The term schizophrenia has come to have so many contradictory meanings and implications. What is schizophrenia?
For me, almost the one certain thing about ‘schizophrenia’ is that it is a diagnosis, that is, a clinical label, applied by some people to others. Until recently, this label meant that the labeller was under the impression that the behaviour of the person he was labelling was symptomatic of some pathological process, itself of unknown nature and origin, going on in the body of the person. This view could be held together with the view that the pathological process was also, primarily or secondarily, a psycho-pathological one, going on in the psyche of the person. In any case the label had one connotation. The person labelled was not like us.
While this view has been at its height in the last quarter of a century, psychiatrists have become so possessed by it that this entirely hypothetical pathological process has ceased to be an assumption and has become a fact. Almost no one quite realized that the ‘process’, somatic or psychic, had never actually been
Briefly, the present position can be stated to be that recent critiques of the work on genetics, and the most recent empirical genetic studies, have alike brought all the apparent advances in this field back to square zero, while biochemical research is still inconclusive.
There now appears to be no substantiated evidence that these labelled persons have any constitutional factors in common with each other, that they do not have with us. It would now be an interesting experiment to study whether the syndrome of ‘labelling’ others runs in families. A pathological process called ‘psychiatrosis’ may well be found, by the same methods, to be a delineable entity, with somatic correlates, and psychic mechanisms, with an inherited or at least constitutional basis, a natural history, and a doubtful prognosis.
The cutting edge of research has now abandoned these sterile categories. The most profound recent development in psychiatry has been to redefine the basic categories and assumptions of psychiatry itself. We are now in a transitional stage, where we still to some extent continue to use old bottles for new wine. We have to decide whether to use old terms in a new way, or abandon them to the dustbin of history.
I do not myself believe that there is any such ‘condition’ as ‘schizophrenia’. Yet the label is a social fact. Indeed this label as social fact, is a political event. This political event, occurring in the civic order of society, imposes definitions and consequences on the labelled person. It is a social prescription that rationalizes a set of social actions whereby the labelled person is annexed by others, who are legally sanctioned, medically empowered, and morally obliged, to become responsible for the person labelled. The person labelled is inaugurated not only into a role, but into a career of patient, by the concerted actions of numerous others who for some considerable time become the only ones with whom a sustained relationship is permitted. The ‘committed’ person labelled as patient, and specifically as ‘schizophrenic’, is degraded from full existential status as human agent and responsible person, no longer in possession of his own definition of himself, unable to retain his own possessions, precluded from the exercise of his discretion as to whom he meets, what he does. His time is no longer his own and the space he occupies is no longer of his choosing. After being subjected to a degradation ceremonial known as a psychiatric examination he is bereft of his civic liberties in being imprisoned in a total institution known as a ‘mental’ hospital. More completely, more radically than anywhere else in our society he is invalidated as a human being. In the mental hospital he must remain, until the label is rescinded or qualified by such terms as ‘remitted’, or socially readjusted. Once a ‘schizophrenic’ there is a tendency to be regarded as always a ‘schizophrenic’.