international perspectives in philosophy and psychiatry
the sublime object of psychiatry schizophrenia in clinical and ...
43 downloads
561 Views
51MB Size
Report
This content was uploaded by our users and we assume good faith they have the permission to share this book. If you own the copyright to this book and it is wrongfully on our website, we offer a simple DMCA procedure to remove your content from our site. Start by pressing the button below!
Report copyright / DMCA form
international perspectives in philosophy and psychiatry
the sublime object of psychiatry schizophrenia in clinical and cultural theory ANGELA W O O D S
The Sublime Object of Psychiatry
International Perspectives in Philosophy and Psychiatry Series editors: Bill (K.W.M.) Fulford, Katherine Morris, John Z. Sadler, and Giovanni Stanghellini Volumes in the series: Portrait of the Psychiatrist as a Young Man: The Early Writing and Work of R.D. Laing, 19271960 Beveridge
Mind, Meaning, and Mental Disorder 2e Bolton a n d Hill
What is Mental Disorder?
Schizophrenia and the Fate of the Self Lysaker a n d Lysaker
Responsibility and Psychopathy Malatesti a n d McMillan
Body-Subjects and Disordered Minds Matthews
Bolton
Rationality and Compulsion: Applying action theory to psychiatry
Delusions and Other Irrational Beliefs
Nordenfelt
Bortolotti
Postpsychiatry
Philosophical Perspectives on Technology and Psychiatry
Bracken a n d T h o m a s
Phillips (ed.)
Philosophy, Psychoanalysis, and the A-Rational Mind The Metaphor of Mental Illness Brakel
Pickering
Unconscious Knowing and Other Essays in Psycho-Philosophical Analysis
Mapping the Edges and the In-between
Brakel
Potter
Psychiatry as Cognitive Neuroscience
Trauma, Truth, and Reconciliation: Healing Damaged Relationships
B r o o m e a n d Bortolotti (eds.)
Potter (ed.)
Free Will and Responsibility: A Guide for Practitioners The Philosophy of Psychiatry: A Companion Callender
Radden
Reconceiving Schizophrenia
The Virtuous Psychiatrist
C h u n g , Fulford, a n d G r a h a m (eds.)
R a d d e n and Sadler
D a r w i n a n d Psychiatry
Feelings of Being
De Block and Adriaens (eds.)
Ratcliffe
Nature and Narrative: An Introduction to the New Philosophy of Psychiatry
Sadler
Fulford, Morris, Sadler, a n d Stanghellini (eds.)
Values and Psychiatric Diagnosis
Oxford Textbook of Philosophy and Psychiatry
Disembodied Spirits and Deanimated Bodies: The Psychopathology of Common Sense
Fulford, T h o r n t o n , a n d G r a h a m
Stanghellini
The Mind and its Discontents
Essential Philosophy of Psychiatry
Gillett
Thornton
Thinking Through Dementia
Empirical Ethics in Psychiatry
Hughes
W i d d e r s h o v e n , McMillan, H o p e a n d V a n der
Dementia: Mind, Meaning, and the Person
Scheer (eds.)
H u g h e s , Louw, a n d Sabat (eds.)
The Sublime Object of Psychiatry: Schizophrenia in Clinical and Cultural Theory
Talking Cures and Placebo Effects Jopling
Woods
The Sublime Object of Psychiatry Schizophrenia in Clinical and Cultural Theory Angela Woods Lecturer in Medical Humanities, Durham University, UK
OXFORD
U N I V E R S I T Y PRESS
OXFORD
U N I V E R S I T Y PRESS
Great Clarendon Street, Oxford ox2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press 2011 The moral rights of the author have been asserted Database right Oxford University Press (maker) First published 2011 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose the same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Data available Typeset in Minion by Cenveo, Bangalore, India Printed in Great Britain on acid-free paper by CPI Antony Rowe, Chippenham, Wiltshire ISBN 978-0-19-958395-9 10
9 8 7 6 5 4 3 2 1
Whilst every effort has been made to ensure that the contents of this book are as complete, accurate and up-to-date as possible at the date of writing, Oxford University Press is not able to give any guarantee or assurance that such is the case. Readers are urged lo take appropriately qualified medical advice in all cases. The information in this book is intended to be useful to the general reader, but should not be used as a means of self-diagnosis or for the prescription of medication.
Acknowledgements
T h e ideas in this b o o k h a v e b e e n i n s p i r e d , d e v e l o p e d , tested, a n d e x t e n d e d t h r o u g h extensive dialogue, a n d I c o u n t myself lucky t o have b e e n in conversat i o n w i t h so m a n y s p a r k l i n g m i n d s . It is a privilege t o b e p u b l i s h e d in t h e Intellectual Perspectives in P h i l o s o p h y a n d Psychiatry series, a n d I t h a n k K. W . M . F u l f o r d a n d t h e editorial b o a r d , a n d the editorial t e a m at O x f o r d University Press, for giving m e the o p p o r t u n i t y t o reach such a d i s t i n g u i s h e d readership. F r o m t h e University of M e l b o u r n e , w h e r e this p r o j e c t began in 2002,1 w o u l d like t o t h a n k D a v i d B e n n e t t , M a r i o n C a m p b e l l , Bret F a r m e r , a n d S t e p h a n i e Trigg. Alex M u r r a y at t h e U n i v e r s i t y of Exeter a n d R o b e r t E a g l e s t o n e f r o m Royal H o l l o w a y w e r e i n s t r u m e n t a l in h e l p i n g this p r o j e c t f i n d a h o m e , a n d I t h a n k t h e m heartily f o r their e n c o u r a g e m e n t . T o m y w o n d e r f u l colleagues at t h e C e n t r e f o r M e d i c a l H u m a n i t i e s at D u r h a m — M a r t y n E v a n s , J a n e M a c n a u g h t o n , a n d Bethan Evans—special t h a n k s f o r giving m e the s u p p o r t t o see this b o o k t o c o m p l e t i o n . Claire C o l e b r o o k , n o w at P e n n State, I t h a n k for h e r exceptional feedback o n an earlier v e r s i o n of The Sublime
Object of Psychiatry.
Amelia Douglas and
M a t t P r i t c h a r d are c h e r i s h e d f r i e n d s a n d a s t u t e critics, a n d I t h a n k t h e m f o r their incisive f e e d b a c k , e m o t i o n a l intelligence, a n d intellectual flair. M a t t h e w Ratcliffe I t h a n k f o r his generosity, originality, a n d invaluable advice t h r o u g h o u t t h e later stages of this p r o j e c t ; Pat W a u g h likewise has b e e n a b e a c o n o f w i s d o m . T o Louis A. Sass, at Rutgers University, I o w e a t r e m e n d o u s d e b t of gratitude. N o t o n l y has his w o r k b e e n an i n s p i r a t i o n to m e f o r m a n y years, his e n g a g e m e n t w i t h a n d advocacy for The Sublime
Object of Psychiatry
has b e e n
decisive in h e l p i n g realize its final f o r m . W r i t e r s d o n o t e m e r g e f r o m o r exist in a v a c u u m . T h r o u g h o u t the lifetime of this b o o k , m y family, Gay, J o h n , a n d James W o o d s , a n d Rebecca Jenkin, an h o n o r a r y f a m i l y m e m b e r f o r t h e d u r a t i o n , h a v e b e e n i n c r e d i b l e s o u r c e s of s t r e n g t h , s u p p o r t , a n d h u m o u r . Finally, t o m y p a r t n e r D a v i d L. M a r t i n — reader, lover, fiery i n t e r l o c u t o r , a n d intellectual i n s p i r a t i o n — a t h a n k y o u that I h o p e will r e s o n a t e for years t o c o m e .
Contents Introduction 1
Part 1 Clinical theory 1 Psychiatry o n s c h i z o p h r e n i a : clinical pictures of a s u b l i m e object 13 Cats, mice, and modern psychiatry 13 Madness and Civilization: insanity and scientificity 16 Approaching a disciplinary sublime 25 Schizophrenia and sublimity 29 Clinical psychiatry and dementia praecox 34 From dementia praecox to schizophrenia 46 Schizophrenia today 54 2 S c h i z o p h r e n i a : the sublime text of psychoanalysis 63 The schizophrenic symptom and its secret 63 Tackling dementia praecox: Jung and Abraham 67 Freud on Schreber 76 Reading Schreber 85 A sublime Schreber 100 Lacan: the sublime structure of psychosis 107 Schizophrenia and the problem of the father 118
Part 2
Cultural theory
3 Antipsychiatry: s c h i z o p h r e n i c experience a n d the s u b l i m e 125 A brief overview of antipsychiatry 127 Thomas Szasz and anti-sublime schizophrenia 132 Between two sublimes: schizophrenia and The Divided Self 136 Schizophrenia as sublime experience 139 4 Anti-Oedipus
a n d the politics of t h e s c h i z o p h r e n i c s u b l i m e 145
Introducing schizophrenia and capitalism 148 Sidelining and sanitizing schizophrenia 150 Deleuze, Guattari, Schreber 153 A politics of the sublime 157
viii
CONTENTS
5 S c h i z o p h r e n i a , m o d e r n i t y , p o s t m o d e r n i t y 162 Dementia, regression, Dionysus: three tropes of madness 163 Schizophrenia and hyperreflexivity 168 Schizophrenia, modernism, and modernity 171 The question of postmodernity 175 6 Postmodern schizophrenia
183
Introducing the figure o f ' t h e postmodern schizophrenic' 186 Schizophrenia and 'The Cultural Logic of Late Capitalism' 189 Beyond Jameson 195 The postmodern stimmung 7 Glamorama,
199
p o s t m o d e r n i t y , a n d t h e s c h i z o p h r e n i c s u b l i m e 203
The town crier of postmodern consciousness 205 A postmodern Schreber? 212 Glamorama and the schizophrenic sublime 215 Conclusion
220
R e f e r e n c e s 225 A u t h o r I n d e x 249 S u b j e c t I n d e x 255
Introduction
T h e w o r d ' s c h i z o p h r e n i a ' first appeared in p r i n t 100 years ago, in Swiss psychiatrist Eugen Bleuler's Dementia
Praecox o r The Group of Schizophrenias
(1950).
T h r o u g h o u t t h e last c e n t u r y , it has b e e n u s e d t o d e s c r i b e s o m e of t h e m o s t severe f o r m s of h u m a n suffering a n d s o m e of the m o s t e x t r a o r d i n a r y thoughts, s e n s a t i o n s , a n d feelings t h e h u m a n s u b j e c t can e x p e r i e n c e . ' S c h i z o p h r e n i a ' describes states in which t h o u g h t s are broadcast, families re-peopled by i m p o s t ers, bodies e m p t i e d of organs and o p e r a t e d mechanically; states in which divine persecution a n d messianic d u t y c o m m i n g l e , feelings are flattened, a n d speech is inaccessible; states in which the world, engulfed in an indescribable brightness, s m a s h e s t h e syntax of the sentence. T h e w o r d ' s c h i z o p h r e n i a ' is used, t o o , in t h e less r e m a r k a b l e r e a l m s of t h e everyday, in struggles prosaic, p a i n f u l , a n d p u r p o s e f u l , in t h e r e l a t i o n s h i p s t h a t s u s t a i n us in t h e search f o r h e a l t h a n d h a p p i n e s s . W e e n c o u n t e r the w o r d ' s c h i z o p h r e n i a ' in clinical settings—early i n t e r v e n t i o n p s y c h o s i s u n i t s a n d o u t p a t i e n t facilities, d o c t o r s ' surgeries a n d psychiatric h o s p i t a l s — a n d in clinical research contexts, genetics a n d p h a r m a ceutical laboratories, r a n d o m i z e d control trials, a n d academic conferences. W e read it, o r its a b b r e v i a t i o n SZ, in the h u n d r e d s of t h o u s a n d s of peer-reviewed j o u r n a l articles r e p o r t i n g a n d debating d e v e l o p m e n t s across this ever-widening field of research. T h e t e r m 'schizophrenia' is defined in diagnostic m a n u a l s , legal statutes a n d guidelines, in m e n t a l health policies, a n d in the w o r k of advocates seeking an e n d t o stigma a n d d i s c r i m i n a t i o n . But t h e w o r d ' s c h i z o p h r e n i a ' is also routinely o p e n e d u p — u s e d a n d abused in t h e mass media, re-imagined, for better o r for worse, in cinema a n d literature, m u s i c a n d art. In contexts i n t i m a t e a n d individual, t h e w o r d 'schizophrenia' circulates in m e m o i r s a n d testimonies, in survivor a n d patient meetings a n d publications, in virtual worlds, e m b o d i e d protests, a n d proliferating n e t w o r k s of s u p p o r t . By international agreement the t e r m is held to describe people in every c o u n t r y a n d in every culture, yet a r o u n d t h e w o r l d t h e r e are t h o s e w h o d e c l a r e it s t i g m a t i z i n g , c u l t u r a l l y insensitive, a n d scientifically illegitimate; a relic t o be r e j e c t e d a n d f r o m w h i c h w e m u s t move on. C o n v e n t i o n dictates t h a t o n e s h o u l d begin a b o o k b y d e f i n i n g its object o f i n q u i r y . I h a v e c h o s e n instead t o e m p h a s i z e t h e c o m p l e x i t y o f m y key t e r m .
If w e a c k n o w l e d g e t h a t t h e w o r d ' s c h i z o p h r e n i a ' is m e a n i n g f u l in e a c h of t h e very different c o n t e x t s m e n t i o n e d above, then we can also a c k n o w l e d g e the relevance of a variety of approaches, methodologies, a n d interpretive f r a m e w o r k s in a n a l y s i n g w h a t ' s c h i z o p h r e n i a ' m e a n s in a n d a c r o s s t h e s e s p h e r e s . T h i s o b s e r v a t i o n , w h i c h a p p l i e s t o all d i a g n o s t i c c a t e g o r i e s , serves t o u n d e r l i n e t h e i m p o r t a n c e o f i n t e r d i s c i p l i n a r y i n q u i r y . 1 B u t ' s c h i z o p h r e n i a ' is, as I will g o o n t o a r g u e , a special case, in p a r t b e c a u s e its c o m p l e x i t y b e a r s t h e u n m i s t a k able s t a m p of c o n f l i c t . O n e of t h e r e a s o n s this b o o k b e g i n s b y t r e a t i n g ' s c h i z o p h r e n i a ' as a w o r d a n d f o r e g r o u n d i n g t h e c o m p l e x i t y o f its s e m a n t i c c o n t e x t s is t h a t t h e r e is n o c o n s e n s u s r e g a r d i n g h o w it m i g h t f u r t h e r b e d e f i n e d . T o w r i t e a n d s p e a k a b o u t ' s c h i z o p h r e n i a ' is t o e n t e r a h i g h l y c o n t e s t e d d i s c o u r s e . Does the w o r d 'schizophrenia' refer to a 'disabling and baffling brain disease' ( M e y e r - L i n d e n b e r g , 2 0 1 0 , p . 194), a ' m u l t i d i m e n s i o n a l p s y c h o t i c s y n d r o m e ' ( v a n O s et al., 2 0 1 0 , p . 2 0 3 ) , o r a s c i e n t i f i c f i c t i o n a n d a s t i g m a t i z i n g l a b e l (Bentall, 2004, 2009)? N o o n e disputes that s o m e people experience a n o m a l o u s a n d o f t e n d i s t r e s s i n g c h a n g e s in t h e i r s e n s e o f self a n d w o r l d , in t h e i r t h o u g h t s a n d feelings, b o d i e s , a n d b e h a v i o u r . B u t a g r o w i n g n u m b e r o f p e o p l e a r g u e t h a t t o c o n t i n u e t o r e f e r t o t h e s e c h a n g e s as ' s c h i z o p h r e n i a ' 'is e x t r e m e l y d a m a g i n g t o t h o s e t o w h o m it is a p p l i e d ' a n d serves ' t o p e r p e t u a t e t h e m y t h that w h e n talking a b o u t " s c h i z o p h r e n i a " we are discussing s o m e t h i n g that a c t u a l l y e x i s t s ' ( H a m m e r s l e y a n d M c L a u g h l i n , 2 0 1 0 ) . 2 T h i s c o n f l i c t is n o t a b o u t h o w b e s t t o u n d e r s t a n d , t r e a t , r e s e a r c h , o r c o p e w i t h t h e clinical reality o f a c o n d i t i o n d e s i g n a t e d ' s c h i z o p h r e n i a ' ( a l t h o u g h all o f t h e s e t h i n g s a r e s t r e n u o u s l y d e b a t e d ) ; it is, at a d e e p e r level, a c o n f l i c t a b o u t w h e t h e r it is l e g i t i m a t e t o u s e t h e t e r m at all. M y a i m is n e i t h e r t o i n f l a m e n o r t o resolve these conflicts, b u t t o s h e d s o m e l i g h t o n h o w a n d w h y t h e y d e v e l o p e d . The Sublime Schizophrenia
in Clinical
and Cultural
Theory
Object
of
Psychiatry:
is a s t u d y o f s c h i z o p h r e n i a in
t h e o r e t i c a l texts: a s t u d y of h o w t h e c o n c e p t o f ' s c h i z o p h r e n i a ' is r e p r e s e n t e d in specific disciplines, a n d of h o w , at t h e m e t a - d i s c u r s i v e level, t h e s e r e p r e s e n t a t i o n s reveal s o m e o f t h e c o m p l e x r e l a t i o n s b e t w e e n disciplines. As its title suggests, o n e of m y k e y a r g u m e n t s will b e t h a t p s y c h i a t r y f r a m e s s c h i z o p h r e n i a as its s u b l i m e o b j e c t o r d i s c i p l i n a r y l i m i t p o i n t . A n d as m y s u b t i t l e m a k e s clear, this b o o k ' s t w o m a j o r areas of f o c u s will b e texts in clinical a n d c u l t u r a l t h e o r y . * *• *
1
2
And in particular, work in the medical humanities—an emerging interdisciplinary research field that seeks to demonstrate the value of the arts, humanities, and social sciences in improving and interrogating 'medical' practice and understanding. This is discussed in more detail on pp. 42-5.
In 1984, A m e r i c a n M a r x i s t literary critic F r e d r i c J a m e s o n p u b l i s h e d his m o s t f a m o u s essay ' P o s t m o d e r n i s m , o r t h e C u l t u r a l L o g i c o f Late C a p i t a l i s m ' . In this essay, J a m e s o n a r g u e d t h a t p o s t m o d e r n c u l t u r e h a s f u n d a m e n t a l l y altered o u r e x p e r i e n c e o f o u r s e l v e s . H e s u g g e s t e d t h a t t r a n s f o r m a t i o n s in o u r e x p e r i e n c e of t i m e , l a n g u a g e , a g e n c y , a n d i d e n t i t y c o u l d b e u n d e r s t o o d t h r o u g h t h e French psychoanalyst Jacques Lacan's theory ofschizophrenia.' P o s t m o d e r n i s m , o r t h e C u l t u r a l Logic o f Late C a p i t a l i s m ' , c o n f i r m e d t h e f i g u r e o f t h e ' s c h i z o p h r e n i c ' , t o u s e J a m e s o n ' s t e r m , as t h e r e p r e s e n t a t i v e p o s t m o d e r n s u b j e c t . 3 T h e article, r e - p u b l i s h e d in a 1991 b o o k of t h e s a m e n a m e , h a s since b e e n c i t e d in p e e r - r e v i e w e d p u b l i c a t i o n s o v e r 7 6 5 0 t i m e s . 4 I began writing this b o o k because the central question raised for m e by J a m e s o n ' s analysis c o u l d n o t b e easily a n s w e r e d . W h y d i d s c h i z o p h r e n i a — o r n o t i o n s t h e r e o f — c o m e t o b e s e e n as h o l d i n g t h e k e y t o u n d e r s t a n d i n g t h e e v e r y d a y e x p e r i e n c e o f p o s t m o d e r n life? M y r e s e a r c h led q u i c k l y t o a series o f discoveries: that schizophrenia has long been o n e of psychiatry's m o s t c o n t e s t e d c l i n i c a l c a t e g o r i e s ; t h a t t h e s c h i z o p h r e n i c p a t i e n t w a s m o b i l i z e d as a c e n t r a l s y m b o l i c f i g u r e in t h e political o p p o s i t i o n t o p s y c h i a t r y a n d p s y c h i a t r i c practices; a n d that the p h e n o m e n o l o g y of schizophrenia has been u n d e r s t o o d t o i l l u m i n a t e ( a n d t o be i l l u m i n a t e d by) t h e s t r u c t u r e s of m o d e r n art a n d t h o u g h t . ' S c h i z o p h r e n i a ' , I realized, h a d b e c o m e o n e o f t h e m o s t p o t e n t a n d politicized t o p o i , o r t h e m e s , in t h e c u l t u r a l t h e o r y o f t h e late t w e n t i e t h c e n t u r y . B u t so far n o a t t e m p t h a s b e e n m a d e t o analyse h o w this t h e o r e t i c a l t o p o s h a d d e v e l o p e d , o r t o e x p l o r e its r e l a t i o n s h i p t o clinical a c c o u n t s o f s c h i z o p h r e n i a . T h i s b o o k is a s t u d y o f r e p r e s e n t a t i o n s o f s c h i z o p h r e n i a in t h e texts of a w i d e r a n g e of d i s c i p l i n e s a n d d i s c o u r s e s : biological a n d p h e n o m e n o l o g i c a l p s y c h i a try, p s y c h o a n a l y s i s , critical p s y c h o l o g y , a n t i p s y c h i a t r y , a n d p o s t m o d e r n p h i l o s o p h y . 5 T h e t e r m s 'clinical' a n d ' c u l t u r a l ' t h e o r i e s a r e d e s c r i p t i v e r a t h e r t h a n t e c h n i c a l , a n d s h o u l d n o t b e i n t e r p r e t e d as r e f e r r i n g t o n a r r o w o r i n t e r n a l l y
3
4 5
See Chapter 7 for a more detailed account of Jameson's claims, his intellectual and political debts, and his influence on postmodern cultural theory. Citation search conducted using Google Scholar, 17 November 2010. Almost all of the texts I examine in detail were written by an elite class of European and American white men, many of whom sought to grasp the essence of a universal form of human experience. Questions of gender, race, and sexuality are seldom if ever foregrounded in their accounts of schizophrenia. Jonathan Metzl's powerful study of the way schizophrenia was transformed during the American civil rights era into a disorder of black, male hostility, has brought renewed urgency to the task of analysing the way 'anxieties about racial difference shape diagnostic criteria', as well as to understanding schizophrenia's 'ongoing clinical-cultural dialectic' (Metzl, 2009, p. xi, 197). 1 hope that the analysis offered here can contribute to future feminist and postcolonial scholarship on the category ofschizophrenia' in clinical as well as cultural theory.
consistent b o d i e s of w o r k . I use 'clinical t h e o r y ' t o refer to w o r k t h a t a i m s t o achieve a clinically m e a n i n g f u l o u t c o m e , w h e t h e r b y increasing o u r scientific u n d e r s t a n d i n g of schizophrenia o r seeking m o r e directly to alleviate the suffering of people w h o receive the diagnosis. T h i s k i n d of t h e o r y is developed largely t h r o u g h t h e analysis of t h e p a t i e n t , w h e t h e r that p a t i e n t is viewed p r i m a r i l y in t e r m s of their psychology, n e u r o c h e m i s t r y , genetic profile, physiology, b e h a v iour, or, in the case of epidemiological studies, as a statistically m e a n i n g f u l part of a p o p u l a t i o n . By c o n t r a s t , cultural theory, as I use t h e t e r m , refers to w o r k s in w h i c h t h e o r i s t s h a v e d r a w n o n c o n c e p t i o n s of s c h i z o p h r e n i a t o i n t e r p r e t aspects of (mostly t w e n t i e t h - c e n t u r y W e s t e r n ) culture. T h e a p p a r e n t l y unlikely a s s o r t m e n t of p h i l o s o p h e r s , l i t e r a r y critics, M a r x i s t s a n d p o s t - M a r x i s t s , psychologists, f u t u r i s t s , sociologists, a n d social h i s t o r i a n s w h o m a k e u p t h e field of cultural t h e o r y vary considerably in their a p p r o a c h e s to s c h i z o p h r e n i a ( o r to w h a t they call ' s c h i z o p h r e n i a ' ) . S o m e have very little declared interest in t h e clinical realities of s c h i z o p h r e n i a ; o t h e r s h a v e extensive clinical t r a i n i n g a n d experience. W h a t u n i t e s t h e m is their conviction that t h e p h e n o m e n o n of s c h i z o p h r e n i a — a s t h e y u n d e r s t a n d it—-gives us insight i n t o something
more
than c o n v e n t i o n a l clinical t h e o r y w o u l d allow. T h e dialogue between clinical a n d cultural theories has so far b e e n fairly o n e way. Cultural theorists, m o s t f a m o u s l y those associated with the antipsychiatry m o v e m e n t s of the 1960s a n d 1970s, have m o u n t e d passionate and powerful critiques of m a i n s t r e a m psychiatry, showing, a m o n g o t h e r things, h o w scientific descriptions of mental disorders reflect the cultural values a n d assumptions of the day. Clinical theorists have, for the m o s t part, preferred to attend to the arguably m o r e pressing tasks of caring for those they consider to be mentally ill. M y h o p e is that this b o o k will help facilitate a greater exchange between thinkers in these theoretical fields, a n d with it the realization that cultural theory, a l t h o u g h n o t always digestible or even palatable, deserves recognition for the quality of its critique of clinical theory a n d its analysis of the cultural m e a n i n g s of schizophrenia. *
*
*
A m o n g m a n y o t h e r t h i n g s , the I n t e r n a t i o n a l Perspectives in P h i l o s o p h y a n d Psychiatry series has s h o w n t h a t classical psychiatry is n o t t h e only discipline interested in a n d i n d e e d capable of d e f i n i n g a n d i n t e r p r e t i n g the m i n d a n d its disorders. Recent studies in the p h i l o s o p h y of psychiatry a n d t h e p h e n o m e n o l ogy of p s y c h o p a t h o l o g y have explored crucial q u e s t i o n s a b o u t the n a t u r e a n d d e f i n i t i o n of m e n t a l d i s o r d e r , t h e c o n c e p t u a l u n d e r p i n n i n g s of m e n t a l health care, a n d t h e subtle c h a n g e s t o bodily feelings a n d p e r c e p t i o n that characterize certain experiences as exceptional (Bolton, 2008; Ratcliffe, 2008; Stanghellini, 2004; T h o r n t o n , 2007). In h e r f a m o u s b o o k Illness as Metaphor,
cultural critic
Susan S o n t a g observed that 'Any i m p o r t a n t disease w h o s e causality is m u r k y ,
a n d f o r w h i c h t r e a t m e n t is i n e f f e c t u a l , t e n d s t o b e a w a s h in s i g n i f i c a n c e ' ( S o n t a g , 1991, p p . 5 9 - 6 0 ) . 6 If p s y c h i a t r y is d e d i c a t e d t o m a k i n g causality less m u r k y a n d t r e a t m e n t s m o r e effective, p h i l o s o p h e r s of p s y c h i a t r y f o c u s m o r e o f t e n o n i n t e r r o g a t i n g the key c o n c e p t s that intersect w i t h o u r a c c o u n t s of n o r m a l a n d p a t h o l o g i c a l ( c o n c e p t s s u c h as r a t i o n a l i t y , p e r s o n h o o d , b e l i e f s , e m o t i o n s , a n d values), addressing the ethics of the psychiatric e n c o u n t e r , a n d d e e p e n i n g o u r u n d e r s t a n d i n g of t h e p h e n o m e n o l o g y o f h e a l t h a n d illness. Being n e i t h e r a p s y c h i a t r i s t n o r a p h i l o s o p h e r of p s y c h i a t r y , b u t c o m i n g f r o m t h e p e r s p e c t i v e of l i t e r a r y a n d c u l t u r a l s t u d i e s , m y i n t e r e s t , like S o n t a g ' s , is in u n d e r s t a n d i n g h o w s c h i z o p h r e n i a c a m e t o b e ' a w a s h in s i g n i f i c a n c e ' . 7 T h i s b o o k is a n analysis o f t h e o r e t i c a l t e x t s — t e x t b o o k s , d i a g n o s t i c m a n u a l s , p h i l o s o p h i c a l treatises, m o n o g r a p h s a n d j o u r n a l articles, b o o k s w r i t t e n for specialists, a n d b o o k s w r i t t e n t o a p p e a l t o a b r o a d e r p u b l i c . I also l o o k in detail at o n e a u t o b i o g r a p h i c a l w o r k , D a n i e l P a u l S c h r e b e r ' s Memoirs
of My
Nervous
Illness ( 1 9 5 5 ) , a n d , in t h e final c h a p t e r o f t h e b o o k , o n e novel. As e v i d e n c e d b y t h e n u m b e r a n d t r e a t m e n t o f d i r e c t q u o t a t i o n s in w h a t follows, m y r e a d i n g of clinical as well as c u l t u r a l t h e o r i e s p r o c e e d s f r o m a n a t t e n t i v e n e s s t o l a n g u a g e , t o t h e g a p s a n d fissures, t h e p a s s i o n s a n d politics t h a t find t h e i r w a y i n t o e v e n t h e m o s t t e c h n i c a l o f texts. M y i n t e r e s t is n o t in essences, b u t effects: I d o n o t seek a n a n s w e r t o t h e q u e s t i o n ' w h a t is s c h i z o p h r e n i a ? ' , r a t h e r , m y w o r k seeks t o u n d e r s t a n d h o w s c h i z o p h r e n i a is d e s c r i b e d a n d c o n c e p t u a l i z e d , h o w it is r e p r e s e n t e d in specific clinical a n d c u l t u r a l c o n t e x t s , b u t p e r h a p s m o r e i m p o r tantly, h o w it functions
a c r o s s t h e s e d i s c o u r s e s . In t h i s it c o n t r i b u t e s t o l a r g e r
medical-humanities inquiries into h o w culture structures knowledge product i o n in m e d i c i n e , a n d h o w m e d i c a l , in t h i s case p s y c h i a t r i c , t e r m s a r e in t u r n used to interpret cultural p h e n o m e n a . In The Psychiatric
Team and the Social Definition
of Schizophrenia,
psychiatrist
a n d a n t h r o p o l o g i s t R o b B a r r e t t states u n e q u i v o c a l l y t h a t in his b o o k ' n o o n e view of s c h i z o p h r e n i a is a c c o r d e d priority. In p a r t i c u l a r , it is n e i t h e r a n a p o l o g y f o r n o r a n a t t a c k o n psychiatric d e f i n i t i o n s of s c h i z o p h r e n i a ' (Barrett, 1996, p. 4).
6
Gillian Beer makes a similar point with respect to science in general in her essay 'Forging the Missing Link: Interdisciplinary Stories' (1996). Beer argues that 'placeholder terms' for concepts and conditions for which there is little satisfactory causal explanation tend to accrue highly charged and conflicted cultural meanings. My thanks to Pat Waugh for introducing me to Beer's work.
7
As is well known, the focus of Sontag's work is tuberculosis, cancer, and then HIV/AIDS. These diseases of the flesh, however, derive their power as metaphors from difference and differentiation, front a capacity to demarcate the Other from the self. What is so striking about the representation of schizophrenia in cultural theory, by contrast, is that it is used to speak to and of the structures of contemporary experience for us all.
Albeit f r o m a very d i f f e r e n t disciplinary perspective, these s t a t e m e n t s c a p t u r e s e n t i m e n t s I share. It is n o t m y i n t e n t i o n to attack o r to valorize any aspect of psychiatric practice o r cultural theory, n o r to posit or d e f e n d a single account of schizophrenia, a n d I a m careful t h r o u g h o u t this b o o k to use language that highlights m y critical distance f r o m the works b e i n g discussed. M y c o m m i t m e n t t o a m b i v a l e n c e — a n o p e n n e s s t o multiple ways of u n d e r s t a n d i n g s c h i z o p h r e n i a — necessitates the suspension of a c o m m o n a s s u m p t i o n , namely, that the terminology of t o d a y is i n h e r e n t l y m o r e accurate, v a l u e - f r e e o r u n c o n t e s t e d t h a n t h e t e r m i n o l o g y it has displaced. T h e r e is a w i d e a n d d i s t i n g u i s h e d b o d y of w o r k d o c u m e n t i n g shifts in the vocabularies of m a d n e s s , m e n t a l health, a n d m e n t a l illness, a n d e x a m i n i n g the values a n d politics, i n t e n d e d a n d otherwise, of t e r m s such as ' l u n a t i c ' , ' m a d p e r s o n ' , ' s c h i z o p h r e n i c ' , ' p e r s o n with s c h i z o p h r e n i a ' , ' p e r s o n having s c h i z o p h r e n i a ' , ' s c h i z o p h r e n i a - s u f f e r e r ' , ' m e n t a l health service user', ' c o n s u m e r ' , 'client', ' p a t i e n t ' , 'survivor', a n d t h e c o m p o u n d ' c o n s u m e r / survivor/ex-patient' (Crossley, 2002; 2004; Crossley a n d Crossley, 2001; Estroff, 2004; Haghighat, 2008; Haghighat a n d Littlewood, 1995; McLean, 2000; R e a u m e , 2002; Speed, 2006, 2007; Sass, 2007; S i m m o n s et al„ 2010). T h e lesson I d r a w f r o m this scholarship is that it is i m p o r t a n t never to lose sight of the historical specificity of the language a n d the semantic contexts associated with schizophrenia, especially w h e n a t t e m p t i n g t o g r a s p t h e t h e o r e t i c a l d i s a g r e e m e n t s o v e r ' d e m e n t i a praecox', ' s c h i z o p h r e n i a ' , ' p a r a p h r e n i a ' , 'psychosis', ' m a d n e s s ' , a n d ' m e n t a l illness' f r o m the late nineteenth to the early twenty-first centuries. Eugen Bleuler s i m p l y d i d n o t treat ' m e n t a l health service users'; R.D. Laing d i d n o t study the existential p h e n o m e n o l o g y o f ' c o n s u m e r s ' ; however, the c o m m i t m e n t of b o t h m e n to i m p r o v i n g the lives of people they d i a g n o s e d as s c h i z o p h r e n i c p a t i e n t s is b e y o n d dispute. In analysing these a n d o t h e r theoretical texts, I a m careful to avoid assigning the paradigms a n d t e r m i n o l o g y of past eras a c o n t e m p o r a r y currency, b u t equally, I refuse the loose historiography that w o u l d m a p c o n t e m p o r a r y u n d e r s t a n d i n g s o r terminologies back o n t o the ' u n e n l i g h t e n e d ' past. M y c o n c e r n t h r o u g h o u t this b o o k is t o preserve t h e scholarly integrity of cultural a n d historical analysis. Schizophrenia's validity as a category of m e n t a l illness m a y be publicly a n d routinely called into question (Ferns et al., 2010), b u t s u s p e n d i n g a c c e p t a n c e of d i a g n o s t i c categories d o e s n o t d e t r a c t f r o m o r cast d o u b t u p o n the reality of people's suffering. W h a t is not in dispute is the reality of people's subjective experience, the power of this diagnosis in shaping that reality, a n d the fact that n o t i o n s a b o u t schizophrenia have h a d cultural impacts in excess of those a c k n o w l e d g e d at the clinical level. T h e t e r m ' s c h i z o p h r e n i a ' is p o w e r f u l in its effects—it has potency, m e a n i n g , a n d agency in the clinical a n d cultural realms, which it is the task of this b o o k to investigate.
P a r t O n e of The Sublime
Object of Psychiatry
e x a m i n e s t h e s t a t u s of s c h i z o -
p h r e n i a in clinical theory, c o n c e n t r a t i n g o n classical psychiatry a n d psychoanalysis. In C h a p t e r 1, I l o o k in detail at key w o r k s b y t h e earliest a n d m o s t influential theorists of s c h i z o p h r e n i a — E m i l Kraepelin's 1907 Clinical (1981), Eugen Bleuler's 1911 Dementia
Praecoxor
The Group of
(1950) a n d Karl Jaspers's 1913 General Psychopathology
Psychiatry
Schizophrenias
(1972). Steady advances
in p s y c h o p h a r m a c o l o g y , n e u r o i m a g i n g , a n d genetic p r o f i l i n g n o t w i t h s t a n d ing, the basic clinical c o n c e p t u a l i z a t i o n s of s c h i z o p h r e n i a o f f e r e d by Kraepelin, Bleuler, a n d Jaspers h a v e c h a n g e d little in o v e r a c e n t u r y ( J o h n s t o n e et al., 1999, p. 38). C h a n g i n g f o c u s f r o m t h e p s y c h i a t r i c t o t h e p s y c h o d y n a m i c , C h a p t e r 2 locates at t h e heart of p s y c h o a n a l y t i c t h e o r i e s of s c h i z o p h r e n i a an a u t o b i o g r a p h i c a l a c c o u n t of psychosis: Daniel Paul S c h r e b e r ' s 1903
Memoirs
of My Nervous Illness ( 1955). Schreber's text was t h e subject of S i g m u n d F r e u d ' s m a j o r a c c o u n t o f s c h i z o p h r e n i a , h i s 1911 ' P s y c h o - A n a l y t i c N o t e s o n a n A u t o b i o g r a p h i c a l A c c o u n t of a Case of P a r a n o i a ( D e m e n t i a Paranoides)' (1981) and, in t u r n , a central focus of Jacques Lacan's third s e m i n a r in 1955-1956 The Psychoses (1993). A l t h o u g h Freud a n d Lacan were b y n o m e a n s t h e m o s t influential p s y c h o a n a l y s t s w h e n it c a m e to t r e a t i n g psychosis, t h e i r i n f l u e n c e o n cultural t h e o r y was a n d c o n t i n u e s to be p r o f o u n d . T h e five m u c h s h o r t e r c h a p t e r s of Part T w o b r i n g together u n d e r the b r o a d category of cultural theory four conflicting but interrelated discourses: the a n t i p s y c h i a t r y o f R . D . L a i n g a n d T h o m a s Szasz, t h e e a r l y w o r k o f Gilles D e l e u z e a n d Félix G u a t t a r i , t h e o e u v r e of p h e n o m e n o l o g i c a l p s y c h o l o g i s t Louis A. Sass, a n d t h e w r i t i n g of F r e d r i c J a m e s o n a n d Jean B a u d r i l l a r d . All these t h e o r i s t s c h a l l e n g e p s y c h i a t r i c a n d p s y c h o a n a l y t i c a c c o u n t s of s c h i z o p h r e n i a , a n d f o c u s m u c h of their a t t e n t i o n o n t h e r e l a t i o n s h i p b e t w e e n this d i s o r d e r a n d c o n t e m p o r a r y society a n d subjectivity. C o n c e n t r a t i n g o n Laing's 1960 The Divided Self (1990) a n d The Politics of Experience Schizophrenia:
The Sacred Symbol of Psychiatry
(1967), a n d Szasz's
(1976), C h a p t e r 3 e x a m i n e s the
v o c i f e r o u s c r i t i q u e s of clinical t h e o r y m o u n t e d by t h e a n t i p s y c h i a t r y m o v e m e n t s of t h e 1960s a n d 1970s, b u t l o o k s as well at t h e a l t e r n a t i v e m o d e l s of s c h i z o p h r e n i a t h e y p r o p o s e d . C h a p t e r 4 o f f e r s w h a t is t o m y k n o w l e d g e t h e first sustained close r e a d i n g of s c h i z o p h r e n i a in Deleuze a n d G u a t t a r i ' s i c o n o clastic Anti-Oedipus:
Capitalism
and Schizophrenia
(1982). C h a p t e r 5 discusses
Sass's c r i t i q u e of clinical a n d a n t i p s y c h i a t r i c t h e o r y , his p h e n o m e n o l o g i c a l m o d e l of s c h i z o p h r e n i a , a n d his analysis of its r e l a t i o n s h i p t o m o d e r n i s m , f o c u s s i n g o n his m a g n u m o p u s Madness
and Modernism
(1992). Chapter 6
addresses the w o r k of a g r o u p of p o s t m o d e r n cultural theorists, led by J a m e s o n a n d Baudrillard, w h o have suggested that s c h i z o p h r e n i a is the e x e m p l a r y m o d e of subjectivity in post m o d e r n i t y . J a m e s o n ' s ' P o s t m o d e r n i s m , o r the C u l t u r a l
Logic of Late C a p i t a l i s m ' ( 1 9 8 4 b a n d 1991) a n d B a u d r i l l a r d ' s The Ecstasy of Communication
(1983 a n d 1988) are key texts here. Part T w o c o n c l u d e s w i t h a
close r e a d i n g of Bret Easton Ellis's Glamorama
(2000), a novel which helps us
t o explore in m o r e d e p t h t h e p h e n o m e n o l o g i c a l a n d s y m b o l i c d i m e n s i o n s of cultural t h e o r y ' s a c c o u n t o f ' p o s t m o d e r n s c h i z o p h r e n i a ' . This b o o k is an analysis of h o w ' s c h i z o p h r e n i a ' c a m e t o acquire such p o t e n c y in a wide range of critical a n d cultural discourses, of h o w a diagnostic category f r o m clinical t h e o r y c a m e t o be t r a n s f o r m e d i n t o a t o p o s o f c u l t u r a l t h e o r y , a n d in that t r a n s f o r m a t i o n , h o w ' s c h i z o p h r e n i a ' c a m e to b e associated with t h e everyday e x p e r i e n c e of p o s t / m o d e r n life. M y a i m is n o t t o a r b i t r a t e b e t w e e n c o m p e t i n g a c c o u n t s of s c h i z o p h r e n i a , b u t t o e x a m i n e t r e n d s in t h e writing of t h o s e w h o have s o u g h t t o d o so. W h a t m e a n i n g s have they a t t r i b u t e d t o schizo p h r e n i a ? H o w d o e s the concept function
w i t h i n d i f f e r e n t discursive fields, a n d
t o w h a t e n d s is it mobilized? Is it possible t o i d e n t i f y a d o m i n a n t v o c a b u l a r y t h r o u g h which s c h i z o p h r e n i a h a s b e e n articulated? Viewed collectively, these c h a p t e r s chart t h e theoretical overlaps a n d divergences between disciplines. But this b o o k makes a f u r t h e r a r g u m e n t regarding the metatheoretical relationship between c o m p e t i n g clinical a n d cultural accounts of schizophrenia by using the aesthetic category of the sublime. In aesthetic theory, the sublime is defined as s o m e t h i n g that exceeds or exists b e y o n d o u r capacity for c o m p r e h e n s i o n a n d representation. Because it threatens to overwhelm o u r senses a n d unsettle o u r sense of self, the sublime initially inspires in its subjects feelings of awe and terror, b u t these, it is said, are t h e n superseded by the sense of delight that c o m e s f r o m mastering the perceived threat. In C h a p t e r 1,1 use art historian M a r k C h e e t h a m ' s suggestion of a 'disciplinary sublime' (derived f r o m a reading of the K a n t i a n s u b l i m e ) t o d e v e l o p a c o n c e p t u a l a p p a r a t u s t h r o u g h w h i c h t o u n d e r s t a n d t h e c o n n e c t i o n s a n d hierarchies of i n f l u e n c e b e t w e e n c o m p e t i n g accounts of schizophrenia. In so doing, I identify f o u r distinct representational m o d e s , which together can be called the schizophrenic sublime: the elevation of schizophrenia t o the status of sublime object (psychiatry), the framing of schizop h r e n i a as a sublime text (psychoanalysis), the celebration of schizophrenia as an experience of the sublime (antipsychiatry a n d Anti-Oedipus),
a n d the rendering
of schizophrenia as paradoxically sublime ( p o s t m o d e r n cultural theory). Sass's w o r k engages b u t then refuses the logic of the sublime, a n d s u p p o r t s m y analysis of it, whereas Glamorama
r e t u r n s to the heartland of psychiatry for its portrayal
of a sublime ' p o s t m o d e r n schizophrenia'. Referring always to the 'schizophrenia' that appears in the texts of clinical a n d cultural theory, the 'schizophrenic subl i m e ' is a concept located within o r d e r s of clinical a n d cultural representation, rather than unproblematically reflecting e m b o d i e d experience.
T o s c h o l a r s w o r k i n g in t h e m e d i c a l h u m a n i t i e s , a n d p a r t i c u l a r l y t h o s e w h o herald f r o m literary a n d cultural studies b a c k g r o u n d s , I h o p e that this b o o k c a n m a k e accessible s o m e i m p o r t a n t a s p e c t s o f t h e clinical h i s t o r y of s c h i z o p h r e n i a , a n d d e m o n s t r a t e its r e l e v a n c e t o c u l t u r a l t h e o r y . A n u n d e r s t a n d i n g o f t h e key c o n c e p t s u s e d in p s y c h i a t r i c a n d p s y c h o a n a l y t i c t h e o r y is essential if w e are to explain h o w a n d w h y schizophrenia b e c a m e so 'awash with significance' o v e r t h e c o u r s e o f t h e last c e n t u r y , 8 a n d I h o p e m y c l o s e r e a d i n g o f m a j o r t h e o r e t i c a l texts in t h e s e fields f u r t h e r s b o t h o u r u n d e r s t a n d i n g a n d o u r c a p a c ity f o r e x p l a n a t i o n . It h a s also b e e n m y a i m t o c h a l l e n g e t h e a s s u m p t i o n t h a t a l i t e r a r y a n d c u l t u r a l s t u d i e s a p p r o a c h t o this t o p i c w o u l d necessarily f o c u s o n literary r e p r e s e n t a t i o n s o f p s y c h o s i s , o n t h e t e x t u a l i t y o f ' s c h i z o p h r e n i c ' w r i t ing, o r o n t h e t h e m e o f m a d n e s s in c o n t e m p o r a r y c u l t u r a l p r o d u c t i o n s . 9 T h e c e n t r a l texts o f t h i s b o o k a r e n o t n o v e l s o r films, b u t p s y c h i a t r i c t e x t b o o k s a n d s t u d i e s of s c h i z o p h r e n i c e x p e r i e n c e ; its c o n t r i b u t i o n is t o t h e h i s t o r y of i d e a s in t h e o r e t i c a l , n o t
fictional,
w r i t i n g ; as s u c h , its c o m m i t m e n t is t o t r a v e r s i n g
disciplinary boundaries. R e g u l a r r e a d e r s o f t h e I n t e r n a t i o n a l P e r s p e c t i v e s in P h i l o s o p h y o f P s y c h i a t r y series m a y likewise find t h a t this b o o k i n t r o d u c e s m a t e r i a l t h a t m i g h t n o t o t h erwise b e f a m i l i a r . H o w e v e r , c u l t u r a l t h e o r y — p a r t i c u l a r l y t h e w o r k o f M i c h e l F o u c a u l t , Gilles D e l e u z e , R.D. Laing, a n d L o u i s A. S a s s — u n d o u b t e d l y d e s e r v e s t o b e t h o u g h t o f as p h i l o s o p h i c a l , a n d , as I h o p e m y close r e a d i n g o f k e y t e x t s m a k e s clear, as m a k i n g i m p o r t a n t c o n t r i b u t i o n s t o t h e b r o a d , a n d intrinsically i n t e r d i s c i p l i n a r y , field o f t h e p h i l o s o p h y o f p s y c h i a t r y . C u l t u r a l t h e o r y invites s u s t a i n e d a n a l y t i c a t t e n t i o n f o r its c r i t i q u e o f clinical t h e o r y as well as f o r its radical, c o m p e l l i n g , a n d p u z z l i n g a p p r o p r i a t i o n s o f clinical a c c o u n t s of schizo p h r e n i a t o e x p l a i n m o d e l s of t w e n t i e t h - a n d t w e n t y - f i r s t - c e n t u r y s e l f h o o d . T h e p h e n o m e n o l o g y o f s c h i z o p h r e n i a , in t h e d i s c o u r s e o f c u l t u r a l t h e o r y , is used to interpret m o d e r n a n d p o s t m o d e r n existence, and rather than simply d i s m i s s t h e o r i s t s ' u s e o f s c h i z o p h r e n i a as illegitimate, insensitive, o r i n a p p r o p r i a t e , w e m u s t i n s t e a d ask w h y this m i g h t b e t h e case.
8
In his masterful book The Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age, Alain Ehrenberg observes in passing that 'We do not have, to my knowledge, a social and cultural history of schizophrenia' (Ehrenberg, 2010, p. 249). The Sublime Object of Psychiatry is intended as a contribution to this long overdue project, and I hope that our respective analyses of the way schizophrenia and depression can illuminate structures of the self in the late twentieth century can be drawn in to fruitful discussion in the future.
9
Although see Madness in Post-1945 British and American Fiction for an extended analysis of these themes, in particular a discussion of the 'psychoticisation of the text' in the postmodern fiction of William S. Burroughs and Kathy Acker (Baker et al„ 2010, p. 165).
T h i s is n o t a b o o k a b o u t s c h i z o p h r e n i a a n d everyday life. It does n o t discuss in detail c o n t e m p o r a r y clinical p r a c t i c e . A n d it is n o t a n analysis of the way s c h i z o p h r e n i a is p o r t r a y e d in p o p u l a r culture. But t o p e o p l e w h o have received a diagnosis of s c h i z o p h r e n i a , psychiatrists, a n d o t h e r s w o r k i n g o r involved in t h e m e n t a l health system, I h o p e t h a t this b o o k offers s o m e insights i n t o w h y s c h i z o p h r e n i a has b e e n seen for so long as ' u n u n d e r s t a n d a b l e ' a n d h o w this, in t u r n , has i n f l u e n c e d t h e o n g o i n g conflict b e t w e e n c o m p e t i n g clinical a c c o u n t s o f t h e d i s o r d e r . W h e t h e r c u l t u r a l t h e o r y ' s use of s o m e of these a c c o u n t s t o i n t e r p r e t aspects of p o s t m o d e r n c u l t u r e is t o be a p p l a u d e d o r c o n d e m n e d is, I h o p e , a q u e s t i o n t h a t readers will feel b e t t e r e q u i p p e d t o d e b a t e after r e a d i n g this b o o k .
Part 1
Clinical theory
Chapter 1
Psychiatry on schizophrenia: clinical pictures of a sublime object
Cats, mice, and modern psychiatry Psychiatric studies of schizophrenia frequently begin by a n n o u n c i n g the arrival of a n ' e x c i t i n g ' n e w e r a in s c h i z o p h r e n i a r e s e a r c h . T h e typical i n t r o d u c t i o n t o a n e d i t e d c o l l e c t i o n o f essays goes like this: This costly, devastating, and puzzling disorder is beginning to yield up its long-held secrets to systematic scientific inquiry. We now have the capability to explore, understand, and eventually control the biological foundations of schizophrenia in its myriad forms. [. ..] The pessimism that once permeated both the scientific study of schizophrenia and its clinical treatment has been replaced by a new spirit of excitement and hope that schizophrenia can be understood and conquered within a reasonable time frame. (Judd, 1994, p. xii) T h e t o n e a n d t e n o r o f L e w i s J u d d ' s i n t r o d u c t i o n t o Schizophrenia: Mind
to Molecule
From
a r e d i s t i n c t i v e b u t b y n o m e a n s u n u s u a l . S c h i z o p h r e n i a is
o f t e n i n t r o d u c e d as a h u g e b u r d e n — a d i s o r d e r w h o s e s i g n i f i c a n t costs m u s t b e m e a s u r e d in e c o n o m i c t e r m s as well as at t h e level of i n d i v i d u a l p s y c h i c h e a l t h ( M c D o n a l d et al., 2 0 0 4 , p . x v i i ) — a n d is f u r t h e r p r e s e n t e d as a n i n t e l l e c t u a l p u z z l e t h a t is o n t h e v e r g e of b e i n g solved t h a n k s t o r a p i d a d v a n c e s in m e d i c a l t e c h n o l o g y ( A n d r e a s e n , 2 0 0 4 , p . x ) . O p t i m i s m , it s e e m s , is t h e o r d e r o f t h e day: ' I t is n o w unequivocally
e s t a b l i s h e d t h a t s c h i z o p h r e n i a is a b r a i n d i s o r d e r ' ,
J u d d c o n t i n u e s , a n d w e a r e b u t m o m e n t s a w a y f r o m b e i n g able t o ' p i n p o i n t ' its o r i g i n s ( J u d d , 1994, p . xii, m y italics). O r a r e we? T e n y e a r s a f t e r t h e p u b l i c a t i o n o f Schizophrenia: Molecule,
G l e n n S h e a n — i n his b l u n t l y t i t l e d What
Can We Fix It?—argues
From Mind
is Schizophrenia
and
to How
with equal conviction that ' W e d o not presently k n o w
w h a t causes s c h i z o p h r e n i a , n o r d o we k n o w t h a t the t e r m refers to a single d i s o r d e r . W e c o n t i n u e t o u s e t h e t e r m f o r lack o f a b e t t e r o r w i d e l y a c c e p t a b l e alternative' ( S h e a n , 2004, p. 95). J u d d ' s ' u n e q u i v o c a l ' a s s u r a n c e s c a n n o t
disguise t h e fact t h a t t o d a y , as in m o r e ' p e s s i m i s t i c ' eras, t h e p s y c h i a t r i c a r e n a a b o u n d s w i t h c o m p e t i n g i n t e r p r e t a t i o n s of t h i s i n c u r a b l e d i s o r d e r . A l t h o u g h t h e r e s e e m s t o b e relative c o n s e n s u s a m o n g p s y c h i a t r i s t s r e g a r d i n g key s y m p t o m s , t h e r e a r e n o p a t h o g n o m i c signs u n i q u e t o s c h i z o p h r e n i a a n d h e n c e n o d e f i n i t i v e w a y t o test f o r its p r e s e n c e . 1 F u r t h e r c o m p l i c a t i n g t h i s d i a g n o s t i c i n d e t e r m i n a c y is t h e lack of c o m p e l l i n g e v i d e n c e c o n s i s t e n t l y i m p l i c a t i n g s p e cific p h y s i c a l , g e n e t i c , n e u r o l o g i c a l , p s y c h o l o g i c a l , o r e n v i r o n m e n t a l f a c t o r s , o r c o m b i n a t i o n s o f f a c t o r s , in t h e a e t i o l o g y o f s c h i z o p h r e n i a ( E d i t o r , 2 0 1 0 ) . T h e r e s e a r c h field is as v a r i e d as it is i n c o n c l u s i v e : ' C o u l d S c h i z o p h r e n i a Be a V i r a l Z o o n o s i s T r a n s m i t t e d f r o m H o u s e Cats?' ( T o r r e y a n d Y o l k e n , 1995; see also T o r r e y , 1988; T o r r e y a n d Miller, 2001; T o r r e y a n d Y o l k e n , 2007). O r is it t h e case t h a t g e n e t i c a l l y e n g i n e e r e d m i c e will u n l o c k its n e u r o c h e m i c a l a n d g e n e t i c secrets (see K e l l e n d o n k et al., 2006; J a a r o - P e l e d et al., 2010; O ' T u a t h a i g h et al., 2 0 1 0 ) ? A f t e r o v e r 100 y e a r s o f i n t e n s i v e r e s e a r c h t h e d e b a t e s still r a g e ( C h u n g et al., 2 0 0 7 , p p . 1 - 2 ) . T h a t s c h i z o p h r e n i a r e f u s e s i n t e r p r e t i v e ' c l o s u r e ' , h o w e v e r , d o e s n o t m e a n t h a t it is a n e m p t y o r f r e e - f l o a t i n g signifier: t h e 1 % o f a n y given p o p u l a t i o n i d e n t i f i e d as s u f f e r i n g f r o m s c h i z o p h r e n i a attest if n o t t o its e x i s t e n c e t h e n c e r t a i n l y t o t h e c o n s i s t e n c y o f its p r o f e s s i o n a l d i a g n o s i s a n d m a n a g e m e n t . 2 W h a t is t h e s t a t u s , t h e n , o f a d i s o r d e r f o r w h i c h t h e r e is n o 1
2
Although research continues into the diagnostic potential of blood testing (Noll, 2006; Tsuang et al., 2005) and electrovestibulography (Haghgooie et al., 2009). The figure of 1% is an approximation that is widely cited but heavily contested, especially as it says nothing about the severity or duration of suffering. Gender is a key variable, as it has been widely observed that more men than women are diagnosed with severe earlyonset schizophrenia, whereas women outnumber men in later-onset cases (Castle, 2000). Meta-analytical studies suggest that 'psychotic outcomes are associated with growing up in an urbanized area, minority group position, cannabis use and developmental trauma' (van Os et al., 2010). In a recent review of research into the epidemiology of schizophrenia, Kinney et al. (2009) confirm findings of an up to ten-fold variance in the prevalence rates for schizophrenia in different geographic sites, increasing significantly with latitude and colder climate. Within these climatic zones, city dwellers are at greater risk than people living in the country, as are recent immigrants, particularly those living in ethnically mixed communities (Bentall, 2004, p. 475). For example, in the UK it has been consistently shown for 40 years that people of Afro-Caribbean descent are up to seven times more likely to be diagnosed with schizophrenia (Morgan and Hutchinson, 2009), a fact that continues to cause justifiable concern and outrage (Lewin, 2009; O'Hara, 2010). In the USA, Jonathan Metzl has argued convincingly that the figure of 1% is 'a delusion', as pernicious as it is persistent. Metzl cites a 1960s National Institute of Mental Health study (which found that "'blacks have a 65% higher rate of schizophrenia than whites'"), and a 2004 study of over 130,000 veterans diagnosed with schizophrenia (which identified a four-fold increase in the likelihood that African-American identified men would receive the diagnosis), as two of the many and varied pieces of evidence in analyzing 'how schizophrenia became a black disease' (Metzl, 2009, pp. x xi, IH7-H).Without ever losing sight
u n c o n t e s t e d e x p l a n a t i o n , b u t w h i c h is itself u s e d t o ' e x p l a i n ' r o u g h l y o n e p e r s o n in every h u n d r e d ? Schizophrenia's i m p o r t a n c e to m o d e r n psychiatry c a n n o t be overestimated, as it is t h r o u g h t h e d e f i n i t i o n a n d c l i n i c a l m a n a g e m e n t o f t h i s d i s o r d e r t h a t p s y c h i a t r y c l a i m e d , a n d c o n t i n u e s t o c l a i m , its a u t h o r i t y t o legislate in t h e n a m e o f science b e t w e e n n o r m a l a n d a b n o r m a l , s a n e a n d i n s a n e , r e a s o n a n d u n r e a s o n . H o w e v e r , s c h i z o p h r e n i a is also a p r o f o u n d l y p r o b l e m a t i c p s y c h i a t ric c o n c e p t : t o t h e e x t e n t t h a t its a e t i o l o g y r e m a i n s i m p e n e t r a b l e , it t h r e a t e n s t o u n d e r m i n e t h e l e g i t i m a c y of t h e d i s c i p l i n e ' s c l a i m s t o h a v e c o n q u e r e d , o r b e o n t h e v e r g e o f c o n q u e r i n g , s e v e r e m e n t a l illness. A s A r t h u r K l e i n m a n s u c c i n c t l y s t a t e s , ' S c h i z o p h r e n i a is the d e f i n i n g p r o b l e m f o r p s y c h i a t r y ' ( 2 0 0 4 , p. xv, italics in t h e o r i g i n a l ) ; so ' " t o k n o w s c h i z o p h r e n i a is t o k n o w p s y c h i a t r y ' " ( R o y G r i n k e r , q u o t e d in G r i n k e r , 2 0 1 0 , p . 168). B u t if s c h i z o p h r e n i a is ' " t h e h e a r t l a n d of p s y c h i a t r y ' " ( K e n d a l l q u o t e d in M c G u f f i n , 2004, p . vi), t h e n it h a s f r e q u e n t l y b e e n d e s c r i b e d as a h e a r t of d a r k n e s s . A c c o r d i n g t o M i c h a e l Foster Green, this has t w o negative consequences: Schizophrenia is shrouded in an overpowering sense of mystery—which is a wonderful quality for a romance or a novel but not for an illness. When an illness is viewed as inexplicable and impenetrable, people tend to react to it with one of two extremes: either they stigmatize the illness or they romanticize it. (Green, 2003, p. 1, italics in the original) T h e r e is, I will a r g u e , a t h i r d r e s p o n s e t o t h e m y s t e r y o f s c h i z o p h r e n i a — clearly G r e e n ' s o w n r e s p o n s e — a n d t h a t is t o c o n s t r u e it as a p r o f e s s i o n a l c h a l l e n g e ; t o p o s i t i o n it at t h e c e n t r e o f p s y c h i a t r i c e n q u i r y . M y f o c u s in t h i s c h a p t e r is n o t o n h o w ' p e o p l e t e n d t o r e a c t ' t o t h e m y s t e r y of s c h i z o p h r e n i a , b u t o n h o w p s y c h i a t r i s t s v e r y c o n s c i o u s l y w r i t e a b o u t it as a m y s t e r y . In d o i n g so, p s y c h i a t r y , I will a r g u e , d o e s n o t s t i g m a t i z e o r r o m a n t i c i z e s c h i z o p h r e n i a , b u t elevates it t o t h e s t a t u s o f t h e s u b l i m e . D r a w i n g p r i m a r i l y o n t h e t h i n k i n g of p h i l o s o p h e r I m m a n u e l K a n t (1969) a n d art h i s t o r i a n M a r k C h e e t h a m (1995), this c h a p t e r argues that schizophrenia b e c o m e s psychiatry's 'sublime o b j e c t ' b y b e i n g p e r p e t u a l l y i n v o k e d as its d i s c i p l i n a r y l i m i t p o i n t . T h r o u g h its o n g o i n g c o n s t r u c t i o n in p s y c h i a t r i c w r i t i n g as o p a q u e , b i z a r r e , a n d r e s i s t a n t t o analysis, s c h i z o p h r e n i a at o n c e a t t r a c t s a n d f r u s t r a t e s ever m o r e s o p h i s t i c a t e d
of these epidemiological differences and their impact, it will be more accurate to say that schizophrenia has been diagnosed in at least 0.5 to 1% of populations across the world since the introduction of standard W H O guidelines. Whether the guidelines themselves have led to 'The Globalization of the American Psyche' is a question taken up by Ethan Walters (Wallers, 2010) in his aptly-titled book of the same name.
f o r m s of scientific e n q u i r y , e x c e e d i n g a n d t h u s m a r k i n g t h e l i m i t s of a n y given interpretive model. T h i s c h a p t e r , t h e n , o p e n s u p a n e w p e r s p e c t i v e o n t h e h i s t o r y of s c h i z o p h r e n i a b y a n a l y s i n g h o w it a c q u i r e d a n d m a i n t a i n e d its f u n c t i o n as t h e s u b l i m e o b j e c t o f p s y c h i a t r y . W e b e g i n w i t h a c o n t r o v e r s i a l b u t c r u c i a l text in t h e i n t e r d i s c i p l i n a r y s t u d y o f m a d n e s s : M i c h e l F o u c a u l t ' s Madness
and
Civilization
( 1 9 9 3 ) . F o u c a u l t ' s analysis of t h e s h i f t i n g h i s t o r i c a l c o n s t r u c t i o n s of m a d n e s s , the d e v e l o p m e n t of psychiatric practices, a n d the precariousness of psychiat r y ' s a s s e r t i o n o f s c i e n t i f i c i t y i n f o r m m y o w n w o r k ; h o w e v e r , it is his m e t a t h e o r e t i c a l c l a i m s t h a t a r e o f m o s t s i g n i f i c a n c e t o t h i s p r o j e c t . M y analysis o f Madness
and Civilization
leads t o a d i s c u s s i o n of t h e ' d i s c i p l i n a r y s u b l i m e ' a n d
its r e l e v a n c e t o u n d e r s t a n d i n g t h e s t a t u s o f s c h i z o p h r e n i a in p s y c h i a t r i c d i s c o u r s e . T h e key p s y c h i a t r i c texts u n d e r c o n s i d e r a t i o n in t h e r e m a i n d e r of this c h a p t e r are t h o s e m o s t i n f l u e n t i a l in t w e n t i e t h - c e n t u r y psychiatry: Emil K r a e p e l i n ' s Clinical
Psychiatry
The Group of Schizophrenias
( 1 9 8 1 ) , E u g e n B l e u l e r ' s Dementia
( 1 9 5 0 ) , a n d Karl J a s p e r s ' s General
Praecox,
or
Psychopathology
( 1 9 7 2 ) . As m y c l o s e r e a d i n g o f t h e i r w o r k s e e k s t o d e m o n s t r a t e , K r a e p e l i n , Bleuler, a n d J a s p e r s a m o n g t h e m n o t o n l y laid t h e f o u n d a t i o n f o r t h e w a y in which psychiatry w o u l d diagnose, treat, and perpetually re-theorize schizop h r e n i a ; t h e i r c l i n i c a l p i c t u r e s o f t h e d i s o r d e r h a v e p l a y e d a decisive r o l e in c o n s t r u c t i n g s c h i z o p h r e n i a as s u b l i m e . T h e final p a r t o f t h e c h a p t e r traces t h e i n f l u e n c e o f t h e s e a c c o u n t s in s h a p i n g c o m p e t i n g c o n t e m p o r a r y r e p r e s e n t a tions of schizophrenia a n d generating the psychiatric controversies that m a r k s c h i z o p h r e n i a ' s s u b l i m e s t a t u s in this d i s c i p l i n e .
Madness and Civilization: insanity and scientificity M i c h e l F o u c a u l t ' s Folie et Déraison:
Histoire
de la Folie à l'Âge Classique
was
p u b l i s h e d in 1961. Six y e a r s later, a t r a n s l a t i o n o f t h e a b r i d g e d F r e n c h e d i t i o n a p p e a r e d as Madness Folie et Déraison
and Civilization:
A History
of Insanity
in the Age of
Reason.
h a s a p l a c e of d i s t i n c t i o n in F o u c a u l t ' s o e u v r e as t h e text t h a t
l a u n c h e d , t o c o n s i d e r a b l e a c c l a i m , his c a r e e r - l o n g i n q u i r y i n t o t h e a r c h a e o l o g y o f t h e h u m a n s c i e n c e s . A l t h o u g h it r a n k l e d — a n d o c c a s i o n a l l y o u t r a g e d — s o m e British h i s t o r i a n s o f p s y c h i a t r y , 3 t h e r e h a s b e e n a g r u d g i n g a c k n o w l e d g e m e n t t h a t this 'cavalier p h i l o s o p h e r ' h a s in m a n y w a y s set t h e r e s e a r c h a g e n d a ( H o u s t o n , 2 0 0 0 , p . 12). F o u c a u l t ' s w o r k i n f l u e n c e d s c h o l a r s o f m a d n e s s f r o m across the h u m a n i t i e s by issuing a sophisticated challenge to psychiatry's 3
Colin Gordon (1992) provides an overview and rebuttal of the debate, which centres principally on questions of the calibre of Foucault's historical records and the accuracy of their interpretation.
n a r r a t i v e of its o w n e n l i g h t e n e d p r o g r e s s i o n . It w a s a c h a l l e n g e t h a t also r e s o n a t e d p o w e r f u l l y w i t h t h e 1960s c o u n t e r - c u l t u r a l a n t i p s y c h i a t r y m o v e m e n t s p e a r h e a d e d b y R . D . Laing. L a i n g ' s r e a d e r ' s r e p o r t , w h i c h p r a i s e d F o u c a u l t ' s ' e x c e p t i o n a l b o o k ' f o r a d v a n c i n g 'a thesis t h a t t h o r o u g h l y s h a k e s t h e a s s u m p t i o n s of t r a d i t i o n a l p s y c h i a t r y ' (Laing, q u o t e d in F o u c a u l t 2 0 0 9 ) , g u a r a n t e e d t h a t f r o m t h e m o m e n t o f its p u b l i c a t i o n Madness
and Civilization
would enjoy
a political r e s o n a n c e a n d s i g n i f i c a n c e b e y o n d t h e c o n f i n e s of t h e a c a d e m i c a n d medical establishments. Nearly 40 years later, Foucault's o n g o i n g i m p o r t a n c e to the study of m a d ness in t h e W e s t is a t t e s t e d t o b y t h e p u b l i c a t i o n o f t w o n e w b o o k s :
Psychiatric
Power ( F o u c a u l t , 2 0 0 8 ) , w h i c h c o l l a t e s f o r t h e f i r s t t i m e F o u c a u l t ' s l e c t u r e s a r o u n d this t h e m e h e l d at t h e College d è F r a n c e in 1 9 7 3 - 1 9 7 4 , a n d History Madness,
t h e first full English t r a n s l a t i o n o f Folie et Déraison.
of
Although addi-
t i o n a l a n d e x t e n d e d c h a p t e r s e x p l o r e in g r e a t e r d e p t h c o m p e t i n g s e v e n t e e n t h a n d e i g h t e e n t h - c e n t u r y s c h é m a s of m a d n e s s , History
of Madness
also r e t u r n s
n e a r l y 1000 f o o t n o t e s t o t h e t e x t ( a n d w i t h t h e m a s c h o l a r l y a p p a r a t u s t h a t appears to have reignited l o n g - s m o u l d e r i n g academic disputes4). These two i m p o r t a n t texts r e w a r d close a n d s u s t a i n e d r e a d i n g ; h o w e v e r , as t h e i r p u b l i c a t i o n h a s n o t s i g n i f i c a n t l y altered t h e ideas a n d s u b s e q u e n t d e b a t e s t h a t a r e t h e f o c u s of m y analysis, m y r e f e r e n c e s t h r o u g h o u t r e m a i n t o t h e o r i g i n a l and Civilization and
a n d t o t h e l i t t l e - k n o w n w o r k t h a t p r e c e d e d it, Mental
Madness Illness
Psychology.
T h e f i r s t p a r t o f Mental
Illness
and Psychology
has received scant critical
a t t e n t i o n , a n d yet o n l y h e r e d o e s F o u c a u l t e x p l i c i t l y c o n s i d e r w h a t m a d n e s s m u s t b e like f o r t h e m a d t h e m s e l v e s . R e j e c t i n g a n y p a r a l l e l b e t w e e n o r g a n i c 4
Far from resolving debate about the quality of Foucault's archival and scholarly research, the publication of History of Madness seems to have prompted Foucault's detractors and defenders back in to the ring with renewed vigour. In a scathing review entitled 'The fictions of Foucault's scholarship: The frail foundations of the Foucaldian monument', Andrew Scull (2007) suggests that the only lesson to be learned from History of Madness is 'the ease with which history can be distorted, facts ignored, the claims of human reason disparaged and dismissed, by someone sufficiently cynical and shameless, and willing to trust in the ignorance and the credulity of his customers'. In response the theory blogosphere erupted with an increasingly impassioned series of posts, led by a long-standing champion of Foucault, Colin Gordon. Wondering 'why Scull chooses to gamble his own scholarly credibility on such an ill-founded and malevolently unbalanced polemic', (Gordon, 2007a) he extols History of Madness as 'a work of masterful accomplishment and prodigious and prodigal energy, grasp and daring', going so far as to claim that 'No richer, more multidimensional work of cultural and intellectual history has been written - including by Foucault himself (Gordon, 2007b). A more balanced evaluation from the perspective of psychiatry and political theory respectively can be found in the work of Bracken et al. (2007) and Hooke (2009).
a n d m e n t a l p a t h o l o g y , F o u c a u l t e x a m i n e s specific f o r m s of m e n t a l illness p r o d u c e d by theories of psychic ev o l u t i on (psychology), individual history ( p s y c h o a n a l y s i s ) , a n d e x i s t e n c e ( p h e n o m e n o l o g y ) , in o r d e r t o ' d e t e r m i n e t h e c o n d i t i o n s that have m a d e possible this strange status of madness, a m e n t a l illness t h a t c a n n o t b e r e d u c e d t o a n y illness' ( F o u c a u l t , 1976, p. 13). A l t h o u g h the teleological, n o r m a l i z i n g narratives of psychology a n d psychoanalysis i m p l y o t h e r w i s e , f o r F o u c a u l t ' t h e p a t h o l o g i c a l s t r u c t u r e of t h e p s y c h e is n o t a r e t u r n t o origins; it is strictly o r i g i n a l ' ( F o u c a u l t , 1976, p. 26). F o u c a u l t ' s a t t e m p t t o u n d e r s t a n d t h e e x p e r i e n c e o f m e n t a l illness f r o m t h e ' i n s i d e ' is o n e o f t h e m o s t original a n d i n t r i g u i n g aspects of his w o r k o n m a d n e s s , n o t least b e c a u s e it d i r e c t l y p r e f i g u r e s R.D. L a i n g ' s ( 1 9 9 0 ) existential p h e n o m e n o l o g i c a l m o d e l o f s c h i z o p h r e n i a . T r a c i n g h o w each p a t h o l o g i c a l c o n d i t i o n distinctively alters t h e subjective e x p e r i e n c e of t i m e , space, e m b o d i m e n t , a n d social relationships, F o u c a u l t finds n o n e m o r e r a d i c a l in its e f f e c t t h a n s c h i z o p h r e n i a . F o u c a u l t ' s d e s c r i p t i o n of t h e t e x t u r e of s c h i z o p h r e n i c e x p e r i e n c e b r i n g s t h e r e a d e r t a n t a lizingly close n o t t o t h e o b j e c t o f p r o f e s s i o n a l analysis, s c i e n t i f i c t r e a t m e n t , o r j u r i d i c a l m a n a g e m e n t , b u t t o a s u b j e c t e n g a g e d in a d y n a m i c r e l a t i o n w i t h t h e world: [In schizophrenia, the person] is submerged in the morbid world and aware of the fact; and, as far as one can guess from the accounts of cured patients, the impression remains ever present to the subject's consciousness that reality can be grasped only in a travestied, caricatured, and metamorphised, in the strict sense of the term, dream mode. (Foucault, 1976, p. 49) Foucault then claims that psychology, psychoanalysis, a n d p h e n o m e n o l o g y c a n e l u c i d a t e t h e f o r m s t h a t m e n t a l illnesses t a k e , b u t a r e u n a b l e t o p r o v i d e satisfactory aetiological explanations: It would be a mistake to believe that organic evolution, psychological history, or the situation of man in the world may reveal these conditions [of appearance]. It is in these conditions, no doubt, that the illness manifests itself, that its modalities, its forms of expression, its style, are revealed. But the roots of the pathological deviation, as such, are to be found elsewhere. (Foucault, 1976, p. 56) It is at this p o i n t in t h e text t h a t F o u c a u l t a b a n d o n s his f o c u s o n t h e e x p e r i e n c e s of d i f f e r e n t f o r m s of m e n t a l illnesses. C o l l a p s i n g this s p e c t r u m of difference to reinstate a simple opposition between aberrant and n o r m a l subj e c t i v i t i e s e n a b l e s F o u c a u l t t o a r g u e t h a t m e n t a l i l l n e s s is s i m p l y m a d n e s s a l i e n a t e d in a n d b y p s y c h o l o g y . T h i s a r g u m e n t , d e v e l o p e d in t h e s e c o n d p a r t o f Mental
Illness and Psychology,
( i n tlif* h U t n r v (if m : u l n * t > ;
lays t h e f o u n d a t i o n s for F o u c a u l t ' s later w o r k
Madness
and Civilization
is a g e n e a l o g y o f t h e s h i f t i n g i n t e r p r e t a t i o n a n d
m a n a g e m e n t o f t h e m a d f r o m t h e m e d i e v a l p e r i o d t o t h e rise of t h e a s y l u m in the n i n e t e e n t h century; an investigation of the cultural m e c h a n i s m s that o p p o s e d m a d n e s s t o r e a s o n , e x c l u d i n g it as a n u n r e a s o n w i t h w h i c h t h e r e could be n o exchange. Challenging d o m i n a n t historical narratives that explain t h e e v o l v i n g t r e a t m e n t of m a d p e o p l e as a h u m a n i s t i c p r o g r e s s i o n a w a y f r o m t h e b a r b a r i t y o f B e d l a m t o w a r d s a n i n f o r m e d a n d c o m p a s s i o n a t e care f o r t h e sick (a p r o g r e s s i o n largely d e t e r m i n e d b y a d v a n c e s in m e d i c a l k n o w l e d g e o f t h e ' r e a l i t y ' o f m e n t a l illness) F o u c a u l t d r a w s a t t e n t i o n t o o t h e r f a c t o r s t h a t w e r e critical in d e f i n i n g m a d n e s s , t h e r e b y i n s t i g a t i n g a n d / o r l e g i t i m i z i n g societal r e s p o n s e s t o it. F o r e x a m p l e , h e a r g u e s t h a t t h e Classical p e r i o d ' s ' g r e a t c o n f i n e m e n t ' of t h e m a d as 'socially useless' w a s a n c h o r e d in a m o r a l i n j u n c t i o n against idleness as t h e r o o t of sin, s u c h t h a t in a d d i t i o n t o its l i m i t e d e c o n o m i c b e n e f i t s , e n f o r c e d l a b o u r in h o s p i t a l w o r k h o u s e s h a d a s i g n i f i c a n t ethical status. ' W h a t m a d e [ c o n f i n e m e n t ] n e c e s s a r y ' , F o u c a u l t writes, ' w a s t h e i m p e r a t i v e of l a b o u r . O u r p h i l a n t h r o p y prefers to recognize the signs of a b e n e v o l e n c e t o w a r d s i c k n e s s w h e r e t h e r e is o n l y a c o n d e m n a t i o n of i d l e n e s s ' ( F o u c a u l t , 1993, p. 4 6 ) . M a d n e s s w a s l a t e r t r a n s f o r m e d i n t o a s p e c t a c l e d i s p l a y i n g 'a bestiality f r o m w h i c h m a n h a d l o n g since b e e n s u p p r e s s e d ' , a n d t h e free and frenzied animality of the m a d w a r r a n t e d control t h r o u g h discipline a n d b r u t a l i z a t i o n ( F o u c a u l t , 1993, p p . 70, 7 5 ) . By t h e e n d o f t h e e i g h t e e n t h century, madness, according to Foucault, had b e c o m e moral aberration, and t h e a s y l u m b o t h p u n i s h e d a n d o r g a n i z e d t h e m a d p e r s o n ' s guilt: The asylum of the age of positivism . . . is not a free realm of observation, diagnosis, and therapeutics; it is a juridical space where one is accused, judged, and condemned, and from which one is never released except by the version of this trial in psychological depth—that is, by remorse. Madness will be punished in the asylum, even if it is innocent outside of it. For a long time to come, and until our own day at least, it is imprisoned in a moral world. (Foucault, 1993, p. 269) V a r i o u s l y e x c l u d e d a n d p u n i s h e d as i d l e n e s s , a n i m a l i t y , a n d m o r a l f a u l t , m a d n e s s , as F o u c a u l t argues, is n o t a n i n n a t e d i f f e r e n c e , disease, o r d y s f u n c t i o n . R a t h e r , u n d e r t h e m o r e general r u b r i c o f ' u n r e a s o n ' , its d e f i n i t i o n is d e t e r m i n e d b y t h e g o v e r n i n g i d e o l o g y a n d m e d i c o - j u r i d i c a l a p p a r a t u s of t h e p e r i o d . Madness
and Civilization,
as R u d i V i s k e r a r g u e s , is m o r e t h a n a h i s t o r y o f
m a d n e s s ; it is a p o w e r f u l c r i t i q u e o f p s y c h o l o g y ' s u n d e r s t a n d i n g o f its o w n h i s t o r y as t h e d i s c o v e r y a n d p r o g r e s s i v e scientific c o n q u e s t of m e n t a l illness. If p s y c h o l o g y ' c o n c e i v e s its e m e r g e n c e literally as a d i s c o v e r y , as t h e e x p o s u r e o f an object which was already there before being discovered, not an object cons t i t u t e d b y its d i s c o v e r y ' , F o u c a u l t ' s c o u n t e r - h i s t o r y s u g g e s t s t h a t m e n t a l
illness, t h e o b j e c t o f p s y c h o l o g y ' s d i s c o v e r y , ' n o t o n l y a r o s e historically, b u t is a l s o d e p e n d e n t o n t h a t d i s c o v e r y ' ( V i s k e r , 1 9 9 5 , p p . 9, 1 9 ) . 5 P s y c h o l o g y ' s selective i n t e r p r e t a t i o n o f its h i s t o r y e n a b l e s t h e c o n s t r u c t i o n o f a p o s i t i v i s t n a r r a t i v e t h r o u g h w h i c h p s y c h o l o g y lays c l a i m t o its o w n scientificity. A n d t h i s c l a i m c o n c e a l s a crisis: By [Foucault's] account, the positivistic forgetting in which psychology gradually loses itself, does not, as one might expect, to a crisis of psychology, but in fact covers up a crisis |. . .] Having arisen as a moral practice, it can only lay claim to being a science by forgetting the stigma of its conditions of emergence, a stigma which has never disappeared. (Visker, 1995, p. 21) W h e r e a s o t h e r h i s t o r i a n s c e l e b r a t e in P h i l i p p e P i n e l ' s r e l e a s e o f t h e m a d f r o m t h e i r c h a i n s t h e b e g i n n i n g s of h u m a n e a n d s c i e n t i f i c a s y l u m p r a c t i c e , F o u c a u l t s u g g e s t s i n Mental
Illness
n o t e x i s t ' w i t h o u t t h e moralizing
and Psychology sadism
that psychology would
in w h i c h t h e n i n e t e e n t h - c e n t u r y
" p h i l a n t h r o p y " enclosed [ m a d n e s s ] , u n d e r the hypocritical a p p e a r a n c e s of " l i b e r a t i o n " ' ( F o u c a u l t , 1976, p. 73, italics in t h e o r i g i n a l ) . P s y c h o l o g y t h u s ' b e f a l l s m a d n e s s ' , a l i e n a t i n g it in m e n t a l i l l n e s s a n d f u r t h e r s u b j e c t i n g it t h r o u g h t h e telling o f its o w n ' i n a u t h e n t i c ' o r ' i m p r o p e r ' h i s t o r y (Visker, 1995, p. 28). By radically d e s t a b i l i z i n g p s y c h o l o g i c a l m e t a n a r r a t i v e s , c o n s t r u c t e d in part t h r o u g h histories of psychology's discovery, epistemological c o n q u e s t , a n d p r o g r e s s i v e l y e n l i g h t e n e d t r e a t m e n t of m e n t a l illness; b y e m p h a s i z i n g t h e distinctions b e t w e e n each historical period's conceptualization of madness; a n d b y f o c u s s i n g o n t h e e c o n o m i c , legislative, religious, a n d ethical f a c t o r s at p l a y in t h e r e g u l a t i o n o f t h e m a d , F o u c a u l t s u g g e s t s t h a t b o t h t h e f o r m a n d a e t i o l o g y o f m o d e r n m a d n e s s m u s t b e s o u g h t n o t in t h e m a d b o d y o r p s y c h e , b u t in t h e h i s t o r y of t h e i r d i s c u r s i v e c o n s t r u c t i o n . 6
5
6
In his recent work, acclaimed Foucauldian sociologist Nikolas Rose (Rose, 2006; Abi-Rached and Rose, 2010) extends this enquiry into the domains of neuroscience, biotechnology, genomics, and psychopharmacology. Recent critical inquiries into the validity of contemporary diagnostic categories have reached a similar conclusion by different means. Berrios, Luque and Villagran, for example, in their analysis of the history of the concept of schizophrenia, have mounted a cogent critique of what they term the 'continuity hypothesis'. Their sarcastic tone speaks volumes about the esteem in which these authors hold one of the founding premises of psychiatry: 'According to this view: (a) "schizophrenia" has always existed (say, as a "rough diamond"), (b) 19th and 20th centuries alienists (Kraepelin, the Bleulers, the Schneiders, etc.) have polished away its blemishes and impurities, culminating in: (c) the DSM IV definition which can therefore be considered as a paragon ( KKUS | real, recognizable, unitary and stable object of inquiry]), and (d) The end of history is nigh for it is only matter of months before the genetics and aetiology of ichizophrrnia is sorted out for good'
Foucault posits critical differences b e t w e e n m e n t a l illness a n d m a d n e s s , e m p h a sizing t h a t m a d n e s s is s o m e t h i n g i n h e r e n t l y b e y o n d t h e c l a s s i f i c a t o r y s c h e m a essential t o t h e scientificity a n d s e l f - p r o c l a i m e d efficacy o f m o d e r n p s y c h i a t r y . At t h e i r m o s t i n t i m a t e , m a d n e s s is o n l y t h e 'lyrical h a l o o f illness' ( F o u c a u l t , 1996, p . 101). W h e r e a s d i s c u s s i o n s of n o s o l o g y , c o m p a r a t i v e s y m p t o m a t o l o gies, a n d specific f o r m s o f m e n t a l illness s u r f a c e i n t e r m i t t e n t l y in Madness Civilization,
and
t h e t e r m ' m a d n e s s ' r e t a i n s its ' s t r a n g e s t a t u s ' , r e m a i n i n g d i f f i c u l t ,
o p a q u e , and seemingly free f r o m positive c o n t e n t . For p h i l o s o p h e r Jacques Derrida, Foucault's use of an 'unverifiable . . . p o p u l a r a n d equivocal notion of madness', . . . would not be serious if Foucault used the word in quotation marks, as if it were the language of others, of those who, during the period under study, used it as a historical instrument. But everything transpires as if Foucault knew what 'madness' means. Everything transpires as if, in a continuous and underlying way, an assured and rigorous precomprehension of the concept of madness, or at least of its nominal definition, were possible and acquired. In fact, however, it could be demonstrated that as Foucault intends it, if not as intended by the historical current he is studying, the concept of madness overlaps everything that can be put under the rubric of negativity. One can imagine the kind of problems posed by such a usage of the notion of madness. (Derrida, 1978, p. 41, italics in the original) A c c o r d i n g t o F o u c a u l t , m a d n e s s w a s d i s t i n g u i s h e d as a p a r t i c u l a r f o r m o f u n r e a s o n o n l y w h e n o t h e r f o r m s of social uselessness ( p o v e r t y , l i c e n t i o u s n e s s , b l a s p h e m y ) w e r e n o l o n g e r l o c k e d in t h e a s y l u m . B e y o n d t h e s e h i s t o r i c a l l y d e t e r m i n e d d e f i n i t i o n s o f w h a t m a d n e s s is o r w a s n o t , D e r r i d a c o r r e c t l y p o i n t s o u t t h a t t h e r e a r e f e w e x p l i c i t r e f e r e n c e s t o its p o s i t i v e c o n t e n t in t h e t e x t . H o w e v e r , F o u c a u l t ' s thesis p r e s u p p o s e s t h a t t h e r e existed, a n d p e r h a p s exists, a n essential o r t r a g i c e x p e r i e n c e of m a d n e s s . T h i s s t r u c t u r i n g p r e s u p p o s i t i o n is explicit in Mental
Illness and Psychology:
'Generally speaking, madness [prior
t o its c o n f i n e m e n t ] w a s a l l o w e d f r e e reign; it c i r c u l a t e d t h r o u g h o u t society, it f o r m e d p a r t of t h e b a c k g r o u n d a n d l a n g u a g e o f e v e r y d a y life, it w a s f o r everyo n e an everyday experience that o n e s o u g h t neither to exalt n o r to c o n t r o l ' ( F o u c a u l t , 1976, p. 6 5 ) . T h e p e c u l i a r s e n t i m e n t a l i t y of t h i s p o r t r a i t of q u o t i d ian m a d n e s s u n d e r s c o r e s its loss a n d t h e i m p o s s i b i l i t y of a c u l t u r a l r e t u r n t o it. F o r in F o u c a u l t ' s a c c o u n t , b y t h e b e g i n n i n g of t h e t w e n t i e t h c e n t u r y , m a d n e s s h a d b e c o m e p s y c h i a t r y ' s v i c t i m , at o n c e t r a g i c a n d n o b l e as t h e i n a r t i c u l a t e t r u t h of u n r e a s o n .
