The Confidence Man

THE CONFIDENCE MAN

IN WHICH THE POSSIBILITY THAT PSYCHIATRY IS A DIDDLE IS DISCUSSED, WITH PARTICULAR ATTENTION PAID TO THE PLACEBO EFFECT AND THE TALKING CURE

discussed: A Great Man in a Great Way, The Destiny of Man, Mr. M’s Authorship, Omni-Balsamic Reinvigorator, Undue Mental Excitements, A Noble Lie, Narrative-Deficit Disorder, Advice from Dale Carnegie, An Original Character

BY GARY GREENBERG

ince the world began,” wrote Edgar Allan Poe in 1843, “there have “ been two Jeremys.” Bentham, the Jeremy who wrote a “Jeremiad about usury… was a great man in a small way.” The other Jeremy, Jeremy Diddler, “was a great man in a great way… indeed, in the veryS greatest of ways.” Poe might have been biased. Jeremy Diddler was indirectly responsible for his existence. Diddler was the rascal who schemed his way into the aristocracy by winning the heart of young (and wealthy) Peggy Plainway in Raising the Wind, a comedy that opened on the British stage in 1803. By the next year, it was playing in American theaters, including one in Richmond, Virginia, in which a seventeen-year-old actress named Eliza Hopkins took the role of Peggy. Her husband, Charles, played a local named Sam, and a young actor from Baltimore, David Poe, appeared as the Plainway servant Richard. Less than a year later, Charles Hopkins died, and in April 1806, Eliza Hopkins married David Poe. The couple trouped together for four more years, Eliza Poe garnering much better reviews than her husband, who, according to one critic, “mutilated some of his speeches in a most shameful manner.” David, perhaps tired of being upstaged, left Eliza in

Taunton State Hospital, Massachusetts’s second insane asylum, constructed 1853 Photograph courtesy of the Library of Congress the spring of 1810, and was never heard how much money is in it, he tells the every man for himself and the invis- from again. In December of that year, man, the owner is sure to reward him. ible hand against all—when, in short, Eliza gave birth to Rosalie, her third But, the man protests, “it was you who the American dream is taking shape child. A year later, Eliza died, orphan- found the book.” True, says the did- and the unfettered market is frustrat- ing the infant along with her brothers: dler, so if you insist I will take a small ing and occasionally fulfilling it, you William, nearly five, and Edgar, who reward. He rummages in the wallet can’t be sure about whom or what to would turn three the following month. and announces that there’s no note believe. After all, the trusting are the Poe’s comments about Diddler smaller than a hundred, which is “too diddler’s prey, their faith the sign of came in an essay that appeared in the much to take.” The captain is fuming, their weakness. It was a diddle-or-be- Philadelphia Saturday Courier. Per- the deckhands loosening the ropes. done world, and it still is. haps in tribute to his parentage, Poe “Never mind!” cries the gentleman titled the piece “Raising the Wind; or, on the shore. He’s now rummaging here is no evidence that Herman Diddling Considered as One of the through his wallet. “I can fix it—here T Melville ever met Edgar Allan Exact Sciences.” What made Diddler is a fifty…throw me the book.” The Poe. He may never have encountered great, Poe argues in the essay, is that he diddle perfectly timed and executed, Raising the Wind—the play or the essay. embodied precisely that which defines the gentleman ends up with a wallet But Jeremy Diddler shows up twice in man—“as an animal that diddles.” If full of paper, the con artist with fifty his 1857 novel, The Confidence-Man: only Plato had figured this out, Poe bucks, and the world with an object His Masquerade, first as the name a pas- explains, he would have “been spared lesson in the essence of being human. senger on a ship called the Fidèle gives the affront of the picked chicken” that Diddling would have been on Poe’s to a beggar whose lameness he suspects Diogenes waved triumphantly in Soc- mind, and nearly everyone else’s, in is fraudulent, and later as the generic rates’s face after Socrates defined man mid-nineteenth-century America, name for the “extraordinary metaphys- as a featherless biped. “A crow thieves; when the capitalist frenzies that pos- ical scamps” another passenger thinks a fox cheats; a weasel outwits; a man sess the country from time to time are rampant on the Fidèle, the riverboat diddles,” Poe continues. “To diddle is were rampant. When speculation on which the novel’s action takes place. his destiny.” runs amok, when stocks rise and fall The passenger is right about this army Poe goes on to provide a “compen- overnight, when financial panics are of diddlers, except for one detail: the dious account” of diddling, describing regular occurrences, when curren- many scamps among the passengers—a some of the scams of man, including cies become worthless in a moment, doctor peddling herbal remedies, for one that starts on a wharf from which when people are shorn today of the instance, along with a stock trader, an a steamboat is about to cast off. A man riches they gained yesterday and head employment agent, a philosopher, a hurrying toward the ship suddenly off tomorrow to do it again, when it is man in rags, a couple of well dressed stoops and picks up something from men, a man named Goodman and a the wharf. “Has any gentleman lost a man named Truman who may or may pocketbook?” he cries. The passen- not be good and true—will prove in the gers pause on the gangplank, waiting end to be the same man, who, in his var- to see who will claim the treasure, and ious disguises, raises wind from stem to the captain tries to hurry them along. stern, diddling passengers out of their “Time and tide wait for no man,” he money, their health, their dignity—and, yells, and makes to cast off. The did- above all, out of their trust in their own dler rushes aboard and from the boat judgment. Each encounter is its own pleads with a man on the shore to take drama about what happens when faith charge of the wallet and advertise it so meets opportunity, when skepticism the owner can claim it. Judging from collides with the wish to live in an

