Another way a person can be diagnosed with schizophrenia is through belonging to an over-stressed group and being chosen as the group's scapegoat. Groups often focus negatively on individual members as a method of relieving stress and psychotherapists routinely have to deal with the problem of schizophrenics being scapegoated by psychotherapy groups:
the schizophrenic being the prime candidate in the group for the role of the scapegoat . . . other members can deny their fears of intimacy and project them on to the scapegoat. The scapegoat acts as a safety valve that protects the group from the imagined dangers of closeness. Shifting attention away from the scapegoat can reduce his or her anxiety.
The diagnostic criteria discussed in the previous section are largely irrelevant for understanding the schizophrenic-as-scapegoat. Any alleged distinguishing indicators, such as delusions and hallucinations, are only artefacts of imagination manufactured by other members of the over-stressed group and/or the diagnostician.
The group from which the schizophrenic/scapegoat has come before diagnosis is most commonly a nuclear family, but other groups and organisations sometimes need scapegoats too. Special conditions of collective stress are necessary to produce this type of schizophrenic because ‘the scapegoat selector—whether inquisitor or psychiatrist—does not work in a social vacuum. The persecution of a minority group is not imposed on a resistant population, but, on the contrary, grows out of bitter social conflicts.’
In The Manufacture of Madness Thomas Szasz undertakes the definitive analysis of the schizophrenic-as-scapegoat. Psychiatric historians normally assert that witches who fell victim to the Inquisition were mentally ill people who were victimised on account of their mental illness. Szasz turns this conventional historical understanding on its head. He asserts that modern people diagnosed with mental illness are made scapegoats, in the same way as witches were in earlier times, by falsely labelling them with an imaginary form of deviance:
the basic function of the medical theory of witchcraft—and, in my opinion, its basic immorality as well—lies in distracting from the persecutory practices of the institutional psychiatrists, and focussing it instead on the alleged disorders of the institutionalised mental patients.
Szasz argues that the tendency for humans to be social and to always live in groups has a strong influence on shaping human nature. Membership of a group has a price, and sometimes members are required to attack non-members as a means of further integrating themselves into the group, and also as a way of adding cohesion to the group itself. Group dynamics can also require that a member be selected for conversion into a non-member for the purpose of being sacrificed. When this happens any members who do not participate in the scapegoating might themselves risk alienation and sacrifice.
The explanation for why this happens concerns the need for self-validation. By declaring an enemy, either internal or external, as invalid, and therefore bad, a person by implication declares themselves to be valid and good: ‘Typically, we confirm our loyalty to our group by asserting the disloyalty of others (in or outside the group) to it; we thus purchase membership in the community by excluding others from it.’
Contemporary people have acquired a habit of attributing sub-human status to classes of people who are selected for scapegoating. This attitude was applied to witches during the Inquisition and to Jews in Nazi Germany, and regularly happens to people who are ethnically or religiously affiliated with the enemy in times of war. Similarly, when family groups find the need to sacrifice a member, a convenient modern method is to declare that the person has a dysfunctional brain.
Descriptions of the schizophrenic-as-scapegoat are mostly given by people who have themselves been declared schizophrenics. Indeed, the dynamics of selecting and out-casting a scapegoat usually mean that only the victims, or other outsiders of the group, are in a position to consciously observe the process. There are a number of personal accounts of schizophrenia told by people who see themselves as scapegoats. A particularly lucid story is told by John Modrow in How To Become A Schizophrenic.
Modrow recounts growing up in a family riddled with stress fractures inherited from previous generations. His mother was the daughter of Norwegian immigrants to the United States who, after her father died, had been forced to play the role of surrogate mother to her siblings while her own mother worked sixteen hours a day.
On Modrow’s father’s side of the family his great-grandmother had died in an insane asylum, providing grounds for whispered expectations of a family curse that would surface once again. A story told to Modrow by his sister, who in turn had heard it from his mother shortly before she died, is critical to his story of selection as the family scapegoat. When he was very young his mother and paternal grandmother were chatting in the kitchen while he was sitting outside in the sun, rocking back and forth, absorbed in thought. His mother, seeing him through the door, and thinking he looked cute, smiled and drew her mother-in-law’s attention to him. The mother-in-law, however, misunderstood her meaning and angrily jumped to the defence of the child, accusing Modrow's mother of mocking him. The result, deduced by Modrow as an adult, was a life-long accusation levelled at Modrow by his mother that he would never let her love him.
