Social Question

tups's avatar

What is the purpose of the concept "sanity"?

Asked by tups (6709points) July 20th, 2012

People are divided into groups. There are sane people and there are insane people. There are all kinds of mental illnesses. I often wonder how we can call some people mental ill and some people are not mental ill. How can we know what the normal mental state is?
Maybe we are all insane. Maybe the sane people are really the insane people, and the so-called insane people are really the sane people.

People are diagnosed with all kinds of illnesses and many of them are giving medications. But why is it not okay to be in a certain mental state? Of course I can understand that it is not nice to be in a depressed state. There’s a lot of states that it’s not nice to be in, of course.
How can we know that the things that schizophrenic people see are not real? Maybe they are just as real as the things we all se, but these things are only visual to some people?

Who decided what’s normal and what is not?

I don’t know if I make sense, but if you think you have an idea about what I’m talking about, feel free to answer.

Just to make clear, this does not have anything to do with my opinion about these things, only my curiosity.

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30 Answers

Coloma's avatar

Truly mentally unwell people never question their sanity. If you question it, you’re more likely neurotic rather than insane.
There are plenty of mentally unwell people that are functional but not mentally/emotionally healthy.
Neurotics blame themselves and carry around too much unwarranted guilt and mentally/emotionally unhealthy people always blame others and take no responsibility for their contributions to problems in their work and relationships.
Quirks, habits and preferences do not make people mentally unwell.

Chronic lying, manipulation, violent behaviors, emotional outbursts do.

poisonedantidote's avatar

Everyone is crazy, it just depends on the flavor. At least that is my opinion after almost 30 years of living on this planet.

Some people may look normal, but if you get to know them long enough you soon start to find crazy ideas and complexes going on.

I have always seen “normal” as a kind of measure for what is “average” or a measure of what the majority usually do. With this in mind, it would not be unreasonable to suggest that “normal” is a load of crap based on the illusions and bullshit we all project as we go about our day, pretending to be normal. Never letting on what we really think, or what we get up to in private.

The so called crazy ones are probably just the ones who get caught or stop hiding it.

I know people will disagree, but before you do, remember that idea you had? and that thing you did when you was alone that time? yea… not so normal after all eh? hehe.

Aethelflaed's avatar

Being the pedant: “insane” and “sane” are legal terms, and not synonymous with mental illness.

The reason for the concept of mental health is power, and a way to differentiate between good people and bad people. People in power decide what’s normal and what’s not.

Mariah's avatar

I feel that the brain is just another organ and the purposes of diagnosing mental illness are basically the same as the purposes of diagnosing physical illness. To determine a factor that might be causing a decrease in quality of life, with the hope that something can be done about it.

That’s not to say that mentally ill brains are somehow inferior to “healthy” brains and we’re trying to assimilate them for that reason. Just want everyone to have a decent quality of life. If someone’s mental illness isn’t getting in the way of their quality of life, there’s no need to treat it.

Coloma's avatar

Well..I think it’s safe to say that the Colorado shooter was, obviously, mentally unstable.
I don’t think it’s possible to be severely mentally unhealthy and NOT have it effect your life and relationships. That’s an oxymoron IMO.Most mentally ill and emotionally unwell people wreak havoc upon innocent people, whether this is hurting others through run of the mill bullshit behaviors, or going completely off the deep end like this lunatic did.
I think the terms sanity/insanity should be replaced with healthy/unhealthy.

Mentally and emotionally healthy people do not harm others, nor themselves to any large degree, bottom line.

Ron_C's avatar

My therapist gets upset when I refer to myself as crazy. but I haven’t heard her come up with another description of my problems. I don’t mind really. My favorite aunt had a certificate that she proudly hung on her wall. It was the release from her psychiatric hospital Her proof that she was no longer crazy. I haven’ got one of those yet.

janbb's avatar

This is a hard question for me to answer because one of my closest friends is mentally ill and is one of the most caring, honest, giving people I know. I don’t think it has anything much to do with how you interact with other people necessarily – there are as many ways of being mentally ill as there are ways of being a “sane” (whatever the fuck that is) person. I think the line is somewhere about whether you are able to carry out what are deemed to be the tasks that allow you to function in society. I think most of us have times when we come pretty close to crossing that line for ourselves.

wundayatta's avatar

First of all, @Coloma, you are very mistaken about your idea that “Truly mentally unwell people never question their sanity.” I have a diagnosis of mental illness, so I was truly mentally unwell. I happened to agree with that diagnosis. In fact, I’d figured it out before I went to the shrink. So your statement is demonstrably false. Please give up that idea. It is quite possible for people who are mentally ill to be acutely aware of what is going on.

The concept of sanity is, perhaps as @Aethelflaed said, a legal term. But it is also used in popular speech, as well. There, the meaning is less specific, and I think that there are so many different ideas about what sanity is and isn’t that I seriously doubt you could get much consensus on it.

