this is something you know so much about, and what you've written about it in your wonderfully titled "Shit for Brains" article in the Baffler. It is so eye opening. And one thing I learned from you is that the claim of any real innovation on the part of the Neuralink researchers under Elon Musk's direction is really a stretch given that effectively, the same technology was already in place by the 1960s, with the work of, I believe his name is Jose Delgado. And what Musk failed to acknowledge, or attempted to conceal might be better, is that all these neural implants are really doing is blocking the motor system in the brain, which is in the end, something that is fairly easily understood and fairly easy to control. But that that is a whole different ballgame than the possible control of deeper, more complex and less easily definable things like thoughts and emotions. And here I think you want to say we're really no closer to being able to do this, let alone to do this at a large scale for human beings, rather than just a couple of pigs—we're really no closer now than then Delgado was in the 1960s. Is that right?

Danielle Carr  [53:42]
So I just want to, like, maybe massage a little bit your gloss here, because it's not that it's impossible to zap certain parts of the brain to produce a psychological effect. So Wilder Penfield was a pioneer in using electrode stimulation in both animals and humans to elicit psychological responses that could include wild laughing, mania, extreme somnolence, extreme sexual arousal and so on. But that it's much—I mean, it's much easier to know where to zap in the brain for motor control, and that, often, claims that you've made huge advances in neural localization of more diffuse concept, like for instance, depression or PTSD, are riding on the, you know, I think pretty robust scientific work of neural localization for movement. And so they are trying to say, well, just like we found movement, we're gonna find PTSD. It's like, well, you know, not so fast. There have of course been changes and advances—and, again, using "advances" in scare quotes here, it's like, advances to what? Like, it's maybe, maybe not so great. In the technology, obviously the computers are better, obviously. There's a movement to couple neural implants and the data that they produce to AI, machine learning and that sort of thing—that was not present in that in the 1960s. And, you know, the electrodes are different in that there are more contact points now. That means that you're zapping more bits of the brain. But I mean, Musk's idea that this is going to be a consumer commodity that's about equivalent to, like, an iPhone or, as he says, "it's a Fitbit for the brain"—and there are, like, multiple regulatory and technological hurdles to overcome. And his company has developed a sewing machine—it's described as a sewing machine—that functions essentially, to use a needle to rapidly implant lots of electrodes over the cortex. For this to be brought to a consumer price point where multiple people are using it, first of all, you would have to get it automated so that you don't have the extremely expensive labor of a neurosurgeon overseeing it. And if one of these goes wrong, you know, you're going to be back in regulatory hell, I would hope, for quite some time, right? So, it's not like you're just going to be able to, like, you know, bring this to like a shopping mall and, like, get your ears pierced at Claire's, or something. But there's also a question of like, can you, with this electrode sewing machine, get the electrodes deep enough into the brain, deep enough into deep brain structures that are—the cortex is not as involved in emotion (the cortex is the outer covering of the brain) as deep brain structures like the nucleus accumbens, like the amygdala. And it's a real question of whether you can stick the needle in that far without damaging other structures. And, you know, there's a reason why the sewing machine has not been tried on humans yet, which is, like, it's pretty dicey. And so… but I think that what this gets to and what my critique is, of a lot of the ways that we on the left, try to go about doing a critique of this type of bad science, is to say, "Well, unfortunately, it works. It works possibly too well, and it's bad." Right? So like, this is the kind of—like, for instance, Shoshana Zuboff line which is like oh, like behavioral engineering, or targeted advertisement worked so well that it's in fact stripping us of like a certain conception of, like, liberal agency or whatever. Which is not really something that I'm particularly invested in anyway. And I think that the critique we should be making more often is: What if this thing doesn't work as well as they're saying it does—at least not for the thing that they're saying it's going to do—and it's still bad because it has other effects? Right?

Justin E.H. Smith  [58:16]
Yeah. The other effects being that you'll accidentally get a blood vessel or…

Danielle Carr  [58:20]
Well, so, one of the other effects would be that whether or not the data is—like, the data that's being harvested—is effective in doing what they say that it's going to do, you know, this data is being speculated upon by venture capitalists for a reason. Which is that, well, you know, it will still be a valuable way to like couple neural data to, like, your phone. For instance. But there are, you know—there are a variety of like other other things that you could make this sort of critique for. For instance, like machine learning you know, it's one thing to match a particular machine learning that says: "Well, clearly this is like bad because it's going to be used to like control us through, like, totally automated society." But it's another and I think, maybe a better critique to say, "Well, a lot of the input that goes into training machines is in fact underpaid human labor, and a lot of the stuff is sold to us as being with the advent of total automation is actually just like there are they're saving human labor in there that's making it appear as this, like, magical new technology." Right?

