How Mad Studies and the Psychological Humanities are Changing Mental Health: An Interview with Narrative Psychiatrist Bradley Lewis

Bradley Lewis works at the intersections of medicine, psychiatry, philosophy, the psychological humanities, mad studies, and disability studies, balancing roles as both a humanities professor and a practicing psychiatrist.

Lewis earned degrees in psychiatry (MD) and Interdisciplinary Humanities (PhD) from George Washington University, and he currently holds an associate professorship at New York University’s Gallatin School of Individualized Study. He also has affiliations with NYU’s Department of Social and Cultural Analysis, the Department of Psychiatry, and the Disability Studies Minor. Additionally, he serves on the editorial board of the Journal of Medical Humanities.

His books include Moving Beyond Prozac, DSM, and the New Psychiatry: The Birth of Postpsychiatry, Narrative Psychiatry: How Stories Shape Clinical Practice, and Depression: Integrating Science, Culture, and Humanities. He has two books forthcoming: Experiencing Epiphanies in Literature and Cinema and a co-edited Mad Studies Reader. His writing offers unique insights into the hegemonic foundations of mental health and champions the role of narrative in therapy.

His work also actively bridges the gap between academia and on-the-ground initiatives. A founding member of the Institute for the Development of Human Arts (IDHA), Lewis champions a paradigm shift in mental health by facilitating collaboration between advocates, service users, and clinicians.

His profound appreciation for the humanities guides his exploration of mental health, often through the lens of art and literature. By analyzing the lives of figures like Vincent Van Gogh or dissecting Chekhov’s narratives, Lewis encourages us to rethink and expand our understanding of psychological experiences.

Join us as we explore the philosophical foundations, practical implications, and transformative potential of his work.

 

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Justin Karter: You live at a pretty unique intersection with medicine and psychiatry on the one hand and the humanities, philosophy, and disability studies on the other. How did you find yourself walking these two roads simultaneously?

Bradley Lewis: Well, I guess it goes back to — I originally trained in medicine and psychiatry. I did my residency in psychiatry in the 1980s. It was a time when psychiatry was toggling back and forth between the biomedical model and the psychoanalytic model. I was at George Washington University, and our department had the last standing psychoanalytic chair.

I was very impressed with how the two worlds of bio-psychiatry and psychoanalysis created wholly different ways of understanding. In one, you look for causal, mechanical understandings and then apply biological interventions. The other is much more about humans, more meaning-oriented, and it’s through talking.

I found this dichotomy so fascinating, and it seemed nobody in psychiatry was really discussing it. So, I ventured across the campus and began taking classes in philosophy, literature, the arts, and anthropology. I wanted to grasp what it meant that these two distinct ways of making sense existed in psychiatry. I believed that by turning to the arts and humanities, we could expand our understanding of this range of possibilities. As a result, I pursued a PhD in Interdisciplinary Arts and Humanities.

I felt a problem with psychiatry was that it was over-disciplined. Even psychoanalysis, it seemed, was narrow. People mainly referenced other psychoanalysts. It was a world where there were clear foundational figures, and most of the readings in psychoanalytic classes were from other psychoanalysts. I wanted to step outside those confines. Hence, I pursued this Interdisciplinary PhD, and I’ve been bridging these domains ever since.

Interestingly, there are a few interdisciplinary academic programs out there. New York University has one called the Gallatin School of Individualized Study. It’s for people who feel that while depth of discipline is crucial, we have many specialists and not enough individuals connecting the dots across fields. Gallatin is a place that values this. I joined their faculty, and on one day of the week, I practice psychiatry.

 

Karter: It seems that one of the clear benefits of your interdisciplinary training, as evident in your work, is the ability to view psychiatry through the lens of other disciplines. This approach situates the diverse ways of thinking in psychiatry within broader ideological and political movements. I’m particularly drawn to your work on post-psychiatry. Could you expand on how you’ve come to conceptualize what post-psychiatry is? Furthermore, how does this interdisciplinary and philosophical approach allow us to perceive psychiatry and the mental health fields from a unique perspective?

