Nobody's Child by Susan Vinocour

Author:Susan Vinocour [Susan Vinocour]
Language: eng
Format: epub
ISBN: 9780393651935
Publisher: W. W. Norton & Company
Published: 2019-08-28T00:00:00+00:00

CHAPTER 30

WHAT DO INTELLIGENCE or mental illness have to do with the capacity to have guilty intent (mens rea), moral comprehension of one’s acts, or reckless disregard and depraved indifference?

We can’t know exactly what people in the Dark and Middle Ages meant when they talked of “madness” or “lunacy.” But it is likely that “lunacy” was mania, the manic end of the spectrum of bipolar disorder, in which a person’s behavior is greatly accelerated. Though during a manic episode a person can be coherent and perform complex acts, he can also cross over into an agitated psychosis and be raving and incoherent, with hallucinations, delusions, and irrational thoughts and behaviors. I knew a churchgoing woman who ran down the street brandishing a butcher knife and singing hymns at the top of her lungs in a manic state, and a prim kindergarten teacher who raced naked through the streets in the middle of January one brutally cold Friday night.

In this state, people are unable to be self-aware, to monitor or curb their behavior, or to accurately perceive reality. Both of the women above, once restored to normalcy through creative pharmaceutical interventions, vaguely remembered what they had done but could give no reason for it or connect it to themselves.

The manic-depressive patient’s sense of reality is significantly disturbed by the neurochemical abnormality of their brains, not by moral depravity, chastisement by God, or the intentions of the sufferer. The problem is a deficiency of lithium, without which the brain cannot function normally. Understanding, discernment, and reason are subverted, as are moral comprehension and impulse control.

If we are manic, we are not ourselves but don’t know it. We can’t perceive the alteration in ourselves, can’t tell that anything is “off.” People experiencing mania often feel wonderful, on top of the world. As neurologist Oliver Sacks observes about the particular tragedy of mania: “The paradox of an illness which can present as wellness—as a wonderful feeling of health and well-being, and only later reveal its malignant potentials—is one of the chimaeras, tricks, and ironies of nature.”

Psychosis is another brain disorder, and it often has a genetic basis; people who develop a psychotic disorder often have a family history of psychosis. In Dorothy Dunn’s case, both her mother and her daughter had had psychotic episodes, or “breaks.” We call it a “psychotic break” because there is a break from reality; a person in a psychotic state is unable to perceive reality as the rest of us do.

Oliver Sacks relates his experience with a patient who had damage to her frontal lobes:

“Yes, Father,” she said to me on one occasion. “Yes, Sister,” on another. “Yes, Doctor,” on a third. She seemed to use the terms interchangeably. “What am I,” I asked, stung, after a while. . . . “You realize the difference between a father, a sister, and a doctor?” “I know the difference, but it means nothing to me. Father, sister, doctor—what’s the big deal?”

And thus it is for those who are psychotic. It is not knowing that is lost but perception, judgment, and the normal self.

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