4 ever-improving world. If Poe’s essay reviewer wrote, adding that “this is he Confidence-Man opens on the is a how-to compendium of diddling, decidedly the worst.” Another critic T dock alongside the Fidèle at day- then Melville’s novel is its anthology. admitted having failed to gain even “the break. A man in a cream-colored suit, The Confidence-Man is also a did- slightest cue to the meaning (should alone and without luggage, boards the dle. It was published on April 1, 1857, there happen to be any)”—a puzzle- ship and is immediately drawn to a and, as we find out nearly at the end, ment that remained even after he read crowd examining a poster advertising a after puzzling over the novel’s con- the book “forwards for twelve chap- reward for the capture of a con man, an tradictions and riddles, the day it ters and backwards for five,” and then “original genius” recently arrived from describes is also an All Fools’ Day. “attacked it in the middle, gnawing the East. The man takes a small slate Melville provides none of the usual at it like Rabelais’s dog at the bone.” out of his pocket, scrawls on it a line handholds a nineteenth-century reader Whether Melville, already smart- from 1 Corinthians 13 (“Charity thin- might expect from a novel. There is no ing from the commercial and critical keth no evil”), and holds it up next to plot to speak of, but rather a series of failure of his recent novels, meant to the placard “so that they who read the disquisitions, some more cryptic than drive the last nail into the coffin of his one might read the other.” After a few others, none entirely decipherable. The own literary life, to flip the bird on the minutes, he erases “thinketh no evil” titular character’s shape-shifting is as way to the gallows, is not known. But and replaces it with “suffereth long, and likely to fool the reader as it is to fool one thing is certain: he never wrote is kind,” which in turn gives way to his mark, leaving both to slap their another novel. “endureth all things” and then to the heads when they realize, for instance, The prescience of The Confidence- rest of the Pauline criteria of charity. that the herb doctor is only the coal- Man goes well beyond the boundar- The crowd, assuming the man is an company man in a new disguise. The ies of the literary world. America may “imbecile,” and also mute, meets him rest of the characters, with a few nota- since have settled on a single currency, first with “epithets and… buffets” and ble exceptions, are vaguely drawn, their and the Securities and Exchange Com- then, when he fails to respond, with manners of speech indistinguishable mission may sometimes punish fraud, indifference. from one another, and sometimes from and swindlers who aren’t too big to In the meantime, the ship’s barber those of the Confidence Man himself. jail do sometimes get their due, but has started his business day by throw- Clever as he is, he doesn’t always suc- the free marketeers’ makers and taking open his door and placing on a nail ceed, but neither does he get his come- ers and Occupy Wall Street’s 1 and 99 above it a placard of his own, reading uppance, and when he fleeces a fellow percenters are only updated versions no trust—“an inscription,” the nar- passenger, it often reflects as much on of what a magazine writer in 1852 rator comments, the dupe as on the swindler. Just in case described as the only “two classes the reader doesn’t feel sufficiently did- in the world—the Skinner and the which, though in a sense not less dled, Melville addresses him directly— Skinned.” Real life is still contested ter- intrusive than the contrasted to upbraid him for expecting characters ritory, but the reality-based commu- ones of the stranger, did not, to be consistent, to chide him for want- nity loses more ground to the skinners as it seemed, provoke any ing “more reality, than real life itself every day. Melville anticipated more corresponding derision or surprise, c a n s h ow.” than the (already) predictable depreda- much less indignation; and still If The Confidence-Man anticipated tions of capitalism, however. He under- less… did it gain for the inscriber Pynchon and Barth in its apparent stood what Marx didn’t quite grasp, and the reputate of being a simpleton. determination to frustrate a reader, what seems to have eluded his follow- it also anticipated postmodern liter- ers: that it isn’t simply, or even primar- And so starts the argument of the ary criticism by inspiring vicious take- ily, greed that makes us so vulnerable book—not its message, for it has none, downs. “Mr. M’s authorship is toward to the diddle, either as mark or maker. or at least not a single one, but the dis- the nadir rather than the zenith,” one It is love. pute it airs and never quite settles. Is

5 it better to suspect everyone than to hypocritical growling of the bears.” As The woman, perhaps moved by pity, be charitable and risk playing the fool does a consumptive who purchases six offers to befriend the man. to a knave? Is it better to trust than vials of Omni-Balsamic Reinvigorator “No one can befriend me who has to doubt? from an herb doctor, and the Missou- not confidence.” “Charity” is the King James Bible’s rian who, despite his vow never again “But I—I have—at least to that translation of the Greek agape, which to hire household help, pays the man degree—I mean that—” most other versions render as “love.” from the “Philosophical Intelligence “Nay, nay, you have none—none Melville surely knew this etymology, Office” to supply him with a boy, and— at all. Pardon, I see it. No confidence.” just as surely as he understood that eventually—even the barber, who, not “You are unjust, sir,” the woman charity, like trust, faith, and credit, was quite intentionally, provides the Con- replies. She suggests that some past a word whose financial meaning was fidence Man a shave on credit. encounter has “unduly biased” in the process of eclipsing its moral How does the con man do it? His him. “Not that I would cast reflec- meaning. In his guise as a gray-suited “not unsilvery tongue” is a help, of tions. Believe me, I—yes, yes—I may philanthropist, the Confidence Man course, combined with “gestures that say—that—that—” explains to a fellow passenger his plan were a Pentecost of added ones” to “That you have confidence? Prove to create a “World’s Charity,” an orga- create a “persuasiveness before which it. Let me have twenty dollars.” nization whose “one object” would be granite hearts might crumble.” But he “Twenty dollars!” is more than just any ordinary bullshit “There, I told you, madam, you had the methodization of the world’s artist—although he certainly matches no confidence.” benevolence; to which end, the the description Harry Frankfurt gives, When she gives him the twenty dol- present system of voluntary and in his book On Bullshit, of someone lars, she has only his word that a cer- promiscuous contribution to be who stands “neither on the side of tain Widow and Orphan Asylum exists, done away, and the Society to the true nor on the side of the false… let alone that he is its agent. Still, she be empowered by the various [whose] eye is not on the facts at all… apologizes for not having more to give. governments to levy, annually, one except insofar as they may be pertinent He does not let her off that hook, but grand benevolence tax upon all to his interest in getting away with what does reassure her. “There is another mankind. he says.” He knows, with devastating register, where is set down the motive. precision, exactly which bullshit will Good-bye; you have confidence. Yea, Fourteen years and “eleven thousand blend in so well with the atmosphere of you can say to me as the apostle said two hundred millions” after bringing everyday life as to remain undetected. to the Corinthians, ‘I rejoice that I have the “Wall Street spirit” to charity, the “By the way, madam,” says the confidence in you in all things.’” man in gray forecasts, “not a pauper man in gray to a “plump and pleas- What the Confidence Man (in all his or heathen could remain the round ant” passenger, “may I ask if you have forms) offers his marks isn’t only a stock world over.” confidence?” or a potion or an opportunity to con- The passenger is incredulous at “Really, sir—why, sir—really—I—” tribute to the well-being of widows and this attempt to monetize generosity, “Could you put confidence in me, orphans. He offers them the certainty and as the boat reaches his landing, he for instance?” that the stock will rise, or the potion will remains unconvinced that the scheme “Really, sir—as much—I mean, as heal, or the downtrodden will be res- could possibly work. Still, he reaches one may wisely put in a—a—stranger— cued—that, in short, the future is sure into his pocket and hands over some an entire stranger…” to be better. And they can rejoice, for he cash. A few minutes later, so does a “Entire stranger!” he says with a has restored what had been taken away passenger who buys stock from an sigh. “Ah, who would be a stranger? by midcentury—as America’s popula- executive of a coal company that has In vain, I wander; no one will have con- tion quintupled, as railroads and tele- been bid down “solely owing to the… fidence in me.” graph wires began to crisscross the

