If Frank Sang Jazz, We Might All Be Crazy

Over their lifetime, about half.

The cross-examining attorney’s eyes widened.

You expect me to believe that?

I was testifying as a mental health expert and she had asked how many people experience mental illness.

I described the studies which support that estimate. I wasn’t mistaken, but I understand her incredulity. Something that occurs in half of people must be normal, right? Sorting people into categories, especially categories as contentious as “mentally ill,” is complicated.

Here are some of my categories. I am male, white, married, a father, a psychiatrist, hypertensive, Canadian, a fan of Neil Young, and afraid of tight spaces. My categories reflect privilege, I understand, but nonetheless the list places me at the intersection of a fairly complicated Venn diagram.

My membership in other categories is less certain. I was raised Protestant, profess atheism, and more-or-less happily shepherded my three children through their preparation for first Roman Catholic communion. I belong to a political party but I have often voted for their opponents.

Importantly, because we sometimes think that people are defined by the intersection of their many identities, even given all these clues, I don’t think you know me. I don’t know you either. But, like me, you can’t escape the categories that organize our world.

The category “mental illness” is the case in point. If you are familiar with the DSM (Diagnostic and Statistical Manual of Mental Disorders), you know that methods of diagnosis are flawed. Illnesses are defined by checklists, many of which change every time a new edition of the manual erases and redraws some of the lines that separate those within a diagnostic group from those outside.

These changes have consequences. Move one line a little this way and more kids are prescribed Ritalin; move another a little that way and a soldier’s incapacitating response to the horrors of war ceases to be called PTSD, which imperils her disability benefits. No one knows where the true lines lay.

This imprecision could be the result of not knowing enough about the nature of mental illness. But knowledge isn’t everything. To some extent, the problem is a built-in result of categorizing anything complicated. Definitions always fail.

Let’s take a drunkard’s walk through some of the problems of categories and definitions.

What is jazz? Take a group of North American adults of a certain age and play something apt but unfamiliar, say a song by Art Pepper that they have never heard, and most will agree it is a good example of jazz. Ask them what characteristics make this song jazz and they will say that it sounds like parts are being improvised, notes are played off the beat, there is a familiar grouping of instruments, there are no words, it swings. Give me ten minutes on Apple Music and I will find a song that is obviously not jazz that has at least one of these “defining” traits. Reggae notes play off the beat, rock guitar solos are improvised, and so on down the list. By the same token, there is music that lacks every single feature, no matter how carefully we build the list, and that someone would still call jazz.

Definitions always fail because they point toward the boundary of a category, its most troublesome part.

On the other hand, categories are obvious at their center. Art Pepper belongs in the middle of the category called jazz, with Duke Ellington and Miles. But at their edges, categories are fuzzy, like an ink spot on rice paper. Frank Sinatra could swing, but his songs are not near the middle of the category called jazz; they are out near the periphery, where jazzy pop stars sing. Art and Duke and Miles define jazz by being good examples. Sinatra and Louis Jordan and Glenn Miller define jazz by being good examples of something else, jazzy but not quite jazz.

A few good examples are all it takes to locate the center of a category. Trickier examples show how boundaries defy definition:

• The middle of the ocean is obviously ocean and, viewed from space, the boundary between the ocean and the continents is just as obvious. But walk along the beach and the division moves. Where the boundary recedes, the sand is wet; ocean and land are indistinct.
• Male and female were treated as a mutually exclusive binary when I grew up, but that is obviously wrong. Fun fact — clown fish are born male, but the dominant fish in a social group switches to female. When she dies, her mate becomes female and chooses the next-most-dominant male as her partner.
• A slime mold which was once a fungus is now an animal. Almost inert in its eternal goopiness, the slime mold hasn’t changed, just the goop-sorters.
• Pregnant vs. not pregnant, alive vs. dead and elected vs. not elected are all susceptible to tricky borderline cases.

Look closely at any boundary and it will become unreliable. The closer you look, the worse it gets.

How many colors are there? I learned the answer in school; there are seven in this order: red, orange, yellow, green, blue, indigo, violet. When my daughter was young, she drew her rainbows with six because she didn’t know the difference between blue and indigo. Nor do I.

Or the answer is three because we can make whatever color we want from combining three primary colors, or it is infinite because colors emerge from waves of light striking our eyes, and wavelengths of life change along a continuum. Look much closer and there is no such continuum — a bit of light might be a discrete particle, at least some of the time.

Or maybe the number of colors depends on how many crayons your parents can afford. Not everyone has the 120-color colossal jumbo pack with the surprise inside.

When I gave this talk to Ethiopian medical students, I tried to switch out the culture-bound reference to jazz with a discussion of Ethiopian pop music, but I don’t have ears for it and the examples fell flat. We couldn’t see the “obvious” center of each other’s categories.

Categories are tools, and tools can be weapons. Membership has its privileges. Who sorts and who names?

Those who have been classified and whose class has been used to harm them must respond somehow. Names change. Crayola changed Flesh to Peach; Indian Red became Chestnut. People too rename their groups, until oppression wrecks the new name as well, and yet another is required. More effectively, the out-group may reclaim the name that was an epithet and seize pride and power back: “We’re here, we’re queer. Get used to it!”

A radical solution to the problems of categories is to claim they don’t exist. There is no such thing as gender, race or schizophrenia. But how can we redress a wrong without referring to the wronged?

Imagine someone walking down a beach, railing against the moving boundary between ocean and land, cursing the wetness of the sand and claiming “There is no ocean. There is no land. There are only spaces that are watered and landed.” You might think the person was insane.

Out at the boundaries, we don’t know for sure when a mental illness is present or not, or which is present, even though the things we are trying to identify are as real as the ocean. So we draw lines in the shifting sand, and move them when new information suggests a change would help. It’s the best we can do, and the process requires constant scrutiny, reassessment, and debate.

There may be mental disorders that live at the center of the category, “good examples” that are as uncontroversial as the mid-Pacific. But there are far more that live closer to the fuzzy boundaries, where Frank almost sings jazz, fish change sex, and fungi turn to animals.

My answer to the attorney who interrogated me, “about half,” was drawn from well-conducted studies, but does anyone really believe that the truth might not instead be “about a third” or “about two thirds” or “it depends”?

I can usually recognize mental illness, and I can treat it, but I can’t define it. And that will have to be, as they say, close enough for jazz.