Lewis: During my PhD in Interdisciplinary Arts and Humanities, post-structural theory and postmodern philosophy were very much the common languages. Interdisciplinary thinkers like Foucault, Derrida, Lyotard, and Julia Kristeva were seen as having insights relevant to many disciplines. I felt that their perspectives were incredibly pertinent to psychiatry.

Rather than viewing psychiatry as a modernist discourse, striving continuously towards an objective truth, postmodern theory encourages us to perceive psychiatry as a means of formulating useful meanings to navigate the world. This perspective emphasizes not just the meanings themselves, but also the individuals involved in creating them. It raises questions about power dynamics: Who gets to participate in this meaning-making process?

This is evident at the point of service, when a patient might be asked if they prefer electroshock therapy, psychoanalysis, or family therapy. Moreover, it probes deeper, asking who has a voice in shaping the foundational knowledge of psychiatry. I believed that postmodern theory could broaden psychiatry’s vision, allowing it to transition from a singular viewpoint to a multi-lensed perspective. Thus, post-psychiatry aims to establish the foundation for such an interdisciplinary approach.

 

Karter: From this perspective, psychiatry is not just seeking the truth about the cause of mental illness; it’s actively engaged in the process of interpreting mental distress and determining who gets a say in that interpretation. Post-psychiatry introduces these questions to the field. So, when we view psychiatry through this lens, what answers emerge? What do we discern about psychiatry and the mental health fields when we question the nature of the meanings they produce and for whose benefit?

Lewis: Well, I think the first thing that becomes apparent is the tremendous diversity of perspectives and how the modernist logic – that one view is correct while all others are mistaken, or one holds the truth while others are myths – doesn’t quite stand up. Once you acknowledge that no single perspective is inherently superior, you’re forced to consider how decisions are made.

Currently, these decisions often rest with those in positions of power. This insight fundamentally challenges the established structure of psychiatry, arguing for the inclusion of a broader range of voices. However, post-psychiatry doesn’t necessarily dictate where psychiatry should head or its final form. It doesn’t claim the mainstream is the wrong path, but rather that it isn’t the only valid one. It doesn’t denounce checkers as a game but argues it’s not the ultimate game. The emphasis shifts to inclusivity and ensuring fairness within this diversity.

 

Karter: One challenge I’ve encountered in my work is balancing a critical, overarching viewpoint of the role mental health fields play with the tangible impact on individual client interactions. Your work on narrative psychiatry intrigued me, particularly how you’ve bridged post-psychiatry and critical psychiatry with your actual practice of psychotherapy. Could you elaborate on this? How does narrative psychiatry shape your clinical practice? And how might your approach differ from someone not influenced by narrative theory or a post-psychiatry perspective?

Lewis: Indeed, I find narrative theory immensely helpful. It distills complex philosophical issues like language and power, grounding them in the tangible realm of available language options we use to narrate our stories.

When confronted with a mental difference or distress, we lean on narrative tools to articulate our experiences. Key among these tools are metaphor, plot, character, and point of view.

Metaphors, in particular, are intriguing. Many models describing mental differences hinge on foundational metaphors. Terms like “broken brain,” “childhood trauma,” “unresolved grief,” and “family dysfunction” come to mind. Then there are also the more celebratory metaphors, likening someone to an artist with heightened sensitivity, attuned to nuances others might miss. These metaphors help us frame our past, interpret our present, and envision our future.

In mainstream settings, there’s often an unconscious reliance on these metaphors to guide understanding. For instance, the prevalent “chemical imbalance” narrative might lead to recommendations like medication. It becomes a default narrative, often adopted without deeper reflection.

By incorporating narrative theory, the therapeutic process becomes markedly collaborative. The individual, whose life and story are central, assumes a pivotal role in shaping their narrative. This approach delves into the specifics of an individual’s life, juxtaposed against broader philosophical frameworks of post-psychiatry. It’s about discerning how best to structure one’s life journey.