Justin E.H. Smith  [59:32]
Right, right, right. Oh that's so interesting, that says so much. So, I'm trying to push towards an end and one way to do that is just to just to get blunt about the question and to repose it. And so I'm not going to just straight-up ask you what is mental health anyway, but I am going to say that I think I got it a hint of your answer already when we were talking about your work on Medicare and your your conception of a future public health system, that would not simply be the current one plus state funding, but would rather be something that is conducive to human thriving. And that that would not eliminate mental illness.

Danielle Carr  [1:00:30]
Certainly. And I don't want—don't get me wrong, that is not what I'm saying.

Justin E.H. Smith  [1:00:34]
Right. Because there is an ineliminable biological substratum to at least a good deal of mental illness.

Danielle Carr  [1:00:45]
Yeah, absolutely.

Justin E.H. Smith  [1:00:48]
Would it significantly diminished mental illness? Or would it only diminish the talk of mental illness? And is this a good way to zero in on an answer to the—like, a succinct answer to the question what mental health is.

Danielle Carr  [1:01:01]
I mean, maybe I'll go ahead and answer the question, even if you were a little equivocal in posing it. I would say: What is mental health? Mental health is a terrain of struggle over the question of what human flourishing is, and how to achieve it. And so, yeah, I do think that it is an open question of what mental health might mean. And I think that's the horizons that I see myself working towards, and many other people who are worth spending time thinking about these issues.

Justin E.H. Smith  [1:01:39]
So we can't really answer it because it's—I mean, we can't give a pat definition; we can't give necessary and sufficient conditions because it in a sense, opens up to a larger question about what the good life is and what the just society is, right?

Danielle Carr  [1:01:57]
Yeah, absolutely. Right. I think it's a lot like, you know, asking, like, what is sexuality?

Justin E.H. Smith  [1:02:02]

Danielle Carr  [1:02:03]
But I think my point is that even if a lot of the manifestations or instantiations, of mental wellness, mental health, are not something that we would really want to accede to or put our weight behind, there is a horizon where we are talking about human flourishing and ways to get towards it. And I think that's like where we want to be doing the work.

Justin E.H. Smith  [1:02:35]
[Bell ringing] Oh, yeah. You know, I realized more and more as I advance in this podcast, that I am a really shitty Socrates, because, as I've told you before, I tend to just find myself [bell ringing] agreeing almost by definition with the person I'm talking to, at any given moment, but I think that's particularly the case today. I think everything you're saying is really…

Danielle Carr  [1:03:07]
Yes, Socrates. That is so.

Justin E.H. Smith  [1:03:11]
I think everything you were saying is really compelling. So I find no reason to rule in disagreement or aporia.

Danielle Carr  [1:03:23]
That's good. Because there's a bucket of slime above my head. If we reached disagreement, I would have been, like, slimed.

Justin E.H. Smith  [1:03:32]
Maybe that would be an even better conceit for a podcast when there's actually some kind of punishment that comes with disagreement, but that's—these are some very valuable insights. What of yours should I read next?

Danielle Carr  [1:03:52]
Well, I have not—I'm trying to think. I think—the pieces that are published are not so extensive that it would take you very much time to read all of them. But I have a piece in Pioneer Works on the history of antipsychiatry, I have a piece coming out in Aeon soon, about how—kind of trying to give some texture on what actually happens in fMRI studies. And I have a single academic article, inflict at your own risk.

Justin E.H. Smith  [1:04:30]
Oh, wonderful. Well, I will watchfor that Aeon piece, definitely. So again, thank you so much, Danielle. Danielle Carr has been talking with me today about mental health. We have sought together an answer to the question, "What is mental health?" I don't think we really answered it, or, at least, we didn't give a single line definition but we also found ourselves in spirited agreement. And thanks again Danielle.

Danielle Carr  [1:05:04]
Thanks so much.

Justin E.H. Smith  [1:05:05]
Once again this is Justin E.H. Smith. This is the "What Is X?" podcast for The Point magazine. Join us next time.