6 land, as westward expansion opened He has made his fortune minister- the Census Bureau. The doctors soon horizons and eroded class distinction, ing to the discomforts of tormented discovered that the insane numbered as racial discrepancies, at least insofar consciences that now have to figure more than they had realized, largely as they justified slavery, foundered, out what is right and wrong, and how because so many of them were hid- threatening to tear apart the country, to live—not least, at this moment, den away in family homes or wander- as destiny became something that one whether or not to believe the Confi- ing the countryside. They urged the manifested rather than suffered, as it dence Man. He’s offering rest to those states to build more mental hospitals, became possible, and then necessary, who are weary of being uncertain—as but subsequent census counts revealed to make something of oneself, rather all of the newly enlightened, upwardly something disturbing: the more hospi- than accept having been made in the mobile are bound to be. tals states built, the more insane peo- image of an omniscient and ever-pres- ple there seemed to be. “It cannot be ent God, and to figure out what was true “A sick philosopher is incurable,” supposed that so many persons were and what was false rather than taking the herb doctor tells a sick man. suddenly attacked with insanity when someone else’s word for it: the hope to “Why?” these successive establishments were regain certainty about the natural order “Because he has no confidence.” opened or enlarged for their healing,” and of one’s place in it. Americans were “How does that make him said Edward Jarvis, the Massachusetts suddenly scrambling for their footing incurable?” doctor who headed his state’s Commis- like ship passengers getting their sea “Because either he spurns his sion on Lunacy in the 1850s. Rather, he legs, and the one among them who was powder, or, if he take it, it proves a suggested, “the more the means of heal- not nonplussed, who spoke in that Pen- blank cartridge, though the same ing are provided and made known to tecost of tongues to the anxiety of peo- given to a rustic in like extremity, the people… the more they are moved ple recently abandoned by God, who would act like a charm. I am no to intrust [sic] their mentally disor- peddled confidence in whatever form materialist, but the mind so acts dered friends to their care.” The growth they needed—that man was bound to upon the body, that if the one have of the ranks of the insane seemed to make their hearts crumble. no confidence, neither has the be driven by growing confidence in “Is it not charity to ease human suf- ot h e r.” doctors. fering?” he asks one of his early marks. By 1872, however, Jarvis was con- He describes an object he has invented Doubt, then, is the universal fever, vinced that there was more at work “in odd intervals stolen from meals and the Confidence Man has the cure, than supply-side economics. a n d s l e e p.” which, out of charity, which is to say out of love, he will provide, if only you In an uneducated community, or My Protean easy-chair is a chair will believe in him—and confirm that where… men are born in castes so all over bejointed, behinged, confidence with money. and die without stepping beyond and bepadded, everyway so their native condition; where the elastic, springy, and docile to fter the publication of Poe’s essay, child is content with the pursuit the airiest touch, that in some A but before Melville’s novel, a and the fortune of his father, and one of its endlessly-changeable new professional organization dedi- has no hope or expectations of accommodations of back, seat, cated to the easing of human suffering any other, these undue mental footboard, and arms, the most was born: the Association of Medical excitements and struggles do restless body, the body most Superintendents of American Insti- not happen, and men’s brains are racked, nay, I had almost added tutions for the Insane. Its members not confused with new plans nor the most tormented conscience were known as alienists, and among exhausted with the struggle for a must, somehow and somewhere, their tasks was tracking the number of higher life, nor overthrown with find rest. insane people, mostly at the request of the disappointment in failure… in

7 such a state of society these causes which the cogito could question its figured out how to mass-produce pen- of insanity cannot operate. way back to a new kind of certainty— icillin in the 1940s, but it made it clear the kind that comes from careful that what were thought to be three sep- On the other hand, insanity is likely and dispassionate research rather arate afflictions—genital sores, a pustu- in a society like Jarvis’s Massachu- than from the enthusiasms of faith. lar rash, and general paresis, a form of setts, which at the time featured all By the nineteenth century, chemists dementia that afflicted as many as half these conditions, particularly among and physicists and biologists and bot- the inmates of European asylums— the educated, who, more than the rus- anists were busy unlocking nature’s were all different stages of the same dis- tic, were subject to the demands that secrets with their microscopes and ease. That conclusion depended on a “arise from excessive culture, and over- flasks and meters—and, above all, kind of knowledge available only to the burden the mental powers.” Nearly 4 with their skepticism. educated and well equipped—that is, percent of the doctors, lawyers, teach- When Melville’s book was pub- doctors, who had always claimed to be ers, and the like in Massachusetts were lished, this new approach to the world custodians of the secret world behind on the rolls—the “professional insane,” was beginning to pay off in a stunning the world of symptoms, but who now Jarvis called them—and he concluded way, as scientists found proof of a the- could prove that they weren’t just did- that the rise in their numbers was “a ory that had been kicking around for dling us when they claimed to know part of the price we are paying for the more than fifty years. The true cause the sources of suffering and what to imperfection of our civilization.” Jarvis of disease, this theory posited, was not do about it. surely did not mean to reject moder- miasmas or humoral imbalances or But for the alienists, soon to be nity, but only to note the effect of its God’s inscrutable will, but germs, the known as psychiatrists, there were displacements, the imperfections that kind that infested the wells in John no slides to show. If their patients created the need for his profession— Snow’s cholera-ridden London, soured suffered from germs, or other biolog- and for anyone else who offered ref- the milk in Louis Pasteur’s France, and ical problems, then it followed that the uge from civilization’s demands. Those killed the anthrax-infected cows and trouble must be in the brain, which lucky enough to be merely confused tubercular humans in Robert Koch’s was proving to be nearly impervious (rather than insane) might not require Germany. Inoculations against one of to their instruments. “In the present anything so elaborate or expensive as these germs, the smallpox virus, had state of our knowledge, no classifica- an asylum. A haven might also be found already become available, and vac- tion of insanity can be erected upon a in assurances that their mental pow- cines and medicines soon would be pathological basis, for the simple rea- ers would eventually catch up with created for other diseases as well. It son that… the pathology of the disease their culture, that they would eventu- was a miracle: illnesses that once were is unknown,” the superbly named psy- ally grope their way out of confusion death sentences, or at least the cause of chiatrist Pliny Earle lamented in 1886. through trust. uncertain vigils over sickbeds and cra- As a result, he said, “we are forced to “Distrust is a stage to confidence,” dles, could now be definitively named fall back upon the symptomatology the herb doctor tells his patient, assur- and cured. of the disease—the apparent mental ing him that his own experience Applying science to suffering led condition, as judged from the outward would soon allow him to figure out not only to effective treatments but manifestations.” It was demoralizing if the medicine on offer was real or also to new understandings of old to be left in the empirical dust as the fake. Of course, that could be the sci- afflictions—and from there to a new rest of medicine galloped off on the entist’s motto as well. The doubt det- understanding of disease and the role back of science. onated in the Enlightenment might of doctors in diagnosing and treating And so it has been for the last 125 have shaken the pillars of the known it. The 1905 discovery of the syphi- years, as psychiatry has struggled to world, but it had also offered a new lis spirochete, for instance, might not move past distrust—its own and that kind of foundation: science, through have led to an effective cure until Pfizer of its patients—and toward confidence.

