Richard J. Severson

Shattered illusions pockmark the footprints of modern history.  The Copernican revolution evicted us from a cozy universe.  Later, Kant conceded that we can’t really know reality in itself because our minds prejudge everything that our senses perceive.  Then the theory of evolution obliterated the pretense that our species has a better pedigree than every other life form.  As if things couldn’t get any worse for human vanity, Freud plunged us into a conflict-ridden mental underworld governed by truly repulsive desires that we find it necessary to repress.  Bitter experience has taught us to be suspicious of our basic assumptions about most things.  Even the idea that there is a real “self” presiding inside of me has become a matter of disbelief.  Where does it all end?  Will anything escape the scrapheap of our steely-eyed scrutiny? 

It would be impossible to live without some illusions, though we don’t like to admit it.  Were we unable to take for granted our own continued health, for example, how could we go about the business of earning a living, raising a family, running to the store, and so forth?  To be fully engaged in the world requires that we forget about ourselves and focus on the projects that need doing.  For those who suffer from a chronic illness, however, it is no longer possible to forget themselves in that way.  When the illusion of continued health is shattered, illness and its repercussions become foremost in our minds. 

There are other necessary illusions that we rely upon as well.  The use of language is a case in point.  We use words to create imaginary connections between ourselves and other things.  Love is a rose, we say with poetic flair.  Is love really a rose?  No, of course not; but it is like a rose in the sense that it can be both beautiful and thorny at the same time.  It is a matter of routine for us to create new meaning by inventing metaphors, or contrived verbal illusions. 

In The Future of an Illusion, Freud compared religion to a childhood wish.¹ Adults long for divine protection against fate and the feeling of utter helplessness just as children long for the protection of their fathers.  It is a classic Freudian analogy.  In his view, there is a fundamental conflict at the heart of human experience that is based upon childhood ambivalence toward the protective father.  Children know they are helpless and dependent, yet they resent it bitterly.  This basic conundrum repeats itself in every civilization.  We need civilization to protect us from nature and criminals, yet we resent the sacrifices it requires to reign in our anti-social instincts.  Of all the psychological assets that civilization has at its disposal in the struggle against the selfishness of individuals, religion was still viewed as the most important in Freud’s time.  Every theology claimed to exorcise the terrors of nature, reconcile us to death and other cruelties of fate, and compensate us for the privations imposed by civilization.  All that would be perfectly fine, Freud admitted with mocking irony, if it had ever actually worked.  The deeply held wishes of religion are vastly overrated in his view.  Every child must outgrow its childishness, and that’s what we should do with regard to religion.  There are better ways to reconcile humanity to the sacrifices of civilization.  According to Freud, science and reason are a better bet for the future because they are “illusions” capable of self-correction, whereas childhood wishes aren’t. 

 I find it ironic that the master interpreter of subversive acts of mental cunning, including unconscious slips of the tongue and temporary acts of memory failure, would confine the role of religious illusion to childhood wishes.  I am surprised that Freud didn’t develop a classification system to accommodate the full variety of religious illusions.  He did make two distinctions, however.  Illusions are not the same thing as errors of fact, meaning they aren’t necessarily false.  Nor are they the same thing as delusions, which tend to be more virulent and self-destructive.  Even if we confine ourselves to the instinctual desires of the family unit, which is the paradigm for Freudian analysis, there is a greater variety of cunning self-deception than wishful thinking alone can explain.  I want to expand Freud’s narrow understanding of illusion to include four different categories.  My goal isn’t just to criticize Freud’s reductive interpretation, though I think that is a legitimate result.  Instead, I want to use the expanded concept of illusion to make the argument that medicine and spirituality are entangled narratives that continue to influence one another in surprising (emergent) ways. 

The first category of illusions is wishful thinking.  Naturally, we are all wishful thinkers with regard to our own health.  It’s like living under a protective spell.  If the spell breaks, our sense of invulnerability disappears along with it.  It’s probably why so many of us avoid going to the doctor even when we suspect that something could be wrong.  I would include Freud’s instinctual desires in this grouping, along with dreams and false beliefs.  The Ptolemaic model of the solar system is an example of a false belief because the earth really isn’t at the center of the solar system, though in hindsight it was probably psychologically comforting to think that it was.  It is an error of fact that had wishful implications.  I think that is exactly what Freud intended to say about religion.

