Why We've Been Thinking About Madness All Wrong: A Conversation With David Dobbs
Nev Jones
David Dobbs' new feature in our October 2017 issue  "The Touch of Madness " tells a story that is both heartbreaking and uplifting  and all too familiar: A young woman with a bright future temporarily loses herself in mental illness  and finds the fraying of her social bonds to be more durably worse  in some respects  than the underlying condition itself. That young woman  Nev Jones  manages to pull herself out of the bottom of the well  finishing graduate school and going on to become a key advocate and scholar among reform-minded thinkers in the world of mental-health treatment and policy. But it wasn't easyâand wouldn't have been possible without the ideas and support of the practitioners and scholars she found shortly after her mental illness derailed her graduate studies.
Your story describes how  the mental-health researcher and activist Nev Jones (and a growing number of others)  are pushing for the medical establishment to think about schizophreniaâor related diagnoses of "madness " as  they  are known colloquiallyâin a radically new way. What is new about it  and what makes it so radical?
 Nev Jones  and other scholars and advocates like  her  want us to see what  they  call madness  meaning schizophrenia  bipolar  and other serious mental ailments  less as biological phenomena  and more as cultural phenomena.  They 're asking us to see these phenomena not only as a breakdown of brain connection  as  they 're typically cast in the West  but as breakdowns in social connection.  They  want us to see how culture shapes madness: People with schizophrenia simply do worse in societies that define schizophrenia as primarily biological and that isolate people who are mad.
Who is  Nev Jones   how did you find  her   and how did  she  come to these ideas?
A few years ago in 2012  after the mass shooting in a movie theater in Aurora  Colorado  I wrote a blog post for Wired about how it's not coincidental that some of the sickest and most paranoid and angry people who go mad in the U.S. resort to violenceâwith guns in particular. It's an expression of madness that does not happen in places that are less gun-oriented and less violent overall. The idea was that culture shapes the expression of madness in that way. It got a lot of pushback  so I did another iteration of the blog post  and in doing that I looked around the Internet to find people who articulated the same idea better than I did  and one of those people was  Nev Jones .  She  had related some episodes from  her  own descent into madness that were helpful in illustrating what I was trying to say.
At the time  she  was a graduate student and still in the middle of  her  recovery from a psychotic episode that  she  had in grad school  after the school bungled a few things in response to  her  psychosis and proved far from helpful. The societal response in  her  case seemed to aggravate  her  deep psychotic state that lasted for some time.  She  was able to climb out of that by connecting to other people and by studying and absorbing  herself  in the literature on how culture shapes madness.  She  connected with other people who studied it and wanted to get the word out.  She  proved effective at this  finishing  her  studies in community psychology at DePaul University  and then becoming more well known in what some people call the madness community. These are people who study it and advocate for those who have had it  whom they call people with lived experience.
 She  ended up getting an invitation to go to Stanford University's anthropology department. What  she  was doing was tapping into a couple of decades of increasingly busy and deep work in academia  looking at how cultureâbroadly definedâaffects our view of madness  in particular how it affects the experience of people who have schizophrenia. In Nev Jones  I found someone who was by all accounts one of the most dynamic and exciting experts in the field  and  she  was also someone who lived through this and had deep insight both from  her  scholarship and from  her  experience of becoming very sick for a couple of years  and used  her  insights on how cultures shapes madness to climb back out of  her  illness to a state of high-function and happiness.
 Nev  and  her  peers are not making the case that physical characteristics like genes and brain chemistry are not involved.  She 'd tell you  of course the brain is involved  and we need to deal with that  sometimes with medication. But overlooked in the West's heavy emphasis on the biological definition of madness and other mental illnesses is how vital social connections are to the experience of mental illness. When people have mental illness in the U.S.  especially if it's a psychotic disorder like schizophrenia  one of the first things that happens is their social networks fall apart and they're left alone precisely at the time when they most need social connections. If you start to understand these things  it should change how you think societyâfriends and family  the broader culture  as well as the medical cultureâshould evaluate and respond to someone experiencing first-episode psychosis.
 Nev Jones  told you about how a mass shooting involving someone diagnosed with schizophrenia shaped others' perceptions of  her  during  her  first episode  while  she  was in graduate school. What does the media tend to get wrong about incidents like the one in Las Vegas just this week? We don't know anything about the shooter's motives yet  but the conversation on social media has quickly turned to mental illness  per usual.
Where did the conventional wisdom that folks like  Nev  are trying to revise come from? Describe the intellectual history you explored for this piece.
Aside from the constant warfare over funding for health care in Congress? In the psychiatry establishmentâthe American Psychiatric Association  for instanceâthere is a heightened awareness with every passing year. That's one of the main goals for  Nev Jones  and other people who advocate along these lines: to increase awareness among the psychiatric establishment  partly so the establishment is more open to making people with lived experience meaningful and full partners in any organization that makes decisions about how to respond to mental healthâwhether it be a board that's trying to help create a first episode psychosis clinic  or a clinic that is going to treat or work with psychotic people. Right now  if you have psychosis and you're in this profession  it's seen as a reason not to include you in treatment level activity  whereas it should actually be seen as a plus  because of the greater understanding and credibility that you'll have with a patient. It's encouraging that the APA is looking at this more.