Mental illness is defined by the psychiatric profession. They have a huge manual that describes all the mental illnesses, and an update to that manual is due out in the next year or two. It is a controversial process, however, as some people propose new diagnoses (such as sex addiction) and others debate whether it belongs in the official diagnostic manual or not.

You should see the idea of mental illness statistically. There is a variety of behavior. If we create some scale of behavior, people will be distributed over that scale. We can draw a line at some point, and say that one percent or five percent or ten percent or twenty percent of all people are over the line, and are thus exceptional in some way.

Typically, we talk about the top five percent or one percent (stop me if you’ve heard this elsewhere). As a statistician, I know that almost five percent of people are three standard deviations from the norm (both higher and lower than the norm). Anyway, it is fairly common for us to say that people who are three or more standard deviations from the norm are abnormal. That’s about one in five people.

But, if you’re in the business, and you make money because people need help, it can be to your advantage to have a definition of abnormal that includes many more people: say two standard deviations from the norm. Or about 32% of the population. Interestingly, psychiatrists like to estimate that about one in five, or 20% of the population suffers from one mental illness or another.

Psychiatrists seem to be winning, because more and more people are being diagnosed with problems that could benefit from psychiatric and therapeutic care, and the demand for therapists greatly exceeds the available supply.

The concept of sanity is to help us sort out who behaves normally and who doesn’t. It helps us sort out who needs help and who should help themselves. It helps us sort out whose mental health care insurers should pay for and whose is “recreational.”

The devil, of course, is in the details: in defining behavioral characteristics, and then deciding which ones are normal and which ones need help. To do that, we have to decide what is acceptable—which is a matter for social groups to work out in any number of flexible ways.

Insanity can hurt society. In some ways, it is easy to say what insanity is. It’s when people run around killing others in a socially unsanctioned way. It’s when you cause harm to others in a socially unsanctioned way. But how much harm?

Is some physical violence acceptable? Is any sexual harm acceptable? What about emotional harm to others? If I kill myself, does that harm others? How so? Is it unacceptable?

And what about unhappiness? What about mental pain? Should that be unacceptable?

You see, here there is a difference, perhaps, between unwanted mental pain, and beneficial mental pain. Depression can kill. Let’s consider a person who wants to die because they see no other way to end the pain. Most people would say that’s wrong. We should force them to live and see if we can help them reduce the pain.

But what if a person wants to feel the pain because even though it makes them want to die, it also gives them compassion. It helps them understand more about other people’s pain. It helps them feel the intensity of life. It makes them feel somehow like their life matters as at the same time it makes them feel worthless.

What if it’s really complex? Good and bad. Dangerous and rewarding? We don’t stop building jumpers from jumping off buildings. We don’t stop other daredevils. So what if a person’s daredeviltry is mental? What if depression is what they joust with because even though it hurts them, they also see a benefit from it? Is that mental illness?

And consider this, too. Medications can change the way you think. Medications can take away depression. You are a different person when you want to die compared to when you don’t want to die—indeed, can not even consider taking your own life.

Which you is you? What does it mean when you can think one thing on one day, and then the next day you literally can not think that thought? Due to meds? Who are you if chemistry changes the way you think? Indeed. Who are we all?

Sanity is different depending on who you are talking to: a lawyer, a doctor, a judge, a scientist, a construction worker, or indeed, anyone else. Sanity is something that everyone either does or does not have an opinion about. Usually, though, sanity is a kind of social consensus that has more to do with building social consensus than it has to do with the facts of an individual case. That’s why people can condemn others in the paper, but when the person comes to trial, they get exonerated, and no one understands how this is possible.

I’m crazy. Not insane. Crazy. I have a certificate to prove it. I work daily to say what I think and not censor myself. Sometimes I annoy people. Sometimes people think I’m wise. I like being thought to be wise, but I’m not going to say the conventional thing in order to try to get a reputation. Or I’ll try not to, anyway. I doubt I’m immune to the pressures of the community.

Sometimes I’m silly. Often, people don’t get that I’m being silly online. We all know that’s a big danger. There are a bunch of stiff shirted people here that I’ve pissed off quite a bit, as a result. So it goes. I don’t want to hurt them, but I don’t want to jump through hoops to try to be acceptable, either. That’s kind of crazy.

It’s also kind of crazy to want intensity, whether it feels good or bad. I’d prefer good, but if I can’t get good, I’ll take bad. I’d rather be in danger of suicide than to be the same all the time. I need my extremes. I think that most people wouldn’t choose that much intensity.

But I don’t think being crazy makes me insane. And I don’t think being mentally ill makes me mentally ill, even though I totally agree with the diagnosis. I think bipolar is a beneficial thing as well as a hurtful thing. But I don’t expect anyone who hasn’t had the experience to really be able to believe me. It’s too foreign and scary and we label it as mental illness and insanity and those words carry lots of baggage.

