Journal of Psychiatric and Mental Health Nursing, 2007, 14, 277–281

Modernity, mental illness and the crisis of meaning

M. ROBERTS rmn diphe ba(hons) pgce pgcrm ma phd(c)
Lecturer, Department of Philosophy, School of Humanities and Social Sciences, Faculty of Arts, Media and Design,
Staffordshire University, Staffordshire, UK

Correspondence: ROBERTS M. (2007) Journal of Psychiatric and Mental Health Nursing 14, 277–281
M. Roberts Modernity, mental illness and the crisis of meaning
Department of Philosophy
School of Humanities and Social Western civilization has, over its relatively recent past, undergone dramatic, unparalleled
Sciences changes. The historical period in which these changes have occurred is commonly referred
Faculty of Arts, Media and
to as ‘modernity’, and although modernity has had profound repercussions on all aspects of
Design
people’s lives, what has received less attention in the nursing literature is how modernity has
Staffordshire University
influenced, and continues to influence, the mental health of modern men and women. In an
College Road
Stoke-on-Trent
attempt to address this, the following paper, drawing on the work of Szasz, Nietzsche and
Staffordshire ST4 2DE Frankl, seeks to present an accessible introduction to one of the most salient features of
UK modernity; namely, the erosion of those traditions that gave life a meaning or a purpose, and
E-mail: marcwarenroberts@ that provided people with ready answers to the problem of how they ought to live. The
aol.com paper will then introduce some of the possible consequences of this on the mental health of
modern men and women, as well as providing preliminary suggestions as to how mental
health nursing might respond. In doing so, the paper also seeks to stimulate further
discussion and research into how modernity has influenced, and continues to influence, the
mental health of modern men and women, and how psychiatric and mental health nursing
might respond.

Keywords: philosophy, psychotherapy, religion

Accepted for publication: 16 January 2007

of social organization (see, e.g. Havel 1996, Cahoone

Introduction
Western civilization has, over its relatively recent past,
undergone unparalleled changes (see, e.g. West 1997, pp.
7–16). The historical period in which these changes have
occurred is commonly referred to as ‘modernity’, and while
the precise historical parameters of this period – and indeed
whether we have entered a new ‘post-modern’ period – are
the subject of much discussion (see, e.g. Harvey 1990,
Lyotard 1997), modernity can be understood, broadly
speaking, as that unique form of civilization that emerged
in Europe and North America over the last several centu-
ries, whereby human beings progressively gained a scien-
tific understanding, and technological control, over their
environment and progressively developed ‘rational’ forms
1997, Weber 2001, Roberts 2005). However, while moder-
nity has had profound repercussions on all aspects of peo-
ple’s lives (see, e.g. Berman 1983, Giddens 2002), what has
received less attention in the nursing literature is how
modernity has influenced, and continues to influence, the
mental health of modern men and women. In an attempt to
address this, this paper seeks to present an accessible intro-
duction to one of the most salient features of modernity;
namely, the erosion of those traditions that gave life a
meaning or a purpose and that provided people with ready
answers to the problem of how they ought to live. The
paper will then introduce some of the possible conse-
quences of this on the mental health of modern men and
women, as well as providing preliminary suggestions as to