The second category of illusions is trickster behavior.  Most cultures have trickster characters in their folklore and mythologies.  For example, Odysseus is considered a trickster in Greek culture because of his cunning intelligence.  He was the inventor of the Trojan horse that ended the bitter stalemate of that eponymous war.  On his wayward journey home, he lashed himself to the mast of his ship to hear the mythical Sirens sing without falling prey to their deadly enchantment.  Tricksters provide comic relief from the sober realities of life and death.  In Native American cultures, they are portrayed as coyotes and ravens.  They had supernatural powers which they occasionally used to assist people who were sick or in danger.  Shamans also fit into this grouping because their symbolic healing séances typically included mythical storytelling and sleight-of-hand magic.  They were performance artists and illusionists for whom reality itself was a tool for recreating the world as it was meant to be. 

The third category of illusions is make-believe worlds.  We live in a world that is filled with alternative worlds of our own making.  We read novels, go to movies, watch sitcoms on television, attend athletic events, pose like ancient warriors in yoga classes, participate in spirit-lifting ceremonies, daydream about winning the lottery, pretend to be sick in order to avoid an unpleasant encounter, etc.  Our lives are largely determined by the imaginative capacity to inhabit multiple worlds at the same time.  I’m reminded of the Seinfeld episode where George is livid because his worlds are colliding.  It drove him crazy that his girlfriend was becoming overly friendly with Jerry, Elaine, and Kramer.  He wanted the world he shared with his buddies to be separate from “relationship” George’s world.  It’s true that we often suffer from trying to juggle too many things at the same time.  We are all stage actors, to paraphrase Shakespeare’s famous line.  To be able to play different roles—to wear different hats, or masks—in different situations is a necessary social survival skill.  For a symbolic creature that lives in and through its own imagination, playing games is a big part of real life.  The distinction between make-believe and reality is easily blurred because of our powers of imagination.  Sometimes that gets us into trouble.  To lose the ability to distinguish what is only imaginary from what is real is one of the root problems of mental illness. 

The final category of illusions that I want to discuss pertains to the naming and classification of things.  We assume that our terminology for phenomena such as medical diseases conforms to some semblance of objective reality.  We wouldn’t be talking about panic anxiety, for instance, if it wasn’t a real problem.  Or would we?  Prior to the invention of Xanax, the idea of having a panic attack didn’t exist according to Peter Kramer.² Yet only a short decade after the medicine became available, panic anxiety was the most commonly diagnosed mental illness in America.  Possessing a medical technology to treat a disease goes a long way toward making the disease itself real.  This social constructionist theory of reality, as it is sometimes called, is especially germane to the conception of mental illnesses that don’t have clear biomarkers like a typical infectious disease would.  In fairness, many (most?) psychiatrists would probably argue that the problem of panic anxiety was always there to begin with even though we didn’t yet have a term to call it, or an effective treatment.  In this common sense view, there is nothing illusory or made-up about our categories of mental illness.  I disagree.  I think we really do construct/invent some, but not all, diseases just as we construct/invent the make-believe worlds that we routinely inhabit. 

Ian Hacking traced the short-lived fascination with multiple personality disorder to the invention of deviant social categories in the 19^th century.³ The first census in America was conducted in 1820, and it led to an avalanche of new statistical classifications within which to put people.  Physicians became obsessed with statistics relating to deviant behaviors in particular—suicide, prostitution, drunkenness, madness, vagrancy, crime, child abuse, etc.  Some deviants displayed co-morbidities that put them into more than one category.  The first clinical case of multiple personality disorder was diagnosed amidst this fascination with counting people as a way of identifying them as social deviants.  After the first case appeared, a whole flurry of them followed in short order. 

We can’t perceive something that we can’t name or talk about first.  Once it became possible to talk about multiple categories of people living inside one individual, they began to crop up everywhere.  Hacking referred to this phenomenon as “semantic contagion.”  (The false-positive epidemic of ADHD diagnosis amongst children and some adults is a more recent case in point.)  Does this mean that multiple personality disorder didn’t really exist?  Was it just a fabrication, or an elaborate illusion?  It’s complicated, but yes, I think there is a make-believe aspect to how we conceive of things and construct our lives.  That isn’t to say there isn’t some element of reality involved as well.  We are by nature realists with a flair for imaginative interpretation.    

