Mental Illness Stigma and Barth’s Doctrine of the Human
ST 360 Union Theological Seminary
17 December 2015
Mental illness stigma may, at some level, be a necessary element of civilization. For us to build things, perhaps we need to cast aside the parts that don’t fall into our scheme. Severely mentally ill people make little contribution that we can readily understand. But we can think of stigma as an answer to a question, where for a moment, the question is unanswered. The question would be something like, Does this strange person belong? And when we stigmatize, we answer no. Fear is involved.
But in the brief instant where we ask if they belong, we might be using some idea of what a human is. This is the opening point for theology in addressing mental illness stigma. Right at that moment where we ask such a fundamental question, we have an opening to understand ourselves in many different ways, depending on our theology. Strictly speaking, other things besides theology could come into play. It could be simply our social conditioning or our accumulated life experience that makes us exclude.
All the same, what if there were, instead of an understanding of life that excludes mentally ill people, an understanding that pointed out and insisted upon a question mark? What if instead of a doctrine of a human that listed traits—traits which might exclude the strange person—we said that humans cannot be satisfactorily defined on their own terms, but that we are in a relation with a wholly other God?
The moment where we stigmatize is like a process of closing a door on someone. I would like to offer a set of ideas that interfere with this process. Could the notion of a God who is for us but not at all the same as us, and the notion of a human who essentially belongs to this God as God’s creation, interfere with the slamming of the door on the strange person?
Mental illness is very hard to understand, as is the human condition. If we resist the idea of a quick understanding, but instead stay puzzled a bit longer, perhaps we might come to a slightly less stigmatizing understanding. Karl Barth’s notions of transcendence and relation give us a chance to puzzle over the strange person. I will argue that the more we puzzle over the strange person’s encounter with transcendence in the context of relation, the more difficult it will be to cast them aside as not belonging to the realm of the full human.
Let us, for the sake of argument, describe the strange person in terms of psychiatry. Ideally an argument could be made about mental illness in a way that includes different diagnosis. But here I will limit myself to bipolar disorder, hoping to suggest that if the person with bipolar disorder is shown to be emphatically fully human, the same may be said for people with different diagnosis. It is somewhat counterproductive for me to start with the construct of psychiatry, for in the end I wish to show limits to psychiatry. But psychiatry makes a good starting point in that to stay within its limits reveals these limits as limitations. Also, there is a great deal of insight within psychiatry which shouldn’t be ignored.
A manic depressive—that is, a person with bipolar disorder—is in a somewhat unfortunate position. There is something different about him or her which we can’t really ignore. This difference can be in plain sight or hidden. Wouldn’t it be a good way of describing a manic depressive to say that she is pulled away? Take the adolescent whose studies are interrupted by a mood episode. School is a kind of group activity, and the teachers and students are within a contained world. The manic depressive may start to pay attention to things which are not a part of this circumscribed world. There is a certain lure leading away from the circumscribed world. The manic depressive stops meeting the expectations of the circumscribed world. This world seems eventually prohibited to her. She is unable to participate in it.
She is pulled away from the world around her. But what is she pulled towards? In the experience of madness she seems to know a kind of negation of the circumscribed world she left. For, we must understand that the negation society and psychiatry makes cuts both ways. Psychiatry and society sees the strange person as ill or crazy. This is a negation of health and sanity. But the strange person sometimes will see the circumscribed world as other, or even unreal or wrong. We as society see the mentally ill person as wrong or sick or insane. But we as the ones called mentally ill may see the conventional world as wrong or unhealthy or violent. The mentally ill person is not just pulled away from the world, but is pulled towards another understanding which reframes life and the understanding of the circumscribed world.