 

Karter: I’m curious. When you’re working with a client who has latched onto a metaphor, like the “broken brain” metaphor — which holds considerable cultural sway and is often endorsed by the psychiatric establishment and even pharmaceutical companies — how do you approach it? If you believe their adherence to this metaphor is hindering their progress, how do you introduce alternative metaphors or suggest a more nuanced understanding, especially when such a metaphor has become integral to their self-conception? How do you handle this in practice?

It really comes down to a dialogue, a conversation. Often, the key decision is choosing between a pathological metaphor and a more celebratory one. Mainstream perspectives, whether they’re biological, psychoanalytic, or cognitive-behavioral, usually imply something is ‘wrong’ or ‘broken’ that requires fixing. But a celebratory or affirmative model views these deviations from the norm more as gifts than dysfunctions. These ‘gifts’ often revolve around heightened sensitivity or profound yearning.

Such sensitive individuals frequently clash with societal norms, leading to advice like “see a therapist” or “take medication.” However, we don’t advise figures like Martin Luther King to be less sensitive to injustice, nor would we tell spiritual leaders to suppress their profound insights. Artists, too, are celebrated for their heightened sensitivity.

The fundamental question then becomes: Are we overly pathologizing this trait? Or is it a form of sensitivity that, though not always comfortable, offers a depth of understanding and perception that many might overlook? Recognizing this sensitivity or yearning doesn’t invalidate the challenges they bring, but it reframes them, moving from seeing them as purely negative to potentially insightful and transformative.

 

Karter: From this viewpoint, it seems that the biomedical metaphor in psychiatry could marginalize or even pathologize political dissent. Your work in madness studies suggests it holds political implications, challenging psychiatry to be more receptive to critiques from service users, peer specialists, social activists, and journalists, like those of us at Mad In America. Could you elaborate on the role of madness studies and how it might pave the way for more democratic practices within psychiatry?

Lewis: Absolutely. Mainstream psychiatry, as illustrated by platforms like Mad In America, has often been a point of contention. Many individuals have felt harmed by traditional psychiatric practices and have organized as activists to challenge or modify its influence. If you attend an American Psychiatric Association event, you’d often witness a protest movement outside. If these protests are only interpreted through a pathological lens, we risk missing the deeper insights these activists offer on how psychiatry could evolve.

This shift can be better understood when aligned with other societal difference issues like racism, sexism, homophobia, ableism, and sanism. While sanism might not yet be as widely recognized, it mirrors the same insidious othering and subordination based on prejudice.

Mad studies, much like gender or disability studies, aims to improve conditions for those marginalized because of their differences. Rather than focusing on changing the individual, the emphasis is on transforming society to be more inclusive and appreciative of diverse perspectives. This also fosters a coalition between activists seeking psychiatric reform and academics, who, through intersectionality, have been considering issues of race, sex, gender, and ability. Incorporating sanism into this intersectional understanding is a logical progression.

Given the rise of disability studies, which now encompasses mental and cognitive differences, the momentum for mad studies continues to grow. It’s about channeling already established understandings of ‘difference’ in academia towards areas that have yet to receive as much attention.

 

Karter: You’ve alluded to the protests outside the American Psychiatric Association meetings. This leads me to wonder, instead of a divide between protestors and psychiatrists, is there a way for dissenting voices to have an influential seat at the table and help shape the future of psychiatry? What might an American Psychiatric Association meeting look like under a more democratic framework in psychiatry?

Lewis: As it stands now, psychiatry hasn’t been particularly open to that idea. Ideally, there’d be more organized democracy, inviting different stakeholders. The individuals impacted by the knowledge base of psychiatry span much wider than just psychiatrists.

Taking from the disability studies mantra, “nothing about us without us,” those who are affected by the knowledge – be it service users, family members, or even community members – should have a say in how that knowledge is created. But, traditionally, psychiatry hasn’t been open to this democratic approach. Philosophically, psychiatry holds the view that good knowledge is tested through empirical methods, not necessarily shaped by democratic consensus.