(Berrios et al., 2003, p. 113). Writing in Nature, Thomas Insel (2010) rather courageously offers a view of what schizophrenia will look like in 2030 which resists the narrative just outlined.
H o w , t h e n , c a n o n e s p e a k o f t h i s m a d n e s s ? ' O n e d a y ' , F o u c a u l t w r i t e s in Mental
Illness and Psychology,
' a n a t t e m p t m u s t b e m a d e t o s t u d y m a d n e s s as
a n overall s t r u c t u r e — m a d n e s s f r e e d a n d d i s a l i e n a t e d , r e s t o r e d in s o m e s e n s e t o its o r i g i n a l l a n g u a g e ' ( F o u c a u l t , 1976, p . 7 6 ) . S o m e c o m m e n t a t o r s c l a i m F o u c a u l t h a s i n d e e d s o u g h t a n d f o u n d ' t h e keys t o t h e l a n g u a g e of m a d n e s s ' : From now on, we have to allow those whom we have not heard previously to speak, even if the substance of their words is m a d n e s s . . . . During three centuries of misery, we have spoken of a mute; and here [in Madness and Civilization] he [sic[ recovers his abolished language and begins to speak by himself, of himself. (Serres, 1994, p. 38) In m y v i e w , t h i s is a case o f w i s h f u l t h i n k i n g r a t h e r t h a n close r e a d i n g , as F o u c a u l t p e r f o r m s n e i t h e r a g e s t u r e of s e m a n t i c r e c u p e r a t i o n o n b e h a l f o f t h e m a d p e r s o n n o r a n act of v e n t r i l o q u i s m . In Madness
and Civilization,
Foucault
p o s i t i o n s t h e e x p e r i e n c e o f m a d n e s s , t h e m a d , a n d m a d s p e e c h , as analytically inaccessible t o t h o s e living in t h e age o f p s y c h i a t r y : As for a common language [between modern 'man' and the 'madman'], there is no such thing; or rather, there is no such thing any longer; the constitution of madness as a mental illness, at the end of the eighteenth century, affords the evidence of a broken dialogue, posits the separation as already effected, and thrusts into oblivion all those stammered, imperfect words without fixed syntax in which the exchange between madness and reason was made. The language of psychiatry, which is a monologue of reason about madness, has been established only on the basis of such a silence. I have not tried to write the history of that language, but rather the archaeology of that silence. (Foucault, 1993, pp. xii-xiii) T h e i d e a o f a n a r c h a e o l o g y o f s i l e n c e e v o k e s t h e s e n s e o f loss F o u c a u l t s o s t r o n g l y associates w i t h m a d n e s s , t h e s e n s e t h a t civilization h a s c r u s h e d t h e life o u t of a m a d n e s s n o w f o s s i l i z e d in t h e r u b b l e c a l l e d s c i e n t i f i c p r o g r e s s . B u t s i f t i n g t h r o u g h this d e b r i s is, as D e r r i d a a r g u e s , a n i m p o s s i b l e p r o j e c t , f o r , . . . is not an archaeology, even of silence, a logic, that is, an organized language, a project, an order, a sentence, a syntax, a work? Would not the archaeology of silence be the most efficacious and subtle restoration, the repetition, in the most irreducibly ambiguous meaning of the word, of the act perpetrated against madness—and be so at the very moment when this act is denounced? (Derrida, 1978, p. 35) D e r r i d a f u r t h e r c o n t e s t s t h a t 'Nothing
w i t h i n t h i s l a n g u a g e , a n d no
one
a m o n g t h o s e w h o s p e a k it, c a n e s c a p e t h e h i s t o r i c a l g u i l t . . . w h i c h F o u c a u l t a p p a r e n t l y w i s h e s t o p u t o n t r i a l ' ( D e r r i d a , 1978, p . 3 5 ) . As r e a s o n c a n n o t
s p e a k u n r e a s o n , s o t o s p e a k of m a d n e s s is t h u s t o r e i t e r a t e t h e c r i m e p e r p e t r a t e d a g a i n s t it. It s e e m s o n e m u s t e i t h e r r e m a i n silent a b o u t ( b u t s o m e h o w c o g n i z a n t o f ) t h i s silence, o r ' f o l l o w t h e m a d m a n d o w n t h e r o a d of his exile' ( D e r r i d a , 1978, p. 3 6 ) . T h r o u g h r e f e r e n c e t o t h e 1961 p r e f a c e of Folie et
dérai-
son, C o l i n G o r d o n ( 1 9 9 2 , p . 3 5 ) a r g u e s t h a t F o u c a u l t ' s a w a r e n e s s o f t h i s i m p a s s e is a l r e a d y a p p a r e n t in h i s d e s c r i p t i o n o f t h e p r o j e c t as 'a s t r u c t u r a l study of the historical e n s e m b l e — n o t i o n s , institutions, juridical and police m e a s u r e s , s c i e n t i f i c c o n c e p t s — w h i c h h o l d c a p t i v e a m a d n e s s w h o s e wild state c a n n e v e r in itself b e r e s t o r e d ' ( F o u c a u l t , 2 0 0 9 , p . xxxiii). H o w e v e r , as D e r r i d a n o t e s , t h i s w i l d n e s s t h a t is s u p p o s e d l y b e y o n d l a n g u a g e ' m u s t r e v e r b e r a t e within the language used to describe the history of m a d n e s s ' , and therefore F o u c a u l t ' a c k n o w l e d g e s t h e necessity o f m a i n t a i n i n g his d i s c o u r s e . . . w i t h o u t s u p p o r t f r o m a n a b s o l u t e r e a s o n o r l o g o s ' ( D e r r i d a , 1978, p. 36). Following Derrida, Shoshana Felman argues that Foucault undertakes a p h i l o s o p h i c a l s e a r c h ' f o r a new status
of discourse,
a discourse which would
u n d o b o t h e x c l u s i o n a n d i n c l u s i o n , w h i c h w o u l d o b l i t e r a t e t h e line of d e m a r cation a n d the opposition between Subject and Object, Inside and Outside, R e a s o n a n d M a d n e s s ' ( F e l m a n , 1985, p . 4 2 ) . F e l m a n s u g g e s t s t h a t t h i s n e w d i s c o u r s e is e s s e n t i a l l y o n e o f p a t h o s a n d m e t a p h o r : ' O n t h e idea t h a t literat u r e , f i c t i o n , is t h e o n l y possible m e e t i n g - p l a c e b e t w e e n m a d n e s s a n d p h i l o s o phy, between delirium a n d t h o u g h t , Foucault w o u l d doubtless agree with D e r r i d a ' ( F e l m a n , 1985, p . 4 8 ) . F o r F e l m a n , m a d n e s s c a n o n l y , if e l u s i v e l y , e x p r e s s itself t h r o u g h literary w r i t i n g . F o u c a u l t ' s o w n v a l o u r i z a t i o n o f w r i t e r s like F r i e d r i c h N i e t z s c h e a n d A n t o n i n A r t a u d ( F o u c a u l t , 1993, p. 2 7 2 ) is e c h o e d in F e l m a n ' s a p p r a i s a l of F o u c a u l t , a l t h o u g h it is u n c l e a r w h y f o r F e l m a n l i t e r a t u r e a l o n e s h o u l d e n j o y p r i v i l e g e d access t o t h e t r u t h o f m a d n e s s , as if m a d n e s s w e r e i n h e r e n t l y literary in f o r m . 7 T h e search for a n e w literary d i s c o u r s e o f m a d n e s s is m o t i v a t e d b y F o u c a u l t ' s r e f u s a l t o s p e a k e i t h e r as m a d ness o r its c a p t o r . H i s p o e t i c a r c h a e o l o g y of m a d n e s s ' s silence effectively s u g gests a p o s i t i o n , h o w e v e r t e n u o u s , o u t s i d e this r e d u c t i v e d u a l i s m ; t h e p o s s i b i l i t y o f a w i t n e s s w h o is n e i t h e r t h e a g e n t o f o p p r e s s i o n n o r e n t i r e l y d e r a n g e d , w h o m i g h t , as D e r r i d a p u t s it, ' p r o v i d e a reason w i t h o u t objectifying, o r even identifying, that is t o say, w i t h o u t e x a m i n i n g ' (Derrida, 1998, p. 71). So, m i g h t w h a t D e r r i d a interprets as pathos, a n d F e l m a n as t h e literary, b e re-conceptualized
7
The pathos of Foucault's writing, and the relationship between madness and literature in Mildness and Civilization, has also received attention from more hostile quarters. So Cutting (1994, p.65) makes the conservative claim that Foucault's analysis of madness in fact 'lies outside of history . . . because it is ambiguous in a way appropriate to literature, rather than an academic discipline'.
as a s p a c e s o m e h o w b e y o n d t h e r e a s o n / u n r e a s o n d i c h o t o m y ? F o r D o m i n i c k LaCapra, Foucault at his most provocative writes neither from the side of the mad nor that of the sane but from the problematic margin that divides the two. Yet a liminal status on this margin, which allows or constrains a hybridized, internally divided voice, is particularly tenuous in the modern world as Foucault himself understands modernity, for modernity has been largely successful in reducing unreason to pathological madness if not at times to mere muteness. In some obscure fashion, Foucault would apparently like that torn and ragged margin to expand or even to explode in affirmatively changing society and culture. (LaCapra, 1992, p. 83) It m a y b e t h a t o n l y b y w r i t i n g f r o m t h i s ' t o r n a n d r a g g e d m a r g i n ' s u g g e s t e d b y F o u c a u l t t h a t f u t u r e t h e o r i s t s c a n a v o i d t h e f u r t h e r o p p r e s s i o n of m a d n e s s . B u t t h e q u e s t i o n r e m a i n s : w h a t exactly is this o b j e c t o f o p p r e s s i o n , t h i s i m p o s sible a n d i n c o m p r e h e n s i b l e s p e a k i n g p o s i t i o n , this m a d n e s s ? F o r F e l m a n , as f o r F o u c a u l t , m a d n e s s is s i m p l y ' n o t h i n g o t h e r t h a n a n irred u c i b l e r e s i s t a n c e t o i n t e r p r e t a t i o n ' ( F e l m a n , 1985, p. 2 5 4 ) . Ironically, c o n s i d e r i n g t h e i r collective a t t e n t i v e n e s s t o m e t a t h e o r e t i c a l i m p l i c a t i o n s o f w r i t i n g ( a b o u t ) m a d n e s s , F o u c a u l t , F e l m a n , a n d t o a lesser e x t e n t D e r r i d a , fail t o r e c o g n i z e t h a t d e s p i t e t h e i r c l a i m s t o t h e c o n t r a r y t h e y h a v e n o t resisted i n t e r p r e t i n g m a d n e s s . E a c h i m p l i c i t l y p o s i t i o n s m a d n e s s n o t j u s t as e x t e r n a l t o r e a s o n , b u t as a n a u t h e n t i c , t r a n s g r e s s i v e , a n d i l l u m i n a t i n g e x p e r i e n c e s o m e h o w lost t o m o d e r n i t y . 8 F o r these a u t h o r s m a d n e s s c a n n o t e s c a p e its t r a n s c e n d e n t s t a t u s . T h e c a u t i o n a g a i n s t p e r p e t u a t i n g r e a s o n ' s u n j u s t t r e a t m e n t of m a d n e s s elevates it as a t r u t h w h o s e e s s e n c e c a n n o t , o r m u s t n o t , b e s u b j u g a t e d in d i s c o u r s e . T h e o r i g i n s o f m e n t a l illness, as a l i e n a t e d m a d n e s s , c a n b e t r a c e d t o t h e d i s c i p l i n a r y r e g i m e s o f p s y c h i a t r y , b u t m a d n e s s itself h a s n o o r i g i n in F o u c a u l t ' s a c c o u n t , i n s t e a d it is h e l d t o u n d e r g o a passage f r o m t h e q u o t i d i a n t o t h e t r a n s c e n d e n t . A b s e n t f r o m Madness Illness and Psychology,
and Civilization
is t h e sense, p r e s e n t in
Mental
t h a t t h e r e are p a r t i c u l a r f o r m s o f m a d n e s s c o m p l i c a t i n g
a n d calling i n t o q u e s t i o n a s i m p l e o p p o s i t i o n b e t w e e n m a d n e s s a n d n o r m a l c y . In its place, t h e r e is t h e c o n v i c t i o n t h a t a n y a t t e m p t t o s p e a k d i r e c t l y o f m a d ness f u r t h e r v i o l a t e s an i n t e g r i t y g u a r a n t e e d o n l y b y silence; a c o n v i c t i o n w h i c h serves t o sever m a d n e s s f r o m its r e l a t i o n s h i p t o t h e b o d i e s a n d e x p e r i e n c e , t o t h e s u f f e r i n g s a n d i n s i g h t s , of t h e m a d t h e m s e l v e s . C a n m a d n e s s b e s o easily
8
In this, the speech of madness, as Michele Crossley and Nick Crossley note, is produced by Foucault as 'the ahistorical "other" of contemporary forms of medical power; a subjugated but authentic discourse which might IK- recovered and restored through progressive political measures' (Crossley and Crossley, 2001, p. 1477).
s e p a r a t e d f r o m its m a t e r i a l i n c a r n a t i o n in t h e m a d p e r s o n ? Is m a d n e s s a silent o r a n u n s p e a k a b l e e x p e r i e n c e f o r t h e m a d as well as t h e i r s p e c t a t o r s ? D o e s n o t d i s c o n n e c t i n g m a d n e s s f r o m its r e f e r e n t in s u f f e r i n g p o t e n t i a l l y inflict a f u r ther injustice o n the m a d , paradoxically recapitulating the rhetorical gestures of p s y c h i a t r i s t s at t h e i r m o s t scientifically self-assuring? In his analysis o f t h e ' s t r a n g e s t a t u s o f m a d n e s s , a m e n t a l illness t h a t c a n n o t b e r e d u c e d t o a n y illness', F o u c a u l t h i m s e l f assigns m a d n e s s a s t r a n g e s t a t u s , o n e a p p a r e n t also in t h e w r i t i n g o f D e r r i d a a n d F e l m a n . A l r e a d y I h a v e r e f e r r e d t o t h i s u n a c k n o w l e d g e d v a l u a t i o n of m a d n e s s as s o m e f o r m of t r a n s c e n d e n c e o r t r a n s g r e s s i o n , as a f o r m of u n r e a s o n d e m a n d i n g t o b e r e c l a i m e d f r o m r e a s o n ' s i n t e r m i n a b l e c o l o n i z a t i o n . In w h a t f o l l o w s , I s u g g e s t t h a t t h e s t r a n g e s t a t u s of m a d n e s s in Madness
and Civilization
c a n b e u n d e r s t o o d as F o u c a u l t ' s
association of m a d n e s s with the s u b l i m e , a n d t h a t this, m o r e o v e r , p o i n t s t o w a r d s F o u c a u l t ' s elliptical r e c o g n i t i o n o f a s s o c i a t i o n s a l r e a d y m a d e b e t w e e n s c h i z o p h r e n i a a n d t h e s u b l i m e in p s y c h i a t r i c d i s c o u r s e .
Approaching a disciplinary sublime ' T h e s u b l i m e ' is a c o n c e p t t h a t a p p e a r s d e c e p t i v e l y easy t o g r a s p . O n t h e o n e h a n d it is a w o r d w e u s e a l m o s t casually t o s u g g e s t s o m e t h i n g t h a t is s o a w e i n s p i r i n g it d e f i e s d e s c r i p t i o n ; o n t h e o t h e r , w e t e n d t o b e u n c o m f o r t a b l y a w a r e t h a t t h e t e r m c o m e s l a d e n w i t h subtleties, c o n t r a d i c t i o n s , a n d a h i s t o r y that spans t w o millennia. T h e sublime takes us f r o m the R o m a n o r a t o r y of L o n g i n u s t h r o u g h t o e i g h t e e n t h - c e n t u r y p h i l o s o p h y a n d politics, R o m a n t i c p o e t r y a n d p a i n t i n g , L a c a n i a n p s y c h o a n a l y s i s , a n d t h e r e p r e s e n t a t i o n of p o s t m o d e r n technology. Supplying a definition suitable for such a wide sweep of e x p e r i e n c e s , h i s t o r i c a l p e r i o d s , a n d d i s c u r s i v e c o n t e x t s is a c h a l l e n g e m e t b y Philip S h a w in h i s b o o k - l e n g t h s t u d y of t h e s u b l i m e : In broad terms, whenever experience slips out of conventional understanding, whenever the power of an object or event is such that words fail and points of comparison disappear, then we resort to the feelings of the sublime. As such, the sublime marks the limits of reason and expression together with a sense of what might lie beyond these limits... (Shaw, 2006, p. 2) F l o a t i n g f a r f r o m its m o o r i n g s in a e s t h e t i c t h e o r y , t h e s u b l i m e c a n call t o m i n d a range of images: f r o m the lone cliff-top figure gazing across a s t o r m y sea, t o t h e r o u s i n g m u l t i - s e n s o r y s p e c t a c l e o f W a g n e r i a n o p e r a ; f r o m t h e s h u t t l e ' s o r b i t t h r o u g h d e e p space t o t h e e l a t i o n o f a n e l e c t o r a l victory. T h e r e l e v a n c e o f t h e s u b l i m e t o an i n q u i r y i n t o t h e o r e t i c a l r e p r e s e n t a t i o n s o f s c h i z o p h r e n i a m a y n o t b e i m m e d i a t e l y o b v i o u s , s o it is t h e task o f t h e next t w o
s e c t i o n s t o e l u c i d a t e t h i s r e l a t i o n s h i p m o r e f u l l y . T h e f i r s t s t e p , t h e n , is t o h i g h l i g h t t h e f e a t u r e s of t h e s u b l i m e t h a t i n f o r m t h e d e v e l o p m e n t o f t h i s t h e o retical m o d e l , as well as t h e k i n d s of a r e a s a n d r e l a t i o n s t h a t t h e s u b l i m e m i g h t b e p a r t i c u l a r l y w e l l - s u i t e d t o e x p l o r i n g . O n e of t h e chief v i r t u e s of t h e s u b l i m e is t h a t it f o c u s s e s o u r a t t e n t i o n o n a n e n c o u n t e r b e t w e e n s u b j e c t a n d o b j e c t , a n d o n t h e i m p o r t a n c e o f c o n t e x t in giving m e a n i n g t o t h a t e n c o u n t e r . As w e shall see, t h e o b j e c t in t h i s e n c o u n t e r h a s n o fixed p r o p e r t i e s : it is p r o d u c e d ( r a t h e r t h a n s i m p l y p e r c e i v e d ) as s u b l i m e t h r o u g h t h e i n t e r p l a y of t e m p o r a l , spatial, a n d social factors. U n s e t t l i n g a n d a f f i r m i n g , the d y n a m i c s of the e n c o u n t e r m a k e t h e s u b l i m e a site of s u b j e c t i v e t r a n s f o r m a t i o n , e n s u r i n g t h e subject a n d object are n o t fixed or static b u t r e m a i n 'in process'. Despite a p p e a r a n c e s t o t h e c o n t r a r y , t h e n , t h e s u b l i m e is n o t a n e n d p o i n t o r a n o u t c o m e ; its e m p h a s i s is o n s i n g u l a r i t y , certainly, b u t o f a k i n d t h a t b e a r s w i t h i n it t h e c a p a c i t y f o r r e p e t i t i o n . F o r t h e s e r e a s o n s , as I h o p e t o d e m o n s t r a t e , it c a n be developed into a compelling model for thinking about the relationship between and the d e v e l o p m e n t of subjects a n d objects of knowledge. P u b l i s h e d in 1757, E d m u n d B u r k e ' s A Philosophical of Our Ideas of the Sublime
and Beautiful
Enquiry
into the
Origin
( 1 9 8 7 ) is t h e first p h i l o s o p h i c a l w o r k
to o f f e r a s u s t a i n e d e x p o s i t i o n of these t w o aesthetic categories. Like the R o m a n t i c artists a n d t h i n k e r s h e h e l p e d t o i n s p i r e , B u r k e ' s f a s c i n a t i o n clearly lies n o t w i t h t h e c a l m o f b e a u t y b u t w i t h t h e t e m p e s t o f t h e s u b l i m e a n d t h e t e r r o r w h i c h is its r u l i n g p r i n c i p l e : Whatever is fitted in any sort to excite the ideas of pain, and danger, that is to say, whatever is in any sort terrible, or is conversant about terrible objects, or operates in a manner analogous to terror, is a source of the sublime; that is, it is productive of the strongest emotion which the mind is capable of feeling. (Burke, 1987, p. 39) T h e s u b l i m e s w e l l s in t h e s u b j e c t p r i o r t o a p r o c e s s o f r e a s o n i n g ; it is a m o m e n t o f t e m p o r a l s u s p e n s i o n in w h i c h t h e o b j e c t o v e r w h e l m s p s y c h i c s p a c e . F o r B u r k e t h e o b j e c t s of t h e s u b l i m e c a n b e classified a c c o r d i n g t o t h e i r sensory appeal o n a schema that ranges f r o m the concrete (stenches, serpents, a n d s u d d e n n o i s e s ) t o t h e less t a n g i b l e ( t h e t e r r i b l e p r i v a t i o n s of vacuity, d a r k ness, s o l i t u d e , a n d silence). A l t h o u g h d a n g e r as a n i m m e d i a t e t h r e a t is ' s i m p l y t e r r i b l e ' , 'at c e r t a i n d i s t a n c e s , a n d w i t h c e r t a i n m o d i f i c a t i o n s ' t h e s e o t h e r w i s e t e r r i b l e o b j e c t s c a n p r o v o k e d e l i g h t in t h e s u b j e c t , a s e n s a t i o n d e r i v e d f r o m t h e r e m o v a l o r n e g a t i o n of t h e i r t h r e a t ( B u r k e , 1987, p p . 40, 4 5 ) . W i t h o u t d i s c u s s i n g t h e f o r m of this d i s t a n c e b e t w e e n s u b j e c t a n d o b j e c t (is it spatial? sensory? a f u n c t i o n o f p o w e r , o r o f m e d i a t e d p e r c e p t i o n ? ) , A Philosophical
Enquiry
figures d i s t a n c e as a n essential c o n d i t i o n o f t h e s u b l i m e . W h e r e a s a n y o n e w i t h
a n i n s t i n c t f o r s e l f - p r e s e r v a t i o n is s u s c e p t i b l e t o b e i n g t e r r i f i e d b y t h e i m m e d i ate, o b s c e n e l y p r o x i m a t e o b j e c t , t h e s u b l i m e is e x c l u s i v e l y t h e p r e r o g a t i v e o f t h e safe s u b j e c t , o n e w h o s e d i s t a n c e , h o w e v e r w e m a y i n t e r p r e t it, a f f o r d s a p e r c e p t i o n of t h e t e r r i b l e as d e l i g h t f u l . C o m b i n i n g e m p i r i c i s m w i t h ' h o m e s p u n ' p s y c h o l o g y , B u r k e ' s s u b l i m e , as T e r r y E a g l e t o n ( 1 9 9 0 , p . 5 4 ) c o r r e c t l y n o t e s , is a s s o c i a t e d w i t h ' e n t e r p r i s e , rivalry a n d i n d i v i d u a t i o n ' , a ' p h a l l i c swelling' f o s t e r e d in a e s t h e t i c e x p e r i e n c e as a c u l t u r a l l y p e r m i s s i b l e a n t i d o t e t o ' s p i r i t u a l e m a s c u l a t i o n ' . T h e s u b l i m e , f o r B u r k e , eclipses o u r c a p a c i t y f o r m e a n i n g - m a k i n g , p l u n g i n g u s i n t o , . . . that state of the soul, in which all its motions are suspended, with some degree of horror. In this case the mind is so entirely filled with its object, that it cannot entertain any other, nor by consequence reason on that object which employs it. Hence arises the great power of the sublime, that far from being produced by them, it anticipates our reasonings, and hurries us on by an irresistible force. (Burke, 1987, p. 57) Burke's a c c o u n t of the sublime strongly influenced R o m a n t i c writers a n d thinkers w h o located the sublime with the spectacles of the natural world. D e s p i t e its e n d u r a n c e in t h e p o p u l a r i m a g i n a r y , this idea o f t h e s u b l i m e as a n ' i r r e s i s t i b l e f o r c e ' in n a t u r e , a r o u s i n g in u s a t r e m e n d o u s d e p t h o f feeling, is precisely not t h e basis f o r t h e t h e o r e t i c a l m o d e l I w a n t t o d e v e l o p . F o r t h a t w e m u s t t u r n to K a n t ' s t h i r d c r i t i q u e a n d his d i s c u s s i o n of t h e m a t h e m a t i c a l a n d dynamic sublime. In his 1790 Critique
of Judgement
Kant does not concern himself with iden-
tifying a c o r n u c o p i a of essentially u n r e p r e s e n t a b l e o b j e c t s i n d i r e c t l y p r e s e n t e d in t h e s u b l i m e , f o r h e a r g u e s t h a t ' t h e s u b l i m e is t o b e f o u n d in a n o b j e c t e v e n d e v o i d o f f o r m , so f a r as it i m m e d i a t e l y involves, o r else b y its p r e s e n c e i n v o k e s , a r e p r e s e n t a t i o n of limitlessness,
yet w i t h a s u p e r - a d d e d t h o u g h t o f its t o t a l i t y '
( K a n t , 1969, p. 9 0 ) . F o r m l e s s n e s s , u n b o u n d e d n e s s , i n c o m p a r a b l e m a g n i t u d e , powerfulness: w h e r e a s these m i g h t be the potentially terrifying qualities of s u c h a n o b j e c t , t h e s u b l i m e ' c a n n o t b e c o n t a i n e d in a n y s e n s u o u s f o r m , b u t r a t h e r c o n c e r n s i d e a s of r e a s o n ' ( K a n t , 1969, p. 92), t h e f a c u l t y t h a t is able t o ' s u p e r - a d d ' t h e t h o u g h t of t o t a l i t y u p o n limitlessness. T h e s u b l i m e m u s t t h e r e fore b e u n d e r s t o o d as a p r o c e s s i n t e r n a l t o t h e j u d g i n g s u b j e c t , o c c a s i o n e d b y a c o n f l i c t b e t w e e n t h e faculties of i m a g i n a t i o n a n d r e a s o n t h a t is t r i g g e r e d b y t h e p e r c e p t i o n o f a n o b j e c t b u t is n o n e t h e l e s s d i s t i n c t f r o m it. T h e s u b l i m e is 'the mere capacity every standard
of thinking
which
evidences
a faculty
of mind
transcending
of sense' ( K a n t , 1969, p. 98, italics in t h e o r i g i n a l ) . F o r e x a m p l e , in
t h e idea of infinity, a n i n s t a n c e of t h e m a t h e m a t i c a l l y s u b l i m e , w e e n c o u n t e r t h e limits o f o u r c a p a c i t y for i m a g i n a t i v e r e p r e s e n t a t i o n . H o w e v e r , this h u m b l i n g
r e c o g n i t i o n o f t h e t r i u m p h of n a t u r e is i m m e d i a t e l y s u p e r s e d e d b y t h e feeling of d e l i g h t p r o d u c e d b y t h e r a t i o n a l f a c u l t y ' s m a s t e r y of t h e c o n c e p t in its t o t a l ity, a m a s t e r y at o n c e d e m o n s t r a t i n g a n d s e c u r i n g o u r i n d e p e n d e n c e f r o m n a t u r e . So, f o r K a n t , s u b l i m i t y ' d o e s n o t r e s i d e in a n y o f t h e t h i n g s of n a t u r e , b u t o n l y in o u r o w n m i n d , in s o far as w e m a y b e c o m e c o n s c i o u s of o u r s u p e r i o r i t y o v e r n a t u r e w i t h i n , a n d t h u s also o v e r n a t u r e w i t h o u t u s (as e x e r t i n g i n f l u e n c e u p o n o n u s ) ' ( K a n t , 1969, p. 114). E a g l e t o n d o w n p l a y s t h e d i m e n s i o n of d e l i g h t in his d i s c u s s i o n of t h e K a n t i a n sublime: [I]n the turbulent presence of the sublime we are forcibly reminded of the limits of our dwarfish imaginations and admonished that the world as infinite totality is not ours to know. It is as though in the sublime the 'real' itself—the eternal, ungraspable totality of things—inscribes itself as the cautionary limit of all mere ideology, of all complacent subject-centeredness, causing us to feel the pain of incompletion and unassuaged desire. (Eagleton, 1990, p. 89) Evocative as it is, I w o u l d a r g u e t h a t E a g l e t o n o b s c u r e s t h e effect o f t h e s u b l i m e in a f f i r m i n g t h e r a t i o n a l s u b j e c t ' s a s c e n d a n c y o v e r n a t u r e a n d h e n c e in actively r e - c e n t r i n g the subject. Kant insists that the d r a m a of the s u b l i m e s p a r e s o u r ' h u m a n i t y ' f r o m ' h u m i l i a t i o n ' , a n d is q u i c k t o r e a s s u r e t h e r e a d e r t h a t s u c h a n ' e s t i m a t i o n of o u r s e l v e s loses n o t h i n g b y t h e f a c t t h a t w e m u s t see o u r s e l v e s safe in o r d e r t o feel t h i s s o u l - s t i r r i n g d e l i g h t ' ( K a n t , 1969, p. 111). R a t i o n a l i t y , it s e e m s , exercises its s u p r e m a c y o n l y at a d i s t a n c e . K a n t h e r e , like B u r k e , e m p h a s i z e s d i s t a n c e as a p r e c o n d i t i o n of t h e s u b l i m e e n c o u n t e r ' s e d i f y i n g t r a n s f o r m a t i o n o f self; h o w e v e r , h e is m o r e e x p l i c i t in h i s a s s e r t i o n t h a t m o r a l d e v e l o p m e n t a l o n e c a n s e c u r e safe access t o t h e s u b l i m e , w h i c h ' m e r e l y strikes t h e u n t u t o r e d m a n as t e r r i f y i n g ' ( K a n t , 1969, p. 115). R a t i o n a l i t y as a n i n d e x o f t h e s u b j e c t ' s h u m a n i t y is a f f i r m e d t h r o u g h a s u b l i m e e x p e r i e n c e predicated u p o n one's already accomplished rational development. Burke's Philosophical
Enquiry
s i d e s t e p s t h e c i r c u l a r i t y of t h i s logic b y p o s i t i o n i n g t h e
( s u b l i m e as a n e m o t i v e r e s p o n s e p r e c e d i n g r a t i o n a l e n g a g e m e n t w i t h a n e c e s sarily t e r r o r - i n v o k i n g o b j e c t . By c o n t r a s t , it c o u l d b e a r g u e d t h a t f o r K a n t t h e a e s t h e t i c j u d g e m e n t of s u b l i m i t y h a s a d i m e n s i o n of p l e a s u r a b l e p e r f o r m a t i v ity a b o u t it, b e i n g at o n c e c o n s t i t u t i v e a n d i n d i c a t i v e o f t h e j u d g i n g s u b j e c t ' s r e a s o n as a t r a n s c e n d e n c e o f t h e n a t u r a l r e a l m . T h e K a n t i a n s u b l i m e is ' e d i f y i n g ' , as M a r k C h e e t h a m ( 1 9 9 5 , p. 3 5 3 ) n o t e s , b e c a u s e 'it s i m u l t a n e o u s l y reveal[s] a n d c o n s i s t s in o u r a w a r e n e s s o f . . . t h e m i n d ' s u l t i m a t e intellectual c o n t r o l — t h r o u g h r e f e r e n c e t o m o r a l i t y — o v e r a n y t h i n g it p e r c e i v e s ' . For this f o u n d i n g m o m e n t in the f o r m a t i o n o f m o d e r n subjectivity, the sublime object is clearly instrumental: 'we have n o interest whatever in the Obiect.
i.e. its real e x i s t e n c e m a y b e a m a t t e r o f n o c o n c e r n t o u s ' , p r o v i d e d 'its m e r e greatness, r e g a r d e d e v e n as d e v o i d of f o r m , is able t o c o n v e y a universally c o m m u n i c a b l e d e l i g h t ' ( K a n t , 1969, p. 96). K a n t ' s insistence u p o n t h e n o n - e s s e n t i a l , a l m o s t i n c i d e n t a l , f o r m of t h e s u b l i m e o b j e c t is, f o r m y p u r p o s e s , c r u c i a l . A s C h e e t h a m observes: 'The experience and pleasure of the sublime does not stem f r o m the p r o m i s e of s o m e t h i n g n o u m e n a l , o u t s i d e a given f r a m e , b u t r a t h e r f r o m t h e p e r p e t u a l , y e t a l w a y s p r o v i s i o n a l , a c t i v i t y o f f r a m i n g itself, f r o m t h e p a r e r g o n ' ( C h e e t h a m , 1995, p. 3 5 4 ) . E x t e n d i n g D e r r i d a ' s ( D e r r i d a , 1987) r e a d i n g o f t h e K a n t i a n s u b l i m e , C h e e t h a m suggests t h a t t h e j u d g i n g s u b ject's d e l i g h t in p a r e r g o n a l activity c a n b e u t i l i z e d t o i n t e r p r e t c o n t e m p o r a r y d e b a t e s s u r r o u n d i n g t h e l i m i t s of d i s c o u r s e : At different times and from different perspectives, even large and imprecisely defined constructs such as disciplines will have their own sublimes, those issues that are at once feared and desired and which, through the disciplinary attention they garner, work to mark the provisional limits and flash points of particular disciplines. (Cheetham, 1995, p. 360) C h e e t h a m ' s n o t i o n o f t h e d i s c i p l i n a r y s u b l i m e is c e n t r a l t o m y analysis o f s c h i z o p h r e n i a as t h e s u b l i m e o b j e c t o f p s y c h i a t r y . D e v e l o p i n g t h i s a n a l y s i s requires that we examine the relationship between schizophrenia and the ( n o n ) q u a l i t i e s o f t h e s u b l i m e o b j e c t , t h e t h e m e of d i s t a n c e , a n d t h e q u e s t i o n of s u b j e c t i v e , o r in t h i s case, d i s c u r s i v e , t r a n s f o r m a t i o n t h a t s t r u c t u r e s K a n t ' s a c c o u n t of t h e s u b l i m e .
Schizophrenia and sublimity As R o n a l d P a u l s o n c a u t i o n s : 'if t h e h u m a n s u b l i m e m e a n s t h e a s s u m p t i o n of s u b l i m e qualities, t h e n e i t h e r t h e h u m a n h a s t o b e t r u l y raised i n t o a n a t u r a l / s u p e r n a t u r a l f o r c e , as b y a k i n d o f p o s s e s s i o n , o r w e a r e d e a l i n g w i t h at b e s t a m e t a p h o r i c a l a n d at w o r s t a p s e u d o / s u b l i m e ' ( P a u l s o n , 1985, p. 4 2 8 ) . It w o u l d c e r t a i n l y b e p o s s i b l e t o p r e s s B u r k e ' s s u b l i m e i n t o t h e service of s u c h a m e t a p h o r , f o r , as F o u c a u l t d e m o n s t r a t e s in Madness
and Civilization,
madness has
i n d e e d p a s s e d t h r o u g h a n u m b e r o f h i s t o r i c a l i n c a r n a t i o n s as w i l d a n i m a l i t y a n d d i v i n e o r s a t a n i c p o s s e s s i o n , a n d scientificity a n d s e c u l a r i z a t i o n n o t w i t h s t a n d i n g , early p s y c h i a t r i c r e p r e s e n t a t i o n s o f s c h i z o p h r e n i a d o b e a r t h e resid u e of t h e s e i n t e r p r e t a t i o n s of m a d n e s s . W e c o u l d e v e n g o f u r t h e r , p e r h a p s , a n d a r g u e t h a t m o u n t a i n p e a k s a n d s t o r m y seas ( s u b l i m e o b j e c t s p a r excellence) f i n d t h e i r a n t h r o p o m o r p h i c e c h o in t h e m u t e i m m o b i l i t y of c a t a t o n i a a n d t h e v i o l e n c e of s o m e d e l u s i o n a l acts. S u c h a n a l o g i e s , h o w e v e r , a r e t e n u o u s , d e h u m a n i s i n g , a n d u l t i m a t e l y u n p r o d u c t i v e , d e p e n d i n g as t h e y d o u p o n p e r c e i v i n g t h e p e r s o n d i a g n o s e d w i t h s c h i z o p h r e n i a as a t e r r i f y i n g spectacle o f calamity, misery, a n d privation.
R a t h e r t h a n s e a r c h f o r a ' h u m a n s u b l i m e ' , t h e n , K a n t ' s analysis d i r e c t s o u r attention away f r o m the object in isolation, a n d o n to the distance between o b j e c t a n d s u b j e c t in t h e s u b l i m e e n c o u n t e r . F o r a n o b j e c t t o b e j u d g e d s u b l i m e is, a c c o r d i n g t o K a n t , d e p e n d e n t n o t o n its a p p r e h e n s i o n , a p r o c e s s t h a t ' c a n b e c a r r i e d o n a d i n f i n i t u m ' , b u t o n its ability t o e x c e e d t h e l i m i t s o f o u r i m a g i n a t i v e c o m p r e h e n s i o n ( K a n t , 1969, p. 99). Recalling t h a t s u b l i m i t y is, f o r K a n t , a p r o p e r t y n o t of t h e o b j e c t b u t t h e j u d g i n g s u b j e c t , t h e s u b j e c t ' s p o s i t i o n as r e g a r d s t h e o b j e c t is n o n e t h e l e s s crucial in s t a g i n g r e a s o n ' s t r a n s c e n d e n c e of i m a g i n a t i o n ' s l i m i t s . K a n t uses t h e e x a m p l e o f t h e p y r a m i d s t o e x p l o r e this in detail: [I]n order to get the full emotional effects of the size of the Pyramids we must avoid coming too near just as much as remaining too far away. For in the latter case the presentation of apprehended parts (the tiers of stones) is but obscure, and produces no effect upon the aesthetic judgement of the Subject. In the former, however, it takes the eye some time to complete the apprehension from the base to the summit; but in this interval the first tiers always in part disappear before the imagination has taken in the last, and so the comprehension is never complete. The same explanation may also sufficiently account for the bewilderment, or sort of perplexity, which, as is said, seizes the visitor on first entering St. Peter's in Rome. For here a feeling comes home to him of the inadequacy of his imagination for presenting the idea of a whole within which that imagination attains its maximum, and, in its fruitless efforts to extend this limit, recoils upon itself, but in so doing succumbs to an emotional delight. (Kant, 1969, pp. 99-100) W h e r e the sublime object appears within a disciplinary context the careful n e g o t i a t i o n of p r o x i m i t y a p p e a r s e q u a l l y as n e c e s s a r y . U p close a n d p e r s o n a l , s c h i z o p h r e n i a m a y b e p e r c e i v e d as ' s i m p l y t e r r i f y i n g ' ; t o o f a r r e m o v e d , a n d a p p r e h e n s i o n itself b e c o m e s s t r a i n e d . R a t h e r t h a n t h e o r i z e d i s t a n c e solely in t e r m s of a spatial s e p a r a t i o n b e t w e e n a c t o r s ( t h e p s y c h i a t r i s t a n d p a t i e n t ) , 1 suggest t h a t t h e d i s t a n c e b e t w e e n s u b ject a n d o b j e c t t h a t is a n essential p r e c o n d i t i o n o f t h e s u b l i m e e n c o u n t e r c a n b e b e s t c o n c e p t u a l i z e d as a n e n s e m b l e of d i s c u r s i v e p r a c t i c e s . It is t h e d e v e l o p m e n t of a professional
p o s i t i o n f r o m w h i c h t o view (label, p r o b e , a n d m a n a g e )
s c h i z o p h r e n i a t h a t p r o d u c e s it as a s u b l i m e o b j e c t ; i n s t i g a t i n g a n d l e g i t i m i z i n g a m e d i a t e d gaze f o c u s s e d o n , b u t n o t j e o p a r d i z e d b y , t h i s d i s o r d e r . F o u c a u l t w r i t e s p e r s u a s i v e l y o n this p o i n t , o b s e r v i n g t h a t t h e r e g i m e n of t h e early p s y chiatric asylum was, . . . necessary for the very constitution of medical knowledge, since exact observation is not possible without this discipline, without this order, without this prescriptive schema of regularities. The condition of the medical gaze (regard midicale), of its neutrality, and the possibility of it gaining access to the object, in short, the effective condition of possibility of the relationship of objectivity, which is constitutive of
medical knowledge and the criterion of its validity, is a relationship of order, a distribution of time, space, and individuals. (Foucault, 2008, pp. 2-3) 9 O n c e it h a s b e e n c o n f i n e d in t h e a s y l u m — b r o u g h t i n t o s p a t i a l p r o x i m i t y with the professional subject, b u t subjected to various distancing measures that m a k e it a s u i t a b l e o b j e c t of s t u d y , w h i l e c o n t a i n i n g a n d o r g a n i z i n g its t h r e a t t o t h e social o r d e r — c a n s c h i z o p h r e n i a b e c o m e c a p a b l e o f p r o d u c i n g ' d e l i g h t ' ? F o r K a n t , t h e a n s w e r m u s t surely b e yes, if w e c o n s i d e r t h a t t h e s u b l i m e o b j e c t ' s r o l e is t o f u n c t i o n as a site t h r o u g h w h i c h j u d g i n g s u b j e c t c a n e x e r c i s e t h e p o w e r o f t h e i r ( p r o f e s s i o n a l ) r e a s o n i n g . As t h e s u b l i m e ' m u s t in e v e r y case h a v e r e f e r e n c e t o o u r way of thinking
( K a n t , 1969, p . 127, italics in t h e o r i g i -
n a l ) , in t h i s i n s t a n c e s c h i z o p h r e n i a ' s s t a t u s as a n o b j e c t o f t h e s u b l i m e is d e p e n d e n t o n d i s c u r s i v e l y m e d i a t e d d i s t a n c e , b u t is s i m u l t a n e o u s l y a n incitem e n t t o e x t e n d d i s c u r s i v e limits, t o c a p t u r e t h e d i s o r d e r i n its totality. T o a r g u e t h a t s c h i z o p h r e n i a a c q u i r e s t h e s t a t u s of s u b l i m e o b j e c t f o r p s y c h i a t r y , t h e n , is n o t t o i m p l y similarities b e t w e e n t h e d i s o r d e r a n d t h e q u a l i t i e s o f t h e s u b l i m e o b j e c t . It is, m o r e s i g n i f i c a n t l y , t o s u g g e s t t h a t s c h i z o p h r e n i a f u n c t i o n s as a l i m i t p o i n t f o r t h i s d i s c i p l i n e , a p o t e n t i a l l y d a u n t i n g u n k n o w n , w h i c h p e r p e t u a l l y s p u r s g r e a t e r e f f o r t s at a n a l y t i c c o n q u e s t . I a m n o t s u g g e s t i n g t h a t t h e logic o f s u b l i m i t y is t h e o n l y m e a n s b y w h i c h p s y c h i a t r y h a s s h o r e d u p t h e r a t i o n a l i t y o f its d i s c o u r s e . O n t h e c o n t r a r y , t h e s u b l i m e ' u n s e t t l e s e v e r y l o c u s of p o w e r ' ; d e s t a b i l i z i n g t h e very d i s c u r s i v e s t r u c t u r e s w h o s e e x p a n s i o n it e n a b l e s . T h e s u b l i m e is n o t ' a n e n d in itself b u t t h e p o w e r t o m a k e every e n d s e e m p r e l i m i n a r y . . . [it] s p o n t a n e o u s l y s u r p a s s e s every d e s i g n a t i o n i n t e n d e d t o locate it' ( P e a s e , 1984). E l i d i n g r e a s o n ' s c o l o n i z a t i o n a n d e x i s t i n g b e y o n d c o n c l u s i v e a n a l y t i c e x p l a n a t i o n , s c h i z o p h r e n i a serves b o t h as a n e x e m p l a r y site of u n r e a s o n u p o n w h i c h p s y c h i a t r y c a n exercise a n o n g o i n g claim t o scientificity, and as a c h a l l e n g e t o t h e scientificity of t h o s e v e r y c l a i m s . T h e u n c e a s i n g
9
Writing of Foucault's work on medicine more generally, Alan Bleakley and John Bligh question whether Foucault's analysis of the disciplinary medical gaze needs to be reconceptualized in an era when simulation, diffusion, and fragmentation have superseded the physical encounter between doctor and patient: 'the future of medical diagnostics is in the technology of imaging and the art of reading such images, which effectively scatters or distributes the diagnostic gaze as it draws in mediating instruments and a variety of specialist practitioners. Also, Foucault does not address the issue of how the clinical gaze is further shaped by the development and sophistication of tests - of sputum, blood, urine, biopsies - where, as with imaging, the diagnostic gaze is now splintered, distributed across a variety of specialty and subspecialty practitioners preserving their boundaries, and no longer holds that original intensity of the coup U'oeil, the penetrating glance of the individual doctor' (bleakley and Bligh, 2009, pp. 376-7).
p r o l i f e r a t i o n of t h e o r i e s a n d t r e a t m e n t s of s c h i z o p h r e n i a testifies t o its c a p a c ity t o p r o d u c e a d e l i g h t f u l c o n f i r m a t i o n o f ever m o r e s o p h i s t i c a t e d r e a s o n i n g , w h e r e a s t h e m a r k e d inability of t h e s e t h e o r i e s a n d t r e a t m e n t s t o c o m p r e h e n d o r c u r e s c h i z o p h r e n i a c a n b e seen as s y m p t o m a t i c of its s u b l i m i t y , its c a p a c i t y t o e x c e e d c o m p r e h e n s i o n . H e r e , s c h i z o p h r e n i a also fulfils B u r k e ' s c o n d i t i o n o f s u b l i m e o b s c u r i t y : it r e m a i n s h i d d e n f r o m t h e p s y c h i a t r i c g a z e w h i l e b e i n g c o n s t a n t l y u n d e r t h e scientific s p o t l i g h t ( B u r k e , 1987, p p . 5 8 - 9 ) . B e f o r e t u r n i n g t o c o n s i d e r in m o r e detail h o w t h e logic o f s u b l i m i t y i l l u m i n a t e s specific a c c o u n t s o f p s y c h i a t r y ' s f r a m i n g o f s c h i z o p h r e n i a , t h e ' s t r a n g e s t a t u s ' o f m a d n e s s in F o u c a u l t ' s w r i t i n g w a r r a n t s r e - e x a m i n a t i o n . A l t h o u g h m y analysis of t h e i m p o r t a n c e o f discursively p r o d u c e d d i s t a n c e in t h e e s t a b lishment of schizophrenia's sublimity owes m u c h to Foucault's reading of the p s y c h i a t r i c c o n f i n e m e n t o f m a d n e s s , it also suggests a w a y o f i n t e r p r e t i n g his i n d e b t e d n e s s t o t h e d i s c o u r s e s h e so r o b u s t l y c r i t i q u e s . F o u c a u l t , a n d D e r r i d a a n d F e l m a n a f t e r h i m , i d e n t i f y a crisis o f r e p r e s e n t a t i o n w h e n it c o m e s t o s p e a k i n g ( a b o u t ) m a d n e s s , a crisis w h i c h I t h i n k is o n l y p a r t i a l l y r e s o l v e d t h r o u g h r e c o u r s e t o a l i t e r a r y m o d e of w r i t i n g . T h e 'lyrical h a l o o f illness' is e x t i n g u i s h e d in t h e l a n g u a g e of r e a s o n , j u s t as m a d n e s s h a s e n d u r e d d i s f i g u r e m e n t in its t r a n s f o r m a t i o n f r o m t h e q u o t i d i a n t o t h e s u b l i m e via t h e d i s c o u r s e and practices of psychology. Foucault's historical d r a m a t i z a t i o n of the c o n finement
of t h e i n s a n e c o u l d t h e r e f o r e b e r e - r e a d as a n a l l e g o r y f o r m a d n e s s ' s
e l e v a t i o n t o t h e s t a t u s o f t h e s u b l i m e , a n d it is as a n i n h e r e n t l y u n r e p r e s e n t a ble, s u b l i m e o b j e c t t h a t F o u c a u l t politicizes m a d n e s s , i m p a r t i n g t o it a t r a n s gressive p o t e n t i a l as a f r e e d o m o u t s i d e r e a s o n . 1 0 P u t s i m p l y , his v a l o u r i z a t i o n of m a d n e s s d e p e n d s o n its c o n f i n e m e n t , o n its s u b l i m e s t a t u s in p s y c h i a t r y . If, as I h a v e s u g g e s t e d , t h e s e d i s c i p l i n e s h a v e a K a n t i a n t u r n a b o u t t h e m ( t h a t is, t h e s u b l i m e e n c o u n t e r reveals t h e s u p r e m e a g e n c y o f r e a s o n ) it is o n e F o u c a u l t radically rejects. P u r s u i n g a l i b e r a t o r y ideal, F o u c a u l t is in fact closer t o B u r k e in i m p l i c i t l y h i n t i n g a t m a d n e s s ' s o b s c u r i t y , p o w e r , a n d u n i n t e l l i g i b i l i t y ; its c a p a c i t y t o e l i c i t p r e - r a t i o n a l a s t o n i s h m e n t r a t h e r t h a n t h e d e l i g h t o f selfc o n t a i n e d s u p e r i o r i t y . F o u c a u l t ' s a n a m o r p h i c r e c o g n i t i o n of t h e s u b l i m i t y of m a d n e s s since the great c o n f i n e m e n t t h e r e f o r e suggests that his hostility t o w a r d s p s y c h i a t r y c o n c e a l s his c o m p l i c i t y w i t h t h e c r e a t o r s o f m e n t a l illness. W h a t , t h e n , d o e s t h i s tell u s a b o u t s c h i z o p h r e n i a , s p e c i f i c a l l y ? A l t h o u g h F o u c a u l t strategically uses t h e a l l - e n c o m p a s s i n g t e r m ' m a d n e s s ' t o d i s t a n c e his a n a l y s i s f r o m p s y c h i a t r y a n d its c l a s s i f i c a t o r y s c h e m a , a n d t o d i s t i n g u i s h m a d n e s s f r o m m e n t a l i l l n e s s , it is c l e a r t h a t b y ' m a d n e s s ' F o u c a u l t m e a n s
10
This is also the case for other antipsychiatric thinkers, as we shall see in Chapters 3 and 4.
s o m e t h i n g v e r y close t o ' s c h i z o p h r e n i a ' . I n d e e d , in The Order of Things h e goes so far as t o d e s c r i b e ' m a d n e s s par excellence'
as t h a t ' w h i c h p s y c h i a t r i s t s t e r m
s c h i z o p h r e n i a ' ( F o u c a u l t , 1970, p. 375). H o w e v e r , as it is m y i n t e n t i o n t h r o u g h o u t this b o o k t o insist o n t h e specificity o f s c h i z o p h r e n i a — o n t h e clinical a n d c u l t u r a l s i g n i f i c a n c e of t h e c o n c e p t , as well as t h e p a r t i c u l a r set o f e x p e r i e n c e s it d e s c r i b e s — w e m u s t resist t h e t e m p t a t i o n t o p u r s u e a n e a s y e q u i v a l e n c e b e t w e e n t h e t e r m s ' m a d n e s s ' a n d ' s c h i z o p h r e n i a ' in F o u c a u l t ' s w o r k o r i n d e e d m y analysis o f it. Madness
and Civilization
c h a r t s a h i s t o r y of m a d n e s s f r o m t h e m i d d l e ages t o
t h e b i r t h o f m o d e r n p s y c h i a t r y in t h e n i n e t e e n t h c e n t u r y , a h i s t o r y t h a t s t o p s s h o r t o f s c h i z o p h r e n i a ' s i d e n t i f i c a t i o n as a d i s c r e t e c l i n i c a l e n t i t y in 1 8 9 6 . A l t h o u g h it is c o m m o n l y a s s u m e d t h a t s c h i z o p h r e n i a is as o l d as h u m a n i t y itself, a s i g n i f i c a n t n u m b e r of s c h o l a r s a r g u e s t r o n g l y t h a t it first a p p e a r e d in the West d u r i n g the industrial revolution. Edward Hare, a psychiatrist a n d a d v o c a t e of t h e ' r e c e n c y h y p o t h e s i s ' , c l a i m s t h a t ' f e w if a n y a d e q u a t e d e s c r i p t i o n s of s c h i z o p h r e n i a w e r e w r i t t e n b e f o r e t h e y e a r 1800' ( 1 9 8 8 , p p . 153, 5 2 1 ) . N o t w i t h s t a n d i n g t h e m e t h o d o l o g i c a l p r o b l e m s of r e t r o s p e c t i v e diagnosis ( F r a g u a s a n d B r e a t h n a c h , 2 0 0 9 ) , L o u i s Sass also d a t e s t h e first c o m p r e h e n s i v e case s t u d y o f s c h i z o p h r e n i a t o 1810 ( 1 9 9 2 , p . 3 2 5 ) , a n d n e u r o p s y c h o l o g i s t C h r i s t o p h e r F r i t h a n d p s y c h i a t r i s t Eve J o h n s t o n e t o 1809 ( 2 0 0 3 , p. 7). H a r e , a d v a n c i n g a less t h a n p o p u l a r viral h y p o t h e s i s , suggests t h a t ' s o m e c h a n g e o f a biological k i n d o c c u r r e d a b o u t 1800, s u c h t h a t a p a r t i c u l a r t y p e of s c h i z o p h r e nia t h e r e a f t e r b e c a m e m u c h c o m m o n e r [sic]' ( 1 9 8 8 , p. 5 2 1 ) , g r a d u a l l y s p r e a d ing t h r o u g h o u t t h e i n d u s t r i a l i z e d w o r l d in a s l o w e p i d e m i c . A n a l y s i n g a s y l u m r e c o r d s a n d e v a l u a t i n g t h e r e l a t i o n s h i p b e t w e e n social f a c t o r s a n d b u r g e o n i n g asylum populations, H a r e concludes that the spread of schizophrenia provides t h e b e s t e x p l a n a t i o n f o r t h e s t a r k i n c r e a s e in a d m i s s i o n s o v e r t h e n i n e t e e n t h c e n t u r y ( H a r e , 1983). T h i s n o t i o n o f a s u b s t a n t i v e i n c r e a s e in i n s a n i t y , w h a t ever t h e s u g g e s t e d cause, h a s b e e n fiercely d e b a t e d , 1 1 b u t t h e idea t h a t s c h i z o p h r e n i a h a s a s p e c i a l r e l a t i o n s h i p w i t h m o d e r n i t y r e m a i n s f r u i t f u l , as t h e s e c o n d half of t h i s b o o k attests.
11
The invisible plague (Torrey and Miller, 2001) offers a comprehensive - if ultimately unconvincing - case for the existence of an epidemic of insanity, as well as a survey of competing views. Challenging the viral hypothesis, sociologist Andrew Scull (1984) draws attention to shifts in lunacy legislation, asylum management practices, and cultural attitudes to poverty that significantly affected asylum admissions in the nineteenth century, arguing that definitions of insanity have always been contingent, historically determined, and governed by the ideological interests of those in positions of psychiatric and legal authority.
M y p o i n t , t h e n , is t o s u g g e s t t h a t t h e f o r e g o i n g a n a l y s i s o f m a d n e s s in Foucault's influential w o r k provides an i m p o r t a n t f o u n d a t i o n for the current s t u d y of s c h i z o p h r e n i a in m u l t i p l e w a y s . S c h i z o p h r e n i a c l e a r l y i n h e r i t s t h e f r a u g h t legacy of a n a l i e n a t e d m a d n e s s a n a l y s e d b y F o u c a u l t , b u t its a p p e a r a n c e in t h e last y e a r s of t h e n i n e t e e n t h c e n t u r y p r o m p t s u s t o e x a m i n e its stat u s as t h e d i s c o v e r y of a n e w era o f p s y c h i a t r y . It is t h i s d i s c o v e r y t h a t c o n s t i t u t e s t h e f o c u s o f t h e rest of t h i s c h a p t e r .
Clinical psychiatry and dementia praecox S c h i z o p h r e n i a ' s s t a t u s in p s y c h i a t r i c d i s c o u r s e c a n n o t b e u n d e r s t o o d w i t h o u t reference to the writings a n d practices of o n e n i n e t e e n t h - c e n t u r y n o r t h G e r m a n clinician, Emil Kraepelin. A c o n t e m p o r a r y of Freud, and o n e - t i m e c o l l e a g u e o f P a u l Flechsig ( w h o w e will m e e t as D a n i e l P a u l S c h r e b e r ' s ' s o u l m u r d e r e r ' in C h a p t e r 2), K r a e p e l i n p r e s e n t e d in his 1896 t e x t b o o k of Psychiatry
Clinical
the first detailed d e s c r i p t i o n s of d e m e n t i a p r a e c o x . A l t h o u g h
d e m e n t i a praecox was swiftly r e n a m e d s c h i z o p h r e n i a by Eugen Bleuler, K r a e p e l i n ' s a c c o u n t o f this m a j o r f o r m o f p s y c h o s i s h a s e n d u r e d w i t h o u t r a d i cal a l t e r a t i o n f o r o v e r 100 years: t h e h e b e p h r e n i c , c a t a t o n i c , a n d p a r a n o i d f o r m s o f K r a e p e l i n ' s d e m e n t i a p r a e c o x h a v e b e c o m e , in t h e m o s t r e c e n t A m e r i c a n Psychiatric A s s o c i a t i o n Diagnostic
and Statistical
Manual
( D S M - I V - T R ) (2000),
disorganized, catatonic, and paranoid schizophrenia (complemented by ' u n d i f f e r e n t i a t e d ' a n d ' r e s i d u a l ' t y p e s ) . 1 2 As a m o r e d e t a i l e d e x a m i n a t i o n will m a k e e v i d e n t , it is n o t j u s t t h e p s y c h o t i c s y m p t o m s d e s c r i b e d b y K r a e p e l i n , theoretically r e c o n f i g u r e d by Bleuler, a n d ranked by Kurt Schneider that h a v e b e e n e s t a b l i s h e d as d i a g n o s t i c g o s p e l b y t o d a y ' s D S M - I V - T R ; a n e n t i r e conceptual a p p a r a t u s has survived a c e n t u r y of psychiatric practice. Indeed, 12
At the time of writing, one of the most significant areas of contention in schizophrenia research is the simultaneous contraction and expansion of definitions of schizophrenia proposed for the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual. DSM-5, as it is known, is due to be published in mid-2013, and there is little doubt that the fifth 'bible' of American psychiatry will continue to exert a huge influence worldwide. Overturning a century of nosological convention, the current draft aims to 'streamline' schizophrenia by replacing its five subtypes with a simple scale for assessing the severity of specific symptoms. At the same time, however, it adds the new diagnostic category of'psychosis risk syndrome'. Although its proponents hope the diagnostic category will facilitate early and effective intervention for those in the prodromal phase of schizophrenia (Carpenter, 2009; Woods et al„ 2009), critics argue that psychosis risk syndrome risks exposing tens of thousands of people with false positive diagnoses to stigma, unwelcome clinical attention, and the debilitating side effects of antipsychotic drugs (Dobbs, 2010; Frances, 2010). If PSM-V has begun a 'civil war' in psychiatry i A I . U I M I I V 21)09). nsvi hosis risk syndrome Is surely among its most conflict ridden arenas
t h e p s y c h i a t r i s t w h o s e a n a l y s i s of d e m e n t i a p r a e c o x m e t w i t h , at b e s t , 'lively r e s i s t a n c e ' ( K r a e p e l i n q u o t e d in M c K e n n a , 1994, p . v ) f r o m h i s p e e r s n o w o c c u p i e s a p o s i t i o n o f a l m o s t i m p e r i a l a u t h o r i t y in o r t h o d o x p s y c h i a t r y . A s Berrios a n d H a u s e r n o t e : ' T h e K r a e p e l i n i a n classification o f t h e psychoses governs t w e n t i e t h - c e n t u r y p s y c h i a t r i c t h i n k i n g a n d n e u r o b i o l o g i c a l r e s e a r c h ' ( B e r r i o s a n d H a u s e r , 1995, p. 2 8 0 , m y i t a l i c s ) . T h r o u g h a c l o s e r e a d i n g o f K r a e p e l i n ' s t r e a t m e n t o f d e m e n t i a p r a e c o x i n Clinical
Psychiatry,
I aim to
d e m o n s t r a t e t h a t s c h i z o p h r e n i a ' s s u b l i m e s t a t u s in psychiatry—-its p a r a d o x i cal l e g i t i m i z a t i o n a n d d e s t a b i l i z a t i o n of p s y c h i a t r y ' s scientificity, its c o n s t r u c t i o n as o t h e r t o t h e c e n t r e d m o d e r n s u b j e c t — i s a l r e a d y clearly e s t a b l i s h e d in t h e first a n d m o s t i n f l u e n t i a l clinical p i c t u r e of this d i s o r d e r . So m u l t i f a c e t e d is t h e i n f l u e n c e o f t h i s t e x t t h a t a d e t a i l e d a n a l y s i s o f its a c c o u n t o f d e m e n t i a p r a e c o x is i n d i s p e n s a b l e t o u n d e r s t a n d i n g t h e s t a t u s of s c h i z o p h r e n i a in c o n t e m p o r a r y psychiatric discourse. It is p o s s i b l e t h a t d e m e n t i a p r a e c o x m i g h t n o t h a v e b e e n i d e n t i f i e d b y K r a e p e l i n at all if it w e r e n o t f o r t w o i d i o s y n c r a s i e s : his b a d eyesight a n d his meticulous record keeping. G e r m a n psychiatry, by the e n d of the nineteenth c e n t u r y , h a d b e c o m e a l m o s t exclusively f o c u s s e d o n t h e s o m a t i c a e t i o l o g y o f psychiatric disease. T h e m i c r o s c o p e was the privileged tool of the alienist's t r a d e , a n d t h e g o a l o f b i o l o g i c a l analysis w a s t o i d e n t i f y p o s t - m o r t e m a r e a s in t h e c e r e b r a l c o r t e x r e s p o n s i b l e f o r v a r i o u s p s y c h o t i c s y m p t o m s ( S h o r t e r , 1997, p p . 7 9 - 8 0 ) . A s a c o n s e q u e n c e , a n y i n t e r e s t in t h e effect o f p s y c h o s i s u p o n t h e patient and their behaviour was considerably diminished. Kraepelin's p o o r eyesight, h o w e v e r , m e a n t t h a t h e w a s u n a b l e t o p u r s u e his c a r e e r t h r o u g h t h e m i c r o s c o p e ( S h o r t e r , 1997, p p . 1 0 0 - 1 ) . I n s t e a d , h e f o l l o w e d his t h e n r a t h e r u n f a s h i o n a b l e i n t e r e s t in p s y c h o l o g y a n d f o c u s s e d his i n v e s t i g a t i o n s o n t h e f a m i l y a n d p e r s o n a l h i s t o r y of t h e p a t i e n t a n d t h e c o u r s e of their illness. R e c o r d i n g this i n f o r m a t i o n alongside clinical o b s e r v a t i o n s o n his f a m o u s p a t i e n t c a r d s , K r a e p e l i n w a s able t o t r a c k p a t i e n t s as t h e y m o v e d f r o m u n i v e r sity clinics t o a s y l u m s , r e l a p s e d , o r r e c o v e r e d ( E n g s t r o m , 1995, p p . 294, 2 9 7 ) . H e t h e r e f o r e a c q u i r e d e n o u g h statistical d a t a o n p a t i e n t p o p u l a t i o n s t o p u r s u e a l o n g i t u d i n a l a p p r o a c h t o t h e s t u d y o f p s y c h i a t r i c illness a n d its n o s o l o g y , a n a p p r o a c h t h a t p r o v e d i n s t r u m e n t a l t o his f o r m u l a t i o n of d e m e n t i a p r a e c o x . In 1860 t h e F r e n c h alienist B é n é d i c t - A u g u s t i n M o r e l , f a m o u s f o r i n t r o d u c ing t o a s y l u m s c i e n c e t h e n o t i o n of d e g e n e r a t i o n , first u s e d t h e t e r m précoce
démence
to describe a chronic insanity p r e d o m i n a n t l y affecting y o u n g m e n
(Healy, 2002, p . 18). 1 3 M o r e l filled a t a x o n o m i c g a p — p s y c h o s i s w i t h a d o l e s c e n t
13
German Berrios and colleagues note that 'Because Morel did not propose "démence précoce" as an official iliimal category hut as a mere description, it had already sunk into "Mivinn liv the time Ki.iepelin hud decided to use the term "dementia praecox'", and was
onset h a d joined the ranks of o t h e r age-specific psychoses a n d absorbed the e a r l i e r d i a g n o s i s o f m a s t u r b a t o r y i n s a n i t y ( G i l m a n , 1988, p. 2 0 5 ) . B u t it w a s Emil Kraepelin w h o used the t e r m to reconfigure f u n d a m e n t a l l y the psychiatric a p p r o a c h t o m e n t a l illness, i n t e r p r e t i n g all p s y c h o t i c b e h a v i o u r n o t s h o w n t o h a v e b e e n c a u s e d b y i n t o x i c a t i o n o r d i r e c t d a m a g e t o t h e b r a i n as t h e p r o d u c t of o n e of t w o n a t u r a l disease entities: m a n i c - d e p r e s s i v e psychosis o r dementia praecox. Kraepelin distinguished dementia praecox from m a n i c d e p r e s s i v e p s y c h o s i s p r i m a r i l y b y t h e c o u r s e of t h e illness: a l t h o u g h t h e r e w a s s o m e o v e r l a p in s y m p t o m s , t h e o u t c o m e o f m a n i c - d e p r e s s i v e p s y c h o s i s w a s f a v o u r a b l e , w h e r e a s d e m e n t i a p r a e c o x , as t h e n a m e s u g g e s t s , w a s c h a r a c t e r ized 'by a p r o n o u n c e d t e n d e n c y to m e n t a l d e t e r i o r a t i o n of varying grades' ( K r a e p e l i n , 1981, p . 2 1 9 ) . It w a s t h e t e n d e n c y t o w a r d s s i g n i f i c a n t d e t e r i o r a t i o n , w h i c h K r a e p e l i n i d e n t i f i e d in h e b e p h r e n i a , c a t a t o n i a , a n d p a r a n o i a , t h a t l e d h i m t o r e c o n c e p t u a l i z e t h e s e p r e v i o u s l y d i s t i n c t p s y c h o s e s as t h e t h r e e f o r m s o f o n e illness. In K r a e p e l i n ' s l o n g i t u d i n a l a n a l y s i s , d e m e n t i a p r a e c o x w a s o n e 'disease e n t i t y w i t h a t a n g i b l e u n d e r l y i n g m o r b i d p r o c e s s ' ( J o h n s t o n e e t al., 1999, p . i x ) . U n a b l e t o d e f i n e t h i s e n t i t y o r d e m o n s t r a t e its p r o c e s s , however, Kraepelin could only speculate about d e m e n t i a praecox's probable causes. C o n c e d i n g t h a t ' t h e disease p r o c e s s in d e m e n t i a p r a e c o x is n o t k n o w n ' , h e n e v e r t h e l e s s b e l i e v e d t h e r e w a s 'a d e f i n i t e disease p r o c e s s in t h e b r a i n ' , p e r h a p s t r i g g e r e d b y a n ' a u t o i n t o x i c a t i o n . . . r e l a t e d t o p r o c e s s e s in t h e s e x u a l organs', a n d that a large percentage of patients were m a d e vulnerable to the disease b y t h e i r ' d e f e c t i v e h e r e d i t y ' ( K r a e p e l i n , 1981, p p . 2 2 1 - 2 ) . 1 4 These u n s u b s t a n t i a t e d aetiological conjectures did n o t prevent Kraepelin f r o m w r i t i n g at l e n g t h a n d w i t h c o n v i c t i o n a b o u t t h e h a l l m a r k s y m p t o m s of this n e w disease e n t i t y . U p o n a d m i s s i o n t o t h e a s y l u m , s u f f e r e r s of d e m e n t i a p r a e c o x c o u l d b e i d e n t i f i e d b y t h e i r lack of a t t e n t i o n , v o l i t i o n , j u d g e m e n t , a p p r o p r i a t e e m o t i o n a l r e s p o n s i v e n e s s , a n d , of c o u r s e , b y t h e 'silliness' of i n t e r m i t t e n t h e b e p h r e n i c d e l u s i o n s a n d h a l l u c i n a t i o n s , t h e rigid i m m o b i l i t y o f c a t a t o n i c s t u p o r , a n d t h e c o m p l e x i t i e s of the fantastical d e l u s i o n s characteristic of p a r a n o i a . Significantly, t h e s y m b o l i c c o n t e n t of t h e b i z a r r e d e l u s i o n s , h a l l u c i nations, or i m m o b i l e postures of the d e m e n t i a praecox patient was d e e m e d by K r a e p e l i n t o b e i n c o n s e q u e n t i a l , a p o s i t i o n in s h a r p c o n t r a s t t o t h e h e r m e n e u t i c a l analyses of t h e p s y c h o s e s a d v a n c e d b y p s y c h o a n a l y s t s . It w a s n o t t h e p r o b i n g analysis of individuals and their s y m p t o m s , b u t the ' m a j e s t y of
14
most probably not known to him (Berrios et al., 2003, p. 117). However, as Rob Barrett (1998a) observes, the concept of degeneration remained profoundly important to Kraepelin's account of dementia praecox. Richard Noll (2007) offers a comprehensive contemporary reappraisal of Kraepelin's theories of autointoxication.