Of course, there isn’t a single understanding in either direction. In the the direction of the conventional world, there is a multiplicity of understandings of what a human is, what life is, how to act etc. And in the direction of madness there is also a multiplicity of understandings. Bipolar disorder is dynamic. Manic depressives are famous for our tendency to have mood swings involving dramatic changes of behavior and value. But at an unusual level of abstraction, we can say that the mood episodes of mania and depression form a kind of unity. Bipolar disorder is called bipolar for the notion of mania and depression being opposite poles of behavior and experience. This is already quite a bit of an abstraction, for if you encounter a manic person, it takes discipline to see him as having slid toward one pole in a continuum. The same goes for a depressed person. We want to treat him like a non-manic depressive and take his behavior at face value and respond to it the way we would to someone whose starting point was our circumscribed world. But if we allow that they are pulled away, both by mania and depression, we understand this pulling away as one thing in a very abstract sense. This understanding is somewhat present in the psychiatric concept of bipolar disorder. It’s not two disorders. It’s one disorder. One thing is causing problems. Sometimes it causes trouble as depression, sometimes as mania. And both depression and mania are themselves diverse experiences/syndromes.
So we have the idea of a human who is set apart. She is pulled away. And there is an otherness to the strange person which works in both directions. She is other to convention and convention is other to her. And of course, the manic depressive tends to experience a kind of doubleness much of the time, knowing herself as other to the world yet also othering her own madness. A manic depressive in remission may identify with convention and other her disease. Yet she may at some level remember other perspectives she has experienced while “sick” and therefore feel that the world she is identifying with when she stigmatizes herself is not “her” or where she is to be found. She therefore neither belongs fully to the world nor to the regions of mind she has known while sick. But she may realize that really neither does anyone else. There is then a freedom that comes from seeing radically. The distinction “mentally normal—mentally ill” is cut in half by the insight of relation. Relation cuts through everything and becomes a point of orientation. The primal self-other distinction undercuts the relatively superficial world-madman distinction. And the distinction of self and other is a relation, not just a static fact. The categories of mentally ill and mentally normal are useful to an extent, but are undercut in the last analysis by our human relatedness. Our human relatedness is relatedness to each other and to God.
For Barth, humans exist in relation to God, in God relation to us, and our relation to each other. We are not defined by a set of traits but by being for God and for each other and by God’s electing to be for us. When we think of mental illness, this “for” is very important. The manic depressive is already set apart, but really isn’t he just set apart in a more conspicuous way? Aren’t we all set apart? The circumscribed world isn’t really any of our worlds. People vary, of course, but most seem to keep private and subdue a kind of irrational current that runs in them. The manic depressive dives in deeper, and sometimes reality bursts, but he dives in the same waters that we all swim in.
But the fundamental point is that this activity of depression and mania occur in a context. This context is described by Barth’s anthropology: we are for each other and for God and God is for us. This means the static concepts and categories of normal and mentally ill are undercut. The fundamental fact about the strange person is not that he has a certain diagnosis, but that I am related to her, she is related to God, and that she is related to me and God is related to her. For Barth, we can’t end our understanding with categories like healthy behavior and unhealthy behavior. Both are bracketed and negated. In The Phenomena of the Human, Barth reiterates his theme in The Epistle to the Romans. We have the idea of human life being put in brackets and negated. God is other. God is creator. Everything else is creation. Creator is distinct from creature. Really, quite simply, we belong to God as his creation. (Barth, 122)
Is it clear how this undercuts the categories of mentally ill and mentally normal? The circumscribed world is in fact circumscribed. That is not to say that it should be abandoned or even that it should be drastically modified. But it takes itself as more than just a circumscribed world. We know that it is circumscribed because of the creator creature relationship. How can human things not be circumscribed when they are at the very least less than God? God may be domesticated and used to support strict convention, but Barth emphatically is opposed to this idea. He is known for the idea of the infinite qualitative distinction and wholly other God who is the Primal Source and who is like a vertical line as opposed to the horizontal line of time. This is included in his doctrine of God. But also in his doctrine of the human, in the idea of relatedness, we have another antidote to the poison of stigma. Radically related, we can’t be boxed into neat categories. The person with bipolar disorder is just as much in relation as a normal person. Because we are radically related, and always in relation to God as other as well as to our fellow human as other, we can’t circumscribe relation so that it ends when someone doesn’t have certain traits. And we can’t say relation begins when we do have certain traits.