So, democratizing knowledge might come through alternative means. Maybe through grassroots organizing, platforms like Mad In America, or even the arts, which provides a vast and rich exploration of the human experience. While there currently isn’t a structure in place to invite such diverse stakeholders into the process, it’s a vision worth pursuing.

 

Karter: That’s an excellent segue. I wanted to ask you about the Institute for the Development of Human Arts (IDHA). It’s an alternative outside of the medical model, addressing mental health and distress by aiming to bring a new discourse through democratic collaboration among advocates, service users, and clinicians. As a co-founder, could you tell us how this organization began? What’s the vision there?

Lewis: Certainly. IDHA represents a shift in the activist community from just critique to reimagining in many ways. Critique has its place and remains a significant part of various protests. However, as time has passed, many critics began to ponder the potential—what services might they prefer? How might Mutual Aid tactics be applied more broadly?

Even SAMSA began to realize the value of incorporating those with lived experience into hospitals and clinics. The idea is that without these firsthand perspectives, there’s a risk of alienating certain individuals.

IDHA’s aim is to curate curriculums that address what’s been overlooked or what stakeholders believe should be discussed more. And it’s not just about including those with lived experiences. The goal is to make them well-informed. If we train peer workers only in the mainstream, then their perspectives won’t differ from it. So, the question becomes: what kind of foundational education would benefit both the mainstream and peer workers?

IDHA’s inception involved activists. Jazmine Russell, with her educational background at NYU and her personal experiences in community mental health, teamed up with Peter Stastny, a long-time reform-minded psychiatrist. The Icarus Project, which was evolving to be more proactive in building knowledge bases, had many members get involved.

So now, it’s more than just protests. It’s about presenting new ideas and methods, promoting democratic procedures, and understanding the essence of Mutual Aid.

They employ a mix of strategies to stay operational. Some content might come with fees, others are offered free, and some are backed by grants. They’re not aiming for exclusive knowledge or profit. The goal is to disseminate information as widely as possible.

 

Karter: At the Institute for Development of the Human Arts, there’s an emphasis on how the arts and humanities can reshape the mental health field. Similarly, you’ve recently discussed the mental health humanities or the psychological humanities as potential ways forward. I’ve also noticed you referencing Vincent van Gogh as an illustration of how art and history might challenge our perceptions of mental difference and disability. Can you share more about that case and what insights Van Gogh provides regarding mental health?

Lewis: Indeed, the arts, broadly speaking, represent an interdisciplinary space that encapsulates the vast range of the human experience. It contrasts with my training where, even though I was exposed to varied perspectives like psychoanalysis and bio-psychiatry, the narratives often fell short of capturing the holistic nature of individuals’ lives. When people share their struggles, they don’t confine their stories to a single discipline. Their stories blend biology with spirituality, childhood memories with current political events, and so much more. The arts have always provided a platform for such multifaceted narratives, outside of academic silos.

From the arts, we can both learn and find therapeutic avenues for ourselves and our communities. Taking Van Gogh as an example: no matter how you interpret his life, his profound sensitivity stands out.

If you visit the library and research books on Van Gogh, roughly half might pathologize him, offering various potential pathologies. The remaining books often celebrate him, suggesting we can learn from Van Gogh, seeing him as a beacon in our lives. He isn’t necessarily broken, but rather, someone who can heal. Many aspects he was sensitive about resonate with topics we discuss today.

Early in his life, Van Gogh was drawn to religion, influenced by his father’s religious vocation. He harbored deep sympathy for the poor and suffering, aspiring to elevate their spiritual consciousness. Over time, his focus shifted more toward a spiritual and natural connection than a strictly theological one. Still, his art emanates an indescribable spiritual connection.

I attended a Van Gogh retrospective at MASS MoCA a few years ago. The atmosphere was electric. Attendees were captivated by his work, especially those iconic swirls. Moreover, Van Gogh was acutely sensitive to issues of inequality and oppression. His artwork often features the downtrodden or marginalized. He belonged to a post-French Revolution era where artists believed that to instill dignity in every individual, change needed to be channeled through the arts as well as politics.