K r a e p e l i n ' s overall s t r u c t u r e ' t h a t , in t h e e s t i m a t i o n of n e o a p o l o g i s t h i s t o r i a n E d w a r d S h o r t e r , ' t r a n s f i x e d t h e p s y c h i a t r i c w o r l d ' ( S h o r t e r , 1997, p . 108). A l t h o u g h K r a e p e l i n ' s w o r k w a s v i e w e d as c o n t r o v e r s i a l b y his c o n t e m p o r a r ies, it swiftly g r e w in s t a t u s t h r o u g h o u t t h e t w e n t i e t h c e n t u r y , ' e c l i p s i n g ' Jean Esquirol's (1965) earlier t a x o n o m i e s of insanity, Carl W e r n i c k e ' s study of brain localization,15 a n d finally the p s y c h o d y n a m i c a n d psychoanalytic a p p r o a c h e s t o m e n t a l illness t h a t d o m i n a t e d A m e r i c a n p s y c h i a t r y u n t i l t h e late 1970s. As P a u l H o f f n o t e s : Kraepelin's psychiatry became so influential, because it offered a pragmatical, clinically and prognostically oriented nosology, developed by a self-confident author who focussed on rather straight-forward quantitative and naturalistic research methods and claimed to abandon speculative aspects from psychiatry as much as possible. (Hoff, 1995, p. 273) K r a e p e l i n h a s b e e n v i e w e d less as a v i s i o n a r y o r r e v o l u t i o n a r y t h i n k e r t h a n as t h e n a t u r a l p r o d u c t of a positivist m o v e m e n t in t h e late n i n e t e e n t h c e n t u r y , a m o v e m e n t t h a t privileged e m p i r i c i s m o v e r m e t a p h y s i c s a n d evinced a ' p r o f o u n d c o n f i d e n c e in t h e i d e a s o f d e v e l o p m e n t a n d p r o g r e s s ' ( H o f f , 1995, p . 2 6 3 ) . A l t h o u g h t h e e m p i r i c a l analysis of s y m p t o m a t o l o g y a n d l o n g i t u d i n a l analysis of t h e c o u r s e of illness e n a b l e d K r a e p e l i n t o d r a w t o g e t h e r several a p p r o a c h e s to psychosis u n d e r the umbrella c o n c e p t of d e m e n t i a praecox, only a confid e n c e in t h e a u t h o r i t a t i v e scientificity o f p s y c h i a t r y j u s t i f i e d his a s s e r t i o n t h a t t h e d i f f e r e n t f o r m s o f d e m e n t i a p r a e c o x w e r e t h e r e s u l t o f a single b u t as yet i n d e t e r m i n a t e disease p r o c e s s . Kraepelin's methodological approach to dementia praecox can be interp r e t e d as t h e d e c i s i v e f a c t o r in e x p l a i n i n g h o w s c h i z o p h r e n i a is at o n c e t h e b e d r o c k of p s y c h i a t r y ' s claim t o scientificity a n d t h e s o u r c e o f its s e i s m i c t r e m ors. T h e g e n i u s o f K r a e p e l i n ' s c o n c e p t of d e m e n t i a p r a e c o x lies in his r e j e c t i o n of t h e p r i m a c y o f a e t i o l o g y a n d b r a i n l o c a l i z a t i o n in t h e i d e n t i f i c a t i o n of t h i s disease e n t i t y , in f a v o u r of d e s c r i b i n g a n d c a t a l o g u i n g its s y m p t o m s a n d t r a c ing t h e i r d e v e l o p m e n t in e a c h p a t i e n t . T h e 'clinical p i c t u r e ' of d e m e n t i a p r a e cox, distilled f r o m the observation of p r e s u m a b l y h u n d r e d s of patients, was d e t a i l e d e n o u g h t o b e of d i a g n o s t i c a n d h e n c e p r o g n o s t i c u s e t o clinicians b o t h in t h e i d e n t i f i c a t i o n of p a t i e n t s f o r t r e a t m e n t a n d o f p a t i e n t p o p u l a t i o n s f o r r e s e a r c h p u r p o s e s . H o w e v e r , w h a t f u r t h e r g u a r a n t e e d its e f f i c a c y a n d l o n g e v ity w a s its e x t r e m e flexibility. T h i s clinical p i c t u r e c o u l d , a n d w o u l d , b e b r o k e n d o w n i n t o its c o n s t i t u t i v e e l e m e n t s a n d r e d r a w n u n d e r n e w p r i n c i p l e s ; it d i d n o t rely u p o n o r a d v a n c e a n y specific t r e a t m e n t of t h e w h o l e disease, e n s u r i n g
There is still no English translation of Wernicke's most comprehensive publication Outlines of Psychiatry. See Wernicke (1900).
it w o u l d b e c o m e a site f o r t h e d e v e l o p m e n t of n e w m e t h o d s ; finally, a n d m o s t i m p o r t a n t l y , by s u b o r d i n a t i n g a n d d e f e r r i n g the q u e s t i o n of aetiology, K r a e p e l i n ' s c o n c e p t of d e m e n t i a p r a e c o x n o t o n l y s t i m u l a t e d f u r t h e r r e s e a r c h b u t itself p r o v i d e d n o g r o u n d s u p o n w h i c h t o d i s c r i m i n a t e b e t w e e n t h e o r e t i c a l analyses, t h u s e n s u r i n g t h e i r o n g o i n g p r o l i f e r a t i o n in a n d b e y o n d t h e field o f biological psychiatry. Twenty years after identifying dementia praecox, K r a e p e l i n w r o t e t h a t t h e c a u s e s o f t h e illness w e r e 'still m a p p e d in i m p e n e t r a b l e d a r k n e s s ' ( K r a e p e l i n , q u o t e d in J o h n s t o n e et al., 1999, p . 4 ) . F i f t y y e a r s later, w i t h its a e t i o l o g y still t h e s u b j e c t of p s y c h i a t r i c d e b a t e , a n d its t r e a t m e n t confined for the m o s t part to ECT, insulin therapy, and the new and serend i p i t o u s l y d i s c o v e r e d a n t i p s y c h o t i c d r u g s , K r a e p e l i n ' s clinical p i c t u r e c o u l d e v e n b e c o m p a t i b l e w i t h a n f i p s y c h i a t r i c m o d e l s of socially c o n s t r u c t e d schizop h r e n i a . W i t h this in m i n d , w e c a n c o n s i d e r h o w t h o s e a s p e c t s of K r a e p e l i n ' s clinical p i c t u r e of d e m e n t i a p r a e c o x , w h i c h h a v e b e e n i n t e n s e l y p r o d u c t i v e , if n o t pivotal, for p s y c h i a t r y ' s p r o j e c t of scientificity, c a n b e s i m u l t a n e o u s l y i n t e r p r e t e d as u n d e r m i n i n g , if n o t u n d o i n g , t h a t p r o j e c t . In h e r b o o k , Schizophrenia:
A Scientific
Delusion,
M a r y Boyle c l a i m s t o ' m a k e
understandable s o m e of the reasons for the chaos and controversy which have s o o f t e n s u r r o u n d e d t h e c o n c e p t [of s c h i z o p h r e n i a ] , f o r its p e r s i s t e n c e in s p i t e o f t h e s e , a n d t o m a k e c l e a r w h y n o a m o u n t o f t i n k e r i n g w i t h it will b e s t o w scientific r e s p e c t a b i l i t y ' (Boyle, 1990, p . vii). K r a e p e l i n is a g a i n i n v o k e d as t h e f o u n d i n g father of schizophrenia, b u t here he b e q u e a t h s n o t order, scientificity, o r ' m a j e s t y ' t o p s y c h i a t r y b u t a n u n s t a b l e , u n s u b s t a n t i a t e d , a n d d e e p l y f l a w e d c o n c e p t d e v e l o p e d , Boyle a r g u e s , as a last r e s o r t t o i m p o s e o r d e r u p o n t h e b i z a r r e b e h a v i o u r of a s y l u m p a t i e n t s (Boyle, 1990, p. 4 5 ) . Boyle's a t t a c k o n K r a e p e l i n ' s m e t h o d o l o g y is m u l t i l a y e r e d a n d u n r e m i t t i n g . D r a w i n g a t t e n t i o n t o t h e i n a d e q u a c y o f his p a t i e n t c a r d s y s t e m , his f a i l u r e t o q u a n t i f y his f i n d ings, a n d his r e c o u r s e t o a r h e t o r i c o f a u t h o r i t y w h e n f a c e d w i t h a d i s t i n c t lack of e m p i r i c a l e v i d e n c e , she lays h e r m o s t severe c h a r g e : Instead of concluding by inferring his construct, having presented evidence in support, Kraepelin began with the construct and proceeded to describe what he called cases of dementia praecox. [ . . . ] Kraepelin's descriptions are in the form, 'one often notices'; 'it is occasionally observed'; 'in some cases', and so on. Thus, Kraepelin wrote as if by some independent and valid criteria, established by past research, dementia praecox had already been inferred in this sample and he was merely engaged in recording his impressions of the group. He wrote, that is, as if data supporting the introduction of his concept had already been presented when in fact they had not. (Boyle, 1990, p. 46) What Boyle finds s o striking about Kraepelin's work o n d e m e n t i a praecox is that despite purporting to e m e r g e from a scientific framework, it is s u p p o r t e d
n o t b y d a t a b u t p u r e l y by belief (Boyle, 1990, p. 75). In this a c c o u n t , t h e elasticity of K r a e p e l i n ' s clinical p i c t u r e of d e m e n t i a p r a e c o x s t r e t c h e s t o b r e a k i n g p o i n t ; scientificity is p e r f o r m a t i v e , an effect of m a s t e r f u l r h e t o r i c r a t h e r t h a n ' p r o p e r l y ' scientific practice. Boyle's call t o d e - c e n t r e a n d d i s m a n t l e t h e p s y c h i a t r i c d e l u s i o n of schizop h r e n i a goes to t h e c o r e of the discipline's claims t o scientificity. A n d she is n o t a l o n e . ' T h e K r a e p e l i n i a n d i c h o t o m y : t h e t w i n pillars c r u m b l i n g ? ' asks o n e historian of psychiatry ( G r e e n e , 2007). ' T h e Kraepelinian d i c h o t o m y — g o i n g , g o i n g . . . b u t still n o t g o n e ' m o l e c u l a r geneticists l a m e n t ( C r a d d o c k a n d O w e n , 2010b; see also C r o w , 1985, 1995; C r a d d o c k a n d O w e n , 2005, 2007; C r a d d o c k et al., 2009; C r a d d o c k , 2010; C r a d d o c k a n d O w e n , 2010a). If progress is to be m a d e in s c h i z o p h r e n i a research, it is claimed, clinical, neuroscientific, genetic, a n d p h e n o m e n o l o g i c a l d a t a m u s t be gathered a n d analysed w i t h o u t regard t o d i a g n o s t i c labels ( C u t h b e r t a n d Insel, 2010; H e c k e r s , 2 0 0 8 ) . M o r e daringly, Richard Bentall, a n o t h e r clinical psychologist, has consistently called f o r t h e a b a n d o n m e n t o f t h e c o n c e p t of s c h i z o p h r e n i a a l t o g e t h e r (see Bentall et al., 1988a; Bentall et al., 1988b; Bentall, 1990), a n d in Madness
Explained
(Bentall,
2004) m o u n t s a c o m p r e h e n s i v e a r g u m e n t in f a v o u r of d i s m a n t l i n g t h e e n t i r e n o s o l o g i c a l s t r u c t u r e o f K r a e p e l i n i a n p s y c h i a t r y . K r a e p e l i n ' s failings, f o r Bentall, are m a n y , b u t s t e m p r i m a r i l y f r o m his c l a i m t h a t p s y c h o s i s can b e e x p l a i n e d b y t w o d i s t i n c t u n d e r l y i n g disease processes, a n d t h a t t h e r e is an u n a m b i g u o u s s e p a r a t i o n between psychotic a n d ' n o r m a l ' experiences. Bentall c o n c l u d e s f r o m his review of the scientific literature t h a t 'Studies of p a t i e n t s ' s y m p t o m s , of t h e role of genes, of t h e c o u r s e a n d o u t c o m e of illnesses o v e r t i m e , a n d of t h e r e s p o n s e of s y m p t o m s t o t r e a t m e n t , all p o i n t t o similarities between s c h i z o p h r e n i a a n d bipolar d i s o r d e r r a t h e r t h a n to differences' (Bentall, 2004, p. 9 4 ) . H e t h e n a d v a n c e s t h e c o n t i n u i t y p r i n c i p l e , w h i c h argues f o r a c o n t i n u u m in t h e f r e q u e n c y , severity, a n d p h e n o m e n o l o g y of a b n o r m a l a n d n o r m a l experiences a n d b e h a v i o u r s (Bentall, 2004, p. 115). A l t h o u g h his call t o 'abandon
psychiatric
diagnoses altogether
stand the actual experiences
and instead try to explain and
and behaviours
of psychotic
people'
under-
(Bentall, 2004,
p. 141, italics in t h e original) r e m a i n s a m i n o r i t y a n d c o n t e s t e d view (Lawrie et al., 2010), it is s u p p o r t e d by a g r o w i n g n u m b e r of researchers (Greene, 2007; R o m m e a n d M o r r i s , 2007). Kraepelin's w o r k e m e r g e d f r o m a positivistic scientific f r a m e w o r k even if it did n o t , u p o n closer analysis, c o n f o r m t o c o n t e m p o r a r y u n d e r s t a n d i n g s of a p r o p e r l y scientific m e t h o d o l o g y . Boyle a c k n o w l e d g e s t h a t t h e l i m i t a t i o n s of Kraepelin's clinical p i c t u r e of d e m e n t i a p r a e c o x w e r e in p a r t dictated b y t h e s t a t u s o f scientific r e s e a r c h in t h e late n i n e t e e n t h c e n t u r y ; w h a t e m e r g e s as particularly problematic for her, as for Bentall, is the e n o r m o u s a n d e n d u r i n g
i n f l u e n c e of K r a e p e l i n ' s ideas i n t o t h e t w e n t i e t h a n d early t w e n t y - f i r s t c e n t u r y . Stephan Heckers, w h o agrees that the d i f f e r e n t i a t i o n of s c h i z o p h r e n i a a n d b i p o l a r d i s o r d e r is a r b i t r a r y a n d u n h e l p f u l , p r o v i d e s a s u c c i n c t r e m i n d e r o f t h e v a l u e of K r a e p e l i n ' s u n d e r l y i n g disease entities: While not perfect, they have predictive power. They simplify complex human behavior and provide a framework for communication among affected individuals, relatives, caregivers, and the society at large. They also justify research efforts that pledge to uncover the basis of mental illness (eg the gene or brain region for schizophrenia). Kraepelin's vision of progress in psychiatric research gives hope to those who struggle to make sense of mental illness. Any research agenda that challenges the Kraepelinian model will have to provide the same kind of inspiration. (Heckers, 2008, p. 592) In a n e d i t o r i a l i n t r o d u c t i o n t o a s p e c i a l i s s u e o f History
of Psychiatry
on
K r a e p e l i n ' s legacy, E r i c E n g s t r o m a n d M a t t h i a s W e b e r f u r t h e r n o t e t h a t in d o m i n a n t p s y c h i a t r i c d i s c o u r s e ' K r a e p e l i n h a s b e c o m e a t o u c h s t o n e of p r o f e s s i o n a l loyalties a n d t h a t h e is p u t t o use in t h e s t r a t e g i c o r g a n i z a t i o n a n d a p p o r t i o n m e n t of disciplinary resources, p o w e r a n d k n o w l e d g e ' ( E n g s t r o m a n d W e b e r , 2007, p. 2 6 8 ) . It s e e m s clear t h a t f o r p s y c h i a t r y t o r e c o g n i z e t h e c e n t r a l o b j e c t o f its s c i e n t i f i c e n q u i r y as t h e b e l i e f s — n o t t h e d i s c o v e r y — o f o n e n i n e t e e n t h - c e n t u r y c l i n i c i a n w o u l d b e t o risk m u c h , i n c l u d i n g , p e r h a p s , its own undoing. W e will r e t u r n t o t h e s e issues later in t h e c h a p t e r . W h a t I w a n t t o d o first, h o w e v e r , is t o l o o k at t h e e x t e n t t o w h i c h in ' r e s u r r e c t i n g ' K r a e p e l i n ' s clinical picture of d e m e n t i a praecox 'to reimpose an o r d e r o n w o r l d psychiatry' (Healy, 2002, p. 174), p s y c h i a t r y i m p o r t e d n o t o n l y a n u n s c i e n t i f i c c o n c e p t , b u t also a c o n c e p t e m b e d d e d in a n d d e p e n d e n t o n a g r a n d n a r r a t i v e of m o d e r n W e s t e r n s e l f h o o d . 1 6 A t t e n d i n g c l o s e l y t o a n u m b e r o f t r o p e s d e p l o y e d r e p e a t e d l y in Clinical
Psychiatry,
w e c a n see h o w d e m e n t i a p r a e c o x is p r i m a r i l y f i g u r e d b y
Kraepelin as a d i s r u p t i o n in t h e capacity of t h e p a t i e n t t o engage in a specific type of l a b o u r , f i g u r e d , t h a t is, as a d i s o r d e r of t h e m o d e r n l a b o u r i n g individual.
16
The relationship between schizophrenia and notions of the self has been widely studied (see for example Fabrega, 1989; Estroff, 1989,2004; Jenkins and Barrett, 2004a, b; Lysaker and Lysaker, 2010), and is one of the central problematics explored in this book. I agree with Barrett that 'psychiatric formulations of schizophrenia have emerged from the background of Western cultural formulations of the person', and see the ensuing analysis of the centrality of labour in Kraepelin's account of dementia praecox as confirmation of Barrett's observation that in a culture oriented towards development and progress, 'The person with schizophrenia, at least in the West, becomes the antithesis of the idealised person' (Barrett, 1998a, p. 618).
For the secular, rational, s e l f - d e t e r m i n i n g s u b j e c t — t h e m o d e r n s e l f — p r o g r e s s ' b e c o m e s p a r t of t h e i m p e r a t i v e of s e l f h o o d ' , c o n c e p t u a l l y u n d e r p i n n i n g t h e p r o j e c t of o r g a n i z e d , d i s c i p l i n e d s e l f - d e v e l o p m e n t in t h e p u r s u i t o f ' a s t a t e o f g r a c e ' (Jervis, 1998, p . 189). P s y c h i a t r y h a s b e e n p i v o t a l in s h a p i n g , m a n a g i n g , a n d p r o m u l g a t i n g t h e r e g u l a t o r y ideal t h a t N i k o l a s Rose (1996, p. 2) calls t h e ' r e g i m e o f t h e s e l f , an ideal w h i c h , in t h e m o d e r n W e s t , ' e m b o d ied t h e social n o r m s a n d v a l u e s of a m i d d l e class' ( G o l d b e r g , 1999, p. 185). K r a e p e l i n ' s w r i t i n g s o n d e m e n t i a p r a e c o x clearly c o n s t r u c t t h e disease e n t i t y as a n t i t h e t i c a l t o t h i s ideal o f a b o u r g e o i s s e l f h o o d c a p a b l e of a n d c o m m i t t e d t o t h e p e r p e t u a l l a b o u r of s e l f - i m p r o v e m e n t . By a r t i c u l a t i n g d e m e n t i a p r a e c o x as t h e d r a m a t i c collapse o r r u p t u r e of t h e r a t i o n a l i t y a n d v o l i t i o n t h a t d e f i n e t h e m o d e r n self a n d u n d e r p i n its c a p a c i t y f o r t h i s e d i f y i n g l a b o u r , K r a e p e l i n locates the patient n o t only symbolically outside the teleological narrative of m o d e r n s e l f h o o d , b u t also as actively r e s i s t a n t t o t h e i m p e r a t i v e s of t h a t n a r r a tive. In t h i s , K r a e p e l i n ' s c l i n i c a l p i c t u r e o f d e m e n t i a p r a e c o x , as a m o d e r n f o r m o f m a d n e s s , e x e m p l i f i e s t r e n d s in t h e a s y l u m p s y c h i a t r y o f h i s e r a . F o u c a u l t a r g u e s t h a t t h e g r e a t c o n f i n e m e n t w a s a n effect of t h e classical p e r i o d ' s e t h i c a l i n j u n c t i o n a g a i n s t idleness; l a b o u r w a s ' a n infallible p a n a c e a ' f o r t h e s i n f u l sloth o f t h e p o o r a n d t h e i n s a n e ( F o u c a u l t , 1993, p . 5 6 ) . Early a s y l u m a d m i n i s t r a t o r s r e c o n f i g u r e d t h e m e a n i n g of l a b o u r b u t retained it as a central f o r m o f t r e a t m e n t , c r e a t i n g a s c e n a r i o in w h i c h ' w o r k is d e p r i v e d o f a n y p r o d u c t i v e value; it is i m p o s e d o n l y as a m o r a l rule; a l i m i t a t i o n of liberty, a s u b m i s s i o n t o o r d e r , a n e n g a g e m e n t of r e s p o n s i b i l i t y ' ( F o u c a u l t , 1993, p . 2 4 8 ) . I w o u l d s u g gest t h a t t h e p s y c h i a t r y of K r a e p e l i n ' s e r a — c l a i m i n g its a u t h o r i t y p r i m a r i l y o n medical a n d n o t religious g r o u n d s — i s nonetheless reliant u p o n these earlier ' u n s c i e n t i f i c ' beliefs in t h e m o r a l v a l u e o f l a b o u r a n d t h e i m p o r t a n c e of l a b o u r to t h e d e f i n i t i o n a n d m a i n t e n a n c e o f t h e m o d e r n self. N o w h e r e is this m o r e in e v i d e n c e t h a n t h e p o r t r a i t o f t h a t self s p s y c h o t i c O t h e r . In his i n v e n t o r y of t h e s y m p t o m a t o l o g y of d e m e n t i a p r a e c o x , t h e first ' f u n d a m e n t a l s y m p t o m s ' K r a e p e l i n i d e n t i f i e s a r e 'a p r o n o u n c e d i m p a i r m e n t o f v o l u n t a r y attention',
p r o f o u n d d i s t u r b a n c e of t h e t r a i n of t h o u g h t , a failing of
j u d g e m e n t r e s u l t i n g in ' i r r a t i o n a l ' a c t i o n s , a n d ' d i s t u r b a n c e in t h e e m o t i o n a l field'
( K r a e p e l i n , 1981, p p . 2 2 3 - 6 , italics i n t h e o r i g i n a l ) . T h e s e s y m p t o m s
a p p e a r t o c u l m i n a t e o r crystallize in, . . . disturbances of conduct, of which the most fundamental is the progressive disappearance of voluntary activity. One of the first symptoms of the disease may be the loss of that activity which is peculiar to the patient. He may neglect his duties and sit unoccupied for the greater part of the day, though capable of doing good work if persistently encouraged. (Kraepelin, 1981, p. 227, italics in the original)
I n a c t i v i t y — n o t o n l y a lack o f p r o d u c t i v i t y , b u t also a n i m p l i c i t r e j e c t i o n of the imperative to be p r o d u c t i v e — i s a h a l l m a r k characteristic of sufferers of d e m e n t i a p r a e c o x p r i o r t o t h e i r i n s t i t u t i o n a l c o n f i n e m e n t ( K r a e p e l i n , 1981, p . 2 3 1 ) . T h e s i t u a t i o n d e t e r i o r a t e s f o l l o w i n g a d m i s s i o n t o t h e a s y l u m : by n o w t h e p a t i e n t ' s 'capacity for employment
is s e r i o u s l y i m p a i r e d ' , a n d t h r e e - q u a r t e r s
of those a d m i t t e d b e c o m e 'dull, indolent, apathetic, anergic, sluggish', 'slove n l y ' , ' u n p r o d u c t i v e a n d m u t e ' , in s h o r t , u n f i t f o r w o r k ( K r a e p e l i n , 1 9 8 1 , p p . 228, 238, italics in t h e o r i g i n a l ) . 1 7 E v e n t u a l l y , t h e p a t i e n t n o l o n g e r h a s t h e desire o r t h e ability t o p e r f o r m m e n t a l a n d m a n u a l l a b o u r , a n d as a n ' u n p r o d u c t i v e v e g e t a t i v e o r g a n i s m ' is n o l o n g e r a self as s u c h ( K r a e p e l i n , 1 9 8 1 , p. 2 3 9 ) . A m i n o r i t y o f ' a p p a r e n t l y r e c o v e r e d ' p a t i e n t s m i g h t regain t h e i r c a p a c ity t o l a b o u r , b u t 'fail t o e m p l o y t h e m s e l v e s p r o f i t a b l y ' f o r t h e i r w o r k d o e s n o t reflect a n a p p r o p r i a t e c o m m i t m e n t t o t h e ideals o f p r o d u c t i v i t y , r a t i o n a l i t y , a n d a m b i t i o n ( K r a e p e l i n , 1981, p. 2 4 0 ) . E i t h e r ' t h e y s p e n d m u c h t i m e in r e a d ing, evolving impractical s c h e m e s , a n d p o n d e r i n g over abstract a n d useless q u e s t i o n s ' , o r t h e y ' s h o w a lack of interest, are u n b a l a n c e d , a n d u n a b l e to a d v a n c e in t h e i r p r o f e s s i o n o r o c c u p a t i o n ' ( K r a e p e l i n , 1981, p . 2 4 0 ) . Finally, t h e q u e s t i o n o f e m p l o y m e n t reveals t h a t t h e r e c a n b e n o c o m p l e t e r e c o v e r y in Kraepelin's m o d e l : even those well-educated patients w h o exhibit n o s y m p t o m s find t h e m s e l v e s u n a b l e t o realize t h e i r p r o f e s s i o n a l a m b i t i o n s a n d i n s t e a d m u s t s e e k s i t u a t i o n s w i t h f e w o r n o i n t e l l e c t u a l d e m a n d s ( K r a e p e l i n , 1981, p. 2 4 1 ) . Kraepelin's c o m p a r a t i v e analysis of d e m e n t i a p r a e c o x a m o n g the p o p u l a t i o n o f Java is n o t e w o r t h y h e r e . W h i l e a s s e r t i n g t h e u n i v e r s a l v a l i d i t y o f h i s d i a g n o s i s ( t h e ' o v e r a l l f a m i l i a r i t y ' of t h e p h e n o m e n o n in Java ' f a r o u t w e i g h e d t h e d e v i a n t f e a t u r e s ' ) h e d o e s r e p e a t e d l y r e m a r k o n t h e ' m u c h less f l o r i d , less d i s t i n c t i v e l y m a r k e d ' a n d less s e v e r e s y m p t o m s e x h i b i t e d b y t h e J a v a n e s e , w h i c h h e suggests c a n b e e x p l a i n e d b y t h e i r ' l o w e r stage of i n t e l l e c t u a l d e v e l o p m e n t ' (Kraepelin, 2000, p. 40). E u r o p e a n s , possessed of w h a t Kraepelin considered to be a greater intellectual capacity and c o m m i t m e n t to higher f o r m s of l a b o u r , w o u l d s e e m t o b e m o r e a t risk o f d e v a s t a t i o n b y d e m e n t i a p r a e c o x as a disease p r o c e s s t h a t isolates a n d o p p o s e s t h e m t o m o d e r n W e s t e r n s e l f h o o d . T h e r e s i s t a n c e t o l a b o u r , p r e s e n t at e v e r y s t a g e in t h e c o u r s e o f d e m e n t i a p r a e c o x a n d e v e n in its w a k e , is n o t s i m p l y a p e r c e i v e d neglect o f o r d i s i n t e r e s t in a p a r t i c u l a r t y p e o f e m p l o y m e n t ; it i n c o r p o r a t e s a r e s i s t a n c e t o the labour of s e l f - i m p r o v e m e n t a n d recovery, a n d t h u s b e c o m e s the central p r o b l e m of t h e disease e n t i t y a n d a m a r k e r of its s t r a n g e n e s s .
17
Reading these descriptions immediately brings to mind Goff man's (1973) classic study of the role of the asylum, or 'total institution', in producing this 'symptomatic' behaviour.
F o r K r a e p e l i n , t h e n , t h e m o s t s i g n i f i c a n t m e a s u r e o f a p a t i e n t ' s w e l l b e i n g is not h o w they c o m m u n i c a t e with others, or express themselves, b u t their capacity f o r w o r k p e r f o r m a n c e . ' P e r f o r m a n c e t u r n s i n t o " w o r k " ' , w r i t e s Karl Jaspers, ' w h e n it is c a r r i e d o u t as a s t e a d y e f f o r t f o r a p r a c t i c a l p u r p o s e , a b s o r b s t h e p e r s o n as a w h o l e , d e p e n d s o n his g e t t i n g t i r e d a n d r e f r e s h e d , a n d is generally s u b j e c t t o q u a n t i t a t i v e m e a s u r e m e n t ' ( J a s p e r s , 1972, p. 2 0 5 ) . K r a e p e l i n p i o n e e r e d e x p e r i m e n t a l m e t h o d s f o r m e a s u r i n g w o r k p e r f o r m a n c e in r e l a t i o n t o s u b j e c t i v e v a r i a b l e s , a n d 'called t h e c h a r a c t e r i s t i c s o b t a i n e d f r o m his " w o r k ing-curve" (fatiguability, capacity for recovery, drive, etc.) characteristics'"
"basicpersonality
( J a s p e r s , 1972, p . 6 2 2 , italics in t h e o r i g i n a l ) . T h e c o n c e p t s
of f u n c t i o n a l i t y a n d p r o d u c t i v i t y t h u s a r e essential t o t h e K r a e p e l i n i a n view o f t h e self; i n d e e d , it is t h r o u g h w o r k p e r f o r m a n c e a n d t h e a t t e n d a n t l a b o u r o f s e l f - i m p r o v e m e n t t h a t s e l f h o o d is g u a r a n t e e d in h e a l t h a n d u l t i m a t e l y j e o p a r d i z e d in p s y c h o s i s . It is of little s u r p r i s e , t h e n , t h a t in t h e case of d e m e n t i a p r a e c o x , K r a e p e l i n insists t h a t a n 'essential f e a t u r e o f t h e c a r e of these m e n t a l s h i p w r e c k s is h e a l t h f u l e m p l o y m e n t , p r e f e r a b l y o u t o f d o o r s ' ( K r a e p e l i n , 1981, p. 2 7 5 ) . W h a t is s u r p r i s i n g is t h a t t h e c e n t r a l i t y o f l a b o u r — e m p l o y m e n t a n d s e l f - i m p r o v e m e n t — t o Kraepelin's system should have been
largely
o v e r l o o k e d in t h e m a n y a n a l y s e s o f his h u g e l y i n f l u e n t i a l w o r k o n d e m e n t i a praecox.18 R e t u r n i n g t o t h e m a t t e r at h a n d , w e m u s t n o w c o n s i d e r h o w , b y p o s i t i o n i n g d e m e n t i a p r a e c o x as o u t s i d e a n d f u n d a m e n t a l l y r e s i s t a n t t o m o d e r n , a u t o n o m o u s , s e c u l a r s e l f h o o d , K r a e p e l i n elevates t h i s d i s e a s e e n t i t y t o t h e s t a t u s o f t h e s u b l i m e . T w i c e in Clinical
Psychiatry
( K r a e p e l i n , 1981, p p . 241, 275),
Kraepelin uses t h e s t r i k i n g i m a g e of a ' m e n t a l s h i p w r e c k ' t o d e s c r i b e p a t i e n t s a f f l i c t e d b y d e m e n t i a p r a e c o x . A s e a f a r i n g vessel b r o k e n b y u n r e p r e s e n t a b l e m e t e o r o l o g i c a l f o r c e s ; a p s y c h e b l o w n o f f t h e n a r r o w c o u r s e of s e l f - i m p r o v i n g p r o g r e s s , r a v a g e d b y a n u n r e l e n t i n g a n d u n k n o w n disease p r o c e s s : in a s u d d e n r u p t u r e of his o w n s c i e n t i f i c d i s c o u r s e , K r a e p e l i n r e c o r d s his p e r c e p t i o n of t h e c a t a s t r o p h e o f d e m e n t i a p r a e c o x t h r o u g h a s t a p l e i m a g e of t h e s u b l i m e . T h e s h i p is a c o n v e n i e n t m e t a p h o r f o r K r a e p e l i n ' s v i e w of n o r m a l / i d e a l s e l f h o o d : p r o g r e s s i n g t h r o u g h t h e vicissitudes o f life t o t h e d e s t i n a t i o n o f p s y c h i c m a t u rity, it is a u t o n o m o u s , i m p e r i a l , a n d c a n b e b o t h r a t i o n a l l y e x p l a i n e d a n d r e p a i r e d b y m e c h a n i c a l l y m i n d e d m e n o f science. A s a s p e c t a c l e o f p r i v a t i o n , recalling B u r k e ' s t e r m , t h e ' m e n t a l s h i p w r e c k ' of d e m e n t i a p r a e c o x suggests it is o t h e r t o t h e m o d e r n self b e c a u s e o f t h e s t a r k v i s i b i l i t y o f its d y s f u n c t i o n rather than for any inherently supernatural qualities. Burke further argued
IM
Although see 'Labours of Si hi/ophrenia' in Peter Barham's Schizophrenia anil Hainan Value (IW).
t h a t o b s c u r i t y , in t e r m s o f m e n t a l as well as s e n s o r y a p p r e h e n s i o n , w a s a vital p a r t of t h e s u b l i m e , f o r ' W h e n w e k n o w t h e full e x t e n t of a n y d a n g e r . . . a great d e a l o f t h e a p p r e h e n s i o n v a n i s h e s ' ( B u r k e , 1 9 8 7 , p p . 5 8 - 9 ) . I n t h e case o f K r a e p e l i n ' s d e m e n t i a p r a e c o x , a clear p r e s e n t a t i o n of t h e d i s e a s e e n t i t y ( c o m p r i s i n g a d e t a i l e d i n v e n t o r y o f s y m p t o m s , i l l u m i n a t i n g d e s c r i p t i o n s of t h e vivid p s y c h o t i c d e l u s i o n s , a n d statistical analysis of p a t i e n t p o p u l a t i o n s ) belies t h e essential o b s c u r i t y s u r r o u n d i n g t h e a e t i o l o g y a n d t r e a t m e n t o f t h e disease process. C l e a r l y t h e p s y c h i a t r i s t is n o t m e r e l y t h e w i t n e s s o f d e m e n t i a p r a e c o x , b u t f r o m the m o m e n t of diagnosis engages with psychosis t h r o u g h the hierarchical s t r u c t u r e s of the a s y l u m a n d t h e culturally m e d i a t e d roles of clinician a n d p a t i e n t , p r o f e s s i o n a l a n d i n m a t e , r a t i o n a l e x p l i c a t o r a n d i r r a t i o n a l v i c t i m of t h e disease p r o c e s s . D i s t a n c e , as I h a v e a l r e a d y i n d i c a t e d , is o f s u p r e m e i m p o r t a n c e in t h e a p p r e h e n s i o n o f a n o b j e c t as s u b l i m e , a n d , in a d d i t i o n t o t h e physical a n d d i s c i p l i n a r y b o u n d a r i e s o f t h e a s y l u m , K r a e p e l i n ' s m e t h o d o l o g y , his l o n g i t u d i n a l a p p r o a c h t o m e n t a l illness, d e p e n d s u p o n f u r t h e r m a i n t a i n i n g t h e p a t i e n t o b j e c t at a p a r t i c u l a r a n d p r e d e t e r m i n e d d i s t a n c e . T h e i n t i m a c y of a p s y c h o a n a l y t i c e n c o u n t e r — t h e g u i d e d e x p l o r a t i o n o f t h e l a t e n t c o n t e n t of s y m p t o m s , the repetition of sessions b u i l d i n g an analytic r e l a t i o n s h i p — a l t h o u g h n o t i n c o n c e i v a b l e in a n a s y l u m c o n t e x t , w a s n e i t h e r s o u g h t a f t e r n o r v a l u e d b y K r a e p e l i n . I n s t e a d , h i s p a t i e n t c a r d s y s t e m k e p t people
suffering
f r o m specific p s y c h i c d i s t u r b a n c e s at a d i s t a n c e , b u t e n s u r e d a c e r t a i n p r o x i m ity t o e a c h patient
( o r ' s y m p t o m - c a r r i e r ' ( P o r t e r , 2 0 0 2 , p. 184)) as t h e i r illness
p r o g r e s s e d u n d e r statistical s c r u t i n y . 1 9 As a c l i n i c i a n , n o t a l a b o r a t o r y p r a c t i t i o n e r , K r a e p e l i n w a s close e n o u g h t o t h e p a t i e n t p o p u l a t i o n s of t h e clinics a n d a s y l u m s in w h i c h h e w o r k e d t o b e c o n f r o n t e d daily w i t h t h e spectacle of i n s a n ity; a r m e d w i t h t h e u n d e r t a k i n g of a c o m p r e h e n s i v e l o n g i t u d i n a l analysis of all p s y c h i a t r i c d i s o r d e r s , a n d r i s i n g q u i c k l y in t h e p r o f e s s i o n a l r a n k s , it a p p e a r s t h a t h e w a s s e l d o m if ever e n g a g e d w i t h p s y c h o t i c p e o p l e in a n y l o n g - t e r m o r individually m e a n i n g f u l way. Kraepelin's position can be juxtaposed with that of his c o n t e m p o r a r i e s , W e r n i c k e a n d K a h l b a u m , w h o s e ' b r a i n - l o c a l i z i n g ' fondness for the microscope paradoxically separated t h e m f r o m dementia p r a e c o x as t h e y a t t e m p t e d t o c a p t u r e a n d c o n q u e r it in t h e c e r e b r a l c o r t e x . K a n t ' s l e n g t h y d e s c r i p t i o n of the best place f r o m w h i c h to a p p r e h e n d the p y r a m i d s as s u b l i m e ( r a t h e r t h a n as t r i a n g l e s o n t h e h o r i z o n o r as m e r e slabs of r o u g h - h e w n s t o n e ) finds a s t r o n g if s t r a n g e e q u i v a l e n c e in t h e p r e c i s i o n o f K r a e p e l i n ' s physical a n d d i s c u r s i v e p o s i t i o n i n g of t h e o b j e c t o f his analysis.
19
Kraepelin (2010) gives a fascinating insight into the structure and operation of the surveillance wards he established for this purpose.
T h e qualities attributed to d e m e n t i a praecox a n d the institutionally mediated m o d e s of identifying and categorizing those qualities contributed to the p r o d u c t i o n o f d e m e n t i a p r a e c o x , a n d in t u r n s c h i z o p h r e n i a , as a s u b l i m e o b j e c t of early p s y c h i a t r y . H o w e v e r , it is t h e t h i r d a s p e c t of t h e s u b l i m e e n c o u n t e r , its ' d e l i g h t f u l ' ( r e ) a f f i r m a t i o n o f t h e s u b j e c t ' s r a t i o n a l i t y , t h a t I w o u l d a r g u e is t h e m o s t s i g n i f i c a n t f a c t o r in t w e n t i e t h - c e n t u r y p s y c h i a t r y ' s e l e v a t i o n of s c h i z o p h r e n i a t o t h e s t a t u s o f s u b l i m e o b j e c t . It is n o t t h e i s o l a t e d e n c o u n t e r b e t w e e n m a d d o c t o r a n d t h e m a d p e r s o n t h a t is at stake h e r e , b u t r a t h e r t h e c u m u l a t i v e effect t h a t t h e t h e o r e t i c a l f r a m i n g of t h e s e e n c o u n t e r s h a s in p e r petually e x t e n d i n g t h e p a r a m e t e r s of psychiatry. Recall, o n c e again, M a r k Cheetham's constructive observation: At different times and from different perspectives, even large and imprecisely defined constructs such as disciplines will have their own sublimes, those issues that are at once feared and desired and which, through the disciplinary attention they garner, work to mark the provisional limits and flash points of particular disciplines. (Cheetham, 1995, p. 360) Kraepelin's clinical p i c t u r e of d e m e n t i a praecox has b e e n f r a m e d a n d r e f r a m e d c o u n t l e s s t i m e s ; it is t h e c a p a c i t y o f t h a t p i c t u r e t o fit a l m o s t a n y scientific f r a m e d r a w n a r o u n d it t h a t h a s s e c u r e d s c h i z o p h r e n i a u n p a r a l l e l e d a n d o n g o i n g d i s c i p l i n a r y a t t e n t i o n . U n d e r s c o r i n g t h a t c l i n i c a l p i c t u r e is Kraepelin's belief that h u m a n b e h a v i o u r can b e m e a s u r e d , quantified, a n d u l t i m a t e l y r e n d e r e d t r a n s p a r e n t by p s y c h i a t r y ; as Jaspers o b s e r v e s , K r a e p e l i n ' s 'basic c o n c e p t u a l w o r l d r e m a i n e d a s o m a t i c o n e ' , his d i s c u s s i o n s of p s y c h o l o g y r e g a r d e d 'as t e m p o r a r y s t o p g a p s u n t i l e x p e r i m e n t , m i c r o s c o p e a n d t e s t - t u b e p e r m i t t e d o b j e c t i v e i n v e s t i g a t i o n ' ( J a s p e r s , 1972, p. 8 5 2 ) . In his o w n e r u d i t e w r i t i n g o n t h e s u b j e c t , J a s p e r s m a k e s clear t h a t n o s u c h t o t a l i z i n g ' o b j e c t i v e i n v e s t i g a t i o n ' i n t o h u m a n b e h a v i o u r is p o s s i b l e : Psychopathology is limited in that there can be no final analysis of human beings as such, since the more we reduce them to what is typical and normative, the more we realise there is something hidden in every human individual which defies recognition. We have to be content with partial knowledge of an infinity which we cannot exhaust. (Jaspers, 1972, p. 1, italics in the original) l a s p e r s locates t h e d i s o r d e r in r e l a t i o n t o t h e u n k n o w a b l e d i m e n s i o n s of all l u t m a n e x p e r i e n c e , n o t as r a d i c a l l y o t h e r t o a n o r m a t i v e m o d e l of b o u r g e o i s s e l f h o o d . A l t h o u g h t h e spectacle o f a n i n d i v i d u a l ' s p s y c h o s i s m a y b e a s u b l i m e m o m e n t f o r a n y p s y c h i a t r i s t (a m o m e n t , t h a t is, in w h i c h a s e n s e of t e r r o r is s w i f t l y m i t i g a t e d b y t h e d i a g n o s i s o f t h a t b e h a v i o u r as a s y m p t o m o f t h e disease p r o c e s s d e m e n t i a p r a e c o x ) , d e m e n t i a p r a e c o x is a s u b l i m e o b j e c t f o r
o r t h o d o x p s y c h i a t r y b e c a u s e it is visible (as a clinical p i c t u r e ) b u t f u n d a m e n tally o b s c u r e (as a disease p r o c e s s of u n k n o w n o r i g i n s ) a n d s o a p e r p e t u a l site o f c o n t e s t a t i o n in a d i s c i p l i n e t h a t w o u l d d e m y s t i f y , r a t i o n a l i z e , a n d r e n d e r t r a n s p a r e n t e v e r y d i m e n s i o n of h u m a n b e h a v i o u r . If a p i v o t a l t e n s i o n in p s y c h i a t r y arises f r o m t h e c o n f l i c t o v e r t h e a e t i o l o g y o f m e n t a l i l l n e s s — n a m e l y , is it o f s o m a t i c , e n v i r o n m e n t a l , p s y c h i c , o r i n t e r s u b j e c t i v e o r i g i n — s c h i z o p h r e n i a h a s b e e n t h e p r i m e site f o r w h a t p s y c h i a t r i s t D a v i d H e a l y d e s c r i b e s as a series of o n g o i n g ' t u r f w a r s ' ( 2 0 0 2 , p . 145). K r a e p e l i n w a s a leader of t h e e u g e n i c b i o l o g i c a l p s y c h i a t r y t h a t d e v e l o p e d f r o m t h e m i d d l e o f t h e n i n e t e e n t h c e n t u r y o n l y t o b e d i s g r a c e d b y its a s s o c i a t i o n w i t h a n d appropriation by Nazi psychiatry.20 A strong psychoanalytic focus guided A m e r i c a n , a n d in t u r n global, p s y c h i a t r y f r o m t h e S e c o n d W o r l d W a r u n t i l t h e 1970s w h e n , in t h e t r i u m p h a n t w o r d s o f E d w a r d S h o r t e r , ' b i o l o g i c a l p s y c h i a t r y c a m e r o a r i n g b a c k o n s t a g e , d i s p l a c i n g p s y c h o a n a l y s i s as t h e d o m i n a n t p a r a d i g m a n d r e t u r n i n g psychiatry to the fold of o t h e r m e d i c a l specialities' ( S h o r t e r , 1997, p. 2 3 9 ) . If K r a e p e l i n , t h e first t o i d e n t i f y d e m e n t i a p r a e c o x , is the intellectual ancestor of the biological psychiatry o n c e again d o m i n a t i n g the m a n a g e m e n t o f m e n t a l illness t o d a y , E u g e n B l e u l e r is t h e p s y c h i a t r i s t w h o p s y c h o l o g i z e d d e m e n t i a p r a e c o x , r e n a m i n g it s c h i z o p h r e n i a a n d b r o a d e n i n g t h e a n a l y t i c p o s s i b i l i t i e s f o r its d i a g n o s i s a n d t r e a t m e n t . I n t h e f o l l o w i n g s e c t i o n o f t h i s c h a p t e r , I will d i s c u s s t h e d e t a i l a n d s i g n i f i c a n c e of B l e u l e r ' s r e c o n c e p t u a l i z a t i o n o f d e m e n t i a p r a e c o x as s c h i z o p h r e n i a , a n d s u g g e s t t h a t e v e n in its d e p a r t u r e f r o m K r a e p e l i n i a n o r t h o d o x y it s e r v e s t o r e i n f o r c e t h e v a l i d i t y a n d scientificity of K r a e p e l i n ' s claims.
From dementia praecox to schizophrenia E u g e n Bleuler's 1911 text, Dementia
Praecox,
or The Group of Schizophrenias,
is
m o s t frequently cited simply for i n t r o d u c i n g the t e r m schizophrenia to m o d e r n p s y c h i a t r y . 2 1 A cynical e x p l a n a t i o n of this c h a n g e in n o m e n c l a t u r e w o u l d n o t e that Bleuler's d e p a r t u r e f r o m the Latin phrase b r o u g h t psychiatric taxo n o m i e s in line w i t h t h e f a s h i o n f o r G r e e k n e o c l a s s i c i s m ( G i l m a n , 1988, 20
21
For an accessible account of the Nazi's psychiatric genocide see Torrey and Yolken (2009). This horrific chapter in psychiatric and medical history has not received the attention it has deserved. However, as Rael Strous notes, 'That it has taken close to 60 years to confront this dark period in the history of psychiatry does not diminish the importance of finally dealing with it. It is painfully shameful that close to 300 000 individuals with schizophrenia were either sterilized or killed at the behest of members of our profession' (Strous, 2010). In fact, he first used the term 3 years earlier in a lecture at the German Psychiatric Association in Berlin (Fusar-Poli and Politi, 200«).
p. 2 0 3 ) . H o w e v e r , t h e a r g u m e n t s Bleuler a d v a n c e s in f a v o u r o f a b a n d o n i n g t h e c u m b e r s o m e ' d e m e n t i a p r a e c o x ' reveal t h a t t h e s h i f t is m o r e t h a n s u p e r f i c i a l . First, Bleuler n o t e s t h a t as d e m e n t i a p r a e c o x ' d e s i g n a t e s t h e d i s e a s e , n o t t h e d i s e a s e d ' , t h e t e r m is n o t o n l y a w k w a r d b u t l i m i t e d in its a p p l i c a t i o n (Bleuler, 1950, p. 7 ) . 2 2 S e c o n d l y , h e d r a w s a t t e n t i o n t o a f a c t t h a t K r a e p e l i n , t o o , w a s f o r c e d t o a c k n o w l e d g e : d e m e n t i a p r a e c o x d o e s n o t , as t h e n a m e s u g g e s t s , always h a v e early o n s e t , n o r d o e s it always r e s u l t in d e m e n t i a . S u c h w e r e t h e p r o b l e m s s e e m i n g l y r e s o l v e d b y t h e r e j e c t i o n o f ' d e m e n t i a p r a e c o x ' , b u t 'schizo p h r e n i a ' w a s in n o w a y a n i n n o c e n t o r u n a s s u m i n g r e p l a c e m e n t . A l t h o u g h h e w r i t e s t h a t 'it is really q u i t e i m p o s s i b l e t o find a p e r f e c t n a m e f o r a c o n c e p t w h i c h is still d e v e l o p i n g a n d c h a n g i n g ' , Bleuler a d v o c a t e s t h e t e r m s c h i z o p h r e nia, m e a n i n g 'split m i n d ' , b e c a u s e in his v i e w ' t h e " s p l i t t i n g " o f t h e d i f f e r e n t p s y c h i c f u n c t i o n s is o n e of its m o s t i m p o r t a n t c h a r a c t e r i s t i c s ' (Bleuler, 1950, p. 8). S c h i z o p h r e n i a r a p i d l y r e p l a c e d d e m e n t i a p r a e c o x as t h e p r e f e r r e d t e r m o f p s y c h i a t r i c d i s c o u r s e , b u t p r o c e e d e d t o a c q u i r e a life of its o w n in t h e n o n psychiatric imaginary: The rise of the term 'schizophrenia' was probably due, in part, to the simultaneously exotic and familiar sound of the word itself, with its echoes of 'schism' and 'frenzy' and 'frenetic', but also, less superficially, to the meaning commonly attributed to the word: not so much 'split mind', as 'split personality'. . . . Although this has had a regrettably powerful influence on what most people understand schizophrenia to be, it bears virtually no resemblance to schizophrenia as currently diagnosed. (Crichton, 2000, p. 14)23 Bleuler's u n d e r s t a n d i n g o f t h e d i s e a s e — ' a specific t y p e of a l t e r a t i o n of t h i n k ing, feeling, a n d r e l a t i o n t o t h e e x t e r n a l w o r l d w h i c h a p p e a r s n o w h e r e else in t h i s p a r t i c u l a r f a s h i o n ' ( B l e u l e r , 1950, p . 9 ) — h a s b e e n less t h a n u n i f o r m l y a c c e p t e d , its p e r c e i v e d v a l i d i t y d e p e n d e n t o n w h e t h e r p s y c h o l o g i c a l o r biological m o d e l s o f p s y c h o s i s d o m i n a t e p s y c h i a t r i c e n q u i r y . 2 4 22
Although Bleuler's positive view of using schizophrenic as a noun no doubt appears scandalous today (the mental health sector strenuously rejects such terminology as stereotyping and stigmatizing), it is worth noting that he in no way intended for this to be dehumanizing. On the contrary, Bleuler's interest in and attachment to his patients has been well documented (see, for example, the second chapter of Bentall, 2004).
23
In an interesting analysis of the history of this informal usage, Kieran McNally takes a different view: 'Schizophrenia as split personality was not then a result of misinterpretation by the general public. It was generated, maintained, and reinforced from within the culture of the psychological professions until it was no longer useful' (McNally, 2007, p. 78).
24
Thus Eve Johnstone (Johnstone et al., 1999, p. 30) writes: 'Although Kraepelin's view retained their popularity in Europe until the 1960s and 1970s, bleuler's ideas held sway in the United States. I lis concept of schizophrenia as an essentially psychological
T h e key d i s t i n c t i o n b e t w e e n Bleuler's a c c o u n t of s c h i z o p h r e n i a a n d Kraepelin's clinical p i c t u r e of d e m e n t i a p r a e c o x has b e e n isolated by Healy: ' w h e r e a s K r a e p e l i n ' s d e m e n t i a p r a e c o x w a s s i m p l y d e s c r i p t i v e , Bleuler o f f e r e d a m o d e l t h a t m a d e s e n s e o f t h e d e s c r i p t i o n s ' ( H e a l y , 2 0 0 2 , p . 2 6 5 ) . Bleuler d i d n o t significantly e x t e n d , n a r r o w , o r o t h e r w i s e d i s p u t e K r a e p e l i n ' s i n v e n t o r y of s y m p t o m s of d e m e n t i a p r a e c o x s o m u c h as o f f e r a d i f f e r e n t r a t i o n a l e f o r t h e i r a p p e a r a n c e . His a c c o u n t of s c h i z o p h r e n i a hinges u p o n the idea that the n o r m a l m i n d w o r k s b y u n i f y i n g p s y c h i c f u n c t i o n s , d r i v e s , a n d p r o c e s s e s . In s c h i z o p h r e n i a , t h e s e b e c o m e ' s p l i t o f f f r o m e a c h o t h e r , a n d t h e p s y c h e is f r a g m e n t e d b y the d o m i n a n c e or i m p o t e n c e of various i n c o m p l e t e psychic processes. U t i l i z i n g this d y n a m i c m o d e l , Bleuler d i v i d e s K r a e p e l i n ' s i n v e n t o r y o f s c h i z o p h r e n i c s y m p t o m s i n t o t w o d i c h o t o m i e s : f u n d a m e n t a l a n d accessory, a n d p r i m a r y a n d s e c o n d a r y s y m p t o m s . S u m m a r i z e d as t h e F o u r A s — A u t i s m , Ambivalence, Affective disturbance, a n d impaired Associations—the f u n d a m e n t a l s y m p t o m s are, a c c o r d i n g t o Bleuler, p r e s e n t in all cases a n d at all stages o f t h e illness ( B l e u l e r , 1950, p. 13). T h e s y m p t o m s t r a d i t i o n a l l y i d e n t i f i e d as 'properly' psychotic—hallucinations, delusions, and catatonic stupor—are d e e m e d accessory, as t h e y a r e less c o n s i s t e n t in p r e s e n t a t i o n a n d d u r a t i o n . T h e primary/secondary dichotomy appears to extend the relationship between f u n d a m e n t a l a n d a c c e s s o r y s y m p t o m s . 2 5 In t h e d y n a m i c d i s e a s e p r o c e s s o f schizophrenic splitting, the psychiatrist m u s t 'distinguish the s y m p t o m s stemm i n g directly f r o m t h e disease p r o c e s s itself f r o m t h o s e s e c o n d a r y s y m p t o m s w h i c h o n l y b e g i n t o o p e r a t e w h e n t h e sick p s y c h e r e a c t s t o s o m e i n t e r n a l o r e x t e r n a l p r o c e s s ' ( B l e u l e r , 1950, p . 3 4 8 ) . F o r e x a m p l e , h a l l u c i n a t i o n s (access o r y a n d s e c o n d a r y s y m p t o m s ) w o u l d b e i n t e r p r e t e d as a r e a c t i o n o r a d a p t a tion to psychic m a l f u n c t i o n i n g precipitated by the f u n d a m e n t a l a n d p r i m a r y s y m p t o m s of t h e disease p r o c e s s . D i r e c t l y i n f l u e n c e d b y J u n g a n d o t h e r s o f t h e Z u r i c h School, Bleuler believed that such s y m p t o m s could be m e a n i n g f u l l y interpreted, n o m a t t e r h o w i n c o m p r e h e n s i b l e they a p p e a r e d to be (Bleuler, 1950, p . 9 6 ) . F o r J a s p e r s t h i s is e s s e n t i a l l y 'a translation concepts
which
have been arrived
at during
the analysis
to schizophrenia of hysteria'
of
(Jaspers,
1972, p. 410, italics in t h e o r i g i n a l ) ; h e n c e , as w e shall see in t h e n e x t c h a p t e r , it is a n a p p r o a c h t h a t o v e r l o o k s t h e specific s t r u c t u r e of s y m p t o m f o r m a t i o n in
25
disorder, possibly with a psychogenic basis, rather than a pathological condition of the nervous system, was compatible with the psychoanalytic orientation prevailing in the USA at that time'. Although as Boyle (1990, pp. 60-1) observes, 'Bleuler's writings give no indication that he meant this to be the case . . . some behaviours called fundamental symptoms appear later as secondary, while behaviours called accessory symptoms were later labelled primary'.
s c h i z o p h r e n i a . In a n y e v e n t , t h e e n d u r i n g effect of p s y c h o l o g i z i n g K r a e p e l i n ' s d e m e n t i a p r a e c o x a n d f o r e g r o u n d i n g t h e i m p o r t a n c e o f t h e least b i z a r r e s y m p t o m s o f p s y c h o s i s ( s u c h as a m b i v a l e n c e a n d a l a c k of a f f e c t ) w a s t o b r o a d e n f u r t h e r b o t h t h e c o n c e p t a n d t h e d i a g n o s t i c criteria of s c h i z o p h r e n i a ( C r i c h t o n , 2 0 0 0 , p . 14). F o r all t h e i r d i f f e r e n c e s , B l e u l e r ' s a c c o u n t of s c h i z o p h r e n i a is t h e first a n d p e r h a p s the s t r o n g e s t t e s t a m e n t to t h e flexibility of t h e clinical p i c t u r e of d e m e n t i a p r a e c o x a d v a n c e d by K r a e p e l i n . As I have a l r e a d y d i s c u s s e d , K r a e p e l i n d e s c r i b e d d e m e n t i a p r a e c o x as a d i s e a s e p r o c e s s w i t h t h r e e f o r m s ( h e b e p h r e n i c , c a t a t o n i c , a n d p a r a n o i d ) , e a c h of w h i c h c o u l d b e d i s t i n g u i s h e d f r o m m a n i c - d e p r e s s i v e p s y c h o s i s by a p r o n o u n c e d t e n d e n c y t o d e t e r i o r a t i o n . T h e title o f B l e u l e r ' s w o r k , Dementia
Praecox
or The Group
of
Schizophrenias,
t h u s a p p e a r s t o c o n t r a d i c t K r a e p e l i n f u n d a m e n t a l l y : if d e t e r i o r a t i o n is n o l o n g e r t h e d e f i n i n g f e a t u r e o f s c h i z o p h r e n i a , of w h i c h t h e r e a r e n o t t h r e e f o r m s b u t p o t e n t i a l l y m a n y , h o w c a n t h e t w o t e r m s d e s i g n a t e t h e s a m e disease p r o c ess? T h e s i m p l e a n s w e r is b e c a u s e t h e q u e s t i o n o f w h a t t h a t d i s e a s e p r o c e s s a c t u a l l y is r e m a i n s u n a n s w e r e d in b o t h t e x t s . F o r K r a e p e l i n , a b e l i e f in t h e n e u r o b i o l o g i c a l o r i g i n of p s y c h o s i s w a s e n o u g h t o j u s t i f y his u n s u b s t a n t i a t e d c l a i m t h a t d e m e n t i a p r a e c o x w a s a disease o f t h e b r a i n . T h i s belief p r o p e l s h i m f r o m t h e u n c e r t a i n t o t h e d e f i n i t i v e in a single s e n t e n c e : The nature of the disease process in dementia praecox is not known, but it seems probable, judging from the clinical course, and especially in those cases where there has been rapid deterioration, that there is a definite disease process in the brain, involving the cortical neurones. (Kraepelin, 1981, p. 221) Bleuler evinces n o s u c h u n s h a k a b l e faith in s o m a t i c aetiology, b u t his o p e n i n g caveat similarly betrays a n u n c e r t a i n t y regarding the n a t u r e of t h e disease process: Our knowledge of the disease group which Kraepelin established under the name of Dementia Praecox is too recent to warrant a complete description. The whole complex is still too fluid, incomplete, tentative. Since it would be rather tedious to draw attention to all the reservations implied by this fact, I hope I am justified in assuming that the reader will bear this in mind. (Bleuler, 1950, p. 1) H e r e , t h e r e a d e r m u s t b e c o m p l i c i t w i t h a n a u t h o r w h o states t h a t p r o d u c i n g a ' c o m p l e t e ' d e s c r i p t i o n o f s c h i z o p h r e n i a is v i r t u a l l y i m p o s s i b l e , y e t w h o p r e s e n t s his w o r k , f o l l o w i n g K r a e p e l i n , as a c o m p r e h e n s i v e if n o t d e f i n i t i v e a c c o u n t of t h e disease. Like t h e a u t h o r , t h e r e a d e r m u s t ( b u t o n l y in t h e i n t e r ests o f a v o i d i n g b o r e d o m ) e f f e c t i v e l y r e p r e s s q u e s t i o n s as t o t h e s c i e n t i f i c validity of his c l a i m s .
Bleuler's systematic p r e s e n t a t i o n a n d psychological subtlety c a n n o t disguise t h e fact t h a t t h e s y m p t o m a t o l o g i c a l d i c h o t o m i e s c o n s t i t u t i v e of his d e p t h m o d e l of s c h i z o p h r e n i a derive f r o m a p h a n t o m o r i g i n : he confesses t o w a r d s the e n d of t h e b o o k 'We do not know what the schizophrenic
process actually is'
(Bleuler, 1950, p. 466, italics in t h e o r i g i n a l ) . K r a e p e l i n ' s clinical p i c t u r e o f d e m e n t i a p r a e c o x is t h e r e f o r e r e f r a m e d a n d r e - t h e o r i z e d in Bleuler's a c c o u n t of s c h i z o p h r e n i a , b u t it is n o t r e n d e r e d invalid o r obsolete. A l t h o u g h i n t r o d u c ing a n o n - b i o l o g i c a l t h e o r y of psychic splitting to Kraepelin's clinical p i c t u r e a p p e a r s t o r e c o n f i g u r e it q u i t e r a d i c a l l y , in d o i n g so B l e u l e r r e p e a t e d a n d so c o n f i r m e d K r a e p e l i n ' s m o s t basic a s s e r t i o n , t h a t t h e r e w a s a c o n s i s t e n t l y identifiable a s y l u m p o p u l a t i o n s u f f e r i n g f r o m a p a r t i c u l a r f o r m of psychosis. ( I n d e e d , Bleuler's a d d i t i o n o f ' s i m p l e ' a n d ' l a t e n t ' s c h i z o p h r e n i a t o the h e b e p h r e n i c , c a t a t o n i c , a n d p a r a n o i d f o r m s f u r t h e r s u p p o r t e d this assertion, as if t h e illness c o u l d m a n i f e s t itself n o w in essential o r n o t yet w h o l l y perceptible f o r m s . ) Bleuler's a c c o u n t f u r t h e r clarified the s y m p t o m a t o l o g y of schizophrenia, b u t left t h e disease process itself s h r o u d e d in obscurity, a n d so r e i n f o r c e d the s u b l i m e status of the disorder. F u r t h e r m o r e , by positing a qualitative difference in g r o u p s of s y m p t o m s , Bleuler o p e n e d u p n e w possibilities f o r (re) f r a m i n g t h e clinical p i c t u r e of this d i s o r d e r , so e x t e n d i n g s c h i z o p h r e n i a as a p o i n t a r o u n d w h i c h psychiatry c o u l d assert a n d reassert its scientific c o n q u e s t of m e n t a l illness. Before a d d r e s s i n g c o m p e t i n g m o d e l s of s c h i z o p h r e n i a t h a t r e c o n f i g u r e a Bleulerian split in s y m p t o m g r o u p s , we m u s t t u r n to the w o r k of his c o n t e m p o r a r y , Karl Jaspers, w h o s e p h e n o m e n o l o g i c a l analysis distinguishes itself f r o m b o t h the Kraepelinian a n d Bleulerian a c c o u n t s of s c h i z o p h r e n i a in its e x a m i n a t i o n of t h e sheer ' u n u n d e r s t a n d a b i l i t y ' of s c h i z o p h r e n i a . A l t h o u g h Jaspers r e t a i n e d the t e r m s c h i z o p h r e n i a t o designate a p a r t i c u l a r constellation of s y m p t o m s , his critique of the philosophical a n d m e t h o d o l o g i c a l a s s u m p t i o n s u n d e r l y i n g b o t h Kraepelin's a n d Bleuler's a c c o u n t s of the d i s o r d e r is a p o w e r f u l o n e . C o m m e n d i n g Kraepelin b o t h for his vivid descriptions of m e n t a l illness a n d his m e t h o d o l o g i c a l e m p h a s i s o n t h e p a t i e n t ' s life history (Jaspers, 1972, pp. 849, 852), Jaspers n o n e t h e l e s s r e m a i n e d sharply critical of w h a t h e calls t h e i n h e r e n t l y u n s c i e n t i f i c ' s o m a t i c p r e j u d i c e ' u n d e r l y i n g Kraepelin's analytic p r o j e c t , a n d the ' b r a i n m y t h o l o g i e s ' p r o m u l g a t e d by o t h e r biological psychiatrists (Jaspers, 1972, p. 18). Clearly u n c o n v i n c e d by the rhetorical p o s t u r i n g a n d lack of aetiological analysis o r e v i d e n c e in Kraepelin's a c c o u n t of d e m e n t i a p r a e c o x , h e a n t i c i p a t e d t h e a r g u m e n t s of Boyle a n d Bentall in w r i t i n g 'No real disease entity has been discovered
by this m e t h o d of
a p p r o a c h ' (Jaspers, 1972, p. 567, italics in the original). Jaspers's critique of the Bleulerian m o d e l of s c h i z o p h r e n i c splitting is less explicit; however, in a d v o cating the e m p a t h e t i c analysis of p s y c h o p a t h o l o g i c a l p h e n o m e n o n ( t h e
patients' c o m m u n i c a t i o n , behaviours, a n d gestures), Jaspers a i m e d to e n s u r e t h a t ' t h e psyche
itself d o e s not b e c o m e an object' ( J a s p e r s , 1972, p. 9, italics in
t h e o r i g i n a l ) , w h i c h a r g u a b l y it is f o r Bleuler. Jaspers a r g u e d t h a t b y i d e n t i f y i n g w i t h p a t i e n t s , p s y c h i a t r i s t s c o u l d a c h i e v e a n e m p a t h e t i c u n d e r s t a n d i n g of h o w m e n t a l e v e n t s a n d m e n t a l d i s o r d e r s arise: t h e p h e n o m e n o l o g i c a l a n a l y s i s o f p a t i e n t s ' b e h a v i o u r w o u l d p r o d u c e i n s i g h t i n t o t h e e x p e r i e n c e of p s y c h o p a thology. S c h i z o p h r e n i a is u n i q u e in Jaspers's a c c o u n t because it is a psychic experience t h a t f r u s t r a t e s genetic u n d e r s t a n d i n g . ' T h e m o s t p r o f o u n d d i s t i n c t i o n in psychic life', J a s p e r s w r i t e s , ' s e e m s t o b e t h a t b e t w e e n w h a t is m e a n i n g f u l a n d allows empathy
a n d w h a t in its p a r t i c u l a r w a y is unnnderstandable,
" m a d " in
t h e literal sense, s c h i z o p h r e n i c p s y c h i c life (even t h o u g h t h e r e m a y b e n o d e l u s i o n s ) ' (Jaspers, 1972, p . 577, italics in t h e o r i g i n a l ) . S c h i z o p h r e n i a in J a s p e r s ' s General Psychopathology
is d e s c r i b e d as a c o m p e l -
ling s p e c t a c l e of s u b l i m i t y — i t is ' p a r t i c u l a r l y f a s c i n a t i n g a n d p s y c h o l o g i c a l l y i n t e r e s t i n g ' , its c h a n g e s t o t h e i n d i v i d u a l ' s p s y c h i c ' " m a c h i n e r y " ' a r e ' r e m a r k able a n d a l a r m i n g ' , a n d 'in c e r t a i n cases t h e v e r y m a n n e r of it, its c o n t e n t s a n d all t h a t it r e p r e s e n t s c a n in itself c r e a t e q u i t e a n o t h e r k i n d of interest; w e find ourselves a s t o u n d e d a n d s h a k e n in t h e p r e s e n c e of alien secrets' (Jaspers, 1972, pp. 608, 577). Unlike Kraepelin a n d Bleuler, Jaspers advances neither a c o m p r e h e n s i v e clinical p i c t u r e n o r p s y c h o d y n a m i c m o d e l of s c h i z o p h r e n i a . E c h o i n g K a n t ' s a n a l y s i s o f t h e s u b l i m e e n c o u n t e r as e s s e n t i a l l y a n i n t r a subjective e v e n t , J a s p e r s insists: It is easier to describe the common factor [among schizophrenic patients] in subjective terms, that is, in terms of the effect on the observer, rather than try to do so objectively. All these personalities have something baffling about them, which baffles our understanding in a peculiar way; there is something queer, cold, inaccessible, rigid, and petrified there, even when the patients are quite sensible and can be addressed and even when they are eager to talk about themselves. We may think we can understand dispositions furthest from our own but when faced with such people we feel a gulf which defies description. (Jaspers, 1972, p. 447) T h e i m m e d i a t e l y p e r c e p t i b l e collapse o f t h e psychiatrist's
empathetic struc-
t u r e s o f u n d e r s t a n d i n g is p a t h o g n o m o n i c o f a d i s o r d e r u n e q u i v o c a l l y c o n s t r u e d as s u b l i m e . If t h e ' n u c l e a r s y m p t o m o f s c h i z o p h r e n i a ' is t h i s ' p r a e c o x f e e l i n g ' , as D u t c h p s y c h i a t r i s t H . C . R u m k e a l s o s u g g e s t s ( H o e n i g , 1 9 9 5 , p. 345), it is a s y m p t o m l a t e n t in b u t n o t a b s e n t f r o m m o r e o r t h o d o x a c c o u n t s of t he d i s o r d e r . J a s p e r s ' s f r a n k a c c o u n t o f t h e f u n d a m e n t a l ' u n u n d e r s t a n d a b i l ily' of t h e p s y c h i c e x p e r i e n c e t h a t a p p e a r s as s c h i z o p h r e n i a is a l r e a d y i m p l i c i t in K r a e p e l i n ' s d e s c r i p t i o n o f ' m e n t a l s h i p w r e c k s ' a n d B l e u l e r ' s a n x i e t y r e g a r d i n g t h e o b s c u r i t y o f t h e s c h i z o p h r e n i c d i s e a s e p r o c e s s . T h e feeling o f a
' g u l f w h i c h d e f i e s d e s c r i p t i o n ' is n o t h e r e d e p e n d e n t o n t h e p e r c e p t i o n of a n y p a r t i c u l a r f u n d a m e n t a l a n d a c c e s s o r y s y m p t o m s ; it is p r o d u c e d in t h e overall a p p r e h e n s i o n o f t h e p e r s o n . F o r e g r o u n d i n g t h e e m o t i o n a l d i m e n s i o n of t h e clinical e n c o u n t e r , n o n - p h e n o m e n o l o g i c a l psychiatry also i n c o r p o r a t e d an a c c o u n t of t h e u n i q u e l y u n u n d e r s t a n d a b l e , o r q u i n t e s s e n t i a l l y b i z a r r e , d i m e n s i o n o f s c h i z o p h r e n i a b u t a t t r i b u t e d it e x c l u s i v e l y t o t h e p r e s e n c e o f f l o r i d , or w h a t Bleuler called the accessory, s y m p t o m s . Effectively ignoring their theoretical a n d m e t h o d o l o g i c a l specificity, m a i n s t r e a m psychiatry e n d e d u p s y n t h e s i z i n g J a s p e r s ' s n o t i o n of a ' p r a e c o x feeling' w i t h Bleuler's s e p a r a t i o n o f non-bizarre f r o m bizarre symptoms. Bleuler i n a u g u r a t e d a n a p p r o a c h t o m a p p i n g s c h i z o p h r e n i c s y m p t o m a t o l ogy that persisted t h r o u g h o u t the twentieth century. H o w e v e r , whereas his d i v i s i o n of s y m p t o m s i n t o d i s t i n c t i v e g r o u p s e n d u r e d , B l e u l e r ' s h i e r a r c h i z e d d i c h o t o m i e s o f f u n d a m e n t a l a n d accessory, p r i m a r y a n d s e c o n d a r y s y m p t o m s were uniformly inverted such that the m o s t 'bizarre' accessory s y m p t o m s c a m e t o b e seen as t h e m o s t d i s t i n c t i v e l y s c h i z o p h r e n i c . A n early a n d h u g e l y i n f l u e n tial r e c o n f i g u r a t i o n o f Bleuler's s y m p t o m d i v i s i o n w a s m a d e in t h e late 1950s b y K u r t S c h n e i d e r , w h o p r o d u c e d a list o f s o - c a l l e d
first-rank
s y m p t o m s of
s c h i z o p h r e n i a d i s p l a y e d in a c u t e e p i s o d e s of t h e d i s o r d e r . S t r i k i n g f o r its detail, t h e list i n c l u d e s t h e e x p e r i e n c e of t h o u g h t i n s e r t i o n a n d t h o u g h t b r o a d c a s t i n g , t h e p r e s e n c e o f h a l l u c i n a t o r y v o i c e s in d i a l o g u e , d e l u s i o n a l p e r c e p t i o n a n d e x p e r i e n c e s o f e x t r e m e p a s s i v i t y , a n d v i c t i m i z a t i o n in t h e fields of d r i v e a n d w i l l p o w e r (see S m i t h , 1982, p. 36). S c h n e i d e r c l a i m e d n o p a r t i c u l a r t h e o r e t i c a l s i g n i f i c a n c e f o r his h i e r a r c h i c a l d i v i s i o n of s y m p t o m s ( J o h n s t o n e et al., 1999, p . 24); h e a d v a n c e d t h e m m e r e l y as a n aid t o c r o s s - s e c t i o n a l (as d i s t i n c t f r o m l o n g i t u d i n a l ) d i a g n o s i s ( M c K e n n a , 1994, p. 46). H o w e v e r , it is n o c o i n c i d e n c e , given their close p r o f e s s i o n a l r e l a t i o n s h i p , t h a t S c h n e i d e r ' s list w a s c o n s t i t u t e d exclusively of s y m p t o m s t h a t Jaspers believed were b e y o n d genetic u n d e r s t a n d i n g ( F a r m e r et al., 1988, p. 38). M o r e s u r p r i s i n g is t h e d i s t i l l a t i o n of Jaspers's p h e n o m e n o l o g i c a l analysis i n t o a n e a s y - r e f e r e n c e list, w h e n J a s p e r s h i m s e l f w a s v e h e m e n t l y o p p o s e d t o t h e ( o v e r ) s i m p l i f i c a t i o n of p s y c h i a t r i c c o n c e p t s : Those who teach should compel their students to rise to a scientific level. But this is made impossible if'compendia' are used, which give students fragmentary, superficial pseudo-knowledge 'for practical purposes', and which sometimes is more subversive for practice than total ignorance. One should not allow a façade of science. There is a decline in culture and intellectual effort in our day and it is the duty of everyone not to compromise. (Jaspers, 1972, p. xi) T w e n t i e t h - c e n t u r y p s y c h i a t r y , in its q u e s t t o c o n q u e r if n o t m e n t a l illness t h e n certainly t h e b u r g e o n i n g m a r k e t for m e n t a l illness m a n a g e m e n t , has
m a d e m a n y such ' c o m p r o m i s e s ' in t h e f o r m of i n t e r n a t i o n a l l y s t a n d a r d i z e d and disseminated diagnostic manuals. Schneider's s y m p t o m ranking was clearly an instance in w h i c h this 'façade of science' was p u t t o strategic ends. By highlighting 'key' e l e m e n t s of Kraepelin's clinical p i c t u r e of d e m e n t i a p r a e c o x in o r d e r t o facilitate faster, m o r e ' o b j e c t i v e ' , a n d t h e r e f o r e m o r e c o n s i s t e n t diagnoses, S c h n e i d e r s h i f t e d t h e d i a g n o s t i c e m p h a s i s f r o m t h e a p p r e h e n s i o n of t h e p e r s o n t o t h e i d e n t i f i c a t i o n of specific a n d isolated b e h a v i o u r s . A f t e r Bleuler h a d significantly b r o a d e n e d t h e c o n c e p t of s c h i z o p h r e n i a , S c h n e i d e r tightened a n d d e l i m i t e d it, b u t still d i d n o t a d d r e s s t h e q u e s t i o n of aetiology. T h u s r a n k e d , t h e s y m p t o m g r o u p s Bleuler i d e n t i f i e d as f u n d a m e n t a l a n d accessory h a v e also b e e n qualitatively d i f f e r e n t i a t e d as negative a n d positive s y m p t o m s of s c h i z o p h r e n i a . This d i f f e r e n t i a t i o n d r a w s u p o n t h e m u c h earlier w o r k of English neurologist H u g h l i n g s Jackson. In 1860, Jackson hypothesized that the s y m p t o m s of b o t h neurological a n d psychiatric d i s o r d e r s were caused by a n a t o m i c a l lesions, lesions that could cause t h e loss of a f u n c t i o n a n d p r o d u c e so-called n e g a t i v e s y m p t o m s , o r d i s i n h i b i t excessive b e h a v i o u r a n d so generate positive s y m p t o m s ( J o h n s t o n e et al., 1999, p. 22). Divesting itself of Jackson's t h e o r e t i c a l f r a m e w o r k , m o d e r n psychiatry deploys t h e t e r m s m o r e simplistically: a negative s y m p t o m designates t h e absence of a certain f u n c t i o n , whereas t h e presence of a b e h a v i o u r d e e m e d pathological, such as a d e l u s i o n , is a positive s y m p t o m ( J o h n s t o n e et al., 1999, p. 22). T e m p o r a l i t y a n d causality are n o t e w o r t h y p o i n t s of distinction b e t w e e n the t h r e e s y m p t o m - d i v i d i n g m o d e l s so far d i s c u s s e d . C l e a r l y f o r Bleuler t h e f u n d a m e n t a l a n d p r i m a r y s y m p t o m s ( t h e ' f o u r As') n o t o n l y p r e c e d e b u t also p r o d u c e t h e s e c o n d a r y , accessory s y m p t o m s . S c h n e i d e r , b y c o n t r a s t , r a n k s s y m p t o m s a c c o r d i n g t o w h e t h e r o r n o t they m a n i f e s t at the t e m p o r a l apex of psychosis, t h e acute episode. Finally, t h e positive/negative s y m p t o m g r o u p i n g of m o d e r n psychiatry m e r e l y s u b d i v i d e s a static clinical p i c t u r e , o f f e r i n g n o a c c o u n t of t h e causal relationship b e t w e e n o r sequential d e v e l o p m e n t of s y m p t o m s . Like Kraepelin's clinical p i c t u r e of d e m e n t i a praecox, t h e Jackson/Bleuler-inspired differentiat i o n o f p o s i t i v e f r o m n e g a t i v e s y m p t o m s w a s a d v a n c e d as a d i s i n t e r e s t e d d e s c r i p t i o n of ways in w h i c h s c h i z o p h r e n i c b e h a v i o u r c o u l d be d e m a r c a t e d f r o m o t h e r f o r m s of pathological a n d n o r m a l b e h a v i o u r , a n d retained regardless of t h e scientific veracity of its a s s u m p t i o n s (Jackson's a n a t o m i c a l lesions, Bleuler's vague biological origin). It was, in short, highly flexible a n d p r o v e d t o be a d a p t a b l e t o wildly d i v e r g e n t a c c o u n t s of s c h i z o p h r e n i a : e p i d e m i o l o g i c a l r e s e a r c h e r s u t i l i z e t h e s y m p t o m d i v i s i o n t o e x p l a i n g e n d e r d i f f e r e n c e s in s c h i z o p h r e n i a ( G o l d s t e i n a n d Lewine, 2000, p. 115); ' i n s t i t u t i o n a l n e u r o s i s ' theories attributed personality-flattening negative s y m p t o m s to hospitalization o r a s y l u m i n c a r c e r a t i o n ; ' d e f e c t i v e filter t h e o r i e s ' h e l d t h a t p o s i t i v e
s y m p t o m s arose f r o m the schizophrenic inability to screen stimuli a n d negative s y m p t o m s w e r e a s t r a t e g y o f w i t h d r a w a l f r o m t h i s o v e r w h e l m i n g s t a t e ; a n d T i m C r o w ' s t h e o r y of t w o t y p e s o f s c h i z o p h r e n i a s a w t h e s e c o n d , n e g a t i v e t y p e as a f o r m of d e g e n e r a t i v e b r a i n d a m a g e , p o s s i b l y t r i g g e r e d b y a v i r u s , t h a t a f f e c t e d s o m e p a t i e n t s a l r e a d y s u f f e r i n g f r o m t h e first, p o s i t i v e t y p e ( C r o w , 1985; see also H e a l y , 2 0 0 2 , p . 2 6 6 ) .
