Orna Ophir

Schizophrenia


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Introduction: The Ends of a Diagnosis

      “It’s a word, that’s all, a word that covers a large, loose category,” the psychiatrist explained, “it’s like saying ‘tree.’ There are all kinds, firs, elms, pines. So there are many kinds and degrees of schizophrenia.” (Louise Wilson, This Stranger, My Son, 1968)1

      When Tony was discharged from the hospital, his father, Jack Wilson (a surgeon by profession), had enough of the conflicting reports and wanted a “real diagnosis.” Dr. Brewster, the psychiatrist, who thought Tony’s parents surely realized he was “very sick,” concluded: “schizophrenia, if you want to label it. The boy is a paranoid schizophrenic.” Shocked by the doctor’s response, Tony’s mother, Louise, echoed the expert’s words: “schizophrenia, if you want a label,” thinking all the while about her son’s dark blue eyes, his beautiful, rare smile, but also about the “ugly contortions of his rage,” his terror and fear.

      What was this strange phenomenon of Tony’s illness? Was it “a thing,” of a natural, biological, or ontological, kind? Was it a phenomenon to be understood as a matter of degree, as part of a broader spectrum, a scale or continuum? The psychiatrist’s choice to describe it as a “loose category” (just a “word”) certainly had not made things easier to decide. Neither had his comparison with the natural kind of a “tree,” or his evoking the “many kinds and degrees” of schizophrenia. Did the name “schizophrenia” or “paranoid schizophrenia” offer an adequate characterization in and of itself, a genuine definition, of the ailment Tony appeared to be suffering from? Or did it merely introduce another label (if one “wanted” one), adding on to the numerous, equally apt or vague, preexisting ones? In other words, what is – and what was – “schizophrenia,” precisely?

      To answer these questions, we will abstain from trying to draw out some timeless essence of schizophrenia, an implausible enterprise if ever there was one. Rather, we will limit ourselves to examining its genesis as a medical and psychiatric diagnosis, and describe and evaluate its uses in the clinical and therapeutic professions over time. In so doing, we will try to understand not only its history and present characteristics, but also what kind of future this diagnosis and the proposed treatment for it might still hold in store. In other words, we will aim to see what picture emerges once one no longer takes the diagnosis of schizophrenia to be that of a stable identity per se, but also one of perspective. At times, the diagnosis will be, and perhaps needs to be, placed on a continuum or a spectrum with the normal and, at other times, be seen and appreciated as if it were a fixed category of illness, a natural kind, of sorts.

      Figure 1 Joseph Jastrow, The duck–rabbit illusion (1899)

      Source: Wikimedia Commons

      Nevertheless, attempts to classify specific mental disturbances and the ways in which they affect the behavior of those suffering from them have a much longer history. One of the first attempts to classify different types of mania – the Greek term for madness – can be found in Plato’s dialogue Phaedrus (c.370 BC). In the text, Socrates defines eros or Love as a form of madness, and thus as a disturbance of our conventions and conducts.8 Socrates then distinguishes between madness that is caused by human ailments, and madness that is sent by the gods:9

      SOCRATES: … we said did we not that love is a kind of madness, didn’t we?

      PHAEDRUS: Yes.

      SOCRATES: And that there are two kinds of madness, one caused by human illnesses, the other from a divine release from the norms of conventional behavior.

      PHAEDRUS: Quite so.

      SOCRATES: And we divided the divine kind of madness into four parts, each with its own deity. We attributed prophetic inspiration to Apollo, mystical inspiration to Dionysus, poetic inspiration to the Muses, and the fourth kind to Aphrodite and to Eros.10