For us to truly value and dignify every individual, our perception must change. Van Gogh’s work aids in recognizing the intrinsic worth of all, regardless of social status.

Of course, another aspect he was deeply sensitive to was the transformative power of art. Art has the potential to reach and profoundly touch people, serving as a medium to convey deep understanding. While his sensitivity was undoubtedly a gift, Van Gogh also faced considerable suffering and challenges. So, how do we interpret Van Gogh? Do we pathologize him or celebrate him? Which lens do we choose? His life presents a myriad of interpretative possibilities.

We can’t truly know how Van Gogh would want his life to be understood. If we consider the Van Gogh within each of us, how would we wish our stories to be told? Different individuals will have varying perspectives. It’s not about pinpointing a singular “truth” of Van Gogh as a celebration or pathology. There are numerous interpretations, and the ones we embrace influence how we view life. These aren’t merely philosophical considerations but also decisions about our personal identities and how we choose to navigate our lives.

 

Karter: It seems like the depth and complexity of Van Gogh’s work sort of confounds our ability to impose a readymade model on him to understand who he was as a person. We can examine his biography, viewing it through various lenses, but then we also have to wrestle with his art, which encourages us to perceive the world differently—perhaps even as he did for a time. The way of seeing and being that his work invites us to makes plain the utter futility of simply applying a diagnostic label or some sort of shallow metaphor to make sense of his life. It pushes us to think beyond the immediate frameworks we typically use to interpret the world.

Lewis: Yes, and I think that’s right. I believe it’s largely because Van Gogh had a distinct voice. I mean, as Foucault said, the history of psychiatry is framed as the “monologue of reason.” And Foucault highlighted that once experts begin to give their verdicts, other voices are muted. But with Van Gogh, you hear him through his art. It’s not just the expert’s voice that prevails; with his art, there’s a powerful dialogue. His work has such weight that you simply can’t dismiss it.

 

Karter: In addition to Van Gogh, you’ve offered analyses of several of Chekhov’s short stories to call for a deeper appreciation of the complexities of the lived realities of depression and melancholia. Is there a particular story you can present for us to illustrate your point?

Well, when considering medicine and psychiatry, Chekhov emerges as a profoundly useful model. In him, there’s a rich interdisciplinarity. On one side, he’s a medical physician, trained, practiced, and deeply rooted in the medical realm. Conversely, he’s an acclaimed short story writer and playwright, revered nearly to the level of Shakespeare in terms of his influence on theatre arts and short stories. This duality allowed him to perceive the world through the lens of medicine while simultaneously viewing it through the language of art.

Indeed, Chekhov’s work features many doctors, each with their own unique perspective. They don’t represent a monolithic voice. In Chekhov, we find someone deeply invested in medicine, yet he understands that it represents just one viewpoint among many. A doctor’s narrative isn’t necessarily an unfiltered reflection of reality.

Moreover, Chekhov himself faced significant hardships. He grappled with personal despair and sadness and succumbed to tuberculosis at a young age. His writings hint at a spiritual depth that’s rare in a secular world. He was keenly aware of societal injustices, and his stories often highlight humans striving amidst overwhelming challenges.

In a recent paper that Jussi Valtonen and I wrote, we analyzed Chekhov’s story “A Nervous Breakdown.” The story centers around a young law student who is acutely sensitive to oppression. More so than his peers, which include a medical student and an art student. As they spend an evening at a brothel, he becomes deeply disturbed by the blatant oppression in the sex worker trade. This heightened awareness leads him to a breakdown. But should we view this heightened sensitivity as a negative trait? As we’ve discussed, while such sensitivity can be admirable, it can also be overwhelming.

And when he consults a clinician, the approach is solely scientific. This overlooks the depth of his despair and offers him a rather superficial treatment, neglecting the complexity of his experience. This is highly relevant to today’s context.

