Where Is Mental Illness?
By Lucas McGranahan
Photography by Micheal McLaughlin
I’m a trained philosopher, which means I like big questions of the form “What is X?” What is knowledge? What is reality? What is the good life? Expansive questions that promise to get to the heart of it all while putting everyday concerns in perspective. Maybe you asked your best friend questions like this at a sleepover in junior high lying on your back wired on Coca-Cola at 1 a.m. Maybe you wrote a term paper on Plato’s Symposium in college (also at 1 a.m.). Maybe you’re one of us who keeps returning to these questions in adulthood, hooked on ennobling abstractions.
What is mental illness?
That’s a natural “What is X?” question for TAP. In reviewing the stories in issue 59.2, however, I’m more struck by another question in the neighborhood: Where is mental illness? Is it in the body, the mind, society, or somehow all three?
The biomedical model locates mental illness in the body (especially the brain), writes you a script, and sends you on your way. The point of view is objective and materialist. In the blunt words of 19th-century German thinker Karl Vogt, “The brain secretes thought as the stomach secretes gastric juice, the liver bile, and the kidneys urine.”
Talk psychotherapy recognizes an interior dimension, the mind, which other minds can tune in to and address using words. Indeed, Freud developed psychoanalysis, the first modern talk therapy, based on the insight that illness can be caused by subjective states (such as intolerable ideas) and treated by subjective states (such as trains of associations leading to catharsis). The body is important as a canvas of symptoms and a wellspring of drives, but to miss the subjective is to miss something essential.
Having staked out and defended the interior world, are we in danger of getting stuck there?
Freud’s focus, especially after ditching the seduction theory, was decidedly intrapsychic: Neurosis derives from conflict among different agencies of the mind. This viewpoint pushes a lot else into the background. Neurotic conflicts have roots in real family systems (e.g., the oedipal triangle), as Freud himself described. Beyond the family, small groups and larger social systems seem to have their own characteristic forms of pathology, which structure and inflect the suffering of individuals. Not to mention that the available diagnostic categories and therapeutic modalities are determined by dominant schools of clinical practice and insurance companies. Both human suffering and our tools for working through it are in some way social products.
The mind is tethered to a body that moves in a social world. You can squint at the whole complex of mind-body-surround from different angles for different purposes. What are our blind spots?
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Today, analysts are being asked, with ever greater urgency, to pay heed to the social. Not everyone agrees on how to do this. In an April 2025 story in Harper’s Magazine, Maggie Doherty draws the battle lines:
On one side are the defenders of the old ways of doing things, of objectivity, rigor, and the universal human subject. On the other side are those who understand norms as culturally constructed. They often argue that the universal subject is always racially coded and that lived experience produces (or limits) certain forms of knowledge. This second camp usually suggests that the profession needs to find new and more equitable ways to do its work.
There are levels of diagnoses and demands here. There is the demand to both grow and diversify the field by attracting a wide range of practitioners and patients. More provocatively, there is the claim that sociocultural factors such as race and gender deeply structure human subjectivity, that clinicians must take these factors into account in treatment, and that even highly trained clinicians may be blinkered in significant ways by their own background.
“The social” in these discussions can sound like a hoary abstraction. Richard Almond helps provide clarity, distinguishing between (1) psychoanalytic theories of social phenomena (a form of social psychology), (2) the application of those theories to conflicts within communities, and (3) social issue advocacy by psychoanalysts. And Max Beshers takes up the social turn in psychoanalysis from the perspective of the Group Relations Conference, arguing that behavior we might pathologize in one person—for example, a racist enactment—is often carrying the unspoken tensions of a group. These stories can help us understand the terms of debate and work through, rather than repeat, group-level defenses.
What about the body? Neal Spira traces the failure to launch of psychosomatics—the study of feedback between mental and physical symptoms—in the US during the heyday of psychoanalysis. Spira looks to France for an example of psychoanalysts who still do psychosomatics, while in America the territory of the body is either ceded to biomedical science or is taken up by schools of therapy outside or adjacent to mainstream psychoanalysis. A path worth revisiting for US psychoanalytic researchers and clinicians?
In clinical practice, one way of centering the body is through the simple act of walking. Lily Meyersohn presents a deeply researched story on the meaning and benefits of walking therapy, questioning whether “Please take a seat” is always the right opening for a session. Another alternative therapeutic method, ketamine therapy, is explored by Tracy Sidesinger in an interview with psychoanalyst John Burton—the first entry in a planned series of interviews with clinicians on key issues of our times. Today, both walking therapy and ketamine therapy are practiced mostly by nonanalysts, but these pieces might pique analysts’ curiosity.
Another new series is our advice column Ask a Psychoanalyst, written by Stephanie Newman, who is fun and engaging as well as informative. Read the question about handling positive transference and submit your own question to advice@tapmag.org.
Austin Ratner introduces the Psychodynamic Research Mentorship Program (PRMP), a partnership of the Erikson Institute of the Austen Riggs Center and the Yale Child Study Center that nurtures young psychoanalytic researchers. The PRMP exemplifies a salutary scientific spirit that psychoanalysis has long been ambivalent about.
Xiaomeng Qiao surveys the role of “dead mothers”—Andre Green’s phrase for mothers who seem emotionally absent to their children—in the lives and work of some major psychoanalytic theorists. Winnicott’s theory, for example, was not based on his experience of a “good-enough mother.”
Have you ever compared your therapist to Marlon Brando? Adam Blum examines a key idea in psychoanalysis and all talk therapy—listening—through a colorful, extended comparison of analysts and method actors, inspired by TV and film actress Robin Weigert.
Speaking of arts, we round out the issue with some striking fashion photography: a selection of images from the exhibition Dress, Dreams, and Desire: Fashion and Psychoanalysis, which runs at FIT in New York City until January 4, 2026; and a shot of the Sigmund Freud statue at Clark University, which is donning its own fashion.
Thanks for reading and for keeping psychoanalysis in style.
Lucas McGranahan
Issue 59.2, Fall 2025