© 2007 The Author. Journal compilation © 2007 Blackwell Publishing Ltd 277
M. Roberts
how mental health nursing might respond. In order to do
this, it will draw on the work of the so-called ‘anti-
psychiatrist’ Thomas Szasz (1983) – specifically The Myth
of Mental Illness, the 19th century German philosopher
Friedrich Nietzsche (1974) – specifically The Gay Science,
and the work of the psychiatrist, and founder of ‘logoth-
erapy’, Viktor E. Frankl – specifically Man’s Search for
Meaning (2004).
Szasz and the myth of mental illness
The guiding question that Szasz (1983) asks in The Myth
of Mental Illness is: ‘Is there such a thing as mental
illness?’ (p. 12). He begins his response by suggesting that
‘the concept of illness, whether bodily or mental, implies
deviation from some clearly defined norm’ (Szasz 1983, p.
15). Thus, in the case of physical illness, this norm is said
to be ‘the structural and functional integrity of the human
body’ (Szasz 1983, p. 15), whereas the attribution of
mental illness is said to be based on a judged ‘deviance’
from certain ‘psychosocial, ethical, or legal norms’ (Szasz
1983, p. 17). What is important to note about these two
types of ‘norms’ is the implication that, in the case of
physical illness, the norm and the deviation from that
norm is, as it were, a matter of ‘value free, objective
facts’, whereas in the case of mental illness, the norm and
the deviation from that norm is a matter of ‘value-laden,
subjective judgements’. This is to say that although psy-
chiatry strives to present itself as somehow ‘value-free’,
‘impartial’ and ‘objective’ (Szasz 1983, pp. 17–20), as
continuous with the natural sciences (Fulford 2000), the
attribution of mental illness demands a value judgement
in which an ‘observer’ makes ‘a covert comparison
between the patient’s ideas, concepts, or beliefs and those
of the observer and the society in which they live’ (p. 14).
Accordingly, Szasz (1983) suggests that the psychiatrist
‘cannot, and does not, stand part from the person he
observes, as the pathologist can and often does’ (p. 19);
rather, the psychiatrist is, as it were, a ‘participant
observer’ in so far as the psychosocial, ethical and legal
norms of ‘society at large’ are active, participatory factors
in the psychiatrist’s observations and in the judgements
about who is ‘mentally ill’.
Importantly, Szasz (1983) suggests that the ‘transgres-
sion’ of psychosocial, ethical and legal norms is not a
consequence of ‘illness’, but of the attempt to confront and
to tackle what he refers to as ‘problems in living’ (p. 20).
This is to say that the variegated phenomena that are
currently identified as ‘mental illnesses’ should be removed
from the category of ‘illness’ altogether in so far as they are
not the consequence of some ‘objective’, intra-personal
‘disease entity’, the consequence of ‘diseases of the brain’
278
(Kendell 1996), but are instead ‘the expressions of man’s
struggle with the problem of how he should live’ (Szasz
1983, p. 21). In particular, Szasz (1983) suggests that
‘human relations at all levels’ are ‘fraught with stress,
strain, and disharmony’ (p. 20) and, as the result of ‘con-
flicting human needs, aspirations and values’ (p. 21), they
leave ‘Man’ pondering: ‘What should he do with himself?
For what should he live?’ (p. 23). Therefore, rather than a
‘real’ entity, Szasz (1983) suggests that the concept of
mental illness is a ‘disguise’ (p. 21), ‘social tranquillizer’ or
‘myth’ (p. 2) that is employed to obscure the ‘problems in
living’ that people confront. It is important to note that by
claiming that mental illness is a myth, Szasz (1983) is not
suggesting that the variegated phenomena that are cur-
rently identified as mental illnesses do not exist (p. 23);
rather, he is claiming that such phenomena is a conse-
quence of the attempt to confront and to tackle the
problem of how to live, and that to identify such phenom-
ena as a ‘disease’ or an ‘illness’ is to hide the very real
problems in living that people face.
Although Szasz (1983) suggests that human beings are
inherently ‘afflicted’ by problems in living (p. 20), a more
sophisticated reading suggests that problems in living, or at
least their intensification, are the result of relatively recent
events that have occurred within, and have irrevocably
transformed, the whole of Western civilization itself. Thus,
somewhat enigmatically, Szasz (1983) suggests that by
‘problems in living’ he is referring to ‘that explosive chain
reaction that began with man’s fall from divine grace by
partaking of the fruit of the tree of knowledge’ (pp. 21–22).
By doing so, Szasz (1983) can be understood as alluding to
the emergence of that period in the history of Western
civilization that is commonly referred to as ‘modernity’
whereby, broadly speaking, human beings began to
increase their understanding of themselves and the world in
which they live; he suggests, however, that an important
consequence of this is ‘an ever larger burden of understand-
ing’ (p. 22). This is to say that with increasing understand-
ing of themselves and the world, along with the
concomitant challenge and erosion of the theological world
view, modern men and women are gaining a growing
awareness that they are free to direct their own lives and
must take responsibility for how they do so. We are, as
Sartre (1996) memorably asserted, ‘condemned to be free’
(p. 439), ‘condemned’ to ‘shoulder’ the ‘burden’ of our
freedom and the responsibility for how we use it; accord-
ingly, Szasz (1983) dismisses any attempt to alleviate this
‘burden’ by ‘taking refuge in an outmoded theological view
of man’ because, he suggests, the only ‘rational’ manner in
which to address the problem of how to live is through
‘more understanding, and appropriate action based on
such understanding’ (p. 22).
© 2007 The Author. Journal compilation © 2007 Blackwell Publishing Ltd