So what else is new?

Aethelflaed's avatar

@wundayatta Mental illness is not defined by the psychiatric community, nor is it used within the DSM. Mental disorders are, but start asking people if things like sleep apnea and dyslexia qualify as mental illness, and it becomes clearer how there is no set definition of mental illness. And to be entirely fair to psychiatrists, I’ve heard many of them argue in favor of people just chilling out and not wanting diagnoses for normal parts of life.

wundayatta's avatar

@Aethelflaed I think that’s right. One of my main points is that this is about the use of language, and the specialized ways various communities use the same language. The thing is, we need to know both how these communities use language (and your point is helpful here), but also to think about what the social understandings of these various words are, as well.

Aethelflaed's avatar

@wundayatta I would agree. That’s actually why I have so little patience for “mental illness” – because so many people use it in so many different ways, to comment not only upon which disorders are considered “illness” but how they view the causes of those disorders and what to do with those who have them. It’s endlessly frustrating.

Coloma's avatar

@wundayatta Point taken, however, there is some truth in my statement.
The most unhealthy people I have ever known have NEVER even remotely entertained the idea that they were responsible for the chaos they caused.

Allow me to rephrase that with many unhealthy people never question their own sanity.

Aethelflaed's avatar

@Coloma Are you perhaps defining who is unhealthy and who isn’t by those who do and don’t wonder if they are responsible for their lives?

Coloma's avatar

Actually this is well documented in much mental health literature.
The personality disordered person is infamous for always blaming others.

@Aethelflaed Yes, I guess that would be fair to say.
Shifting the blame is hallmark of emotionally unwell people.

janbb's avatar

@Coloma That is only one type of mental illness or personality disorder; there are also many mentally ill people who blame themselves unmercifully.

YARNLADY's avatar

Ever since the beginning of mankind, we have coined words from concepts. Every group of people that has ever existed has been able to understand the concept that some people are different than the rest. Lately, the words sane and insane try to describe that difference.

There is no . People in power decide what’s normal and what’s not.

Aethelflaed's avatar

@Coloma But you’re conflating “diagnosed personality disorder” with “mental illness” and “mentally unwell”. Bipolar, depression, ADHD – none of those are a personality disorder. And there are lots of people who would not qualify for a mental disorder diagnosis much less a personality disorder diagnosis who somehow manage to not take responsibility.

Dr_Lawrence's avatar

Professionals in the mental health research and treatment field do not consider “sanity” to be a meaningful or useful term. Labelling people as sane or insane is more harmful than it is of any clinical or medico-legal use.

The legal community may define it in terms of the ability of an individual to understand and deal with the consequences of their behaviour.

Mental illnesses are operationally defined by identifying clusters of observable (or inferred) behavioural features and their frequency of occurrence in the general population. This is how the Diagnostic and Statistical Manual (DSM) attempts to define things. While considered useful, there is much debate among different segments of society about the value or purpose of this approach.

flutherother's avatar

Some mentally ill people suffer from skewed perception. They are as reasonable and logical and rational as you or I and they have the same emotions. But the world they inhabit is quite different and quite unimaginable to ‘sane’ people. Inside a crazy person you might well find a very lonely very sane individual struggling to survive.

Sunny2's avatar

The purpose of the term is to understand and recognize those who have specific symptoms. My understanding of insanity is that the individuals are unable to distinguish reality from unreality. Their 5 senses may tell them that something is true, when it is not. They may hear voices, see things that aren’t there, smell odors that no one else smells, feel insects on their bodies when they are not there and the like. When they get well, they don’t have these hallucinations. Most psychoses are treated with medication.
Personality disorders are not included in a diagnosis of insanity. They are called neuroses. Other medications can help them too. Psychotherapy may also be helpful. Crazy is NOT a technical term.

Coloma's avatar

@Sunny2

Well said. I agree with your clarification.
Mental illness takes many forms and varies to a large degree. It really comes down to degree of dysfunction. Eating too many cookies as a neurotic person is not the same as a complete psychotic break from reality or being a sociopath, which is not considered insane. lol

tups's avatar

Thank you for all of your answers, people. It’s always interesting to read your thoughts and opinions.

GracieT's avatar

I’m BiPolar but I also am the proud benificary of (sarcastic comment!) a Traumatic Brain Injury. Am I sane? Like @janbb said I blame myself
for both. Would I be classified
as mentally ill? I, along with many other people dislike the
destinction.

wundayatta's avatar

Isn’t it kind of a joke to be classified as mentally ill? I don’t think we’re all that different. Yet some shrink somewhere decided that we’re different enough to get a label, and all of a sudden, if people know, it makes a huge difference. That’s why I don’t tell people, except those who are likely to understand.

