01. 13. 2009. 10:31

Psychiatry (two sketches)

Frigyes Karinthy

"...if I have a delusion, I am insane. But you just said that I am insane. In that case, my belief is not a delusion, but a correct idea. Therefore I have no delusion. Therefore I am not, after all, insane. It is only a delusion that I am insane; hence I have a delusion; hence I am insane; hence I am right; hence I am not insane." – Two sketches from the 1930s on the traps and paradoxes of psychiatry, translated by Thomas Szasz, the renowned antipsychiatrist.

The Baker
 
Why was Zoltán Fisher, the baker, locked up in the insane asylum?
 
The official report lies before me. The facts are clear. Nothing needs to be added to the report or taken away from it. It is enough to record it.
 
I wish to emphasize the necessity for writing down and publishing this case. Why? Because, according to official scientific psychiatry, there is absolutely nothing unusual or worth recording in this case: Zoltán Fischer was removed to the asylum for the simple reason that he was mentally ill, had a nervous breakdown – in short, because he went insane. Period. It's a purely clinical problem. We must therefore speak of it through the rhetoric of psychopathology; more specifically, through the so-called anamnesis. If, then, I propose to describe the case not in the special language of scientific psychiatry, but in everyday language, I realize that I commit a grave insult against the legally constituted authority of psychiatric medicine.
 
I respect the laws of science. If I make an exception here, it is because although the judgments and actions of psychiatry are clear, its explanations are not. If a person is mentally ill (excepting general paresis), his illness cannot be inferred from the objective condition of his brain or nervous system... Nor can it be inferred from an examination of the brain and nervous system at autopsy. Psychiatric science is satisfied therefore with noting certain actions engaged in by the insane person, which are indeed unusual. That is the basis of the diagnosis. In other words, the psychiatrist describes the unusual actions of the so-called patient.
 
I shall do the same.
 
Recently, Zoltán Fischer, the baker, had been feeling restless. Or, as those around him said, he "behaved" as if he were agitated: he was irritable, inattentive, moody. This disturbance is unusual only if we assume that the baker had nothing to be disturbed about. This is just what his "loved ones" maintained to be the case: business was good, and the baker had ample savings, a healthy family, and a well-functioning digestive tract. However, if we assume that the baker was disturbed by something other than his business, family, or digestion, his irritability and restlessness need not appear unusual. Let us suppose that Zoltán Fischer was mulling over some problem. When a person is preoccupied and in deep thought, it is quite natural for him to be irritable and restless; indeed, it would be unusual if he were not.
 
Well, then, it soon became apparent that the baker was in fact seriously considering a problem. His family, disturbed by the baker's condition, sent him to P. for a rest. (Aha! his family was also disturbed. Yet they were not committed to a mental hospital.) When Fischer returned form P. he appeared to be much improved. He was not restless or irritable.
 
This was because he was no longer preoccupied by the problem.
The trouble was now much more serious.
The baker began to act.
 
One morning, Zoltán Fischer began to distribute copies of a circular in the neighbourhood. It was an announcement that the price of bread and rolls had been reduced drastically – so low, in fact, that they would bring no profit at all. The price was nominal, enough only to distinguish the goods from a free gift. Fischer also explained why he did this: "to help the poor people." As if to complete this "insane logic," he began himself to help deliver the products of his ovens.
 
At this point it became clear that here was a case for the insane asylum.
 
Had the baker believed that he was Napoleon, and had he addressed a petition to the government – it would have depended on the style and content of his appeal whether he would have been locked up (in a mental hospital or in a prison), or proclaimed Great Leader. In any case, the diagnosis would have been uncertain.
 
The chances of commitment would have been greatly increased had the baker believed that he was a butcher. Being a butcher is not like being a Leader. The butcher must have certain skills. A group of butchers could thus determine whether Zoltán Fischer was in fact a competent butcher or whether his belief of being a butcher was a delusion.
 
In the present case, there was no such problem. It was a sure case for the madhouse. For the baker believed that he was a baker.
 
Of course, he considered himself to be a baker in a very basic sense: A baker, he believed, was a man who breaks bread and rolls for people who hunger after bread and rolls so that their hunger will be appeased.
 
This was the problem that had preoccupied and troubled Zoltán Fischer until he decided on a course of action while resting at P. If only he had continued to think and worry, but refrained from acting, he might never have been committed to a mental hospital.
 
For, so long as we cannot infer insanity from brain lesions, we must define it as follows: The insane person is an individual who acts on the basis of his beliefs, even if the actions to which he is so led are unusual in the time and place where he lives; he is especially insane if he acts in accordance with what he considers right, even if in so doing he will be said to harm himself or others.
 
Zoltán Fischer must have felt that there was something wrong with him, something very wrong, when he began to take the path which his reason and his conscience chose for him.
 