8 be defined,” the government ought to SHOOTING POSSUMS FROM consider ratcheting back support for THE BACK PORCH OF ROGER’S BAR research and treatment. by Michael McGriff The confusion also upset Robert Spitzer, the man called upon by the The bones in the possum’s hand APA to bolster confidence in psychi- are a set of reduction gears atry by revising its Diagnostic and Sta- turning in a machine that brings light tistical Manual of Mental Disorders. to this valley of burnt oil and narrow rivers, He told me that he knew that “psychiatry was regarded as bogus,” that my favorite drunks, a few chairs away, laughing hard, it would not command trust until forming a theory of everything. “it was accepted as a medical disci- pline.” His revision, the third edition of the DSM, published in 1980, was an open attempt to earn that accep- tance by adopting a scientific rhetoric. Much of this difficulty has focused on One infamous study showed that And the disarray really bothered Allen the issue that so bothered Pliny Earle: doctors in England, presented with Frances, who presided over the fourth the failure to identify diseases with any a patient whom their American col- revision of the DSM, released in 1994, kind of certainty. It also worried psy- leagues would diagnose as schizo- and who—sitting in the sunny yard of chiatrist Thomas Salmon, who in 1917 phrenic, would, with equal confidence, his home in Carmel, California, in the told an assembly of his colleagues that determine that he was suffering from summer of 2010, in his stocking feet the “chaotic” state of their nosology manic depression. And because all and tennis shorts, the sweat of a work- “discredits the science of psychiatry any doctor had to fall back on was the out still beaded on his large, bronzed and reflects unfavorably upon our asso- apparent mental condition, there was forehead, his shock of white hair some- ciation,” and George Raines, a leader no way to say who was right. In the how unruffled—admitted to me that of the American Psychiatric Associa- mid-1970s, this chaos began to bother even now, one hundred sixty-five years tion, who pointed out that as of 1948, the insurance executives and govern- after the founding of his profession, psychiatrists had three incompati- ment bureaucrats who were psychi- fifty-eight years after the first DSM, ble nomenclatures—the APA’s own, atry’s major patrons. When the APA fifty-six years after Thorazine came as well as a system developed by the voted to delete homosexuality from to market, and twenty-two years after army and another used by the Veter- its manual—a decision that, no mat- the introduction of the antidepressant ans Health Administration— from ter how right it was, could not be said drugs that now flow through the blood- which to choose, and that these were in to be scientific, and which indeed stream of 11 percent of the American turn so frequently modified by specific may have constituted the first time in populace (and the water supply of all institutions that the field had become human history that a disease was erad- of us), “there is no definition of a men- a Babel of private languages. Diagnoses icated at the ballot box—they had had tal disorder.” The DSM does attempt of similar patients varied from hospi- enough. Insurers began to reduce ben- to provide one, he added, but “it’s bull- tal to hospital, city to city, even coun- efits because of the lack of “clarity and shit. I mean, you just can’t define it.” try to country, and it wasn’t even clear uniformity of terminology concern- Frances was furious with me when that terms like paranoid schizophrenic ing mental diagnoses,” while a pres- I led a 2010 magazine story about his or personality disorder meant the same idential commission concluded that objections to the then-forthcoming thing to the listener and the speaker because “opinions vary on how men- fifth revision of the DSM-5 with the within a conversation. tal health and mental illness should above comment. I was hurling hand