Schizophrenia today A l t h o u g h t h e o r e t i c a l d i v e r g e n c e s of this m a g n i t u d e e x e r t a c e r t a i n f a s c i n a t i o n , especially w h e n t h e y u n d e r p i n t h e d i a g n o s i s o f o n a v e r a g e 1 % o f t h e p o p u l a t i o n , w e c a n n o t h e r e c h a r t t h e rise a n d fall o f e v e r y t h e o r y o f s c h i z o p h r e n i a d e v e l o p e d b y t w e n t i e t h - c e n t u r y psychiatry.26 Kraepelin's clinical picture of d e m e n t i a p r a e c o x a n d B l e u l e r ' s m o d e l of s c h i z o p h r e n i a a r e t h e f o u n d a t i o n a l a c c o u n t s of s c h i z o p h r e n i a ; b a l a n c i n g s y m p t o m a t o l o g i c a l clarity a n d aetiological o b s c u r i t y , t h e y h a v e e n s u r e d t h a t s c h i z o p h r e n i a is p e r c e i v e d as a d e f i n i t e disease e n t i t y b u t o n e t h a t a t t r a c t s o n g o i n g analysis in o r d e r t o p r o v e t h i s is so. If a d e m o n s t r a b l e o r g a n i c l e s i o n o r a n u n d e r l y i n g d i s e a s e p r o c e s s h a d b e e n d i s c o v e r e d , s c h i z o p h r e n i a , like t h e t e r t i a r y f o r m o f syphilis ( g e n e r a l paralysis, o r paresis, o f t h e i n s a n e ) , m i g h t well h a v e f a d e d f r o m v i e w as a s o m a t i c m a d n e s s c u r a b l e w i t h s o m e t h i n g as s i m p l e as p e n i c i l l i n . I n t h e a b s e n c e o f s u c h a d i s c o v e r y o r even s u c h a t r e a t m e n t , n e w t h e o r i e s c o n t i n u e t o b e d e v e l o p e d a n d f r u s t r a t e d w i t h i n t h e c o n c e p t u a l f r a m e w o r k s o f early p s y c h i a t r y , t h e o r i e s t h a t are not only substantively indebted to b u t metatheoretically complicit with t h e s e early p r e s e n t a t i o n s . In t h e rest of this c h a p t e r , I a r g u e t h a t s c h i z o p h r e n i a c o n t i n u e s t o f u n c t i o n as t h e s u b l i m e o b j e c t o f p s y c h i a t r i c d i s c o u r s e b y f o c u s s i n g u p o n t h r e e t h i n g s : t h e i n f l u e n c e K r a e p e l i n ' s Clinical
Psychiatry
exerts o n
m o d e r n p s y c h i a t r y , s c h i z o p h r e n i a ' s p o s i t i o n at t h e c u t t i n g e d g e o f p s y c h i a t r i c t r e a t m e n t s , a n d t h e i n d e t e r m i n a c y t h a t still c h a r a c t e r i z e s t h e d i s c u r s i v e r e p r e s e n t a t i o n s of t h e d i s o r d e r . T h e clinical p i c t u r e o f s c h i z o p h r e n i a in t h e p r e - e m i n e n t c o n t e m p o r a r y catal o g u e of m e n t a l d i s o r d e r s , t h e revised f o u r t h e d i t i o n of t h e A m e r i c a n P s y c h i a t r i c A s s o c i a t i o n ' s ( A P A ' s ) Diagnostic
and Statistical
Manual
( D S M - I V - T R ) , is a
detailed i n v e n t o r y of s c h i z o p h r e n i c s y m p t o m s u n h a m p e r e d by a n y overtly t h e o r e t i c a l a c c o u n t o f t h e d i s o r d e r . 2 7 Since t h e p u b l i c a t i o n of D S M III in 1980, the APA's t a x o n o m i c enterprise has ' a t t e m p t e d to be neutral with respect to t h e o r i e s o f e t i o l o g y ' ( A m e r i c a n P s y c h i a t r i c A s s o c i a t i o n , 2 0 0 0 , p. xxvi), a n d its 26
27
For a comprehensive overview of current international research, see Hirsch and Weinberger (2003); MacDonald and Schulz (2009); Mueser and Jeste (2008). For a discussion of DSM-V, due to be published in 2013, please see footnote 12.
s t r i v i n g f o r i m p a r t i a l i t y is e v i d e n t in t h e s h i f t i n g d e f i n i t i o n s of t h e t e r m ' p s y c h o t i c ' in successive e d i t i o n s of t h e m a n u a l . P r e v i o u s l y d e f i n e d as a 'loss of e g o b o u n d a r i e s ' , a ' g r o s s i m p a i r m e n t o f reality t e s t i n g ' , a n d a g r o s s i n t e r f e r e n c e ' w i t h t h e c a p a c i t y t o m e e t t h e o r d i n a r y d e m a n d s of life', in D S M - I V - T R ' p s y chotic' simply 'refers to the presence of certain s y m p t o m s ' , namely, positive s c h i z o p h r e n i c s y m p t o m s ( A m e r i c a n P s y c h i a t r i c A s s o c i a t i o n , 2 0 0 0 , p. 2 9 7 ) . D S M - I V - T R lists f i v e s u b t y p e s o f s c h i z o p h r e n i a d i s t i n g u i s h e d b y t h e n o n / a p p e a r a n c e of c e r t a i n s y m p t o m s . O f t h e s e , t h e first t h r e e — p a r a n o i d , d i s o r g a n i z e d ( h e b e p h r e n i c ) , a n d c a t a t o n i c — r e p r o d u c e K r a e p e l i n ' s t h r e e f o r m s of dementia praecox; undifferentiated and residual schizophrenia correspond to Bleuler's a d d i t i o n of s i m p l e a n d l a t e n t s u b t y p e s . T h e A P A ' s g e n e r a l d i a g n o s t i c c r i t e r i a a r e w o r t h r e p r o d u c i n g in full f o r d e s p i t e t h e i r m a n y f l a w s ( C o o p e r , 2 0 0 4 , 2005; K i r k a n d K u t c h i n s , 1992), t h e y c o m p r i s e t h e single m o s t i n f l u e n tial c o n t e m p o r a r y clinical p i c t u r e of s c h i z o p h r e n i a : 2 8
Diagnostic criteria for schizophrenia A
Characteristic
symptoms:
T w o ( o r m o r e ) o f t h e f o l l o w i n g , each p r e s e n t
f o r a s i g n i f i c a n t p o r t i o n o f t i m e d u r i n g a 1 - m o n t h p e r i o d ( o r less if successfully t r e a t e d ) : (1) d e l u s i o n s (2) h a l l u c i n a t i o n s (3) d i s o r g a n i z e d s p e e c h (e.g. f r e q u e n t d e r a i l m e n t o r i n c o h e r e n c e ) (4) grossly d i s o r g a n i z e d o r c a t a t o n i c b e h a v i o r (5) n e g a t i v e s y m p t o m s , i.e. affective f l a t t e n i n g , alogia, o r a v o l i t i o n N o t e : O n l y o n e C r i t e r i o n A s y m p t o m is r e q u i r e d if d e l u s i o n s are b i z a r r e o r h a l l u c i n a t i o n s c o n s i s t of a voice k e e p i n g u p a r u n n i n g c o m m e n t a r y o n t h e p e r s o n ' s b e h a v i o r o r t h o u g h t s , o r t w o o r m o r e voices c o n v e r s i n g w i t h each other. B Social/occupational
dysfunction:
F o r a s i g n i f i c a n t p o r t i o n of t h e t i m e
since t h e o n s e t o f t h e d i s t u r b a n c e , o n e o r m o r e m a j o r a r e a s o f f u n c t i o n i n g s u c h as w o r k , i n t e r p e r s o n a l r e l a t i o n s , o r s e l f - c a r e a r e m a r k edly b e l o w t h e level a c h i e v e d p r i o r t o t h e o n s e t ( o r w h e n t h e o n s e t is in c h i l d h o o d o r a d o l e s c e n c e , f a i l u r e t o a c h i e v e e x p e c t e d level of i n t e r personal, academic, or occupational achievement).
28
The World Health Organisation's International Classification of Diseases (ICD) 10 (2007) is also widely used. One of the key differences between the diagnostic schemas is that ICD only requires that symptoms to be present for I month.
C Duration:
C o n t i n u o u s signs o f t h e d i s t u r b a n c e p e r s i s t f o r at least
6 m o n t h s . T h i s 6 - m o n t h p e r i o d m u s t i n c l u d e at least 1 m o n t h of s y m p t o m s ( o r less if successfully t r e a t e d ) t h a t m e e t C r i t e r i o n A (i.e. active-phase s y m p t o m s ) and m a y include periods of p r o d r o m a l or residual s y m p t o m s . D u r i n g these p r o d r o m a l o r residual p e r i o d s , t h e signs of t h e d i s t u r b a n c e m a y be m a n i f e s t e d b y o n l y negative s y m p t o m s o r t w o o r m o r e s y m p t o m s listed in C r i t e r i o n A p r e s e n t in an a t t e n u a t e d f o r m (e.g. o d d beliefs, u n u s u a l p e r c e p t u a l experiences). D Schizoaffective
and Mood Disorder exclusion:
Schizoaffective D i s o r d e r
a n d M o o d Disorder with Psychotic Features have been ruled o u t because either ( 1 ) n o M a j o r Depressive, Manic, o r Mixed Episodes have occurred c o n c u r r e n t l y with the active-phase s y m p t o m s ; o r (2) if m o o d episodes have o c c u r r e d d u r i n g active-phase s y m p t o m s , their total d u r a t i o n has been brief relative t o the d u r a t i o n of the active a n d residual periods. E Substance/general
medical condition
exclusion:
T h e d i s t u r b a n c e is n o t
d u e to t h e d i r e c t p h y s i o l o g i c a l effects of a s u b s t a n c e (e.g. a d r u g of abuse, a m e d i c a t i o n ) o r a general medical c o n d i t i o n . F
Relationship
to a Pervasive Developmental
Disorder: If there is a history
of Autistic D i s o r d e r o r a n o t h e r Pervasive D e v e l o p m e n t a l D i s o r d e r , the a d d i t i o n a l diagnosis of S c h i z o p h r e n i a is m a d e o n l y if p r o m i n e n t d e l u s i o n s o r h a l l u c i n a t i o n s are also p r e s e n t f o r at least a m o n t h ( o r less if successfully t r e a t e d ) . ( A m e r i c a n Psychiatric Association, 2000, p. 312, italics in t h e original) T h i s is K r a e p e l i n ' s c l i n i c a l p i c t u r e o f d e m e n t i a p r a e c o x r e f r a m e d i n l a t e - t w e n t i e t h - c e n t u r y psychiatric t e r m i n o l o g y , i n c o r p o r a t i n g t h e Bleulerian distinction b e t w e e n s y m p t o m s f o r ease of identification, a n d r e c o d i n g Jaspers's h a l l m a r k ' u n u n d e r s t a n d a b i l i t y ' of s c h i z o p h r e n i c b e h a v i o u r as distinctively ' b i z a r r e ' positive s y m p t o m s . It is a d i s o r d e r m a r k e d by an inability t o l a b o u r ( w h e r e l a b o u r signifies p a i d e m p l o y m e n t as well as social i n t e r a c t i o n ) , identified t h r o u g h l o n g i t u d i n a l analysis, a n d explicitly d i f f e r e n t i a t e d f r o m m a n i c depressive psychosis a n d s u b s t a n c e - i n d u c e d psychosis. D S M - I V - T R ' s r h e t o r i c o f s c i e n t i f i c i t y a n d its s t r a t e g i c silence o n t h e fiercely d e b a t e d q u e s t i o n o f aetiology facilitate global c o n s i s t e n c y in t h e d i a g n o s i s of m e n t a l illness, b u t legitimize the t e n d e n c y t o ignore the very vexed issue of w h e t h e r s c h i z o p h r e nia is indeed a disease entity. T h e clinical p i c t u r e o f f e r e d here, like Kraepelin's b e f o r e it, s t i m u l a t e s an already prolific research interest in this i n d e t e r m i n a t e d i s o r d e r b y itself b e i n g i m p o t e n t t o d i s c r i m i n a t e b e t w e e n f i n d i n g s . So it is precisely in being a dry, d e t a c h e d d e s c r i p t i o n of this m o d e r n m a d n e s s that the DSM reinforces s c h i z o p h r e n i a ' s status as the sublime object of psychiatry.
T h e Diagnostic and Statistical Manual
itself does little to explain o r resolve the
seemingly inexhaustible a n d irresolvable challenges p o s e d b y Kraepelin's elusive disease entity. It also d o e s n o t give a s t r o n g indication of t h e specific i m p o r tance of s c h i z o p h r e n i a t o the disciplinary d e v e l o p m e n t of psychiatry, n o r t h e psychiatric r e p r e s e n t a t i o n of s c h i z o p h r e n i a as a f u n d a m e n t a l l y i n d e t e r m i n a t e o r u n k n o w a b l e disorder, b o t h of which c o n t r i b u t e , I argue, t o s c h i z o p h r e n i a ' s sublime status in psychiatric discourse. W h e r e a s s o m e f o r m s of m a j o r m e n t a l illnesses have b e e n f o r g o t t e n (for example, governess psychosis (Bleuler, 1950, p. 3 4 2 ) ) , s u b s u m e d b y s u b s e q u e n t t a x o n o m i e s ( m a s t u r b a t o r y p s y c h o s i s ( G i l m a n , 1988, p. 205)), a b a n d o n e d as a result of political p r o t e s t ( h o m o s e x u ality (Shorter, 1997, p. 301)), a n d v e h e m e n t l y c o n t e s t e d even within o r t h o d o x psychiatry ( m u l t i p l e personality d i s o r d e r (Goldberg, 1999, p p . 183-4)), schizo p h r e n i a has, since its i d e n t i f i c a t i o n , b e e n c o n s i s t e n t l y viewed as the p r o p e r o b j e c t of a s c i e n t i f i c p s y c h i a t r y a n x i o u s t o alleviate o n e of t h e m o s t severe f o r m s of h u m a n suffering, as well as secure a n d m a i n t a i n its p o s i t i o n as p r e e m i n e n t a u t h o r i t y o n m e n t a l health. Still c o m p r i s i n g a significant percentage, if n o t the m a j o r i t y , of l o n g - t e r m psychiatric cases, p e o p l e d i a g n o s e d as suffering f r o m s c h i z o p h r e n i a are also at t h e ' c o r e of p s y c h i a t r i c b u s i n e s s ' ( H e a l y , 2002, p. 329). Psychiatrists, like m o s t medical practitioners, d i d n o t delay the t r e a t m e n t of severe d i s o r d e r s u n t i l o u t s t a n d i n g t h e o r e t i c a l issues h a d b e e n resolved b u t p u r s u e d a n u m b e r of d i f f e r e n t t h e r a p e u t i c p a t h w a y s s i m u l t a n e o u s l y . M o d e r n psychiatry's m o s t n o t o r i o u s i n t e r v e n t i o n s in m e n t a l illness have b e e n m a d e in the n a m e o f ' c u r i n g ' s c h i z o p h r e n i a . As T h o m a s Szasz wryly observed in 1976 (pp. 112-9), people diagnosed with schizophrenia have been subjected to a p l e t h o r a of largely ill-conceived ' c u r e s ' , f r o m m e g a - v i t a m i n s t o fasting, religious i n s t r u c t i o n to regular beating. M o r e c o m m o n a n d widely k n o w n treatm e n t s such as insulin c o m a t h e r a p y a n d electro-convulsive t r e a t m e n t , a l t h o u g h credited w i t h alleviating certain psychotic s y m p t o m s , are n o t necessarily b e t t e r theoretically s u b s t a n t i a t e d t h a n their m o r e bizarre p r e d e c e s s o r s (Shorter a n d Healy, 2 0 0 7 ) . T h e p r a c t i c e of t r e a t i n g s c h i z o p h r e n i a b y p e r f o r m i n g f r o n t a l lobe l o b o t o m y — a l s o developed w i t h o u t significant theoretical j u s t i f i c a t i o n is u n q u e s t i o n a b l y the m o s t i n f a m o u s of all psychiatry's strategies of s y m p t o m management. It was, h o w e v e r , t h e use of antipsychotic d r u g s t o c o n t r o l the positive s y m p t o m s of s c h i z o p h r e n i a t h a t r e v o l u t i o n i z e d p s y c h i a t r i c p r a c t i c e , f o r g i n g n e w a n d p o w e r f u l c o n n e c t i o n s between psychiatry a n d t h e p h a r m a c e u t i c a l i n d u s try. In The Creation
of Psychopharmacology,
David Healy describes the discov-
ery of c h l o r o p r o m a z i n e as n o less t h a n ' o n e of t h e s e m i n a l events of h u m a n history* (2002, p . 4), a n d m a k e s clear that s c h i z o p h r e n i a ' s i m p o r t a n c e to t h e
d e v e l o p m e n t of p s y c h o p h a r m a c o l o g y a n d t h e p h a r m a c e u t i c a l m a n a g e m e n t of all m e n t a l illness c a n n o t b e o v e r e m p h a s i z e d . T h e efficacy o f n e u r o l e p t i c d r u g s in relieving c e r t a i n f l o r i d p s y c h o t i c s y m p t o m s w a s t h e first g r e a t success s t o r y o f p s y c h o p h a r m a c o l o g y , b u t a success n o t w i t h o u t n e g a t i v e side-effects. Early a n t i p s y c h o t i c s c a u s e d t h e e x t r e m e l y d e b i l i t a t i n g t a r d i v e d y s k i n e s i a , failed t o affect the so-called negative a n d cognitive s y m p t o m s of schizophrenia, a n d qualitatively and quantitatively diminished the c o m m u n i c a t i o n between patient a n d psychiatrist (Healy, 2002, pp. 2 4 5 - 8 5 ) . Second-generation, or ' a t y p i c a l ' a n t i p s y c h o t i c s h a v e b e e n s u c c e s s f u l in r e d u c i n g t h e a p p e a r a n c e of e x t r a p y r a m i d a l s y m p t o m s , b u t d o n o t n e c e s s a r i l y i m p r o v e u p o n earlier a n t i p s y c h o t i c s ( A b b o t t , 2010; G e d d e s et al„ 2000; L i e b e r m a n et al., 2 0 0 5 ) , p a r t i c u larly in their p r o p e n s i t y t o cause diabetes, loss of libido, a n d c o n s i d e r a b l e w e i g h t gain ( N a s r a l l a h , 2 0 0 3 , 2 0 0 8 ) . 2 9 T h e acknowledgement o r realization that schizophrenic s y m p t o m s could be m o d i f i e d if n o t a b o l i s h e d s i g n a l l e d a s i g n i f i c a n t s h i f t in p s y c h i a t r i c t h i n k i n g . E a r l y t w e n t i e t h - c e n t u r y p s y c h i a t r i s t s r e g a r d e d s c h i z o p h r e n i a as a h e r e d i t a r y , e n d o g e n o u s disease, a n d as s u c h a n y r e s p o n s e t o t r e a t m e n t w o u l d h a v e b e e n e v i d e n c e t h a t t h e d i a g n o s i s itself w a s i n c o r r e c t ( H e a l y , 2 0 0 2 , p. 72). T h e c o n troversial t r e a t m e n t s of s c h i z o p h r e n i a that arose t h r o u g h o u t the twentieth c e n t u r y , a n d t h o s e n o w e n d o r s e d in t h e t w e n t y - f i r s t , 3 0 exist in s u c h n u m b e r s 29
Psychiatry's dependence on neuroleptic drugs in the treatment of schizophrenia has been widely criticized by certain antipsychiatrists, as I discuss in Chapter 3, and has also attracted passionate criticism from those within its own ranks. Peter Breggin, for example, argues that antipsychotic drugs are the pharmacological equivalent for surgical lobotomy: by placing a 'chemical clamp on the higher brain' they 'can have no specifically beneficial effect on any particular human problem' regardless of whether or not they modify the appearance of schizophrenic symptoms (Breggin, 1991, pp. 55-7). Recent books by Joanna Moncrieff (2009) and Richard Bentall (2009) similarly argue for a radical reappraisal of received wisdoms about the efficacy of psychopharmacological interventions, and the UK-based critical psychiatry network (http://www.critpsynet.freeuk. com/) has as one of its main goals 'the development of a critique of the influence of the pharmaceutical industry on the theory and practice of psychiatry' (Bracken and Thomas, 2010a, p. 226).
30
Although the exploration of off-beat therapies persists (see Mitchell and Michalczuk, 2010; Xia and Grant, 2009), the evidence base is building for a range of psychosocial (Dixon et al., 2010; Tai and Turkington, 2009; Velligan, 2009) as well as psychopharmacological treatments (Buchanan et al., 2010). The latest report from the Patient Outcomes Research Team (PORT) identifies '24 treatment areas that have strong empirical evidence for improving outcomes and which should comprise the basic menu of treatments and services available to all people with schizophrenia' (Kreyenbuhl et al., 2010, p. 100). Frustrated by the pace of evidence based research in this area, and the lack of any significant breakthroughs, the PORT authors arc careful to note that 'These treatments do not "cure" schizophrenia or fully ameliorate symptoms and problems for the
in p a r t b e c a u s e of d i v e r g e n c e s in p s y c h i a t r i c o p i n i o n r e g a r d i n g t h e a e t i o l o g y o f s c h i z o p h r e n i a . In s o m e cases, n e w t r e a t m e n t s h a v e n o t s i m p l y relied u p o n b u t h a v e d i r e c t l y s p a w n e d n e w t h e o r i e s of t h e d i s o r d e r — t h e d o p a m i n e h y p o t h e s i s o f s c h i z o p h r e n i a b e i n g a case in p o i n t . 3 1 G e n e t i c t h e o r i e s o f s c h i z o p h r e n i a have c o n t i n u e d to be influential since Kraepelin a n d Bleuler a d v a n c e d their beliefs t h a t t h e disease w a s i n h e r i t e d , a l t h o u g h t h e s e a r c h f o r s c h i z o p h r e n i a ' s g e n e t i c o r i g i n s r e m a i n s elusive ( C r o w , 2008; K e n d l e r , 2005; W i l l i a m s o n , 2 0 0 7 ) a n d still c r i t i c i z e d ( B e n t a l l , 2 0 0 9 ) . B u t t h a n k s i n p a r t t o t h e i n f l u e n c e o f a n t i p s y c h o t i c d r u g s , d e v e l o p m e n t s in n e u r o s c i e n c e , a n d t h e r e - e m e r g e n c e of a K r a e p e l i n i a n a c c o u n t o f s c h i z o p h r e n i a in D S M - I I I a n d IV, t h e i d e a t h a t schizo p h r e n i a is c a u s e d b y a n a s - y e t - u n k n o w n b r a i n d i s e a s e still d o m i n a t e s c o n temporary psychiatry.32 T h e r e c e n t Diagnosis: Families
and Helping
Schizophrenia:
Professionals
A Comprehensive
Guide for
Patients,
d i s s e m i n a t e s t h i s r e c e i v e d w i s d o m t o a lay
reader: Schizophrenia is a disease of the brain that affects about one percent of the population. [. ..] A number of researchers are investigating different possible causes of schizophrenia, but for now the exact cause is u n k n o w n . . . . But no matter how this disease develops, it is important to remember that schizophrenia is an illness of the brain, and it's no one's fault. (Miller and Mason, 2002, p. 35) 33
31
majority of affected individuals; such objectives remain for future generations of research' (Kreyenbuhl et al., 2010, pp. 101-2). Writing in 2002, Healy suggests that 'The dopamine hypothesis of schizophrenia . . . argued backward from the efficacy of the treatment to what might be the cause of the disorder. That made little more sense that arguing that because aspirin was useful in treating rheumatoid arthritis there must be some kind of aspirin deficiency implicated in rheumatoid arthritis. Yet, despite its weakness, the dopamine hypothesis of schizophrenia was successfully used by the pharmaceutical industry to sell drugs' (p. 191). The current status of the dopamine hypothesis is usefully summarized in Howes and Kapur (2009).
32
This point finds support in the fascinating research conducted by Harland and colleagues (2009) into the attitudes of trainee psychiatrists. Measuring the trainee's attitudes towards eight models of mental illness as applied to four psychiatric disorders, the researchers found that attitudes towards schizophrenia were expressed with the greatest conviction and that of the 32 possible models the biological model of schizophrenia enjoyed the strongest support. As the authors point out, a more comprehensive understanding of the attitudes with which mental health professionals approach mental illness, perhaps especially schizophrenia, has the potential to improve multi-disciplinary communication and ultimately patient care.
13
leffrey Poland suggests that the public education campaigns around the biology of schizophrenia have been 'aggressive' 'partly in an attempt to offset widespread stigma associated with the label and partly to reinforce the existing practices centred around the
Even e x p e r t o p i n i o n r e p r o d u c e s K r a e p e l i n ' s a u t h o r i t a t i v e r h e t o r i c as well as his n e u r a l p r e f e r e n t i a l i s m : 'Eventually, t h e r e will b e s o m e highly specific physical m e t h o d f o r d e t e c t i n g s c h i z o p h r e n i a , as well as t h e p r e d i s p o s i t i o n t o it. W e k n o w t h a t s o m e t h i n g goes w r o n g chemically a n d / o r physically in t h e b r a i n of t h e schizo p h r e n i c , b u t w e d o n o t y e t k n o w w h a t ' ( G o t t e s m a n , 1991, p. 19). O t h e r s a r e m o r e c a n d i d a b o u t psychiatry's failure t o p r o v e conclusively Kraepelin's beliefs: As far as defining the clinical boundaries of schizophrenia/dementia praecox is concerned, we have not moved very far in the last 100 years. We still have the same difficulty that Kraepelin had; we believe we are defining an entity which will be shown to have a tangible underlying morbid process, but we cannot demonstrate that process. Things are better for us than they were for Kraepelin . . . the darkness does not seem so impenetrable any more, but the dawn will have to break more fully before we can be clear about the central cluster of clinical features which mean that someone should be diagnosed as having schizophrenia. (Johnstone et al., 1999, p. 38) In 1913, Jaspers a t t a c k e d t h e p e r c e p t i o n t h a t ' b r a i n r e s e a r c h ' s h o u l d b e ' n o t o n l y o n e t a s k a m o n g m a n y b u t the t a s k of p s y c h i a t r y ' , a n d u r g e d his colleagues t o ' g u a r d a g a i n s t any one viewpoint
becoming
an absolute
e v e n if s u c h a view-
p o i n t p r o v e s f r u i t f u l f o r r e s e a r c h a n d m i g h t n o w a n d t h e n e v e n b e decisive f o r r a d i c a l t h e r a p y ' (Jaspers, 1972, p. 577, italics in t h e o r i g i n a l ) . It is t h e i n a b i l i t y t o p r o d u c e c o n c l u s i v e e v i d e n c e of s c h i z o p h r e n i a ' s aetiology ( F a t e m i a n d F o l s o m , 2009; S t e p h a n et al., 2 0 0 9 ) t h a t p r e v e n t s ' b r a i n r e s e a r c h ' f r o m c u r t a i l i n g t h e i n v e s t i g a t i o n o f s c h i z o p h r e n i a . E l u d i n g p s y c h i a t r y at b o t h t h e m a c r o a n d m o l e c u l a r levels, s c h i z o p h r e n i a h a s yet t o b e s h o t d o w n e i t h e r b y ' m a g i c b u l l e t ' t r e a t m e n t s o r b y aetiological e x p l a n a t i o n . Although neuroscientific accounts of schizophrenia r e m a i n d o m i n a n t , n e w a p p r o a c h e s t o t h e s t u d y a n d t r e a t m e n t o f s c h i z o p h r e n i a a r e e m e r g i n g as p a r t o f b r o a d e r s h i f t s in clinical p r a c t i c e a n d policy. W e are, a c c o r d i n g t o P a t r i c k Bracken a n d Philip T h o m a s , entering an era o f ' p o s t p s y c h i a t r y ' characterized b y a diversity of clinical perspectives, an attentiveness to social a n d cultural d i f f e r e n c e , a r o b u s t q u e s t i o n i n g o f t h e d o m i n a n c e of t h e b i o m e d i c a l m o d e l a n d of p s y c h o p h a r m a c o l o g i c a l interventions, a n d a p r o f o u n d c o m m i t m e n t t o i n c r e a s i n g t h e i n v o l v e m e n t o f s e r v i c e u s e r s in r e f o r m i n g , r e s e a r c h i n g , a n d d e l i v e r i n g m e n t a l h e a l t h services ( B r a c k e n a n d T h o m a s , 2 0 0 5 , 2 0 1 0 a , b; G a w i t h a n d A b r a m s , 2 0 0 6 ) . T h e r e is also i n c r e a s i n g r e c o g n i t i o n t h a t c u l t u r e is
concept' (Poland, 2007, p. 168). However, recent studies have shown that such programmes of education in mental health literacy can have the unwanted and unanticipated effect of increasing stigma and the desire for social distance (Angermeyera et al., 2009; Sartorius, 2010).
critical t o u n d e r s t a n d i n g e v e r y a s p e c t of s c h i z o p h r e n i a ( J e n k i n s a n d B a r r e t t , 2004a, p. 6), a n d t h u s t h a t e x p e r i e n c e s of s c h i z o p h r e n i a will v a r y f r o m r e g i o n t o r e g i o n as well as f r o m p e r s o n t o p e r s o n . W h e r e o n c e s c h i z o p h r e n i a w a s s y n o n y m o u s with long-stay hospitalization a n d an expectation of p e r m a n e n t disability, t o d a y t h e ' r e c o v e r y ' a p p r o a c h is r a p i d l y g r o w i n g in i n f l u e n c e (Craig, 2 0 0 8 ; D a v i d s o n , 2 0 1 0 ; R a m o n et al., 2 0 0 7 ) . 3 4 A l t h o u g h t h e r e is g r e a t h o p e a m o n g m a n y that an e m p h a s i s o n recovery, o n valuing individual experience, and o n a service-user-led approach to psychiatric research and therapeutic s u p p o r t will s i g n i f i c a n t l y i m p r o v e t h e e x p e r i e n c e o f p e o p l e d i a g n o s e d w i t h severe m e n t a l illness ( H o r n s t e i n , 2 0 0 9 ) , c h a l l e n g e s t o t h e c o n c e p t of s c h i z o p h r e n i a itself h a v e yet t o r e a c h a t i p p i n g p o i n t . 'Is it p o s s i b l e t o s u m m a r i s e t h e s e t h e m e s a n d v a r i a t i o n s , o r is t h e n o t i o n of s c h i z o p h r e n i a t o o d i f f u s e t o clarify?' asks T r e v o r T u r n e r ( 1 9 9 5 , p . 3 5 5 ) . F o r Healy, lack of clarity h a s b e e n integral t o s c h i z o p h r e n i a ' s s t a t u s in t h e big b u s i ness of p s y c h o p h a r m a c o l o g y : ' T h e e m e r g e n c e a n d survival o f c o n c e p t s in b o t h t h e b u s i n e s s a n d a c a d e m i c m a r k e t p l a c e s is o f t e n d e t e r m i n e d b y t h e " s l o g a n " v a l u e of t h e c o n c e p t [ a n d ] t e r m s like s c h i z o p h r e n i a . . . w o r k e d b e c a u s e t h e y c a r r i e d j u s t t h e r i g h t level of a m b i g u i t y ' ( 2 0 0 2 , p. 2 5 4 ) . T h e s t a r k p r e s e n t a t i o n of d i a g n o s t i c c r i t e r i a in D S M - I V - T R d i s g u i s e s t h e i n h e r e n t i n d e t e r m i n a c y of t h e c o n c e p t , a n d it is t h i s b a l a n c e b e t w e e n K r a e p e l i n i a n clarity a n d c o n c e p t u a l i n d e t e r m i n a c y t h a t h a s b e e n crucial t o p s y c h i a t r y ' s d i s c i p l i n a r y l e g i t i m i z a t i o n and expansion. Books o n schizophrenia endlessly reiterate the professional fascination with this d i s o r d e r , poetically describing the disciplinary pursuit of t h i s d i s t i n c t b u t u n k n o w a b l e ' e s s e n c e o f m a d n e s s ' as if it w e r e i n d e e d t h e m a p p i n g of t h e s u b l i m e : Albeit the heartland of psychiatry, schizophrenia remains a will o' the wisp landscape, full of shadows and chimeras. Explorers here have laboured hard to define the territory, establish landmarks, and to discover the cause and meaning underlying what they have seen. Alas, this journey of discovery has been painstakingly slow . . . [However] the inadequacy always apparent in our theories is gradually giving rise to new appraisals of a more radical kind. These reappraisals enshrine what we have always known, that schizophrenia is a most subtle and challenging disorder, but, in addition, they are accompanied by a new determination to meet the challenge with a whole range of sophisticated techniques. (Bebbington and McGuffin, 1988, p. 1)
14
In the UK, for example, New Horizons was the first cross-government strategy to foreground well-being, health, and recovery in the treatment of schizophrenia (Mental Health Division, 2009), and the multi-million pound Time to Change campaign has explicitly challenged misconceptions about schizophrenia as part of its effort to end mental health discrimination.
N o m a t t e r h o w great their d e t e r m i n a t i o n , or h o w sophisticated their techn i q u e s , psychiatrists h a v e so far b e e n u n a b l e t o r e d u c e s c h i z o p h r e n i a to the c o m f o r t a b l e status of s o m e t h i n g like a s u b s t a n c e - a b u s e psychosis—aetiologically a n d symptomatologically explicable, a n d r o u t i n e l y c u r e d . But a l t h o u g h this o b s e r v a t i o n m a y a p p l y t o a r a n g e o f p s y c h i a t r i c d i s o r d e r s , s c h i z o p h r e n i a is f r e q u e n t l y a s s i g n e d a special s t a t u s : ' A m o n g all t h e m a l a d i e s a n d d i s o r d e r s t h a t c h a l l e n g e o u r species, t h e r e is, q u i t e s i m p l y , n o t h i n g else like it' ( G r e e n , 2003, p. xii). Szasz's c l a i m t h a t like ' " d i v i n e " a n d " d e m o n i c " , " s c h i z o p h r e n i c " is a c o n c e p t w o n d e r f u l l y v a g u e in its c o n t e n t a n d t e r r i f y i n g l y a w e s o m e in its i m p l i c a t i o n s ' (Szasz, 1976, p. xiv) still r e s o n a t e s o v e r 30 y e a r s later. T h i s c h a p t e r h a s p r e s e n t e d a n a c c o u n t of p s y c h i a t r y ' s o n g o i n g K r a e p e l i n i a n c o n v i c t i o n that s c h i z o p h r e n i c s y m p t o m s result f r o m an u n d e r l y i n g disease p r o c e s s . 3 5 I h a v e d e s c r i b e d a p s y c h i a t r y c o n f i d e n t in its p o t e n t i a l t o m a n a g e s c h i z o p h r e n i a in t h e o r y a n d in p r a c t i c e b u t u n a b l e t o e x p l a i n o r t r e a t it c o n c l u s i v e l y . T h e s e c l a i m s n e e d n o w t o b e u n d e r s t o o d in r e l a t i o n t o clinical t h e o r y m o r e b r o a d l y . T h e d i s c i p l i n a r y d o m i n a t i o n of biological p s y c h i a t r y w a s b r o u g h t t o a n e n d b y t h e N a z i s ' g e n o c i d a l e u g e n i c s p r o g r a m m e , a n d it t o o k t h e p u b l i c a t i o n o f D S M - I I I in 1980 t o b r i n g K r a e p e l i n ' s clinical p i c t u r e o f d e m e n tia p r a e c o x b a c k t o t h e c e n t r e o f p s y c h i a t r i c t h i n k i n g , w h e r e it n o w d o m i n a t e s t h e r e s e a r c h a g e n d a . T o p r o v i d e a m o r e c o m p r e h e n s i v e a c c o u n t of s c h i z o p h r e n i a in t w e n t i e t h - c e n t u r y clinical t h e o r y , it is vital t o c o n s i d e r t h e w a y s in w h i c h psychoanalysis not only challenged psychiatric m o d e l s of schizophrenia b u t a l s o a d v a n c e d c o m p e t i n g a c c o u n t s of t h i s d i s o r d e r . T h e f o l l o w i n g c h a p t e r , t h e n , e x t e n d s m y analysis o f t h e s t a t u s of s c h i z o p h r e n i a t o t h e k e y texts of psyc h o a n a l y s i s . W h e r e a s p s y c h i a t r y p u r s u e s s c h i z o p h r e n i a p r i m a r i l y t h r o u g h its s y m p t o m a t o l o g y a n d c a n n o t , e v e n b y its o w n e s t i m a t i o n , p r o v i d e an a d e q u a t e aetiological e x p l a n a t i o n f o r t h e d i s o r d e r , p s y c h o a n a l y s i s investigates t h e m e a n ing of s c h i z o p h r e n i c e x p e r i e n c e a n d o f f e r s vivid a c c o u n t s of its p s y c h i c origins. D e s p i t e t h e s i g n i f i c a n t t h e o r e t i c a l d i f f e r e n c e s b e t w e e n t h e s e d i s c i p l i n e s , I will a r g u e t h a t in t h e case of s c h i z o p h r e n i a t h e y c o n v e r g e at t h e level o f m e t a t h e o r y : for psychoanalysts, psychiatry's sublime object refuses the conventional p a r a m e t e r s of t h e a n a l y t i c e n c o u n t e r o n l y t o b e i n t e r p r e t e d as a s u b l i m e text.
35
Indeed, despite the fact that 'accumulating genomic evidence indicates that there may be scores or hundreds of lesions contributing to [a] final common syndrome', and that the 'clinical evidence supports the possibility that what we have labelled schizophrenia for the past century may be many different disorders with different outcomes' (Insel, 2010, p. 191), the sense that 'it' is and will still be a meaningful concept seems doggedly to persist.
Chapter 2
Schizophrenia: the sublime text of psychoanalysis
The schizophrenic symptom and its secret As w e h a v e seen, s c h i z o p h r e n i a o c c u p i e s a c e n t r a l p o s i t i o n in p s y c h i a t r i c d i s c o u r s e : f r a m e d as a n o p a q u e a n d b i z a r r e d i s o r d e r of u n k n o w n o r u n k n o w a b l e aetiology, it e x c e e d s a n d t h u s m a r k s d i s c i p l i n a r y l i m i t s as a f o r m o f u n r e a s o n which can be neither adequately represented n o r analytically mastered. A l t h o u g h p s y c h i a t r y is u n q u e s t i o n a b l y t h e d o m i n a n t c l i n i c a l d i s c o u r s e o n s c h i z o p h r e n i a t o d a y , t h e i n f l u e n c e of p s y c h o a n a l y t i c a c c o u n t s of s c h i z o p h r e n i a o n t h e c r i t i c a l a n d p o p u l a r i m a g i n a r i e s is i n d i s p u t a b l e , e v e n t h o u g h d e m e n t i a praecox, paranoia, p a r a p h r e n i a , a n d psychosis are the t e r m s privileged in p s y c h o a n a l y s i s . 1 So, w h a t is t h e s t a t u s o f s c h i z o p h r e n i a in k e y p s y c h o a n a l y t i c texts? D o p s y c h o a n a l y t i c a c c o u n t s of p s y c h o s i s relate s c h i z o p h r e n i a t o t h e s u b l i m e ; a n d if so, h o w ? A n d h o w c a n a n a n a l y s i s o f s c h i z o p h r e n i a a n d s u b l i m i t y in p s y c h o a n a l y t i c w r i t i n g b e t t e r e q u i p u s t o i d e n t i f y a n d i n t e r p r e t t h e s u b s e q u e n t a p p r o p r i a t i o n , a d a p t a t i o n , a n d r e j e c t i o n of p s y c h o a n a l y t i c c o n c e p t s in c u l t u r a l t h e o r y ? It is n o t t h e a i m of t h i s c h a p t e r t o p r o v i d e a c o m p r e h e n s i v e c h r o n o l o g i c a l s u r v e y o f a c e n t u r y o f p s y c h o a n a l y t i c w r i t i n g o n s c h i z o p h r e n i a . N o r is it t o p r o v i d e a d e t a i l e d c o m p a r a t i v e s t u d y o f p s y c h i a t r i c a n d p s y c h o a n a l y t i c clinical p r a c t i c e . M y c o n c e r n is r a t h e r w i t h t h e b r o a d t h e o r e t i c a l a n d m e t h o d o l o g i c a l differences b e t w e e n the disciplines that centre on questions of the aetiology a n d c o n t e n t of s c h i z o p h r e n i c s y m p t o m s . E x t e n d i n g m y i n q u i r y i n t o t h e s t a t u s of s c h i z o p h r e n i a in clinical t h e o r y a l o n g t h e s e axes, in t h i s c h a p t e r I c o n s i d e r h o w t h e ' d i s c i p l i n a r y s u b l i m e ' o f p s y c h i a t r y is r e c o n f i g u r e d as w h a t I call a ' t e x t u a l s u b l i m e ' b y p s y c h o a n a l y s i s . Privileging t h e analysis o f p s y c h o t i c s p e e c h o v e r s o m a t i c s y m p t o m o r g e n e t i c m a k e - u p , p s y c h o a n a l y s i s , I will a r g u e ,
1
Whereas Freud and Lacan prefer to retain paranoia (or paraphrenia) as a separate diagnostic category, I follow Louis Sass (1994b, p. ix) in identifying their object of analysis as paranoid schizophrenia, hence, schizophrenia. I also consider Lacan's use of the term psychosis to encompass si hi/ophrenia.
S C H I Z O P H R E N I A : THE S U B L I M E TEXT OF P S Y C H O A N A L Y S I S
a p p r o a c h e s s c h i z o p h r e n i a as a d i s o r d e r of signification, a n d t h e s c h i z o p h r e n i c p a t i e n t as a text. T h e goal o f t h e p s y c h o a n a l y t i c t r e a t m e n t o f h y s t e r i a is t o u n c o v e r a n d t r a n s l a t e t h e r e p r e s s e d p s y c h o s e x u a l o r i g i n of n e u r o t i c s y m p t o m s , effectively relieving t h e m . In t h e case of s c h i z o p h r e n i a , however, there is n o intrinsic c o n n e c t i o n b e t w e e n t h e h e r m e n e u t i c r e a d i n g of t h e s c h i z o p h r e n i c s y m p t o m a n d t h e t h e r a p e u t i c t r e a t m e n t of t h e p a t i e n t . It is t h r o u g h a process o f ' t e x t u a l i z a t i o n ' , an implicit division b e t w e e n speech a n d p a t i e n t , that psyc h o a n a l y s i s s i m u l t a n e o u s l y d i s p e l s a n d p e r p e t u a t e s t h e a u r a of s u b l i m i t y a r o u n d s c h i z o p h r e n i a . S c h i z o p h r e n i c signification can be r e n d e r e d intelligible a n d analytically m a s t e r e d ; however, t h e p e r s o n d i a g n o s e d w i t h s c h i z o p h r e n i a is d e e m e d , at least f o r F r e u d , t o be b e y o n d dialogue, i n c a p a b l e of transference, a n d h e n c e inaccessible t o p s y c h o a n a l y t i c t r e a t m e n t . T h e d o u b l e , paradoxical gesture of the textual s u b l i m e is t o tackle that w h i c h is bizarre o r u n k n o w a b l e about schizophrenia—to 'rescue' through interpretation
schizophrenic
s i g n i f i c a t i o n — w h i l e at t h e s a m e t i m e p r e s e r v i n g t h e essential e n i g m a of t h e d i s o r d e r itself. Like psychiatry's disciplinary sublime, t h e o n g o i n g o p e r a t i o n of t h e textual s u b l i m e is e n s u r e d b y t h e fact t h a t n o limit can be i m p o s e d o n (re) i n t e r p r e t a t i o n s of t h e s c h i z o p h r e n i c text because n o criteria of t h e r a p e u t i c success can be m o b i l i z e d t o arbitrate b e t w e e n t h e m . As this c h a p t e r e n d e a v o u r s t o d e m o n s t r a t e , t h e p s y c h o a n a l y t i c c o n s t r u c t i o n of s c h i z o p h r e n i a as a s u b l i m e t e x t is n o w h e r e m o r e a p p a r e n t t h a n in t h e case of D a n i e l P a u l S c h r e b e r ' s Memoirs
of My Nervous
Illness (1955), an a u t o b i o g r a p h i c a l a c c o u n t of p a r a -
n o i d s c h i z o p h r e n i a c e n t r a l t o t h e a c c o u n t s of p s y c h o s i s a d v a n c e d b y F r e u d (1981), Lacan (1993), a n d i n n u m e r a b l e psychoanalytic, o r psychoanalytically engaged, c o m m e n t a t o r s . A detailed d i s c u s s i o n of t h e w o r k of F r e u d a n d Lacan is i n d i s p e n s a b l e f o r analysing the influence of psychoanalysis o n t h e p o r t r a y a l of s c h i z o p h r e n i a in t h e theoretical texts u n d e r c o n s i d e r a t i o n in Part T w o of this b o o k . F u r t h e r m o r e , as F r e u d a n d Lacan's respective interests in s c h i z o p h r e n i a are p r i m a r i l y t h e o retical a n d textual, r a t h e r t h a n p s y c h o t h e r a p e u t i c o r even clinical, it is in their w o r k o n p s y c h o s i s , a n d t h e w o r k t h e y i n s p i r e d , t h a t t h e t e x t u a l s u b l i m e of psychoanalysis m o s t clearly operates. By c o n t r a s t , t h e psychoanalytic a c c o u n t s of s c h i z o p h r e n i a t h a t d o m i n a t e d A m e r i c a n p s y c h i a t r y f r o m t h e 1950s t o t h e 1970s, a n d i n t r o d u c e d t h e i n f a m o u s s c h i z o p h r e n o g e n i c m o t h e r to t h e p o p u l a r i m a g i n a r y , a d v a n c e a d i f f e r e n t m e t a t h e o r e t i c a l f r a m e w o r k a n d so n e g o t i a t e t h e s u b l i m e status of s c h i z o p h r e n i a in diverse ways. D e f i n i n g s c h i z o p h r e n i a as a 'loss of ego b o u n d a r i e s ' a n d a 'gross i m p a i r m e n t of reality testing' ( A m e r i c a n Psychiatric Association, 2000, p. 297), ego psychologists a n d o b j e c t - r e l a t i o n s theorists r e c o n c e p t u a l i z e d s c h i z o p h r e n i a as the regression t o an earlier, i n f a n tile phase of psychosexual d e v e l o p m e n t . T h e effect of this 'regressive m o d e l of
THE S C H I Z O P H R E N I C S Y M P T O M A N D ITS SECRET
s c h i z o p h r e n i a ' , as it h a s b e e n called b y L o u i s Sass ( 1 9 9 2 , p . 2 0 ) , is essentially t h e d i f f u s i o n o f t h e s u b l i m e s t a t u s s c h i z o p h r e n i a a c q u i r e s in p s y c h i a t r i c d i s c o u r s e . If s c h i z o p h r e n i a is a s t a g e t h r o u g h w h i c h e v e r y o n e m u s t p a s s , if it is m a r k e d b y a r e t u r n t o i n f a n t i l e m o d e s o f b e h a v i o u r , if it is c a u s e d b y t h e ' t r a n s m i s s i o n of i r r a t i o n a l i t y ' in a p e r s o n ' s f a m i l y (Fine, 1979, p. 2 8 8 ) , if it s h o u l d b e l o c a t e d o n a c o n t i n u u m w i t h o t h e r m e n t a l d i s t u r b a n c e s , o r i n d e e d is s e e n t o u n d e r l i e all f o r m s o f ' m e n t a l m o r b i d i t y ' ( J o n e s , 1948, p . 3 7 3 ) , t h e n it is n o t surprising that o n e f a m o u s American psychoanalyst should have claimed that half t h e a d u l t p o p u l a t i o n w a s a f f e c t e d b y it t o s o m e d e g r e e ( H a r r y S. Sullivan q u o t e d in Fine, 1979, p . 4 9 7 ) . It is also u n r e m a r k a b l e t h a t a c o n t e m p o r a r y e g o p s y c h o l o g i s t w o u l d u n e q u i v o c a l l y state t h a t ' T h e r e is p e r h a p s n o b e t t e r e x a m ple of a p s y c h o a n a l y t i c t h e o r y t h a t h a s t u r n e d o u t t o b e i n c o r r e c t t h a n t h e o n c e p r e v a l e n t t h e o r y r e g a r d i n g t h e etiology of s c h i z o p h r e n i a ' (Willick, 2001, p. 2 8 ) . Clearly, this d i f f u s i o n of t h e s c h i z o p h r e n i c s u b l i m e is s u b s t a n t i v e l y d i f f e r e n t f r o m t h e p e r p e t u a t i o n o f a t e x t u a l s u b l i m e , a n d as it is t h e l a t t e r w h i c h h a s b e e n m o s t i n f l u e n t i a l in c u l t u r a l t h e o r y , I d o n o t c o n s i d e r t h e s e 'regressive' p s y c h o a n a l y t i c m o d e l s of s c h i z o p h r e n i a in detail h e r e . 2 T e m p t i n g as it w o u l d b e t o p r o c e e d s t r a i g h t t o F r e u d ' s a n d L a c a n ' s f o u n d a t i o n a l p s y c h o a n a l y t i c s t u d i e s o f s c h i z o p h r e n i a , it is n e c e s s a r y first t o e x a m i n e t h e c o n t e x t in w h i c h t h e y d e v e l o p e d . At issue is t h e p s y c h o a n a l y t i c d i s t i n c t i o n b e t w e e n t h e p s y c h i c s t r u c t u r e a n d m e c h a n i s m s o f n e u r o s i s a n d t h o s e of p s y chosis, a n d t h e first p a r t of this c h a p t e r a d d r e s s e s t h e p r o b l e m s d e m e n t i a p r a e c o x initially p o s e d f o r t h e e m e r g i n g d i s c i p l i n e . C a r l J u n g a n d Karl A b r a h a m p u b l i s h e d t h e first sustained psychoanalytic a c c o u n t s of d e m e n t i a p r a e c o x w h i l e w o r k i n g w i t h Bleuler at t h e U n i v e r s i t y C l i n i c in Z u r i c h . D i r e c t l y i n f l u e n c e d by F r e u d , t h e y in t u r n c o n t r i b u t e d to F r e u d ' s s e m i n a l analysis of S c h r e b e r ' s Memoirs.
W o r k i n g at t h e i n t e r s e c t i o n of p s y c h i a t r y a n d p s y c h o a -
nalysis, J u n g a n d A b r a h a m s o u g h t t o e x t e n d p s y c h o a n a l y t i c c o n c e p t s d e v e l o p e d t h r o u g h t h e s t u d y of t h e n e u r o s e s t o t h e a n a l y s i s of d e m e n t i a p r a e c o x , a n d d i d so by h i g h l i g h t i n g the d i s o r d e r s ' s t r u c t u r a l a n d s y m p t o m a t o l o g i c a l s i m i l a r i t i e s . I n The Psychology
of Dementia
Praecox
(1944), Jung argued that
the psychological m e c h a n i s m s of d e m e n t i a p r a e c o x a n d hysteria are similar b u t t h a t t h e f o r m e r is t r i g g e r e d b y a m u c h d e e p e r a n d m o r e c e n t r a l d i s t u r b a n c e , p r o b a b l y b y t h e r e l e a s e o f ' t o x i n ' , as B l e u l e r a l s o h y p o t h e s i z e d . Abraham's 'The Psycho-Sexual Differences between Hysteria and Dementia Praecox' ( A b r a h a m , 1972) a d h e r e s t o K r a e p e l i n i a n d i a g n o s t i c criteria a n d
2
For a useful overview of these models, see 'What's it like? Psychoanalytic theories of schizophrenia' in Suffering Psychosis: Psychoanalytic Essays on Psychosis (Hinshelwood, 2004).
o r t h o d o x F r e u d i a n c o n c e p t s in its suggestion that d e m e n t i a p r a e c o x is m a r k e d b y the display of a u t o - e r o t i c i s m a n d a d i m i n i s h e d capacity for s u b l i m a t i o n a n d t r a n s f e r e n c e . M y analysis of t h e s e t e x t s , i n c l u d i n g J u n g ' s case s t u d y , f o r e g r o u n d s t h e w a y in w h i c h psychoanalysis d i s t i n g u i s h e d itself m e t h o d o l o g i c a l l y a n d theoretically f r o m p s y c h i a t r y t h r o u g h its a t t e n t i v e n e s s t o t h e c o n t e n t of s c h i z o p h r e n i c s y m p t o m s . A l t h o u g h d e m e n t i a p r a e c o x also played an i m p o r t a n t p a r t in t h e politics of the p s y c h o a n a l y t i c m o v e m e n t at t h a t t i m e (Jung's rejection of t h e p r i m a r y role of the sexual libido in its aetiology was a central issue in his split f r o m F r e u d (Steele, 1982)) A b r a h a m ' s a n d Jung's a c c o u n t s of t h e d i s o r d e r are m o s t significant, I will argue, f o r i n a u g u r a t i n g the p s y c h o a n a lytic a p p r o a c h t o s c h i z o p h r e n i a as a text, a n d privileging p a r a n o i d s c h i z o p h r e nia as t h e text m o s t a m e n a b l e to psychoanalytic i n t e r p r e t a t i o n . Freud's definitive analysis of psychosis, his 'Psycho-Analytical N o t e s ' o n the S c h r e b e r case, crystallized this a p p r o a c h t o s c h i z o p h r e n i a as p s y c h o a n a l y t i c o r t h o d o x y . T h e c h o i c e of a s e l f - p u b l i s h e d a u t o b i o g r a p h y as t h e e x e m p l a r y psychotic text allowed F r e u d t o treat s c h i z o p h r e n i a as an abstract interpretive p r o b l e m quite detached f r o m the incarcerated, bellowing Schreber himself. F u r t h e r m o r e , Memoirs
p r o v i d e d F r e u d w i t h an i n - d e p t h description of a delu-
sional s c h e m a d e v e l o p e d a n d r e f i n e d o v e r m a n y years, a s e d u c t i v e illusion, I w o u l d suggest, of c o h e r e n c e a n d c o n s i s t e n c y f r o m w h i c h a p s y c h o a n a l y t i c a c c o u n t of p a r a n o i a c o u l d be derived. M y r e a d i n g of F r e u d ' s 'Psycho-Analytical N o t e s ' c o n c e n t r a t e s o n F r e u d ' s selective i n t e r p r e t a t i o n of S c h r e b e r ' s schizop h r e n i c s y m p t o m s (in particular the hallucinations a n d d e l u s i o n s m o s t clearly related to sexuality) t o refine his h y p o t h e s i s a b o u t p a r a n o i a . Strategically b l u r r i n g d i a g n o s t i c criteria in a m a n n e r K r a e p e l i n w o u l d h a v e a b h o r r e d , F r e u d theoretically distinguished psychotic and neurotic s y m p t o m f o r m a t i o n but n o n e t h e l e s s treated insanity as a c o d e d narrative of psychosexual t r a u m a t h a t c o u l d , like its hysteric c o u n t e r p a r t , be psychoanalytically d e c i p h e r e d . T h i s is m o s t clearly reflected in F r e u d ' s e m p h a s i s o n Schreber's ' u n m a n n i n g ' fantasy, w h i c h , w i t h o u t d i s p u t i n g the s o p h i s t i c a t i o n of F r e u d ' s i n t e r p r e t a t i o n of Schreber's transvestism, I argue entirely overlooks S c h r e b e r ' s m o r e u r g e n t a n d consistent efforts t o p r o v e his rationality to G o d . F r e u d ' s 'Psycho-Analytic N o t e s ' elevated Memoirs
t o t h e status of a psycho-
analytic classic. It also i n s p i r e d a p r o l i f e r a t i o n of interdisciplinary i n t e r p r e t a t i o n s of Schreber's text w h i c h c o n t i n u e the practice of selectively i n t e r p r e t i n g Schreber's s y m p t o m s in o r d e r to establish a c o h e r e n t n a r r a t i v e of o r b e n e a t h his madness. Each of the m a j o r a c c o u n t s of Schreber's Memoirs p u r p o r t s to decip h e r , decisively, t h e 'textualized' sublimity of schizophrenia, to have f o u n d the interpretive master key that will reconcile the text's c o n t r a d i c t i o n s and its c o n nection to the e m b o d i e d reality of psychosis. My analysis of the interdisciplinary
field o f ' S c h r e b e r studies' argues that it is h e r e that t h e o p e r a t i o n of the textual s u b l i m e is m o s t starkly revealed. If psychiatry's disciplinary s u b l i m e entailed the c o n s t a n t r e f r a m i n g of t h e general clinical p i c t u r e of s c h i z o p h r e n i a , h e r e it is the specific c o n t e n t of a single s y m p t o m a t o l o g i c a l profile that is perpetually r e i n t e r p r e t e d . As an i n t e r v e n t i o n in t h e field, m y analysis of S c h r e b e r ' s of My Nervous
Memoirs
Illness takes as its p o i n t of d e p a r t u r e s o m e t h i n g o m i t t e d f r o m
F r e u d ' s analysis, n a m e l y , t h e centrality of the collapse a n d restitution of reason in Schreber's a c c o u n t of his s y m p t o m a t o l o g y . T h e text of Memoirs,
I will argue,
can be persuasively i n t e r p r e t e d as an a r t i c u l a t i o n of t h e s u b l i m i t y of his psychosis: it b o t h r e c o r d s a n d c o n t i n u e s a fight t o establish critical distance f r o m the s u d d e n , direct, a n d u n m e d i a t e d revelation of t h e b e y o n d - h u m a n ; f r o m t h e a p p r e h e n s i o n of a terrifying a n d m a g n i f i c e n t c o s m o l o g y . Recalling the i m p o r t a n c e of d i s t a n c e in f a c i l i t a t i n g t h e s u b l i m e e n c o u n t e r a n d a f f i r m i n g t h e rational faculty, I will a r g u e t h a t Memoirs
is part of S c h r e b e r ' s o n g o i n g p r o j e c t
of d e t a c h i n g f r o m , describing, a n d stabilizing his experience, c o n s t r u c t i n g it as s u b l i m e as o p p o s e d t o ' s i m p l y terrifying'. S c h r e b e r ' s u n d e r t a k i n g in
Memoirs
t h e r e f o r e has m u l t i p l e a n d h i t h e r t o u n r e c o g n i z e d parallels w i t h t h e p s y c h o analytic a p p r o a c h t o psychosis. F r e u d a n d s u b s e q u e n t p s y c h o a n a l y t i c c o m m e n t a t o r s , like Schreber, m a i n t a i n s c h i z o p h r e n i a at a theoretical distance b y treating t h e p e r s o n as a text, d o w n p l a y i n g the i m p o r t a n c e of s o m a t i c a n d cognitive s y m p t o m s , a n d privileging the p s e u d o - n e u r o t i c p a r a n o i d narrative. T h e final p a r t of this c h a p t e r will r e t u r n us to t h e p r i n c i p a l q u e s t i o n of t h e relationship b e t w e e n s c h i z o p h r e n i a , sublimity, a n d textuality in psychoanalysis, a n d specifically t o t h e w o r k of Jacques Lacan. In his a c c o u n t of psychosis, Lacan takes u p directly t h e idea of s c h i z o p h r e n i a as an experience of the s u b lime m a r k e d b y a failure of symbolic r e p r e s e n t a t i o n . T h e psychotic exists, a n d , a c c o r d i n g t o L a c a n , h a s always existed, o u t s i d e t h e s y m b o l i c r e a l m , b a r r e d f r o m access t o it by t h e foreclosure of its g r o u n d i n g signifier, the N a m e - o f - t h e Father. In d r a w i n g o u t s o m e of t h e f u n d a m e n t a l differences b e t w e e n F r e u d i a n a n d Lacanian t h e o r i e s of psychosis, m y a i m is to illustrate ways in which Lacan nonetheless follows F r e u d in distancing the psychotic p a t i e n t f r o m p s y c h o a n a lytic t e c h n i q u e (insisting that people d i a g n o s e d with s c h i z o p h r e n i a are b e y o n d c u r e o r even t h e r a p y , Lacan t r a n s f o r m s t h e p a t i e n t i n t o a p u r e l y i n t e r p r e t i v e p r o b l e m ) while simultaneously suggesting that psychoanalysis provides the master t h e o r y o f s c h i z o p h r e n i a ' s aetiology, s t r u c t u r e , a n d s y m p t o m a t o l o g y .
Tackling dementia praecox: Jung and Abraham In a n y s t u d y o f p s y c h o a n a l y s i s , e s p e c i a l l y o n e t h a t i n v o l v e s t h e e x c h a n g e b e t w e e n F r e u d a n d l u n g , it is easy t o b e s w e p t a w a y by t h e p o l i t i c s o f t h e
p s y c h o a n a l y t i c m o v e m e n t , t h e r e l a t i o n s h i p s o f its key players, a n d t h e c o n s t e l l a t i o n of t h e o r e t i c a l i n n o v a t i o n s t h a t u n d e r p i n n e d its d e v e l o p m e n t . 3 A l t h o u g h the significance of theoretical disputes c a n n o t be overlooked, s u c c u m b i n g to these a c a d e m i c s e d u c t i o n s is a t e m p t a t i o n this c h a p t e r will resist; m y a i m h e r e is t o analyse t h e c h a l l e n g e s early p s y c h o a n a l y t i c t h e o r i s t s o f d e m e n t i a p r a e c o x f a c e d , a n d t h e w a y s in w h i c h t h e y a t t e m p t e d t o resolve t h e m . As a p r i v a t e p r a c t i t i o n e r f o r V i e n n a ' s m i d d l e classes, F r e u d d i d n o t t r e a t p s y c h o t i c p a t i e n t s ; h e h a d n o d i r e c t access t o a s y l u m p o p u l a t i o n s , n o r d i d h e p a r t i c u l a r l y d e s i r e it ( S h o r t e r , 1997, p. 100). F u r t h e r m o r e , as is well k n o w n , h y s t e r i a a n d n o t p s y c h o s i s is t h e p r i v i l e g e d p s y c h i c d i s o r d e r of p s y c h o a n a l y s i s , a n d t h e r e f o r e it is u n s u r p r i s i n g t h a t F r e u d , at t h e o u t s e t , e v i n c e d little t h e o r e t i c a l i n t e r e s t in t h e t h r e e f o r m s o f d e m e n t i a p r a e c o x i d e n t i f i e d b y K r a e p e l i n . All b u t i g n o r i n g h e b e p h r e n i a a n d c a t a t o n i a , F r e u d d i d p o n d e r t h e s u b j e c t o f p a r a n o i a in his l e t t e r s t o W i l h e l m Fliess f r o m 1895 t o 1899, b u t v i e w e d it a l o n g s i d e h y s t e r i a a n d o b s e s s i o n a l n e u r o s i s as a ' s e x u a l p s y c h o n e u r o s i s ' ( F r e u d , 1985a, p. 2 0 9 ) . By e x p l o r i n g c o n n e c t i o n s b e t w e e n p a r a n o i a , a u t o e r o t i c i s m , a n d sexual t r a u m a ( d i s c u s s e d in m o r e detail later in this c h a p t e r ) h e d e f i n e d p a r a n o i a in a n 1896 p a p e r as t h e ' n e u r o s i s o f d e f e n s e p a r excellence' ( F r e u d , 1985b, p. 188), a statem e n t w h i c h u n e q u i v o c a l l y d e m o n s t r a t e s key n o s o l o g i c a l d i f f e r e n c e s b e t w e e n p s y c h o a n a l y s i s a n d t h e b i o l o g i c a l p s y c h i a t r y o f t h e d a y . T h e s e early s p e c u l a t i o n s o n t h e p s y c h o s e x u a l o r i g i n s of p a r a n o i a f o r m t h e f o u n d a t i o n o f F r e u d ' s 1911 a n a l y s i s o f S c h r e b e r ' s Memoirs.
H o w e v e r , it is J u n g a n d A b r a h a m , as
p r a c t i s i n g p s y c h i a t r i s t s , w h o a r e c r e d i t e d w i t h t h e first m a j o r p s y c h o a n a l y t i c i n c u r s i o n s i n t o t h e t e r r i t o r y of d e m e n t i a p r a e c o x . By t h e early t w e n t i e t h c e n t u r y , E u g e n Bleuler's B u r g h o l z l i clinic w a s o n e o f t h e M e c c a s o f w o r l d p s y c h i a t r y . Bleuler t o o k a 'lively i n t e r e s t ' ( F r e u d , 1995, p . 32) in F r e u d ' s w o r k , a n d F r e u d in t u r n c o u r t e d t h e Swiss p s y c h i a t r i s t s as t h e y w e r e in a u n i q u e p o s i t i o n t o test a n d legitimize p s y c h o a n a l y t i c t h e o r y a n d p r a c t i c e t h r o u g h t h e i r w o r k w i t h a s y l u m p a t i e n t s ( T h e w e l e i t , 1990, p. 6 0 ) . In s h a r p c o n t r a s t t o J a s p e r s ' s later a c c o u n t o f t h e u n b r e a c h a b l e g u l f o f u n d e r standing b e t w e e n clinician a n d schizophrenic patient, Jung's a n d A b r a h a m ' s analyses, in their reliance o n Freud's insights into the t r e a t m e n t of hysteric p a t i e n t s , p u r s u e d a s t r a t e g y o f e q u i v a l e n c e r a t h e r t h a n r a d i c a l d i f f e r e n c e . 4 If s t r u c t u r a l a n d s y m p t o m a t o l o g i c a l similarities b e t w e e n d e m e n t i a p r a e c o x a n d 3
4
For an account in this vein, see Chapter 8 'Schizophrenia' of Lisa Appignanesi's book Mad, Bad and Sad (2008). Indeed, Jung (1944, pp. 16-17) states: 'In general we know by far too little about the psychology of the normal and the hysteric to dare accept in such an untransparent disease as dementia praecox, a totally new mechanism unknown to all psychology. One should be economical with new principles of interpretation'.
neurosis could be d e m o n s t r a t e d , n o t only could psychosis b e b r o u g h t into the p s y c h o a n a l y t i c f o l d , b u t t h e t e n e t s o f p s y c h o a n a l y s i s w o u l d also w i n scientific legitimacy. M o s t s t r i k i n g a b o u t t h e i r w o r k , h o w e v e r , is its c o m p l e t e d e p a r t u r e f r o m the m o d e s of inquiry d o m i n a t i n g biological psychiatry. S h u n n i n g the microscope, Kraepelin's longitudinal a p p r o a c h , a n d any concrete search for the somatic origins of d e m e n t i a praecox, Jung a n d A b r a h a m , with Bleuler's e n c o u r a g e m e n t , f o c u s s e d t h e i r a t t e n t i o n s o n t h e s u b s t a n c e of s y m p t o m s . T h e m o s t c o n t e n t i o u s issue b e t w e e n J u n g a n d A b r a h a m , a n d in t u r n F r e u d , w a s t h e role t h a t i n f a n t i l e s e x u a l i t y a n d t h e l i b i d o w o u l d p l a y in t h e i r a p p e a r a n c e . T h e p u b l i c a t i o n o f J u n g ' s The Psychology F r e u d ' s The Interpretation Three
Essays
of Dreams
on the Theory
of Dementia
Praecox
followed
(of which Jung was an avid reader) a n d
of Sexuality,
b u t it p r e c e d e d p e r s o n a l c o n t a c t
b e t w e e n t h e t w o m e n . J u n g b e g i n s his s t u d y b y h a i l i n g Bleuler as his r e s p e c t e d s u p e r i o r a n d c l a r i f y i n g h i s p o s i t i o n r e g a r d i n g t h e as yet r e l a t i v e l y u n k n o w n science of p s y c h o a n a l y s i s . H i s p r e f a c e is w o r t h q u o t i n g at l e n g t h as it gives a n i n d i c a t i o n of t h e s t a t u s of p s y c h o a n a l y s i s at t h e t i m e a n d a n t i c i p a t e s t h e m a j o r issues of c o n t e n t i o n b e t w e e n J u n g a n d F r e u d : Even a superficial glance at my work will show how indebted I am to the ingenious conceptions of Freud [who] . . . has not yet attained fair recognition and appreciation . . . I can assure you that in the beginning I naturally entertained all the objections which are advanced in the literature against Freud. But, I said to myself Freud could only be refuted by one who himself had made much use of the psychoanalytic method . . . Fairness to Freud does not, however, signify, as many may fear, a conditionless surrender to dogma; indeed, independent judgment can very well be maintained beside it. If I, for instance, recognize the complex mechanisms of dreams and hysteria, it by no means signifies that I ascribe to the infantile sexual trauma the exclusive importance seemingly attributed to it by Freud. Still less does it mean that I place sexuality so preponderantly in the foreground, or that I even ascribe to it the psychological universality which Freud apparently postulates under the impression of the very powerful role which sexuality plays in the psyche .. . Nevertheless, all these are quite incidental and completely vanish beside the psychological principles, the discovery of which is Freud's greatest m e r i t . . . (Jung, 1944, pp. iii-iv) J u n g ' s text s t r u g g l e s b e t w e e n g u a r d e d q u a l i f i c a t i o n s a n d p r a i s e o f F r e u d as an ' i n g e n i o u s ' i f ' a s yet h a r d l y r e c o g n i z e d i n v e s t i g a t o r ' ( J u n g , 1944, p p . 29, 2 1 ) . A f t e r r e v i e w i n g t h e r e l e v a n t c o n t e m p o r a r y l i t e r a t u r e , h e t a k e s as t h e s t a r t i n g p o i n t f o r his analysis F r e u d ' s h y p o t h e s i s t h a t p a r a n o i a arises 'from sion of painful content
memories,
of the repression
and that the form of the symptoms
the
is determined
represby the
( F r e u d ( 1 8 9 6 ) q u o t e d in J u n g , 1944, p. 26, italics in
the original). H o w e v e r , if the psychic m e c h a n i s m s of hysteria can be d i s c e r n e d in t h e p a r a n o i d f o r m o f d e m e n t i a p r a e c o x , w h a t a c c o u n t s for t h e greater rigidity of
psychotic s y m p t o m s , and, moreover, what explains the appearance of one disorder rather t h a n another? P r o n o u n c i n g Freud's analysis insufficiently c o m p l e x , J u n g argues that 'we m u s t t h e r e f o r e p o s t u l a t e t h a t in t h e case of d e m e n t i a p r a e c o x t h e r e is a s p e c i f i c r e s u l t a n t of t h e a f f e c t s ( t o x i n e ? ) , w h i c h causes the definite fixation of the c o m p l e x b y i n j u r i n g the s u m total of the p s y c h i c f u n c t i o n s ' ( J u n g , 1944, p. 32). T h e c o n c e p t u a l a p p a r a t u s f r o m w h i c h J u n g d e v e l o p s his o w n a c c o u n t o f d e m e n t i a p r a e c o x is loosely p s y c h o a n a l y t i c a n d yet decidedly o p p o s e d t o F r e u d ' s analysis of p a r a n o i d s y m p t o m f o r m a t i o n : w i t h t h e a e t i o l o g i c a l r o l e of c h i l d h o o d sexuality explicitly r e j e c t e d , a n d a n u n k n o w n somatic origin repeatedly postulated, Jung integrates the received w i s d o m of fin-de-siecle
psychiatry with Freudian concepts and methodologies
a n d t h e B u r g h o l z l i ' s o w n b r a n d of p s y c h o l o g y . C h i e f a m o n g t h e e x p e r i m e n t a l t e c h n i q u e s f a v o u r e d b y Bleuler a n d J u n g w a s t h e w o r d - a s s o c i a t i o n test, w h i c h r e s e m b l e s w h a t w e n o w t h i n k of as f r e e assoc i a t i o n . 5 A c c o r d i n g t o J u n g , t h e p s y c h e is c o m p o s e d o f m a n y i n t e r c o n n e c t e d ' f e e l i n g - t o n e d c o m p l e x e s ' , e a c h of w h i c h h a s a s e n s o r y , affective, a n d intellect u a l c o m p o n e n t ( J u n g , 1944, p. 32). T h e w o r d - a s s o c i a t i o n test revealed t o h i m t h a t 'every association
belongs . . . to some complex
, t h a t is, every w o r d triggers
a l r e a d y e x i s t i n g c o m p l e x e s w i t h i n t h e p s y c h e ( J u n g , 1944, p. 35, italics in t h e o r i g i n a l ) . A l t h o u g h t h e e g o c o m p l e x is t h e ' h i g h e s t p s y c h i c f o r c e ' ( i b i d . ) , it e x i s t s in d y n a m i c r e l a t i o n w i t h o t h e r i d i o s y n c r a t i c c o m p l e x e s . 6 In o r d e r t o t h e o r i z e t h e a b e r r a n t f u n c t i o n i n g of c o m p l e x e s in d e m e n t i a p r a e c o x as i n d i c a t e d b y t h e w o r d - a s s o c i a t i o n test, J u n g i n v e s t i g a t e d parallels b e t w e e n d e m e n tia praecox, d r e a m s , a n d hysteria. D r e a m s , o n his F r e u d - i n s p i r e d m o d e l , a p p e a r as ' s y m b o l i c e x p r e s s i o n s of r e p r e s s e d c o m p l e x e s ' , w h i c h ' c o n t a i n t h e c h a r a c t e r i s t i c f e a t u r e s of m y t h o l o g i c a l t h i n k i n g ' a n d a r e i d e n t i c a l t o t h o s e o f d e m e n t i a p r a e c o x : 'Let t h e d r e a m e r w a l k a b o u t a n d act like o n e a w a k e n e d a n d w e h a v e t h e clinical p i c t u r e of d e m e n t i a p r a e c o x ' ( J u n g , 1944, p p . 51, 56, 7 9 ) . Hysteria, like d e m e n t i a p r a e c o x , is f o r J u n g t h e result of a p a r t i c u l a r l y p e r n i c i o u s ( b u t n o t n e c e s s a r i l y sexual) c o m p l e x e x p r e s s e d in all a r e a s of p s y c h i c activity, a n d in d r a w i n g e l a b o r a t e parallels b e t w e e n t h e d i s o r d e r s o n t h e levels o f ' c h a r acterlogical a b n o r m a l i t y ' , s t e r e o t y p y , e m o t i o n a l a n d i n t e l l e c t u a l d i s t u r b a n c e , J u n g c o n s i s t e n t l y i m p l i e s t h a t d i f f e r e n c e s b e t w e e n t h e m a r e a m a t t e r of d e g r e e . 5
6
Interestingly, it was from Kraepelin's clinic in Munich that Bleuler and Jung first learned of this psychological experiment, and in turn demonstrated its capacity to provide empirical evidence for the presence of unconscious patterns of association (Kerr, 1993, pp. 44-5). Jung's junior colleague Ludwig Binswager identified 11 complexes in his superior, among them, Goethe and Siegfried complexes and the wish to have a son (Kerr, 1993).