After this incident, when Modrow was six, his mother decided he was in need of a psychiatric examination. There was apparently a minor incident involving Modrow and a man in a wheelchair which triggered this unusual course of action, but the first psychiatrist was so unconcerned about it that he declined to make the examination. Six weeks later Modrow’s mother took him to be examined by a psychiatric team at the University of Washington. According to his mother, the psychiatrists told her: ‘We don’t know exactly what is wrong with your son, but whatever it is, it is very serious. We recommend that you have him committed immediately or else he will be completely psychotic within less than a year’.
His mother did not follow the advice at that time, but the assumption that he had a serious mental illness became incorporated into his family identity. Although by his own estimation there was nothing wrong with him, he was by degrees schooled into playing the role of the mad member of the family. Modrow’s description is of a family with unusual levels of stress, and his supposed difference within this group allowed the other members of the family to contrast themselves with him and thereby assume normal roles. In this way the family maintained outward signs of normality until Modrow was finally hospitalised for schizophrenia as an adolescent.
His stay in hospital was only brief, but it took him another three decades of introspection and family analysis to properly understand what had happened to him. Modrow says he wrote his book because he believes ‘it is a fact beyond reasonable dispute that I had been victimised by a series of events—not by a disease. And I believe this can be demonstrated to be true of all people who have been labelled schizophrenic.’
Families are not the only groups in need of scapegoats. Work-places sometimes need them too. For instance, there is a consistent pattern of scapegoating whistleblowers, who are usually somewhat out of the ordinary in that they are likely to have elevated levels of personal integrity and courage, combined with a naive faith in the prevalence of justice. If an organisation chooses to ignore a whistleblower’s complaint, this combination of personality traits can easily lead the whistleblower into a situation of doggedly repeating assertions that something is wrong in the organisation. The whistleblower is then perfectly positioned to be a scapegoat for the organisation, to relieve the stress that might have been generated by the attempted revelation.
A common reaction to whistleblowing is for employers to arrange a psychiatric examination of the whistleblower, as a condition of continued employment, which often results in a diagnosis of mental illness. This practice has been documented in a recently released report by Australia’s ombudsman’s office. An investigation into the harassment of whistleblowers in the Australian Federal Police (AFP) found ‘four relevant instances since 1992 where the AFP has arranged for officers to undergo inappropriate psychiatric assessments, either under duress, or without their knowledge or consent’.
The support group Whistleblowers Australia is conducting a continuing survey of its members to discover how many have been treated in this way. It has found that many of them have received psychiatric diagnoses ranging from non-specific conditions such as cognitive dysfunction to personality disorders and schizophrenia.
At least one member of Whistleblowers Australia has lodged a complaint about her harassment with the World Psychiatric Association’s Committee to Review the Abuse of Psychiatry. Shortly after receiving acknowledgment of the complaint from the secretary of the Committee in Denmark, the complainant was asked to attend another psychiatric examination. The subsequent examination, presumably conducted under quality control pressure from the peak body of the psychiatric profession, found she was in perfect mental health.
 Alan R. Beeber, ‘Psychotherapy with Schizophrenics in Team Groups: a systems model’, pp. 78–87.
 Szasz, The Manufacture of Madness, p. 136.
 Ibid., pp. 127–8.
 Ibid., p. 316.
 John Modrow, How To Become A Schizophrenic: the case against biological psychiatry, 1992.
 Ibid., p. 1.
 Ibid., p. 3.
 Whistleblowers Australia, Abuse of Medical Assessments to Dismiss Whistleblowers.
 Commonwealth Ombudsman, AFP professional reporting & internal witnesses, p. 53.
 Louise Roy, Psychiatry and the Suppression of Dissent, unpublished report on the use of psychiatric labels to intimidate whistleblowers, December 1997.