Even if irrational and bizarre forms of behaviour are only adaptive strategies the psychiatric profession is not alone in refusing to tolerate them. It is fairly obvious there is a general consensus amongst modern people which supports the psychiatric view that schizophrenic behaviour should be controlled. This cultural intolerance has its origins in eighteenth-century Enlightenment thinking which held that people who appear to lose control of their minds are thereby deprived of some essential aspect of their humanity. Enlightenment thinkers bequeathed to the people of contemporary industrial societies a belief that rational, self-controlled thought is the essential function of a fully developed human being. Mental activity that lacks rationality and self-control is viewed as harmful and as being less than fully human. Throughout the Enlightenment people who were thought to be mad were usually treated as if they had lost their humanity and had reverted to an animalistic state. This Enlightenment view of madness allowed for mad inmates of institutions to be kept in chains and sometimes displayed as zoological exhibits.
It is from this treatment-as-animals that the medical profession claims to have rescued mad people around the turn of the nineteenth century by medicalising their condition and redefining it as mental illness. In doing so, however, some elements of the medical profession retained the notion that irrationality and loss of mental control are expressions of less than full humanity.
In relation to schizophrenic symptoms, modern psychiatry has two alternative regression theories. One explanation is that schizophrenic symptoms indicate a reversion to thought patterns which are believed to have prevailed in the minds of early or primitive human types. In this context schizophrenic delusions have been referred to as ‘paleological thinking’ by some psychiatric theorists. This psychiatric hypothesis, however, is largely speculative and does not have a substantial following.
A second, more commonly accepted explanation was originally provided by early psychiatric theorists such as Freud. These early theorists assumed that ‘psychotic processes reflected some regression to an earlier, and more "primitive" level of organisation’[26] found in children. Freud used the term ‘primary process’ to describe a child’s first mode of thinking. He contrasted this with ‘secondary process’ which he thought was an adult way of thinking.
"Primary process thinking is, first of all, drive-directed. Its content and direction are determined by impulses rather than by considerations of external reality. Secondary process thinking is, instead, reality-oriented, having been developed to facilitate adaptation to the world outside the self."[27]
Using this formula there are a number of ways that the inward focus of schizophrenic thinking can be likened to childish thought processes. Delusions and hallucinations can be interpreted as wish fulfilment; schizophrenics can be observed to deny reality in the pursuit of their own goals in the way that demanding children do; and demonstrably infantile forms of behaviour, such as playing with faeces, can sometimes be observed in schizophrenics.
However, there is no universal pattern to these observations and the same childish thinking and behaviour can be observed in various types of non-schizophrenic people. Prisoners, for instance, will sometimes smear faeces on the walls of cells as a form of protest, and many gamblers may attempt wish fulfilment by holding delusions about being in contact with forces that control the outcome of chance.
But the weaknesses of regression theories do not threaten to undermine the medical model. The assumptions of the medical model do not rest on either closely argued theory or empirical evidence. Instead they remain largely unformulated and mostly rely on affirmation provided by a widespread lay understanding, often gained directly through observation of family members, that the behaviour of people with schizophrenic symptoms is self-evidently caused by a weakness in the mind. Psychiatric text-books even refer to popular knowledge to confirm psychiatric theory:
"Literary portrayals such as the madness of Orestes in the Oresteia of Aeschylus and the mumblings of Poor Tom in King Lear make it clear that serious psychoses have been recognised even by lay people for many years".[28]
The psychiatric profession prefers to focus most of its attention on the problem of standardising the diagnostic criteria for schizophrenia rather than going to the trouble of providing a persuasive philosophical rationale for pathology. This focus is necessary since diagnoses have to maintain a semblance of consistency without the assistance of laboratory tests.
Next: Diagnosing Schizophrenia
[26] Fred R. Volkmar, ‘Childhood and adolescent psychosis: a review of the past 10 years’, pp. 843–52.
[27] Loren J. Chapman and Jean P. Chapman, Disordered Thought in Schizophrenia , p. 208.
[28] Donald W. Black et al., ‘Schizophrenia, Schizophreniform Disorder, and Delusional (Paranoid) Disorders’, p. 358.