Compelled, however, to a c c o u n t for the distinctive splitting, disintegration, a n d dissociation of psychic f u n c t i o n s in d e m e n t i a praecox, J u n g h y p o t h e s i z e d that .1 p a t h o g e n i c c o m p l e x p r o d u c e s ' a n a n o m a l o u s m e t a b o l i s m (toxine?), w h i c h i n j u r e s t h e b r a i n ' a n d p r e v e n t s t h e a c q u i s i t i o n o r d e v e l o p m e n t of n e w c o m plexes ( J u n g , 1944, p p . 3 1 - 2 ) . 'At b e s t ' , t h e p a t i e n t ' e s c a p e s w i t h a p s y c h i c m u t i l a t i o n ' , b u t as t h e y s t a n d ' u n d e r t h e b a n of an i n v i n c i b l e c o m p l e x ' t h e 'separation of t h e s c h i z o p h r e n i c f r o m reality [and] t h e loss of interest in objective h a p p e n i n g s ' c a n n o t really be r e m e d i e d (Jung, 1944, p. 32). By a t t r i b u t i n g a single affective cluster of s e n s a t i o n s a n d m e m o r i e s such d e v a s t a t i n g agency within the psyche, J u n g was effectively saying ' t h a t certain t h o u g h t s , o r at least certain feelings, were metabolically d a n g e r o u s ' (Kerr, 1993, p. 180). Following the p u b l i c a t i o n of The Psychology of Dementia
Praecox, J u n g pre-
sented his toxin t h e o r y of d e m e n t i a p r a e c o x at the First I n t e r n a t i o n a l C o n g r e s s for Psychoanalysis, held in Salzburg in 1908. It was a prestigious a n d political o c c a s i o n , a n d , t h a n k s t o t h e p a r t i c i p a t i o n of t h e B u r g h o l z l i psychiatrists, it m a r k e d a t u r n i n g p o i n t in t h e psychoanalytic u n d e r s t a n d i n g of d e m e n t i a praecox. H o w e v e r , it w a s Karl A b r a h a m , a n d n o t his e r s t w h i l e c o l l e a g u e J u n g , whose p a p e r was c o m m e n d e d f o r its psychoanalytic i n n o v a t i o n s . T h e title of Abraham's paper, 'The Psycho-Sexual Differences between Hysteria and D e m e n t i a Praecox', succinctly states his principal assertion, n a m e l y that n e u rosis a n d psychosis c o u l d b e substantively d i s t i n g u i s h e d w i t h o u t r e c o u r s e t o e i t h e r a K r a e p e l i n i a n m o d e l o f inevitable d e m e n t i a o r a toxic X - f a c t o r , b u t instead t h r o u g h a F r e u d i a n t h e o r y o f p s y c h o s e x u a l aetiology. J u n g b r o u g h t psychosis i n t o t h e psychoanalytic fold methodologically b y d e m o n s t r a t i n g that ' m e a n i n g ' could be d i s c e r n e d b e h i n d t h e ' m a d n e s s ' of individual patients, b u t he refused to c o n c e d e that a sexual c o m p l e x was the decisive factor in all cases. Uy c o n t r a s t , A b r a h a m , in theoretically d i f f e r e n t i a t i n g d e m e n t i a p r a e c o x f r o m hysteria, actually s u c c e e d e d in f o r g i n g t h e crucial (because psychosexual a n d therefore ' p r o p e r l y ' psychoanalytic) c o n n e c t i o n b e t w e e n the two. In his p a p e r , A b r a h a m s p o k e w i t h clinical a u t h o r i t y a b o u t all f o r m s o f d e m e n t i a p r a e c o x a n d referred to a significant n u m b e r of individual cases. H e began b y asserting t h a t as t h e s y m p t o m s of b o t h hysteria a n d d e m e n t i a p r a e cox 'originate in t h e repressed sexual complexes', t h e difference between t h e m can t h e r e f o r e be u n d e r s t o o d in t e r m s of t h e psychosexual d e v e l o p m e n t of t h e child, or, specifically, its capacity t o t r a n s f e r its libido o n t o the external w o r l d ( A b r a h a m , 1972, p p . 6 4 - 5 ) . N o t i n g t h e f l a t n e s s of a f f e c t a n d t e n d e n c y t o hostility in d e m e n t i a p r a e c o x , a n d h a v i n g ' t r a c e d b a c k all t h e t r a n s f e r e n c e of feeling of s e x u a l i t y ' , t h e analyst m u s t , a c c o r d i n g t o A b r a h a m , ' c o m e t o t h e c o n c l u s i o n t h a t d e m e n t i a p r a e c o x d e s t r o y s t h e p e r s o n ' s c a p a c i t y f o r sexual
t r a n s f e r e n c e , i.e. f o r o b j e c t l o v e ' ( A b r a h a m , 1972, p . 6 9 ) . In a s t r i k i n g e a r l y e x a m p l e o f t h e p s y c h o a n a l y t i c regressive h y p o t h e s i s in a c t i o n , A b r a h a m u r g e d his audience towards a n o t h e r conclusion: Only one similar sexual condition is known to us, namely, that of early childhood; we term it, with Freud, 'auto-eroticism'. In this period, too, interest in objects and sublimation is lacking. The psychosexual characteristic of dementia praecox is the return of the patient to auto-eroticism, and the symptoms of his illness are a form of autoerotic sexual activity. (Abraham, 1972, pp. 73-4) In lieu of s u p p l y i n g e m p i r i c a l e v i d e n c e f o r his h y p o t h e s i s , o r a n y clear i n d i c a t i o n t h a t a n u n d e r s t a n d i n g o f i n f a n t i l e a u t o - e r o t i c i s m c o u l d aid in t h e t r e a t m e n t of d e m e n t i a praecox, A b r a h a m offers reassuring o p t i m i s m : A great part of the pathological manifestations of dementia praecox would, it seems to me, be explicable if we assumed that the patient has an abnormal psychosexual constitution in the direction of auto-eroticism. Such an assumption would render the recently discussed toxin theory unnecessary. (Abraham, 1972, p. 78) N o t o n l y d i d A b r a h a m s u p p l y p r e c i s e l y t h e t h e o r y t h a t F r e u d h a d b e e n tryi n g t o ' p l a n t ' w i t h J u n g a n d A b r a h a m since t h e c o u r t s h i p w i t h t h e B u r g h o l z l i p s y c h i a t r i s t s b e g a n , h e a l s o s u c c e e d e d in t a k i n g a d i r e c t s w i p e at t h e t o x i n t h e o r i e s o f h i s rival, J u n g . S a l z b u r g was, as J o h n K e r r w r y l y o b s e r v e s , A b r a h a m ' s ' c o m i n g - o u t p a r t y ' as a tactical p s y c h o a n a l y s t ( K e r r , 1993, p p . 1 8 1 - 2 ) . A l t h o u g h i t s o r i g i n s l a y in F r e u d ' s u n p u b l i s h e d t h i n k i n g o n p a r a n o i a , A b r a h a m ' s p r e s e n t a t i o n served the strategic f u n c t i o n of linking a theory of a u t o - e r o t i c i s m with clinical observations of d e m e n t i a p r a e c o x patients f r o m the highly respected Burgholzli.7 'The Psycho-Sexual Differences between Hysteria a n d D e m e n t i a Praecox' was p r o o f that psychoanalysis h a d something t o say a b o u t t h e psychic
origins of d e m e n t i a p r a e c o x . By c o n t r a s t , J u n g ' s t o x i n
t h e o r y p r o v e d d e c i d e d l y u n p o p u l a r in p s y c h o a n a l y t i c circles at t h e t i m e , a n d , a l t h o u g h h e w a s still c h a m p i o n i n g it as late as 1958 ( S a m u e l s , 1997, p. 6), it h a s c o n s i s t e n t l y f a i l e d t o w i n m a n y n o n - J u n g i a n s u p p o r t e r s . J u n g ' s b i t t e r split f r o m F r e u d , his d e v e l o p m e n t of a n a n a l y t i c p s y c h o l o g y p r i n c i p a l l y c o n c e r n e d w i t h t h e a r c h e t y p e s o f a collective u n c o n s c i o u s , a n d a l l e g a t i o n s t h a t h e w a s a N a z i s y m p a t h i z e r h a v e all b u t e x t i n g u i s h e d a c a d e m i c i n t e r e s t in his first m a j o r
7
In later publications, Freud is careful to reference Abraham's paper in such a way that it is clear he assumes ultimate responsibility for its accuracy. Citing Abraham, Freud (1981, p. 41) states in a footnote: 'In the course of this paper its author, referring to a correspondence between us, scrupulously attributes to myself an influence upon the development of his views' (see also Freud, 1963a, p. 415).
p u b l i c a t i o n . H o w e v e r , s e t t i n g aside t h e s u b s e q u e n t c a r e e r o f its a u t h o r , I w o u l d a r g u e t h a t The Psychology
of Dementia
Praecox
is m o s t s i g n i f i c a n t n o t f o r t h e
validity o r i n f l u e n c e o f J u n g ' s t o x i n t h e o r y o f d e m e n t i a p r a e c o x , b u t f o r t h e e x t r e m e l y d e t a i l e d a n a l y s i s o f o n e o f his p a t i e n t s , B a b e t t e S. T h i s case s t u d y h i g h l i g h t s J u n g ' s p r i n c i p a l c o n t r i b u t i o n t o t h e p s y c h o a n a l y t i c i n v e s t i g a t i o n of dementia praecox, namely that: Unlike the majority of psychiatrists before or since, he gave serious attention to what his schizophrenic patients actually said and did, and was able to demonstrate that their delusions, hallucinations, and gestures were not simply 'mad' but full of psychological meaning. (Stevens, 1994, p. 12) W h i l e J u n g d i d n o t s u p p l y t h e k i n d o f c o m p r e h e n s i v e , linear n a r r a t i v e F r e u d w o u l d p r o d u c e f r o m S c h r e b e r ' s Memoirs,
h e analytically u n t a n g l e d B a b e t t e ' s
f r e q u e n t l y b i z a r r e w o r d a s s o c i a t i o n s a n d s u c c e e d e d in i n t e r p r e t i n g s e e m i n g l y d i s c o n n e c t e d , d i s p a r a t e , i m p e n e t r a b l e signifiers as e l e m e n t s of p a r t i c u l a r c o m plexes. It is this i m p u l s e — t h i s p r o c e s s — t h a t m o s t d i s t i n g u i s h e s t h e p s y c h o a n a l y t i c a p p r o a c h t o s c h i z o p h r e n i a f r o m its p s y c h i a t r i c c o u n t e r p a r t . B a b e t t e S., a n i m p o v e r i s h e d s e a m s t r e s s , h a d b e e n i n s t i t u t i o n a l i z e d f o r o v e r 15 y e a r s b e f o r e c o m m e n c i n g analysis w i t h J u n g . S h e s u f f e r e d f r o m p a r a n o i d delusions of physical m u t i l a t i o n a n d g r a n d e u r , severe hallucinations a n d affectless, d i s c o n n e c t e d s p e e c h , b u t s o u g h t t o e x p l a i n herself as clearly as p o s s i b l e t o J u n g in t h e v a i n h o p e t h a t h e m i g h t s e c u r e h e r r e l e a s e f r o m t h e Burgholzli. T h e case s t u d y i n c l u d e s list a f t e r list of B a b e t t e ' s w o r d a s s o c i a t i o n s . Drawing attention to her 'extraordinarily long reaction times', her neologisms, a n d h e r b i z a r r e a n d s o m e t i m e s e m b e l l i s h e d r e s p o n s e s , J u n g c o n c l u d e d t h a t his patient was psychically d o m i n a t e d by n u m e r o u s complexes, so m u c h so that ' s h e s p e a k s , acts, a n d d r e a m s o f n o t h i n g else b u t w h a t t h e c o m p l e x i n s p i r e s ' ( J u n g , 1944, p. 101). E a c h n e o l o g i s m o r s t e r e o t y p e c o n n e c t e d t o o n e of t h r e e interrelated c o m p l e x e s — w i s h - f u l f i l l m e n t (delusions of g r a n d e u r ) , ideas of i n j u r y ( d e l u s i o n s of p e r s e c u t i o n ) , o r a n e r o t i c c o m p l e x . As p a r t of his e x p e r i m e n t , J u n g r e p e a t e d B a b e t t e ' s n e o l o g i s m s ( w h a t she calls h e r ' p o w e r - w o r d s ' ) t o h e r as s t i m u l u s w o r d s . H e r r e s p o n s e t o t h e g r a n d i o s e s t e r e o t y p e , 'I a m t h e finest p r o f e s s o r s h i p ' , b e g i n s like this: This is again the highest activity—double—twenty-five francs—I am double polytechnic irretrievable—professorship includes in itself the fine learned world—the finest world of art—I am also these titles—snail museum clothing, am I, that emanates from me—to cut no thread, to choose the best samples, those representing much, and consuming little cloth—I created that—that concerns me—the fine art world is, to apply the trimming where it can best be seen—plum cake on an Indian meal l a y e r . . . . (Jung, 1944, p. 106)
W h e r e J u n g p r o v e s m a s t e r f u l in h i s a n a l y s i s o f h e r ' w o r d s a l a d ' (a t e r m c o i n e d b y J u n g ) is t h r o u g h a r i g o r o u s , m e t i c u l o u s r e a d i n g o f s e e m i n g l y i m p e n e t r a b l e n e o l o g i s m s as s y m p t o m a t i c o f specific c o m p l e x e s . R e l u c t a n t t o s p e c u l a t e o n why t h e s e c o m p l e x e s d e v e l o p e d , h e a i m s t o s h o w ' h o w t h e p a t i e n t , b r o u g h t u p u n d e r sad d o m e s t i c c o n d i t i o n s , a m i d distress a n d h a r d l a b o r , crea t e s in h e r p s y c h o s i s a n e n o r m o u s l y c o m p l i c a t e d , a n d s e e m i n g l y a l t o g e t h e r c o n f u s e d f a n t a s t i c s t r u c t u r e ' ( J u n g , 1944, p. 135). It is d i f f i c u l t w h e n r e a d i n g B a b e t t e ' s r e s p o n s e s n o t t o b e s t r u c k b y t h e literary q u a l i t y of h e r f a n t a s t i c s t r u c t u r e . J u n g t r e a t s t h e m as a c o d e t o b e d e c i p h e r e d o r a p o e m t o b e i n t e r p r e t e d , a n d also r e m a r k s f r e q u e n t l y o n t h e i r r e s e m b l a n c e to dreams: Like a poet impelled by his inner impulses, the patient pictures to us in the symptoms the hopes and disappointments of her life. ( . . . ] [She] speaks as if in dreams—I know of no better expression. [ . . . ] [Tjhis uneducated and scantily endowed patient thinks without any directing idea, in obscure dreamlike pictures and amid indistinct expressions. All this contributes to make her stream of thought as incomprehensible as possible. [ . . . ] [Unlike the dreams of normal people, here] we have long and extensively elaborated fancies, which on the one hand are comparable to a great poem and on the other to the romances and fantastic pictures of somnambulists. (Jung, 1944, pp. 135-6) A l t h o u g h t h e c o m p a r i s o n is s e d u c t i v e , Avital R o n n e l l c h a l l e n g e s t h e m o v e t o equate dreams with dementia praecox, arguing that 'while the dream was t h o u g h t t o h a v e l a t e n t c o n t e n t , a r e t r i e v a b l e u n c o n s c i o u s n a r r a t i v i t y , t h e schizo p h r e n i c u t t e r a n c e r e m a i n s a pistol s h o t in t h e d a r k o f m e t a p h y s i c s , s h a t t e r e d , f r a g m e n t e d ' ( R o n e l l , 1989, p . 137). By ' m a k i n g s e n s e ' of a n u m b e r o f B a b e t t e ' s m o r e o p a q u e p h r a s e s , w h a t J u n g u l t i m a t e l y delivers is o n l y a series of d i s c r e t e i n t e r p r e t a t i o n s of e l e m e n t s of his p a t i e n t ' s d i s t u r b e d p s y c h e r a t h e r t h a n a n a r rative that would d r a w these together. Fragmentary u n d e r s t a n d i n g , then, c o m e s t o d i s p l a c e a n d r e p l a c e a n y d i s c u s s i o n o f c u r e o r t h e alleviation of s y m p t o m s a n d o p e r a t e s i n d e p e n d e n t l y of a t h e o r y of aetiology, toxin-related or otherwise. T h r o u g h his analysis o f Babette, J u n g s o u g h t t o establish t h e p a r a n o i d f o r m of d e m e n t i a p r a e c o x as t h e d i s o r d e r m o s t a m e n a b l e t o p s y c h o a n a l y t i c investigation, d e m o n s t r a t i n g , albeit tenuously, h o w the idiosyncratic c o n t e n t of a patient's s y m p t o m s followed previously identified narrative patterns (delus i o n s o f g r a n d e u r a n d p e r s e c u t i o n ) . F o r J u n g , t h e d o m a i n of d e m e n t i a p r a e c o x w a s ' t o o extensive a n d yet t o o o b s c u r e ' f o r his w o r k o n p a r a n o i a t o b e c o n c l u sive; p r o m i s i n g t o e x t e n d his i n q u i r y i n t o c a t a t o n i c a n d h e b e p h r e n i c s c h i z o p h r e n i a at a f u t u r e d a t e , his final s t a t e m e n t is at o n c e a p o l o g e t i c , d e f e n s i v e , a n d s e l f - a g g r a n d i z i n g : ' S o m e b o d y finally h a d t o t a k e il u p o n h i m s e l f t o set t h e s t o n e r o l l i n g ' ( J u n g , 1944, p p . 1 3 5 - 6 ) . A n d roll il d i d
inexorably o n towards
F r e u d ' s analysis o f a text i n t r o d u c e d t o h i m b y J u n g , Memoirs
of My
Nervous
Illness. A l t h o u g h m a n y critics w o u l d p r e f e r n o t t o call a t t e n t i o n t o t h e i n f l u e n c e of J u n g ' s case s t u d y o n ' P s y c h o - A n a l y t i c N o t e s ' , its i m p o r t a n c e s h o u l d n o t be u n d e r e s t i m a t e d . W h a t J u n g p r e s e n t e d was an analysis of an acutely p s y c h o t i c patient—an
analysis b a s e d u p o n p s y c h o l o g i c a l e x p e r i m e n t s in real
t i m e , c o n d u c t e d in a n a s y l u m , a n d i n v o l v i n g a r a n g e o f n o n - v e r b a l a n d e m o tional c o m m u n i c a t i o n s which could not be captured adequately o n the page. B a b e t t e d i d n o t p r o v i d e h i m w i t h a c o g e n t o r c o m p e l l i n g n a r r a t i v e of h e r illness b u t w i t h d i s c o n n e c t e d s p e e c h a n d ' d i f f i c u l t ' b e h a v i o u r . It is u n s u r p r i s i n g , t h e n , t h a t J u n g ' s text d e a l s in f r a g m e n t s a n d c a n n o t a t t e m p t a c o m p l e t e p s y c h o l o g i c a l p i c t u r e o f his p a t i e n t , especially as h e suggests t h a t t h e d i s o r d e r h a s a m e t a b o l i c — n o t p s y c h o l o g i c a l — o r i g i n . D e s p i t e u n c a n n y similarities b e t w e e n t h e d e l u s i o n a l s c h e m a of B a b e t t e a n d S c h r e b e r , 8 t h e case h i s t o r y o f this p o o r a n d u n e d u c a t e d w o m a n could not m a t c h the analytic possibilities presented b y t h e a u t o b i o g r a p h y o f a n e s t e e m e d m a l e j u r i s t . Equally, w h e n it c a m e t o t h e weaving of linear narratives, Jung's t h e o r y of co-existent complexes was n o m a t c h f o r t h e c a p a c i t y of l i b i d o t h e o r y t o t r a c e all s y m p t o m s a n d p s y c h i c dysf u n c t i o n s b a c k t o a p r i m a r y p s y c h o s e x u a l d i s t u r b a n c e . W h a t J u n g did establish was the possibility of p e n e t r a t i n g the supposedly i m p e n e t r a b l e s y m p t o m s of dementia praecox by subjecting t h e m to psychoanalytic investigation. This, t o g e t h e r w i t h A b r a h a m ' s a u t h o r i t a t i v e a c c o u n t of t h e p s y c h o s e x u a l o r i g i n s o f dementia praecox, constitutes a foundation for Freud's work on paranoia. B e f o r e m o v i n g o n t o a d e t a i l e d a n a l y s i s o f ' P s y c h o - A n a l y t i c N o t e s ' , it is w o r t h recalling Karl J a s p e r s ' s c o m m e n t s o n t h e w o r k o f F r e u d a n d t h e Z u r i c h s c h o o l o n d e m e n t i a p r a e c o x . A l t h o u g h Jaspers a c k n o w l e d g e d t h a t t h e p s y c h o a n a l y t i c s c r u t i n y of t h e ' d e l u s i o n a l c o n t e n t s of d e m e n t i a p r a e c o x ' can b e seen as a n i m p r o v e m e n t o n p s y c h i a t r y ' s e f f o r t s t o classify t h e c h a o s o f s c h i z o p h r e n i a , h e r e m a i n e d j u s t i f i a b l y s u s p i c i o u s of p s y c h o a n a l y t i c m e t h o d o l o g y : They have thus come to 'understand' almost all the contents of these psychoses by applying a procedure which as the results show only leads on into endlessness. In the most literary sense they have rediscovered the 'meaning of madness' or at least they believe they have. The whole interpretation is a translation to schizophrenia of concepts which have been arrived at during the analysis of hysteria. We should, however, never forget the radical differences which exist between hysteria and a schizophrenic p r o c e s s . . . (Jaspers, 1972, pp. 539, 410, italics in the original)
8
For example, Babette believes that her actions are continuously monitored by telephones, just as Schreber is consistently scrutinized by God's 'rays'. Both also suffer the presence of 'little men', literally, tiny figures emerging from or molesting their bodies (see Jung, 1944, pp. 140,91; Schreber, 1955, pp. 112, 157).
Jaspers's o b s e r v a t i o n s f r o m 1913 i n f o r m the p r i m a r y a r g u m e n t of this c h a p ter, that psychoanalysis a p p r o a c h e s s c h i z o p h r e n i a as a s u b l i m e text t h a t reveals t h e collapse of psychic f u n c t i o n i n g if o n l y it is p r o p e r l y d e c i p h e r e d . Jung's The Psychology of Dementia
Praecox is, I suggest, the f o u n d i n g text in this psycho-
a n a l y t i c t r a d i t i o n . As h e s h o w e d , t h e a n a l y s t ' s i n t e r p r e t i v e m a s t e r y o v e r d e m e n t i a p r a e c o x , s e c u r e d t h r o u g h a p o t e n t i a l l y i n e x h a u s t i b l e process, d o e s n o t deliver the a n a l y s a n d f r o m their s c h i z o p h r e n i c s y m p t o m s as it m i g h t with neurosis. It is simply an e n d in itself, a n d , if Jaspers is correct, o n e that actually o b f u s c a t e s the f u n d a m e n t a l inaccessibility—or s u b l i m i t y — o f s c h i z o p h r e n i a . J u n g c o u l d o n l y p o i n t t o h o w B a b e t t e ' s s p e e c h revealed h e r c o m p l e x e s ; t h e q u e s t i o n of w h y she b e c a m e psychotic, w h e n o t h e r s w h o experience 'distress a n d h a r d s h i p ' a m o n g 'sad d o m e s t i c c o n d i t i o n s ' d o n o t , is u n a n s w e r e d , a n d it is clear t h a t his analysis d i d little t o m i t i g a t e h e r distress. A l t h o u g h t r e a t i n g s c h i z o p h r e n i a as a d i s o r d e r of s i g n i f i c a t i o n allows t h e analyst t o r e s t o r e o r a t t r i b u t e m e a n i n g t o s c h i z o p h r e n i c s p e e c h , t h e a n a l y s t ' s n a r r a t i v e (like t h e p s y c h i a t r i s t ' s clinical p i c t u r e ) fails t o a d d r e s s t h e s t r u c t u r e o f s c h i z o p h r e n i c experience, o r t o explain why s c h i z o p h r e n i a arises a n d c a n n o t b e ' c u r e d ' . T h e clinical p i c t u r e of s c h i z o p h r e n i a is recast as a text in w h i c h t h e ' m e a n i n g of m a d n e s s ' is rediscovered, b u t in revealing a n d exceeding the limits of i n t e r p r e t a t i o n or textualization, t h e p e r s o n herself is assigned a s u b l i m e status in psychoanalytic discourse.
Freud on Schreber F r e u d ' s 'Psycho-Analytical N o t e s o n an A u t o b i o g r a p h i c a l A c c o u n t of a Case of P a r a n o i a ( D e m e n t i a P a r a n o i d e s ) ' h a s b e e n d e s c r i b e d by o n e h i s t o r i a n of psychoanalysis as ' t h e first t i m e a n y o n e h a d ever p e n e t r a t e d so deeply i n t o t h e m e n t a l life of a p s y c h o t i c ' (Fine, 1979, p. 54). T h e s a m e o b s e r v a t i o n applies equally t o t h e a u t o b i o g r a p h i c a l a c c o u n t in q u e s t i o n , the m e m o i r s of psychiat r y ' s m o s t q u o t e d a n d c e r t a i n l y m o s t f a m o u s s c h i z o p h r e n i c p a t i e n t , Daniel Paul Schreber. Schreber w a s a d i s t i n g u i s h e d jurist w h o s u f f e r e d three distinct p e r i o d s o f w h a t h e called ' n e r v o u s illness' ( M a c a l p i n e a n d H u n t e r , 1955b, p. 3). In 1884, he was a d m i t t e d t o the University Clinic of Leipzig a n d successfully treated by Paul Emil Flechsig for severe h y p o c h o n d r i a . In 1893, s o o n after his a p p o i n t m e n t to the high office of Senatspriisident
( P r e s i d e n t of the C o u r t of
A p p e a l ) in D r e s d e n , he w a s again a d m i t t e d to Flechsig's clinic with psychotic s y m p t o m s , and was subsequently transferred to the Sonnenstein Asylum. Memoirs
of My Nervous
Illness is S c h r e b e r ' s a c c o u n t of his e i g h t - y e a r i n c a r -
ceration; w r i t t e n while h e was still a patient at S o n n e n s t e i n , it was a key d o c u m e n t in h i s legal a p p e a l t o be r e c o g n i z e d as fit t o m a n a g e h i s o w n a f f a i r s . S c h r e b e r ' s tutelage w a s e v e n t u a l l y r e s c i n d e d b y t h e c o u r t s in 1902, a n d t h e
f o l l o w i n g year h e d i s c h a r g e d h i m s e l f a n d p u b l i s h e d his Memoirs.
Unbeknown
t o F r e u d , S c h r e b e r ' s w i f e S a b i n e s u f f e r e d a s t r o k e in 1907, a n d i m m e d i a t e l y afterwards he was again a d m i t t e d to an asylum with acute psychosis. H e died t h e r e in 1911, m o n t h s a f t e r F r e u d p u b l i s h e d ' P s y c h o - A n a l y t i c N o t e s ' . D e s p i t e his p a i n s t a k i n g e f f o r t s t o e l u c i d a t e f o r t h e r e a d e r t h e detail a n d s i g n i f i c a n c e of his r e l i g i o u s r e v e l a t i o n s , S c h r e b e r ' s a u t o b i o g r a p h i c a l a c c o u n t of his p s y c h o t i c e x p e r i e n c e s is as b y z a n t i n e as it is b i z a r r e . At t i m e s d a u n t i n g in its i n t r i c a c y , Memoirs
d e f i e s s u m m a r y , s o w h e r e v e r p o s s i b l e w e will let S c h r e b e r s p e a k f o r
himself. T h e t e x t u a l s o u r c e s u p o n w h i c h F r e u d b a s e d h i s analysis o f S c h r e b e r w e r e b o t h a d d r e s s e d , at least in p a r t , t o t h e legal q u e s t i o n o f S c h r e b e r ' s tutelage. T h e official medical reports s u b m i t t e d to the courts by the
Sonnenstein
S u p e r i n t e n d e n t , D r W e b e r , w e r e p u b l i s h e d as a p p e n d i c e s t o Memoirs,
and
t h u s F r e u d h a d t o r e c o n c i l e c o n f l i c t i n g a c c o u n t s o f S c h r e b e r ' s illness in his o w n p r e s e n t a t i o n o f t h e case h i s t o r y . D r a w i n g a clear d i s t i n c t i o n b e t w e e n t h e psychiatric a p p r o a c h to psychotic behaviour and the psychoanalytic 'wish to g o m o r e d e e p l y i n t o t h e details o f t h e d e l u s i o n a n d i n t o t h e h i s t o r y of its develo p m e n t ' ( F r e u d , 1981, p . 18), F r e u d b e g i n s b y c h a l l e n g i n g W e b e r ' s d e s c r i p t i o n of Schreber's delusional system. In his r e p o r t , W e b e r n o t e d that Schreber's early d e l u s i o n s of b o d i l y p e r s e c u t i o n e v e n t u a l l y gave w a y t o a fixed s t r u c t u r e o f ' p a t h o l o g i c a l ideas': The patient's delusional system amounts to this: he is called to redeem the world and to bring back to mankind the lost state or Blessedness. He maintains he has been given this task by direct divine inspiration . . . The most essential part of his mission to redeem the world is that it is necessary for him first of all to be transformed into a woman. Not, however, that he wishes to be transformed into a woman, it is much more a 'must' according to the Order of the World, which he simply cannot escape, even though he would personally very much prefer to remain in his honourable manly position in life. (Weber, 1955, p. 268, italics in the original) T h e ' n a t u r a l ' c o n c l u s i o n t o d r a w f r o m t h i s , a c c o r d i n g t o F r e u d , is t h a t Schreber's emasculation fantasy was motivated by the original redeemer delusion; b e c o m i n g a w o m a n was, for Schreber, a s e c o n d a r y r e q u i r e m e n t of his m e s s i a n i c role. F r e u d p o i n t s o u t , h o w e v e r , t h a t Memoirs
tells a v e r y d i f f e r e n t
story: the partial sexual t r a n s f o r m a t i o n h a p p e n e d first, for the p u r p o s e s of sexual abuse by G o d , a n d only later c a m e to be related to the r e d e e m e r delusion. Assigning a u t o b i o g r a p h y priority over psychiatric evaluation, he concludes: The position may be formulated by saying that a sexual delusion of persecution was later on converted in the patient's mind into a religious delusion of grandeur. The part
of the prosecutor was at first assigned to Professor Flechsig, the physician in whose charge he was; later, his place was taken by God Himself. (Freud, 1981, p. 18) A l t h o u g h p r e s e n t e d as a s t a t e m e n t of fact r a t h e r t h a n t h e a u d a c i o u s analysis it is, t h i s is t h e i n t e r p r e t i v e m o v e u p o n w h i c h F r e u d ' s s u b s e q u e n t analysis o f S c h r e b e r , a n d of p a r a n o i a m o r e generally, h i n g e s . I g n o r i n g a l m o s t c o m p l e t e l y Weber's report of Schreber's c o m p l e x symptomatology—severe h y p e r e s t h e sia, suicidal t e n d e n c i e s , p e r i o d i c b e l l o w i n g , a n d c a t a t o n i c i n t e r v a l s b e i n g o n l y s o m e of t h e m o r e s t r i k i n g — F r e u d f o c u s e s exclusively o n t h e d e l u s i o n a l s t r u c t u r e , a n d assigns o n e a s p e c t o f it, n a m e l y t h e s e x u a l o n e , u n p a r a l l e l e d a e t i o logical i m p o r t a n c e . 9 S i g n i f i c a n t l y , d e l u s i o n a l beliefs r e m a i n t h e sole f o c u s of F r e u d ' s a n a l y s i s , a n d b y e s t a b l i s h i n g a d e l u s i o n o f s e x u a l p e r s e c u t i o n as p r i mary, Freud attributes to Schreber's entire cosmology a sexual significance. T h i s p a r a n o i d s c h i z o p h r e n i a is n o t t h e ' " n e g a t i v e c a s e " w h i c h h a s so l o n g b e e n s o u g h t f o r — a c a s e in w h i c h s e x u a l i t y p l a y s o n l y a v e r y m i n o r p a r t ' ; o n t h e c o n t r a r y , it is p o s i t i v e l y p e r f e c t f o r p s y c h o a n a l y s i s : ' S c h r e b e r h i m s e l f s p e a k s again a n d again as t h o u g h h e s h a r e d o u r p r e j u d i c e . H e is c o n s t a n t l y t a l k i n g in t h e s a m e b r e a t h o f " n e r v o u s d i s o r d e r " a n d e r o t i c l a p s e s , as t h o u g h t h e t w o w e r e i n s e p a r a b l e ' ( F r e u d , 1981, p. 34). S e c t i o n t w o of F r e u d ' s essay, ' A t t e m p t s at I n t e r p r e t a t i o n ' , b e g i n s b y s k e t c h i n g t w o p o s s i b i l i t i e s f o r t h e p s y c h o a n a l y t i c i n v e s t i g a t i o n of p s y c h o s i s as p i o neered by Jung a n d A b r a h a m : ' W e m i g h t start either f r o m the patient's o w n d e l u s i o n a l u t t e r a n c e s o r f r o m t h e e x c i t i n g c a u s e s o f h i s illness' ( F r e u d , 1981, p. 35). F r e u d clearly sees little c h a l l e n g e in a n a l y s i n g t h e d e l u s i o n a l u t t e r a n c e , b u t t o p r o v e t h e ease o f t h e u n d e r t a k i n g o f f e r s a n i n t e r p r e t a t i o n o f S c h r e b e r ' s ' m i r a c l e d b i r d s ' as r e p r e s e n t i n g y o u n g girls ( F r e u d , 1981, p p . 3 5 6 ) . 1 0 H o w e v e r , it is clearly t h e ' e x c i t i n g c a u s e ' t h a t m o s t excites F r e u d ; p s y c h o a n a l y s i s w o u l d h a v e t o a n s w e r t h e q u e s t i o n of a e t i o l o g y if it w e r e t o p r o d u c e a t h e o r y of p a r a noia that explained delusional systems rather than m e r e utterances. Thus, having already established the p r i m a c y of the sexual persecution delusion, F r e u d t u r n s t o a n analysis of S c h r e b e r ' s initial p e r s e c u t o r : t h e ' s o u l - m u r d e r e r ' P r o f e s s o r Flechsig. F r e u d offers his o w n ' s i m p l e f o r m u l a ' for explaining the delusion of persecution: the patient's intense emotional attachment to a p a r t i c u l a r p e r s o n b e c o m e s u n a c c e p t a b l e t o t h e ego, s o it is p r o j e c t e d o u t w a r d s
9
10
Freud is unequivocal on this point: 'The idea of being transformed into a woman was the salient feature and earliest germ of his delusional system' (Freud, 1981, p. 21). Although clearly seeking to impress the reader through this 'easy' reading, it is ultimately isolated and ineffectual, as Freud fails to relate his findings here to the father-complex thesis subsequently developed.
o n t o t h a t p e r s o n a n d i t s a f f e c t i v e c o n t e n t is t r a n s f o r m e d ( F r e u d , 1 9 8 1 , p p . 4 0 - 1 ) . In F r e u d ' s r e a d i n g , S c h r e b e r d e n i e d his love f o r Flechsig a n d c o n s e q u e n t l y i m a g i n e d t h a t Flechsig w a s his p e r s e c u t o r : The exciting cause of his illness, then, was an outburst of homosexual libido; the object of this libido was probably from the very first his doctor, Flechsig; and his struggles against the libidinal impulse produced the conflict which gave rise to the symptoms. (Freud, 1981, p. 43)" T h e d e l u s i o n o f p e r s e c u t i o n is t h e r e f o r e a d e f e n c e a g a i n s t w h a t F r e u d calls a ' f e m i n i n e ( t h a t is, a p a s s i v e h o m o s e x u a l ) w i s h f u l f a n t a s y ' ( F r e u d , 1 9 8 1 , p p . 4 6 - 7 ) . W h e n S c h r e b e r believes t h a t h e is p e r s e c u t e d n o t j u s t b y Flechsig, b u t b y G o d h i m s e l f , t h e d e l u s i o n a p p e a r s t o i n d i c a t e p s y c h i c c o n f l i c t o n a n even g r e a t e r scale; h o w e v e r , its i n f l a t i o n i n s t e a d p r o v i d e s t h e m e a n s b y w h i c h t h e e g o can accept the u n c o n s c i o u s fantasy. Freud h a d hypothesized earlier that the r e d e e m e r delusion served to legitimate Schreber's fantasy of e m a s c u l a t i o n — b e c o m i n g Flechsig's w h o r e w a s i n t o l e r a b l e , b u t if S c h r e b e r w a s c h o s e n b y G o d t o r e d e e m h u m a n k i n d t h e n it w a s his d u t y t o e n j o y his t r a n s f o r m a t i o n i n t o a w o m a n . If G o d is, in S c h r e b e r ' s c o s m o l o g y , a s y m b o l f o r t h e f a t h e r , t h e n t h e e x p l a n a t i o n f o r his l o n g i n g f o r t r a n s s e x u a l m e t a m o r p h o s i s is easily i d e n t i f i e d : ' T h e f e m i n i n e p h a n t a s y , w h i c h a r o u s e d s u c h v i o l e n t o p p o s i t i o n in t h e p a t i e n t , t h u s h a d its r o o t s in a l o n g i n g , i n t e n s i f i e d t o a n e r o t i c p i t c h , f o r his f a t h e r a n d b r o t h e r ' ( F r e u d , 1981, p. 50). F r e u d explains S c h r e b e r ' s e n t i r e d e l u s i o n a l s t r u c t u r e — c o m m u n i c a t i o n w i t h rays a n d n e r v e s , u p p e r a n d l o w e r G o d s , t h e f o r e c o u r t s o f h e a v e n , a n d feelings of s o u l - v o l u p t u o u s n e s s — a s d e r i v a t i v e o f a father complex wherein he assumes a 'feminine' attitude towards God-as-thefather. S c h r e b e r ' s b i z a r r e p s y c h o t i c s c h e m a is effectively r e m o u l d e d b y F r e u d i n t o a c o g e n t n e u r o t i c n a r r a t i v e of p s y c h o s e x u a l o r i g i n s . R e c o g n i z i n g t h a t 'in all t h i s t h e r e is n o t h i n g c h a r a c t e r i s t i c of t h e f o r m of disease k n o w n as p a r a n o i a , n o t h i n g t h a t m i g h t n o t b e f o u n d ( a n d t h a t h a s n o t in f a c t b e e n f o u n d ) in o t h e r kinds of neuroses', F r e u d t u r n s to address psychic m e c h a n i s m s particular to p a r a n o i a ( F r e u d , 1981, p. 59). P r o j e c t i o n is singled o u t as a p r o c e s s integral t o p a r a n o i d s y m p t o m f o r m a t i o n , 1 2 b u t it is t h e analysis o f t h e p a r t i c u l a r m e c h a n i s m of r e p r e s s i o n in p a r a n o i a t h a t e s t a b l i s h e s a v i t a l l i n k t o l i b i d o t h e o r y .
'' And continues with dramatic flair: 'I will pause here for a moment to meet a storm of remonstrances and objections. Any one acquainted with the present state of psychiatry must be prepared to face trouble'. 12 Freud (1981, p. 66) offers the following definition of projection: 'An internal perception is suppressed, and, instead, its content) after undergoing a certain kind of distortion, enters consciousness in the form of an external perception'.
P a r a n o i a , a c c o r d i n g t o F r e u d , is c h a r a c t e r i z e d by ' t h e f a i l u r e of r e p r e s s i o n , o f irruption,
o f return
of the repressed'
originating f r o m a p o i n t of fixation, or a
p o i n t of a r r e s t e d d e v e l o p m e n t , in t h e l i b i d o ( F r e u d , 1981, p . 68, italics in t h e o r i g i n a l ) . O n e of t h e s t r o n g e s t a n d m o s t p e r s u a s i v e passages in ' P s y c h o - A n a l y t i c N o t e s ' is t h e i n t e r p r e t a t i o n o f S c h r e b e r ' s ' w o r l d - c a t a s t r o p h e ' d e l u s i o n as o n e such irruption:13 The patient has withdrawn from the people in his environment and from the external world generally the libidinal cathexis which he had hitherto directed on to them. Thus everything has become indifferent and irrelevant to him, and has to be explained by means of a secondary rationalization as being 'miracled up, cursorily improvised'. The end of the world is the projection of this internal catastrophe; his subjective world has come to an end since his withdrawal of his love from it. (Freud, 1981, p. 70) T h e ' d e l u s i o n a l f o r m a t i o n ' o f a p r o f o u n d l y c h a n g e d w o r l d is t h e r e f o r e n o t in itself t h e p a t h o l o g i c a l p r o d u c t , r a t h e r it 'is in reality a n a t t e m p t at r e c o v e r y , a p r o c e s s o f r e s t i t u t i o n ' ; it ' u n d o e s t h e w o r k o f r e p r e s s i o n ' b y r e d i r e c t i n g t h e libido on to the external w o r l d t h r o u g h a k i n d of radical p r o j e c t i o n , w h e r e ' w h a t w a s a b o l i s h e d i n t e r n a l l y r e t u r n s f r o m w i t h o u t ' ( F r e u d , 1981, p . 7 1 ) . F r e u d s p e c u l a t e s t h a t t h e w i t h d r a w a l of l i b i d o f r o m t h e w o r l d is in fact a r e g u l a r f e a t u r e of n o r m a l life a n d o t h e r less s e v e r e d i s o r d e r s ; w h a t is d i s t i n c t i v e a b o u t p a r a n o i a is t h a t t h e w i t h d r a w n l i b i d o is p u t t o a ' s p e c i a l u s e ' , t h a t it is, as t h e m e g a l o m a n i a c t e n d e n c i e s of p a r a n o i a c s i n d i c a t e , r e d i r e c t e d o n t o t h e e g o ( F r e u d , 1981, p. 72). A b r a h a m h a d a l r e a d y a r g u e d t h a t d e m e n t i a p r a e c o x c o u l d b e u n d e r s t o o d as r e g r e s s i o n t o t h e a u t o - e r o t i c ( p r i m a r y ) stage of libidinal d e v e l o p m e n t ; h e r e , F r e u d suggests t h a t in p a r a n o i a t h e l i b i d o is f i x a t e d at t h e s e c o n d , narcissistic stage, a n d so a s s o c i a t e d w i t h h o m o s e x u a l i t y . C r y s t a l l i z e d d e l u s i o n a l s t r u c t u r e s , m e g a l o m a n i a , passive h o m o s e x u a l f a n t a s i e s — l i b i d o t h e o r y o f f e r s its o w n r e l a t i v e l y c o m p r e h e n s i v e e x p l a n a t i o n f o r t h e s e e l e m e n t s o f p a r a n o i a , b u t w h a t of t h e m o r e a c u t e l y p s y c h o t i c , inaccessible d e m e n t i a p r a e c o x ? As I s u g g e s t e d earlier, F r e u d elided d i s c u s s i o n of Schreber's p a n o p l y of schizophrenic s y m p t o m s , concentrating instead o n his c o m p l e x d e l u s i o n a l f o r m a t i o n s . It b e c o m e s clear t o w a r d s t h e e n d o f ' P s y c h o A n a l y t i c N o t e s ' t h a t t h e s u c c e s s of F r e u d ' s l i b i d o - t h e o r y analysis o f p a r a n o i a d e p e n d s u p o n g r o u p i n g it a m o n g t h e n e u r o s e s , effectively r e j e c t i n g K r a e p e l i n ' s a n d Bleuler's clinical p i c t u r e of p a r a n o i a as a type o f d e m e n t i a p r a e c o x o r schizo p h r e n i a . ' W h a t s e e m s t o m e m o s t e s s e n t i a l ' , F r e u d w r i t e s , 'is t h a t p a r a n o i a
13
Schreber (1955, p. 86) reports that he had 'innumerable visions . . . in connection with the idea that the world had perished' and that these 'were partly of a gruesome nature, partly of an indescribable sublimity'.
should be m a i n t a i n e d as an i n d e p e n d e n t clinical type, h o w e v e r f r e q u e n t l y t h e picture it offers m a y be c o m p l i c a t e d b y t h e presence of s c h i z o p h r e n i c features' (Freud, 1981, p. 76). Suggesting that d e m e n t i a p r a e c o x be r e n a m e d ' p a r a p h r e nia', F r e u d p r o p o s e s two key differences b e t w e e n d e m e n t i a p r a e c o x a n d paranoia: first, d e m e n t i a p r a e c o x d o e s n o t involve p r o j e c t i o n b u t an u n s p e c i f i e d ' h a l l u c i n a t o r y ( h y s t e r i c a l ) m e c h a n i s m ' ; s e c o n d l y , t h e p o i n t of f i x a t i o n is ' f u r t h e r b a c k ' at t h e stage of a u t o - e r o t i c i s m ( F r e u d , 1981, p. 77). If p a r a n o i a c a n n o t , as F r e u d acknowledges, be definitively d i s t i n g u i s h e d f r o m o t h e r n e u roses, a n d the m o r e m a r k e d l y psychotic aspects of p a r a p h r e n i a similarly fail t o w a r r a n t a significant i n n o v a t i o n in psychoanalytic t h e o r y , t h e n a c o n t i n u u m between neurosis, p a r a n o i a , a n d p a r a p h r e n i a is implicitly established. Despite calling f o r d i s t i n c t n o s o l o g i c a l c a t e g o r i e s , F r e u d o n l y f u r t h e r c o n f u s e s t h é issue: ' O u r h y p o t h e s e s as t o t h e dispositional fixations in p a r a n o i a a n d p a r a p h r e n i a m a k e it easy t o see t h a t a case m a y begin w i t h p a r a n o i a c s y m p t o m s a n d m a y yet d e v e l o p i n t o a d e m e n t i a praecox, a n d that p a r a n o i d a n d schizop h r e n i c p h e n o m e n a m a y b e c o m b i n e d in any p r o p o r t i o n ' (Freud, 1981, p. 77). S c h r e b e r ' s t r a n s l a t o r s , p s y c h o a n a l y s t s Ida M a c a l p i n e a n d R i c h a r d H u n t e r , n o t e t h a t in spite of F r e u d ' s e q u i v o c a t i o n s , his t h e o r e t i c a l f o r m u l a t i o n s o n p a r a n o i a ' w e r e n e v e r t h e l e s s i m p e r c e p t i b l y e x t e n d e d in p s y c h o a n a l y s i s t o s c h i z o p h r e n i a a n d t h e psychoses in general; as such they e n t e r e d psychiatric literature as " t h e psychoanalytic t h e o r y of p s y c h o s i s " ' ( M a c a l p i n e a n d H u n t e r , 1955b, p p . 10-11). Ultimately, as Lacan observes, F r e u d ' s analysis of p a r a n o i a / p a r a p h r e n i a 'leaves t h e fields of t h e p s y c h o s e s a n d t h e n e u r o s e s b o t h o n t h e s a m e level' (Lacan, 1993, p p . 10-11), a n d , I w o u l d argue, establishes t h e translation of psychosis i n t o a n e u r o t i c n a r r a t i v e a d e f i n i n g f e a t u r e of the p s y c h o analytic a p p r o a c h t o s c h i z o p h r e n i a . T h e key c o n c e p t s i n t r o d u c e d b y F r e u d in his analysis of Schreber's
Memoirs—
homosexuality, narcissism, the r e t u r n of the repressed, a n d the restitutive f u n c t i o n of t h e s y m p t o m — b e c a m e i n t e g r a l t o s u b s e q u e n t p s y c h o a n a l y t i c a c c o u n t s of s c h i z o p h r e n i a . H o w e v e r , 'Psycho-Analytic N o t e s ' was arguably as influential in i n a u g u r a t i n g a p a r t i c u l a r way of r e a d i n g psychosis as it was f o r p r e s e n t i n g a t h e o r y of p a r a n o i d s y m p t o m f o r m a t i o n . I w a n t t o t u r n n o w to the significance o f ' P s y c h o - A n a l y t i c N o t e s ' in establishing a m e t h o d o l o g y for the analysis of psychosis, o n e t h a t is s u m m a r i z e d b y L a c a n ' s c o m m e n t : ' [ F r e u d ] d e c i p h e r s [Memoirs]
in t h e way h i e r o g l y p h i c s are d e c i p h e r e d ' (Lacan, 1993,
p. 10). T w o distinguishing features of the psychoanalytic a p p r o a c h t o schizophrenia are m a d e a p p a r e n t in Freud's work: the presentation of schizophrenia as a textual puzzle, a n d t h e i n t e r r e l a t e d n e g o t i a t i o n of i n t i m a c y a n d d i s t a n c e (close contact with the hieroglyphic, but spatial, temporal, a n d even psychic s e p a r a t i o n
f r o m its c r e a t o r ) . 1 4 F r e u d m a k e s it clear f r o m t h e o u t s e t t h a t p e o p l e w i t h p s y c h o s i s p o s e specific d i f f i c u l t i e s f o r t h e a n a l y t i c i n v e s t i g a t o r : ' W e c a n n o t a c c e p t p a t i e n t s s u f f e r i n g f r o m t h i s c o m p l a i n t , o r , a t all e v e n t s , w e c a n n o t k e e p t h e m f o r l o n g since w e c a n n o t o f f e r t r e a t m e n t u n l e s s t h e r e is s o m e p r o s p e c t of t h e r a p e u t i c s u c c e s s ' ( F r e u d , 1981, p . 9). A n y i n q u i r y i n t o p a r a n o i a is t h e r e f o r e f r u s t r a t e d b y a lack o f first-hand e x p e r i e n c e , a d i s t a n c e f r o m t h e p a t i e n t s t h e m selves. F r e u d o v e r c o m e s t h i s a p p a r e n t l y i n s u r m o u n t a b l e o b s t a c l e b y a r g u i n g t h a t s u c h p a t i e n t s ' p o s s e s s t h e p e c u l i a r i t y o f b e t r a y i n g (in a d i s t o r t e d f o r m , it is t r u e ) precisely t h o s e t h i n g s w h i c h o t h e r n e u r o t i c s k e e p h i d d e n as a secret'; a n d b y v i r t u e of t h e s e f l a g r a n t displays o f u n c o n s c i o u s m a t e r i a l , 'it f o l l o w s t h a t t h i s is p r e c i s e l y a d i s o r d e r in w h i c h a w r i t t e n r e p o r t o r a p r i n t e d case h i s t o r y c a n t a k e t h e p l a c e o f p e r s o n a l a c q u a i n t a n c e w i t h t h e p a t i e n t ' ( F r e u d , 1981, p. 9). H e r e it is a text, n a m e l y S c h r e b e r ' s Memoirs,
that bridges the distance between
p s y c h o a n a l y s t a n d p a t i e n t , b u t i n s o d o i n g calls i n t o q u e s t i o n t h e v e r y n a t u r e of p s y c h o a n a l y t i c t e c h n i q u e . 1 5 T h e text is a s u b s t i t u t e f o r n o t o n l y t h e p a t i e n t b u t also t h e a n a l y t i c r e l a t i o n s h i p ; t h e h e r m e n e u t i c e n t e r p r i s e h a s n o t h e r a p e u t i c e f f e c t s , a n d w h a t w o u l d o t h e r w i s e h a v e b e e n i n a c c e s s i b l e t o F r e u d is, b y virtue of being laid bare o n the page, ripe for p s e u d o - l i t e r a r y analysis.16 A l t h o u g h F r e u d r e m a r k s n o f u r t h e r o n t h e s i g n i f i c a n c e of b a s i n g his r e m a r k s a b o u t p a r a n o i a o n S c h r e b e r ' s Memoirs,
rather than on a patient whose behav-
i o u r m i g h t d i s t u r b , u n d e r m i n e , c o n f i r m , o r d i s t r a c t f r o m t h e analytic p r o c e s s , it is clear t h a t t h i s text p r e d e t e r m i n e s t o s o m e e x t e n t t h e s c o p e o f his i n q u i r y . U n l i k e B a b e t t e ' s w o r d a s s o c i a t i o n s , S c h r e b e r ' s s t o r y is b o t h a m e m o i r (a retelli n g o f t h e h i s t o r y o f his r e l i g i o u s r e v e l a t i o n s , w r i t t e n d u r i n g a p e r i o d of relative 14
15
16
Michel de Certeau (1983, p. 21) also notes that Freud 'preferred what was distant, as if a separation created the analytic space'. In a later paper, Freud resolved this by (re)defining paranoia as a 'narcissistic neurosis', which could not be cured by psychoanalysis due to the absence of transference. The paranoid person's indifference to the analyst means that 'the mechanism of cure which we carry through with other people—the revival of the pathogenic conflict and the overcoming of the resistance due to repression—cannot be operated with them. They remain as they are. Often they have already undertaken attempts at recovery on their own which have led to pathological results [i.e. delusions]. We cannot alter this in anyway. [...] They manifest no transference and for that reason are inaccessible to our efforts and cannot be cured by us' (Freud, 1963b, p. 447). Establishing the impossibility of an analytic relationship as a cardinal feature of psychosis bears striking resemblance to Jaspers's thesis of an unbreachable gulf between the psychiatrist and schizophrenic patient. However, for Jaspers, unlike Freud, the gulf is structural to the definition of schizophrenia. As Pamela Thurschwell (2000, p. 62) observes, 'The Schreber case is . . . a psychoanalytic reading of a text, rather than an analysis of a person. In some ways it has more in common with Freud's reading of other literary and artistic works than it does with the other case histories'.
psychic stability) a n d an appeal (to have the validity of these revelations a c k n o w l e d g e d , a n d h i s t u t e l a g e r e s c i n d e d ) . Its f o r m a n d f u n c t i o n t h e r e f o r e allow for the p r e s e n t a t i o n of a comparatively cogent narrative w h i c h charts t h e o n s e t a n d d e v e l o p m e n t of S c h r e b e r ' s s c h i z o p h r e n i c s y m p t o m s . F r e u d r e - p r e s e n t s this n a r r a t i v e in o r d e r t o give a p s y c h o a n a l y t i c a c c o u n t of its origins. T h e a n a l y t i c d i s t a n c e i m p o s e d b y t h e s u b s t i t u t i o n o f text f o r p a t i e n t p r o v e d e n o r m o u s l y p r o d u c t i v e f o r F r e u d a n d , p a r a d o x i c a l l y , it is t h i s s e p a r a t i o n w h i c h allowed h i m to f o r m an intimate identification with Schreber. Indeed, by consistently praising Schreber's intelligence, his professional a c c o m p l i s h m e n t s , a n d his p o w e r s of c o m m u n i c a t i o n , F r e u d s e e m s t o align h i m s e l f s o closely w i t h S c h r e b e r t h a t b y t h e e n d o f ' P s y c h o - A n a l y t i c N o t e s ' h e feels c o m p e l l e d t o assert his t h e o r e t i c a l r i g o u r a n d originality: [So many] details of Schreber's delusional structure sound almost like endopsychic perceptions of the processes whose existence I have assumed in these pages as the basis of our explanation of paranoia. I can nevertheless call a friend and fellow-specialist to witness that I had developed my theory of paranoia before I became acquainted with the contents of Schreber's book. It remains for the future to decide where there is more delusion in my theory than I should like to admit, or whether there is more truth in Schreber's delusion than other people are as yet prepared to believe. (Freud, 1981, p. 79) H e r e , F r e u d e c h o e s S c h r e b e r ' s o w n a p p e a l t o b e believed: Even now I would count it a great triumph for my dialectical dexterity if through the present essay, which seems to be growing to the size of a scientific work, I should achieve only the one result, to make the physicians shake their heads in doubt as to whether after all there was some truth in my so-called delusions and hallucinations. (Schreber, 1955, p. 123, italics in the original) So s t r o n g w a s h i s i d e n t i f i c a t i o n w i t h S c h r e b e r t h a t F r e u d u s e d his n e o l o g i s m s t o d e v e l o p a p r i v a t e d i s c o u r s e w i t h J u n g , r e f e r r e d t o h i m as ' t h e w o n d e r f u l Schreber, w h o ought to have been m a d e a professor of psychiatry and director o f a m e n t a l h o s p i t a l ' ( F r e u d , in F r e u d a n d J u n g , 1974, p . 3 1 1 ) , a n d , as J o h n Farrell discusses at l e n g t h , c a m e t o u n d e r s t a n d m a n y o f his o w n r e l a t i o n s h i p s t h r o u g h S c h r e b e r ' s p a r a n o i a (Farrell, 1996, p p . 1 8 8 - 9 4 ) . F r e u d e v e n a t t e m p t e d t o i n s u l a t e S c h r e b e r f r o m a n y s u s p i c i o n t h a t h e m i g h t b e a n average p s y c h o t i c patient by disclaiming any similarity between Babette and Schreber: her ' d e m e n t i a praecox' was a p p a r e n t l y 'far severer t h a n this o n e ' a n d 'exhibited s y m p t o m s far m o r e r e m o t e f r o m t h e n o r m a l ' ( F r e u d , 1981, p. 35). T h e s e c l a i m s t o k n o w S c h r e b e r i n t i m a t e l y , m a d e in a n d b e y o n d ' P s y c h o - A n a l y t i c N o t e s ' , serve, I w o u l d a r g u e , a d o u b l e f u n c t i o n . First, t h e y c r e a t e t h e i m p r e s s i o n t h a t p s y c h o a n a l y s i s h a s p r i v i l e g e d access t o t h e s e c r e t s o f p s y c h o s i s , u n c o v e r i n g
m e a n i n g in w h a t p s y c h i a t r y t a k e s t o b e of d i a g n o s t i c i n t e r e s t o n l y . H o w e v e r , a l t h o u g h it w o u l d a p p e a r t h a t s c r u t i n i z i n g t h e s y m b o l i c c o n t e n t o f d e l u s i o n s a n d h a l l u c i n a t i o n s f o r t h e p s y c h o s e x u a l o r i g i n s of p s y c h o s i s p r o m o t e s a type of u n d e r s t a n d i n g u n i m a g i n a b l e in a n a s y l u m , t h e i d e a of a n i n t i m a c y b e t w e e n F r e u d a n d S c h r e b e r h i m s e l f is u t t e r l y illusory as it is t h e s c h i z o p h r e n i c text, a n d n o t t h e analytic r e l a t i o n s h i p , in w h i c h F r e u d invests. W h e r e a s K r a e p e l i n r o u tinely c o n c e d e d t h a t t h e b e h a v i o u r of his d e m e n t i a p r a e c o x p a t i e n t s w a s s i m p l y b e y o n d c o m p r e h e n s i o n , F r e u d ' s ' P s y c h o - A n a l y t i c N o t e s ' , in ' p e n e t r a t [ i n g ] t h e d y n a m i c s o f p s y c h o s i s ' (Fine, 1979, p. 83), c a n b e r e a d as a c o m p l e x a t t e m p t t o n e g o t i a t e a safe d i s t a n c e f r o m s c h i z o p h r e n i a b y t r e a t i n g it as a t e x t u a l p u z z l e , a n d t o m i t i g a t e t h e i n s c r u t a b i l i t y o f m a d n e s s b y s o l v i n g t h a t puzzle. W e h a v e a l r e a d y seen t h a t t h e c a r e f u l c o n t r o l of d i s t a n c e w a s a d e t e r m i n i n g f a c t o r in K a n t ' s a c c o u n t of t h e s u b l i m e e n c o u n t e r , a n d t h a t p s y c h i a t r y ' s elevat i o n o f s c h i z o p h r e n i a t o t h e s t a t u s of s u b l i m e o b j e c t likewise d e p e n d e d u p o n a distance carefully c o n t r o l l e d t h r o u g h an e n s e m b l e of discursive a n d clinical practices. T h e p s y c h o a n a l y t i c a p p r o a c h t o p s y c h o s i s is in s o m e sense s i m i l a r t o this p r o c e s s : t h e a n a l y s t p u r p o r t s t o ' p e n e t r a t e ' t h e o t h e r w i s e o p a q u e i n t e r n a l d y n a m i c s of t h e p a t i e n t t h r o u g h a p s e u d o - l i t e r a r y analysis m a d e p o s s i b l e b y a spatial a n d t e m p o r a l gulf. B u t r a t h e r t h a n i n q u i r i n g i n t o s c h i z o p h r e n i a as d i s ease, p s y c h o a n a l y s i s f r a m e s s c h i z o p h r e n i a as a s u b l i m e t e x t , a series o f signs t h a t starkly e x p o s e t h e s u b l i m e ' s e c r e t s ' of t h e u n c o n s c i o u s , a n d c h a l l e n g e t h e analyst to assert their h e r m e n e u t i c mastery by d e c i p h e r i n g t h e m . 1 7 W h a t allows f o r t h e o p e r a t i o n of a d i s c i p l i n a r y s u b l i m e in p s y c h i a t r y is t h e fact t h a t s c h i z o p h r e n i a r e t a i n s its s t a t u s as s o m e h o w ' u n k n o w a b l e ' ; p s y c h o a n a l y s i s , b y c o n t r a s t , claims t o ' k n o w ' t h e psychic m e c h a n i s m s , p s y c h o s e x u a l aetiology, a n d symbolic significance of schizophrenic s y m p t o m s , b u t only, 1 a m suggesting, b e c a u s e it recasts d i s o r d e r as text. A n a l y s e s of S c h r e b e r ' s Memoirs
a r e e x e m p l a r y o f t h e o p e r a t i o n of a t e x t u a l
s u b l i m e in p s y c h o a n a l y t i c d i s c o u r s e m o r e b r o a d l y . ' W h a t e v e r [its] p s y c h o logical s i g n i f i c a n c e ' , w r i t e s V i n c e n t C r a p a n z a n o ( 1 9 9 8 , p . 7 3 9 ) , ' f r o m a litera r y - d i s c u r s i v e p o i n t o f v i e w it is o n e o f t h e m o s t c h a l l e n g i n g t e x t s o f t h e c e n t u r y ' . 1 8 Its s e d u c t i o n s , as L o u i s Sass p u t s it ( 1 9 9 2 , p. 2 4 4 ) , a r e m a n y , . . . the more closely one reads, the more difficult it becomes to dismiss the hope for achieving some kind of interpretive or empathetic understanding of Schreber's 17
18
The issue of narrative is here once again worth noting. Freud's reading of Schreber is, it would seem, more celebrated than Jung's account of Babette's responses to word-association tests because it establishes a coherent, linear narrative of Schreber's delusions. Or, as Barrett (1998c, p. 471) wryly observes: 'During his illness Schreber suffered the most agonising self-scrutiny, but nothing like the intensity ol the posthumous psychiatric scrutiny'.
experiences. The whole structure of his lived world seems to have such specificity and precision; one cannot help but wonder whether it is possible to discover a coherent system lying behind it all. T h e i n t e r p r e t a t i v e c h a l l e n g e o f S c h r e b e r ' s text h a s b e e n t a k e n u p b y a stagg e r i n g n u m b e r o f p s y c h o a n a l y t i c a n d c u l t u r a l critics, all of w h o m c l a i m a cert a i n m a s t e r y o v e r its c o n t e n t s . Yet t h e essential e n i g m a o f t h e s c h i z o p h r e n i c , b e l l o w i n g , a n d l o n g - d e p a r t e d S c h r e b e r still r e m a i n s . In t h e n e x t s e c t i o n , I will b r i e f l y s u r v e y t h e m o s t i n f l u e n t i a l of t h e s e a n a l y s e s o f Memoirs,
not only to
d e m o n s t r a t e h o w w i l d l y d i v e r g e n t e a c h r e a d i n g is in its i n t e r p r e t a t i o n o f S c h r e b e r ' s s y m p t o m a t o l o g y , b u t t o a r g u e t h a t t h i s p r o l i f e r a t i o n of s c h o l a r l y r e i n t e r p r e t a t i o n s o f Memoirs
testifies t o t h e t e x t u a l s u b l i m i t y o f s c h i z o p h r e n i a
w i t h i n ( a n d b e y o n d ) p s y c h o a n a l y s i s . A c c o r d i n g t o t h e logic o f t h e t e x t u a l s u b l i m e , it is n o t t h e d i s o r d e r b u t t h e t e x t — l i t e r a l l y , t h e s y m b o l i c o u t p u t — o f s c h i z o p h r e n i a t h a t is p e r p e t u a l l y r e f r a m e d ; t h e text c a n b e d e c i p h e r e d b u t t h e d i s o r d e r n e v e r w h o l l y e x p l a i n e d . O f c o u r s e , t h e f a c t t h a t S c h r e b e r is d e a d m e a n s t h a t n o single a c c o u n t c a n assert its i n t e r p r e t i v e s u p e r i o r i t y t h r o u g h a n a p p e a l t o t h e r a p e u t i c success. T h i s is w i d e l y u n a c k n o w l e d g e d b u t d i m i n i s h e s n o c o m m e n t a t o r ' s i n t e r p r e t i v e zeal; it o n l y f u r t h e r r e i n f o r c e s t h e p r o f o u n d s c h i s m b e t w e e n t h e p s y c h o t i c text a n d t h e p e r s o n t o w h o m it b e l o n g s . A i m i n g t o c a p t u r e t h e t r u t h of S c h r e b e r ' s d e l u s i o n s , o r t o ' p e n e t r a t e ' t h e secrets of his p s y c h o s i s , t h e p s y c h o a n a l y t i c d i s c o u r s e g e n e r a t e d b y Memoirs
continues
F r e u d ' s a p p r o a c h t o s c h i z o p h r e n i a as a t e x t u a l p u z z l e , a n d r e i n f o r c e s his view t h a t t h e s c h i z o p h r e n i c p a t i e n t c a n o n l y b e t a l k e d about b u t n o t t a l k e d to.
Reading Schreber Psychoanalysis and (psycho)biography Freud's 'Psycho-Analytic Notes' established the terms of reference for psychoanalytic r e a d i n g s o f S c h r e b e r ' s Memoirs,
a n d i n d e e d p s y c h o s i s in g e n e r a l , u n t i l
at least t h e m i d - 1 9 5 0 s . P e r h a p s t h e m o s t f r e q u e n t l y c i t e d F r e u d i a n a n a l y s t of t h e S c h r e b e r c a s e is M a u r i t s K a t a n . K a t a n p u b l i s h e d a n u m b e r o f p a p e r s e n d o r s i n g t h e t e n e t s o f F r e u d ' s h o m o s e x u a l i t y thesis, e l a b o r a t i n g o n t h e ' b a s i c m a s t u r b a t o r y f a n t a s y ' at w o r k t h r o u g h o u t S c h r e b e r ' s illness, a n d s u g g e s t i n g t h a t p s y c h o s i s o c c u r s w h e n t h e O e d i p a l c o m p l e x fails t o c o n t a i n t h e ' d a n g e r o u s p a s s i v e f e m i n i n e u r g e ' o f t h e h o m o s e x u a l l i b i d o ( K a t a n , 1949, 1950a, b , 1952a, b ) . H o w e v e r , t h e t r a n s l a t i o n , b y Ida M a c a l p i n e a n d R i c h a r d H u n t e r , of S c h r e b e r ' s Memoirs,
a n d their stringent critique of Freud's 'Psycho-Analytic
N o t e s ' , a p p e a r t o m a r k t h e f i r s t m a j o r t u r n i n g p o i n t in t h e p s y c h o a n a l y t i c s t u d y o f b o t h texts. Explicitly c h a l l e n g i n g t h e ' t a b o o o f a classic . . . a t t a c h e d t o F r e u d ' s p a p e r ' M a c a l p i n e a n d H u n t e r take issue w i t h F r e u d ' s c o n f u s e d n o s o l o g y ,
his ( m i s t a k e n ) t r e a t m e n t o f p s y c h o s i s as a n O e d i p a l p s y c h o n e u r o s i s , his selective a n d s e l f - s e r v i n g c o n c e n t r a t i o n o n S c h r e b e r ' s p e r s e c u t o r y d e l u s i o n s , a n d his neglect of t h e ' o t h e r , o f t e n m u c h earlier, d i s t u r b a n c e s o f e m o t i o n , feeling, association [and] bodily sensations', which occurred during Schreber's prepsychotic phase a n d persisted t h r o u g h o u t his psychiatric incarceration ( M a c a l p i n e a n d H u n t e r , 1955a, p p . 3 6 9 - 8 0 ) . F i n d i n g in Memoirs
n o evidence
to s u p p o r t Freud's thesis that Schreber's psychosis originated f r o m an irruption of h o m o s e x u a l libido, Macalpine a n d H u n t e r look b e y o n d the O e d i p u s c o m p l e x t o e x p l a i n its a e t i o l o g y , a n d in p a r t i c u l a r his s o m a t i c d e l u s i o n s a n d h y p o c h o n d r i a . Like F r e u d , t h e y s u g g e s t t h a t t h e ' u n m a n n i n g ' f a n t a s y is at t h e c o r e o f S c h r e b e r ' s d e l u s i o n a l s c h e m a , b u t i n s t e a d of v i e w i n g it as a c a s t r a t i o n t h r e a t o r as e v i d e n c e o f S c h r e b e r ' s h o m o s e x u a l i t y , t h e y i n t e r p r e t h i s e n t i r e p s y c h o s i s 'as a r e a c t i v a t i o n of u n c o n s c i o u s , a r c h a i c p r o c r e a t i o n f a n t a s i e s c o n c e r n i n g life, d e a t h , i m m o r t a l i t y , r e b i r t h , c r e a t i o n , [ a n d ] s e l f - i m p r e g n a t i o n . . . a c c o m p a n i e d b y a b s o l u t e a m b i s e x u a l i t y e x p r e s s e d in d o u b t a n d u n c e r t a i n t y a b o u t his sex' ( M a c a l p i n e a n d H u n t e r , 1955a, p. 395). F o r M a c a l p i n e a n d H u n t e r , it w a s t h e i n t e n s e u n h a p p i n e s s r e s u l t i n g f r o m S c h r e b e r ' s i n a b i l i t y t o h a v e c h i l d r e n ( S a b i n e S c h r e b e r s u f f e r e d six p r e g n a n c i e s r e s u l t i n g in m i s c a r riage o r still b i r t h ) , a n d n o t a n u n c o n s c i o u s h o m o s e x u a l l o n g i n g f o r t h e f a t h e r , that u n d e r s c o r e d the archaic procreation fantasy structuring his psychosis. M a c a l p i n e a n d H u n t e r ' s original psychoanalytic r e r e a d i n g of Schreber's Memoirs
certainly challenged Freudian o r t h o d o x y by pointing towards the
p r e - O e d i p a l origins of psychosis. H o w e v e r , their analysis was, for the m o s t p a r t , c o n f i n e d t o t h e text itself. T h e decisive t r a n s f o r m a t i o n in S c h r e b e r s t u d ies w a s b r o u g h t a b o u t b y W i l l i a m G . N i e d e r l a n d ' s r e s e a r c h i n t o a n a r r a y o f o t h e r t e x t s p e r t i n e n t t o t h e S c h r e b e r case, in p a r t i c u l a r , t h e a u t o c r a t i c p e d a gogical writings of Daniel Gottlieb M o r i t z Schreber.19 Schreber's father, an e s t e e m e d a n d z e a l o u s p e d a g o g u e , p u b l i s h e d o v e r t h e c o u r s e o f his l i f e t i m e n u m e r o u s b o o k s o n t h e t o p i c o f c h i l d r e a r i n g in w h i c h h e a d v i s e d ' p a r e n t s a n d e d u c a t o r s [to] use a m a x i m u m of p r e s s u r e a n d c o e r c i o n d u r i n g the earliest y e a r s of t h e c h i l d ' s life' ( N i e d e r l a n d , 1984, p. 5 0 ) . 2 0 T o a t w e n t y - f i r s t - c e n t u r y r e a d e r , t h e e d u c a t i o n system a d v a n c e d b y M o r i t z S c h r e b e r s e e m s at best severe a n d excessively disciplinarian, a n d at w o r s t a despotic, sadistic r e g i m e g u a r a n t e e d t o s c a r a n y c h i l d s u b j e c t e d t o its p r i n c i p l e s a n d p r a c t i c e s . P r o m i n e n t a m o n g M o r i t z S c h r e b e r ' s r e c o m m e n d a t i o n s t o p a r e n t s is t h e u s e o f h i s s e l f - d e v i s e d
19
Daniel Gottlieb Moritz Schreber—the father o f Daniel Paul Schreber, author of Memoirs—I shall henceforth refer to as Moritz Schreber.
20
Note that The Schreber Case includes a revised collcctlou <>l Niederland's publications on Schreber, dating from 1951.
a n d p r e s u m a b l y f a m i l y - t e s t e d p r o s t h e t i c devices: s t r a p s , belts, b a r s , a n d h e l mets w o r n by children to correct posture, prevent masturbation, and p r o m o t e obedience. N i e d e r l a n d argues that the study of these devices a n d educational m a n u a l s ' e n a b l e [ s ] u s — a s F r e u d h a d s u g g e s t e d — t o t r a c e n u m e r o u s details of Schreber's delusions t o their sources a n d to correlate a n u m b e r of h i t h e r t o o b s c u r e p a s s a g e s in t h e d e s c r i p t i o n o f his d e l u s i o n a l s y s t e m w i t h p a r t i c u l a r ideas, p r i n c i p l e s , a n d t h e l i f e w o r k c h e r i s h e d b y t h e f a t h e r ' ( N i e d e r l a n d , 1984, p. 4 9 ) . A p s y c h o a n a l y s t b y t r a d e , N i e d e r l a n d i n t e r p r e t s S c h r e b e r ' s s o m a t i c s u f f e r i n g (specifically, t h e ' c o m p r e s s i o n - o f - t h e - c h e s t - m i r a c l e ' , ' h e a d - b e i n g - t i e d t o g e t h e r - m a c h i n e ' , a n d v a r i o u s o t h e r ' m i r a c l e s ' p e r f o r m e d o n h i s eyes a n d eyelids) 2 1 as, . . . a highly condensed, symbolized, archaically distorted, yet essentially correct version of many of the paternal physical maneuvers to which the young Schreber was subjected, a sort of 'primary-process' catalogue of those remote infantile experiences, shaped, altered, and strongly cathected ('deified') by the father-son conflict. (Niederland, 1984, pp. 75-80) N i e d e r l a n d claims that his extensive biographical research uncovers a 'nucleu s ' o r ' k e r n e l ' of t r u t h in S c h r e b e r ' s d e l u s i o n s ( N i e d e r l a n d , 1984, p p . xvi, 101). W h a t b e a r i n g his p s y c h o b i o g r a p h i c a l analysis h a s o n t h e q u e s t i o n of t h e aetiolo g y of t h e s e a n d o t h e r s c h i z o p h r e n i c d e l u s i o n s is m u c h less clear, p r i n c i p a l l y b e c a u s e N i e d e r l a n d s t r u g g l e s t o r e c o n c i l e his h i s t o r i c a l a c c o u n t o f t h e ' p a t h o logical' a n d a b u s i v e f a t h e r w i t h F r e u d ' s i n s i s t e n c e u p o n t h e i n t r a p s y c h i c , psychosexual origins of paranoia.22 Niederland does e n d e a v o u r to c o n f i r m Freud's hypothesis by suggesting that 'the manipulations p e r f o r m e d o n the child's b o d y ' w e r e b o t h ' p u n i t i v e ' and ' s e d u c t i v e ' , a n d h e n c e a r o u s e d in t h e y o u n g S c h r e b e r d e e p l y c o n t r a d i c t o r y feelings t o w a r d s his f a t h e r ( N i e d e r l a n d , 1984, p p . 60, 74). Later, he suggests t h a t t h e o n s e t of S c h r e b e r ' s p s y c h o s i s was a direct result of his p r o f e s s i o n a l a p p o i n t m e n t , the c o n f r o n t a t i o n with his
21
Schreber writes that 'From the first beginnings of my contact with God up to the present day my body has continuously been the object of divine miracles . . . I might say that hardly a single limb or organ in my body escaped being temporarily damaged by miracles, nor a single muscle being pulled by miracles, either moving or paralyzing it according to the respective purpose. Even now the miracles which I experience hourly are still of a nature as to frighten every other human being to death . . . ' . He goes on to say that the 'compression-of-the-chest-mimcle', for example, 'consisted in the whole chest wall being compressed, so that the state of oppression caused by the lack of breath was transmitted to my whole body' (Schreber, 1955, pp. 131-3).
22
Man Israels (quoted in Santner, 1996, p. 169) suggests that this is because Niederland's influence anxiety prevents him from appreciating, or clearly articulating, the sharp distinction between his own findings and those of Freud.
'greatest d r e a d ' : ' t a k i n g t h e place of t h e f a t h e r ' a n d ' a s s u m i n g an active m a s c u line role in real life' ( N i e d e r l a n d , 1984, p. 41). H o w e v e r , as N i e d e r l a n d rightly p o i n t s o u t , n e i t h e r these n o r F r e u d ' s original hypothesis can adequately explain S c h r e b e r ' s 40 y e a r s of a p p a r e n t m e n t a l h e a l t h . D e s p i t e i l l u m i n a t i n g a n e w symbolic d i m e n s i o n in Schreber's delusional s c h e m a , The Schreber Case m a k e s n o significant m e t h o d o l o g i c a l d e p a r t u r e f r o m psychoanalytic o r t h o d o x y . In a m o v e r e m i n i s c e n t of F r e u d ' s a b a n d o n m e n t of t h e s e d u c t i o n theory, N i e d e r l a n d h i n t s at b u t n o w h e r e p o s i t s a direct, causal r e l a t i o n s h i p b e t w e e n S c h r e b e r ' s c h i l d h o o d experiences a n d the o n s e t of his psychosis. N i e d e r l a n d raised this f u n d a m e n t a l q u e s t i o n r e g a r d i n g Schreber's psychosis in the early 1950s. T w e n t y years later, M o r t o n S c h a t z m a n a n s w e r e d it r e s o u n d ingly in his Soul Murder:
Persecution
in the Family ( S c h a t z m a n , 1973; see also
S c h a t z m a n , 1971, p p . 117-207). W h e r e a s N i e d e r l a n d w a s justifiably wary that a ' c o n s p i r a t i o n a l t h e o r y ' of s c h i z o p h r e n o g e n i c p a r e n t s is 'simplistic a n d r e d u c t i o n i s t ' ( N i e d e r l a n d , 1984, p. 109), S c h a t z m a n insists t h a t N i e d e r l a n d ' s
find-
i n g s 'call f o r r a d i c a l l y new h y p o t h e s e s ' a n d s p e a k t o t h e u r g e n t n e e d f o r a reappraisal of Memoirs
as well as a m o r e r i g o r o u s investigation of t h e f a m i l y
life of all people d i a g n o s e d with s c h i z o p h r e n i a ( S c h a t z m a n , 1973, pp. 8, xvi, 1, italics in t h e original). S c h a t z m a n ' s overtly political a n d p a s s i o n a t e discussions o f s c h i z o p h r e n i a l o c a t e h i m s q u a r e l y in t h e a n t i p s y c h i a t r y m o v e m e n t . Like R.D. Laing, S c h a t z m a n ascribes a c o n s i d e r a b l e a g e n c y t o t h e s c h i z o p h r e n i c patient: he argues t h a t S c h r e b e r ' s delusional experiences are direct 'images' o r ' t r a n s f o r m s ' o f h i s f a t h e r ' s p r o c e d u r e s , t h a t t h e y r e p r e s e n t an ' i n g e n i o u s a t t e m p t ' t o negotiate the c o n t r a d i c t i o n s i n h e r e n t in those p r o c e d u r e s , a n d that ultimately Schreber's 'miracles' are not s y m p t o m s b u t memories and re-enactments of his t o r m e n t ( S c h a t z m a n , 1973, p p . xii, xiii, 23, 4 5 - 7 ) . S c h a t z m a n is u n e quivocal in assigning M o r i t z Schreber t h e role of villain in Schreber's suffering, d e s c r i b i n g h i m as ' p a r a n o i d o g e n i c ' o r generative of his s o n ' s p a r a n o i d states ( S c h a t z m a n , 1973, p p . 1 2 2 - 4 ) . S c h a t z m a n ' s d i s c u s s i o n o f t h e b i o g r a p h i c a l origins of s o m e of Schreber's delusions is certainly d r a m a t i c , a n d suggestive u p t o a p o i n t , a l t h o u g h he gives only a c u r s o r y a c c o u n t of t h e psychic m e c h a n i s m s a n d processes of s c h i z o p h r e n i c s y m p t o m f o r m a t i o n a n d his ' c o n s p i r a t i o n a l ' p a r a n o i d o g e n i c - f a t h e r t h e s i s is, as N i e d e r l a n d m i g h t h a v e o b s e r v e d , ill-equipped to explain Schreber's 40 years of a p p a r e n t n o r m a l c y . If S c h a t z m a n a p p r o a c h e d t h e Schreber case in the spirit of R.D. Laing, Zvi L o t h a n e is closer t o t h e T h o m a s Szasz s c h o o l of a n t i p s y c h i a t r y . 2 3 As I will d i s c u s s in t h e next c h a p t e r , Laing a n d Szasz r e p r e s e n t t w o d i s t i n c t t r e n d s in
2t
Lothane (1992, p. ix) refers to Szasz. .is one of liis 'good friends', but does not explicitly identify himself as an antipsychiatrlit. Although I.othnnr ilies Niederland as 'the doyen
a n t i p s y c h i a t r y : t h e f o r m e r d e d i c a t e d t o e l u c i d a t i n g t h e f a m i l i a l , societal, a n d political causes o f ' s c h i z o p h r e n i a ' , the latter m o r e directly c o n c e r n e d with c r i t i q u i n g t h e i n s t i t u t i o n o f p s y c h i a t r y . A n t i p s y c h i a t r y radically calls i n t o q u e s t i o n t h e e x i s t e n c e o f s c h i z o p h r e n i a (as severe p s y c h i c d i s o r d e r , a n d especially as disease), a n d for very d i f f e r e n t r e a s o n s , S c h a t z m a n ( 1 9 7 3 , p. 23) a n d L o t h a n e ( 1 9 9 2 , p. 7) c a t e g o r i c a l l y reject b o t h p s y c h i a t r i c a n d p s y c h o a n a l y t i c d i a g n o s e s o f S c h r e b e r . L o t h a n e ' s t o m e , In Defense of Schreber,
is a n e x h a u s t i v e b i o g r a p h -
ical s t u d y o f t h e S c h r e b e r s a n d t h e b i o l o g i c a l p s y c h i a t r i s t s w h o a d m i n i s t e r e d t h e a s y l u m s in w h i c h S c h r e b e r w a s i n c a r c e r a t e d , as well as a m u l t i f a c e t e d crit i q u e of S c h r e b e r s t u d i e s u p t o t h e early 1990s. M o s t strikingly, L o t h a n e a t t e m p t s a r e d e m p t i v e r e - r e a d i n g o f M o r i t z S c h r e b e r ' s p e d a g o g i c texts, a n d comes to the conclusion that: It is the posture-improving appliances that have procured for Schreber the reputation of a malevolent and sadistic educator. It is due to the horrific imagery created by the exaggerated descriptions of these allegedly immobilizing and pain-producing appliances by Niederland, and the even greater distortions by Schatzman, that this legend about Moritz Schreber arose and took root in the popular imagination . . . [and] fictions became historical facts. (Lothane, 1992, pp. 178-9, my italics)24 A s t h e title o f h i s w o r k s u g g e s t s , L o t h a n e ' s p r i m a r y o b j e c t i v e is t o d e f e n d b o t h the Schrebers f r o m the 'character assassinations' m a d e legend by Freud, Niederland, and particularly Schatzman: It comes to this: Moritz Schreber and [Daniel] Paul Schreber, father and son, have been the target of gross distortions. The father was made to look like a crank, the son queer and crazy. Both are gross distortions. Both caricatures stem from prejudice and ignorance of the historical facts. (Lothane, 1992, pp. 438, 7) L o t h a n e ' s p o r t r a y a l of S c h r e b e r , b y c o n t r a s t , a p p e a r s t o s t e m f r o m a s t r o n g a n d a l m o s t l o v i n g a t t a c h m e n t t o h i m : a p p r o a c h i n g S c h r e b e r 'as if [he] h a d e n t e r e d i n t o a d i a l o g u e w i t h a f r i e n d ' ( L o t h a n e , 1992, p . 5), h e views
Memoirs
as a ' g l o r i o u s ' b o o k , ' a r t i c u l a t e d w i t h intelligence a n d style,' filled w i t h ' d r a m a a n d p o i g n a n c y ' , a n d w r i t t e n in t h e c o m p l e m e n t a r y styles o f ' o r d i n a r y r e a l i s m
24
of Schreber studies', Eric Santner (1996, p. xiv) later claims that Lothane himself has since become 'the de facto dean of contemporary Schreber studies'. More than Niederland's 'exaggerated descriptions', Moritz Schreber's own drawings of these devices seem by themselves capable of producing the 'horrific imagery' to which Lothane refers. Nonetheless, Lothane seems rather desperately to insist that in fact '|t]hese appliances were no more menacing than braces for the teeth' (Lothane, 1992, p 180).
a n d magical r e a l i s m ' ( L o t h a n e , 1992, p p . 2, 3). A n u m b e r of distinct claims e m e r g e in In Defense
of Schreber
t o c o u n t e r f u r t h e r t h e p e j o r a t i v e label o f
' p s y c h o t i c ' : S c h r e b e r e x p e r i e n c e s ' d a y m a r e s ' a n d n o t d e l u s i o n s ; his
Memoirs
are intelligible w i t h i n t h e c o n t e x t s of m y s t i c i s m a n d late n i n e t e e n t h - c e n t u r y p h i l o s o p h y , a n d are t h e r e f o r e n o t p r o p e r l y psychotic; Schreber is so r e m a r k a ble as to be an e x c e p t i o n t o the n o r m of psychosis; a n d Schreber m o r e consistently exhibits s y m p t o m s of a depressive s y n d r o m e a n d transvestite fantasies r a t h e r t h a n s c h i z o p h r e n i a ( L o t h a n e , 1992, p p . 384, 393, 4 3 1 ^ 1 ) . L o t h a n e ' s o v e r a r c h i n g c o n t e n t i o n is that n o o n e has h i t h e r t o c o n s i d e r e d t h e 'reality
of S c h r e b e r ' s l o n g years in m e n t a l h o s p i t a l s a n d h o w i m p o r t a n t this
was in itself. For the Memoirs
are a b o u t his adult life, illnesses a n d hospitaliza-
t i o n s ' ( L o t h a n e , 1992, p. 6, italics in t h e o r i g i n a l ) . E s c h e w i n g p s y c h i a t r i c , p s y c h o a n a l y t i c , a n d S c h a t z m a n ' s p a r a n o i d o g e n e t i c a c c o u n t s of S c h r e b e r ' s experience, L o t h a n e n o n e t h e l e s s shares w i t h S c h a t z m a n a desire t o e x o n e r a t e Schreber f r o m t h e ' c h a r g e ' of m e n t a l illness. Accordingly he, t o o , e n d e a v o u r s t o i d e n t i f y t h e c u l p r i t s b e h i n d his i l l - t r e a t m e n t . A l t h o u g h t h e r e are just a n d s t r i n g e n t c r i t i q u e s t o be m a d e o f t h e b i o l o g i c a l p s y c h i a t r y of t h e p e r i o d , L o t h a n e effectively casts S c h r e b e r ' s p s y c h i a t r i s t s — E m i l Flechsig a n d G u i d o W e b e r (the forensic psychiatrist w h o ran the Sonnenstein asylum)—as the principal s c o u n d r e l s in the Schreber tale, i n c l u d i n g Sabine Schreber in a s u p p o r t i v e role t o t h e e x t e n t t h a t she c o n s p i r e d w i t h Flechsig a n d W e b e r t o r o b Schreber of his civil liberties. ( H e r e , L o t h a n e echoes Friedrich Kittler's (1990, p . 297) s u g g e s t i o n t h a t ' S c h r e b e r ' s p a r a n o i a f o l l o w e d t h e lead of an i n s a n e n e u r o l o g i s t ' . ) A l t h o u g h S c h r e b e r r e f e r s t o Flechsig as h i s ' s o u l - m u r d e r e r ' , L o t h a n e reserves his m o s t severe criticism f o r W e b e r , d e s c r i b i n g h i m as an 'adversary', 'actual persecutor', and 'oppressor' w h o maintained a 'double s t r a n g l e h o l d o n [ S c h r e b e r ] , b o t h m e d i c a l a n d j u r i d i c a l ' ( L o t h a n e , 1992, p p . 295, 300, 277). W e b e r ' s professional r e p o r t t o t h e c o u r t (in which h e reco m m e n d e d against r e s c i n d i n g tutelage) is a p p a r e n t l y indicative of an o v e r t , p e r s o n a l hostility to Schreber; likewise, Sabine's willingness to curtail the legal r i g h t of h e r p s y c h o t i c h u s b a n d t o m a n a g e t h e i r finances, a n d h e r failure t o u n d e r s t a n d his t r a n s f o r m a t i o n i n t o a w o m a n , is s u p p o s e d l y evidence of ' t h e i n t e l l e c t u a l a n d s p i r i t u a l gulf b e t w e e n h u s b a n d a n d w i f e ' ( L o t h a n e , 1992, p. 4 5 2 ) . Fuelled b y m o r e t h a n a h i n t of m e a n - s p i r i t e d n e s s , L o t h a n e ' s e f f o r t s t o r e d e e m his ' f r i e n d ' f r o m a c c u s a t i o n s of p a r a n o i a a n d s c h i z o p h r e n i a a r e u n a b a s h e d : ' T h e r e was n o small a m o u n t of t r u t h in S c h r e b e r ' s s t a t e m e n t that there was a c o n s p i r a c y t o u n m a n h i m f o r he was effectively u n m a n n e d insofar as the w o m a n h a d o v e r p o w e r e d h i m with t h e assistance of the legal a n d psychiatric e s t a b l i s h m e n t s ' ( L o t h a n e , 1992, p. 456).
