What is sanity? And who, among us, is sane?

Once, shortly after I hung out my shingle as a practising psychiatrist, I was approached by a young, and obviously distressed, man beseeching me to evaluate and issue him a ‘sanity certificate'. I can't quite remember what exactly prompted such an extraordinary request, but I do remember feeling absolutely flummoxed by it. A few months ago, I was approached by a not-as-young, but equally distressed lady with an identical request, for she wanted to submit it to the Family Court where her estranged husband was trying to prove her legally ‘insane'. Although about 26 years separate the two incidents, my response remains the same: I am still flummoxed. I know how to certify a person who is not ‘ sane', one who suffers from a mental disorder, or even one who has clinically recovered from a mental illness. But a certificate of ‘sanity'? Nobody has taught me how to diagnose ‘sanity' and I don't have a clue where to begin. What is sanity? And who, among us, is sane?

Fuzzy definitions

As any good psychiatrist will tell you, conventional teaching has it that the concept of sanity can be considered at several levels. Also, as any honest psychiatrist will tell you, when the term ‘several levels' is invoked, it more often than not implies that one is groping in the dark; the more the levels, the more frantic the groping. My experience as a practising mental health professional tells me that, whether or not one has a clear definition of sanity, the thing one fears most after death and income tax, is the loss of one's sanity. Which probably explains why psychiatrists aren't exactly the most popular creatures at social gatherings. When someone asks me what I do for a living and I tell them I'm a psychiatrist, they often sidle away imagining I am going to read their minds even if I tell them I'm off duty. The more intrepid tell me, usually accompanied with nervous chuckles, one of three standard ‘ psychiatrist' jokes that I used to tell before I became one, and the more brazen ask me with feigned insouciance whether I have shrunk any good heads lately.

Originally referred to as ‘alienists', an entirely appropriate term considering how much they, along with the sufferers they were attempting to heal, were alienated from the social mainstream, psychiatrists later came to be known as head-shrinkers, fashionably abbreviated in recent times to shrink. For those not in the know, the term head-shrinker owes its origins to the shamans and witch-doctors who allegedly used their fabled magical powers to shrink the heads of those who threatened them and their societies. And even today many people fear that, this is precisely what a psychiatrist does. Which is perhaps why, when anyone is asked to see a psychiatrist, the first response is usually, ‘Are you nuts? I'm not insane!' In modern times however, the term shrink has entered popular parlance and despite its unprepossessing origins need not be a pejorative reference, unless accompanied by a snigger. However, the fact does remain that psychiatrists are still considered a pretty quirky lot, necessary for others though not for yourself. At last count, there's only over 3000 of us in India, practising our craft, still groping in the dark for a definition of sanity.

In matters of law the definition of sanity has been operationally addressed, although the primary concern in criminal law is the assessment of culpability, and in civil law, ‘soundness of mind' when it comes to the discharge of statutory rights or responsibilities. Put simply, if, at the time of performing a crime, an individual knew that s/he was engaging in a criminal act and understood the consequences of the said act, then the person is not ‘legally insane' and is therefore culpable. Similarly, if when discharging a civil responsibility (making a will, getting into or staying in a marriage etc), an individual is completely aware of what s/he is doing and its consequences, then no insanity exists. However, although many legal tomes have been written on insanity and unsoundness of mind, even the law is not really conclusive on what precisely sanity is.

Easier to identify?

By and large, physicians and healers have concerned themselves more with ‘insanity' than sanity, leaving the latter to the cogitations of philosophers, theologists and ethicists, preferring instead to define sanity as the absence of insanity. However, here too, the solutions are not readily forthcoming. Religious and theological definitions of sanity and normal behaviour are too rooted in their respective monotheistic fundaments for universal acceptance; statistical definitions of sanity are subject to too much variance; social definitions are too restrictive; philosophical and existential definitions are too obscure for day-to-day living; and New Age definitions are too fanciful. What we're then left with are personal definitions of sanity.

As I see it, until we reach a universally applicable definition, if indeed that is even necessary, let us for the moment agree that we are sane until proven insane. Let us also agree that seeing a psychiatrist does not mean we're insane, nor does not seeing one make us sane. For, from where I sit, the universe is shrinking and in this New Age of ours, when the only things psychiatrists need consider shrinking are their waistlines, sanity, whether statistical, social, moral, ethical, or legal, will indeed prevail, provided we neither fear losing it nor go around looking for sanity certificates.

The writer is the author of the Fifty-50 Marriage: Return to Intimacy and can be contacted at vijay.nagaswami@gmail.com

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