9 grenades, he said, acting with wanton that be the fair thing in Asmodeus? it’s bullshit that is scientifically proved disregard for the consequences, play- Or, as Hamlet says, were it ‘to consider to work. Doctors don’t call it “bullshit,” ing Leibowitz’s canticle, turning him the thing too curiously?’” of course. They call it “the placebo into my Charlie McCarthy by throw- Is it unfair to tell the truth when effect.” It’s the oldest medicine in the ing my tone into his voice, making the truth will undermine confidence? world, the one practiced by Jesus and him sound like he was rejecting psy- Can a lie really be noble? Hippocrates and Galen and the rest of chiatric diagnosis in general rather Allen Frances thinks so. And the the ancient doctors, who had no idea than what he thought was a botched Confidence Man agrees. “I will not germs existed, who prescribed mer- attempt at making it better. He claimed force confidence on you,” he tells a cury and other potions that by rights he wasn’t angry because the lawyers in crippled man who resists purchasing should have killed their patients (and trials where he appeared as a forensic the pain dissuader. “Still I would fain sometimes did), who applied leeches expert were now leading their ques- do the friendly thing by you.” He hands and drilled skulls and blew tobacco tioning by waving the magazine in his him a box of the liniment and tells him smoke into rectums, and yet some- face, or because the Scientologists, his to rub it on twice a day. how, sometimes, actually healed their profession’s archenemy, were repeat- “Thank ’ee,” the patient says. “But patients, harnessing (without knowing his comment with the glee of the will this really do me good? Honor ing it, we must presume) the uncanny vindicated, or because in the inter- bright, now; will it?” The doctor tells power summoned when a frightened, net echo chamber “DSM-IV leader him just to try it and moves to leave. ailing person offers himself body and thinks psychiatry is bullshit” had “Stay, stay! Sure it will do me good?” soul to someone who claims to know become a meme. It was, he insisted, “Possibly, possibly; no harm in try- how to save him, who has the reputa- nothing to do with him, but only with ing. Good-bye.” tion and the charisma and the knowing the patients. I had used his words to “Stay, stay; give me three more look that kindle confidence, and with render “an unbalanced and inaccu- boxes, and here’s the money.” it relief. There is every indication that rate portrait of psychiatry in a harm- The herb doctor hands over the even in the age of germs and magic ful way that tarnishes its credibility boxes but refuses the money. “I rejoice bullets, every pill is part drug, part for those who really need our help.” in the birth of your confidence and communion wafer, and that without “But do you think it the fair thing hopefulness. Believe me that, like your the placebo effect, healing people for to unmask an operator that way?” a crutches, confidence and hopefulness money would be a much tougher busi- passenger asks his seatmate after one will long support a man when his own ness—especially if what they need to be of the herb doctor’s would-be marks legs will not. Stick to confidence and healed of is the kind of suffering that calls him a “profane fiddler on heart- hopefulness, then…” brings them into psychiatrists’ offices. strings” and felling him with a “sud- “Stay, stay! You have made a bet- The placebo effect comes to this: den side-blow.” ter man of me. You have borne with if a doctor tells you to take a purple “Fair? It is right.” me like a good Christian, and talked pill once a day before bedtime, and “Supposing that at high ’change on to me like one, and all that is enough that within a couple of weeks you’ll the Paris Bourse, Asmodeus1 should without making me a present of these be feeling less miserable and worried, lounge in, distributing hand-bills, boxes. Here is the money.” you’re more likely to achieve that out- revealing the true thoughts and designs come than if you had stumbled upon of all the operators present—would ike the powder given to the rus- the same purple pill on a table with a L tic, the liniment might act like a sign next to it saying swallow me. charm, the doctor’s confidence infusing No one understands this phenomenon 1. A demon who appears in the Apocrypha’s Book it with the power to heal, the exchange fully. Nobody knows why people given of Tobit, and also in an eighteenth-century French novel, in which he “lifts the roofs off houses to of money augmenting that power. That fake morphine experience dramatic [reveal] what is passing within.” may seem like bullshit, but even if it is, pain relief, an effect that disappears

10 when the ersatz medicine is chased people. They know that psychiatry is as its superiority to placebos, the pla- with a real morphine-blocking drug, a confidence game. cebo effect itself is hardly ever studied. or why in clinical drug trials more sub- I mean that in the best way. You That’s partly because no one has fig- jects who are given placebos get bet- may think that the once-hidden but ured out how to turn a sugar pill into a ter than do subjects who are given no now public fact that antidepressant pharmaceutical blockbuster. But there drugs at all. People have ventured the- drugs did not, in aggregate, outper- is another reason. “Granting that his ories: that expectation or hope makes form placebos in their clinical trials— dependence on my medicine is vain,” us feel better, that it is a conditioned that, indeed, 80 percent of their effect says the herb doctor of a hypothetical response to taking a pill prescribed can be attributed to the power of the patient, “is it kind to deprive him of by a doctor, that it is just the natural placebo—means that they are mere what, in mere imagination, if nothing course of illness and that getting better snake oil and that people who have more, may help eke out, with hope, his has nothing to do with the treatment. traded in their sex lives and waist- disease?” Allen Frances thinks it is not But none of those reasons quite proves lines for antidepressants are playing kind, which is why he thinks I should out, and the only signal that emerges the fool to the knaves of psychophar- have kept my big mouth shut. He loves strongly from the noise is that confi- macology. But that’s not entirely fair. his patients and he doesn’t want to see dence—the doctor’s in the treatment, Another way to look at it, and surely them hurt, even by the truth. Irving the patient’s in the doctor—is crucial, the way the Confidence Man would, is Kirsch, a professor at Harvard, has pro- that confidence itself heals. that psychiatrists and their drug-com- posed a simple design that might yield Allen Frances would never deny pany cohorts have yoked that ancient definitive results, whereby some peo- this. Indeed, the placebo effect is exactly healing power to science, to its claim ple are given placebos and told they what he was worried I would weaken to know the truth, thus providing all are placebos, some are given drugs and by telling the public what he and his of us rustics a chance to feel better. For told they are placebos, some are given colleagues have been telling each other most of us can believe in science, and placebos and told they are drugs, and for years: that their diagnostic manual since we can’t begin to penetrate the some are given drugs and told they are isn’t really scientifically valid. “Open it mumbo jumbo of biomedical research, drugs. No one has done that study yet, up,” Robert Spitzer told me. “It looks that means we must place our con- on the grounds that it is unethical to like they must know something.” But fidence in the priests of science, the deceive people, even in the name of what they know for certain isn’t that people who bring it to the laity: the science, as it might hurt the public’s diseases like schizophrenia and major doctors. trust in medical researchers. depressive disorder and hoarding dis- Despite the fact that almost every order exist in the same way that can- clinical trial gives a placebo to half he relief of psychological suffer- cer and diabetes exist—because they the participants, and although nearly T ing is not solely, or even mostly, don’t. Even Thomas Insel, the head of every drug’s effectiveness is defined the bailiwick of medical doctors like the National Institute of Mental Health, Allen Frances. It’s also purveyed by has been saying publicly for nearly a PhD doctors, like me, and all the other decade that the categories of psychiat- therapists who deliver the talking cure, ric disorders are not scientifically valid. or as Sigmund Freud (according to What psychiatrists do know is that if Carl Jung, according to Bruno Bet- they don’t look like they know some- telheim) called it, “the cure through thing, they will be out of a job—and love.” We don’t have any pills to dis- not only because insurers and govern- pense, nor do we own the franchise on ment bureaucrats won’t pay them any- naming pain. But somehow, despite all more, but because they will no longer that, we still command enough con- be able to inspire the faith that heals fidence that some of us can make a

