The simplest view of mental disorder divides it in three: “mad, sad or bad”. The mad have psychoses that disable. Fortunately, only a few go mad. Many more suffer. Here belong the depressed, the anxious and the obsessive, in most cases enduring the sad interludes that net everybody in a lifetime. The bad make others suffer. The alcoholic, drug addict and gambler, the antisocial, the confidence trickster, charming psychopath, sexual deviant and the like do this. To some extent all of us do too, particularly  in demoralised societies, where all hurt each other. Like the diagnoses of DSM, the simple view has the fatal flaw of the descriptive approach (see the Elephantanopia series) that can tag anybody as psychiatric.

In Welcome to the Loony Bin I use the tripartite boundaries to highlight the differences between conditions as varied as addiction, child abuse and the frontal syndrome, well aware of the overlap that its crude simplicity permits. Reassuringly to me, the guru of reforming psychiatrists, Allen Frances, in Saving Normal (2009) uses it too for setting boundaries. In the section “Turning Bad into Mad” (p.110) he deplores the efforts of psychiatrists to coerce courts into conferring on vile deeds the protection that only madness deserves. The politically-motivated killers he chose, the assassin of President James Garfield in 1881 and the Norwegian mass murderer Anders Breivik, both refused to plead insanity. Revealingly, one screamed that he “would rather be hung as a man than acquitted as a fool.” His group’s memes had more value to him than his life. Not mental illness, but meme tyranny drove both of them. I suggest that our memes, fortunately for most of us a different selection, drive all of us.

Here we have a paradox of our times. Although what goes on in the mind captures the attention of psychiatrists, psychiatry ignores the directive force of memes. Even politicians and salespersons, who depend on manipulating memes, do not analyse their nature. They use memes so well they do not need to. Psychiatry has an excuse. Meme tyranny belongs to normal function even when its results seem insane. Psychiatrists cannot resolve mass outbreaks such as Nazism or property speculation nor even curb their own vulnerability to fads and the diagnostic inflation that Allen Frances deplores. How maddeningly sad and bad.