Nietzsche and the death of God
Perhaps more than any other, it was Friedrich Nietzsche
(1974) who explored the impact and the implications of
modernity upon the lives of modern men and women,
encapsulated within his now infamous proclamation that:
‘God is dead’ (p. 181). It is important to note, however,
that Nietzsche’s work has always elicited conflicting
responses, and his aphoristic and often highly dramatic
discursive style has meant that his work has been subject
to a variety of interpretations, uses and even damaging
misuses (Kaufmann 1974, pp. 3–9); accordingly, what
Nietzsche means by proclaiming that ‘God is dead’ has
been, and continues to be, the subject of varying consid-
eration, discussion and disagreement (see, e.g. Schacht
1992, Deleuze 2002, Pearson 2005). For the purposes of
this paper, however, it is enough to suggest that by pro-
claiming that God is dead, Nietzsche (1974) was propos-
ing that Western civilization was undergoing one of its
most profound historical and cultural events; namely, the
demise of the belief in the existence of God (p. 279). In
particular, he was suggesting that human beings, by virtue
of their own enquires, investigations and reflections upon
themselves and the world, have irrevocably discredited the
theological, Judeo-Christian world view, that human
beings themselves have ‘killed God’. Thus, in a memo-
rable, aphoristic passage, Nietzsche (1974) has his pro-
tagonist, ‘the madman’, run into a crowded market place
and cry: ‘Whither is God?’ to which he replies: ‘I will tell
you. We have killed him – you and I. All of us are his
murderers . . . God is dead. God remains dead. And we
have killed him’ (p. 181).
Writing in 1887, Nietzsche (1974) suggested that the
recognition of the ‘death of God’, and certainly the full
implications of this event, would elude many people; as he
made clear: ‘The event itself is far too great, too distant, too
remote from the multitudes capacity for comprehension-
. . . Much less may one suppose that many people know as
yet what this event really means’ (p. 279). However,
Nietzsche (1974) suggested that its repercussions would,
given time, affect more and more people so that, at least
initially, we would begin to experience a profound ‘insta-
bility’ and ‘disorientation’, and we would do so because the
belief in God, and the Judeo-Christian world view gener-
ally, had so greatly influenced the conception of ourselves
and others, the values that we hold and the morality that
we espouse, the meaning we believe our lives to have and
the direction we believe our lives ought to take (p. 279).
This theological world view prevented, or to a large degree
mitigated, what Szasz refers to as problems in living
because it provided ready answers to the problem of how
life ought to be lived and what its overall meaning and
© 2007 The Author. Journal compilation © 2007 Blackwell Publishing Ltd
Modernity, mental illness and the crisis of meaning
purpose was, and faith in the existence of God gave the
reassurance that the validity of that form of life had, as it
were, a ‘divine guarantee’. With the demise of this faith in
God, however, the form of life that was built upon it begins
to disintegrate (Nietzsche 1974, p. 279), and so, as
Nietzsche (1968) forewarned, ‘we have to pay for having
been Christians for two thousand years: we are losing the
center of gravity by virtue of which we have lived; we are
lost for a while’ (p. 20).
With the death of God, the ‘ruin’ of the Judeo-Christian
interpretation of the world and the loss of meaning and
guidance that it gave to people’s lives, Nietzsche (1974)
suggests that human beings are faced with a terrifying
question; namely: ‘Has existence any meaning at all?’ (p.
308). For Nietzsche (1974), it will take time and courage
for people to confront and ‘honestly’ attempt to tackle this
most profound of questions; indeed, he makes it clear that:
‘It will require a few centuries before this question can even
be heard completely and in its full depth’ (p. 308).
However, Nietzsche (1968) suggested that the initial
response to it would be one of despair, whereby people
would: ‘rebound from “God is truth” to the fanatical faith