There is a certain idolatry that is possible in regarding the mentally ill. If we take the circumscribed world to be divine, emphasizing the divinity of humans, rather than the deity of God, we may think that the mighty fortress of our society is the last word. Certainly we don’t want to advocate for the deity of the crazy person. We don’t want to create an idol out of human society or out of the crazy person who stands in opposition to it. When we pathologize, we run the risk of moving simultaneously in the other direction. We may pathologize the strange person and at the same time idolize psychiatry. We may push away and at the same time feel we receive God’s favor for doing so. But the pathology and the idol are human creations. The human is a creature created by God. So in Barths’ anthropology we are creatures. No matter how convinced we are of our human inventions, we are always already in relation to a wholly Other who is the true source of creation.
With this in mind, we can see differently our manic depressive mentioned above. She is pulled away from the circumscribed world. She is other, and to her the world is other. She becomes no more or less human because of being pulled away toward madness. The more traits we assign her: bipolar, crazy, etc—he more we stigmatize—the more we idolize. The transcendence the mentally ill person faces—the “other” than pulls away the strange person—is not any more other than anything else. Otherness is at the center of human creatureliness. We are inescapably in relation.
Just as Barth is critical of existentialism’s focus on frontier experiences as a way of understanding fully the human condition, we can say that the human isn’t really revealed in our relation to madness. Madness can be seen as a sort of extreme frontier experience. The depressed person as well as the manic person are faced with a kind of transcendence, this thing that has pulled them away from the circumscribed world. The nature of this transcendence is unclear, just as, for Barth, the nature of transcendence in frontier experiences is unclear. Is the crazy person in touch with God? The Devil? But Barth uses the word “game” in his discussion of existentialism. (Barth, 119). Couldn’t we see psychiatry as a game in the same sense? The point is that we are focused on the phenomena of the human when we work with this transcendence, which is built into the human and not distinct from us the way God is. (Barth, 119)
Here I am freely relating mental illness to frontier experiences. But is bipolar disorder more (or less) than a frontier experience? Is it possible that the manic depressive somehow has a divine experience? Or an experience of the divine? Barth believed God can’t be experienced, of course, but when we look at the question we see that if we try to divinize certain people or experiences, we are doing the same thing as pathologizing and stigmatizing. We are not understanding the human properly, or at least not along Barthian lines. No matter what we call the transcendence away from the circumscribed world, we cannot see the human who transcends as fundamentally defined by it. The person is not fundamentally a sick person. Nor is he fundamentally a holy person. No matter what strange behavior he has exhibited he remains a related creature. He may have caused lots of problems or glowed with angelic light. He may have been miserable or ecstatic. He may have come across as disturbing or come across as wonderfully beneficent. But these facts have not bearing on who he is.
Life simply involves transcendent experiences, problems, strangeness, angelic energy, misery, ecstasy, disturbance and beneficence, among many other things. The manic depressive may have more extremes than most people, and his mind may feel very different because of an encounter with a transcendence that is somewhat rare. He may act differently and may not fit into the world around him. But the things that make him different are all within the realm of the creature. He is still defined by his relation to God and God’s relation to him and his relation to his fellow human. So in this sense, the wild mood swings of a manic depressive are not constitutive of his identity. His identity comes from God’s relation to him. The apparent difference of the mentally ill person is a really a distraction from his nature.
This is true for two reasons. The bipolar person is a human regardless of his traits. Also, the person labeling him is not in a position to set limits on the human. The labeler, the stigmatizer, the pathologizer, is not above creation in a position to label it and isolate parts of it. The labeler is also a creature and therefore limited. The labeler derives his humanness not from belonging to a circumscribed world, but by being in relation with God and fellow human.
This is why, when it is understood precisiely, psychiatry can operate as its own enterprise, but when it is understood less carefully, it can be destructive. The concepts of psychiatry’s limited gaze filter into a society that has a vested interest in setting limits on the human. In a kind of darkness, a person is called mentally ill and their humanity is forgotten. In that moment of labeling the labeler forgets their own humanity. God is forgotten. But God doesn’t forget any of us. Grace abounds.
Barth, Karl. Church Dogmatics III.2 The Doctrine of Creation. (New York: T and T Clark, 2010)Barth Stigma Human