Ciencia pura

The question is neither capricious nor itself insane.  However much we may be personally convinced that we can tell the normal from the abnormal, the evidence is simply not compelling.  It iscommonplace, for example, to read about murder trials wherein eminent psychiatrists for the defence are contradicted by equally eminent psychiatrists for the prosecution on the matter of the defendant’ssanity.  More generally, there are a great deal of conflicting data on the reliability, utility, and meaning of such terms as “sanity,” “insanity,” “mental illness,” and “schizophrenia.”  Finally, asearly as 1934, {Ruth} Benedict suggested that normality and abnormality are not universal. What is viewed as normal in one culture may be seen as quite aberrant in another.  Thus, notions of normality andabnormality may not be quite as accurate as people believe they are.
            To raise questions regarding normality and abnormality is in no way to question the fact that some behaviours aredeviant or odd.  Murder is deviant.  So, too, are hallucinations.  Nor does raising such questions deny the existence of the personal anguish that is often associated with “mental illness.”  Anxiety anddepression exist.  Psychological suffering exists.  But normality and abnormality, sanity and insanity, and the diagnoses that flow from them may be less substantive than many believe them to be.            At its heart, the question of whether the sane can be distinguished from the insane (and whether degrees of insanity can be distinguished from each other) is a simple matter:  Do the relevantcharacteristics that lead to diagnoses reside in the patients themselves or in the environments and contexts in which observers find them?  From Bleuler, through Kretchmer, through the formulators ofthe recently revised Diagnostic and Statistical Manual of the American Psychiatric Association, the belief has been strong that patients present symptoms, that those symptoms can be categorized,...