We don’t interact with reality as it is in itself.  Instead, we create worlds within which to shape reality to fit our perceptions and needs.  There is a cultural interface that we construct in order to go about our business in life, no matter what that might entail.  It’s true with regard to medicine just as it is in every other endeavor.  The worlds we live in are real enough, but they are not pure (raw) reality.  Being in the world is a work of imagination in addition to being a biological struggle for survival.  That means the manufacture and use of illusions is a necessary part of our existence.  The complicated worlds that we live in today really are different from the worlds that ancient people inhabited.  In the Stone Age, for instance, it was necessary to believe that rivers were inhabited by spirits that had to be respected, but that’s not the case for us.  Were those spirits real?  To them they were, but not to us.  However, the actual river was as real for them as it is for us, but not the meaning of it.  The meaning of our own existence is dependent upon the worlds that we undeniably construct in order to thrive and live more fully.           

Allan Young argued that Post-Traumatic Stress Disorder was made real by psychiatric practices in a special unit of the U.S. Department of Veterans Affairs.⁴ It all began in the 19^th century when the concept of trauma was expanded to include psychological phenomena in addition to physical injuries.  Freud interpreted traumatic memories as secrets that we hide from ourselves in the unconscious mind.  Those buried memories could then resurface at a later time, revivifying the old trauma.  PTSD didn’t become a standard classification of the psychiatric profession until 1980, when it was included in the 3^rd edition of the Diagnostic and Statistical Manual of Mental Disorders.  Ironically, that is the same edition of the DSM that dropped Freud’s concept of neurosis from the practice of psychiatry.  In many ways, traumatology has replaced neurosis as the ubiquitous explanation for our everyday mental foibles.  I think it explains why we tend to see ourselves as victims more than prior generations did.  Every bad experience that we suffer adds to the hidden reservoir of prior traumas, the implication being that there is only so much we can take before we break down.  Like all scientists, psychiatrists tend to focus on phenomena that can be manipulated by their technologies, practices, and ways of looking at the world.  They ignore the aspects of nature that aren’t so amenable to their methods of inquiry.  According to Young, that’s how illusions infiltrate into our best efforts to be objective and impartial in the study of mental disorders such as PTSD.      

The 19^th century asylum is where psychiatry and the classification of madness began.  After WWII, the focus shifted away from the severe cases of the asylum to the psychological problems of ordinary people.  Published in 1952, the original DSM viewed the symptoms of mental illness as predictable responses to the difficulties of life.  Homosexuality was finally removed from the 7^th printing of DSM-II, which bolstered the widespread criticism that its disease classifications are simply labels for undesirable behavior, not real illnesses.  DSM-III was published in 1980, as I mentioned above.  As a response to the legitimacy crisis in psychiatry, it marked a shift toward a more biologically sound method of diagnosis and treatment instead of the Freudian interpretive approach.  The latest two editions of the manual have continued the effort to fortify psychiatry against naysayers by vigorously aligning it with data-driven empirical science.  It hasn’t worked very well because there are no strict biomarkers that distinguish normal reactions to life’s difficulties from pathological ones.  When you lose your job, it’s normal to feel depressed; it’s not a symptom of mental illness.  It’s an oversimplification, but I think the futility of doggedly chasing after an illusion sums up the entire history of the Diagnostic and Statistical Manual of Mental Disorders.  The American Psychiatric Association has been enchanted by the false belief that we can easily differentiate sickness from wellness.  We can’t, as Freud knew all too well.  The fact that we find it hard to abandon cherished dreams is a sign of our everyday trafficking with illusions.  Even the names we use to classify things are often tainted by them.       

Nor is psychiatry the only medical discipline susceptible to illusions.  The whole edifice of modern medicine is built upon utopian dreams.  Chief amongst them is the belief that we can eliminate most, if not all, of the belittling diseases that plague our existence.  Can we really win a war with cancer?  Probably not, yet the conviction that we can is a dogma of modern civilization.  The cheerful embrace of death that Socrates achieved after a lifetime of querulous debate in the agora of Athens is not something most people aspire to imitate.  Like all creatures, we want to live for as long as we possibly can.  Perhaps the original illusion is life itself.  Somehow, it found a way to transcend the dead matter from which it was formed.  It is the fate of every living thing to take up the task of existence with a wholehearted willingness that defies life’s mortal predicament.  Medicine emerged almost at the same moment our distant ancestors comprehended the true precariousness of this life.  From the beginning, its mighty purpose has been to dream the impossible dream.      

