In 1835, Belgian social scientist Adolphe Quetelet introduced the idea of the “normal distribution” to the study of man, suggesting that many human traits followed a statistical Gaussian curve, with the bulk of the population situated within a centre block showing minimal deviation from each other, and smaller populations at either end. Such a model was eagerly adopted within medicine. Concepts of health shifted from a disease-based model (which regarded health and illness as entirely separate states) to a quantitative model, whereby health became the mid-point on a normal distribution. As this distribution was increasingly used to explain disparate human concerns, the very meaning of the word “normal” changed, from a mathematical term suggesting a median point, to something that was considered desirable. To be healthy was to be normal; not to be normal was to be pathological.
Such a paradigm shift had obvious ramifications for mental, as well as physical, health: the remit of which appears to have expanded ever since. Thus, a recent debate organised by the English National Opera encouraged some attention to the slippery distinctions between madness and sanity. How do the ideas of normality, madness, genius and sanity interconnect? What do we mean by these terms, and how do we judge them?
The debate was part of a series of events connected to the first performance in English of the opera Jakob Lenz, to celebrate the 60th birthday of German composer Wolfgang Rihm. The opera itself, a powerful Expressionist piece (with an impressively muddy set!), focuses on the real life mental breakdown of Romantic poet, Lenz. As Lenz hurls himself into pools after actresses we assume are phantoms, and his friends debate his state of mind, the overwhelming orchestra lends an ominous air to the short piece, which, the publicity claims, asks: Where does genius end and madness begin? How does it feel to cross the borderline between imagination and insanity?
Although these questions might appear somewhat clichéd (and presuppose certain possibilities of definition) the debate itself encouraged a more nuanced discussion. In addition to our Friends Secretary’s contribution around the history of the so-called “borderlands of insanity”, Radio 3 presenter Stephen Johnson reflected on his own experiences of bipolar disorder, and in what ways these did – and, perhaps more importantly, did not – relate to the questions posed. Journalist Jon Ronson, meanwhile, covered some interesting material from his recent book, The Psychopath Test, reflecting on his interview with Robert Spitzer (editor of DSM-III) about the massive expansion of classifications in the third edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. A refreshingly un-dogmatic medical perspective was provided by Professor Gill Livingston, of the UCL Mental Health Sciences Unit, and encouraged very varied questions from the audience about a topic that one hopes will continue to inform discussion.