YARNLADY's avatar

@wundayatta It is counter-productive to use the pejorative name shrink when talking about a professional medical provider. It is no joking matter to people who are desperately in need of help.

They perform a valuable service. The psychiatrists do not sit around and make up labels. They diagnose issues in people who are having so much trouble trying to live their lives that they have to ask for help.

The help the patients receive is dependent on the standards that the psychiatric professionals have come to recognize and publish in a journal as a guide so their members can help their patients.

wundayatta's avatar

Well, I don’t have such faith in psychiatrists. I’ve only been to one, so this doesn’t affect me personally. But I know people who have gone to five and have five different diagnoses and five different drug regimens.

The DSM IV and V are jokes. You have all these highly trained people and they can diagnose the same way. They are adding things to the DSM V… or they might add things that seem absurd. And I’m sorry, I’m not giving away my power just because they are the supposed experts. If they haven’t had bipolar, then I think there’s a good chance that I am more an expert than they are.

I have seen many psychiatric patients get more help from group of other crazy people than they are able to from the health care system. Perhaps that’s because we don’t charge, and the people that people with no money can see aren’t all that good. Certainly, they are moving around all the time, so indigent patients get little continuity of care.

I feel fine using the term “shrink.” I think it is important that mental patients understand their doctors are not necessarily right. I think it is important they understand they are entitled to be treated with respect, not just ignorant crazy schmucks.

It is important that there is a rebalance of power in the mental patient/psychiatrist relationship. Shrinks need to listen more. They need to respect their patients more. Some do a good job, but far too many are really dropping the ball all over the place. Just attend a dbsa meeting in your area and ask them about this. You’ll get an earful.

Ron_C's avatar

Here’s the deal. I was just released from a mandatory lock up initiated by a psychiatrist that talked to me for less than 15 minutes, The process was totally involuntary in my part. My rights, shoe strings, wallet, belt, and even I pod were confiscated. They then tried to do a “skin search” which I fought vigorously. The even took away my cane. Iost my rights for 4 entire days for no reason other than the opinion of one sub-standard shrink. Then I had to prove that I was sane before I was released. I was also told that anger was part of “my disease”. It was a true nightmare. Evidently, it hurts the psychiatrist’s feelings if you call her patients nut cases. That got me thrown out of the office.

Anyway, I’m free now, even though to the head shring wanted me to “volunteer” to spend a couple extra days. That’s the last time any of those shrinks see me!

The point is that sanity is a nebulous thing and the definition of sanity is purely subjective. If you let the wrong people judge you, there is no way to prove you’re sane because,at this time, sanity is purely a subjective choice made by professionals with their own problems

wundayatta's avatar

This will happen. Sometimes, for whatever reason, a psychiatrist will just get it wrong with a given patient. Things might get antagonistic, and the psychiatrist will interpret this as a sign of mental illness, instead of a reaction to the psychiatrist. This happens more often with inexperienced psychiatrists who feel insecure about what they are doing.

Unfortunately, supposedly mentally ill people suffer as a result. I’m sorry you were involuntarily committed. Personally, I don’t believe in involuntary commitments. I think they do more harm then good, even when warranted. In the long run, trust between patients and doctors is more important to the long run success of treatment, and an involuntary commitment can easily keep a patient from getting treatment then need for a long time due to the established mistrust.

I’m sorry you got committed. I hope you can see that not all psychiatrists are that incompetent. They can and do help. You need to find one you can work with, @Ron_C. One you can trust. And trust me, I know how many asshole shrinks there are, out there. I know how many incompetent ones there are. But they are people, like we are, and make mistakes, and just because this one made a mistake, doesn’t mean you can’t find a good one. Although, if you are on Medicaid, I know it can be really hard to find a good one who accepts Medicaid.

Ron_C's avatar

@wundayatta I hope you got the message that I sent.

I have only met three psychiatrists in my life, once when I was young and had a claustrophobic reaction. I remember that the guy had a lot of nervous ticks and he made me think that I was on the wrong side of the desk.

The second was when I was at our local hospital. I connected with him and felt I could trust him. Unfortunately he doesn’t take private patients, he only works in the hospital.
The third was my VA psychiatrist. I never felt that she understood what I was saying. The last time she proved it. The notes she took, and used to commit me, had little bearing with what I said during my short 15 minute interview.

1 out of three is pretty bad odds I need to find someone to continue my meds but don’t ever want to talk to my last psychiatrist. If I don’t get my meds continued, I’m pretty sure that will be the end of me. Some dilemma huh?

wundayatta's avatar

It is a dilemma that many of us face. I don’t think we have a choice but to persevere and find a psychiatrist we can trust. The odds should probably be in your favor now, since you’ve already met so many you can’t trust. We can hope, anyway.

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