David Dobbs' new feature in our October 2017 issue  "The Touch of Madness " tells a story that is both heartbreaking and uplifting  and all too familiar: A young woman with a bright future temporarily loses herself in mental illness  and finds the fraying of her social bonds to be more durably worse  in some respects  than the underlying condition itself. That young woman  Nev Jones  manages to pull herself out of the bottom of the well  finishing graduate school and going on to become a key advocate and scholar among reform-minded thinkers in the world of mental-health treatment and policy. But it wasn't easyâand wouldn't have been possible without the ideas and support of the practitioners and scholars she found shortly after her mental illness derailed her graduate studies.
Your story describes how   [TGT] are pushing for the medical establishment to think about schizophreniaâor related diagnoses of "madness " as   [TGT]   are known colloquiallyâin a radically new way. What is new about it  and what makes it so radical?
  [TGT] and other scholars and advocates like  her  want us to see what   [TGT]   call madness  meaning schizophrenia  bipolar  and other serious mental ailments  less as biological phenomena  and more as cultural phenomena.   [TGT]  're asking us to see these phenomena not only as a breakdown of brain connection  as   [TGT]  're typically cast in the West  but as breakdowns in social connection.   [TGT]   want us to see how culture shapes madness: People with schizophrenia simply do worse in societies that define schizophrenia as primarily biological and that isolate people who are mad.
Who is   [TGT]    how did you find   [TGT]    and how did   [TGT]   come to these ideas?
A few years ago in 2012  after the mass shooting in a movie theater in Aurora  Colorado  I wrote a blog post for Wired about how it's not coincidental that some of the sickest and most paranoid and angry people who go mad in the U.S. resort to violenceâwith guns in particular. It's an expression of madness that does not happen in places that are less gun-oriented and less violent overall. The idea was that culture shapes the expression of madness in that way. It got a lot of pushback  so I did another iteration of the blog post  and in doing that I looked around the Internet to find people who articulated the same idea better than I did  and one of those people was  Nev Jones .  She  had related some episodes from  her  own descent into madness that were helpful in illustrating what I was trying to say.
At the time  she  was a graduate student and still in the middle of  her  recovery from a psychotic episode that  she  had in grad school  after the school bungled a few things in response to  her  psychosis and proved far from helpful. The societal response in  her  case seemed to aggravate  her  deep psychotic state that lasted for some time.  She  was able to climb out of that by connecting to other people and by studying and absorbing  herself  in the literature on how culture shapes madness.  She  connected with other people who studied it and wanted to get the word out.  She  proved effective at this  finishing  her  studies in community psychology at DePaul University  and then becoming more well known in what some people call the madness community. These are people who study it and advocate for those who have had it  whom they call people with lived experience.
 She  ended up getting an invitation to go to Stanford University's anthropology department. What  she  was doing was tapping into a couple of decades of increasingly busy and deep work in academia  looking at how cultureâbroadly definedâaffects our view of madness  in particular how it affects the experience of people who have schizophrenia. In Nev Jones  I found someone who was by all accounts one of the most dynamic and exciting experts in the field  and  she  was also someone who lived through this and had deep insight both from  her  scholarship and from  her  experience of becoming very sick for a couple of years  and used  her  insights on how cultures shapes madness to climb back out of  her  illness to a state of high-function and happiness.
 Nev  and  her  peers are not making the case that physical characteristics like genes and brain chemistry are not involved.  She 'd tell you  of course the brain is involved  and we need to deal with that  sometimes with medication. But overlooked in the West's heavy emphasis on the biological definition of madness and other mental illnesses is how vital social connections are to the experience of mental illness. When people have mental illness in the U.S.  especially if it's a psychotic disorder like schizophrenia  one of the first things that happens is their social networks fall apart and they're left alone precisely at the time when they most need social connections. If you start to understand these things  it should change how you think societyâfriends and family  the broader culture  as well as the medical cultureâshould evaluate and respond to someone experiencing first-episode psychosis.
  [TGT] told you about how a mass shooting involving someone diagnosed with schizophrenia shaped others' perceptions of   [TGT]   during   [TGT]   first episode  while   [TGT]   was in graduate school. What does the media tend to get wrong about incidents like the one in Las Vegas just this week? We don't know anything about the shooter's motives yet  but the conversation on social media has quickly turned to mental illness  per usual.
Where did the conventional wisdom that folks like  Nev  are trying to revise come from? Describe the intellectual history you explored for this piece.
Aside from the constant warfare over funding for health care in Congress? In the psychiatry establishmentâthe American Psychiatric Association  for instanceâthere is a heightened awareness with every passing year. That's one of the main goals for  Nev Jones  and other people who advocate along these lines: to increase awareness among the psychiatric establishment  partly so the establishment is more open to making people with lived experience meaningful and full partners in any organization that makes decisions about how to respond to mental healthâwhether it be a board that's trying to help create a first episode psychosis clinic  or a clinic that is going to treat or work with psychotic people. Right now  if you have psychosis and you're in this profession  it's seen as a reason not to include you in treatment level activity  whereas it should actually be seen as a plus  because of the greater understanding and credibility that you'll have with a patient. It's encouraging that the APA is looking at this more.