What if we were to succeed in unmasking every possible illusion?  Where would we end up?  I think the final destination would be similar to the situation that Thomas Metzinger described in Being No One.⁵ According to Metzinger, the brain is a very sophisticated virtual reality simulator.  What we call the “self” is actually the world-zero perspective of the brain.  We instinctively believe that the processes that are being simulated by the brain are the real experiences of a real person.  For most of us, the simulated self is impenetrable; however, some people have out-of-body experiences that disclose the simulation for what it is. 

It took our Stone Age ancestors thousands of years to learn how to harness and stabilize the powers of the mind.  Shamans played a critical role in that evolution.  They invented what we have been calling the “soul” for more than 50,000 years.  They taught us to travel through time via the imagination, which eventually became the subconscious routines of memory and anticipation that we take for granted today.  The point I want to make is that unmasking the illusion of the self represents a critical turning point in our existence.  If my own self-identity is a chimera, then so presumably are many other things, including the biological givenness of my gender—or my species, for that matter.  Freed from even the most stable and undetectable illusions, we have entered into a new era of self-exploration that will challenge the boundaries of biological life itself. 

To live completely unmasked, without illusion, is like being unmoored from the past and thrown into the open waters of the unforeseen future.  From this point forward, the necessity of our own illusions will never be hidden from us again.  In a sense, the Freudian project to make us fully aware of the unconscious secrets that we kept hidden from ourselves is now complete.  To live without illusions is to live with the full awareness of our own mental fragilities.  It is a foreboding that never quite disappears even when we must forget ourselves so that we can live outward and forward into the world.  The animistic tenor of our spirituality—the quest for an immortality of the soul—appears to be at an end.  We have been thrown back into a materialistic universe, not a supernatural one.  That does not mean every spiritual avenue has been barred to us.  “I am spiritual, but not religious” is one of the most common refrains of our time.  Even our biology is fortified with transcendental aspirations.         

The great unmasking of all illusions has discredited most dualistic theories of human nature.  We are fully embodied creatures, not half-body/half-mind hybrids.  Symbols are part of us, integrated into our neurobiology, not separate metaphysical utterances.  If there are no unmasked illusions, then there can be no hidden dualisms either.  Being without a “soul” has freed us to become the embodied creatures we have always been.  We are once again tinkering with our self-identities in elemental ways that haven’t been attempted since our distant ancestors forged the soul in the crucible of their untrained imaginations.  What is the future of illusions?  We are certainly adept at unmasking them, but that’s not the same thing as getting rid of them altogether.  We need the illusion of selfhood, for instance, in order to function as normal human beings.  However, that doesn’t mean we must passively accept the cultural norms of selfhood.  We can subvert the original purpose of any illusion, making it fit our own creative intentions.  I think that’s what we are witnessing today in the transgender community, and others like it that transcend the traditional boundaries of self-identity.  I also think the pace of experimentation with alternative ways of being human is quickening.     

We are in the early stages of exploring the plasticity of our own biology, and the consequences are far reaching.  It means that we are capable, or soon will be, of controlling many aspects of our own biological evolution.  Geneticists are now capable of creating artificial chromosomes and inserting them into the DNA of germline cells (special reproductive cells).  They have already done it with mice.  Despite the fact that more than 40 nations have outlawed human germline engineering for moral reasons, a Chinese researcher recently claimed to have created the first genetically edited babies, which are known by the pseudonyms of Lulu and Nana.  It is doubtful that we will ever completely understand the complex interactions of our entire genome.  However, there are enough genes that we do understand well enough to make “designer babies” a possibility in the near future.  

Many observers would agree with the sentiments so eloquently expressed by Leon Kass in “The Wisdom of Repugnance,” an essay he wrote in response to the cloning of a sheep famously known as Dolly.⁶ He argued that most people feel a deep sense of repugnance at the prospect of human cloning because it threatens our human decency, which is grounded in long-standing traditions that deserve our respect.  Essentially, it is the “brave new world” reaction to the potential evils and unintended consequences of technological innovation.  Since we cannot anticipate every potential outcome of our innovations, we are obligated to take necessary precautions in order to avoid disaster for future generations.  It makes a lot of sense to be cautious in that way.  We have learned from bitter experience that new technologies aren’t always the harbingers of progress that their boosters proclaimed.  The list of innovations gone wrong—the toxic qualities of PVC plastic used in medical products, for instance—is shamefully long, and I certainly don’t want to minimize the moral peril that we face.  However, I disagree with Kass’s assessment of what is happening here.  He thinks our problems are traceable to the narcissistic tendencies of modern individualism that belittle the cultural traditions that make us human.  My own view is that what we are witnessing today is a recapitulation of the original spiritual revolution that enabled our Stone Age ancestors to invent the soul.  Far from disparaging cultural traditions that reach back thousands of years, I think modern individualism represents a rekindling of the experimental audacity that enabled Homo sapiens to thrive in difficult times.    