 

Karter: And specifically, in your recent book, you explore depression and melancholia through the lens of the humanities. How does the depiction of depression differ from the clinical perspective when you delve into the works of Chekhov for insights on melancholia, or study Van Gogh’s pieces to understand suffering? How would you define or describe depression? I’m hesitant to even use that term, but what alternative understanding of that experience do you present?

Well, when we ask, “What is depression?” we must remember that it’s essentially a term. History offers a lens to challenge our current understanding. Examining the historical record reveals diverse interpretations of what we now refer to as melancholia or depression. Notably, it’s not always the same concept, even though the name changes. Each label slightly shifts its definition. For example, the term “melancholia” originates from the idea of black bile, rooted in the ancient humoral system. Today, the notion of bile seems foreign and nonsensical to us. It was thought to make people sluggish and heavy. But did we label people as sluggish because we believed they had an excess of black bile? Or did the theory of humors lead us to categorize individuals based on observable traits, such as that which matched our concept of black bile? It appears that we often categorized people based on these theories as much as the theories were based on observed behaviors.

We all have unique belly buttons and ears, but we don’t use these differences to segregate spaces like bathrooms. There are myriad ways we could categorize ourselves. Terms like “melancholia” appear to originate and then evolve, shifting over time.

Considering history, cultural diversity, subcultural nuances, and the arts provide diverse lenses to challenge a monolithic interpretation. The question then arises: How can both our mental health system and individuals striving to understand themselves do justice to these varied perspectives?

 

Karter: I’m intrigued by your perspective on the future trajectory of psychiatry and mental health fields. With the rise of social media and organized movements, we’re seeing a diversification of narratives. These range from neurodiversity and psychoanalytic concepts to biomedical terminology. People are shaping their self-perceptions and forming communities around these narratives. Do you think these emerging perspectives challenge traditional psychiatry? Is there potential for a more democratic inclusion of these diverse voices? How optimistic are you that the field will genuinely welcome these perspectives?

Lewis: I’m genuinely optimistic. The dominance of the biomedical model seems to be waning. Entities like Mad in America, academic contributions, and protest movements have all played roles in this shift. The lived experiences of many underscore its limitations. Additionally, the financial incentives behind this model are changing, especially as fewer products remain under patent. It feels like we’re entering a phase where the conversation is broadening. There’s a renewed interest in psychotherapy. Moreover, with the emergence of fields like Disability Studies and now, Mad Studies, more individuals are becoming aware of the diverse perspectives available.

I’m drawn to the concept of mental health humanities. Similarly, psychology is exploring areas like psychological humanities. Throughout my career, I’ve engaged in interdisciplinary areas such as medical and health humanities. These fields question how medicine and broader healthcare can harness the arts and humanities to enhance clinical empathy, understanding, and narrative competency. The appealing aspect is that this integration doesn’t necessitate a complete overhaul. You don’t need to entirely replace the biomedical model. In medicine, it might be a matter of supplementing the existing model with fresh perspectives and offering additional certifications, courses, and programs. Essentially, it’s about infusing an appreciation for the arts and humanities within the healthcare community. Moreover, considering the prevalent burnout and emotional fatigue among healthcare professionals, the arts and humanities could play a role in rejuvenating their sense of purpose and meaning.

I appreciate the concept of integrating the arts and humanities into the realm of mental health. It would be beneficial for psychology, social work, and psychiatry departments to incorporate aspects of the arts and humanities. Some faculty members should have ties with these disciplines and specific classes should be dedicated to them. This would foster a more diverse and less monological perspective.

 

Karter: Thank you. Before we conclude today, are there any final thoughts or anything else you’d like to share with our readers or listeners?

Lewis: Actually, I believe we’ve covered a lot. Justin, I’d be interested in interviewing you someday. I genuinely admire what Mad in America is accomplishing, and I appreciate your initiative in amplifying diverse voices. This, in my eyes, is truly a form of democracy—making sure multiple perspectives are heard. Overall, I feel more celebratory than anything.

 

 

 

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MIA Reports are supported, in part, by a grant from The Thomas Jobe Fund.