Such are the i n t e r p r e t a t i o n s of Schreber's psychosis m o t i v a t e d by a reapp r a i s a l o f t h e p s y c h o a n a l y t i c a c c o u n t o f u n c o n s c i o u s h o m o s e x u a l c o n f l i c t in p a r a n o i a in f a v o u r o f h i s t o r i c a l i n v e s t i g a t i o n . In t h e a b s e n c e o f a g r o u n d e d theory of the schizophrenic psyche, Schatzman a n d Lothane b o t h imply that Memoirs
is first a n d f o r e m o s t a tale of g e n u i n e , b i o g r a p h i c a l l y verifiable p e r s e -
c u t i o n , w i t h t h e r o l e of t o r m e n t o r v a r i o u s l y a s s i g n e d t o M o r i t z S c h r e b e r a n d a n o p p r e s s i v e f a m i l y s t r u c t u r e , o r Flechsig, W e b e r , a n d a j u r i d i c a l l y p o w e r f u l biological psychiatry. According to these c o m m e n t a t o r s , the ' t r u t h ' of S c h r e b e r ' s e x p e r i e n c e c a n o n l y b e a s c e r t a i n e d b y d e c o d i n g t h e text o f
Memoirs
w i t h t h e m a s t e r k e y o f d o c u m e n t a r y e v i d e n c e . In t h e i r r e c o u r s e t o a n e w set o f texts—Moritz Schreber's writings, asylum records, and extra biographical material—these accounts d o not challenge but b r o a d e n a n d perpetuate the o p e r a t i o n o f t h e t e x t u a l s u b l i m e . T h e r e are, h o w e v e r , a s i g n i f i c a n t n u m b e r o f c o m m e n t a t o r s f o r w h o m Memoirs
of My Nervous
Illness
is v a l u a b l e n o t s o
m u c h as a case s t u d y o r a n e x p o s é of p e r s o n a l s u f f e r i n g , b u t as a r e v e l a t i o n o f t h e political, p h i l o s o p h i c a l , p h e n o m e n o l o g i c a l , s p i r i t u a l , a n d s y m b o l i c s t r u c t u r e s o f m o d e r n i t y . 'It c a n b e s a i d ' , a n d L o t h a n e ( 1 9 9 2 , p. 9) says it, ' t h a t t h e Memoirs
b e c a m e a s c r i p t u r e l e a d i n g t o a m u l t i f a r i o u s exegetical l i t e r a t u r e t h a t
is still g r o w i n g ' . In t h e w r i t i n g s of, a m o n g o t h e r s , Elias C a n e t t i , Eric S a n t n e r , a n d L o u i s Sass, S c h r e b e r ' s s c h i z o p h r e n i c s i g n i f i c a t i o n is i n v e s t e d w i t h a n u n p a r a l l e l e d c a p a c i t y t o s y m b o l i z e e l e m e n t s of t h e m o d e r n self. 2 5
Schreber: power and politics M a n y attempts have been m a d e to read Schreber independently of psychiatric, p s y c h o a n a l y t i c , a n d a n t i p s y c h i a t r i c f r a m e w o r k s b y l o c a t i n g h i m in a g e n e a l o g y of saints, seers, s h a m a n s , a n d the divinely m a d . T h e S c h r e b e r - a s - s h a m a n thesis is t e n t a t i v e l y a d v a n c e d b y S c h a t z m a n ( 1 9 7 3 , p p . 5 , 9 ) a n d L o t h a n e ( 1 9 9 2 , p. 393) b u t finds its f u l l - b l o w n e x p r e s s i o n in t h e w o r k o f B r e n t D e a n R o b b i n s ( 2 0 0 0 ) . F o r R o b b i n s , t h e u n m a n n e d S c h r e b e r is s i m u l t a n e o u s l y a mystic, p o e t , p r o t o - f e m i n i s t , a n d p r o t o - e c o l o g i s t . R o b b i n s a r g u e s t h a t Memoirs
is a k i n d of
s h a m a n i s t i c p r o p h e c y , a t e x t t h a t t e a c h e s t h o s e r e c e p t i v e t o its m e s s a g e t o reject t h e n a r r o w c o n s t r i c t i o n s of W e s t e r n m a s c u l i n i s t c o n s c i o u s n e s s : Out of love for Schreber and with the desire to validate the logos of his pathos, it is possible to read the letter of his memoirs as closely as possible so that, in his difference, he can reveal his being otherwise to us. Having taken up this task, at least upon one reading of Schreber's text, we can discover that he, almost a century ago, had already
2S
Deleuze and Guattari's (1982) analysis of Schreber will be examined in detail in Chapter 4.
given voice to a being otherwise which others, less mad, would also speak and, so doing, change the world. For this task... we must allow Schreber's being otherwise to disrupt the totality of our self-same existence so that we might hear what he has to teach us. (Robbins, 2000, p. 138) 26 N o t so, a c c o r d i n g t o p h i l o s o p h e r M e r o l d W e s t p h a l . R a t h e r t h a n i l l u m i n a t e a t r a n s f o r m a t i v e p a g a n spirituality, t h e S c h r e b e r case, in W e s t p h a l ' s view, s h o w s u s n o t h i n g less t h a n ' t h e p s y c h o l o g y o f h o l y w a r ' ( W e s t p h a l , 1 9 9 3 , p . 75). W e s t p h a l r e a d s S c h r e b e r ' s d e l u s i o n of b e i n g G o d ' s w i f e as a n e x p e d i e n t b u t m o r a l l y c o r r u p t m e a n s of l e g i t i m i z i n g his h o m o s e x u a l desires, a n d j u s t as religion serves t o j u s t i f y ' i m m o r a l f a n t a s i e s in t h e w o r l d o f p s y c h o t i c s ' , so t o o is it u s e d b y w a r - m o n g e r i n g zealots t o l e g i t i m i z e t h e i r e q u a l l y i m m o r a l f a n t a sies ( W e s t p h a l , 1993, p p . 7 4 - 5 ) . C o n t i n u i n g t h e e x p l o r a t i o n o f t h e r e l i g i o u s d y n a m i c s in S c h r e b e r ' s d e l u s i o n s , J o h n F a r r e l l ( 1 9 9 6 , p. 172) a r g u e s t h a t S c h r e b e r ' s m i n d is 'a late b a t t l e f i e l d o f t h e R e f o r m a t i o n , s u b j e c t t o C a t h o l i c p r o s e l y t i z i n g a n d Jesuit i n t r i g u e , m i x e d w i t h Jewish c o n s p i r a c i e s ' . H e goes o n to suggest that Schreber's delusional s t r u c t u r e also d r a w s s o m e t h i n g f r o m every 'historical resource of paranoia': religious and scientific, class-based, genealogical, m a c r o - a n d m i c r o - p o l i t i c a l (Farrell, 1996, p. 174). F r o m s h a m a n t o zealot t o p a r a n o i d e v e r y m a n , Memoirs
has enjoyed a long
career of symbolic association with a spiritual a n d religious discourse. M o r e f a m o u s , a n d m o r e b o l d , is Elias C a n e t t i ' s analysis o f Memoirs
as a r e v e l a t i o n o f
t h e p s y c h o l o g y of f a s c i s m . In his b o o k Crowds and Power, Elias C a n e t t i finds in Schreber's delusional structure n o direct c o n n e c t i o n to s h a m a n i s m , b u t o n the c o n t r a r y , 'a p r e c i s e m o d e l of political
p o w e r , p o w e r w h i c h feeds o n t h e c r o w d
a n d derives its s u b s t a n c e f r o m it' ( C a n e t t i , 1962, p . 441, italics in t h e o r i g i n a l ) . Like m a n y c o m m e n t a t o r s , C a n e t t i c o n t e s t s t h e p s y c h o a n a l y t i c e m p h a s i s o n
26
Robbins explains the virtues of his methodology in the following passage; however, it must be noted that the 1992 edition of Lothane's In Defense of Schreber does not contain the quotations attributed to the 1993 edition here: 'With Lothane (1993), a method which truly attempts to comprehend Schreber must be "informed by the ethics of love and love of Schreber... on his terms, based on the oxymoron that love makes one see more clearly than scientific detachment" (p. 4). One can easily read Schreber's text with clinical distance and simply write him off as deranged and unusual. Yet read with love, Schreber can come alive again as a person who lived, suffered and triumphed, and with a certain level of empathic engagement, we can imagine what it must have been like to be him in his own time, struggling for his freedom. We will never possess Schreber and know him in any totalizing way, but the sheer volume of literature dedicated to the man over the years is a testament to the fact that his story lives on. I le still touches us' (Robbins, 2000, p. 136).
S c h r e b e r ' s ' u n m a n n i n g ' a n d rejects t h e causal link b e t w e e n h o m o s e x u a l i t y a n d p a r a n o i a . I n s t e a d , h e suggests t h a t G o d ' s u n r e l e n t i n g a t t a c k o n S c h r e b e r ' s r e a s o n lies at t h e c e n t r e of his p e r s e c u t i o n s (a p o i n t t o w h i c h w e shall r e t u r n ) , a n d insists t h a t t h e e s s e n c e of p a r a n o i a 'is t h e structure t h e w a y it is peopled'
of the delusional world and
( C a n e t t i , 1962, p p . 4 4 9 - 5 0 , italics in t h e o r i g i n a l ) . It is t h e
r e l i g i o u s a n d p o l i t i c a l d i m e n s i o n s of S c h r e b e r ' s d e l u s i o n a l s c h e m a t h a t a r e f u n d a m e n t a l l y i m p o r t a n t , i n e x t r i c a b l y l i n k e d , a n d m o s t clearly d e m o n s t r a t i v e of the drive for p o w e r that characterizes paranoia. 'Paranoia', Canetti writes, 'is a n illness of power
in t h e m o s t literal sense', a n d t h e d e l u s i o n a l s t r u c t u r e o f
the p a r a n o i d — a s exemplified by Schreber—is identical to the psychic struct u r e o f t h e d e s p o t : ' A m a d m a n , helpless, o u t c a s t a n d d e s p i s e d , w h o d r a g s o u t a twilight e x i s t e n c e in s o m e a s y l u m , m a y , t h r o u g h t h e i n s i g h t s h e p r o c u r e s us, p r o v e m o r e i m p o r t a n t t h a n H i t l e r o r N a p o l e o n , i l l u m i n a t i n g f o r m a n k i n d its c u r s e a n d its m a s t e r s ' ( C a n e t t i , 1962, p p . 448, 4 6 2 , italics in t h e o r i g i n a l ) . Canetti i n t r o d u c e d to the world a Schreber whose e x t r e m e psychic disturb a n c e s — h i s m e s s i a n i c a n d a p o c a l y p t i c vision of e t e r n i t y , b o d i l y e x p e r i e n c e s of miracles a n d 'little m e n ' , 2 7 r e l a t i o n s h i p to an equally d e s p o t i c G o d , f e m a l e t r a n s f o r m a t i o n , a n d a b o v e all, his l u s t f o r p o w e r — e x p o s e t h e p s y c h o l o g i c a l s t r u c t u r e o f f a s c i s m . W i t h o u t d i s p u t i n g C a n e t t i ' s t h e s i s , S c h a t z m a n ( w h o is c o m p e l l e d , o n c e a g a i n , t o r e m i n d u s o f t h e t r u e villain in t h e S c h r e b e r e q u a t i o n ) suggests t h a t it is M o r i t z S c h r e b e r w h o s e ideas d i r e c t l y a n t i c i p a t e d H i t l e r ' s and whose child-rearing practices influenced a generation of Nazis (Schatzman, 1973, p p . 1 4 8 - 5 4 ) . L o t h a n e , u n s u r p r i s i n g l y , v e h e m e n t l y r e j e c t s a n y s u c h s u g g e s t i o n : t h e ' t r e n d ' s t a r t e d b y C a n e t t i 'is n o t j u s t false a n d p r e p o s t e r o u s : it is a n a b u s e o f a p s y c h i a t r i c d i a g n o s i s a n d a n o f f e n s e t o P a u l S c h r e b e r ' s m e m o r y . It trivializes t h e c o m p l e x i t y o f N a z i s m as a s o c i o h i s t o r i c a l p h e n o m e n o n b y r e d u c ing it t o a p s y c h i a t r i c f o r m u l a ' ( L o t h a n e , 1992, p. 353). Biological p s y c h i a t r y is, a c c o r d i n g t o L o t h a n e , t h e o n l y h i s t o r i c a l l y a c c u r a t e link b e t w e e n t h e S c h r e b e r case a n d N a z i s m . 2 8 W h a t links C a n e t t i , S c h a t z m a n , a n d L o t h a n e , d e s p i t e t h e i r 27
Schreber, as I have already noted, discusses at length the various torments visited upon him by 'little men': 'The remarkable thing about it was that souls [of people both living and dead] or their single nerves could in certain conditions and for particular purposes assume the form of tiny human shapes (as mentioned earlier only of a few millimetres in size), and as such made mischief on all parts of my body, both inside and on the surface' (Schreber, 1955, p. 144).
28
'Did the dehumanization of psychiatric patients lead logically to the idea of concentration camps and death camps? At the end of the war Sonnenstein was closed down as a psychiatric facility. The last director was under investigation as a war criminal and committed suicide' (Lothane, 1992, p. 301). For a more extensive discussion of the role of Nazi psychiatric institutions in developing the methods of mass murder later used in concentration camps see Torrey and Yolken (2009).
d e e p d i v e r g e n c e s , is t h a t t h e y all r e i n t e r p r e t S c h r e b e r ' s p s y c h o s i s as a p r o b l e m o f p o w e r , a p r o b l e m o f f a r - r e a c h i n g social, n o t p s y c h o s e x u a l , s i g n i f i c a n c e . E r i c S a n t n e r j o i n e d t h i s i n c r e a s i n g l y d i s c o r d a n t c h o r u s i n 1997 w i t h t h e p u b l i c a t i o n of My Own Private of Modernity.
Germany:
Daniel Paul Schreber's
Secret
History
S a n t n e r extends Canetti's analysis b e y o n d the psychological
a r e n a : '1 a m ' , h e w r i t e s , ' c o n v i n c e d t h a t S c h r e b e r ' s b r e a k d o w n a n d e f f o r t s at s e l f - h e a l i n g i n t r o d u c e d h i m i n t o t h e d e e p e s t s t r u c t u r a l layers o f t h e h i s t o r i c a l i m p a s s e s a n d c o n f l i c t s t h a t w o u l d p r o v i s i o n a l l y c u l m i n a t e in t h e N a z i c a t a s t r o p h e ' ( S a n t n e r , 1996, p. xi). S i d e - s t e p p i n g t h e d i v i s i o n s a n d p o l i t i c s of v i c t i m i z a t i o n in t h e a n t i p s y c h i a t r i c c a m p , S a n t n e r a r g u e s c o m p e l l i n g l y t h a t S c h r e b e r is s u b j e c t e d t o b o t h m e d i c o - p e d a g o g i c and p s y c h i a t r i c r e g i m e s o f p o w e r k n o w l e d g e , b u t a r g u e s t h a t Memoirs b o l i c a u t h o r i t y in fin-de-siècle
also p o i n t s t o a w i d e s p r e a d crisis of s y m -
Germany.
S c h r e b e r ' s a p p o i n t m e n t as Senatsprâsident
o f t h e c o u r t o f a p p e a l led, a c c o r d -
ing to Santner, directly to his psychotic break. T h e ' p e r f o r m a t i v e magic' of s y m b o l i c i n v e s t i t u r e f a i l e d — i t b r o u g h t S c h r e b e r in excessive p r o x i m i t y t o t h e law, a n d , m o r e i m p o r t a n t l y , its s u r p l u s of p o w e r , t h u s p r e c i p i t a t i n g a p s y c h i c crisis: Schreber's crisis was a crisis of investiture. He discovered that his own symbolic power and authority as judge—and German man—was founded, at least in part, by the performative magic of the rites of institution, that his symbolic function was sustained by an imperative to produce a regulated series of repeat performances. It was this idiotic repetition compulsion at the heart of his symbolic function that Schreber experienced as profoundly sexualizing, as a demand to cultivate jouissance. (Santner, 1996, pp. 124-5) My Own Private
Germany
is a m o n g t h e m o s t s o p h i s t i c a t e d a n a l y s e s o f t h e
c o n t e n t o f S c h r e b e r ' s d e l u s i o n s largely b e c a u s e t h e t h e o r e t i c a l m o d e l it p r o p o s e s e n c o m p a s s e s e l e m e n t s of m a n y p r e v i o u s l y i r r e c o n c i l a b l e i n t e r p r e t a t i o n s o f Memoirs.
S a n t n e r l i n k s M o r i t z S c h r e b e r ' s m e d i c o - p e d a g o g y w i t h Flechsig's
b i o l o g i c a l p s y c h i a t r y as t w o e x a m p l e s of t h e l a w o p e r a t i n g in excess o f its o w n authority. Schreber's a c c o u n t s of experiencing soul m u r d e r a n d cultivating v o l u p t u o u s n e s s a r e t h e n r e - r e a d as a t t e m p t s t o a r t i c u l a t e t h e i n t e n s e l y libidinalizing effects of his o v e r e x p o s u r e to the disciplinary p o w e r of the ' f a t h e r s who knew too much'
( S a n t n e r , 1996, p p . 8 6 - 7 , italics in t h e o r i g i n a l ) . 2 9 As his
d e l u s i o n a l o b s e s s i o n w i t h d e c o m p o s i t i o n a n d d e g e n e r a t i o n reveals, 3 0 S c h r e b e r d i s c o v e r e d r o t t e n n e s s at t h e c o r e o f s y m b o l i c i d e n t i t y s a n c t i o n e d b y t h e law,
29
30
On the relationship between Moritz Schreber's medico-pedagogy and the Foucauldian concept of disciplinary power, see also Sass (1987b, pp. 101-47). On this, see also de Certeau (1988, pp. 90-1).
a n d his d e l u s i o n s a r e a n e f f o r t at n e g o t i a t i n g t h i s r e a l i z a t i o n ( S a n t n e r , 1996, p p . x i - x i i , 6, 61, 124). D r a w i n g o n S a n d e r G i l m a n ' s ( 1 9 9 6 , p . 142) a s s e r t i o n t h a t S c h r e b e r ' s d e e p e s t f e a r w a s t h a t ' h e w a s t u r n i n g i n t o a n e f f e m i n a t e Jew', S a n t n e r c o n t i n u e s t h e p a s s a g e q u o t e d earlier: That [Schreber] experienced this sexualization as feminizing and 'Jewifying' suggests that at the advent of European modernity, 'knowledge' of jouissance was ascribed to women and Jews, meaning that women and Jews were cursed with the task of holding the place of that which could not be directly acknowledged: that symbolic identities are, in the final analysis, sustained by drive, by performativity-as-repetition-compulsion. (Santner, 1996, pp. 124-5, italics in the original) S c h r e b e r d o e s n o t s i m p l y reflect a m i s o g y n i s t a n t i - S e m i t i s m c u l t u r a l l y p r e v a l e n t d u r i n g t h e p e r i o d . R a t h e r , his i n a b i l i t y t o m e e t t h e p e r f o r m a t i v e d e m a n d s o f a u t h o r i t y p r o d u c e d a k i n d o f u n c o n s c i o u s i d e n t i f i c a t i o n w i t h 'the
symptom
t h a t . . . f o r G e r m a n c u l t u r e m o r e g e n e r a l l y . . . m a t e r i a l i z e d t h e b l o c k a g e in t h e s m o o t h f u n c t i o n i n g o f t h e s o c i a l b o d y ' ( S a n t n e r , 1996, p. 144, italics in t h e original). As G i l m a n p o i n t s o u t , S a n t n e r ' s S c h r e b e r is n e i t h e r a ' p r é f i g u r a t i o n o f t h e f a s c i s t ' n o r t h e ' p e r p e t u a l v i c t i m ' o f p o w e r , b u t a ' c a n a r y in t h e m i n e s h a f t w h o s e r e s p o n s e s i d e n t i f y t h e a c t u a l v i c t i m s in t h e c u l t u r e in w h i c h h e lives, w o m e n a n d Jews' ( G i l m a n , 1996, p . 16). In a c l a i m t h a t is at o n c e a u d a c i o u s a n d p r o b l e m a t i c , S a n t n e r u l t i m a t e l y s u g g e s t s t h a t Memoirs
o f f e r s real insight
into the experiences of the dispossessed: To traverse, with Schreber, the fantasy space of his own private Germany . . . is to encounter European modernity from the perspective of those figures in whom modern European society 'secreted' its disavowed knowledge of chronic structural crisis and disequilibrium. Of course, Schreber's fate as a psychotic suggests that one should not, as they say, try this at home; it is, in other words, genuinely maddening to find oneself occupying the place of abjection in the absence of some minimal form of human solidarity. (Santner, 1996, p. 144, italics in the original) S a n t n e r s u c c e e d s i n r e w r i t i n g S c h r e b e r ' s Memoirs
as a n a r r a t i v e w h i c h
reveals a crisis b e s e t t i n g t h e e n t i r e social s y s t e m at t h e t u r n o f t h e t w e n t i e t h c e n t u r y . H o w e v e r , a l t h o u g h h e p e r s u a s i v e l y u n c o v e r s in Memoirs
an elite
G e r m a n m a s c u l i n i t y - i n - c r i s i s ( i n s t e a d o f a p r o t o - f a s c i s t will t o p o w e r ) , t h e c l a i m t h a t t h i s s o m e h o w s p e a k s d i r e c t l y of t h e e x p e r i e n c e of w o m e n a n d Jews at the fin de siècle s e e m s t o m e t o v e n t u r e , p e r h a p s u n w i t t i n g l y , i n t o d a n g e r o u s t e r r i t o r y . T h r o u g h it, S a n t n e r s e e m s t o p r e s e n t t h e e n t i r e h i s t o r y o f m o d e r n i t y — b o t h c o v e r t a n d o v e r t — a s a s t o r y in w h i c h A r y a n m e n a r e t h e o n l y p r o t a g o n i s t s c a p a b l e of s e l f - r e p r e s e n t a t i o n , a n d suggests that t h e d i s p o s s e s s e d are,
b y v i r t u e of t h e i r alleged a f f i n i t y w i t h S c h r e b e r , a s s o c i a t e d w i t h p s y c h o s i s . T h i s in t u r n r e n d e r s his a c c o u n t of p s y c h o s i s f u n d a m e n t a l l y p r o b l e m a t i c , t o say t h e least. R e p e a t e d l y c i t i n g t h e crisis o f s y m b o l i c i n v e s t i t u r e as t h e p a t h o g e n i c fact o r in S c h r e b e r ' s p s y c h o s i s , S a n t n e r e m p h a s i z e s t h e aetiological s i g n i f i c a n c e of failed p e r f o r m a t i v e , p u b l i c - s p h e r e i d e n t i t y , b u t r e m a i n s u n w i l l i n g t o c o n s i d e r the b r o a d e r implications of his diagnosis. Certain q u e s t i o n s i m m e d i a t e l y spring to mind: Does psychosis only threaten those whose symbolic investiture b r i n g s t h e m t o o close t o t h e excess o r c o r r u p t i o n of p o w e r ? D o s u b j e c t s w h o a r e s u b o r d i n a t e d w i t h i n t h e s y m b o l i c o r d e r t h e r e f o r e e n j o y a relative f r e e d o m f r o m p s y c h o s i s , as if i n c o m p e n s a t i o n f o r a r e d u c e d a c c e s s t o p o w e r ? O r a r e t h e y a l r e a d y m a d , if t o b e p s y c h o t i c is in s o m e s e n s e t o b e t h e o b j e c t , n o t s u b j e c t , of p o w e r ? My Own Private
Germany
seems frequently to overstep the
p a r a m e t e r s i m p l i e d b y its title: b y a p p r o a c h i n g t h e a u t o b i o g r a p h y o f a p s y c h o t i c m a l e Jurist as n o t h i n g less t h a n t h e p a l i m p s e s t o r u n c o n s c i o u s a r c h i v e of m o d e r n i t y ( S a n t n e r , 1996, p. 145), S a n t n e r e n d s u p i m p l y i n g t h a t S c h r e b e r ' s p s y c h o t i c b r e a k is t h e p r e r o g a t i v e of a w h i t e m a l e elite, b u t t h a t his p s y c h o t i c e x p e r i e n c e s r e s o n a t e w i t h t h e e v e r y d a y e x p e r i e n c e s of w o m e n a n d Jews. M u l t i f a c e t e d , w i d e l y r e s e a r c h e d , a n d m a s t e r f u l in its a s s i m i l a t i o n of p r e v i o u s l y a n t a g o n i s t i c v i e w p o i n t s , My Own Private
Germany
is n o n e t h e l e s s a h i g h
w a t e r m a r k in t h e p o s t - F r e u d i a n q u e s t t o d e c o d e t h e s y m b o l i c c o n t e n t — a n d p r o t e s t — o f S c h r e b e r ' s p s y c h o s i s . I w o u l d like t o t u r n n o w t o t h e w o r k o f a n o t h e r e q u a l l y p r o m i n e n t a n a l y s t o f Memoirs
of My Nervous
Illness,
Louis
Sass. Sass explicitly r e j e c t s t h e F r e u d i a n a p p r o a c h t o p s y c h o s i s a n d b r e a k s w i t h t h e p s y c h o a n a l y t i c a l l y - i n s p i r e d t r a d i t i o n of f o c u s i n g o n t h e s y m b o l i c d i m e n sions of Schreber's experience. Instead, he concentrates on the p h e n o m e n o l o g y o f s y m p t o m a t o l o g y a n d its r e l a t i o n s h i p t o m o d e r n p h i l o s o p h y , r e a d i n g S c h r e b e r via W i t t g e n s t e i n as a n e x e m p l a r y ' m a d m a n ' (Sass, 1994b, p . ix) a n d in t u r n a n ' e x e m p l a r y ' ' m a n o f m o d e r n c i v i l i z a t i o n ' ( S a s s , 1 9 9 2 , p . 2 4 6 ) . A l t h o u g h Schreber's delirium revealed to Santner the subtext o f f i n - d e - s i e c l e G e r m a n c u l t u r e , f o r Sass e v e r y d e l u s i o n a l , s o m a t i c , a n d a f f e c t i v e e x p e r i e n c e speaks directly of t h e structures of m o d e r n consciousness. Altogether disreg a r d i n g t h e v e x e d issue of t h e a e t i o l o g y of S c h r e b e r ' s s c h i z o p h r e n i a , Sass o f f e r s us two further incarnations of the world's m o s t q u o t e d psychotic p a t i e n t — t h e p a n o p t i c a n d solipsistic S c h r e b e r — b o t h ' c h a r a c t e r i z e d b y a n i n t e n s e a n d ultim a t e l y r e i f y i n g s e l f - s c r u t i n y , a n i n n e r d i v i s i o n , a n d a n a l i e n a t i o n f r o m self, w o r l d , a n d i n s t i n c t ' (Sass, 1987b, p. 124). 3 1
31
In other words, 'Madness, on (Sass's] reading, is neither the psyche's return to its primordial condition, nor the malfunctioning of reason, nor even some inspired alternative to human reason. It is, to be sure, a self-deceiving condition, but one that is generated from within rationality itself rather than by the loss of rationality' (Sass, 19941), p. 12).
A l t h o u g h Sass is h i g h l y c r i t i c a l o f F o u c a u l t ' s a n t i p s y c h i a t r i c s e n t i m e n t in Madness
and Civilization
(Sass, 1987b, p. 106; 1994b, p. 3), h e uses F o u c a u l t ' s
n o w f a m o u s analysis of J e r e m y B e n t h a m ' s p a n o p t i c o n in Discipline ( 1 9 7 7 ) as t h e basis f o r his first r e a d i n g of Memoirs.
and
Punish
For Foucault, the p a n o p t i -
c o n signals a t r a n s f o r m a t i o n in t h e o p e r a t i o n of p o w e r i n m o d e r n i t y : i n s t e a d of t h e spectacle of p u b l i c , c o r p o r e a l p u n i s h m e n t , t h e p r i s o n e r in t h e p a n o p t i c o n is s u b j e c t t o c o n s t a n t s u r v e i l l a n c e , a n e f f e c t i v e d i s c i p l i n a r y t e c h n i q u e b e c a u s e t h e p o s s i b i l i t y o f always b e i n g w a t c h e d i n c u l c a t e s in t h e p r i s o n e r a n e v e r - v i g i l a n t self-scrutiny.
A s Sass n o t e s , M o r i t z S c h r e b e r ' s e d u c a t i o n a l r e g i m e
is in e s s e n c e p a n o p t i c , d e s i g n e d t o instil o b e d i e n c e in t h e c h i l d t h r o u g h selfm o n i t o r i n g , o r t h e i n t e r n a l i z a t i o n o f t h e gaze o f t h e a l l - p o w e r f u l , a l l - s e e i n g p a r e n t (Sass, 1987b, p p . 1 1 2 - 1 7 ) . M o d e r n i t y in g e n e r a l a n d M o r i t z S c h r e b e r ' s ' d e p t h p e d a g o g y ' i n p a r t i c u l a r f i n d t h e i r e x t r e m e e x p r e s s i o n in S c h r e b e r ' s s c h i z o p h r e n i a , in a split a n d s e l f - a l i e n a t e d c o n s c i o u s n e s s ' b o t h r e n t a n d j o i n e d b y a n i n n e r p a n o p t i c i s m ' (Sass, 1992, p . 2 5 3 ) . T h u s , f o r Sass, S c h r e b e r ' s cosm o l o g y — c o m p r i s i n g rays, n e r v e s , a n d a d i v i d e d G o d — ' d e m a n d s t o b e r e a d as a p s y c h o l o g i c a l r a t h e r t h a n a c o s m o l o g i c a l v i s i o n , as a k i n d of a l l e g o r y o f t h e d i v i d e d s t a t e o f S c h r e b e r ' s o w n h y p e r - a w a r e , a c u t e l y r e f l e x i v e m i n d ' (Sass, 1992, p . 2 5 8 ) . 3 2 C o n t i n u i n g t o a d d r e s s t h e f o r m , s t r u c t u r e , a n d p h e n o m e n o l o g y of S c h r e b e r ' s s c h i z o p h r e n i c e x p e r i e n c e — r a t h e r t h a n t h e s y m b o l i c c o n t e n t of his d e l u s i o n s a n d s o m a t i c f a n t a s i e s — S a s s m o v e s b e y o n d p a n o p t i c i s m in his l a t e r w o r k t o a r g u e t h a t w e c a n b e s t u n d e r s t a n d Memoirs
through the philosophical doctrine
o f s o l i p s i s m . S c h r e b e r ' s h e i g h t e n e d state o f a w a r e n e s s , ' i n w h i c h h e s c r u t i n i z e d t h e w o r l d , a n d s c r u t i n i z e d his a w a r e n e s s of t h e w o r l d ' , a n d t h e 'affectless, d e v i talized, o r o t h e r w i s e d e r e a l i z e d a t m o s p h e r e ' o f his lived w o r l d are, a c c o r d i n g t o Sass, in ' p e r f e c t a c c o r d a n c e w i t h W i t t g e n s t e i n ' s analysis o f s o l i p s i s m ' (Sass, 1994b, p p . 37, 43, 4 0 ) . C e n t r a l t o b o t h S c h r e b e r ' s i n n e r p a n o p t i c i s m a n d his s c h i z o p h r e n i c s o l i p s i s m is t h e i d e a o f a n i n t e r n a l l y a n d i r r e p a r a b l y d i v i d e d p s y c h e : h e s i m u l t a n e o u s l y e x p e r i e n c e s ' h i s o w n c o n s c i o u s n e s s as b o t h a
,2
The reifying effects of this schizophrenic inner panopticism are elsewhere noted by Mark Roberts, for whom Schreber's 'psychomechanics' demand to be read as protocyborgian: '"Plugged into" madness, rendered into a machine, strapped into restraints, probed by devices, subjected to the psycho- and electromechanical theories of the time, Schreber was naturally both intensely aware of the fact that he had become a machine and horrified that he was one' (Roberts, 1996, pp. 31-47). John Peters discusses Wolfgang Hagan's more historically grounded view that 'Schreber's fantasies owe much to wireless technology anil the now outdated ether-physics, with its dreams of combined thought- and signal-transference" (Peters, 2010, p. 132).
c o n s t i t u t e d o b j e c t a n d t h e u l t i m a t e , c o n s t i t u t i n g s u b j e c t ' (Sass, 1994b, p . 7 7 ) . 3 3 T h e doubling of the T
d e m o n s t r a t e s f o r Sass t h a t ' W h a t S c h r e b e r lacks is n o t
the observing ego e m p h a s i z e d b y ego psychologists b u t , instead, a f u n d a m e n tal r o o t e d n e s s in t h e l i v e d - b o d y a n d t h e c o n s e n s u a l a n d p r a c t i c a l w o r l d ' (Sass, 1994b, p. 7 9 ) . S c h r e b e r , t h e n , exists at t h e e x t r e m i t i e s o f C a r t e s i a n d u a l i s m , a n d Sass is q u i c k t o e x p l o r e t h e g e n d e r e d e x p r e s s i o n of S c h r e b e r ' s split s u b j e c tivity in his c o n c l u d i n g analysis o f S c h r e b e r ' s ' u n m a n n i n g ' . O n t h i s r e a d i n g , Schreber's delusional schema reproduces the binary opposition of masculine subject a n d f e m i n i n e object: t r a n s f o r m a t i o n into a w o m a n involves, for S c h r e b e r , b e c o m i n g t h e o b j e c t a n d n o t t h e s u b j e c t of a w a r e n e s s . A l t h o u g h as ' s o u l m u r d e r ' ' u n m a n n i n g ' is p o t e n t i a l l y a n n i h i l a t i n g , it f u n c t i o n s as a p a n a c e a for Schreber's t o r m e n t e d m i n d : Femininity stands, then, for the sensual as against the intellectual, 'Blessedness' as against the insidious anxieties of 'compulsive thinking', the body as against the selftorturing mind. Tactile voluptuousness is capable of dissolving, at least for a moment, the alienated, scrutinizing consciousness of Schreber's quasi-solipsism . . . (Sass, 1994b, p. 127) R e s e r v i n g his final c o m m e n t s f o r a w h o l e s a l e r e f u t a t i o n of F r e u d ' s r e a d i n g of Memoirs,
a n d s c h i z o p h r e n i a m o r e generally, Sass insists t h a t 'A p u r e l y l i b i d -
i n a l i n t e r p r e t a t i o n m i s s e s t h e c r u c i a l s e n s e in w h i c h s c h i z o p h r e n i c f a n t a s i e s c o n c e r n n o t sex b u t k n o w l e d g e , e x p r e s s i n g a y e a r n i n g n o less i n t e n s e , a n d n o less pervasive, f o r b e i n g e p i s t e m o l o g i c a l at its c o r e ' (Sass, 1994b, p. 129). T h e s e i n t e r p r e t a t i o n s of Memoirs
of My Nervous
Illness are, as I h a v e s h o w n ,
r e m a r k a b l e f o r t h e i r m e t h o d o l o g i c a l a n d s u b s t a n t i v e d i f f e r e n c e s . So, s h o u l d we view Schreber t h r o u g h a psychoanalytic, psychobiographical, historical, p h i l o s o p h i c a l , o r p h e n o m e n o l o g i c a l lens, o r s i m p l y w i t h love a n d c o m p a s sion? A n d w h a t d o e s lie at t h e c o r e of his d e l u s i o n a l s c h e m a ? Is it t h e h o m o sexual l i b i d o , a m a s t u r b a t o r y f a n t a s y , o r a p r e - O e d i p a l p r o c r e a t i o n fantasy? Is it t h e d i s c i p l i n a r y p o w e r o f M o r i t z S c h r e b e r ' s m e d i c o - p e d a g o g y , o r Flechsig's biological psychiatry? Is it p r o t o - f a s c i s t i c d e s p o t i s m , religious p a r a n o i a , a failu r e t o t a k e u p a p o w e r f u l p o s i t i o n in t h e s y m b o l i c o r d e r , o r a n e p i s t e m o l o g i c a l crisis? It is relatively easy t o b e p e r s u a d e d b y t h e s e analyses w h e n a p p r o a c h i n g t h e m individually; viewed collectively, they are i m p o s s i b l e t o reconcile. O f c o u r s e , t o t h e l i t e r a r y critic, t h i s is h a r d l y s u r p r i s i n g — t h e t e x t itself c a n n o t c o n t a i n a final o r s i n g u l a r t r u t h b e c a u s e its m e a n i n g will always b e p r o d u c e d t h r o u g h the process of reading, a n d so even the m o s t m u n d a n e m a n u s c r i p t s
33
There are clear parallels with this reading and Crapanzano's (1998) analysis of Schreber's intcrlocutionary collapse.
are p e r m a n e n t l y o p e n t o r e i n t e r p r e t a t i o n . W h a t is s u r p r i s i n g is t h a t t h e c a n o n of S c h r e b e r s t u d i e s s h o u l d h a v e d e v e l o p e d in so literary a f a s h i o n . Although Freud's 'Psycho-Analytic Notes' had—post-Niederland—been f o r c e d t o r e l i n q u i s h its c l a i m o n t h e t r u t h of S c h r e b e r ' s e x p e r i e n c e , t h e p s y c h o analytic e m p h a s i s o n d e c i p h e r i n g t h e s y m b o l i c s i g n i f i c a n c e o f
representations
of s c h i z o p h r e n i c d e l u s i o n s h a s m a d e p o s s i b l e a 9 0 - y e a r d e b a t e o v e r t h e m e a n ing of o n e J u r i s t ' s p s y c h o s i s . 3 4 It is i n c o n c e i v a b l e t h a t s u c h a d e b a t e c o u l d h a v e b e e n i g n i t e d a n d f o s t e r e d in p s y c h i a t r i c d i s c o u r s e , w h e r e t h e d e a t h o f t h e a u t h o r m e a n s that only the retrospective diagnosis of s y m p t o m s could be a s o u r c e o f c o n t e n t i o n . P s y c h i a t r y c a n n o t f u r n i s h its clinical p i c t u r e o f s c h i z o p h r e n i a with decisive evidence of the origins of the d i s o r d e r w h i c h , I have a r g u e d , elevates s c h i z o p h r e n i a t o t h e s t a t u s of s u b l i m e o b j e c t . Similarly, c o m m e n t a t o r s w i t h i n S c h r e b e r s t u d i e s can n e i t h e r p r o v e t h e m e r i t s of t h e i r analysis n o r d e m o n s t r a t e t h e w h o l e s a l e i n a d e q u a c y o f o t h e r s , if o n l y b e c a u s e n o a p p e a l t o t h e ' t r u t h ' of t h e text itself, let a l o n e S c h r e b e r ' s e x p e r i e n c e , is p o s s i b l e in this literary m o d e of i n t e r p r e t a t i o n . As it s t a n d s in f o r S c h r e b e r ' s e x p e r i e n c e , Memoirs
of My Nervous
Illness c a n t h e r e f o r e b e s e e n as a s u b l i m e t e x t w i t h i n
psychoanalytic discourse a n d for the cultural critics r e a p p r a i s i n g 'PsychoAnalytic N o t e s ' . Like all l i t e r a r y texts, it s u p p o r t s a p r o l i f e r a t i o n of i n t e r p r e t a t i o n s , j o s t l i n g f o r v a l i d i t y in t h e a b s e n c e o f a n a u t h o r - p a t i e n t t o a u t h o r i z e o r v a l i d a t e a n y of t h e n a r r a t i v e s o f f e r e d . W h a t sets it a p a r t f r o m literary texts is its f u n c t i o n w i t h i n t h e field of psychoanalysis: Memoirs
is s u b l i m e b e c a u s e ' t h e dis-
c i p l i n a r y a t t e n t i o n ' it h a s g a r n e r e d w o r k s ' t o m a r k t h e p r o v i s i o n a l l i m i t s a n d flash p o i n t s ' ( C h e e t h a m , 1995, p. 360) of psychoanalysis a n d related disciplines. H o w e v e r , Memoirs
is, as I h o p e t o d e m o n s t r a t e , s u b l i m e f o r a n o t h e r r e a s o n ,
n a m e l y t h a t it r e c o r d s S c h r e b e r ' s t e r r i f y i n g e x p e r i e n c e o f t h e b e y o n d - h u m a n , a n d his c o n s t a n t struggle to assert his rationality against the cosmological f o r c e s t h a t w o u l d o v e r w h e l m h i m . In t h e n e x t s e c t i o n of this c h a p t e r , t h r o u g h a close r e a d i n g of Memoirs,
I will a r g u e t h a t S c h r e b e r ' s a u t o b i o g r a p h i c a l p r o j e c t
a n d h i s d e l u s i o n a l s t r u c t u r e c a n b o t h b e r e a d t h r o u g h t h e logic of t h e K a n t i a n s u b l i m e , t h a t is, as a t t e m p t s t o reassert r a t i o n a l i t y in t h e face o f t h e t e r r o r a n d anxiety aroused by the sublime encounter.35 Although I a m aware that any c ontribut ion to Schreber studies cannot escape perpetuating the interpretative t r e n d j u s t d e s c r i b e d , m y p u r p o s e is n o t t o p r o v i d e t h e d e f i n i t i v e i n t e r p r e t a t i o n 14
15
In one of the latest contributions to this debate, McGlashan (2009, p. 480) makes the point that because 'pharmacotherapy that has truncated extended periods of active positive psychotic symptoms', Schreber's ongoing importance to understanding acute psychosis is assured. I should make absolutely clear at this point that I am not making any claims about schizophrenic experience more generally.
o f Memoirs
b u t t o d e m o n s t r a t e t h a t S c h r e b e r , like t h e t h e o r i s t s s o f a r d i s -
c u s s e d , h a s r e c o u r s e t o t h e s u b l i m e t o d e s c r i b e his s c h i z o p h r e n i c e x p e r i e n c e . N o t only d o psychiatrists, psychoanalysts, a n d antipsychiatrists f r a m e schizop h r e n i a as s u b l i m e , t h e w o r l d ' s m o s t f a m o u s a n d m o s t q u o t e d p s y c h i a t r i c patient shares their t e n d e n c y . C o n c e n t r a t i n g o n t h e s t r u c t u r e of Schreber's d e l u s i o n a l s y s t e m a n d t h e w a y t h a t s y s t e m is d e s c r i b e d a n d c o n t e x t u a l i z e d , m y analysis d o e s n o t a d d r e s s t h e q u e s t i o n of s c h i z o p h r e n i a ' s a e t i o l o g y a n d o n s e t , n o r d o e s it c o n s i d e r e x t r a - t e x t u a l b i o g r a p h i c a l m a t e r i a l , t h e t h e m e o f s e x u a l identity, o r S c h r e b e r ' s capacity t o s y m b o l i z e this o r t h a t aspect of m o d e r n c o n sciousness. T h e significance o f this c o n t r i b u t i o n t o S c h r e b e r s t u d i e s lies n o t o n l y in t h e a t t e n t i o n p a i d t o a n aspect of Memoirs
all t o o f r e q u e n t l y o v e r l o o k e d — t h e
crisis of r a t i o n a l i t y t h a t I suggest o c c u p i e s c e n t r e stage in t h e t e x t — b u t also in the connections d r a w n between the obsession with reason, the dynamics of the s u b l i m e a n d t h e d i s c o u r s e of S c h r e b e r s t u d i e s . Like t h o s e o f m a n y critics b e f o r e m e , m y r e a d i n g o f S c h r e b e r takes as its s t a r t i n g p o i n t F r e u d ' s ' P s y c h o - A n a l y t i c N o t e s ' , specifically, F r e u d ' s failure t o a c c o u n t f o r S c h r e b e r ' s crisis of rationality.
A sublime Schreber F r e u d , as I h a v e s h o w n , a c c o r d s p s y c h o s e x u a l d i s t u r b a n c e a p r i m a r y role in t h e s y m p t o m a t o l o g y a n d aetiology of Schreber's psychosis. H e refers only twice a n d in p a s s i n g t o S c h r e b e r ' s c o n s t a n t struggle t o p r o v e his s a n i t y t o G o d . First c i t e d as e v i d e n c e o f S c h r e b e r ' s a m b i v a l e n t a n d r e b e l l i o u s a t t i t u d e t o w a r d s G o d - a s - t h e - f a t h e r , it is later p r o d u c e d as c o n f i r m a t i o n o f S c h r e b e r ' s i n f a n t i l e sexual urge: Finally, we come to enforced thinking to which the patient submitted himself because he supposed that God would believe he had become an idiot and would withdraw from him if he ceased thinking for a moment. This is a reaction . . . to the threat of fear of losing one's reason as a result of indulging in sexual practices and especially in masturbation. Considering the enormous number of delusional ideas of a hypochondriacal nature which the patient developed, no great importance should perhaps be attached to the fact that some of them coincide word for word with the hypochondriacal fears of masturbators. (Freud, 1981, pp. 56-7) Schreber's compulsive t h i n k i n g — w h i c h c o n t i n u e d w i t h o u t respite—is in o n e swift m o v e e x p l a i n e d a n d d i s m i s s e d as m e r e m a s t u r b a t o r y f a n t a s y . 3 6 ' N o o t h e r p a r t of his d e l u s i o n s is t r e a t e d b y t h e p a t i e n t so e x h a u s t i v e l y , o n e m i g h t
36
Maurits Katan would later publish a series of papers (see especially 1949, 1950a) arguing that a homosexual masturbatory fantasy was not only present during all phases of Schreber's illness, but actually precipitated it.
a l m o s t say s o insistently, as his alleged t r a n s f o r m a t i o n i n t o a w o m a n ' ( F r e u d , 1981, p . 3 2 ) — F r e u d ' s exclusive f o c u s o n w h a t S c h r e b e r calls ' u n m a n n i n g ' is possible only because he overlooks the frequency a n d significance of Schreber's a p p a r e n t l y o n a n i s t i c d e l u s i o n s t h a t G o d is c o n t i n u a l l y s e a r c h i n g f o r c o n f i r m a t i o n S c h r e b e r h a s s u c c u m b e d t o d e m e n t i a . T h i s is a p o i n t a l r e a d y n o t e d b y C a n e t t i , Sass, a n d C r a p a n z a n o . 3 7 H o w e v e r , as I will a r g u e , t h i s d e l u s i o n is in fact c e n t r a l to S c h r e b e r ' s b e h a v i o u r a n d s y m p t o m a t o l o g y , his feelings t o w a r d s G o d , i n d e e d his e n t i r e p r o j e c t in Memoirs;
it c a n , m o r e o v e r , b e m o r e u s e f u l l y
i n t e r p r e t e d n o t as m a s t u r b a t o r y h y p o c h o n d r i a b u t as i n t e g r a l t o S c h r e b e r ' s r e p r e s e n t a t i o n of his e x p e r i e n c e as s u b l i m e . S c h r e b e r d o e s n o t h e s i t a t e t o d e s c r i b e h i s p s y c h o s i s as a r e v e l a t i o n o f t h e s u b l i m e . A l o n g s i d e distinctly ' g r u e s o m e ' visions of t h e e n d of the w o r l d , S c h r e b e r w r i t e s o f h a v i n g b e e n filled w i t h ' t h e m o s t s u b l i m e ideas a b o u t G o d a n d t h e O r d e r o f t h e W o r l d ' , i d e a s t h a t in h i s o w n e s t i m a t i o n s u r p a s s a n y h i s t o r i c a l c o n c e p t i o n s of t h e h o l y ( S c h r e b e r , 1955, p p . 79, 86, 54). As his i n t r o d u c t o r y r e m a r k s i n d i c a t e , h i s is a n e x p e r i e n c e t h a t e x c e e d s t h e l i m i t s o f comprehension: I cannot of course count upon being fully understood because things are dealt with which cannot be expressed in human language; they exceed human understanding. Nor can I maintain that everything is irrefutably certain even for me: much remains only presumption and probability. After all I too am only a human being and therefore limited by the confines of human understanding; but one thing I am certain of, namely that I have come infinitely closer to the truth than human beings who have not received divine revelation. (Schreber, 1955, p. 41, see also 117, italics in the original) A l t h o u g h his d e l u s i o n s d e f y e v e n S c h r e b e r ' s c o m p l e t e u n d e r s t a n d i n g , h e n e v e r t h e l e s s o f f e r s a n u m b e r o f r e a s o n s as t o w h y h e is c o m p e l l e d t o r e c o r d t h e m . A c c o r d i n g t o L o t h a n e , t h e English title Memoirs
of My Nervous
Illness is
a n i n a c c u r a t e t r a n s l a t i o n t h a t fails t o d o j u s t i c e t o t h e u n d e r l y i n g r a t i o n a l e o f S c h r e b e r ' s p r o j e c t . H i s t r a n s l a t i o n of t h e f u l l t i t l e — G r e a t Thoughts Patient
with Postscripts
what Premises HisOwn
and an Addendum
Can a Person Considered
Declared
Concerning
Insane be Detained
of a
Nervous
the Question:
'Under
in an Asylum
Against
Will?.' ( L o t h a n e , 1992, p . 7, italics in t h e o r i g i n a l ) — h i g h l i g h t s
m o r e d r a m a t i c a l l y b o t h S c h r e b e r ' s g r a n d i o s i t y a n d his d i r e c t e n g a g e m e n t w i t h 17
Canetti, for example, suggests that the real aim of Schreber's imagined conspirators 'was the destruction of Schreber's reason, and this they persisted in for years. They wanted to turn him into an imbecile, to push the illness of his nerves to the point where he would appear permanently incurable. Could there be any prospect more terrible for a human being as highly gifted as he thought himself?' (Canetti, 1962, p. 439, see also Sass, 1992, p. 248; C r a p a n / a n o , I9V8).
t h e legal a n d m o r a l q u e s t i o n s s u r r o u n d i n g h i s t u t e l a g e . A f u r t h e r p r a c t i c a l f u n c t i o n of Memoirs
is t h a t it f a c i l i t a t e s h i s r e t u r n t o t h e ' c i v i l i z e d ' w o r l d b y
i n f o r m i n g f a m i l y a n d f r i e n d s o f his r e l i g i o u s b e l i e f s a n d t h e i r i m p a c t o n his b e h a v i o u r ( S c h r e b e r , 1955, p. 4 1 ) . H o w e v e r , t h e s e c o n s i d e r a t i o n s a p p e a r seco n d a r y t o his d e s i r e t o h a v e t h e t r u t h of his e x p e r i e n c e r e c o g n i z e d , a n a l y s e d , a n d l e g i t i m i z e d b y t h e scientific e s t a b l i s h m e n t . In his ' O p e n l e t t e r t o P r o f e s s o r Flechsig', S c h r e b e r s t a t e s t h a t his a i m is 'solely t o f u r t h e r k n o w l e d g e o f t r u t h in a vital field, t h a t of r e l i g i o n ' , b u t later h e i n d i c a t e s t h a t w i t h Flechsig's c o n f i r m a t i o n , t h e r e l i g i o u s d i m e n s i o n s of his e x p e r i e n c e w o u l d ' g a i n u n i v e r s a l cred e n c e a n d w o u l d i m m e d i a t e l y b e r e g a r d e d as a serious scientific investigated
in every possible
way'
problem
to be
( S c h r e b e r , 1955, p p . 3 3 , 35, italics in t h e
o r i g i n a l ) . S c h r e b e r ' s c o n t r a d i c t o r y i m p e r a t i v e is t o elicit s c i e n t i f i c c o n f i r m a t i o n o f his s u p e r n a t u r a l e x p e r i e n c e . C o g n i z a n t of h o w p o t e n t i a l l y d i f f i c u l t this m i g h t be, h e c o n c l u d e s Memoirs
in t h e h o p e t h a t e m p i r i c a l s t u d y will u n c o v e r
p h y s i c a l e v i d e n c e o f his s u b l i m e t r a n s f o r m a t i o n : I can do no more than offer my person as object of scientific observation for the judgment of experts. My main motive in publishing this book is to invite this. Short of this I can only hope that at some future time such peculiarities of my nervous system will be discovered by dissection of my body, which will provide stringent proof. (Schreber, 1955, p. 251, italics in the original) S c h r e b e r r e p e a t e d l y calls a t t e n t i o n t o h o w his e x p e r i e n c e e x c e e d s l a n g u a g e , b u t does not a b a n d o n the search for a discourse that m i g h t provide a vocabulary a n d an e p i s t e m o l o g i c a l f r a m e w o r k t h r o u g h w h i c h t o establish t h e t r u t h of his d e l u s i o n s . Biological p s y c h i a t r y is a m o n g t h e first d i s c i p l i n e s t o b e f o u n d wanting. Noting that some of Kraepelin's technical observations regarding s y m p t o m f o r m a t i o n a r e v a l u a b l e f o r his o w n ideas, S c h r e b e r n o n e t h e l e s s rails against the a t t e n d a n t discussion of patients' deteriorating rational faculties (Schreber, 1955, p p . 8 9 - 9 0 ) . 3 8 T h e question of a p p r o a c h i n g 'delusional' experience w i t h t h e ' r i g h t k i n d o f r e a s o n ' is b r o u g h t t o t h e f o r e : He who in Kraepelin's sense (p. 146) understands 'sound experience' simply as the denial of everything supernatural, would in my opinion lay himself open to the reproach of allowing himself to be led only by the shallow 'rationalistic ideas' of the 38
Schreber, quoting Kraepelin, then writes almost testily that 'the total content of the present work will hardly show anything in my case which justifies speaking of "the inability of the patient to use earlier experiences to correct thoroughly and accurately his new ideas" (p. 146), or of "faulty judgement", which Kraepelin (p. 145) says "invariably accompanies delusions". I trust I have proved that I am not only not "controlled by fixed and previously formed ideas", but that 1 also possess in full measure the "capacity to evaluate critically the content of consciousness with the help of judgement and deduction"' (p. 146).
period of enlightenment of the 18th century, which after all are mostly considered to have been superseded, particularly by theologians and philosophers, and also in science. (Schreber, 1955, p. 90, italics in the original) Just as a n o u t m o d e d biological p s y c h i a t r y fails t o a c c o u n t f o r t h e s u p e r n a t u ral, t h e o l o g y is likewise i l l - e q u i p p e d t o e x p l a i n in b r o a d l y a c c e p t e d t e r m s w h a t S c h r e b e r insists is s c i e n t i f i c e v i d e n c e o f his ' u n m a n n i n g ' . A g a i n , t o assert t h e reality of his t r a n s f o r m a t i o n i n t o t h e w o r l d ' s r e d e e m e r , h e a p p e a l s t o t h e c o n d i t i o n of his b o d y , ' w h i c h o n e x a m i n a t i o n s h o w s r e c o g n i z a b l e f e m i n i n e c h a r acteristics c o n v i n c i n g t o e v e r y b o d y ' a n d is o p e n t o o b s e r v a t i o n b y ' a n y s e r i o u s specialist w h o s e m o t i v e is scientific i n t e r e s t a n d n o t m e r e c u r i o s i t y ' ( S c h r e b e r , 1955, p p . 2 0 3 , 2 0 7 ) . O n m a t t e r s m o r e h o l y , like t h e c r e a t i o n o f t h e w o r l d , S c h r e b e r is u n d e r s t a n d a b l y less c o n f i d e n t o f s c i e n t i f i c v i n d i c a t i o n a n d falls back o n a defensive o p t i m i s m . 3 9 H e m a y lack the m e a n s to p r o v e his beliefs scientifically ( S c h r e b e r , 1955, p. 184) a n d t o assert t h e m as r e l i g i o u s t r u t h , b u t , as b e f i t s a o n c e - d i s t i n g u i s h e d j u r i s t , S c h r e b e r h a s n o d i f f i c u l t y c o n d u c t i n g his s t r u g g l e t o b e b e l i e v e d at t h e level of r h e t o r i c . W e b e r ' s r e p o r t f r o m 1899 m a k e s clear t h a t in s p i t e o f h i s r i g i d d e l u s i o n a l s y s t e m , S c h r e b e r ' s m e n t a l f a c u l t i e s w e r e i n t a c t a n d his i n t e l l i g e n c e u n c o m p r o m i s e d ( W e b e r , 1955, p. 2 7 1 ) . I n d e e d , as O c t a v e M a n n o n i o b s e r v e s , ' S c h r e b e r d e v o t e s all his m a d e f f o r t s t o p r o v i n g t h a t h e h i m s e l f is alive a n d in full p o s s e s s i o n o f his i n t e l l e c t u a l f a c u l t i e s . T h e p r o j e c t of w r i t i n g a b o o k is p r e c i s e l y o n e o f t h e s e e f f o r t s , a n d t h e b o o k itself will c o n s t i t u t e p r o o f a g a i n s t G o d a n d Flechsig' ( M a n n o n i , 1988, p . 57). Memoirs
i n c l u d e s d i r e c t a p p e a l s t o Flechsig, p h y s i c i a n s , a n d o t h e r s w h o s e
p r o f e s s i o n a l e x p e r t i s e w o u l d l e n d s u p p o r t t o S c h r e b e r ' s ideas a n d his release, as well as i n n u m e r a b l e a p p e a l s t o t h e i m p l i e d r e a s o n a b l e n e s s o f his g e n e r a l r e a d e r s . T h i s is a n e x a m p l e o f o n e s u c h p e t i t i o n , a g a i n r e l a t e d t o t h e t r u t h value o f t h e physical: This [that I 'once had a different heart'] as indeed the whole report about the miracles enacted on my body, will naturally sound extremely strange to all other human beings, and one may be inclined to see in it only the product of a pathologically vivid imagination.
19
'1 cannot be expected to furnish scientific proof of this fundamental idea; I do not intend writing a scientific treatise on the history of the evolution of the universe. I only wish to relate what I have experienced and learned, and draw a few legitimate conclusions in the light of this knowledge. I expect confirmation of my fundamental idea mainly from my own personal fate and fortune as they will develop in the future; the time will come when other human beings will also have to recognize as a fact that my person has become the centre of divine miracles. I would then have to leave to other people to elaborate scientifically the conclusions I have hinted at and perhaps to correct some details' (Schreber, 1955, p. 94).
In reply I can only give the assurance that hardly any memory from my life is more certain than the miracles recounted in this chapter. What can be more definite for a human being than what he has lived through and felt on his own body? (Schreber, 1955, p. 132) T h a t clarity o f j u d g e m e n t also p e r s i s t e d within
Schreber's delusional system
is e v i d e n c e d b y his d e c i s i o n t o a c c e p t his u n m a n n i n g b o t h as d i v i n e d u t y and strategic c h o i c e : Since [that realization] I have wholeheartedly inscribed the cultivation of femininity on my banner, and I will continue to do so so far as consideration of my environment allows, whatever other people who are ignorant of the supernatural reasons may think of me. I would like to meet the man who, faced with the choice of either becoming a demented human being in male habitus or a spirited woman, would not prefer the latter. Such and only such is the issue for me. The pursuit of my previous profession, which I loved wholeheartedly, every other aim of manly ambition, and every other use of my intellectual powers in the service of mankind, are now all closed to me through the way circumstances have developed. (Schreber, 1955, p. 149, italics in the original) Even if, f o l l o w i n g F r e u d , S c h r e b e r ' s e n t i r e c o s m o l o g i c a l s y s t e m is a n e l a b o r a t e u n c o n s c i o u s s t r a t e g y t h r o u g h w h i c h t h e e g o c a n a c c e p t his h o m o s e x u a l l i b i d o , it is still s i g n i f i c a n t t h a t S c h r e b e r d e s c r i b e s it as a c h o i c e b e t w e e n t r a n s sexuality a n d d e m e n t i a , a choice that entails the a b a n d o n m e n t of previously c h e r i s h e d i n t e l l e c t u a l p u r s u i t s . It is n o t s i m p l y t h a t S c h r e b e r is a r t i c u l a t e o r intelligent in his m a d n e s s ; it is t h a t h e m a k e s every e f f o r t t o p r e s e n t a r e a s o n a b l e a n d r a t i o n a l a c c o u n t of his u t t e r l y f a n t a s t i c e x p e r i e n c e s . Having established the centrality of reason t o Schreber's autobiographical p r o j e c t — t h e r e a s o n s o f f e r e d f o r p r o d u c i n g t h e t e x t , as well as a p p e a l s m a d e t h r o u g h o u t it t o t h e r e a s o n a b l e n e s s o f its a u t h o r a n d r e a d e r s — w e c a n n o w t u r n t o t h e crisis of r a t i o n a l i t y t h a t o c c u p i e s p r i m e p o s i t i o n within
his d e l u -
s i o n a l s c h e m a . T h e c e n t r a l c o s m o l o g i c a l c o n u n d r u m is t h i s : h u m a n b e i n g s w i t h n e r v e s as h i g h l y excited as S c h r e b e r ' s exert a n irresistible p o w e r of a t t r a c t i o n f o r G o d , b u t in s u c c u m b i n g t o t h i s a t t r a c t i o n , G o d e n d a n g e r s h i s o w n e x i s t e n c e . G o d c a n e x t r i c a t e h i m s e l f f r o m t h i s ' n e r v e - c o n t a c t ' o n l y , it a p p e a r s , b y r e c e i v i n g c o n f i r m a t i o n t h a t S c h r e b e r is d e m e n t e d . G o d is p e r s i s t e n t in his e f f o r t s t o p r o v e S c h r e b e r a d e m e n t a n d this c o n s t a n t t e s t i n g is e x p e r i e n c e d as p e r s e c u t i o n . S c h r e b e r t h e r e f o r e insists t h a t 'All t h e a t t a c k s m a d e o v e r t h e years, o n m y life, m y b o d i l y i n t e g r i t y , m y m a n l i n e s s a n d m y r e a s o n , w e r e a n d still a r e b a s e d o n t h e s a m e idea: t o w i t h d r a w again as f a r as p o s s i b l e f r o m t h e p o w e r o f a t t r a c t i o n o f m y o v e r - e x c i t e d n e r v e s , w h i c h far s u r p a s s e s a n y t h i n g t h a t h a s ever e x i s t e d b e f o r e ' ( S c h r e b e r , 1955, p . 119). A g a i n a n d a g a i n ( S c h r e b e r , 1955,
p p . 78, 7 9 , 1 1 4 , 1 1 9 , 1 3 1 ) , this litany of a t t e m p t e d p e r s e c u t i o n is repeated, each t i m e c r o w n e d b y t h e attack o n reason. Schreber divides his stay at S o n n e n s t e i n i n t o t w o p e r i o d s distinguished by t h e severity of these attacks. At first, believing the w o r l d h a d e n d e d a n d was p o p u l a t e d only by ' f l e e t i n g - i m p r o v i s e d - m e n ' , he r e p o r t s h o r r i f i c b o d i l y a n d m e n t a l t o r t u r e s . T h e list of b e h a v i o u r s o r s y m p t o m s Schreber describes as direct a t t e m p t s to d e m o n s t r a t e his rational faculties to G o d is impressive. It includes compulsive thinking, the ' w r i t i n g - d o w n - s y s t e m ' ( c o m p u l s i v e writing), c o n s t a n t speaking a l o u d a n d n o i s e - m a k i n g , b a n g i n g o n the p i a n o o r r e a d i n g d u r i n g meals, i n s o m n i a , bellowing, reciting historical a n d geographical facts in French, a n d even t h e r e t e n t i o n o f faeces (Schreber, 1955, p p . 68, 69, 123, 160, 162). Schreber d o e s n o t , as F r e u d w o u l d seem t o imply, s p e n d m o s t of his t i m e cultivating s o u l - v o l u p t u o u s n e s s ; he is engaged in c o n s t a n t i n t r a - p s y c h i c b a t t l e . A f t e r this first a n d o v e r w h e l m i n g year, S c h r e b e r gradually c a m e t o suspect t h a t t h e w o r l d h a d n o t in fact b e e n d e s t r o y e d a n d t h a t G o d w o u l d n o t succeed in his p e r s e c u t o r y project. His delusional system t h e n stabilized a n d a l t h o u g h 'miracles' like t h e o n e s m e n t i o n e d earlier c o n t i n u e d u n a b a t e d , they b e c a m e less severe. Schreber's r e p r e s e n t a t i o n of a p a n o p l y of p e r s e c u t o r y divine beings f u r t h e r reinforces the c o n n e c t i o n b e t w e e n t h e crisis of rationality a n d the sublime. In his d e l u s i o n a l system, S c h r e b e r c o n s t r u c t s a vast, p o t e n t i a l l y i n f i n i t e c o s m i c reality, in w h i c h G o d figures as a d i s t a n t being capable of p e n e t r a t i n g Schreber's m i n d . Regardless of w h e t h e r G o d is a s u b l i m a t e d s y m b o l of the father or, foll o w i n g Sass, a s y m b o l of p a n o p t i c c o n s c i o u s n e s s , t h e way in w h i c h S c h r e b e r e x p l a i n s t h e i r r e l a t i o n s h i p in spatial t e r m s c o n t r i b u t e s t o his a l r e a d y stated c o n v i c t i o n t h a t G o d is s u b l i m e . A f t e r c r e a t i n g t h e w o r l d , G o d ' r e t i r e d t o an e n o r m o u s d i s t a n c e ' , a position f r o m w h i c h , in a c c o r d a n c e w i t h 'the O r d e r of the W o r l d ' , he dealt only w i t h corpses (Schreber, 1955, p p . 191,75). Schreber's highly excited nerves attract a n d t h r e a t e n t o e n t a n g l e G o d b u t w h e r e a s p r o x imity t o an exceptional h u m a n carries the risk of divine a n n i h i l a t i o n , p r o x i m ity t o a d e m e n t p o s e s n o such d a n g e r . As h e c a n n o t d i s c o n t i n u e ' n e r v e - c o n t a c t ' w i t h G o d , S c h r e b e r m u s t c o n s t a n t l y s u f f e r t h e a b o v e - m e n t i o n e d tests of his r e a s o n , w h i c h h e p e r c e i v e s as an i n v a s i o n o f his m e n t a l a u t o n o m y : T also o u g h t to have the right of being m a s t e r in m y o w n head against the i n t r u s i o n of strangers' (Schreber, 1955, p. 175). W h a t m e d i a t e s t h e relationship b e t w e e n G o d a n d S c h r e b e r — p r e s e r v i n g t h e i r close c o n t a c t b u t e n s u r i n g t h a t G o d ' s plan c a n n o t b e s u c c e s s f u l — i s t h e O r d e r of t h e W o r l d , w h i c h 'reveals its very g r a n d e u r a n d m a g n i f i c e n c e b y d e n y i n g even G o d Himself in so irregular a case as m i n e the m e a n s of achieving a p u r p o s e c o n t r a r y to the O r d e r of the W o r l d ' (Schreber, 1955, p. 78). (In a f o o t n o t e , Schreber explains that the O r d e r of t h e
W o r l d is t h e i n h e r e n t l y c o n s t r u c t i v e r e l a t i o n s h i p o f G o d t o h u m a n b e i n g s ; G o d ' s a t t e m p t e d destruction
of a m a n ' s r e a s o n is t h e r e f o r e a n i n t e r n a l c o n t r a -
d i c t i o n a n d b o u n d t o fail ( S c h r e b e r , 1955, p . 7 9 ) . 4 0 ) T h e f o l l o w i n g p a s s a g e — s i g n i f i c a n t f o r its u n c h a r a c t e r i s t i c a l l y c o n f u s e d p r o s e — d e t a i l s S c h r e b e r ' s f r u s t r a t i o n w i t h G o d ' s f a i l u r e t o r e c o g n i z e his o w n l i m i t a t i o n s , a n d gives a n i n d i c a t i o n of just h o w incessantly intrusive G o d ' s n e r v e s ( ' r a y s ' ) are: It seems to be impossible for God to draw a lesson for the future from such an experience, perhaps because of some qualities innate in His nature. For these phenomena are repeated in exactly the same way year in year out, day after day, particularly in the attempt to withdraw at first sight (in the twinkle of an eye) which every pause in my thinking activity (when the not-thinking-of-anything-thought starts), and the assumption that I have then succumbed to dementia; this is usually expressed in the fatuous phrase 'Now he should (scilicet think or say) I will resign myself to the fact that I am stupid', followed in senseless monotony like a barrel-organ by all the other tasteless forms of speech 'Why do you not say it (aloud)?' or 'But then for how much longer' (scilicet will your defence against the power of the rays still be successful) etc., etc.,: this goes on until I proceed to take up some new occupation which proves my undiminished mental powers. It is an extremely difficult question even for me to explain the inability on the part of God to learn by experience. (Schreber, 1955, p. 154) P a r a d o x i c a l l y , this p e r p e t u a l i n t e r n a l d i a l o g u e is a f o r m o f m e n t a l s t i m u l a tion that encourages Schreber's methodological, reasoned discourse: the u p s h o t o f a n s w e r i n g s u c h i r r i t a t i n g q u e s t i o n s all t h e t i m e is t h a t 'I a m u n a v o i d ably f o r c e d t o give m y s e l f a n a c c o u n t o f t h e r e a s o n a n d p u r p o s e of every single j o b ' ( S c h r e b e r , 1955, p. 179). G o d in his s t u b b o r n n e s s m a y n e v e r cease t o b e s u s p i c i o u s t h a t h e is d e a l i n g w i t h a p e r s o n b e r e f t o f i n t e l l i g e n c e ( S c h r e b e r , 1955, p. 247), b u t , s p e c u l a t i n g o n his f u t u r e t o w a r d s t h e e n d of
Memoirs,
S c h r e b e r writes: All I can say with absolute certainty is something negative, namely that God will never succeed in his purpose of destroying my reason. I have been absolutely clear on this point for years . . . with it the main danger which seemed to threaten me during the early years of my illness is removed. Can there be any prospect more terrible for a human being so highly gifted in such various ways, as I may say of myself without conceit, than the prospect of losing one's reason and perishing an imbecile? Hence anything which might befall me seemed more or less trivial, once I had gained the absolute conviction through years of experience that all attempts in this direction were
40
Crapanzano offers a detailed discursive analysis of the Order of the World as 'the Third', or 'laws and their embodiments that govern communicative and other interpersonal encounters' between the self and other, or Schreber and his God (Crapanzano, 1998, p. 749).
predestined to fail, as within the Order of the World not even God has the power to destroy a person's reason. (Schreber, 1955, pp. 211-12, italics in the original) S e c u r e in t h e k n o w l e d g e that his r e l a t i o n s h i p w i t h a n aggressive G o d is safeg u a r d e d a n d m e d i a t e d b y t h e O r d e r of t h e W o r l d , S c h r e b e r c a n t h e n go o n t o express his h o p e s t h a t his c o m p l e t e t r a n s f o r m a t i o n i n t o a w o m a n will e v e n t u a t e , a n d his r o l e as t h e w o r l d ' s r e d e e m e r will b e fully realized. S c h r e b e r ' s p e r p e t u a l ( r e ) a s s e r t i o n o f h i s r a t i o n a l i t y is a c o r e f e a t u r e o f h i s d e l u s i o n a l s y s t e m as well as o f t h e text in w h i c h it finds e x p r e s s i o n , a n d in b o t h p o s i t i o n s it serves t o c o n s t r u e his p s y c h o s i s as a n e x p e r i e n c e at t h e t h r e s h o l d o f t h e s u b l i m e . F o r t h e s u b j e c t o f t h e K a n t i a n s u b l i m e , feelings o f e m o t i o n a l p o w erlessness in t h e p r e s e n c e of t h e b o u n d l e s s facilitate a d e l i g h t f u l a f f i r m a t i o n of t h e r a t i o n a l faculty; t h i s is a l i n e a r p r o c e s s c u l m i n a t i n g in c o n c e p t u a l m a s t e r y , a n u n d o i n g a n d r e a s s e r t i o n o f t h e r a t i o n a l self. S c h r e b e r , b y c o n t r a s t , s e e m s c o n d e m n e d t o exist in a k i n d of t i m e l o o p at its t h r e s h o l d , f o r e v e r s t r i v i n g t o assert his r a t i o n a l f a c u l t y — t o G o d , his p h y s i c i a n s a n d r e a d e r s — b u t d i s b a r r e d f r o m t h e p l e a s u r e s o f m e n t a l s e c u r i t y . Memoirs
is a s t r u g g l e t o e s t a b l i s h a n d
defend sufficient distance f r o m Schreber's inner cosmology; his obsession with defending, reasserting, and proving reason constitutes, I would argue, the m o s t s i g n i f i c a n t r e c u r r i n g t h e m e w i t h i n t h e text. S e c u r e in t h e k n o w l e d g e t h a t the O r d e r of the W o r l d deems o n e m a n ' s reason too i m p o r t a n t to be destroyed b y G o d , Memoirs
of My Nervous
Illness c o n c l u d e s w i t h S c h r e b e r ' s m e g a l o m a -
niac expectation that, . . . a very special palm of victory will eventually be mine. As possibilities I would mention that my unmanning will be accomplished with the result that by divine fertilization offspring will issue from my lap, or alternatively that great fame will be attached to my name surpassing that of thousands of other people much better mentally endowed. (Schreber, 1955, p. 214) S c h r e b e r d i e d childless, physically ill, a n d a c u t e l y p s y c h o t i c , b u t it m a y h a v e pleased h i m to k n o w that he w o u l d b e c o m e the world's m o s t f a m o u s sufferer o f p a r a n o i d s c h i z o p h r e n i a , h e r a l d e d as b r i l l i a n t b y v i r t u a l l y e v e r y o n e o f his numerous commentators.