I don’t think Kass has directed his concern far enough into the past.  Had it not been for the adventurous spirit of shamans, the first doctors, we would never have mastered the feats of time-consciousness that enable us to maintain multiple perspectives of reality at the same time.  We are able to imagine a better future and invent new technologies today because the hard work of taming the imagination was done in the ancestral environment long before civilizations emerged.  Consider the drum, for example.  It was not just an instrument of entertainment for shamans.  On the contrary, it was a sophisticated technology used to reset the rhythm of the brain so that it could always find its way back to the world-zero perspective of the soul.  Medical experimentation has been an essential part of our spiritual evolution since the moment we achieved self-awareness.  We are not a timid species.  We never would have survived the ice ages had we not been inveterate risk takers. 

Human nature didn’t just fall from the tree of biological life already fully formed.  Our ancestors had to work at perfecting their mental prowess in particular, and it was a risky business.  So is some of the behavior we are witnessing today.  The human experiment is not finished yet.  That’s partly what makes us so unique.  We are a species committed to its own perpetual evolution.  We came from a brave new world, and we are now on the brink of repeating that grand experiment all over again.  We are not throwing away our humanity by selling our souls to technology.  One of the most persistent illusions of civilization is the pretence that nothing prior to its invention really matters.  Nothing could be further from the truth in my estimation.                                      

Human biology is our playing field now.  This is what modern medicine is making accessible to us.  It is the spiritual destiny of the materialistic self.  It is not the wish fulfillment of a child yearning for its father.  Rather, it is the intentional remaking of an embodied soul in charge of its own destiny.  This, I believe, is what we are witnessing today.  The soul of our Stone Age ancestors has been steadily degraded over a period of a few centuries, and in its place we are finding new opportunities to reinvent ourselves.  The pace is quickening.  It is no longer confined to the cultural channels of Romantic individualism.  It has infiltrated our subversive uses of medicine as well. 

Spirituality is not a religious belief that can be set aside like a childish wish.  It is part of our nature that circumscribes the effort to transcend the belittling circumstances of life.  Medicine and spirituality have always been entangled narratives in that great adventure.  The future of illusions is to continue to push the boundaries of what is possible for conscious life to achieve on its own merits.  To feel at home in this silent, empty universe is perhaps the only wish that life has not yet fulfilled. 

In The Denial of Death, Ernest Becker concluded that we need new illusions to replace the loss of our religious illusions.⁷ In his view, the purpose of human life is to transcend the finality of death through heroic immortality projects.  In the absence of religious options, our heroism has been impoverished.  Following in Freud’s footsteps, I think Becker overemphasized the tensions between our physical biology and symbolic minds.  The mind is part of the body, not a separate self.  We are not solely reliant upon our own creative acts of heroism in the quest to transcend death.  That has been the goal of biological life from its earliest inceptions.  Life itself represents a heroic transcendence of dead matter.  Every living creature is saddled with its own heroic immortality project, not just human beings.  Granted, we take the task to unprecedented imaginative heights.  But the life of the mind is a recapitulation of life itself, not a separate avenue of life that only humans can comprehend.  

Notes:

1. Sigmund Freud, The Future of an Illusion, translated by James Strachey (Norton, 1961). 
2. Peter Kramer, Listening to Prozac (Viking, 1993). 
3. Ian Hacking, Historical Ontology (Harvard, 2002). 
4. Allan Young, The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder (Princeton, 1995). 
5. Thomas Metzinger, Being No One: The Self-Model Theory of Subjectivity (MIT, 2003). 
6. Leon Kass, “The Wisdom of Repugnance,” New Republic June 2, 1997, 17-26.
7. Ernest Becker, The Denial of Death (Free Press, 1973).