Thursday, July 31, 2025

No more normal ... and how science fiction handles mental illness

My current reading is "No more normal" by Dr Alastair Santhouse, a fascinating and very interesting discussion of various issues connected with mental health, and how our view of these issues has changed over the past century. Fortunately, I haven't really come across most of the issues raised in the book, although I identify with the rhetorical question, At what point does a low mood tip over into depression? I was very unhappy from the autumn of 1977 through to the spring of 1978, but was I depressed? I thought so, but psychiatrists thought not.

I don't want to write about most of the issues raised in the book, but rather something that seems somewhat tangential and amusing. Santhouse writes: I often used to wonder how mental illness would be treated in the future. Generally, it was a topic ignored by science fiction writers. Inasmuch as it was covered in the Star Trek world, there were two broad approaches. The main theme seemed to be that mental illness was a quaint relic of a near-forgotten past, like money or petty ambition. I imagine the assumption was that the social utopia that led people to the stars also cured the world of mental illness. The second approach was the use of a telepathic, albeit human-looking woman from another planet, who could sense emotion and then offer counselling. [Chapter 13]

Robert Silverberg touched on this topic several times: sometimes the solution would be a 'happy pill', and sometimes an expulsion of the self and its replacement by another 'self' (e.g. "The second trip"). But I think that the best treatment comes from the novella "How it was when the past went away" (which after a long search I found in the collected stories volume "To the dark star"). One thread of this excellent story is concerned with Nate Haldersen. A dialog with a diagnostic computer reads as follows:
“You have been suffering from social displacements and dysfunctions whose origin, Dr. Bryce feels, lies in a situation of traumatic personal loss.” 
“Loss of what?” 
“Your family, Dr. Haldersen.” 
“Yes. That’s right. I recall, now—I had a wife and two children. Emily. And a little girl—Margaret, Elizabeth, something like that. And a boy named John. What happened to them?” 
“They were passengers aboard Intercontinental Airways Flight 103, Copenhagen to San Francisco, September 5, 1991. The plane underwent explosive decompression over the Arctic Ocean and there were no survivors.” 
Haldersen absorbed the information as calmly as though he were hearing of the assassination of Julius Caesar. “Where was I when the accident occurred?”
“In Copenhagen,” the robot replied. “You had intended to return to San Francisco with your family on Flight 103; however, according to your data file here, you became involved in an emotional relationship with a woman named Marie Rasmussen, whom you had met in Copenhagen, and failed to return to your hotel in time to go to the airport. Your wife, evidently aware of the situation, chose not to wait for you. Her subsequent death, and that of your children, produced a traumatic guilt reaction in which you came to regard yourself as responsible for their terminations.”

The guilt arising from this situation caused Halderson to become severely depressed; when introduced in the story, he says that he hasn't left his hospital room for two and a half years. 

When the sensors discovered him slipping below the depression line, ultrasonic snouts came nosing up from the recesses of the mattress, proximity nozzles that sought him out in the bed, found the proper veins, squirted him full of dynajuice to cheer him up. Modern science was wonderful. It could do everything for Haldersen except give him back his family.... 
“How can I make a conscious effort to forget something? Tim, Tim, isn’t there some drug I can take, something to wash away a memory that’s killing me?” 
“Nothing effective.” 
“You’re lying,” Haldersen murmured. “I’ve read about the amnesifacients. The enzymes that eat memory-RNA. The experiments with diisopropyl fluorophosphate. Puromycin. The—” 
Dr. Bryce said, “We have no control over their operations. We can’t simply go after a single block of traumatic memories while leaving the rest of your mind unharmed. We’d have to bash about at random, hoping we got the trouble spot, but never knowing what else we were blotting out. You’d wake up without your trauma, but maybe without remembering anything else that happened to you between, say, the age of fourteen and forty. Maybe in fifty years we’ll know enough to be able to direct the dosage at a specific—” 
“I can’t wait fifty years.” 
“I’m sorry, Nate.” 
“Give me the drug anyway. I’ll take my chances on what I lose.” 
“We’ll talk about that some other time, all right? The drugs are experimental. There’d be months of red tape before I could get authorization to try them on a human subject.”

The point of the story is that several antisocial subjects dumped into San Francisco's water supply various chemicals that destroy parts of one's memory; different people in the story lose different parts of their memory (Halderson forgets the adultery and so loses his guilt - he becomes a 'free' man, whereas Dr Tim Bryce seems to be fine - except that he forgets everything about his wife). There are those who drink bottled water and so were not effected. Between a coalition of people who lost some memories but not all, Dr Bryce and others manage to put the city back together again.

Returning to real life, I am sure that Dr Santhouse would be pleased to know about these amnesifacients but he would be worried about their non-specificity. Maybe in the future there will be developed such drugs that can work on specific memories - but how could one program them? My memories of late 1977 lie in some part of the brain, whereas someone else's memories of the same period could lie in a different part of the brain. Not only that: when I access those memories, they are brought into short-term memory and deleted from long-term memory; when I stop remembering, they either get transferred immediately to somewhere in long-term memory (almost certainly not the same location) or they get transferred at night when I sleep. 

Santhouse writes: Even if science fiction has failed to conjure a convincing future psychiatry, it is possible for us to draw on our knowledge of recent technological advances in physical medicine to imagine their application to conditions of the mind, understanding that mental problems originate or are marked within the brain. Where exactly though? Future technologies may have the answers. We may be able to follow thinking processes in the brain, to ‘see’ depression, anxiety and psychosis and prove that they are real and not, as some critics of psychiatry maintain, socially constructed artefacts.

Maybe I'll be able to find an address for Dr Santhouse and pass him the Silverberg reference. This episode only goes to show that Star Trek does not speak for all science fiction, but rather for only a very small part. 



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