7. Mental as Anything: schizophrenic symptoms as manufactured artefacts
Many people are diagnosed with schizophrenia when they are not undergoing a spiritual/mystical emergency and have quite normally functioning minds. The problems that lead these people to a diagnosis are not concerned with the classic inner mental symptoms like delusions and hallucinations but are simply difficulties with social relationships. In fact, so common is this type of diagnosis that a substantial school of psychiatric criticism has developed which argues that everyone who gets a schizophrenia diagnosis can be fitted into this description, and that all 'mental' illness is a psychiatric myth. In taking this position, the myth of mental illness school neglects the problems of people who are diagnosed when they are undergoing genuine mystical emergencies, as described in the foregoing chapters.
This neglect of the mystical problem in schizophrenia by some psychiatric critics is a serious but understandable error. It comes from having sufficient intelligence to see through the flaws in the medical model but not enough reflexivity or personal experience to overcome the cultural bias against mysticism. The result is that critics of the medical model are divided into two loosely assembled schools; one that focuses on people abused for having mystical problems, the other focussing on people abused for having social problems.
Notwithstanding its failure to recognise spiritual/mystical emergency the latter school has very effectively criticised the institution of psychiatry with the argument that all mental illness is a myth. The basic premise of this argument is simply that there cannot be any disease of the mind because the mind is an abstract concept without any physical reality. The use of the term ‘mental illness’ to describe unusual patterns of thought and behaviour was originally clearly understood as being metaphorical. The subsequent application of a medical model to this metaphor, and the modern literal understanding of it, is therefore unsound. A ‘sick’ mind—like a ‘sick’ joke or a ‘sick’ society—cannot be treated medically and would only be literally understood as a medical problem by a fool.
From this perspective, the only way that the symptoms of schizophrenia can be indicative of disease is if they are manifestations of a brain disease, not a mental disease. However, despite the many hypotheses which try to link schizophrenia with brain abnormalities, no firm pattern of schizophrenia-typical lesions has yet been detected in the brains of deceased schizophrenics, so there is no evidence of brain disease. Therefore, there is no such thing as a brain disease, let alone a mental disease, called schizophrenia: ‘Schizophrenia is a moral verdict masquerading as a medical diagnosis’.[1]
The relatively large number of people supposedly displaying schizophrenic indicators does not threaten this position. On the one hand it is argued that schizophrenic indicators fall within the range of natural psychological and behavioural experience, and they have only been defined in pathological terms because they fall outside the boundaries of cultural tolerance. As such there are social expectations that ‘good citizens’ will avoid these patterns of thought and behaviour. People who do not avoid them are subsequently identified as deviants because, in a metaphorical sense, they have ‘sick’ minds.
On the other hand, it is also argued that a provision by the medical profession of an otherwise non-existent category of human types called schizophrenics has required that individuals of this type be manufactured to fill it. To describe how this manufacturing process takes place, analogies are drawn between modern schizophrenics and medieval witches.[2] Just as it is now thought to be unlikely that people with magical powers, and a compulsive desire to corrupt Christian citizens, actually existed in late-medieval Europe, so it is also thought unlikely that people actually manifest the extraordinary mental contortions, and compulsive forms of dangerous behaviour, attributed to modern schizophrenics.
What brings these types of people into existence is the human imagination. Belief in their existence is a kind of shared collective delusion, which fulfils transitory cultural needs, and which can be initiated when the holders of epistemological authority categorically assert that such things are true. In other words, these culturally based delusions are initiated when transmission of the false belief is from the top down.
In the case of late-medieval witches, this process occurred with the publication of the Malleus Maleficarum in 1486. The Malleus Maleficarum was a precise diagnostic manual for witch-hunters, and it was published specifically to implement a papal bull empowering Inquisitors ‘to proceed to the just correction, imprisonment, and punishment’[3] of heretics who corrupted the Catholic faith by conversing with devils. After its publication ‘there soon followed an epidemic of Witchcraft’,[4] and people manifesting the malignant signs were discovered everywhere.
In the case of modern schizophrenics the official declaration of their imagined existence can't be so easily dated to a single publication. Kraepelin’s and Bleuler’s seminal works were part of an evolving definition of pathology to which many other researchers had contributed before them. To be valuable as scientific knowledge, the belief in schizophrenia must support continuing scientific research. Continuing research keeps the details of the concept shifting as new knowledge is negotiated into existence. This movement gives rise to the illusion that progress is being made and that break-throughs in scientific comprehension are imminent.
Needless to say, critics argue that this research is necessarily founded on false assumptions. If the indicators of schizophrenia are actually quite natural forms of human expression, which are only made abnormal by cultural restrictions, nothing more can be discovered about schizophrenics beyond what is already self-apparent: that is, that they are people who do not conform with unwritten codes of behaviour. On the other hand, if the supposed signs and symptoms are truly extraordinary, such as the ones that were supposed to identify witches, then they actually exist in the minds of the observers of schizophrenia, not in the minds of the schizophrenics. If this is the case then we are confronted with the paradox that the minds which are routinely distorting reality are those which are researching into a non-existent disease by examining and deliberately modifying minds which would otherwise be quite normal. Once again the persecution of witches by the Inquisition is a useful analogy.
Powerful as these arguments are it is clear they are only partially correct. For the most part this type of critique has been developed by dissident mental health professionals, most notably Thomas Szasz, and it reflects the already familiar weaknesses in the knowledge base of the psychiatric profession. Although these arguments are useful for introducing the dilemma of people who are diagnosed for having social problems, they only add to the confusion surrounding the mystical experience described in foregoing chapters. This line of psychiatric criticism developed by Thomas Szasz and his followers, certainly applies to some schizophrenics, but not to those who undergo a spiritual/mystical emergency.
The people to whom these arguments do apply have the common denominator of a serious social problem without the added difficulty of a psychological crisis. In order to explain how a social problem can be mistaken for a mental disease it is necessary to break down this class of people into three types.
The first type can be described as the schizophrenic-as-cultural-outsider. Schizophrenics of this type are, by definition, different from normal people, but only marginally so. Sometimes they might be aware of their difference, and deliberately cultivate it, and sometimes they might be surprised to discover that other people perceive them as abnormal. The invention of schizophrenia, and the use of forced medical treatments, are methods of dealing with these people who have wandered outside the cultural envelope.
The second type is the schizophrenic-as-scapegoat. Here the person designated as schizophrenic is himself or herself quite normal, and would otherwise be content to live within the cultural boundaries, but has the misfortune of belonging to a group that is under stress. The group might be a company, a neighbourhood, or even a nation, but most frequently it is a nuclear family.
The third type involves schizophrenia-as-role-play. This is where the symptoms of schizophrenia are simulated. The simulation might be initiated by either the patient or the diagnostician. When it is initiated by the patient it could be motivated by the desire to adopt the schizophrenic role as a career. When the role-playing is initiated by the diagnostician it might involve the maintenance of professional norms. Either way the result can be that the person who receives the diagnosis also receives a detailed script describing how to think and behave like a schizophrenic. A person who receives this script is thenceforth compelled by social expectations to rigidly adhere to it. This scripting of the schizophrenic role by diagnosis is often referred to as ‘labelling’.[5]
[1] Theodore R. Sarbin and James C. Mancuso, Schizophrenia: medical diagnosis or moral verdict?, p. 220.
[2] Thomas Szasz, The Manufacture of Madness: a comparative study of the inquisition and the mental health movement.
[3] Malleus Malificarum, quoted in Szasz, The Manufacture of Madness, p. 35.
[4] Ibid.
[5] See for example, Thomas Scheff, Labelling Madness.