Lacan: the sublime structure of psychosis M o r e t h a n a n y c l i n i c a l case s t u d y o r a s y l u m - b a s e d r e s e a r c h , Memoirs Nervous
of My
Illness is p i v o t a l t o t h e p s y c h o a n a l y t i c c o n s t r u c t i o n of s c h i z o p h r e n i a
as a s u b l i m e t e x t . A s w e h a v e s e e n , t h e s u b l i m e is d o u b l y p r e s e n t w i t h i n S c h r e b e r ' s text: it is a n e x p e r i e n c e t o w h i c h S c h r e b e r is p e r p e t u a l l y c o n d e m n e d
a n d it also p r o v i d e s t h e s t r u c t u r e t h r o u g h w h i c h his d e l u s i o n a l s y s t e m is a r t i c u l a t e d . D e p l o y i n g p s y c h o t i c s i g n i f i c a t i o n as a n u n p r o b l e m a t i c m e t o n y m f o r t h e c o m p l e x i t i e s o f s c h i z o p h r e n i c e x p e r i e n c e , analysts o f Memoirs
in t u r n c o n -
s t r u e s c h i z o p h r e n i a itself as a s u b l i m e text, r i p e f o r i n t e r p r e t a t i o n b u t f u n d a m e n t a l l y i n a c c e s s i b l e t o a n a l y t i c o r t r a n s f e r e n t i a l i n f l u e n c e . J a c q u e s L a c a n is n o e x c e p t i o n . T h a t S c h r e b e r s h o u l d f e a t u r e so p r o m i n e n t l y in his t h i r d s e m i n a r , The Psychoses,
a p p e a r s u n s u r p r i s i n g , especially w h e n h e o b s e r v e s t h a t ' O f
all t h e literary p r o d u c t i o n s of t h e t y p e t h a t p l e a d a c a u s e , of all t h e c o m m u n i c a t i o n s of t h o s e w h o , h a v i n g g o n e b e y o n d t h e limits, h a v e s p o k e n of t h e p s y c h o t i c ' s a l i e n e x p e r i e n c e , S c h r e b e r ' s w o r k is c e r t a i n l y o n e o f t h e m o s t r e m a r k a b l e ' ( L a c a n , 1993, p. 10). H o w e v e r , u n l i k e F r e u d , L a c a n h a d b y t h e m i d - 1 9 5 0 s a l o n g p r o f e s s i o n a l h i s t o r y of w o r k i n g w i t h p a r a n o i d - s c h i z o p h r e n i c p a t i e n t s a n d h i s e n g a g e m e n t a n d f a s c i n a t i o n w i t h p s y c h o s i s w a s far f r o m l i m ited t o t h e s t u d y of a u t o b i o g r a p h y ( R o u d i n e s c o , 1997, p . 80). I n d e e d , L a c a n ' s f i r s t a n d o n l y case s t u d y , Le Cas Aimée, thesis, On Paranoiac
Psychosis
w a s p u b l i s h e d in h i s 1932 d o c t o r a l
in Its Relation
to Personality.
It a p p e a r s signifi-
c a n t , t h e n , t h a t a l t h o u g h L a c a n h a d r e a d y access t o a w e a l t h of case m a t e r i a l , i n c l u d i n g h i s o w n , h e s h o u l d c o n s t r u c t h i s t h e o r y o n t h e t e x t s of S c h r e b e r , F r e u d , a n d I d a M a c a l p i n e , as M a r c e l l e M a r i n i ( 1 9 9 2 , p . 159) o b s e r v e s . O n c e a g a i n , Memoirs
d i s p l a c e s clinical e x p e r i e n c e as t h e s o u r c e a n d test o f p s y c h o -
a n a l y t i c a c c o u n t s o f s c h i z o p h r e n i a : it is 'a d o c u m e n t w h o s e g u a r a n t e e s o f c r e d i b i l i t y a r e u n r i v a l l e d ' a n d , as L a c a n e n d e a v o u r s t o d e m o n s t r a t e in ' O n a q u e s t i o n p r e l i m i n a r y t o a n y p o s s i b l e t r e a t m e n t o f p s y c h o s i s ' , its s t r u c t u r e 'will p r o v e t o b e s i m i l a r t o t h e p r o c e s s o f p s y c h o s i s i t s e l f ( L a c a n , 1966, p . 2 0 1 ) . B e f o r e d i s c u s s i n g L a c a n ' s r e a d i n g o f Memoirs
in m o r e d e p t h a n d its e l a b o r a -
t i o n of a n e w r e l a t i o n s h i p b e t w e e n s c h i z o p h r e n i a a n d s u b l i m i t y , I w a n t t o l o o k first at t h e c o n t e x t in w h i c h L a c a n s i t u a t e s his c o n t r i b u t i o n t o t h e p s y c h o a n a lytic s t u d y of p s y c h o s i s , t h a t is, his c r i t i q u e o f F r e u d . D e s p i t e c a s t i n g h i m s e l f as F r e u d ' s t r u e disciple, L a c a n is u n e q u i v o c a l in h i s r e j e c t i o n o f F r e u d ' s a c c o u n t of p a r a p h r e n i a . Q u e s t i o n i n g b o t h t h e selective i n t e r p r e t a t i o n of Schreber's d e l u s i o n a l system a n d the b r o a d e r theoretical m o d e l F r e u d d e r i v e d f r o m his analysis o f t h e case, h e writes: Does the entire delusion consist of the dialogue of this unique Schreber, who, with his enigmatic partner, the Schreberian God, is the new starting point for the regeneration of humanity through the birth of a new Schreberian generation? No, it doesn't. Not only is this not the whole delusion, but it's quite impossible to understand it entirely at this level. | In 'Psycho-Analytic Notes'] the entire dynamics of the Schreber case are explained to us on the basis of the ego's efforts to escape from a so-called homosexual drive
threatening its completeness .. . The narrowing of perspective, the clinical inadequacies of this construction, are self-evident. (Lacan, 1993, pp. 106, 105, see also 307-12)
L a c a n d i s t i n g u i s h e s his a p p r o a c h t o t h e q u e s t i o n of p s y c h o s i s f r o m F r e u d ' s in a n u m b e r of i m p o r t a n t w a y s . First, in t h e i n t r o d u c t o r y s e m i n a r L a c a n m a k e s clear t h a t t h e t h o r n y issue of n o s o l o g y is b e y o n d his c o n c e r n . R a t h e r t h a n p r e varicate over the differences between schizophrenia, paraphrenia, and paran o i a , h e states s i m p l y t h a t t h e p s y c h o s e s ' c o r r e s p o n d t o w h a t h a s always b e e n c a l l e d a n d l e g i t i m a t e l y c o n t i n u e s t o b e called madness'
( L a c a n , 1993, p . 4 )
( a l t h o u g h h e r e , as i n so m a n y o t h e r p s y c h o a n a l y t i c a c c o u n t s o f p s y c h o s i s , t h e p a r a n o i d - s c h i z o p h r e n i c n a r r a t i v e f u n c t i o n s as t h e p r i v i l e g e d o b j e c t of investigation). Lacan's a p p a r e n t indifference to psychiatric t a x o n o m y contrasts sharply, however, with his insistence on a f u n d a m e n t a l difference between n e u r o s i s a n d p s y c h o s i s , a n d o n t h e n e e d f o r a radically revised a p p r o a c h t o t h e latter. T h u s Lacan praises Freud for his interpretive skill—'it's the genius of t h e linguist w h o sees t h e s a m e sign a p p e a r several t i m e s in a text, b e g i n s f r o m t h e idea t h a t t h i s m u s t m e a n s o m e t h i n g , a n d m a n a g e s t o s t a n d all t h e signs of t h i s l a n g u a g e r i g h t side u p a g a i n ' — b u t c a u t i o n s t h a t t h i s k i n d o f ' s y m b o l i c o r d e r ' r e a d i n g 'leaves t h e fields of t h e p s y c h o s e s a n d t h e n e u r o s e s b o t h o n t h e s a m e level' ( L a c a n , 1993, p p . 1 0 - 1 1 ) . F u n d a m e n t a l t o e s t a b l i s h i n g t h e d i f f e r e n t 'levels' of n e u r o s i s a n d p s y c h o s i s is t h e s t a t u s o f t h e u n c o n s c i o u s . F r e u d , like Jung before h i m , insisted that psychotic patients openly display the u n c o n scious 'secrets' otherwise h i d d e n by those with neurosis, a n d thereby sought to j u s t i f y b a s i n g his analysis of p a r a p h r e n i a exclusively u p o n w r i t t e n t e s t i m o n y . 4 1 A l t h o u g h L a c a n c o n c u r s t h a t p s y c h o t i c s i g n i f i c a t i o n is o f p a r a m o u n t i m p o r t a n c e t o t h e d i a g n o s i s , if n o t analysis, of p s y c h o s i s , h e explicitly c h a l l e n g e s t h e i d e a t h a t it s h o u l d b e i n t e r p r e t e d as a f o r t h r i g h t s y m b o l i c r e v e l a t i o n o f t h e unconscious: It's classically said that in psychosis the unconscious is at the surface, conscious. That is even why articulating it doesn't seem to have much effect... Translating Freud, we say—the unconscious is a language. Its being articulated doesn't imply its recognition, though. The proof of this is that everything proceeds as if Freud were translating a foreign language, even carving it up and reassembling it. The subject is, with respect to his own language, quite simply in the same position as Freud. If it's ever possible for
41
Recall that for Freud (1981, p. 9), psychosis 'is precisely a disorder in which a written report or a printed case history can take the place of personal acquaintance with the patient'.
someone to speak in a language that he is totally ignorant of, we can say that the psychotic subject is ignorant of the language he speaks. (Lacan, 1993, pp. 11-12, see also 191-2) 42 P s y c h o s i s c a n n o t , a c c o r d i n g t o L a c a n , b e a p p r o a c h e d as o n e w o u l d a n e u r o sis: a l t h o u g h t h e r e is ' g r e a t s a t i s f a c t i o n in r e d i s c o v e r i n g c e r t a i n n e u r o t i c s y m b o l i c t h e m e s in p s y c h o s i s . . . o n e really m u s t r e c o g n i z e t h a t it o n l y c o v e r s a t i n y bit of t h e p i c t u r e ' (Lacan, 1993, p. 106). Again, u n l i k e F r e u d , a n d t h e m a j o r i t y of c o m m e n t a t o r s since F r e u d , L a c a n is u n i n t e r e s t e d in f i n d i n g a n e w way to decrypt or unscramble Schreber's schizophrenic code. Instead, he turns his a t t e n t i o n t o t h e s t a t u s of t h e c o d e o r u t t e r a n c e itself, a n d p r o p o s e s a r a d i cally n e w w a y o f a p p r o a c h i n g p s y c h o s i s through
language, and through the
question of the father u n d e r p i n n i n g Freud's research. If p s y c h o s i s c a n n o t b e p r o p e r l y u n d e r s t o o d in t e r m s of h o m o s e x u a l l i b i d o , narcissistic r e g r e s s i o n , p s y c h o n e u r o s i s , o r t h e h i e r o g l y p h i c p r e s e n t a t i o n o f t h e u n c o n s c i o u s , h o w t h e n is it t o b e d e f i n e d ? T o a n s w e r t h i s q u e s t i o n , L a c a n t u r n s t o a p r i m o r d i a l stage o f p s y c h i c d e v e l o p m e n t , t o t h e p r o c e s s b y w h i c h t h e child's ' i m a g i n a r y r e g i s t e r — t h a t of visual images, a u d i t o r y , olfactory, a n d o t h e r sense p e r c e p t i o n s of all k i n d s , a n d f a n t a s y — i s r e s t r u c t u r e d , r e w r i t t e n , o r " o v e r w r i t t e n " b y t h e s y m b o l i c ' ( F i n k , 1997, p . 8 8 ) . T h e o r i g i n s o f p s y c h o s i s lie in t h e s u b j e c t ' s f a i l u r e t o e n t e r t h e r e a l m o f s i g n i f i c a t i o n : Prior to all symbolization—this priority is not temporal but logical—there is, as the psychoses demonstrate, a stage at which it is possible for a portion of symbolization not to take place. This initial stage precedes the entire neurotic dialectic, which is due to the fact that neurosis is articulated speech, insofar as the repressed and the return of the repressed are one and the same thing. It can thus happen that something primordial regarding the subject's being does not enter into symbolization and is not repressed, but rejected. (Lacan, 1993, p. 81) ' N o t repressed, b u t rejected'—Lacan here refers to a psychic m e c h a n i s m p e c u l i a r t o p s y c h o s i s . 4 3 F o r e c l o s u r e , a t r a n s l a t i o n of F r e u d ' s Verwerfung,
is t h e
42
Lacan (1993, p. 132) later expands on this point: 'This discourse, which has emerged in the ego, shows itself... to be irreducible, unmanageable, incurable. In short, it could be said that the psychotic is a martyr of the unconscious, giving this term martyr its meaning, which is to be a witness. It's an open testimony. The neurotic is also a witness to the existence of the unconscious, he gives a closed testimony that has to be deciphered. The psychotic, in the sense in which he is in a first approximation an open witness, seems arrested, immobilized, in a position that leaves him incapable of authentically restoring the sense of what he witnesses and sharing it in the discourse of others'.
41
Russell Grigg (1999, p. 70) notes that Lacan, in an analysis of |oyce published 20 years after The Psychoses, revised his theory ol foreclosure to be the universal condition of the
p r o c e s s b y w h i c h a g r o u n d i n g s i g n i f i e r is e x p e l l e d o r r e f u s e d , t h u s c r e a t i n g a ' g a p o r f i s s u r e ' in t h e s u b j e c t ' s e n t i r e s i g n i f y i n g s y s t e m ( R i c h a r d s o n , 1988, p. 2 4 ) . P s y c h o s i s arises t h e n f r o m a r u p t u r e o r h o l e in a s y m b o l i c o r d e r s t r u c t u r e d b y phallic s i g n i f i c a t i o n : It is an accident in this register and in what takes place in it, namely, the foreclosure of the Name-of-the-Father in the place of the Other, and in the failure of the paternal metaphor, that I designate the defect that gives psychosis its essential condition, and the structure that separates it from neurosis. (Lacan, 1966, p. 215) T h e N a m e - o f - t h e - F a t h e r is a c o m p l e x c o n c e p t : a s u b s t i t u t e f o r t h e D e s i r e o f - t h e - M o t h e r , it is a s y m b o l i c i n t e r v e n t i o n in t h e i m a g i n a r y m o t h e r - c h i l d d y a d , a n i n t e r v e n t i o n t h a t m a y o r m a y n o t b e e n a c t e d b y a biological f a t h e r o r f a t h e r f i g u r e . T h e N a m e - o f - t h e - F a t h e r is e x p e r i e n c e d as t h e loss o r c a s t r a t i o n u p o n which the child's entry into language a n d Oedipal d e v e l o p m e n t depends. As L a c a n e x p l a i n s : The Oedipus complex means that the imaginary, in itself an incestuous and conflictual relation, is doomed to conflict and ruin. In order for the human being to be able to establish the most natural of relations, that between male and female, a third part has to intervene, one that is the image of something successful, the model of some harmony. This does not go far enough—there has to be a law, a chain, a symbolic order, the intervention of the order of speech, that is, of the father. Not the natural father, but what is called the father. The order that prevents the collision and explosion of the situation as a whole is founded on the existence of this name of the father. (Lacan, 1993, p. 96, see also 210) In p s y c h o s i s , t h e f o r e c l o s u r e o f t h e N a m e - o f - t h e - F a t h e r f u n d a m e n t a l l y alters t h e s u b j e c t ' s r e l a t i o n s h i p t o l a n g u a g e : 'If t h e n e u r o t i c i n h a b i t s l a n g u a g e , t h e p s y c h o t i c is i n h a b i t e d , p o s s e s s e d , b y l a n g u a g e ' , so it is in t h e register o f s p e e c h t h a t t h e p h e n o m e n o l o g y o f p s y c h o s i s a p p e a r s ( L a c a n , 1993, p p . 2 5 0 , 3 6 ) . Lacan is at p a i n s t o e m p h a s i z e , h o w e v e r , t h a t s c h i z o p h r e n i c n e o l o g i s m s c a n n o t b e t r e a t e d as u n c o n s c i o u s h i e r o g l y p h s , pace F r e u d ; r a t h e r , s u c h s i g n i f i e r s h a v e ' t h e p r o p e r t y of r e f e r r i n g essentially t o m e a n i n g as such', t h a t is, t h e y r e m a i n ' i r r e d u c i b l e ' ( L a c a n , 1993, p. 33, italics in t h e o r i g i n a l ) . L a c a n o f f e r s t h e f o l l o w ing e x p l a n a t i o n of h o w p s y c h o t i c h a l l u c i n a t i o n s a n d d e l u s i o n s d i f f e r s t r u c t u r ally f r o m t h e n e u r o t i c s y m p t o m s a r i s i n g f r o m r e p r e s s i o n : Let's start with the idea that a hole, a fault, a point of rupture, in the structure of the external world finds itself patched over by psychotic fantasy. How is this to be explained? We have at our disposal the mechanism of projection. symptom'. This revision, however, has no direct bearing on the arguments presented here.
Projection in psychosis i s . . . the mechanism that makes what has got caught up in the Verwerfung—that is, what has been placed outside the general symbolization structuring the subject—return from without. (Lacan, 1993, pp. 45, 47) O n e of L a c a n ' s m o s t f a m o u s s t a t e m e n t s o n p s y c h o s i s — ' w h a t e v e r is r e f u s e d in t h e s y m b o l i c o r d e r , in t h e s e n s e o f Verwerfung,
r e a p p e a r s i n t h e real' ( L a c a n ,
1993, p. 13, see also 1 3 6 ) — e n c a p s u l a t e s his a c c o u n t of t h e p s y c h o t i c s y m p t o m : it c o m e s to t h e s u b j e c t f r o m a p l a c e b e y o n d t h e i m a g i n a r y o r s y m b o l i c registers, f r o m t h e Real o f u n r e p r e s e n t a b l e e x p e r i e n c e . Psychotic s y m p t o m s erupt w h e n something h a p p e n s to m a k e apparent the h o l e in t h e s y m b o l i c , f o r e x a m p l e , w h e n s o m e o n e a p p e a r s in t h e p l a c e o f t h e N a m e - o f - t h e - F a t h e r , a p l a c e w h i c h is i m p o s s i b l e o r n o n - e x i s t e n t f o r t h e p s y c h o t i c p a t i e n t . If t h e p s y c h e is a s t r u c t u r e c o n s e q u e n t u p o n o u r s u b j e c t i o n t o a n d h a b i t a t i o n o f l a n g u a g e , it f o l l o w s t h a t t h e f o r e c l o s u r e o f t h e N a m e - o f - t h e F a t h e r is t h e decisive f a c t o r in t h e e s t a b l i s h m e n t o f a p s y c h i c s t r u c t u r e , w h i c h m a y o r m a y n o t b e revealed t h r o u g h p s y c h o t i c s y m p t o m a t o l o g y . O n c e d e t e r m i n e d , t h i s p s y c h i c s t r u c t u r e c a n n o t b e a l t e r e d : ' t h e p a t e r n a l f u n c t i o n is c o n s i d e r e d t o b e all o r n o t h i n g : e i t h e r a f a t h e r (as n o u n , n a m e o r " N o ! " ) has b e e n a b l e t o t a k e o n all t h e s y m b o l i c f u n c t i o n o r h e h a s n o t . T h e r e a r e n o i n - b e t w e e n s ' ( F i n k , 1997, p. 82, italics in t h e o r i g i n a l ) . ( O r , t o p u t it c r u d e l y : ' p s y c h o s i s is like p r e g n a n c y : y o u h a v e it o r y o u d o n ' t ' (Hill, 1997, p. 110)). So if n o p s y c h i c s t r u c t u r e c a n b e c h a n g e d , w h a t e x a c t l y c a n L a c a n i a n p s y c h o a nalysis o f f e r t h e p s y c h o t i c p a t i e n t ? G i v e n t h a t t h e f i s s u r e in t h e s y m b o l i c regist e r c a n n o t b e r e m e d i e d , t h e r e c o n s t i t u t i o n of t h e s u b j e c t c a n o n l y b e a t t e m p t e d in t h e r e a l m o f t h e i m a g i n a r y . In t h e w o r d s of B r u c e F i n k ( 1 9 9 7 , p. 101): ' T h e goal, s u p e r f i c i a l l y s t a t e d , is t o r e t u r n t h e i m a g i n a r y t o t h e stable state t h a t c h a r a c t e r i z e d it p r i o r t o t h e p s y c h o t i c b r e a k ' . H o w e v e r , as L a c a n o f f e r s n o i n s i g h t in The Psychoses o r e l s e w h e r e i n t o h o w this m i g h t b e a c h i e v e d , it s e e m s t h a t h e h a s little i n t e r e s t in o r e n t h u s i a s m f o r r a d i c a l l y r e v i s i n g t h e p e s s i m i s m w i t h w h i c h p s y c h o a n a l y s t s h a v e a p p r o a c h e d t h e t r e a t m e n t of p s y c h o s i s . 4 4
44
Marcelle Marini wryly observes that Lacan 'was more interested in understanding the apparently incomprehensible than in creating a liberating psychotherapy' (Marini, 1992, p. 31). Rodney Kleiman, Director of the Freudian School of Melbourne, has suggested that the analyst offers someone with psychosis recognition that they 'reveal the truth about man's [sic] subjection to language': 'When they ask, "Am 1 mad?" . . . is there a way of replying which says to them this—"That what you are saying is of value in a discursive sense because at the very least it's a commentary on meaning of man's relationship to language". What would they do with that? |., .| What it docs is say there's a point to what you have to say' (Kleiman, 2003), Kugcnie Georgia's (2001) case study ofa literature
It s h o u l d b e clear e v e n f r o m this b r i e f a c c o u n t o f L a c a n ' s t h e o r y o f p s y c h o s i s w h y S c h r e b e r ' s Memoirs
s h o u l d o c c u p y p r i d e of place in its e x p l i c a t i o n . O v e r
t h e c o u r s e o f The Psychoses,
Lacan consistently refers to Schreber's delusions to
illustrate the m e c h a n i s m s of psychosis a n d the structural i m p o r t a n c e of the p a t e r n a l m e t a p h o r . 4 5 I h a v e a l r e a d y d e a l t at l e n g t h w i t h c o m p e t i n g i n t e r p r e t a t i o n s o f specific a s p e c t s o f S c h r e b e r ' s d e l u s i o n a l s y s t e m ; m y c o n c e r n h e r e is t o p i n p o i n t t h e m a j o r c l a i m s L a c a n m a k e s r e g a r d i n g its o r i g i n s . A c c o r d i n g t o F r e u d , S c h r e b e r ' s s e c o n d e n c o u n t e r w i t h Flechsig c a u s e d a n u p s u r g e o f h o m o sexual l i b i d o , releasing a p r e v i o u s l y r e p r e s s e d d e s i r e f o r his f a t h e r a n d b r o t h e r . Similarly, Lacan is f o r c e d t o p o s i t a d o u b l e o r i g i n in o r d e r t o a d d r e s s t h e issue o f h o w S c h r e b e r , d e s p i t e his u n d e r l y i n g p s y c h o t i c p s y c h i c s t r u c t u r e , lived a n a p p a r e n t l y n o r m a l , e v e n s u c c e s s f u l , life u n t i l t h e o n s e t of his s e c o n d ' n e r v o u s illness'. A s t h e f o r e c l o s u r e o f t h e N a m e - o f - t h e - F a t h e r o c c u r s d u r i n g i n f a n c y , t h e s u b j e c t will s u b s e q u e n t l y , . . . have to bear the weight of this real, primitive dispossession of the signifier and adopt compensation for it, at length, over the course of his life, through a series of purely conformist identifications with characters who will give him the feeling for what one has to do to be a man. The situation may be sustained for a long time this way, psychotics can live compensated lives with apparently ordinary behavior considered to be normally virile, and then all of a sudden, mysteriously, God only knows why, become decompensated. What is it that suddenly renders insufficient the imaginary crutches which have enabled the subject to compensate for the absence of the signifier? How does the signifier as such again lay down its requirements? How does what is missing intervene and question? (Lacan, 1993, p. 205) In o t h e r w o r d s , w h a t e v e n t reveals t h e p s y c h o t i c s t r u c t u r e o r p r e c i p i t a t e s t h e psychotic break? Lacan identifies two experiences that o c c u r r e d immediately p r i o r t o t h e o n s e t of S c h r e b e r ' s p s y c h o s i s — h i s r e p e a t e d l y t h w a r t e d e x p e c t a t i o n s of p a t e r n i t y a n d his p r e s t i g i o u s a p p o i n t m e n t t o a c o u r t p r e s i d e d o v e r b y m e n 20 y e a r s his s e n i o r — s u g g e s t i n g t h a t ' [ u l t i m a t e l y t h e q u e s t i o n is w h e t h e r o r n o t t h e s u b j e c t will b e c o m e a f a t h e r ' ( L a c a n , 1993, p p . 3 2 0 - 1 ) . If t h e q u e s t i o n w a s t h u s r a i s e d , it w a s u n a b l e t o b e a n s w e r e d ; i n d e e d , it e x p o s e d a g a p i n g hole w h e r e t h e N a m e - o f - t h e - F a t h e r s h o u l d o t h e r w i s e have b e e n . A c k n o w l e d g i n g t h a t ' e v e r y a u t h o r h a s in f a c t a t t e m p t e d t o e x p l a i n t h e o n s e t o f S c h r e b e r ' s d e l u sion w i t h r e f e r e n c e t o t h e f a t h e r ' (Lacan, 1993, p. 2 1 2 ) , L a c a n ' s d i s t i n c t i o n is t o teacher diagnosed as psychotic gives an excellent account of how Lacan's theory of psychosis can be more practically applied in the clinical context. Like Freud, however, Lacan appears singularly uninterested in Schreber's struggle to prove his rationality to God.
place the e m p h a s i s o n the symbolic f u n c t i o n of the Father, r a t h e r t h a n o n S c h r e b e r ' s l i b i d i n a l a t t a c h m e n t t o M o r i t z S c h r e b e r , o r his c h i l d h o o d p e r s e c u t i o n . F o r Elisabeth R o u d i n e s c o , t h i s d i s t i n c t i o n r e c o n c i l e s a n y l i n g e r i n g d e b a t e o v e r h o w t o i n t e r p r e t Memoirs
in t h e w a k e of N i e d e r l a n d ' s r e s e a r c h :
With this sophisticated abstract formula, Lacan brilliantly solved the problem that all other commentators on the Memoirs of My Nervous Illness, including Freud, had puzzled over before him. All of them had noticed the link between the father's educational creed and the son's delusions, but Lacan was the first to build a theory on it and to define its functioning in the autobiographical ravings of a crazy narrator. The younger Schreber's pen described a universe full of instruments of torture strangely resembling the apparatuses recommended in the books bearing the name of D. G. M. Schreber—the 'name-of-the-father' excluded from or censored out of both the Memoirs and the memory of the son. (Roudinesco, 1997, p. 290) T h e case p r e s e n t e d h e r e is, in m y view, e x a g g e r a t e d a n d i n a c c u r a t e . A l t h o u g h Lacan c e r t a i n l y laid t h e t h e o r e t i c a l f o u n d a t i o n s f o r w o r k s u c h as S a n t n e r ' s My Own Private
Germany,
n o w h e r e in The Psychoses
d o e s h e d i s c u s s in a n y d e p t h
t h e m e d i c o - p e d a g o g i c r e g i m e o f M o r i t z S c h r e b e r o r its i m p a c t o n t h e y o u n g S c h r e b e r . M o r e o v e r , t o insist o n t h e i m p o r t a n c e of early c h i l d h o o d e x p e r i e n c e w o u l d c o n t r a d i c t the claim that the foreclosure of the N a m e - o f - t h e - F a t h e r o c c u r s at t h e t i m e t h e i n f a n t e n t e r s t h e register o f s p e e c h . T h e i m p o r t a n c e o f L a c a n ' s t h i r d s e m i n a r , I w o u l d s u g g e s t , e x t e n d s well b e y o n d h i s r e a d i n g o f Memoirs
of My Nervous
Illness, e v e n as it r e i n f o r c e s t h a t l a t t e r ' s s t a t u s as a s u b -
l i m e text in p s y c h o a n a l y t i c d i s c o u r s e . T h e s i g n i f i c a n c e o f The Psychoses f o r t h e b r o a d e r q u e s t i o n o f p s y c h o a n a l y t i c a c c o u n t s of s c h i z o p h r e n i a lies in its s t a r k portrayal of schizophrenic s i g n i f i c a t i o n — a n d indeed psychosis itself—as sublime. T h e o p e r a t i o n of t h e t e x t u a l s u b l i m e — t h e t e x t u a l i z a t i o n of s c h i z o p h r e n i a is m o r e a p p a r e n t in L a c a n ' s w o r k t h a n in a n y o t h e r p s y c h o a n a l y t i c o e u v r e . M a r i n i h a s a l r e a d y a r g u e d t h a t h i s r e l i a n c e o n t e x t u a l r a t h e r t h a n clinical m a t e rial in The Psychoses
is p r o b l e m a t i c : ' L a c a n w o u l d s t u d y t e x t s a b o u t texts c o n -
c e r n i n g t h e case o f S c h r e b e r ; t h e f e w a l l u s i o n s t o his o w n p a t i e n t s , w h o m h e h a d m e t only once, were n o t e n o u g h to redeem this seminar f r o m being a readi n g o f texts of t e x t s ' ( M a r i n i , 1992, p. 33). F o r F r e u d , t h e p a r a p h r e n i c d i s p l a y of u n c o n s c i o u s m a t e r i a l r e n d e r e d t h e s u b s t i t u t i o n of a u t o b i o g r a p h y f o r i n t e r p e r s o n a l e n c o u n t e r a c c e p t a b l e , if n o t d e s i r a b l e . H a v i n g a l r e a d y r e j e c t e d t h i s r e a d i n g of p s y c h o s i s , Lacan o f f e r s a far m o r e e l a b o r a t e t h e o r e t i c a l j u s t i f i c a t i o n f o r w h y it is t h a t S c h r e b e r ' s m a n u s c r i p t a p p e a r s t o b e m o r e v a l u a b l e t h a n a n i n - p e r s o n a p p e a r a n c e . L a c a n i a n p s y c h o a n a l y s i s is, e v e n by c o m p a r i s o n w i t h c o m p e t i n g psychoanalytic traditions, singularly focused o n language and the
a p p e a r a n c e of t h e s y m p t o m in t h e s y m b o l i c r e g i s t e r . 4 6 T h e q u e s t i o n of s c h i z o p h r e n i a ' s n o n - v e r b a l m a n i f e s t a t i o n s is r a i s e d b y h i m o n l y t o b e d i s m i s s e d : e v e n t h o u g h ' t h e b y n o m e a n s m e t a p h y s i c a l q u e s t i o n arises o f w h a t is really g o i n g o n in t h e lived e x p e r i e n c e of t h e p s y c h o t i c ' , h e states clearly: ' W e a r e n o t yet in a p o s i t i o n t o give a n a n s w e r a n d p e r h a p s at n o t i m e will t h e q u e s t i o n ever h a v e a n y m e a n i n g f o r u s ' ( L a c a n , 1993, p . 6 7 ) . Easily d i s p e n s e d w i t h at
first,
this a p p a r e n t l y u n m e a n i n g f u l q u e s t i o n later resurfaces in a discussion of Memoirs
of My Nervous
Illness.
I h a v e a l r e a d y n o t e d t h e p r o p e n s i t y of c o m -
m e n t a t o r s o n t h i s t e x t t o o v e r l o o k t h e c o n d i t i o n s o f its p r o d u c t i o n , s p e c i f i cally, its s t a t u s as m e m o i r . L a c a n , t o o , o b s e r v e s t h a t S c h r e b e r p r e s e n t s h i s d e l u s i o n a l s y s t e m t o t h e r e a d e r m a n y y e a r s a f t e r its o n s e t a n d c o n c e d e s : In this respect I have some reservations, legitimate ones, since something that we may suppose is more primitive, prior, originary, escapes us—the lived experience, the famous ineffable and incommunicable lived experience of psychosis in its primary or fertile period. (Lacan, 1993, p. 118) H o w e v e r , h e t h e n u r g e s u s t o ' a b a n d o n t h e idea, i m p l i c i t in m a n y s y s t e m s , t h a t w h a t t h e s u b j e c t p u t s i n t o w o r d s is a n i m p r o p e r a n d a l w a y s d i s t o r t e d e n u n c i a t i o n of a lived e x p e r i e n c e t h a t w o u l d be s o m e i r r e d u c i b l e reality' ( L a c a n , 1993, p. 1 1 8 ) . It is, a f t e r all, in t h e s y m b o l i c o r d e r t h a t p s y c h o s i s is m a d e a p p a r e n t . W h a t is s i g n i f i c a n t , a c c o r d i n g t o L a c a n , is n o t w h e t h e r o r n o t a p a r t i c u l a r aspect of lived experience o r psychotic speech can o r c a n n o t b e understood:
' W h a t , o n t h e c o n t r a r y , is a l t o g e t h e r s t r i k i n g is t h a t it's i n a c c e s -
sible, i n e r t , a n d s t a g n a n t w i t h r e s p e c t t o a n y d i a l e c t i c ' ( L a c a n , 1993, p . 2 2 ) . If ' u n d e r s t a n d i n g ' , in t h e s e n s e of i n t e r p e r s o n a l e m p a t h y , is i n c o n s e q u e n t i a l if n o t i m p o s s i b l e , t h e n all t h a t r e m a i n s t o b e d o n e is s c r u t i n i z e p s y c h o t i c d i s c o u r s e . H e r e , L a c a n effectively m a k e s S c h r e b e r t h e b e l l o w i n g m a d m a n s u p e r f l u o u s t o t h e a n a l y s i s o f Memoirs,
and by implication, the flesh-and-blood
p a t i e n t t o t h e analysis o f p s y c h o s i s . Lacan takes t h e p s y c h o a n a l y t i c textualization of s c h i z o p h r e n i a to the e x t r e m e , b u t his p o r t r a y a l also r e p r o d u c e s e l e m e n t s o f p s y c h i a t r y ' s f r a m i n g of 46
As Dylan Evans notes, this almost exclusive emphasis on the analysand's speech is justified on three main grounds: 'Firstly, all human communication is inscribed in a linguistic structure; even "body language" is, as the term implies, fundamentally a form of language, with the same structural features. Secondly, the whole aim of psychoanalytic treatment is to articulate the truth of one's desire in speech rather than in any other medium; the fundamental rule of psychoanalysis is based on the principle that speech is the only way to this truth. And thirdly, speech is the only tool which the analyst has; therefore, any analyst who does not understand the way speech and language work does not understand psychoanalysis itself ( Evans. 1996, pp. 97 8).
s c h i z o p h r e n i a as s u b l i m e . A l t h o u g h h e s q u a r e l y o p p o s e s J a s p e r s ' s a c c o u n t o f t h e i m p o r t a n c e o f i n t e r p e r s o n a l ' u n d e r s t a n d i n g ' in p s y c h i a t r i c a n d p s y c h o logical p r a c t i c e , L a c a n p a r a d o x i c a l l y a p p e a r s t o b e m o r e closely a l i g n e d w i t h Jaspers t h a n w i t h m a n y o t h e r p s y c h o a n a l y s t s . In a d d i t i o n t o criticizing F r e u d ' s a t t e m p t t o t r a n s l a t e t h e ' m e a n i n g of m a d n e s s ' , b o t h J a s p e r s a n d Lacan insist t h a t t h e s u b l i m e ( u n k n o w a b l e , i n a c c e s s i b l e , i n e f f a b l e , o r u n r e p r e s e n t a b l e ) is central to the s t r u c t u r e of schizophrenia. ' N o t only can m a n ' s being n o t be u n d e r s t o o d w i t h o u t m a d n e s s , it w o u l d n o t b e m a n ' s b e i n g if it d i d n o t b e a r m a d n e s s w i t h i n i t s e l f as t h e l i m i t o f h i s f r e e d o m ' ( L a c a n , 1 9 6 6 , p . 2 1 5 ) . P s y c h o s i s in t h e s e a c c o u n t s r e v e a l s — a n d t h r e a t e n s t o r u p t u r e — o n t o l o g i c a l boundaries. Not only do schizophrenic delusions and hallucinations appear f r o m b e y o n d t h e t h r e s h o l d o f t h e s y m b o l i c , L a c a n ' s t h e o r y o f p s y c h o s i s also c o n d e m n s t h e s u f f e r e r herself t o exist in a n u n r e p r e s e n t a b l e a n d u n s p e a k a b l e p s y c h i c space. It is t h e idea of radical e x t e r i o r i t y , a ' p s y c h o t i c abyss o u t s i d e t h e s y m b o l i c d o m a i n ' ( L a c a n q u o t e d in Z i z e k , 1999, p. 2 7 3 ) , w h i c h clearly p a y s h o m a g e t o a v i s i o n o f t h e s c h i z o p h r e n i c s u b l i m e as e x c e e d i n g t h e l i m i t s o f ' n o r m a l ' subjectivity. Although the psychic structure of psychosis and the m e c h a n i s m s o f its o p e r a t i o n c a n b e t h e o r i z e d , L a c a n , like Jaspers, r e p e a t e d l y highlights the futility of a t t e m p t i n g to interpret the ineffable psychotic utterance, or decipher the central, incomprehensible mystery of schizophrenia: At the heart of the psychoses there is a dead end, perplexity concerning the signifier. Everything takes place as if the subject were reacting to this by an attempt at restitution, at compensation. Fundamentally the crisis is undoubtedly unleashed by some question or other. Which is . . . ? I've got no idea. I suppose that the subject reacts to the signifier's absence by all the more emphatically affirming another one that as such is essentially enigmatic. (Lacan, 1993, p. 184) D e l u s i o n s m a y b e 'legible' b u t ' t h e r e is n o w a y o u t ' , p r e s u m a b l y f o r b o t h t h e p s y c h o t i c a n a l y s a n d a n d t h e a n a l y s t ( L a c a n , 1993, p . 104). Classical p s y c h o a n a l y s t s n e g o t i a t e d this i m p a s s e b y r e a d i n g o r r e w r i t i n g t h e p s y c h o t i c l i t e r a r y o u t p o u r as a n e s s e n t i a l l y i m m u t a b l e n e u r o t i c n a r r a t i v e ; L a c a n , o n t h e o t h e r h a n d , c o n s i s t e n t l y e m p h a s i z e s t h e p r o b l e m of l e g i b i l i t y in s u c h a w a y as t o e x a c e r b a t e its s t r u c t u r a l s i n g u l a r i t y a n d d i s t i n c t i o n f r o m n e u r o s i s . L a c a n ' s t h e o r y o f p s y c h o s i s t h u s m a p s a t w o f o l d r e l a t i o n s h i p b e t w e e n schizo p h r e n i a a n d s u b l i m i t y . First, it r e p e a t s a n d h e i g h t e n s t h e a l r e a d y e s t a b l i s h e d logic of t h e t e x t u a l s u b l i m e . If p s y c h o a n a l y s i s has, since J u n g , s h o w n t h a t psyc h o t i c d e l u s i o n s c a n b e i n t e r p r e t e d , it h a s b e e n u n a b l e t o d e m o n s t r a t e t h a t such interpretation has any psychotherapeutic value, intent, o r consequence. L a c a n r a i s e s t h e s t a k e s h e r e : o n c e it is m a n i f e s t e d d i s c u r s i v e l y , t h e p s y c h i c s t r u c t u r e o f p s y c h o s i s c a n b e i d e n t i f i e d a n d e x p l a i n e d b u t never
altered.
T h e d e f i n i n g c h a r a c t e r i s t i c of t h e p s y c h o t i c p s y c h i c s t r u c t u r e , t h e f o r e c l o s u r e o f t h e N a m e - o f - t h e - F a t h e r , is p r e c i s e l y t h a t w h i c h m a k e s t h e p s y c h o a n a l y t i c ' t r e a t m e n t ' of schizophrenia impossible. Secondly, although Lacan's psychoanalytic t h e o r y o f t h e o r i g i n s of p s y c h o s i s d e p l o y s a m o d e l o f t h e p s y c h e r a d i cally d i f f e r e n t f r o m a n y a d v a n c e d in p s y c h i a t r y , it n e v e r t h e l e s s r e a f f i r m s t h e p s y c h i a t r i c view o f s c h i z o p h r e n i c p h e n o m e n a as b i z a r r e , b e y o n d c o m p r e h e n sion, resistant to p s y c h o t h e r a p e u t i c treatment, a n d f u n d a m e n t a l l y distinct f r o m o t h e r f o r m s o f p s y c h i c d i s t u r b a n c e . In s h o r t , a l t h o u g h t h e r e is n o t h e o r e t i c a l c o n v e r g e n c e b e t w e e n L a c a n i a n p s y c h o a n a l y s i s a n d p s y c h i a t r y in t h e s u b j e c t o f s c h i z o p h r e n i a , at t h e level o f m e t a t h e o r y b o t h f r a m e p s y c h o s i s as sublime. A b r i e f c o m p a r i s o n b e t w e e n The Psychoses
a n d t h e m o d e l of s c h i z o p h r e n i a
a d v a n c e d b y L a c a n ' s c o n t e m p o r a r y , M e l a n i e Klein, h i g h l i g h t s t h e w a y in w h i c h his a p p r o a c h t o p s y c h o s i s d e p a r t s f r o m p s y c h o a n a l y t i c t r a d i t i o n t o r e i n f o r c e t h e d o m i n a n t (i.e. p s y c h i a t r i c ) p e r c e p t i o n of s c h i z o p h r e n i a as s u b l i m e . Klein is t h e s t r o n g e s t a d v o c a t e b o t h o f t h e p s y c h o a n a l y t i c 'regressive h y p o t h e s i s ' of s c h i z o p h r e n i a a n d of a n urcsublime p s y c h o s i s ; she a r g u e s t h a t s c h i z o p h r e n i a is a l a t e n t p o s s i b i l i t y f o r e v e r y i n d i v i d u a l as it is a r e g r e s s i o n t o t h e ' p a r a n o i d s c h i z o i d p o s i t i o n ' o f earliest i n f a n c y (Klein, 1952, p. 2 9 4 ) . A n e c e s s a r y stage in p s y c h i c d e v e l o p m e n t , t h e p a r a n o i d - s c h i z o i d p o s i t i o n is s o c a l l e d b e c a u s e ' a n x i e t i e s c h a r a c t e r i s t i c o f p s y c h o s i s arise w h i c h d r i v e t h e e g o t o d e v e l o p s p e cific d e f e n c e - m e c h a n i s m s ' also seen in s c h i z o p h r e n i a : t h e e g o r e s p o n d s t o t h e ' a n x i e t y of b e i n g a n n i h i l a t e d b y a d e s t r u c t i v e f o r c e w i t h i n ' a n d s u b s e q u e n t f e a r of p e r s e c u t i o n b y s u b d i v i d i n g itself a n d s p l i t t i n g i n t e r n a l a n d e x t e r n a l o b j e c t s (Klein, 1952, p p . 2 9 2 , 2 9 7 , 317). Failure t o w o r k t h r o u g h t h e p a r a n o i d - s c h i z o i d position a n d progress to the depressive position has dire i m m e d i a t e a n d longterm consequences: If states of splitting and therefore of disintegration, which the ego is unable to overcome, occur too frequently and go on for too long, then in my view they must be regarded as a sign of schizophrenic illness in the infant, and some indications of such illness may already be seen in the first few months of life. In adult patients, states of depersonalization and of schizophrenic dissociation seem to be a regression to these infantile states of disintegration. (Klein, 1952, p. 302) D e f i n i n g p s y c h o s i s as t h e r e t u r n t o a c h a o t i c p r e - O e d i p a l , p r e - l i n g u i s t i c stage o f p s y c h i c d e v e l o p m e n t , Klein d o w n p l a y s t h e i m p o r t a n c e of i n t e r p r e t i n g o r d e c o d i n g s c h i z o p h r e n i c speech in s y m b o l i c t e r m s . I n s t e a d , she c o n c e n t r a t e s o n t h e o t h e r challenges s c h i z o p h r e n i a raises for t h e analyst: 'It is generally agreed t h a t schizoid p a t i e n t s are m o r e difficult t o analyse t h a n m a n i c - d e p r e s s i v e types. T h e i r w i t h d r a w n , u n e m o t i o n a l a t t i t u d e , t h e n a r c i s s i s t i c e l e m e n t s in t h e i r
o b j e c t - r e l a t i o n s [ a n d ] a k i n d of d e t a c h e d hostility w h i c h p e r v a d e s t h e w h o l e r e l a t i o n t o t h e analyst create a very d i f f e r e n t t y p e of resistance' (Klein, 1952, p. 313). Klein's e m p h a s i s o n the i n t e r p e r s o n a l a n d affective d i m e n s i o n of s c h i z o p h r e n i a is r e i n f o r c e d b y f r e q u e n t r e f e r e n c e s t o h e r clinical experience, a n d a l t h o u g h she d o e s o f f e r a brief a c c o u n t of Schreber's psychic splitting, she is n o t p a r t y t o t h e g e n e r a l p s y c h o a n a l y t i c l o v e a f f a i r w i t h Memoirs
of My
Nervous Illness. By t h e o r i z i n g s c h i z o p h r e n i a as psychic regression t o an earlier p h a s e in ego d e v e l o p m e n t , u n d e r t a k i n g analysis w i t h i n f a n t s as well as adults, a n d c o n c e n t r a t i n g o n t h e n o n - v e r b a l signs o f t h e d i s o r d e r , Klein o f f e r s an a c c o u n t of psychosis t h a t c o u l d h a r d l y b e m o r e o p p o s e d t o Lacan's. O n this m o d e l , w e are all at least potentially a little bit s c h i z o p h r e n i c , a n d t h e suggest i o n of a c o n t i n u u m b e t w e e n psychosis a n d a m y r i a d of o t h e r d i s o r d e r s 4 7 — u n i m a g i n a b l e in Lacanian p s y c h o a n a l y s i s — f r a m e s s c h i z o p h r e n i a in t e r m s n o t of t h e s u b l i m e b u t of the q u o t i d i a n .
Schizophrenia and the problem of the father Klein's ' N o t e s o n S o m e Schizoid M e c h a n i s m s ' is an e x c e p t i o n t o t h e rule of p s y c h o a n a l y t i c a c c o u n t s of psychosis. As I have e n d e a v o u r e d t o d e m o n s t r a t e in t h i s c h a p t e r , t h e p s y c h o a n a l y t i c i n c u r s i o n i n t o p s y c h i a t r i c t e r r i t o r y h a s yielded a variety of c o m p e t i n g m o d e l s of s c h i z o p h r e n i a metatheoretically l i n k e d t h r o u g h t h e l o g i c o f t h e t e x t u a l s u b l i m e . F r o m The Psychology Dementia
of
Praecox t o The Psychoses, analysts have claimed t o m a s t e r the m e a n -
i n g o f m a d n e s s a n d h e n c e d i s p e l s c h i z o p h r e n i a ' s a u r a of s u b l i m i t y , w h i l e s i m u l t a n e o u s l y l o c a t i n g t h e s c h i z o p h r e n i c p a t i e n t in a n u n k n o w a b l e r e a l m b e y o n d p s y c h o a n a l y t i c r e a c h . T h e m a n y a t t e m p t s t o d i s c o v e r in S c h r e b e r ' s Memoirs
literary p r o o f of a p a r t i c u l a r p a r a d i g m of psychosis are f u r t h e r evi-
d e n c e t h a t s c h i z o p h r e n i a m u s t be c o n s t r u e d as a text o r interpretive puzzle in o r d e r to be (psycho)analysed. T h a n k s t o t h e significant n u m b e r of rival readings of t h e S c h r e b e r case already in c i r c u l a t i o n , Memoirs
has become some-
t h i n g of a s u b l i m e text w i t h i n its o w n interdisciplinary arena, a n d it is t h e r e f o r e s t r a n g e l y fitting t h a t S c h r e b e r ' s e x p e r i e n c e , a n d his r e p r e s e n t a t i o n of t h a t e x p e r i e n c e , can also b e u n d e r s t o o d t h r o u g h t h e s u b l i m e . H o w e v e r , it is in Lacan's t h i r d s e m i n a r , I have a r g u e d , t h a t s c h i z o p h r e n i a , f r a m e d as a d i s o r d e r of signification, is m o s t clearly c o n n e c t e d to t h e sublime, a n d it is to this text t h a t I w a n t t o r e t u r n in t h e final p a r t of this c h a p t e r in o r d e r t o c o n s i d e r t h e
47
Klein points to an 'inherent relation' between hysteria and schizophrenia, and suggests that 'the group of schizoid or schizophrenic disorders is m u c h wider than has been acknowledged', and should even be extended to include 'certain forms of mental defi-
q u e s t i o n s L a c a n ' s w o r k raises r e g a r d i n g t h e r e l a t i o n s h i p b e t w e e n s c h i z o p h r e nia, s u b l i m i t y , a n d g e n d e r . A k e y p o i n t o f c o n t e n t i o n b e t w e e n L a c a n a n d Klein is t h e r o l e a s s i g n e d t o p a r e n t s in a g g r a v a t i n g o r f o r e s t a l l i n g t h e d r a m a o f f o r e c l o s u r e o r f i x a t i o n at t h e p a r a n o i d - s c h i z o i d p o s i t i o n . F o r Klein, t h e o n l y p r o t a g o n i s t s in t h e i n c h o ate p r e - O e d i p a l stage o f t h e p a r a n o i d - s c h i z o i d p o s i t i o n a r e t h e i n f a n t a n d t h e m o t h e r , or m o r e accurately, the infant's f r a g m e n t e d experience of the m o t h e r ' s b o d y as t h e g o o d a n d b a d b r e a s t . I f ' t h e m o t h e r ' s love a n d u n d e r s t a n d i n g of t h e i n f a n t c a n b e s e e n as t h e i n f a n t ' s g r e a t e s t s t a n d - b y in o v e r c o m i n g states o f d i s i n t e g r a t i o n a n d a n x i e t i e s of a p s y c h o t i c n a t u r e ' ( K l e i n , 1952, p. 3 0 2 ) , it s t a n d s t o r e a s o n t h a t a lack of m a t e r n a l c a r e w o u l d e x a c e r b a t e s u c h anxieties, p o s s i b l y r e s u l t i n g in f i x a t i o n at t h i s stage ( M a n n , 1994, p p . 7 0 - 1 ) . A m e r i c a n ego psychologists a n d British object-relations theorists s u b s e q u e n t l y develo p e d Klein's implied link between schizophrenia a n d p o o r m o t h e r i n g into a r o b u s t , if n o w d i s c r e d i t e d , t h e o r y of t h e s c h i z o p h r e n o g e n i c m o t h e r (Willick, 2 0 0 1 , p . 33). L a c a n , t o o , c o n s t r u e s t h e m o t h e r - i n f a n t r e l a t i o n s h i p as p r o b l e m a t i c , b u t o n l y i n s o f a r as paternal
i n t e r v e n t i o n fails t o r u p t u r e t h e d y a d . O f
c o u r s e , L a c a n c o n c e i v e s o f p a t e r n a l i n t e r v e n t i o n in s y m b o l i c t e r m s — i t is t h e foreclosure of the N a m e - o f - t h e - F a t h e r that determines the psychotic psychic s t r u c t u r e — b u t this e v e n t is n o t e n t i r e l y u n r e l a t e d t o t h e p r e s e n c e o r a b s e n c e o f a f a t h e r f i g u r e i n t h e i n f a n t ' s life. T o w h a t e x t e n t , t h e n , d o i n d i v i d u a l p a r e n t s , o r societies at large, b e a r r e s p o n s i b i l i t y f o r t h e f a i l u r e o f t h e p a t e r n a l function? In o r d e r t o a d d r e s s this q u e s t i o n , it is n e c e s s a r y t o r e - e x a m i n e t h e s t a t u s of t h e N a m e - o f - t h e - F a t h e r in L a c a n ' s t h e o r y o f p s y c h o s i s ; specifically, t o c o n s i d e r w h e t h e r it is the m a s t e r s i g n i f i e r t h a t ' g r o u n d s o r a n c h o r s t h e s y m b o l i c o r d e r as a w h o l e ' ( F i n k , 1997, p . 7 9 ) o r o n e a m o n g m a n y p o s s i b l e ' q u i l t i n g p o i n t s ' at w h i c h ' t h e s i g n i f i e d a n d t h e s i g n i f i e r a r e k n o t t e d t o g e t h e r ' ( L a c a n , 1993, p. 2 6 8 ) . T h e q u i l t i n g p o i n t , o r point
de capiton,
is a n u p h o l s t e r y t e r m : it
r e f e r s t o t h e p o i n t at w h i c h t h e c o v e r a n d t h e s t u f f i n g a r e j o i n e d t o e a c h o t h e r i n d e p e n d e n t l y of t h e f r a m e of the f u r n i t u r e . Like t h e u n b o u n d fabric a n d filling of a c h a i r , ' t h e r e l a t i o n s h i p b e t w e e n t h e signified a n d t h e signifier always a p p e a r s f l u i d , always r e a d y t o c o m e u n d o n e ' ; it is t h e q u i l t i n g p o i n t s t h a t create t h e i m p r e s s i o n t h a t signifier a n d s i g n i f i e d are b o u n d t o g e t h e r a n d m e a n i n g is fixed. P s y c h o s i s c a n b e c o n c e i v e d o f as a d i v i s i o n of s i g n i f i e r a n d s i g n i f i e d p r o d u c e d b y t h e a b s e n c e of s u c h b u t t o n ties: I don't know how many there are, but it isn't impossible that one should manage to determine the minimal number of fundamental points of insertion between the signifier and the signified necessary for a human being to be called normal, when they are not established, or when they give way, make a psychotic.
H o w e v e r , in t h e case o f S c h r e b e r , L a c a n i d e n t i f i e s o n l y o n e s u c h d y s f u n c t i o n a l ' p o i n t of i n s e r t i o n ' : To all appearances President Schreber lacks this fundamental signifier called being a father. This is why he had to make a mistake, become confused, to the point of thinking of acting like a woman. He had to imagine himself a woman and bring about in pregnancy the second part of the path that, when the two were added together, was necessary for the function of being a father to be realized. (Lacan, 1993, p. 293) So, a l t h o u g h L a c a n s h o w s t h e f o r e c l o s u r e of t h e N a m e - o f - t h e - F a t h e r t o b e t h e d e c i s i v e f a c t o r in S c h r e b e r ' s p s y c h o s i s , is it n e c e s s a r i l y t h e case t h a t t h e p a t e r n a l s i g n i f i e r is t h e only p o i n t r e l e v a n t t o t h e f o r m a t i o n o f a p s y c h o t i c psychic structure? Marcelle M a r i n i argues persuasively that Lacan's failure to e x p l a i n t h e r o l e o f o t h e r q u i l t i n g p o i n t s is a s i g n i f i c a n t s h o r t c o m i n g o f h i s t h e o r y of psychosis; t h e f o r e c l o s u r e of t h e N a m e - o f - t h e - F a t h e r is, she suggests, s o i n t i m a t e l y c o n n e c t e d t o t h e case of S c h r e b e r t h a t it is ' i m p o s s i b l e t o k n o w if t h i s c o n c e p t w o u l d t r u l y w o r k in t h e case o f A i m e e o r in t h e c r i m e of t h e P a p i n sisters, w h i c h Lacan h a d p r e v i o u s l y s t u d i e d ' ( M a r i n i , 1992, p p . 1 5 9 - 6 0 , 4 1 - 2 ) . 4 8 W h a t is clear is that w h e r e a s hysteria—via Lacan's analysis of t h e D o r a c a s e — i n volves t h e q u e s t i o n ' What is it to be a woman? via S c h r e b e r ' s 'being a father'—becomes
(Lacan, 1993, p. 175), p s y c h o s i s —
a p r o b l e m f u n d a m e n t a l l y related to
the symbolic f u n c t i o n of the father. Bruce Fink m a k e s this p o i n t explicit: ' t o reject the f a t h e r ' s role, to u n d e r m i n e t h e f a t h e r ' s c u r r e n t s y m b o l i c f u n c t i o n , will l e a d t o n o g o o d ; its c o n s e q u e n c e s a r e likely t o b e w o r s e t h a n t h o s e of t h e f a t h e r f u n c t i o n itself, i n c r e a s i n g t h e i n c i d e n c e of p s y c h o s i s ' ( F i n k , 1997, p. 111). C o n t e m p o r a r y society, in his view, is m a r k e d b y j u s t s u c h a d e c l i n e , if n o t crisis, in p a t r i a r c h a l a u t h o r i t y : Combined with the de facto increase in the divorce rate and the consequent increase in the number of children being raised solely by their mothers, and with the growing antiauthoritarian attitude toward children among men (no doubt at least in part encouraged by certain modern-day feminist discourse), the paternal function seems to be in danger of extinction in certain social milieus. (Fink, 1997, p. 110) F i n k h e r e s u g g e s t s t h a t t h e p a t e r n a l f u n c t i o n is n o t m e r e l y s y m b o l i c , b u t d i r e c t l y r e l a t e d t o t h e r o l e s a s s i g n e d t o a n d f u l f i l l e d b y h e t e r o s e x u a l m e n in r a i s i n g c h i l d r e n , a n d in t u r n t h a t a 'crisis' of m a s c u l i n i t y c a n b e causally l i n k e d
48
Grigg disagrees on this point, arguing that for Lacan 'it is only when what is foreclosed is specifically concerned with the question of the father, as in Schreber's case, that psychosis is produced' (Grigg, 1999, p. 54, my italics).
t o a n i n c r e a s e in p s y c h o s i s . A l t h o u g h it is n o t u n c o m m o n t o s u g g e s t t h a t M o r i t z S c h r e b e r w a s a ' p a r a n o i d o g e n i c ' f a t h e r , as d o e s S c h a t z m a n , F i n k takes t h e a r g u m e n t t o a n e w level. H e r e , ' t h e f a t h e r ' h a s b e e n e m a s c u l a t e d b y a n e w social o r d e r , w h i c h m u s t b e a r u l t i m a t e r e s p o n s i b i l i t y f o r t h e i n c r e a s e d n u m b e r o f p s y c h o t i c i n d i v i d u a l s it p r o d u c e s . 4 9 Is t h i s t h e p a r a n o i a o f a p e r s e c u t e d p a t r i a r c h s p e a k i n g ? U n s u p p o r t e d b y a n y sociological o r p s y c h o l o g i c a l r e s e a r c h , F i n k ' s c l a i m s a r e a n t i - f e m i n i s t a n d o v e r s t a t e d . M o r e d i s t u r b i n g l y , t h e y are n o t as c o n t r o v e r s i a l a n i n t e r p r e t a t i o n o f L a c a n as t h e y m i g h t a p p e a r . In a 1938 article o n t h e f a m i l y , L a c a n p o i n t e d t o ' t h e c o n t e m p o r a r y social d e c l i n e in t h e p a t e r n a l i m a g o (clearly visible in t h e i m a g e s o f a b s e n t f a t h e r s a n d h u m i l i a t e d f a t h e r s ) as t h e c a u s e o f c u r r e n t p s y c h o p a t h o l o g i c a l p e c u l i a r i t i e s ' (Evans, 1996, p . 6 1 ) , 5 0 w h i c h g o e s s o m e w a y t o e x p l a i n i n g his c o n v i c t i o n in 1955 t h a t t h e q u e s t i o n o f p s y c h o s i s h a d a t t a i n e d a g r e a t e r ' d e g r e e of a c u t e n e s s o r u r g e n c y ' ( L a c a n , 1993, p. 81) t h a n in F r e u d ' s day. A n d b y 1966, ' p a t e r n a l i n a d e q u a c y ' , as well as t h e m o t h e r ' s r e l a t i o n t o t h e p e r s o n a n d s p e e c h o f t h e f a t h e r , w a s clearly i m p l i c a t e d in t h e d e v e l o p m e n t o f a p s y c h o t i c p s y c h i c s t r u c t u r e ( L a c a n , 1966, p. 2 1 8 ) . T h e q u e s t i o n r e m a i n s , 40 o d d years later, ( h o w ) h a s this s i t u a t i o n changed? If F r e u d first i d e n t i f i e d t h e f a t h e r as t h e love o b j e c t at t h e c e n t r e of t h e p a r a p h r e n i c d r a m a , Lacan's thesis assigns the father a n d the p a t e r n a l f u n c t i o n u n p a r a l l e l e d a g e n c y in t h e d e t e r m i n a t i o n of p s y c h o s i s . As is well d o c u m e n t e d , p s y c h o a n a l y s i s h a s s i n c e its e a r l i e s t d a y s a s s o c i a t e d h y s t e r i a w i t h ' t h e f e m i n i n e ' . I w o u l d a r g u e t h a t in t h e w o r k o f F r e u d a n d L a c a n t h e c o n n e c t i o n b e t w e e n p s y c h o s i s a n d ' t h e m a s c u l i n e ' is e q u a l l y as s t r o n g , in n o s m a l l p a r t b e c a u s e b o t h a n a l y s t s d e f e r t o S c h r e b e r ' s d e l u s i o n a l s y s t e m as t h e e x e m p l a r y p s y c h o t i c t e x t . M o r e t h a n in a n y p s y c h i a t r i c a c c o u n t , s c h i z o p h r e n i a h e r e is aetiologically
l i n k e d t o a s y m b o l i c a n d t o s o m e e x t e n t i n d i v i d u a l failure
in n o r -
m a t i v e h e t e r o s e x u a l m a s c u l i n i t y . T h i s issue w a r r a n t s f u r t h e r i n v e s t i g a t i o n o n a scale t h a t is, u n f o r t u n a t e l y , b e y o n d t h e s c o p e o f t h e c u r r e n t p r o j e c t . W h a t is i m p o r t a n t t o n o t e at t h i s j u n c t u r e is t h a t in a t t r i b u t i n g t o s c h i z o p h r e n i a t h i s
49
50
In his enthusiasm for explaining schizophrenia as a consequence of changing gender relations in the twentieth century, Fink does not mention the fact that schizophrenia has been shown to be more or less stably distributed across global populations, regardless of cross-cultural variations in the symbolic status of the father (Miller and Mason, 2002, p. 35). In the article in question—'The Family: The complex, a concrete factor in familial psychology. Familial complexes in pathology'—Lacan offers 'unconditional praise of the "paternalist" family', 'vibrant regrets over "the social decline of the paternal i m a g e " . . . and over the increased role of the mother or of woman' according to Marini (1992, p. 144).
k i n d of s y m b o l i c agency, p s y c h o a n a l y s i s at a s t r u c t u r a l level a n t i c i p a t e d t h e p r o d u c t i o n in cultural t h e o r y of a n o t i o n of s c h i z o p h r e n i a i m b u e d w i t h social significance. W e are n o w in a p o s i t i o n t o e x a m i n e in m o r e detail t h e way in w h i c h clinical t h e o r y — p s y c h i a t r i c b u t especially p s y c h o a n a l y t i c — h a s b e e n i n t e r r o g a t e d a n d r e - i m a g i n e d b y cultural t h e o r y . A n d t h e r e is n o better place t o b e g i n t h a n w i t h t h e m o s t i m p a s s i o n e d , p o l e m i c a l of t h e s e d i s c o u r s e s : antipsychiatry.
Part 2
Cultural theory
Chapter 3
Antipsychiatry: schizophrenic experience and the sublime
T h e a n t i p s y c h i a t r y m o v e m e n t of t h e 1960s a n d 1970s m a r k e d a decisive t u r n i n g p o i n t in t h e h i s t o r y o f r e p r e s e n t i n g s c h i z o p h r e n i a : it r e c o n c e p t u a l i z e d in s u b j e c t i v e t e r m s p s y c h i a t r y ' s s u b l i m e o b j e c t . W i t h v a r y i n g d e g r e e s of s u b t l e t y a n d s o p h i s t i c a t i o n , a n t i p s y c h i a t r i c t h i n k e r s c h a l l e n g e d t h e clinical p i c t u r e s o f psychosis offered b y psychiatrists and psychoanalysts, suggesting that schizop h r e n i c s y m p t o m a t o l o g y is n o t b a f f l i n g , b i z a r r e , o r o t h e r w i s e u n f a t h o m a b l e , b u t o n t h e c o n t r a r y rich in m e a n i n g . I n s t e a d of a p p r o a c h i n g s c h i z o p h r e n i a as t h e e x p r e s s i o n o f a disease p r o c e s s , g e n e t i c a b e r r a t i o n , n e u r o l o g i c a l a b n o r m a l ity, l i b i d i n a l u p s u r g e , o r p s y c h i c s t r u c t u r e , a n t i p s y c h i a t r i c t h i n k e r s f o c u s s e d o n t h e p e r s o n as a n e m b o d i e d s u b j e c t b o u n d b y h i s t o r y , g e o g r a p h y , a n d social class; a p e r s o n w h o s e ' m a d n e s s ' w a s f u n d a m e n t a l l y s o c i a l in c h a r a c t e r , a n d t h e r e f o r e h a d t o b e u n d e r s t o o d in t h e c o n t e x t of t h e f a m i l y , t h e w e l f a r e state, t h e t o t a l i n s t i t u t i o n o r p a t r i a r c h a l W e s t e r n c u l t u r e at large. ' R e s c u i n g ' , as it w e r e , t h e s c h i z o p h r e n i c p a t i e n t f r o m t h e relatively closed w o r l d of t h e clinic o r t h e a s y l u m , a n t i p s y c h i a t r i c d i s c o u r s e r e - f r a m e d ' t h e s c h i z o p h r e n i c ' as a n o w capable of s u s t a i n i n g m u l t i p l e a n d s o m e t i m e s c o n t r a d i c t o r y
figure
symbolic
r o l e s . A n d in o p e n i n g u p s c h i z o p h r e n i a t o a s s o c i a t i o n s a n d f u n c t i o n s f a r b e y o n d t h o s e c i r c u m s c r i b e d b y p s y c h i a t r y , a n t i p s y c h i a t r y a l s o c a l l e d in t o q u e s t i o n s c h i z o p h r e n i a ' s s t a t u s as s u b l i m e . T h i s c h a p t e r a n a l y s e s t h e w a y s c h i z o p h r e n i a is r e p r e s e n t e d , m o b i l i z e d , a n d p o l i t i c i z e d in a n a n t i p s y c h i a t r y m o v e m e n t c h a r a c t e r i z e d b y d i v e r s i t y a n d d i s a v o w a l . F o r t h e p u r p o s e s o f t h i s a n a l y s i s , a n d a l t h o u g h n o n e o f its m a n y t h e o r e t i c a l l y d i v e r g e n t p r a c t i t i o n e r s e m b r a c e t h e label, I use t h e t e r m ' a n t i p s y chiatry m o v e m e n t ' t o refer to the w o r k of Erving G o f f m a n (1973), M i c h e l F o u c a u l t ( 1 9 9 3 ) , T h o m a s Szasz (1972; 1976), a n d R . D . Laing ( 1 9 9 0 ) , as well as to the various countercultural m o v e m e n t s across E u r o p e a n d America which p r o t e s t e d a g a i n s t t h e i n s t i t u t i o n s o f p s y c h i a t r y a n d p s y c h o a n a l y s i s . 1 I will 1
This critique was also vigorously mounted by Anglo-American feminists, especially in the wake of Phyllis Chesler's widely celebrated Women and Madness (1972). Highlighting the patriarchal nature of psychiatry's pathologization of woman and its oppressive
a r g u e t h a t w h i l e f r a m i n g s c h i z o p h r e n i a in social a n d s u b j e c t i v e t e r m s a p p e a r s a n t i t h e t i c a l t o p s y c h i a t r y ' s c o n s t r u c t i o n of s c h i z o p h r e n i a as s u b l i m e , t h e d i v e r gent discourses loosely assembled u n d e r the rubric of antipsychiatry enact a m o r e c o m p l e x c r i t i q u e o f t h e p s y c h i a t r i c m o d e l o f s c h i z o p h r e n i a t h a n o n e of simple opposition. Antipsychiatrists have proposed three distinct responses to psychiatry's e l e v a t i o n of s c h i z o p h r e n i a t o t h e s t a t u s of s u b l i m e o b j e c t . T h e first a n d p e r h a p s t h e m o s t i m m e d i a t e l y o b v i o u s is t h e w h o l e s a l e r e p u d i a t i o n of a n y a s s o c i a t i o n b e t w e e n s c h i z o p h r e n i a a n d s u b l i m i t y f o u n d in t h e w o r k of T h o m a s Szasz, E r v i n g G o f f m a n , a n d T h o m a s S c h e f f . C o n c e n t r a t i n g o n Szasz's 1 9 7 6 m o n o g r a p h o n s c h i z o p h r e n i a , I will a r g u e t h a t b y r e j e c t i n g t h e m e d i c a l m o d e l of m e n t a l illness a n d e s t a b l i s h i n g a c o n t i n u u m b e t w e e n s o - c a l l e d s c h i z o p h r e n ic a n d n o r m a l b e h a v i o u r , t h i s p o s i t i o n e f f e c t i v e l y d e n i e s t h a t a n y p e r s o n o r e x p e r i e n c e c a n b e ' i n t r i n s i c a l l y ' p s y c h o t i c . P s y c h i a t r i c d i a g n o s i s is all t h a t dist i n g u i s h e s p e o p l e d i a g n o s e d as s c h i z o p h r e n i c f r o m t h e d i s t r e s s e c k d e v i a n t , o r d i s e n f r a n c h i s e d . T h e s e c o n d a n t i p s y c h i a t r i c r e i n t e r p r e t a t i o n of s c h i z o p h r e n i a , like m a n y o f its p s y c h o a n a l y t i c c o u n t e r p a r t s , oscillates b e t w e e n r e j e c t i n g a n d r e i n f o r c i n g s c h i z o p h r e n i a ' s s u b l i m i t y . R . D . L a i n g ' s The Divided
Self is t h e
e x e m p l a r y t e x t h e r e : a l t h o u g h its e x i s t e n t i a l - p h e n o m e n o l o g i c a l a c c o u n t o f s c h i z o p h r e n i a seeks p r i m a r i l y t o r e n d e r s c h i z o p h r e n i a intelligible, s o m e t h i n g o f t h e ' e s s e n t i a l m y s t e r y ' o f p s y c h o t i c e x p e r i e n c e is p r e s e r v e d as its d e f i n i n g c h a r a c t e r i s t i c . F i n a l l y , t h e r e is t h e c o n t e n t i o n , a d v a n c e d v a r i o u s l y b y L a i n g , C o o p e r , a n d F o u c a u l t , t h a t s c h i z o p h r e n i a is m o r e t h a n a s u b l i m e o b j e c t ; t h a t it is, in fact, a n e x p e r i e n c e of t h e s u b l i m e , t h e t r a n s c e n d e n t , a n d t h e l i b e r a t i n g . This third response, then, paradoxically confirms the psychiatric attitude t o w a r d s s c h i z o p h r e n i a at t h e p r e c i s e m o m e n t w h e n t h e d i s o r d e r is c o m p l e t e l y r e d e f i n e d in s p i r i t u a l , n o n - c l i n i c a l t e r m s . In o r d e r t o grasp t h e subtleties a n d significance of these diverse antipsychiatric a c c o u n t s of s c h i z o p h r e n i a , h o w e v e r , it is i m p o r t a n t first t o locate a n t i p s y c h i a t r y w i t h i n its b r o a d h i s t o r i c a l c o n t e x t a n d t o u n d e r s t a n d h o w t h e m o v e m e n t as a w h o l e utilized s c h i z o p h r e n i a in its m u l t i f a c e t e d a s s a u l t o n p s y c h i a t r i c t h e o r y a n d p r a c t i c e . T h i s in t u r n d e m a n d s t h a t w e revisit t h e t h o r n y issue of l a n g u a g e w i t h r e s p e c t t o s c h i z o p h r e n i a . T h e a n t i p s y c h i a t r y m o v e m e n t o f t h e 1960s a n d
institutional response to women's suffering, feminist theorists and activists called for radically new ways of understanding madness and healing distress. Although their claims clearly overlap with the extremely male-dominated antipsychiatry movement, feminists by and large tended to engage the category of madness rather than schizophrenia (see Busfield, 1996; Russell, 1995; Ussher, 1991). Given the focus and expressed intentions of the present study, Anglo American feminist critiques of madness and psychiatry, powerful as they continue to be, arc for this reason not examined in depth.
1970s played a vital if n o t decisive role in creating the discursive a n d political space f o r s u b s e q u e n t survivor a n d service-user m o v e m e n t s , critical psychology, a n d p o s t - p s y c h i a t r y to flourish. T h e activists, clinicians, patients, a n d m e n tal h e a l t h p r o f e s s i o n a l s w o r k i n g in a n d t h r o u g h t h e legacy of a n t i p s y c h i a t r y have n o w , f o r t h e m o s t part, rejected t h e n o u n ' s c h i z o p h r e n i c ' as a pejorative, stigmatizing, a n d d e h u m a n i z i n g label, w h i c h reduces t h e p e r s o n t o their illness ( C O P E I n i t i a t i v e , 2 0 1 0 ) . H o w e v e r , w h e n it c o m e s t o w r i t i n g a n d t h i n k i n g a b o u t the antipsychiatry m o v e m e n t itself, as well as the cultural t h e o r y t h a t is the focus of t h e rest of this b o o k , the c o n c e p t of ' t h e s c h i z o p h r e n i c ' is n o t o n e t h a t c a n be j e t t i s o n e d , i g n o r e d , o r o t h e r w i s e willed away. A n t i p s y c h i a t r i s t s gave A n g l o - A m e r i c a n c u l t u r e t h e f i g u r e of ' t h e s c h i z o p h r e n i c ' — a f i g u r e invested with multiple a n d sometimes contradictory political meanings, a figure charged w i t h a p o t e n t symbolic f u n c t i o n , a figure w h o s e cultural status far exceeds t h e experiences of any individual. W h e n I use the t e r m 'the schizop h r e n i c ' , t h e n , I a m r e f e r r i n g t o an a l m o s t m y t h i c a l a n d c e r t a i n l y at t i m e s o v e r - d e t e r m i n e d figure. I a m n o t m a k i n g claims a b o u t the experience of p e o ple w h o have received this diagnosis, n o r a m I in a n y w a y seeking t o intervene in clinical a n d p h i l o s o p h i c a l d e b a t e s a b o u t w h a t s c h i z o p h r e n i a really is o r is n o t . M y q u o t a t i o n m a r k s signal b o t h t h a t I a m u s i n g t h e l a n g u a g e of o t h e r s a n d that t h e r e is n o t h i n g n a t u r a l o r self-evident a b o u t a category t h a t is b o t h c o n s t r u c t e d a n d highly contested.
A brief overview of antipsychiatry A n t i p s y c h i a t r i s t s m a y b e t h e m o s t well k n o w n a n d widely p u b l i s h e d o p p o n e n t s of m a i n s t r e a m psychiatry, b u t t h e y were b y n o m e a n s t h e first or t h e o n l y critics of w h a t w e n t o n in asylums, clinics, a n d universities in t h e n a m e of psychological science. Ever since its earliest days as a fledgling medical discipline, psychiatry h a s e n c o u n t e r e d s o m e f o r m of v i b r a n t o p p o s i t i o n t o its practices. 2 It will n o t be s u r p r i s i n g t o learn that Daniel Paul Schreber is again o n e of t h e m o s t f a m o u s f i r s t - h a n d critics of biological psychiatry. In a d d i t i o n to r e p o r t ing a t t e m p t e d ' s o u l m u r d e r ' a n d p h y s i c a l a b u s e d u r i n g h i s i n c a r c e r a t i o n , S c h r e b e r in a l e n g t h y a p p e n d i x t o his 1903 Memoirs
of My Nervous
Illness
addressed himself t o t h e p e r t i n e n t q u e s t i o n : ' I n w h a t c i r c u m s t a n c e s can a p e r s o n c o n s i d e r e d i n s a n e b e d e t a i n e d in a n a s y l u m a g a i n s t his d e c l a r e d will?' A l t h o u g h S c h r e b e r ' s physicians, Emil Flechsig a n d G u i d o W e b e r , d i d n o t feel c o m p e l l e d to a n s w e r t o t h e a r g u m e n t s of a d e c l a r e d lunatic, t h e y were f o r c e d
2
Nick Crossley is o n e o f the foremost analysts o f o p p o s i t i o n to psychiatry in the UK (Crossley, 1998, 1999, 2002, 2004, 2005, 2006; Crossley and Crossley, 2001). For a more global perspective see McLean, 1995; Nelson et ul„ 2006; Nelson et al„ 2007.
t o d e f e n d p u b l i c l y t h e scientific l e g i t i m a c y o f p s y c h i a t r y in t h e face of escalating a t t a c k s o n its m o r a l c r e d i b i l i t y . I n d e e d , r e v i s i n g i n s a n i t y laws, i m p r o v i n g a s y l u m c o n d i t i o n s , r e i n s t a t i n g p a t i e n t rights, a n d s u p e r v i s i n g p s y c h i a t r i s t s a n d l a w y e r s w e r e s u c h c o n t e s t e d issues in t u r n - o f - t h e - c e n t u r y G e r m a n y t h a t t h e y b e c a m e t h e f o c u s o f p a r l i a m e n t a r y i n q u i r y ( L o t h a n e , 1992, p . 2 2 2 , see a l s o p p . 273, 2 8 8 - 9 0 ) . F a r f r o m f a d i n g i n t o o b s c u r i t y , t h e s e issues a r e still relevant t o c o n t e m p o r a r y d e b a t e s in a n d a r o u n d W e s t e r n p s y c h i a t r y . C o n t e m p o r a r y m e n t a l h e a l t h c h a r i t i e s , activists, a n d a d v o c a c y g r o u p s , 3 f o r e x a m p l e , in a d d i t i o n t o p r o v i d i n g d i r e c t s u p p o r t t o p a t i e n t s o r ' c o n s u m e r s ' a n d their families, undertake comprehensive media monitoring, promote 'stigma-busting' and o t h e r a n t i - d i s c r i m i n a t i o n p r a c t i c e s , a n d a d v o c a t e f o r i m p r o v e m e n t s t o all aspects of m e n t a l health services. W h e r e a s s o m e c a m p a i g n specifically for increased e d u c a t i o n o n m e n t a l health issues to e n s u r e that m e n t a l disorders a r e u n d e r s t o o d t o b e m e d i c a l l y l e g i t i m a t e diseases of t h e b r a i n , o t h e r s are vocal in h i g h l i g h t i n g t h e l i m i t a t i o n s o f t h e b i o m e d i c a l m o d e l a n d a d v a n c e a r a n g e o f a l t e r n a t i v e ways of u n d e r s t a n d i n g d i s t r e s s i n g e x p e r i e n c e . T o d a y , as in S c h r e b e r ' s d a y , s u c h g r o u p s issue p o w e r f u l calls f o r r e f o r m , a d d r e s s i n g t h e i r d e m a n d s as m u c h t o a society d e e m e d i g n o r a n t a n d i n t o l e r a n t of t h e reality o f m e n t a l illness as t o t h e p s y c h i a t r i c s y s t e m in q u e s t i o n . T h e s e e x a m p l e s c a n o n l y h i n t at h o w c o n s i s t e n t l y c o n t r o v e r s y h a s p l a g u e d p s y c h i a t r y , its s u b j e c t s a n d o b j e c t s of analysis. Yet it is n o t o v e r s t a t i n g t h e p o i n t t o s u g g e s t t h a t psychiatry's scientific credentials, history, a n d ethical s t a n d i n g have been m o r e fiercely a n d m o r e f r e q u e n t l y c o n t e s t e d t h a n t h o s e o f a n y o t h e r b r a n c h o f m e d i c i n e ( H e a l y , 2 0 0 2 , p . 173; P o r t e r a n d Micale, 1994, p . 4 ) . In c o n t r a s t t o p a t i e n t - d r i v e n c r i t i q u e s of biological p s y c h i a t r y , h o w e v e r , t h e a n t i p s y c h i a t r y m o v e m e n t w a s p r i m a r i l y a t h e o r y - d r i v e n c r i t i q u e of a p s y c h i a try on the b r i n k of a psychopharmacological revolution. A m o n g the most i n f l u e n t i a l e v e n t s in p o s t - W a r p s y c h i a t r y w e r e t h e d i s c o v e r y o f t h e first a n t i p s y c h o t i c d r u g , c h l o r p r o m a z i n e , in 1952, a n d its r a p i d d i s t r i b u t i o n ; t h e u n p r e c e d e n t e d i n c r e a s e in a s y l u m a d m i s s i o n s , p e a k i n g i n t h e m i d - 1 9 5 0 s ; t h e subsequent trend towards deinstitutionalization within the same decade; the c o n s i d e r a b l e i n f l u e n c e of p s y c h o a n a l y t i c t h e o r y in t h e t r e a t m e n t a n d d e f i n i t i o n of severe psychic d i s o r d e r s ; a n d t h e significant d i a g n o s t i c d i v e r g e n c e s b e t w e e n national psychiatries (Healy, 2002, pp. 9 6 - 1 1 2 ; Shorter, 1997). T h e m o s t 3
Such groups are diverse in their aims, interests, and agendas, and many operate at the local level. Among the most prominent groups are: internationally, the World Network of Users and Survivors of Psychiatry and the Hearing Voices Network; in America, the National Alliance on Mental Illness and the National Coalition of Mental Health C o n s u m e r / S u r v i v o r Organizations; and in the UK, Mind, SANE, the National Schizophrenia Fellowship, Rethink and the Menial I Icallh Foundation.
p o w e r f u l c r i t i q u e s of p s y c h i a t r y e m e r g e d in r e s p o n s e t o t h e s e p a r a d i g m s h i f t s in b o t h t h e c o n c e p t u a l i z a t i o n a n d m a n a g e m e n t o f p s y c h o l o g i c a l d i s o r d e r s . T h o u g h t h e y e a c h s t r e n u o u s l y d i s a v o w e d t h e label ' a n t i p s y c h i a t r i s t ' , 4 G o f f m a n , F o u c a u l t , Szasz, a n d L a i n g w e r e swiftly e s t a b l i s h e d as t h e a n t i p s y c h i a t r y m o v e m e n t ' s f o u n d a t i o n a l t h e o r i s t s ( K o t o w i c z , 1997; P o r t e r a n d Micale, 1994; Sedgwick, 1982). R e a p p r a i s i n g t h e s t a t u s o f m a d n e s s a n d t h e m a d , t h e y s t a k e d o u t the intellectual a n d political territory of antipsychiatry by r e d r a w i n g the b o u n d a r i e s of sociology, philosophy, psychiatry, a n d psychoanalysis. S c h i z o p h r e n i a was, of course, o n e of the p r i n c i p a l g r o u n d s u p o n w h i c h antipsychiatrists fought, and the m o v e m e n t challenged the d o m i n a n t psychiatric a c c o u n t of s c h i z o p h r e n i a in t w o d i s t i n c t a r e n a s . T h e first of t h e s e w a s t h e c l i n i c itself: a n t i p s y c h i a t r i s t s r e j e c t e d t h e m e d i c a l m o d e l o f m e n t a l illness; focused public attention on psychiatry's inability to p r o d u c e a definitive a c c o u n t of t h e a e t i o l o g y o f s c h i z o p h r e n i a (let a l o n e t r e a t it s u c c e s s f u l l y ) ; a n d p r o p o s e d r a d i c a l n e w ideas a b o u t t h e n a t u r e a n d o r i g i n s o f m e n t a l d i s o r d e r . A s w e h a v e seen, since its clinical d e b u t in 1896, p s y c h i a t r i s t s a n d p s y c h o a n a l y s t s h a d argued that s c h i z o p h r e n i a was variously caused by viral infection, an u p s u r g e of h o m o s e x u a l l i b i d o , d e f e c t i v e h e r e d i t y , n e u r o c h e m i c a l i m b a l a n c e s , psychic regression to an infantile p a r a n o i d - s c h i z o i d position, obstetric c o m p l i c a t i o n s , a n d t h e f o r e c l o s u r e o f t h e N a m e - o f - t h e - F a t h e r . O v e r t h e first half of t h e t w e n t i e t h c e n t u r y , clinicians s o u g h t t o m a n a g e s c h i z o p h r e n i c s y m p t o m s using i n s u l i n - c o m a therapy, straitjackets, neuroleptic or antipsychotic drugs, sterilization and castration, regular beating, electroconvulsive or 'electric shock' treatment, 12-step p r o g r a m m e s , psychotherapy, fasting, frontal lobe l o b o t o m y , a n d ' m e g a - v i t a m i n t h e r a p y ' . 5 A n t i p s y c h i a t r i s t s w e r e as q u i c k t o p o i n t o u t i n c o n s i s t e n c i e s in t h i s i m p r e s s i v e list of c o m p e t i n g h y p o t h e s e s a n d t h e r a p i e s as t h e y w e r e t o a d d t o t h e m . As w e shall see, t h e y variously, a n d p a s sionately, a r g u e d t h a t s c h i z o p h r e n i a w a s really a label a p p l i e d t o n o n - n o r m a t i v e behaviour, a rational response to psychiatric incarceration, a n d a direct p r o d u c t of m a t e r n a l a n d f a m i l y r e l a t i o n s h i p s if n o t c a p i t a l i s t s o c i e t y in g e n e r a l . * Of these, Thomas Szasz is by far the most sweeping: 'I reject the term antipsychiatry because it is imprecise, misleading, and cheaply self-aggrandizing' (Szasz, 1976, p. 48). It would appear, however, that despite repeated insistence that he is 'anti-coercion, not antipsychiatry' (Szasz, 2010), Szasz is destined to remain forever associated with the movement he so detests. 5 Many of these treatments for schizophrenia are of course well known. On the use of castration and sterilization by biological psychiatrists in early twentieth-century Germany, see Lothane, 1992, p. 210. On the sterilization of patients in mental hospitals in 1950s America, see Whitaker, 2002, p. 142. On psychiatric advocacy of vitamin cures, fasting, physical violence, and 12-step programmes as treatments for schizophrenia see Szasz, 1976, pp. 112-9.