“All is false”’ (p. 7); this is to say that the Judeo-Christian
world view has so deeply influenced Western people’s lives
that its loss will entail the belief, the nihilistic belief, that
everything is lost. Set to become the defining characteristic
of our age (Nietzsche 1968, p. 3), Nietzsche (1968) sug-
gests that nihilism is that condition wherein what were
previously ‘the highest values devalue themselves’, a state
in which life lacks any aim, purpose or meaning and, more
generally still, a state in which ‘“why?” finds no answer’ (p.
9). Therefore, one of Western civilization’s most significant
events, the death of God engenders the most profound
cultural, sociological and psychological repercussions,
leaving many facing an ‘existential crisis’, a crisis in dis-
cerning a meaning or purpose for their existence and strug-
gling to tackle the problems in living that this engenders;
indeed, elucidating Nietzsche’s (1974) famous passage on
the death of God entitled: ‘The Madman’ (p. 181),
Kaufman (1974) ominously suggested that ‘to have lost
God means madness; and when mankind will discover that
it has lost God, universal madness will break out’ (p. 97).
Frankl and the search for meaning
One notable figure who has attempted to respond to ‘exis-
tential crisis’, and whose work can therefore assist mental
health nursing to consider how it might respond to the
psychological manifestations of the nihilism that the death
of God engenders, is Viktor E. Frankl. For Frankl (2004),
the traditions that provided existence with a meaning and
with ready answers as to how we should live are now
279
M. Roberts
‘rapidly diminishing’, leaving an ‘existential vacuum’ in
their wake and the sense that life no longer has a meaning
or purpose (2004, p. 111); as he makes clear: ‘The existen-
tial vacuum which is the mass neurosis of the present can
be described as a private and personal form of nihilism’ (p.
131). Moreover, he suggests that this existential vacuum,
this nihilism, has many varied and far-reaching conse-
quences for modern men and women, and many will
respond by simply doing what other people do, while
others will do what they are told to do – ‘conformism’ and
‘totalitarianism’, respectively (Frankl 2004, p. 111). In
addition, we can suggest that others will cling more pas-
sionately to what has been lost, becoming more ‘fundamen-
tal’ in their religious convictions, while yet others will
adopt ‘new’, quasi-religious beliefs, such as those of ‘New
Age Spiritualism’ (see, e.g. Simmel 2000, p. 293). Impor-
tantly, much of the phenomena that is referred to as ‘mental
illness’ is, for Frankl (2004), best understood as the varied
expression of how modern men and women are struggling
to confront the ‘existential vacuum’, and thus the nihilism,
of their age; as he makes clear: ‘Such widespread phenom-
ena as depression, aggression and addiction are not under-
standable unless we recognize the existential vacuum
underlying them’ (Frankl 2004, p. 112).
Frankl’s (2004) therapeutic response to those experienc-
ing such phenomena, a practice that he refers to as logo-
therapy, is to ‘reorient’ the person to the meaning, or the
purpose of their existence (p. 104). This is to say that a
person is orientated to confront the question of the
meaning of their existence, to explore this question and,
ultimately, to provide a positive answer to this question
(Frankl 2004, p. 108). Accordingly, the search to find a
meaning or a purpose for one’s life is not to be understood
as some ‘idle, academic curiosity’ that one engages in once
supposedly ‘more urgent’ or ‘more fundamental’ needs
have been met; rather, the striving to search for and to
possess a meaning or a purpose for one’s life is said to be
‘the primary motivational force in man’ (Frankl 2004, p.
104). For Frankl (2004), if a person’s life lacks a meaning
or a purpose, if a person does not have something to live
for, then life’s strivings, struggles and projects become,
ultimately, futile, and again, for Frankl (2000), ‘such phe-
nomena as addiction, aggression, and depression are, in the
final analysis, due to a sense of futility’ (p. 140). However,
with a meaning, life’s strivings, struggles and projects