11 living dispensing this peculiar form on chemo-brain and Dilaudid, and enough that they can finally appear to of love by the hour. I have to get her back into the house, you in their fullness. To the extent that “Who was ever cured by talk?” the and I feel so cold I get goose bumps. what happened has become a story, it consumptive man asks when he tires That kind of thing.” hasn’t become enough of one. The part of the herb doctor’s patter. “Did any of this actually happen?” that gets left out is all the horror and He should meet Amelia. She was “All of it. I was the only child, my fear of witnessing those events and of a thirty-five-year-old doctor and a dad was working two jobs and over- seeing your mother suffer like that, and patient of mine. (Or at least she would whelmed by her illness, so I became her whatever feelings that created in you, be if she really existed, but I am mak- nurse. I know that sounds all dramatic, and then being alone with it. I think ing her up because it is against the law, but I’ve never thought much about it, you need a better story.” and probably wrong and definitely at least not much. I mean, if you’d So we spent our hours trying to unfair, to use real names or identifying asked me what her cancer was like, make one. Amelia was as disciplined details in presenting case material. So I might have mentioned these things, going about the task as she had been the events that I am about to describe and I never would deny they bothered about getting through medical school happened to someone, or maybe more me, but I just never… I guess this must and residency. She kept a journal. She than one person, and not to Amelia, seem so obvious to you.” wrote an autobiography focusing on who in any case is fictional.) She was “How so?” the two years of her mother’s illness. short and dark and she kept her brown “Oh, you know, that this is why She told me more harrowing tales, she eyes fixed on me as she told me her I became a doctor.” spared no medical details, and one day story, as if she were searching for the “Do you think so?” she said, “I realized last night how slightest hint of my reaction. “No, but I’ll bet you do.” much I wanted her to die. I remem- “Everything is the way it was sup- “Well, maybe so. But I’m more bered looking down at her lying in her posed to be,” she says. “Good husband, focused on why these memories come bed, the covers pulled up to her chin, kids, great job, lots of money. I mean, up now, and in the way they do. I think nothing but her face all twisted up in the usual stresses, not enough time, all maybe it’s because you’ve settled down pain, that wasted body under the sheet, that, but really I should just be hum- and I wanted her to die. Not only for ming along. But every once in a while— mercy’s sake. But because she was too well, really now, every day, that’s why sick to love me anymore, and I hated I’m here—maybe I’m in the shower, her for that. I hated her. I totally fuck- maybe the car, or just walking down ing hated her.” the hallway in the hospital—it can The next time I saw her, Amelia happen pretty much anytime noth- pronounced herself cured. “Two weeks ing is demanding my attention—I find of no daymares,” she said. “Completely myself in a reverie. It’s like a daymare or gone. And I’ve been talking to Jeff [her even a flashback. I’m seeing my mother husband, who also does not exist] lying on the floor in a puddle of her about what happened—he knew my own urine, I’m twelve years old, and mom died young, but not much else. I have to help her get back into bed. And I called up my aunt, who was there I mean, I can smell it, it’s so real. Or a lot, and she remembers the same sto- she’s left the house in her nightgown in ries. I’m beginning to think it’s over the winter, all bald and weak from the forever.” chemo, and she’s out on the sidewalk Had talking cured her? Of course, on her knees, puking into the gutter, I’d like to think so. Amelia told me that no idea where she is, totally whacked opening up these memories had made

12 her realize she’d drawn a line across That’s not necessarily a knock against Frank Goodman. Night is falling. He is her life, that she had lived as if she my profession; delivering confidence talking, engaging in a series of debates were two people, the one who lived to the demoralized is not something with earnest interlocutors on heady before her mother died and the one just anyone can do—or would want to. subjects: the nature of truth, the exis- who lived after, and she really wanted “The truth is like a thrashing-ma- tence of evil, whether Polonius’s advice to put them back together. Her illness chine,” a passenger tells the Confidence to Laertes was loving, and, above all, evidently called for the treatment I pro- Man. “Tender sensibilities must keep the relative merits of philanthropy and vide. But had I merely convinced her out of the way.” Maybe I helped Ame- misanthropy. that this was so, and that the way to lia to toughen her sensibilities and Soon the cosmopolitan is tipping do that was to seek out and accept the reclaim as wheat what had been dis- his glass with a man who says his matricide in her? What was it in talking carded as chaff. But maybe not. Maybe name is Charlie Noble. Talk turns to that cured her? she was cured not by talking or by lis- the geniality that wine induces, and Maybe mental health is no more tening or by the truth we had discov- which, Goodman tells Noble, is fast on or less than a good story, one that we ered (or was it fashioned?) together, the rise among the moderns. “Noth- can believe, and we suffer from sto- but by confidence—hers in me, mine ing better attests the advance of the ries too awful or confusing or fright- in stories. Maybe I just diddled her day- humanitarian spirit,” he says, adding ening to tell. Maybe there is a single mares away. that in ancient times it mental illness: narrative-deficit disor- Which would make me a con- der. But maybe not. Maybe we suffer fidence man, for sure. But does it “was mostly confined to the from loneliness, from the fear that if make me a con artist? I took Amelia’s fireside and table. But in our age— we can’t prevent horrible events, if we money; I gave her a story. I believe it’s the age of joint-stock companies can’t save our mothers or comfort our the truth, but I wasn’t there, and the and free-and-easies—it is with this fathers or shelter ourselves from their Amelia who is now remembering her precious quality as with precious shortcomings, if, even worse, we want matricidal wish wasn’t there, either. gold in old Peru…Yes, we golden to kill them for their failures, then we We were, however, both there, in my boys, the moderns, have geniality won’t be loved. office, laboring under these peculiar everywhere—a bounty broadcast “Many persons call a doctor when arrangements. I was lending her an ear, like moonlight.” all they want is an audience,” said that she was crediting me with knowledge, “True, true…” [says Noble]. twentieth-century confidence man and in the current of our conversa- Geniality has invaded each Dale Carnegie. A therapist is a doc- tion, underneath the words and ges- department and profession. tor trained to be an audience. Was it tures, flowed something real, maybe We have genial senators, genial talking that cured Amelia, or being lis- the only real thing: not the story, but authors, genial lecturers, genial tened to? the love that conjures it, that it kindles doctors, genial clergymen, genial No one knows how to answer that and then holds. surgeons, and the next thing we question any more than anyone knows shall have genial hangmen.” why the purple pills make people feel he Fidèle passes into the section better. And it may not shed any light on T of the Mississippi Valley that is Eventually, says Goodman, we will even the subject to say this, but I think there fully in the shadow of slavery in the have genial misanthropes, a “new kind is an active ingredient common to both twenty-third chapter, the exact half- of monster,” who will “take steps, fid- the talking and the drugs: the placebo way point of the novel. The Confi- dle in hand, and set the tickled world effect. Therapy is a placebo treatment dence Man, having donned and doffed a’ dancing.” Armed with geniality, he even more than drugs are, though the at least seven costumes in the first half predicts, “the misanthrope of the com- drugs at least have side effects that help of the book, will spend the second in ing century will be almost as popular you to think they are doing something. one guise, that of the cosmopolitan as, I am sincerely sorry to say, some