The report states that when the men in white coats came for him, he was not surprised. He did not resist. He acknowledged their arrival with composure, with a faint smile on his lips, almost a sigh of relief. He knew where they were taking him. He expected them.
 
"I am glad you are taking me to Leopoldfield [the name of the state mental hospital serving Budapest]." he said. "It's a quiet place. I can get some sleep there. I am so sleepy."
 
Zoltán Fischer wanted to sleep. He was like the person who realizes that in trying to correct one mistake, the mistake of a lifetime, he has made another; such a person wants to sleep.
 
I shall mention, but not belabor, a comparison. Our Master, who was also a baker, fed five thousand men with five loaves of bread. Yet, even in His day, five loaves of bread were thought to be enough for only five men.
 
Perhaps there is only one way to determine whether a good act is in fact good, always and everywhere: one must sleep on it. For three days, for three hundred years, if necessary, for three thousand years. In the story of the Redemption, I think we pay too much attention to the Crucifixion, and not enough to the Resurrection.
 
 
Psychiatry
 
"My dear colleague, I am here to consult you in an extraordinary case. You know why I have come to you? Because I trust you as a scientific psychiatrist; in fact, I trust you as I trust myself."
 
"I am honored, my dear colleague. And I must agree with you: in psychiatry, it's a dead heat between us."
 
"There can be no doubt about it. About mental illness, we always agree. I regard this as a proof that psychiatry, correctly understood, is a mature science. This is why I have come to see you. Because 'Four eyes see better than two.' I want to discuss this interesting case with you. In strict confidence, of course."
 
"I am all ears, my dear friend."
 
"The question is simply this: Am I, your friend and colleague who is speaking to you, insane or not?"
 
"A very interesting qquestion. It has occurred to me, too. So this is what you want to discuss with me?"
 
"Yes. At first, I thought that as the nation's foremost psychiatrist, I myself ought to decide this question. But then I decided that since it's an important case, I ought to have a consultant. Two doctors are always better than one. So I invited myself and you to this consultation."
 
"I approve. That is the correct medical procedure. Perhaps we ought to get right down to the case."
 
"I am at your service."
 
"So far, I do not have a firm opinion about the problem. I would be most anxious to hear your views about it."
 
"In my opinion, I am insane."
 
"That is certainly an important judgment, coming from an expert of your eminence."
 
"You flatter me, my dear colleague."
 
"Not at all. But let's get back to the problem. We agree – I think – about what constitutes the single most important diagnostic sign of insanity?"
 
"Of couse. You have in mind what the French call l'idée fixe; the fixed idea. Is that not so?"
 
"Naturally. We must determine, then, whether or not you, my dear colleague, have any fixed ideas. I trust we agree what we mean by 'fixed ideas'?"
 
"Of course we agree. A fixed idea is a delusion. An individual capable of perfectly logical reasoning holds a belief about himself that is completely false; for example, he thinks he is the Emperor, when in fact he is not."
 
"Correct. We both know, my dear friend, that save for his fixed idea, the insane person is perfectly reasonable. Let us see, then, if you have any fixed ideas. Because if you don't, if your reasoning is correct and logical, then you are not insane."
 
"I agree."
 
"Let's find out, then. Do you have any delusions, or fixed ideas, about yourself? What is your name?"
 
"Such and such."
 
"Correct. And who are you?"
 
"A psychiatrist."
 
"Correct. And where do you live?"
 
"At such and such address."
 
"Right again. It is already clear that you know perfectly well who you are and what you are, because what you told me is correct. I would conclude that you have no delusions about yourself and are therefore not insane."
 
"But I think that I am insane."
 
"But you don't have any delusions! You know what you are!"
 
"Yes, insane."
 
"No. We saw that you are not."
 
"You really think so?"
 
"Certainly. I have proved it to you."
 
"Oh, no, not so fast! For if I am really not insane, but believe that I am, then my belief is a delusion, a fixed idea."
 
"You are right!"
 
"You see, I told you: I have a delusion, therefore I am insane."
 
"Of course. If you have a delusion, you are insane."
 
"So, am I insane?"
 
"Well, since you have a delusion, evidently you are."
 
"Oh, no, there you go again! Now you say that if I have a delusion, I am insane. But you just said that I am insane. In that case, my belief is not a delusion, but a correct idea. Therefore I have no delusion. Therefore I am not, after all, insane. It is only a delusion that I am insane; hence I have a delusion; hence I am insane; hence I am right; hence I am not insane. Isn't psychiatry a magnificent science?"
 
"The most magnificent, my dearest colleague! But of course it's necessary to master it as well as only you and I have."
 
Translated by Thomas Szasz
 
Previously on HLO
 
Gulliver in Hungary: a portrait of Frigyes Karinthy
Karinthy: A Journey Round My Skull in English (news)

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