After a 16 year break, Cormac McCarthy, considered by many to be among the greatest living American authors, published two new novels at the end of 2022. McCarthy has written a number of novels which have become popular movies including The Road and No Country for Old Men. His themes are dark, picking up in the Southern Gothic style of Flannery O’Connor and William Faulkner. And in his newest book, Stella Maris, McCarthy turns his brooding eye towards our own field of work: the therapeutic encounter, madness, and wellness.
Stella Maris is named after the asylum into which our protagonist, a twenty-year old woman, has just turned herself in. Each chapter is a conversation session between Alicia and her psychiatrist. There is no explanatory language at all, the entire book consisting only of the dialogue between therapist and patient. I didn’t expect to find McCarthy turning his attention to therapy and psychiatry, so I was keen to see what kinds of lens he would use as his frame. Ultimately he draws from the encounter important questions about the nature of reality, the nature of perception, and what kinds of things “count” as sanity, madness, and genius.
Alicia Western is a 20-year-old math prodigy. She is more than a prodigy, she is a caricature of genius. She is the kind of person who at her young age has read ten thousand books and memorized them all (“or else what’s the point in reading them?” she asks). Also, the person who was given a PhD position in her teens but dropped out anyways to deepen into her studies in her own ways. And so much of the book will hinge on the relationship between genius and madness, and how we tease them apart, and on what grounds.
But there’s more to it, because mathematics is a special kind of thing. Compared to all of the arts and sciences it is possible that math is the most abstract. They seem to reflect two things simultaneously: an abstraction that absolutely doesn’t exist and certain absolute truths about the makeup of the universe that are revealed here and nowhere else. At the deep levels, math is both pure idea and fantasy, and pure concrete truth. They are the perfect feeding ground for a story about how we carve up the world of thoughts and 
decide which ones are real, which ones are crazy, and which ones are visionary. From my point of view, this is an essential debate for therapists to at least have some interest in.
Sure, I’m a therapist so I like to see this stuff wherever I look. But McCarthy makes it pretty explicit in this book that he is taking aim at the psy-disciplines: at one point Alicia dissects her “reservations about the souldoctors,” saying “Maybe their lack of imagination. Their confusion about the categories into which they’re given to sorting their patients. As if name and cure were one. The way they ignore the total lack of evidence for the least efficacy in their treatments. Other than that they’re fine”. Spicy!
And before we move on let me add the juicy part of the story: it’s not just that Alicia sees hidden truths of the universe in the form of mathematical equations produced by her nonconscious (more on this later!). She also has a lifelong relationship with a hallucinated character with flippers for hands, with whom she doesn’t particularly get along. So in this way we are set up to ask real questions about the kind of nonconscious visions, which we call madness or genius.
Alicia, despite the uncomfortable hallucinations that seem to plague or at least irritate her, has to trust her nonconscious self, and does not get to simply vilify the part of the self which is not obviously generated by the front of the brain, in the light of day. For her, it means taking the good with the bad. But for us, there is a wonderful articulation of trusting and indulging the nonconscious:
The deeper question, which we touched, is that is mathematical work is performed mostly in the unconscious we still have no notion as to how it goes about it. You can try and picture the inner mind adding and subtracting and muttering and erasing and beginning again but you won't get very far. And why is it so often right? Who does it check its work with? I’ve had solutions to problems simply handed to me. Out of the blue. The locus ceruleus perhaps. And it has to remember everything. No notes.
Most therapists that I speak with are nonpathologizing in an ethical sense. They believe that it is inappropriate and cruel to malign, scold, shame, and punish those of us who are having troubles in our psycho-emotional lives. This is an important ethical position, rooted in the historical degradations the psy-disciplines committed against vulnerable peoples. For these practitioners, the ethic of Do No Harm is always at the forefront of their minds, and they would be willing to trade other possible therapeutic outcomes to take a low risk position towards harming patients. The ethical nonpathologist says that whether or not it’s helpful to patients and clients, it’s the only way we can do right by them and our profession.
Or, from Stella Maris,
Women enjoy a different history of madness. From witchcraft to hysteria we’re just bad news. We know that women were condemned as witches because they were mentally unstable but no one has considered the numbers — even few as they might be —of women who were stoned to death for being bright. That I haven’t wound up chained to a cellar wall or burned at the stake is not a testament to our ascending civility but to our ascending skepticism. If we still believed in witches we’d still be burning them.
Other therapists are non pathologizing for a different reason: they believe that by approaching people’s problems without calling them illnesses and diseases, but instead referencing them as ordinary parts of human experience, that this in itself is helpful. For functional nonpathologists, there is a belief that we don’t have to make the trade-off that the ethicists are willing to commit to. From this lens we can argue that not only is it morally correct, but it is also clinically correct.
But there is a third order of nonpathologizing, where the debate that Stella Maris intercedes, which is whether nonpathologizing is actually correct. Which is to say that not only is it inappropriate and unhelpful to pathologize people’s ordinary and extraordinary human experiences, it is wrong: i.e. that bizarre varieties of experience are not very often, in fact, representations of sickness or disease. This is what is so interesting about Stella Maris from a therapist’s perspective. He shows us the depths of bizarre mathematical visioning and mysticism, and compares that with the kinds of visual hallucinations which are the bread and butter of our sense of psychoses, and asks us to tell the difference between them.
McCarthy likely doesn’t care about therapy. But I do. And so I read him, and I try to take heed of his provocations: that the categories by which we order human experience are bleak and harried and incoherent much of the time. I’m not saying all of the time. I am not making an argument that we return to the polemics of Thomas Szasz and throw the baby out with the bath water. But I do believe in the massive varieties of human experience, and in the ethical, functional, and ontological necessity of taking seriously our experiences for a good long while before we really decide to throw them into the camp of madness, psychosis, or even neurosis. There is so much to this world, and more coming. I’ll let McCarthy finish for us on that note:
… not every view of the world with but a single speculation is hereby a false one. Or a mistaken one. Any number of truths hitherto unknown to us have entered the human domain through the testimony of a single witness.