‘make sense’, they become meaningful, and mental health
nurses are well placed to attempt to reinstall meaning,
purpose and hope into people’s lives (see, e.g. Moore 2005,
Skaggs & Barron 2006). Indeed, stressing the importance
of meaning or purpose for a person’s life, Frankl (2004)
suggests that: ‘There is nothing in the world . . . that would
so effectively help one to survive even the worst conditions
280
as the knowledge that there is a meaning in one’s life’
(p. 109).
Now, the manner in which logotherapy attempts to
assist a person to address the question of the meaning of
their existence – and thereby ameliorate the threat of nihil-
ism and its various psychological manifestations – cannot
be discussed in detail here. However, as a broad and
insightful introduction, it is instructive to consider All-
port’s (2004) account of how Frankl would assist his
clients to make clear the implicit, and sometimes forgotten,
actual or potential meaning or purpose of their existence
(p. 7); so, for example, there might be the love of one’s
children, a talent to be developed and used or ‘perhaps only
lingering memories worth preserving’ (Allport 2004, p. 7).
As this suggests, the answers a person gives to the question
of the meaning of their existence will reflect the particular-
ity of that person’s life (Frankl 2004, p. 113), and a person
is free to decide what is, or what will be, the meaning or
purpose of their existence, and how they will live. It is
important to note, however, that a person’s life is ‘lived
against the backdrop’, as it were, of wider ethical, legal and
psychosocial ‘horizons’ (see, e.g. Taylor 2003, pp. 31–41),
and so the answer that a person gives to the question of the
meaning of their existence can be measured against those
horizons, and so it is against those horizons that a person
will be called to account for what they do with their life.
This is to say that a person must take responsibility for
what they have deemed to be the meaning or purpose of
their existence, and therefore how they address the ongoing
question, the ongoing problem of how they ought to live; as
Frankl (2004) concludes: ‘In a word, each man is ques-
tioned by life; and he can only answer to life by answering
for his own life; to life he can only respond by being
responsible’ (pp. 113–114).
Conclusion
Szasz, Nietzsche and Frankl all provide, in their own way,
a ‘diagnosis’ of the state of contemporary, Western society
and explore its implications upon the mental health of
modern men and women. Characterized by expanding sci-
entific understanding, and a concomitant erosion of the
religiosity that gave life a meaning and a ready answer to
the problem of how one ought to live, modernity leaves
men and women susceptible to nihilism, and the variegated
mental health problems that can arise as a consequence. If
that ‘diagnosis’ and its implications are accepted, then
there exists an opportunity for mental health nurses to
conduct further research into how modernity, and in par-
ticular ‘the death of God’, has influenced, and continues to
influence, the sense of meaning or purpose in people’s lives,
the implications of this for their mental health and how
© 2007 The Author. Journal compilation © 2007 Blackwell Publishing Ltd

mental health nurses may ‘therapeutically’ respond. More-
over, if we take Frankl’s work as a productive point of
departure, and understand a therapeutic response in terms
of assisting people to find a meaning or a purpose in their
lives, then there exists an increasing body of accessible
work concerned with ‘the meaning of life’ that can serve
mental health nurses as a ready resource (see, e.g. LeBon
2001, Marinoff 2004, Baggini 2005, Young 2005, Cotting-
ham 2006). Finally, it presents mental health nurses with an
opportunity to develop, as it were, a broader, more ‘philo-
sophical’ perspective in which the aetiology, development
and treatment of mental health problems are also viewed in
the context of the shape and the direction of a person’s life
as a whole, and as a life embedded within, and therefore
shaped by, the unique particularities of our historical
epoch.
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