13 philanthropists of the present time enough to refrain from fucking our Just as Melville predicted, there was would seem not to be.” mothers and killing our fathers—and, gold in this geniality. And indeed the Just fifteen years into the next cen- when we’re done with them, everyone mental health professions in recent tury, Dale Carnegie was telling the else’s as well. years have turned toward a model unconfident that we “choose our char- Psychoanalysis could not hold based on two appealing and distinctly acters,” and that once you choose, you geniality at bay for long, at least not non-Freudian ideas: that we harbor must “ENTER INTO the character you in the US. Soon enough, it was hijacked within us not monstrous impulses and impersonate, the cause you advocate, (in Freud’s view anyway) by psychia- dirty yearnings but cool rationality and the case you argue—enter into it so trists, who declared in 1926 that only sane sensibilities; and that we live not deeply that it clothes you, enthralls you, medical doctors could practice psy- in a malevolent, or at least tragic, uni- possesses you wholly.” Become that choanalysis. That wasn’t the situation verse, but rather in one that stands at genial, shape-shifting audience—or, as in Vienna. Freud believed that medi- the ready to make and keep us happy. Carnegie put it, long before Allen Fran- cal education was exactly the wrong This psychotherapy with a friendly ces worried over what would happen if preparation for analysis, what with face was invented in the 1960s and his operation was unmasked, “Dyna- its focus on finding and eliminating achieved dominance by the 1990s. It mite the ‘I’ out of your conversation,”— diseases, and he trained art historians is called cognitive behavioral therapy and you will have all the friends and and other laypeople and even, once, (CBT). I once attended a weeklong influence (and, presumably, money) a princess to be analysts. For the US workshop to learn how to conduct it. that you want. It was genial misan- doctors, it wasn’t enough to offer the “OK, let’s get right down to business,” thropy at its best: putting on the dis- miserably neurotic only the consola- the instructor, Leslie Sokol, said in the guise of someone who cares in order tions of common unhappiness; that first minute of the first day. She was per- to help people. was hardly medical. They wanted to fectly groomed in her tailored outfit, There was perhaps no misanthrope do what doctors do: provide a cure. her blond hair coiffed tightly, her fair less genial than Freud, who visited Rejecting Freud’s dour sense that we skin scrubbed like a shiny apple, and she America six years before Carnegie’s could never be cured of ourselves, exuded the same confidence that she first book came out (and never again). and that that reason could not pos- told us it was our job to instill in our- For Freud, the triumphs of culture, the sibly triumph fully over instinct, they selves and our clients. “If we’re asking ecstasies of love, the epiphanies of reli- proceeded to make good on Freud’s them to embrace the model, we have to gion, the yearning for transcendence prophecy that a “psychoanalysis swal- already understand and believe in the were, in the end, further evidence of lowed by medicine” would tempt ana- model. I’m a believer and I’m here to our depravity. We wouldn’t have to lysts “to flirt with endocrinology and make you a believer,” she said. The great- work so hard to cover our stink, he the autonomic nervous system,” and est obstacle to achieving that embrace reminds us, if it didn’t smell so bad. turn it into just another “specialized is skepticism of the kind that made me “Inter urinas et faeces nascimur,” Saint branch of medicine, like radiology.” wonder if I was only diddling Amelia. Augustine (reputedly) wrote, a senti- “Self-doubt is contagious,” she warned. ment Freud quotes approvingly as he Self-doubt, Sokol told us, is exactly reveals us as operators of a civiliza- what brings our patients to us in the tion that is a doomed and desperate first place. And to remedy this malady, attempt to prove that our origins are she added, it’s not sufficient for us to lofty and our accomplishments pure, provide an audience. We “need empa- and reminds us that the best we can thy, but it’s not enough.” Our true busi- do is subscribe to the illusion of good- ness is to “socialize the patient to the ness, con ourselves into living by the model,” she declared. Which we do by lights of our better angels, at least “teach[ing] you [the patient] how to

14 cope, to help you more effectively nav- will, when repeated and reinforced, to make it.” This is not a placebo effect, igate life. We’re here to say that when lead to “cognitive restructuring,” and she promised (as if that would be a bad bad things happen, you’re going to be she is bound to overcome her “nega- thing), because CBT is tried and tested; equipped to deal with them so they tive triad” of past regret, present unhap- it has active ingredients that make it don’t get the best of you.” As psychi- piness, and despair about the future, work like a pill targeted at the cause atrist and CBT founder Aaron Beck to replace her “task-interfering cogni- of suffering. She left out the part about says, that’s what a therapist is for: to tions” with “task-oriented cognitions” how those tests were carried out: their teach you “to master problems and sit- (“Stop TICking and start TOCking,” as authors constructed two manuals, one uations which [you] previously con- Sokol put it). She will realign her think- containing the instructions for CBT, sidered insuperable…[and] to realign ing with reality and she will learn that the other a therapy that its implement- [your] thinking with reality.” Having reality slings no arrows that a prop- ers knew was made up for the occasion, learned this, having inoculated yourself erly realigned mind cannot absorb or and in which they had no reason to be against doubt, having finally affirmed deflect. She will, in short, become resil- confident. When their stalking horses that Freud was wrong, that there is no ient, and, Sokol assured us, “the resil- came in second, these therapists could reason to see yourself as anything other ient person is the person who is going hardly have been surprised. than perfectly equipped for the genial reality in which our lives unfold, you will be able to navigate between the Scylla of disbelief and the Charybdis CONVERSATION FROM THE SHADOW LANDS of setback, to sail smoothly on the seas PART I of self-confidence. It might be nice to know where LEV GROSSMAN: People describe you (as they do me) as a writer who works Amelia’s reveries came from, what in the shadow lands between literary fiction and science fiction. Is that how you’d made them surface in the way they describe yourself? did, why they felt to her as they did— in short, their meaning—but it is not CHARLES YU: As much as I like the idea of being some kind of creature lurking mandatory, and there are reasons to in the shadow lands, I can’t say I do think of it that way. I wish to politely yet think it might be harmful to do so. firmly deny the premise of the question. There’s a kind of “implied map of fiction” As the ninety-year-old father of CBT, embedded within the whole way of thinking about this—the idea that “literary” Aaron Beck, told us toward the end is Norway and “science fiction” is Sweden. Not only do I not think those two of that week, we must bear in mind sovereign nations are mutually exclusive; I don’t think they are even well-defined the fate of Lot’s wife, calcified by her territories, right? I don’t believe in the genre distinction. insistence on looking backward toward It’s not as if I sit around classifying myself. When I sit down to write, I don’t her burning past rather than forward think, Today I shall write fabulist-inflected literary fiction, etc. It’s more like, Unn- toward a genial future. Help Lot’s wife ngggh, and, Grrrrr, and, I can’t believe I squeezed out 150 words today and they identify her “automatic thoughts” all suck. But maybe that’s just me. and record them on a “dysfunctional I’ll flip the question back to you: how do you describe yourself? thought record.” Show her how to use the “downward arrow” to point to the LG: I once thought as you do. Lately I’ve been getting more interested in borders. “core negative beliefs,” how to chart her I get a lot of enjoyment out of playing the different conventions of literary fiction progress from belief to thought to emo- and fantasy off each other, and I feel like you can’t do that unless you’re committed tion to behavior on a “cognitive con- to the idea that somewhere out there there’s a line between them. Though I wouldn’t ceptualization diagram,” and how to want to have to actually point to it. fashion an “alternative response” that I’m pro-border: I like them because I like sneaking across them. O

15 It doesn’t get much more genial than the dispensation of love, by the pill or the narrator with one final opportunity this. Leslie Sokol loves us, and she loves by the hour, the opportunity to com- to address the reader directly—and to our patients, and she loves the world that fort each other with stories, boluses confound him with the insistence that provides us all the opportunity we need deployed against the vastness of time indeed he is no such thing. In fact, Mel- to be people who can make it. She has and the inevitability of loss. In which ville tells us, an original character is as taught us the dance, and she wants us case it is possible that all these lies are rare as “a new law-giver, a revolution- to set our patients to dancing, confident equally brave. izing philosopher, or the founder of a that their legs are just right for the tune, “A fresh and liberal construction new religion.” An original character, he that they have the great good luck to would teach us to regard… this whole continues, is not just some humdrum have been born with a cognitive appa- cabin full of players as playing at games persona a novelist picks up in town (“a ratus designed for happiness in a land in which… not a player but shall win,” kind of man-show, where the novelist dedicated to its pursuit, and where they the Confidence Man tells a merchant goes for his stock as the agriculturist can, if they have lost the beat, pay some- in the morning. goes to the cattle-show for his”), and one to put them back in step. Who would “Now, you hardly mean that; because who “sheds not its characteristic on its not want to believe that the world is our games in which all may win, such games surroundings,” but rather Protean easy chair, that all we have to remain as yet in this world uninvented, do, once we have bought it, is to learn I think,” the merchant replies. is like a Drummond light2, raying how to entrust our racked bodies and Soon enough, however, that game away from itself all round it— tormented consciences to its joints and would be invented—by Lewis Car- everything is lit by it, everything hinges, and then we will find our rest? roll, who, eight years after The Con- starts up to it (mark how it is with fidence-Man appeared, devised the Hamlet), so that, in certain minds, he barber, for one. Midnight Caucus Race, which the Dodo Bird there follows upon the adequate T approaches, and the Confidence ended by declaring, “Everybody has won conception of such a character, Man, having won many and lost a few, and all must have prizes.” The Dodo an effect, in its way, akin to that visits the man who has no trust. And Bird verdict is what researchers call a which in Genesis attends upon the why should he? “Can one be forever phenomenon noted by social scientists beginning of things. dealing in macassar oil, hair dyes, cos- for more than seventy-five years: that, metics, false moustaches, wigs and other than in CBT’s rigged games, all This is Melville’s final diddle, because toupees, and still believe that men are therapies of the mind prove to be equally of course this is exactly what the Confi- wholly what they look to be?” the bar- effective. There is only one factor that dence Man has done to his marks, what ber asks by way of explaining his dis- makes a difference: whether or not the Melville has done to his readers, and trust. “They may talk of the courage therapist believes in what he or she is what good diddlers—novelists, thera- of truth, but my trade teaches me that doing. It doesn’t matter in what disguise pists, lovers—everywhere do, and what truth sometimes is sheepish. Lies, lies, we show up, it seems—so long as we we can all do for one another: light up sir, brave lies are the lions!” can hand out confidence confidently. the darkness, raise us up on the wind, But whose lies are actually brave? Which I’ve been doing for thirty and put the world at our feet, giving us The psychiatrist, with his bullshit about years now—less cynically, I hope, than a view of ourselves and our lives from knowing something? The cognitive Melville’s antihero, and less genially, which, if we are brave enough to look, we behaviorist, with her TICk-TOCk I know, than Leslie Sokol, but with no can take heart, if only for a moment. O geniality? The retro-Freudian ther- more proof than they have that the con- apist, with his diddle about the bot- fidence in which I trade is warranted. tomless depravity of the self, and the It is the barber who, after the Con- 2. Drummond was the inventor of an early stage light, one that directed heat at a cylinder of lime to necessity of excavating it? All these fic- fidence Man has shorn him of a shave, produce an intense incandescence, better known tions may only provide the occasion for calls him “quite an original,” providing to us as limelight.