In s h o r t , t h e d i s o r d e r ' s o r i g i n s w e r e t o b e f o u n d e v e r y w h e r e b u t in b i o l o g y . D a v i d C o o p e r ' s 1967 d e f i n i t i o n o f s c h i z o p h r e n i a is e x e m p l a r y o f t h e s h i f t in interest f r o m the schizophrenic individual to a schizophrenogenic world: Schizophrenia is a micro-social crisis situation in which the acts and experiences of a certain person are invalidated by others for certain intelligible cultural and micro-cultural (usually familial) reasons, to the point where he is elected and identified as being 'mentally ill' in a certain way, and then is confirmed (by a specifiable but highly arbitrary labelling process) in the identity 'schizophrenic patient' by medical or quasi-medical agents. This statement, it will be noted, refers to extreme disturbance (crisis) in a group and says nothing about disorder in a 'schizophrenic' person. (Cooper, 1970, p. 16, italics in the original) T h e antipsychiatry m o v e m e n t not only exposed the definitional chaos surr o u n d i n g s c h i z o p h r e n i a b u t also i n t r o d u c e d t o it n e w , politically c h a r g e d w a y s of i n t e r p r e t i n g t h e m o s t severe of m e n t a l d i s o r d e r s . Antipsychiatry f u r t h e r challenged psychiatric a n d p o p u l a r p e r c e p t i o n s of s c h i z o p h r e n i a b y r e p o s i t i o n i n g t h e s c h i z o p h r e n i c p a t i e n t as a key p r o t a g o n i s t in t h e p o l i t i c a l a r e n a . A c c o r d i n g t o o n e h i s t o r i a n , ' t h e s c h i z o p h r e n i c , a l o n g with w o m e n , homosexuals, low-paid workers, prisoners, a n d army conscripts, b e c a m e p a r t of " t h e o p p r e s s e d ' " ( P o s t e l a n d Allen, 1994, p. 387) a n d t o o k o n a p o t e n t r o l e as s o c i e t y ' s ' u l t i m a t e u n d e r d o g ' ( H e a l y , 2 0 0 2 , p . 148; S e d g w i c k , 1982, p. 102). T h e s i g n i f i c a n c e of t h e s y m b o l i c f u n c t i o n o f ' t h e s c h i z o p h r e n i c ' was guaranteed b y the high profile of antipsychiatry within the broader c o u n t e r c u l t u r a l m o v e m e n t s o f t h e p e r i o d . N e v e r c e l e b r a t e d f o r its u n i f o r m i t y , a n t i p s y c h i a t r y a p p e a r e d in a d i v e r s e r a n g e o f political guises a c r o s s a n u m b e r o f n a t i o n a l c o n t e x t s . In 1967, f o r e x a m p l e , l e a d i n g B r i t i s h a n t i p s y c h i a t r i s t s c o n v e n e d a t w o - w e e k c o n g r e s s in o r d e r t o t a c k l e w h a t t h e y p e r c e i v e d as a n ' e m e r g i n g global crisis' ( B u r s t o n , 1996, p. 105). T h e ' D i a l e c t i c s o f L i b e r a t i o n ' w a s a n a l l - m a l e ' s t a r - s t u d d e d L e f t - W i n g l i n e - u p ' (Laing, 1994, p. 135) o f ' a c a d e m i c s , e c o n o m i s t s , p s y c h i a t r i s t s , p o l i t i c a l a c t i v i s t s , l i t e r a r y critics, a n t h r o pologists, sociologists, theatrical directors a n d Buddhist m o n k s ' ; Stokely C a r m i c h a e l , H e r b e r t M a r c u s e , Allen G i n s b e r g , a n d R . D . L a i n g m o s t f a m o u s l y a m o n g t h e m ( M u l l a n , 1999, p. 105). A c r o s s t h e c h a n n e l in M a y 1968, s t u d e n t s a t t a c k e d t h e d e p a r t m e n t o f p s y c h i a t r y at t h e U n i v e r s i t y o f Paris a n d f o r c e d t h e r e s i g n a t i o n of J e a n D e l a y , t h e m a n w h o first d e m o n s t r a t e d c h l o r p r o m a z i n e ' s antipsychotic p r o p e r t i e s (Healy, 2002, pp. 176-7). C o n d e m n i n g 'chemical s t r a i t j a c k e t s ' as i n s i d i o u s a n d o p p r e s s i v e , t h e y w a v e d p l a c a r d s p r o c l a i m i n g ' S c h i z o p h r e n i c s a r e t h e P r o l e t a r i a t ' ( P o s t e l a n d A l l e n , 1994, p . 3 8 7 ) . M o r e revolutionary even than their French c o u n t e r p a r t s were the patients of the u n i v e r s i t y c l i n i c in H e i d e l b e r g . In 1970 t h e y w e r e a c c u s e d by a u t h o r i t i e s o f using terrorist tactics to d e m a n d the r e s t r u c t u r i n g of their m e n t a l hospital,
a n d w h e n t h e SPK, o r Socialist P a t i e n t s ' C o l l e c t i v e , later d i s b a n d e d , m a n y o f its m e m b e r s j o i n e d t h e Red A r m y F r a c t i o n ( K o t o w i c z , 1997, p p . 7 9 - 8 1 ; P a t i e n t e n k o l l e k t i v ( H ) ; H u f f m a n ) . T h e Semiotext(e)
Schizo-Culture conven-
t i o n in N e w Y o r k 1 9 7 5 — a t t e n d e d b y h u n d r e d s , i n c l u d i n g J e a n - F r a n ç o i s L y o t a r d , M i c h e l F o u c a u l t , Gilles D e l e u z e , a n d Félix G u a t t a r i — w a s p e r h a p s t h e last m a j o r a n t i p s y c h i a t r i c e v e n t . 6 In d e n o u n c i n g t h e role t h a t p s y c h i a t r y p l a y e d in f u r t h e r i n g t h e a d v a n c e d capitalist agenda, antipsychiatrists across E u r o p e a n d A m e r i c a m o b i l i z e d ' t h e s c h i z o p h r e n i c ' e i t h e r as t h e a p o t h e o s i s of t h e o p p r e s s e d , a n e x e m p l a r y m i l i t a n t in t h e fight against o p p r e s s i o n , o r as a figurehead for psychic a n d political e m a n c i p a t i o n . 7 T h e b r o a d e r a r g u m e n t s , politics, a n d p e r s o n a l i t i e s of t h e a n t i p s y c h i a t r y m o v e m e n t h a v e b e e n well d o c u m e n t e d elsewhere; h a v i n g t h u s briefly s i t u a t e d a n t i p s y c h i a t r y w i t h i n its p s y c h i a t r i c a n d s o c i a l c o n t e x t s , m y c e n t r a l t a s k in t h i s c h a p t e r is t o e x a m i n e t h e w a y in w h i c h s c h i z o p h r e n i a h a s b e e n f r a m e d in key a n t i p s y c h i a t r i c t e x t s . W i t h t h e e x c e p t i o n o f F o u c a u l t , w h o s e Madness Civilization
and
I d i s c u s s e d in d e t a i l in C h a p t e r 1, a n t i p s y c h i a t r i s t s d i d n o t d e a l
exclusively in g e n e r a l , t r a n s - h i s t o r i c a l c o n c e p t s like m a d n e s s o r p s y c h o s i s b u t f o c u s e d specifically o n s c h i z o p h r e n i a as ' t h e m a j o r p r o b l e m a r e a ' of p o s t - W a r p s y c h i a t r y ( C o o p e r , 1970, p p . 9, 11). A l t h o u g h a n t i p s y c h i a t r i s t s u n i f o r m l y rejected t h e m e d i c a l m o d e l s of s c h i z o p h r e n i a ( B o l t o n , 2008, p p . 1 0 3 - 5 ) , p l a c i n g a n e m p h a s i s o n t h e social ( t h e i n t e r p e r s o n a l p s y c h i a t r i c e x c h a n g e , t h e f a m i l y , capitalist society) as e i t h e r s c h i z o p h r e n o g e n i c , o r as r e s p o n s i b l e f o r c o n s t r u c t i n g a false m y t h o l o g y o f s c h i z o p h r e n i a , t h e y d i d n o t u n i f o r m l y c o n t e s t s c h i z o p h r e nia's s t a t u s as t h e s u b l i m e o b j e c t o f psychiatry. T h e rest of this c h a p t e r e n d e a v o u r s t o u n d e r s t a n d t h e a n t i p s y c h i a t r i c m o d e l s of s c h i z o p h r e n i a m o s t p r o m i n e n t in t h e p o p u l a r a n d critical i m a g i n a t i o n s as f o l l o w i n g o n e of t h r e e r e s p o n s e s t o t h e c o n s t r u c t i o n of s c h i z o p h r e n i a as s u b l i m e w i t h i n p s y c h i a t r i c d i s c o u r s e . W e begin w i t h T h o m a s Szasz's p o l e m i c a l a t t a c k o n p s y c h i a t r y ' s s u b l i m e o b j e c t .
6
For more on the Schizo-Culture convention itself see Schwarz and Balsamo (1996) and Lotringer and Cohen (2001 ). The convention also gave rise to a special issue of Semiotext(e) called Schizo-Culture (1978). A radical, exuberant, multidimensional publication, the journal features stories, interviews, artworks, poetry, parodied advertisements, photo essays, hand-written notes, and articles by many stars of antipsychiatry and the avantgarde, among them, Michel Foucault, Kathy Acker, William Boroughs, David Cooper, Ulrike Meinhof, Gilles Deleuze, and Jean-François Lyotard. It also includes 'The Boston Declaration on Psychiatric Oppression' of 1976.
7
Sec Donnelly (1992), in particular Giovanni Jervis 'Psychiatrists and Polities', a revised version of the paper presented at the 1967 Dialectics of Liberation Conference. See also Boyers and Orrill (1972),
Thomas Szasz and anti-sublime schizophrenia A p s y c h o a n a l y s t a n d e m e r i t u s p r o f e s s o r o f p s y c h i a t r y , T h o m a s Szasz is a n A m e r i c a n civil l i b e r t a r i a n a n d o u t s p o k e n o p p o n e n t of o r t h o d o x , o r w h a t h e calls ' i n v o l u n t a r y ' , p s y c h i a t r y . Szasz's c r i t i q u e o f t h e e n t i r e p s y c h i a t r i c e n t e r p r i s e b e g a n in 1961 w i t h t h e a p t l y titled The Myth
of Mental
Illness ( 1 9 7 2 ) a n d
h a s c o n t i n u e d u n a b a t e d f o r n e a r l y 50 y e a r s . H i s c e n t r a l c o n t e n t i o n — n e a t l y s u m m a r i z e d in a 2 0 0 1 p u b l i c a t i o n — i s t h a t t h e r e is n o s u c h t h i n g as a m e n t a l illness, a n d t h a t p s y c h i a t r y p e r p e t u a t e s t o its o w n a d v a n t a g e a f u n d a m e n t a l category mistake: When we negate the distinction between physical objects and social beings, between bodies and persons, the concept of disease ceases to be limited to the dysfunction of cells, tissues, and organs and expands to include personal conduct. This enables persons deputized by the state as its agents (psychiatrists) and informants (family, teachers, students, employers) to transform any behavior they deem troublesome into a mental illness requiring psychiatric intervention. The result is an erosion of privacy, dignity, liberty and responsibility. 8 (Szasz, 2001, p. 97) Szasz's m a j o r c o n t r i b u t i o n t o t h e a n t i p s y c h i a t r i c l i t e r a t u r e o n p s y c h o s i s is his b o o k Schizophrenia:
The Sacred Symbol
of Psychiatry,
a n d h e lists its o b j e c -
tives as follows: In this book I shall try to show how schizophrenia has become the Christ on the cross that psychiatrists worship, and in whose name they march into battle to reconquer reason from unreason, sanity from insanity; how reverence toward it has become the mark of psychiatric orthodoxy, and irreverence toward it the mark of psychiatric heresy; and how our understanding of both psychiatry and schizophrenia may be advantaged by approaching this 'diagnosis' as if it pointed to a religious symbol rather than to a medical disease. (Szasz, 1976, p. xiii)9
8
Szasz's career, his principal claims and ongoing concerns as well as his contribution to psychiatry, is compellingly documented in a series of radio interviews and discussions featured on the Australian ABC radio programme All in the Mind (Mitchell and Szasz, 2009a, b; Mitchell et al., 2009). The relevance of Szasz's work to the project of critical psychiatry has also been debated in a recent issue of Philosophy, Psychiatry & Psychology (Bracken and Thomas, 2010a, b; Ratcliffe, 2010; Szasz, 2010). For a sympathetic appraisal of Szasz's capacity to out-argue his critics, see Cresswell (2008).
9
After his keynote presentation at the 13th annual International Network for Philosophy and Psychiatry conference (Manchester, luly 2010), I asked Szasz whether he thought schizophrenia was still 'the sacred symbol of psychiatry'. 'More than ever', he replied, beaming.
' " S c h i z o p h r e n i c " is a c o n c e p t w o n d e r f u l l y v a g u e in its c o n t e n t a n d t e r r i f y i n g l y a w e s o m e i n its i m p l i c a t i o n s ' , h e w r i t e s , a n d ' i t s m e a n i n g is t h e m o r e p o w e r f u l b e c a u s e it is i n s c r u t a b l e ' (Szasz, 1976, p p . xiii, 8 7 ) . A l t h o u g h t h e r e are clear parallels b e t w e e n m y r e a d i n g of s c h i z o p h r e n i a as t h e s u b l i m e o b j e c t o f p s y c h i a t r y a n d Szasz's ' s a c r e d s y m b o l ' a n a l o g y , h i s t h e s i s d e p e n d s u p o n a m i n d - b o d y d u a l i s m t h a t is c r u d e a n d a b s o l u t e : h e r e j e c t s b o t h t h e validity o f s c h i z o p h r e n i a a n d t h e d i s c i p l i n e o f p s y c h i a t r y o n t h e g r o u n d s t h a t illness c a n only b e d e f i n e d in c o r p o r e a l t e r m s . In t h e a b s e n c e of a n y d e m o n s t r a b l e p h y s i cal a b e r r a t i o n , t h e d i a g n o s i s of s c h i z o p h r e n i a is f o r Szasz s i m i l a r t o t h e c h a r g e of u n - A m e r i c a n i s m ; c o n s e q u e n t n o t u p o n ' e m p i r i c a l o r scientific' o b s e r v a t i o n b u t ' e t h i c a l a n d political d e c i s i o n m a k i n g ' (Szasz, 1976, p p . 115, 3). K r a e p e l i n a n d B l e u l e r — t h e f a t h e r s of m o d e r n p s y c h i a t r y a n d t h e first t o i d e n t i f y s c h i z o p h r e n i a as a d i s e a s e e n t i t y — t h e r e f o r e c o m e t o b e s e e n a l o n g s i d e F r e u d as ' c o n q u i s t a d o r s a n d c o l o n i z e r s of t h e m i n d of m a n ' , ' r e l i g i o u s - p o l i t i c a l l e a d e r s a n d c o n q u e r o r s ' , a n d ' w a r d e n s ' w h o p r a c t i s e d ' p s y c h i a t r i c slavery' at t h e b e h e s t o f a n e n t i r e s o c i e t y e a g e r t o s e q u e s t e r a n d p u n i s h its m i s f i t s ( S z a s z , 1 9 7 6 , p p . 2 1 - 3 , 35, 3 8 ) . Szasz's w h o l e s a l e r e j e c t i o n of p s y c h i a t r y ' s disease m o d e l b e g s t h e q u e s t i o n o f w h a t exactly h e t h i n k s s c h i z o p h r e n i a is. A l t h o u g h at n o p o i n t d o e s h e explicitly o f f e r a positive d e f i n i t i o n of s c h i z o p h r e n i a , r e f e r e n c e s s c a t t e r e d t h r o u g h o u t t h e text a d d u p t o a fairly suggestive p o r t r a i t of t h e 'so-called s c h i z o p h r e n i c ' : ' i n c o m p e t e n t ' , ' s e l f - a b s o r b e d ' , a n d 'socially i n a d e q u a t e o r i m p a i r e d ' , s / h e d i s t u r b s o t h ers, speaks in socially u n a c c e p t a b l e m e t a p h o r s , a n d leads a ' d i s o r d e r e d ' , ' a i m l e s s ' , a n d 'useless' life (Szasz, 1976, p p . 136, 182, 36, 14, 7 4 ) . T o p u t it d i f f e r e n t l y , . . . what we call 'sanity'—what we mean by 'not being schizophrenic'—has a great deal to do with competence, earned by struggling for excellence; with compassion, hard won by confronting conflict; and with modesty and patience, acquired through silence and suffering. (Szasz, 1976, pp. 82-3) S c h i z o p h r e n i a , o n t h i s m o d e l , is a m o r a l c h o i c e c o n c e p t u a l i z e d in n a r r o w l y i n d i v i d u a l i s t t e r m s . A t p a i n s t o e m p h a s i z e ' p a t i e n t ' agency, Szasz clearly views t h e s c h i z o p h r e n i c p a t i e n t as o n e w h o s e freely c h o s e n f a i l u r e in life reflects o n l y t h e i r r e f u s a l t o face its vicissitudes a n d n e g o t i a t e its r h e t o r i c a l c o d e s ( V a t z a n d W e i n b e r g , 1994, p . 3 1 3 ) . T h e r e f u s a l — t o b e s t o i c , t o s u f f e r in s i l e n c e in t h e n a m e o f s e l f - i m p r o v e m e n t — t h a t is c o n s t i t u t i v e o f s c h i z o p h r e n i a is e n a c t e d in a social s p a c e u n a f f e c t e d b y s y s t e m i c i n e q u a l i t i e s . As P e t e r S e d g w i c k a r g u e s , t h e s o c i a l - D a r w i n i s t o r t w e n t i e t h - c e n t u r y H e r b e r t S p e n c e r in Szasz 'is c o n t e n t to redefine o u t of existence the s t r u c t u r e d social p r o b l e m s of the exploited c o m m u n i t i e s o f A m e r i c a ' a n d o f f e r s n o ' g e n e r a l i s e d s y m p a t h y f o r p e o p l e in
t r o u b l e ' (Sedgwick, 1982, p p . 1 6 3 - 4 ) . 1 0 Szasz t h e civil l i b e r t a r i a n is n o n e t h e l e s s a c o m m i t t e d c a m p a i g n e r f o r t h e p e o p l e s ' r i g h t to b e p r o t e c t e d f r o m ' p s y c h i a t r i c r a p e ' (Szasz, 1976, p. 49) o r i n v o l u n t a r y c o m m i t m e n t , a n d t o b e e m a n c i p a t e d f r o m e n s l a v e m e n t in t h e p s y c h i a t r i c s y s t e m . P s y c h i a t r y h a s — m u c h like a n a b u s i v e h u s b a n d in a n a r r a n g e d m a r r i a g e , t o p a r a p h r a s e f r o m a n o t h e r o f S z a s z ' s a n a l o g i e s — d e p r i v e d t h e p e r s o n it d i a g n o s e s as s c h i z o p h r e n i c o f h e r r i g h t s a n d f r e e d o m s . B u t s e t t i n g e m p a t h y aside o n c e again, w e m u s t also, . . . acknowledge that mental patients have exploited their positions as slaves, and that the only way to overcome their subjection is by both economic and personal independence from psychiatrists. This means that 'psychotics' should not expect to be supported by psychiatrists (society) as patients, but must support themselves by work saleable in the marketplace. To the extent that women and 'psychotics' cannot, or do not, so liberate themselves, they will remain enslaved to men who 'love' them and psychiatrists who 'treat' them. (Szasz, 1976, p. 176) O n l y w h e n financially solvent a n d hence morally upright can people diagn o s e d as s c h i z o p h r e n i c w i n l e g i t i m a c y as clients of Szasz's p r e f e r r e d m o d e l o f private, fee-paying 'contractual' psychiatry. If t h e p e r s o n d i a g n o s e d w i t h s c h i z o p h r e n i a is in f a c t a f r e e , r a t i o n a l , a n d a u t o n o m o u s a g e n t w h o c h o o s e s t o lead a d i s o r d e r e d life, w h a t c a n s c h i z o p h r e n i a h a v e t o d o w i t h t h e s u b l i m e ? T h e a n s w e r is v e r y little. Szasz's a u d a c i o u s c r i t i q u e o f t h e m e d i c a l m o d e l o f s c h i z o p h r e n i a is c e r t a i n l y c o g e n t in p l a c e s , a n d in m y v i e w h e is r i g h t t o p o i n t o u t t h a t p s y c h i a t r y elevates s c h i z o p h r e n i a t o s o m e t h i n g a p p r o a c h i n g a sacred status. D a v i d R o s e n h a n ' s f a m o u s 1973 s t u d y ' O n B e i n g S a n e in I n s a n e Places' s u p p o r t s t h e a r g u m e n t t h a t A m e r i c a n p s y c h i a t r y d u r i n g t h e m i d - 1 9 7 0 s w a s a n y t h i n g b u t scientifically r i g o r o u s w h e n o v e r - d i a g n o s i n g s c h i z o p h r e n i a ( R o s e n h a n , 1975). 1 1 H o w e v e r , so total is Szasz's r e p u d i a t i o n of p s y c h i a t r y t h a t h e e n d s u p t h r o w i n g t h e b a b y o u t w i t h t h e b a t h w a t e r , so t o s p e a k . In r e j e c t i n g s c h i z o p h r e n i a a n d its s u b l i m e a s s o c i a t i o n s , h e r e d e f i n e s its s y m p t o m s as s i g n s m e r e l y of q u o t i d i a n d i s t r e s s o r d i s t u r b a n c e ,
10
Szasz has remained adamant on this point. Where there is almost universal consensus that it is difficult to dispute the suffering of those diagnosed with mental illness, Szasz maintains on the contrary that it is 'easy' to do so on the grounds that 'most people who psychiatrists characterise as "seriously mentally ill" do not suffer: they make others suffer' (Szasz, 2004, p. 51).
11
In the study, eight 'normal' people admitted themselves to mental hospitals complaining of hearing voices. Seven received a diagnosis of schizophrenia. Once admitted, the 'pseudopatients' ceased feigning any symptoms, but remained in hospital for an average of 19 days before being discharged as 'schizophrenics in remission'.
u n r e m a r k a b l e variations of everyday b e h a v i o u r . This effectively denies that t h e r e is a n y s u c h t h i n g as a p s y c h o t i c e x p e r i e n c e , m u c h less a n o n t o l o g y o f s c h i z o p h r e n i a . S e d g w i c k is a g a i n critical o f t h i s m o v e : severe m e n t a l illness is ' t o b e s u r e , a social s t a t u s : b u t , b e f o r e t h a t , it is a p r i v a t e hell. Szasz a t t a i n s his r o l e as p r o x y s p o k e s p e r s o n f o r t h e r i g h t s o f t h e m e n t a l p a t i e n t b y i g n o r i n g , simply, w h a t it is t o b e a m e n t a l p a t i e n t ' (Sedgwick, 1982, p. 158). T h e reason t h a t Szasz's ' s o - c a l l e d s c h i z o p h r e n i c ' h a s all t h e c h a r a c t e r i s t i c s o f a w o r k - d o d g i n g , t r u c u l e n t t e e n a g e r is p r i n c i p a l l y b e c a u s e d e l u s i o n s , h a l l u c i n a t i o n s , a n h e d o n i a , alogia, a n d o t h e r h a l l m a r k s y m p t o m s of s c h i z o p h r e n i a a r e n o t a m o n g t h e m . Szasz's m o d e l — t h e n e g a t i o n o f p s y c h i a t r y ' s s a c r e d s y m b o l — c e r t a i n l y d e s e r v e s t o b e t h o u g h t of as ' a n t i - s u b l i m e ' ; t h e m o r e p r e s s i n g q u e s t i o n is w h e t h e r it says a n y t h i n g m o r e a b o u t t h e e x p e r i e n c e o f s c h i z o p h r e n i a t h a n it d o e s a b o u t t h e e x p e r i e n c e of a d o l e s c e n c e o r l o n g - t e r m u n e m p l o y m e n t . Szasz is p r o b a b l y t h e m o s t f a m o u s a n d u n d o u b t e d l y t h e m o s t p o l i t i c a l l y c o n t e n t i o u s a d v o c a t e o f a n a n t i - s u b l i m e s o c i a l - c o n s t r u c t i v i s t m o d e l of s c h i z o p h r e n i a , b u t h e w a s n o t a l o n e . I n Asylums: Mental
Patients
and other Inmates,
Essays on the Social Situation
of
Erving G o f f m a n p r o d u c e d compelling
sociological e v i d e n c e t h a t t h e a s y l u m itself w a s d e e p l y i m p l i c a t e d in t h e develo p m e n t of its i n m a t e s ' s y m p t o m a t o l o g i e s . T h e r i t u a l i z e d , d e h u m a n i z i n g p r a c tices of t h e ' t o t a l i n s t i t u t i o n ' i n d u c e s e l f - d e f e n s i v e r e s p o n s e s , w h i c h a r e t h e n i n t e r p r e t e d as s y m p t o m s of a n u n d e r l y i n g p s y c h o p a t h o l o g y , w h e r e a s t h e y a r e b e t t e r u n d e r s t o o d w i t h i n the c o m p l e x social c o n t e x t of t h e closed asylum c o m m u n i t y . Like Szasz, G o f f m a n casts d o u b t o v e r p s y c h i a t r y ' s s c i e n t i f i c a n d m o r a l l e g i t i m a c y , a n d c o n f i n e s h i m s e l f t o a strictly sociological m o d e l of m e n tal illness in w h i c h ' t h e p s y c h i a t r i c view o f a p e r s o n b e c o m e s s i g n i f i c a n t o n l y in so f a r as t h i s v i e w itself alters his social f a t e ' ( G o f f m a n , 1973, p. 119). T h e category of s c h i z o p h r e n i a b e c o m e s a 'magical' way of r e d e f i n i n g the patient's b e h a v i o u r as a single e n t i t y eligible f o r ' p s y c h i a t r i c s e r v i c i n g ' ( G o f f m a n , 1973, p . 3 2 6 ) . A sociologist, a n d n o t a critical social t h e o r i s t (Sedgwick, 1982, p. 63), G o f f m a n concentrates primarily on the i m m e d i a t e m i c r o c o s m of face-to-face i n t e r p e r s o n a l e x c h a n g e a n d s e l d o m l o c a t e s t h e p r o c e s s of p s y c h i a t r i c d i a g n o s i s a n d t r e a t m e n t w i t h i n its b r o a d e r s o c i a l a n d p o l i t i c a l c o n t e x t s . Asylums
was
nonetheless a d e t e r m i n i n g influence o n the d e v e l o p m e n t of a m o r e radical a n t i p s y c h i a t r i c p o s i t i o n u n d e r t h e r u b r i c ' l a b e l l i n g t h e o r y ' . In his ' S c h i z o p h r e n i a as I d e o l o g y ' , T h o m a s S c h e f f a d v a n c e s t h e w o r k o f Szasz a n d G o f f m a n in a n unmistakably polemical direction: The concepts of mental illness in general—and schizophrenia in particular—are not neutral, value-free scientifically precise terms but are, for the most part, the leading edge of an ideology embedded in the historical and cultural present of the white
middle class of Western societies. The concept of illness and its associated vocabulary— symptoms, therapies, patients, and physicians—reify and legitimate the prevailing public order at the expense of other possible worlds. (Scheff, 1975b, p.6) P s y c h i a t r y , i n c o n s t r u c t i n g s c h i z o p h r e n i a as its s u b l i m e o b j e c t , i m p l i e s a l w a y s t h a t there is something
more t o t h e d i s o r d e r , a n e l u s i v e o r e n i g m a t i c
e s s e n c e t h a t h a s y e t t o b e u n d e r s t o o d . T h e f o u n d a t i o n a l m e t a t h e o r e t i c a l gest u r e o f Szasz, G o f f m a n , a n d Scheff, b y c o n t r a s t , is t h e i n s i s t e n c e t h a t s c h i z o p h r e n i a is p e r f e c t l y c o m p r e h e n s i b l e , t h a t it is nothing
more than a label d e p l o y e d
w i t h great effect in specific social c o n t e x t s . 1 2 T h e s e t h e o r i s t s m a y n o t agree o n h o w the diagnosis/label of schizophrenia reflects or intersects with b r o a d e r i s s u e s o f p o w e r , s u b j e c t f o r m a t i o n , a n d t h e m a i n t e n a n c e o f social o r d e r , b u t t h e i n s i s t e n c e u p o n a n a n t i - s u b l i m e s c h i z o p h r e n i a is p i v o t a l t o e a c h o f t h e i r antipsychiatric projects.
Between two sublimes: schizophrenia and The Divided Self 'If w h a t m a k e s " s c h i z o p h r e n i c " u t t e r a n c e s " s y m p t o m s " is t h a t t h e y are i n c o m p r e h e n s i b l e , d o t h e y still r e m a i n " s y m p t o m s " a f t e r t h e y a r e n o l o n g e r i n c o m p r e h e n s i b l e ? ' (Szasz, 1976, p. 15). T h i s q u e s t i o n , p o s e d in p a s s i n g b y T h o m a s Szasz, goes s t r a i g h t t o t h e h e a r t of R . D . L a i n g ' s c a r e e r - l o n g i n t e r e s t in s c h i z o p h r e n i a . R e n o w n e d as t h e f o u n d e r of Kingsley Hall, a n e x p e r i m e n t a l t h e r a p e u t i c c o m m u n i t y established in 1965, Laing, a Glaswegian p s y c h i a t r i s t - c u m - c o u n t e r c u l t u r a l - h e r o , h a s at o n e t i m e o r a n o t h e r h e l d o r b e e n a t t r i b u t e d t h e full g a m u t of antipsychiatric positions o n schizophrenia.13 Of particular interest to this d i s c u s s i o n o f a n t i p s y c h i a t r y , s c h i z o p h r e n i a , a n d t h e s u b l i m e a r e t h e analyses o f p s y c h o s i s o u t l i n e d in his t w o m o s t c e l e b r a t e d p u b l i c a t i o n s : The Divided An Existential
Study in Sanity
and Madness
a n d The Politics of Experience.
Self: In the
l a t t e r b o o k — p u b l i s h e d d u r i n g t h e V i e t n a m W a r at t h e h e i g h t of his f a m e a n d p o p u l a r a p p e a l — L a i n g p r e s e n t s s c h i z o p h r e n i a as a n e x p e r i e n c e o f t h e s u b l i m e , a p o r t r a y a l I will a d d r e s s in m o r e d e p t h in t h e n e x t s e c t i o n . T h e e a r l i e r The Divided
Self
by contrast, has a very different 'basic purpose': 'to m a k e
m a d n e s s , a n d t h e p r o c e s s of g o i n g m a d , c o m p r e h e n s i b l e ' ( L a i n g , 1990, p. 9).
12
13
The issue here could also be construed as a distinction between schizophrenia as unknowable ontology versus schizophrenia as oppressive ideology. Unlike Foucault, Szasz, Goffman, and Scheff seem optimistic about the individual's capacity to oppose psychiatric ideology. For an overview of these see Janus Head 'Special Issue: The legacy ofR. I). Laing'(2001), in particular Burston (2001a, h) and Bortle (2001).
H e r a l d e d , n o t w i t h o u t c a u s e , as 'a classic o f p s y c h i a t r i c l i t e r a t u r e ' ( K o t o w i c z , 1997, p. 25), The Divided
Self also h o l d s a place o f d i s t i n c t i o n in
antipsychiatric
l i t e r a t u r e as it l o c a t e s s c h i z o p h r e n i a b e t w e e n m u l t i p l e s u b l i m e s — t h e a n t i s u b l i m e j u s t d i s c u s s e d , t h e t e x t u a l s u b l i m e of p s y c h o a n a l y s i s , a n d t h e disciplin a r y s u b l i m e o f p s y c h i a t r y as f i g u r e d in t h e w o r k o f Karl Jaspers. The Divided
Self sets o u t a n e x i s t e n t i a l - p h e n o m e n o l o g i c a l m o d e l of p s y c h o -
sis. S c h i z o p h r e n i a is t h e i n t e n s i f i c a t i o n o f a s c h i z o i d s t a t e c h a r a c t e r i z e d b y p s y c h i c s p l i t t i n g , o r r e n t s b e t w e e n t h e self a n d t h e w o r l d , b e t w e e n t h e m i n d a n d t h e b o d y , a n d b e t w e e n t h e t r u e i n n e r self a n d t h e o u t e r 'false-self s y s t e m ' . 1 4 T h e s c h i z o i d state is o n e o f e x t r e m e o n t o l o g i c a l i n s e c u r i t y w h e r e i n a n x i e t y — specifically c o n c e r n i n g the e n g u l f m e n t , i m p l o s i o n , a n d petrification of the s e l f — r e i g n s . Its ' s y m p t o m s ' a r e t h e r e f o r e b e s t s e e n as s t r a t e g i e s f o r g u a r d i n g a g a i n s t t h e d e s t r u c t i o n o f p e r s o n a l i t y o r t h e a n n i h i l a t i o n of t h e self: If the individual cannot take the realness, aliveness, autonomy, and identity of himself and others for granted, then he has to become absorbed in contriving ways of trying to be real, of keeping himself or others alive, of preserving his identity, in efforts, as he will often put it to prevent himself losing his self. (Laing, 1990, pp. 42-3) L a i n g ' s a n a l y s i s o f t h e d i v i d e d self u n f o l d s t h r o u g h a series of case s t u d i e s , v i g n e t t e s , a n d vivid a c c o u n t s o f s c h i z o i d d e s p a i r a n d i s o l a t i o n . H i s s t r a t e g y is t o o r i e n t t h e r e a d e r w i t h i n t h e life w o r l d o f t h e p a t i e n t ( L a i n g , 1990, p . 2 6 ) . W h e r e catatonic, h e b e p h r e n i c , a n d p a r a n o i d s y m p t o m s are only m e a n i n g f u l t o p s y c h i a t r i s t s as signs of a n u n d e r l y i n g disease p r o c e s s o r e v i d e n c e of p s y c h i c m a / f u n c t i o n , t o L a i n g t h e y a r e r a t i o n a l , c o d e d c o m m u n i q u é s t h a t can o n l y b e u n d e r s t o o d b y r e t u r n i n g t h e p e r s o n d i a g n o s e d as s c h i z o p h r e n i c t o h e r e x i s t e n tial s t a t u s as a b e i n g a m o n g o t h e r s . T h r o u g h d e t a i l e d e x a m p l e s , o t h e r w i s e f r a g m e n t e d o r n o n s e n s i c a l s c h i z o p h r e n i c s p e e c h is t r a n s l a t e d i n t o a n e l o q u e n t c o m m e n t a r y o n d a m a g e d , a n d d a m a g i n g , i n t e r p e r s o n a l r e l a t i o n s . Laing t h e r e f o r e e l u c i d a t e s a n a n t i - s u b l i m e m o d e l of s c h i z o p h r e n i a o n t w o d i s t i n c t levels. T h e m a j o r t h e o r e t i c a l c l a i m of The Divided
Self is t h a t s c h i z o p h r e n i a is intelli-
gible: as t h e e x a c e r b a t i o n o f s c h i z o i d p s y c h i c s t a t e s w i t h w h i c h w e all h a v e s o m e f a m i l i a r i t y , it is t h e r e f o r e s o m e t h i n g w i t h w h i c h w e c a n e m p a t h i z e . 1 5 B u t L a i n g f u r t h e r p o r t r a y s s c h i z o p h r e n i a as a n t i - s u b l i m e in t h e s e n s e t h a t it is a n e m o t i o n a l l y a n d psychically d e v a s t a t i n g e x p e r i e n c e , w h i c h t h r e a t e n s t o d e s t r o y
14 15
See Laing, 1990, pp. 17, 69, 94-105. Here, Laing is indebted to Klein (1952). This emphasis on a continuum between normalcy and psychosis is shared by Szasz, Scheff, and Goffman, although they do not concede a schizophrenic ontology; it is also evident in Melanie Klein's theory of schizophrenia as psychic regression to the paranoidschizoid position.
r a t h e r t h a n r e i n v i g o r a t e t h e self. ( T h i s is o f c o u r s e t h e d i r e c t i n v e r s e o f h i s thesis in The Politics of Experience
t h a t s c h i z o p h r e n i a is t h e s u b l i m e t r a n s c e n d -
e n c e o f e g o i c e x i s t e n c e . ) If w e recall t h a t K a n t a n d B u r k e b o t h d i s t i n g u i s h e d t h e s u b l i m e f r o m t h e ' s i m p l y t e r r i f y i n g ' , it b e c o m e s c l e a r t h a t i n all ' h i s s e p a r a t e n e s s a n d loneliness a n d d e s p a i r ' (Laing, 1990, p. 38), Laing's 1960 ' s c h i z o p h r e n i c ' f a r f r o m r e s e m b l e s t h e s e l f - a f f i r m e d s u b j e c t of t h e s u b l i m e o r t h e s p i r i t u a l v o y a g e r ' h e ' w o u l d later b e c o m e . Laing's existential m o d e l posits an a n t i - s u b l i m e s c h i z o p h r e n i a twice over, e v e n if t h e q u e s t i o n of understanding
s c h i z o p h r e n i a is n o t as easily r e s o l v e d in
The Divided Self as a p p e a r a n c e s a n d r e p u t a t i o n m i g h t suggest. Laing's a t t e m p t e d s y n t h e s i s of p s y c h o a n a l y s i s a n d J a s p e r i a n p h e n o m e n o l o g i c a l p s y c h i a t r y c r e ates c o n s i d e r a b l e t e n s i o n w i t h r e g a r d t o t h e v e x e d issue o f c o m p r e h e n s i b i l i t y . A s I d i s c u s s e d in C h a p t e r 1, J a s p e r s m a i n t a i n e d t h a t s c h i z o p h r e n i a ' s d e f i n i n g c h a r a c t e r i s t i c is t h e i m p r e s s i o n c r e a t e d in t h e o b s e r v e r : It is easier to describe the common factor [among schizophrenic patients] in subjective terms, that is, in terms of the effect on the observer, rather than try to do so objectively. All these personalities have something baffling about them, which baffles our understanding in a peculiar way; there is something queer, cold, inaccessible, rigid, and petrified there, even when the patients are quite sensible and can be addressed and even when they are eager to talk about themselves. We may think we can understand dispositions furthest from our own but when faced with such people we feel a gulf which defies description. (Jaspers, 1972, p. 447) Like Jaspers, L a i n g h e l d t h a t 'sanity between
or psychosis
two persons
where
is tested by the degree of con-
junction
or disjunction
the one is sane by
common
consent.
T h e c r i t i c a l test o f w h e t h e r o r n o t a p a t i e n t is p s y c h o t i c is a lack o f
c o n g r u i t y , an i n c o n g r u i t y , a clash, b e t w e e n h i m a n d m e ' ( L a i n g , 1990, p. 36, italics in t h e o r i g i n a l ) . W h e r e L a i n g d e p a r t s f r o m t h e f r a m e w o r k of p h e n o m e n o l o g i c a l p s y c h i a t r y is in h i s c o n v i c t i o n t h a t this s e e m i n g l y alien e x p e r i e n c e c a n in f a c t b e u n d e r s t o o d . T h i s i n t e r p r e t i v e i m p u l s e — t h e e f f o r t t o d e c i p h e r t h e c o n t e n t o f t h e p s y c h o t i c u t t e r a n c e r a t h e r t h a n s i m p l y r e g i s t e r its f o r m a l f e a t u r e s — i s , as L a i n g a c k n o w l e d g e s , s h a r e d b y classical p s y c h o a n a l y s i s . O n c e a n o b j e c t o f i n t e r p r e t a t i o n , s c h i z o p h r e n i a is n o w c o n s t r u e d as a textual p u z z l e : ' T h e difficulties f a c i n g u s h e r e a r e s o m e w h a t a n a l o g o u s t o t h e d i f f i c u l t i e s faci n g t h e e x p o s i t o r o f h i e r o g l y p h i c s , an a n a l o g y F r e u d w a s f o n d of d r a w i n g ; t h e y are, if a n y t h i n g , g r e a t e r ' (Laing, 1990, p. 3 1 ) . 1 6 W e h a v e seen t h a t s c h i z o p h r e n i a is f r a m e d as a s u b l i m e text in p s y c h o a n a l y t i c d i s c o u r s e t h r o u g h a d o u b l e
16
Lacan (1993, p. 10) makes the same observation: '| Freud | deciphers | Memoirs of My Nervous Illness] in the way hieroglyphics are deciphered'.
g e s t u r e — i t is d e c l a r e d a m e n a b l e t o e n d l e s s r e i n t e r p r e t a t i o n b u t f u n d a m e n tally b e y o n d t h e r a p e u t i c r e a c h . L a i n g ' s d i s t i n c t i o n i n The Divided
Self is t o
suggest that the therapist s h o u l d e n d e a v o u r to c o m p r e h e n d n o t just the c o n t e n t of t h e s c h i z o p h r e n i c u t t e r a n c e b u t its s t a t u s w i t h i n t h e overall c o n t e x t of the patient's experience: Like the expositor [of ancient texts], the therapist must have the plasticity to transpose himself into another strange and even alien view of the world. In this act, he draws on his own psychotic possibilities, without forgoing his sanity. Only thus can we arrive at an understanding of the patient's existential position. (Laing, 1990, p. 34, italics in the original) A sufficiently empathetic therapist can u n d e r s t a n d schizophrenic experie n c e , a n d , m o r e o v e r , L a i n g suggests u n d e r s t a n d i n g itself h a s a d i s t i n c t t h e r a p e u t i c v a l u e . O r so it w o u l d a p p e a r . T h i s c o n t e n t i o n is i m m e d i a t e l y f o l l o w e d , however, by Laing's appeal to the u n d e r l y i n g — o r i n t r i n s i c — s u b l i m i t y of schizophrenia: What is required of us? Understand him? The kernel of the schizophrenic's experience of himself must remain incomprehensible to us. As long as we are sane and he is insane, it will remain so. But comprehension as an effort to reach and grasp him, while remaining within our own world and judging him by our own categories whereby he inevitably falls short, is not what the schizophrenic either wants or requires. We have to recognize all the time his distinctiveness and differentness, his separateness and loneliness and despair. (Laing, 1990, p. 38) S c h i z o p h r e n i a t h e r e f o r e t r a v e r s e s a c o n c e p t u a l l y c o n f u s e d t e r r i t o r y in Divided
The
Self. It is a n t i - s u b l i m e in s o far as p s y c h o t i c e x p e r i e n c e c a n b e r e n d e r e d
intelligible, a n d a n t i - s u b l i m e i n s o f a r as o n e c a n e m p a t h i z e w i t h t h a t e x p e r i e n c e . Yet s c h i z o p h r e n i a h e r e , as in J a s p e r s ' s General
Psychopathology
and
m a n y p s y c h o a n a l y t i c a c c o u n t s , r e t a i n s its s t a t u s as a d i s o r d e r t h a t is in essence ultimately beyond understanding.
Schizophrenia as sublime experience D e s p i t e , o r p e r h a p s e v e n b e c a u s e o f , its i n t e r n a l l y c o n f l i c t e d t h e s i s o n t h e i n c o m p r e h e n s i b i l i t y of s c h i z o p h r e n i a , The Divided
Self is a c o m p e l l i n g a c c o u n t
o f ' s c h i z o p h r e n i c ' e x p e r i e n c e s of t h e w o r l d , t h e d e m a n d s o f o t h e r s , e m b o d i m e n t , p s y c h i c s p l i t t i n g , a n d s i m p l e s u r v i v a l in t h e face o f o n t o l o g i c a l i n s e c u rity. In his n e x t b o o k , t h e 1964 Sanity,
Madness
and the Family,
Laing s w i t c h e d
the focus f r o m intrapsychic despair to interpersonal conflict; schizophrenia w a s n o w an intelligible r e s p o n s e t o a m a d d e n i n g f a m i l y . By 1967, L a i n g ' s p a r a d i g m s of s c h i z o p h r e n i a h a d again d e v e l o p e d a n d m u l t i p l i e d . O n e of t h e m o s t
s t r i k i n g a n d c o n s i s t e n t t h e m e s in The Politics of Experience
is t h e r e j e c t i o n o f
t h e a s s u m p t i o n t h a t n o r m a l i t y is d e s i r a b l e : . . . social adaptation to a dysfunctional society may be very dangerous. The perfectly adjusted bomber pilot may be a greater threat to species survival than the hospitalized schizophrenic deluded that the Bomb is inside him. Our society may itself have become biologically dysfunctional, and some forms of schizophrenic alienation from the alienation of society may have a sociobiological function that we have not recognized. (Laing, 1967, p. 120) 17 It is w i t h i n this d i c h o t o m y o f ' n o r m a l , i m p o v e r i s h e d , a n d i n a u t h e n t i c ' v e r sus 'schizophrenic' experience that Laing elaborates a n d endorses a n u m b e r of cont radi ctor y definitions of psychosis. Following G o f f m a n a n d anticipating Scheff, h e a r g u e s t h a t s c h i z o p h r e n i a is a label a p p l i e d w i t h i n i n s t i t u t i o n a l a n d interpersonal contexts, emphasizing, but without offering further explanation, t h a t ' t h e label is a social fact a n d t h e social fact a political
e v e n t ' (Laing, 1967,
p . 120, italics i n t h e o r i g i n a l ) . In p r a i s e o f G r e g o r y B a t e s o n ' s t h e o r y o f t h e s c h i z o p h r e n i c d o u b l e b i n d , L a i n g also suggests t h a t s c h i z o p h r e n i a is as m u c h a p r o p e r t y of t h e m o d e r n n u c l e a r f a m i l y as it is of t h e i n d i v i d u a l . 1 8 A l t h o u g h h e later d i s a v o w e d this p o s i t i o n (Laing, 1985, p p . 8 - 9 ) , L a i n g in 1967 w a s u n r e l e n t ing in his i n d i c t m e n t o f t h e s c h i z o p h r e n o g e n i c f a m i l y 1 9 a n d saw s c h i z o p h r e n i c s y m p t o m s as ' a special strategy that a person invents in order to live in an situation
unlivable
(Laing, 1967, p. 114, italics in t h e o r i g i n a l ) . A n e v e r - e x p a n d i n g field of
17
The change in Laing's thinking is also apparent in his Preface to the 1964 edition of The Divided Self. 'Thus 1 would wish to emphasize that our "normal" "adjusted" state is too often the abdication of ecstasy, the betrayal of our true potentialities, that many of us are only too successful in acquiring a false self to adapt to false realities' (Laing, 1990, p.12). This view was also taken up by Scheff (1975a, p.18): 'Perhaps the time has come to consider the possibility that the reality that the so-called schizophrenics are out of touch with is so appalling that their view of the world may be more supportive to life than conventional reality.'
18
'.. . no schizophrenic has been studied whose disturbed pattern of communication has not been shown to be a reflection of, and reaction to, the disturbed and disturbing pattern characterizing his or her family of origin' (Laing, 1967, p. 114, see also 65). This view was shared by Laing's friend and colleague David Cooper, who went so far as to argue that 'schizophrenia, it if means anything, is a more or less characteristic mode of disturbed group behaviour. There are no schizophrenics' (Cooper, 1970, p. 43).
19
'The family's function is to repress Eros; to induce a false consciousness of security; to deny death by avoiding life; to cut off transcendence; to believe in God, not to experience the Void; to create, in short, one-dimensional man; to promote respect, conformity, obedience; to con children out of play; to induce a fear of failure; to promote a respcct for work; to promote a respect for "respectability'" (l aing, 1967, p. 65).
inquiry—and culpability—sees a progression f r o m the individual to the family a n d finally t o society at large: Questions and answers have so far been focused on the family as a social subsystem. Socially, this work must now move to further understanding, not only of the internal disturbed and disturbing patterns of communication within families, of the doublebinding procedures, the pseudo-mutuality, of what I have called the mystifications and the untenable positions, but also to the meaning of all this within the larger context of the civic order of society—that is, of the political order, of the ways persons exercise control and power over one another. (Laing, 1967, p. 114, italics in the original) The Politics
of Experience
here gestures t o w a r d s the political territory sug-
gested b y its title; h o w e v e r , d e s p i t e c l a i m i n g t h a t ' t h e social s y s t e m , n o t single i n d i v i d u a l s e x t r a p o l a t e d f r o m it, m u s t b e t h e o b j e c t o f s t u d y ' ( L a i n g , 1967, p. 114, italics in t h e o r i g i n a l ) , Laing d o e s n o t p r o c e e d far in his i m p l i e d c r i t i q u e o f a s c h i z o p h r e n o g e n i c m o d e r n society. I n s t e a d , a n d in w h a t a p p e a r s t o b e a complete about-face, he argues that the 'desperately and urgently required p r o j e c t for o u r t i m e ' is t h e e x p l o r a t i o n o f ' t h e i n n e r space a n d t i m e of c o n s c i o u s ness', a n d s c h i z o p h r e n i c c o n s c i o u s n e s s in p a r t i c u l a r (Laing, 1967, p. 127). It is t o w a r d s t h e e n d o f The Politics
of Experience
t h a t L a i n g e l u c i d a t e s his
f a m o u s a c c o u n t o f s c h i z o p h r e n i a as a n ecstatic v o y a g e i n t o ' i n n e r s p a c e ' (Laing, 1 9 6 7 , p . 1 2 7 ) . ' M a d n e s s n e e d n o t b e all b r e a k d o w n . It m a y a l s o b e b r e a k t h r o u g h . It is p o t e n t i a l l y l i b e r a t i o n a n d r e n e w a l as well as e n s l a v e m e n t a n d e x i s t e n t i a l d e a t h ' ( L a i n g , 1967, p. 133). F u t u r e g e n e r a t i o n s , L a i n g a s s u r e s u s , 'will see t h a t w h a t w e call " s c h i z o p h r e n i a " w a s o n e of t h e f o r m s in w h i c h , o f t e n t h r o u g h q u i t e o r d i n a r y p e o p l e , t h e light b e g a n t o b r e a k t h r o u g h t h e c r a c k s in o u r a l l - t o o - c l o s e d m i n d s ' (Laing, 1967, p. 129). 2 0 O n c e d e f i n e d b y Laing as a n o n t o l o g y o f e x i s t e n t i a l d e s p a i r a n d i s o l a t i o n , t h e n as a d i s t u r b a n c e in t h e r e a l m o f t h e i n t e r p e r s o n a l , p s y c h o s i s is n o w , in a shift b a c k f r o m t h e social t o p s y c h i c i n t e r i o r , a n a l o g o u s t o religious a n d m y s t i c a l r e v e l a t i o n . I n d e e d , s c h i z o p h r e n i a e v e n eclipses s a n i t y as t h e p r e f e r r e d m o d e of b e i n g : ' C a n w e n o t see t h a t this voyage is not what we need to be cured of, but that it is itself a natural ing our own appalling
state
of alienation
called
normalityV
p. 136, italics in t h e o r i g i n a l ) . The Politics of Experience
way of heal-
(Laing, 1967,
c u l m i n a t e s in this v i s i o n
of s c h i z o p h r e n i a as a R o m a n t i c e x p e r i e n c e of t h e s u b l i m e — a t r a n s c e n d e n t loss o f self f o l l o w e d b y t h e r e c o v e r y of a u t h e n t i c i t y , a n essential o r o r i g i n a l f o r m o f 20
This is foreshadowed in The Divided Self: 'I am aware that the man who is said to be deluded may be in his delusion telling me the truth, and this in no equivocal or metaphorical sense, but quite literally, and that the cracked mind of the schizophrenic may let in light which does not enter the intact minds of many sane people whose minds are closed' (Laing, 1990, p. 27).
b e i n g u n m a r r e d b y m o d e r n i t y a n d t e c h n o - s c i e n t i f i c r a t i o n a l i t y . In k e e p i n g w i t h t h e late 1960s Zeitgeist, L a i n g ' s s c h i z o p h r e n i a - a s - e n l i g h t e n m e n t t h e s i s c a p t u r e d t h e p u b l i c i m a g i n a t i o n o n a p o l i t i c o - s p i r i t u a l level in p a r t b e c a u s e of its clear r e j e c t i o n o f ' n e g a t i v e ' m e d i c a l m o d e l s of m a d n e s s . H o w e v e r , b e c a u s e it n o t o n l y p r e s e r v e s , b u t also h e i g h t e n s a n d celebrates, t h e 'essential m y s t e r y ' o f s c h i z o p h r e n i a , L a i n g ' s r e a d i n g of s c h i z o p h r e n i a as s u b l i m e e x p e r i e n c e c a n a c t u a l l y b e seen t o r e i n f o r c e its s t a t u s in p s y c h i a t r i c d i s c o u r s e . T h i s is a n t i p s y chiatry's translation of sublime object into sublime ontology: bypassing a n y d i s c u s s i o n of i n d i v i d u a l case histories o r s y m p t o m a t o l o g i c a l profiles, Politics of Experience
The
p o s i t s s c h i z o p h r e n i a n o t as c o m p r e h e n s i b l e in p e r s o n a l ,
p s y c h o l o g i c a l t e r m s (as f o r t h e early L a i n g , a n d m a n y p s y c h o a n a l y s t s ) b u t as a n e s s e n t i a l l y u n m a p p a b l e f o r m o f s p i r i t u a l l y s u p e r i o r b e i n g . In p s y c h i a t r y , schizophrenia's sublimity b o t h incites a n d unsettles scientific investigation, t h u s facilitating the e x p a n s i o n of the discipline. In Laingian antipsychiatry, o n e s h o u l d n o t so m u c h i n t e r r o g a t e s c h i z o p h r e n i a as r e v e r e its r o l e in facilitati n g t h e e x p a n s i o n of t h e p s y c h e . O u t s i d e its c o u n t e r c u l t u r a l c o n t e x t , L a i n g ' s c e l e b r a t i o n o f i n s a n i t y as a s p i r i t u a l j o u r n e y o f e g o loss s e e m s at b e s t r o m a n t i c a n d n a i v e . Yet at P e t e r S e d g w i c k n o t e s , w i t h i n o n l y a f e w y e a r s of The Politics of Experience
'virtually the entire
left a n d a n e n o r m o u s p r o p o r t i o n of t h e l i b e r a l - a r t s a n d s o c i a l - s t u d i e s r e a d i n g p u b l i c w a s c o n v i n c e d t h a t R . D . L a i n g a n d his b a n d of c o l l e a g u e s h a d p r o d u c e d novel a n d essentially accurate r e n d e r i n g s of w h a t psychotic experience truly s i g n i f i e d ' (Sedgwick, 1982, p. 6). Z b i g n i e w K o t o w i c z also n o t e s t h a t Laing w a s ' e l e v a t e d t o s t a r d o m ' b y its p u b l i c a t i o n a n d ' c a m e t o b e p e r c e i v e d as a m a v e r ick g u r u of s c h i z o p h r e n i c s , a l e a d e r of society's v a n g u a r d w h o , t h r o u g h e x p e r i e n c e s of t r a n s c e n d e n t a l reality, w o u l d b r e a k o u t o f t h e v i c i o u s circle in w h i c h t h e m o d e r n c a p i t a l i s t s o c i e t y i m p r i s o n s its c i t i z e n s ' ( K o t o w i c z ,
1997,
p. 2). As I have already suggested, analysts of a n t i p s y c h i a t r y , Sedgwick a n d K o t o w i c z i n c l u d e d , s e l d o m p r o b e o r p r o b l e m a t i z e its o p p o s i t i o n a l s t a n c e a g a i n s t m a i n s t r e a m p s y c h i a t r y . Ironically, it is T h o m a s Szasz w h o , in his vitriolic c r i t i q u e of L a i n g a n d t h e socialist a s p i r a t i o n s of Kingsley H a l l , p o i n t s o u t t h a t L a i n g i a n a n t i p s y c h i a t r y 'is, in s o m e ways, t h e m i r r o r i m a g e of t h e cult of m o d e r n i n s t i t u t i o n a l p s y c h i a t r y . A s in p s y c h i a t r y t h e c o r e c o n c e p t , t h e s a c r e d s y m b o l , is " s c h i z o p h r e n i a , " s o i n a n t i p s y c h i a t r y it is " a u t h e n t i c i t y " ' (Szasz, 1976, p. 57), 2 1 a n a u t h e n t i c i t y t h a t is o b t a i n a b l e , so L a i n g m a i n t a i n s , t h r o u g h t h e s c h i z o p h r e n i c v o y a g e . Szasz c o n t i n u e s : The antipsychiatrists' lack of imagination in inverting not only the logic and the vocabulary, but even the trappings, of psychiatry, and appropriating them all as their 21
Would that S/.as/. thought through the implications <>1 litis u llii|ue with reference to his own work.
own 'original' theoretical principles and therapeutic methods provokes, in me at least, only contempt and pity. (Szasz, 1976, p. 76) A l t h o u g h I o b v i o u s l y d o n o t share Szasz's s e n t i m e n t , I agree that Laing's a c c o u n t of s c h i z o p h r e n i a as a n e x p e r i e n c e of t h e s u b l i m e d o e s i n v e r t t h e logic, t h e v o c a b u l a r y , a n d t h e t r a p p i n g s of p s y c h i a t r y , b u t w o u l d a r g u e t h a t this says m o r e a b o u t t h e i n h e r e n t flexibility o f p s y c h i a t r y ' s clinical p i c t u r e o f s c h i z o p h r e n i a t h a n it d o e s a b o u t a n y f a i l u r e of i m a g i n a t i o n o n L a i n g ' s p a r t . U n d e r l y i n g t h i s c h a p t e r ' s analysis of t h e a n t i p s y c h i a t r y m o v e m e n t , s c h i z o phrenia, and the s u b l i m e has been the s u p p o s i t i o n that to stake a claim o n s c h i z o p h r e n i a — a s d i s t i n c t f r o m m a d n e s s in g e n e r a l , o r e v e n f r o m p s y c h o s i s — is also t o c o m m e n t o n its s t a t u s in p s y c h i a t r i c a n d p s y c h o a n a l y t i c d i s c o u r s e . In t h e case o f a n t i p s y c h i a t r y , a f o c u s o n p s y c h o l o g i c a l m e t a t h e o r y reveals t h r e e d i s t i n c t t r e n d s . Szasz's p o s i t i o n explicitly divests s c h i z o p h r e n i a of a n y associat i o n s w i t h t h e s u b l i m e , b u t in s o d o i n g it a l s o d e n i e s t h a t t h e r e is a n y s u c h t h i n g as a s c h i z o p h r e n i c experience
that can be meaningfully distinguished
f r o m e v e r y d a y m a l i n g e r i n g . T h e i n t e r m e d i a r y v i e w — L a i n g ' s analysis of schizo p h r e n i a in The Divided
Self—hinges
o n t h e issue o f u n d e r s t a n d a b i l i t y , p a r a -
doxically f r a m i n g s c h i z o p h r e n i c e x p e r i e n c e as a n t i - s u b l i m e ( w h o l l y intelligible) a n d s u b l i m e ( b e c a u s e essentially b e y o n d c o m p r e h e n s i o n ) . L a i n g ' s s u b s e q u e n t v a l o u r i z a t i o n o f s c h i z o p h r e n i a as s u b l i m e e x p e r i e n c e resolves this t e n s i o n b y a s s i g n i n g s c h i z o p h r e n i a a n o n t o l o g i c a l s t a t u s t h a t is a t o n c e t r a n s c e n d e n t , m y s t i c a l , a n d s u p e r i o r t o a n a l i e n a t e d e x i s t e n c e . In s o d o i n g , it e x p o s e s a n d a f f i r m s p s y c h i a t r y ' s c o n s t r u c t i o n o f s c h i z o p h r e n i a as s u b l i m e . A l t h o u g h t h e r e is n o d e n y i n g t h a t a n t i p s y c h i a t r i c a c c o u n t s o f t h e o r i g i n s o f s c h i z o p h r e n i a w e r e t h e o r e t i c a l l y at o d d s w i t h t h e received w i s d o m o f t h e day, t h e elasticity of p s y c h i a t r y ' s d e f i n i t i o n of s c h i z o p h r e n i a — a disease w i t h n o e m p i r i c a l l y c e r t a i n cause o r c u r e — w a s such that most of these could simply be absorbed into the g r a b b a g of a l r e a d y c o m p e t i n g t h e o r i e s . It w o u l d a p p e a r t h a t a n t i p s y c h i a t r i s t s e i t h e r s t r u g g l e d t o e s c a p e f r a m i n g s c h i z o p h r e n i a as a s u b l i m e o r u n k n o w a b l e d i s o r d e r , o r s u c c e e d e d in d e m y s t i f y i n g t h e p s y c h i a t r i c a c c o u n t of s c h i z o p h r e nia only to r e n d e r the t e r m virtually meaningless. T h e s u b l i m e , t h e n , o f f e r s a flexible f r a m e w o r k t h r o u g h w h i c h t o u n d e r s t a n d h o w t h e antipsychiatric critique of psychiatry a n d psychoanalysis r e m a i n s c o m p l i c i t w i t h t h e s e d i s c o u r s e s at a ' m e t a ' level. T h e s i g n i f i c a n c e o f t h e a n t i p s y c h i a t r y m o v e m e n t is n o t l i m i t e d to t h e s h o r t - l i v e d a p p e a r a n c e of p o l e m i c s , p o l i t i c a l c o n v i c t i o n , a n d p a s s i o n in t h e c l i n i c a l s e t t i n g . A s N i c k C r o s s l e y o b s e r v e s , w h i l e n o o n e w a s f o r c e d t o a g r e e w i t h a n t i p s y c h i a t r y , a n d m a n y in t h e m e d i c a l e s t a b l i s h m e n t d i d n o t , ' n o b o d y c o u l d c a r r y o n as b e f o r e a f t e r a n t i p s y c h i a t r y . T h e field ol p s y c h i u t i i i l o n l c n l i o n w a s o p e n e d u p f o r n e w ,
m o r e critical t r a i n s o f t h o u g h t . T h e g r o u n d h a s m o v e d a n d t h e p a r a d i g m s h i f t e d ' (Crossley, 2006, p. 123). In a d d i t i o n t o o p e n i n g u p n e w p a t i e n t a n d survivor m o v e m e n t s , o n e of the lasting a c h i e v e m e n t s of antipsychiatry was t o t r a n s f o r m the ways in w h i c h s c h i z o p h r e n i a c o u l d b e c o n c e p t u a l i z e d in n o n clinical c o n t e x t s . If s c h i z o p h r e n i c s y m p t o m s registered p a r t i c u l a r effects of capitalism, psychiatric disciplinary p o w e r , families, a n d social life at large o n t h e subject, o r else were a m e a n s of rejecting o r t r a n s c e n d i n g t h e entire messy b u s i n e s s of m o d e r n i t y , ' t h e s c h i z o p h r e n i c ' was s u d d e n l y available t o take o n m u l t i p l e , p o t e n t , a n d h i t h e r t o u n e x p l o i t e d symbolic roles. O f these, arguably t h e m o s t n o t o r i o u s w a s as a r e v o l u t i o n a r y s u b j e c t . T u r n i n g n e x t t o Deleuze a n d G u a t t a r i ' s analysis of c a p i t a l i s m a n d s c h i z o p h r e n i a , w e c a n see h o w t h e antipsychiatric critique of psychiatry e x t e n d s t o an a n t i - O e d i p a l critique of the w h o l e psychological enterprise. A final observation t o close w h a t is a pivotal c h a p t e r w i t h i n t h e overall argum e n t of this b o o k . T h e n a r r a t i v e t r a j e c t o r y of The Sublime Object of
Psychiatry—
w h i c h flows f r o m clinical psychiatry, t o psychoanalysis, t o antipsychiatry a n d cultural theory, c o n c l u d i n g in the imaginative w o r l d s of literary fiction—is, as I have e m p h a s i z e d repeatedly, b y n o m e a n s t h e o n l y story t h a t can o r s h o u l d be told a b o u t the c o n c e p t of s c h i z o p h r e n i a . J o n a n a t h a n Metzl's p o w e r f u l b o o k The Protest Psychosis: How Schizophrenia
Became a Black Disease is an interdis-
ciplinary study of t h e c o m p l e x ' c o n f l u e n c e of social a n d m e d i c a l forces', w h i c h e f f e c t e d ' s c h i z o p h r e n i a ' s r h e t o r i c a l t r a n s f o r m a t i o n f r o m an illness of w h i t e f e m i n i n e docility t o o n e o f black m a l e hostility' in A m e r i c a d u r i n g t h e civil r i g h t s e r a ( 2 0 0 9 , p. x v ) . Stokely C a r m i c h a e l , w h o p a r t i c i p a t e d in t h e 1967 'Dialectics of L i b e r a t i o n ' c o n f e r e n c e in L o n d o n , is a key figure in Metzl's s t u d y (see especially p p . 121, 1 3 3 - 4 ) a n d r e p r e s e n t s t h e c e n t r a l p o i n t o f o v e r l a p b e t w e e n o u r t w o very d i f f e r e n t a c c o u n t s of h o w s c h i z o p h r e n i a has b e e n c o n c e p t u a l i z e d a c r o s s clinical a n d c u l t u r a l d o m a i n s t h r o u g h o u t t h e t w e n t i e t h c e n t u r y . I n s t i t u t i o n a l i z e d r a c i s m , racialized d i a g n o s t i c c a t e g o r i e s , p r o t e s t , resistance, violence, hostility, m a r g i n a l i z a t i o n , c r i m i n a l i t y , g e n d e r , race, a n d b o d i e s are central c o n c e p t s in The Protest Psychosis. It is telling that they h a r d ly figure at all in t h e w o r k of t h e cultural theorists u n d e r c o n s i d e r a t i o n in the next few chapters. I n d e e d , as we shall see, o n e of the h a l l m a r k s of what I have b e e n calling cultural t h e o r y ' s 'figure of t h e s c h i z o p h r e n i c ' is that there is little sense at all of b e i n g a figure, of b e i n g e m b o d i e d . O n e of t h e q u e s t i o n s Metzl's w o r k raises, a n d t o w h i c h we shall r e t u r n , is t o w h a t extent the highly abstracted ' f i g u r e of the s c h i z o p h r e n i c ' in cultural t h e o r y is t h e r e f o r e inextricably (if still invisibly) tied t o whiteness.
Chapter 4
Anti-Oedipus and the politics of the schizophrenic sublime
T o begin, a quotation: The schizo carries along the decoded flows, makes them traverse the desert of the body without organs, where he installs his desiring-machines and produces a perpetual outflow of acting forces. He has crossed over the limit, the schiz, which maintained the production of desire always at the margins of social production, tangential and always repelled... These men of desire—or do they not yet exist?—are like Zarathustra. They know incredible sufferings, vertigos, and sicknesses. They have their specters. They must reinvent each gesture. But such a man produces himself as a free man, irresponsible, solitary, and joyous, finally able to say and do something simple in his own name, without asking permission; a desire lacking nothing, a flux that overcomes barriers and codes, a name that no longer designates any ego whatever. He has simply ceased being afraid of becoming mad. He experiences and lives himself as the sublime sickness that will no longer affect him. Here, what is, what would a psychiatrist be worth? (Deleuze and Guattari, 1982, p. 131) Anti-Oedipus:
Capitalism
and Schizophrenia
( 1 9 8 2 ) is o n e of t h e m o s t n o t o -
rious p h i l o s o p h i c a l w o r k s of the late t w e n t i e t h c e n t u r y . 1 A c o l l a b o r a t i o n b e t w e e n F r e n c h p h i l o s o p h e r Gilles D e l e u z e a n d Italian p s y c h o a n a l y s t a n d activist Félix G u a t t a r i , it was, as I a n B u c h a n a n so b e a u t i f u l l y p u t s it, a n ' i n t e l lectual cluster b o m b ' l o b b e d i n t o the fray of p o s t - 1 9 6 8 F r e n c h t h e o r y ( B u c h a n a n , 2008, p. 21). Deleuze and Guattari claim to have written their b o o k f o r 15- t o 2 0 - y e a r o l d s ( D e l e u z e , 1990, p p . 7 - 8 ) , a n d o f f e r it as a t o o l f o r political struggle r a t h e r t h a n a p h i l o s o p h i c a l t r a c t t o b e d i g e s t e d in its e n t i r e t y . W h e t h e r Anti-Oedipus
r e a c h e d , e n g a g e d o r m o b i l i z e d i n t o a c t i o n its i n t e n d e d
t e e n a g e a u d i e n c e I d o n o t k n o w , b u t it d i d s u c c e e d in s e n d i n g s h o c k w a v e s t h r o u g h t h e a c a d e m i c e s t a b l i s h m e n t . Q u i t e a p a r t f r o m its s e n s a t i o n a l i s m — t h e s c a n d a l o u s t r e a t m e n t of F r e u d a n d M a r x , s t r i k i n g b u t d i f f i c u l t style, intellectual hybridity, a n d a l m o s t m a n i c e x u b e r a n c e — i t played a decisive role in
1
And has been cited over 2700 times in peer reviewed publications in English (Google scholar search, 17 November 2010),
p r o m o t i n g s c h i z o p h r e n i a as a p a r a d i g m t h r o u g h w h i c h to u n d e r s t a n d subjectivity in t h e late capitalist era. Anti-Oedipus
c a p i t a l i z e d o n t h e m o m e n t u m of t h e a n t i p s y c h i a t r y m o v e -
m e n t , e x t e n d e d its c r i t i q u e of p s y c h i a t r i c a n d p s y c h o a n a l y t i c p r a c t i c e , a n d intensified its valorization o f ' t h e s c h i z o p h r e n i c ' (or 'schizo') as a r e v o l u t i o n ary a n d revelatory figure. Deleuze a n d G u a t t a r i ' s w o r k m a r k s a n e w m o m e n t in t h e history of r e v o l u t i o n a r y struggle, a m o m e n t in w h i c h all f o r m s of social o r d e r ( i n c l u d i n g class-based o p p o s i t i o n a l politics, identity politics, a n d even i d e n t i t y itself) are r e j e c t e d as covertly t o t a l i t a r i a n ( P l a n t , 2001, p. 1097). In o r d e r t o be true to its n a t u r a l l y rebellious state, desire h a d t o be freed f r o m the systems w h i c h s o u g h t t o c o n t a i n a n d r e d e p l o y it in t h e service of capitalism. R a t h e r t h a n reinvigorate o r even redefine t h e r e v o l u t i o n a r y subject of M a r x i s m , Deleuze a n d G u a t t a r i t h e r e f o r e a d v o c a t e d a b a n d o n i n g t h e n o t i o n of integrated subjectivity altogether, mobilizing instead the micro-political, machinic p r o d u c t i v i t y of t h e u n c o n s c i o u s in t h e struggle against capitalism. Enter s c h i z o p h r e n i a . S c h i z o p h r e n i a , in Anti-Oedipus,
is a process of psychic
d e t e r r i t o r i a l i z a t i o n w h i c h liberates desire f r o m t h e straitjacket of O e d i p u s , a p r o c e s s t h a t is s i m u l t a n e o u s l y t h e r e a l i z a t i o n of c a p i t a l i s m a n d its p o t e n t i a l u n d o i n g . S c h i z o p h r e n i a p r o v i d e s the p r i m a r y c o n c e p t u a l vehicle for Deleuze a n d G u a t t a r i ' s articulation of a radically d e c e n t r e d , desiring, a n d r e v o l u t i o n a r y f o r m of (non)subjectivity, as well as the basis f o r a 'materialist psychiatry' that views desire in t e r m s of p r o d u c t i o n a n d p r o d u c t i o n in t e r m s of desire (Deleuze, q u o t e d in D e l e u z e a n d G u a t t a r i , 1990, p. 17; see also D e l e u z e a n d G u a t t a r i , 1982, p. 5). Breaking with t h e p s y c h o a n a l y t i c fixation o n O e d i p u s , n e u r o s i s , a n d psychic interiority, Deleuze a n d Guattari's schizoanalysis aims 'to deoedipalize the u n c o n s c i o u s ' , ' t o d e m o n s t r a t e the existence of an u n c o n s c i o u s libidinal investment of sociohistorical p r o d u c t i o n ' (Deleuze a n d Guattari, 1982, p p . 81, 98) a n d ' t o get r e v o l u t i o n a r y , artistic, a n d a n a l y t i c m a c h i n e s w o r k i n g as p a r t s , cogs, o f o n e a n o t h e r ' ( D e l e u z e a n d G u a t t a r i , q u o t e d in Deleuze 1990, p. 23). Rather t h a n locate Anti-Oedipus
w i t h i n its usual c o n t e x t s — p o s t - M a r x i s m ,
p o s t - m o d e r n i s m , t h e e v e n t s of M a y 1968, a n d t h e o e u v r e of D e l e u z e — t h i s c h a p t e r a p p r o a c h e s the text f r o m the perspective of the interdisciplinary d e b a t e s a b o u t s c h i z o p h r e n i a that have so far been the f o c u s of this b o o k . W i t h t h e p u b l i c a t i o n o f A Thousand Schizophrenia
Plateaus
( v o l u m e t w o o f Capitalism
and
( 1 9 8 7 ) , b u t a t o m e in w h i c h r e f e r e n c e s t o s c h i z o p h r e n i a are
practically n o n - e x i s t e n t ) , a n d t h e e n d o f t h e a n t i p s y c h i a t r i c era, a c a d e m i c s have evinced little interest in Anti-Oedipus'a
m a n y a n d c o m p l e x representations
of schizophrenia, a n d to m y knowledge n o o n e has engaged in a n y d e p t h with the question of why Deleuze and G u a t t a r i assign this specific p s y c h o p a t h o l o g y
s u c h a c e n t r a l r o l e in t h e i r a n a l y s i s . M y r e a d i n g o f s c h i z o p h r e n i a in Oedipus
Anti-
c o n s i d e r s h o w D e l e u z e a n d G u a t t a r i u s e s c h i z o p h r e n i a strategically,
but not unproblematically, to reconceptualize a revolutionary (non)subject, a n d to challenge psychoanalytic, antipsychiatric, a n d , by extension, psychiatric m o d e l s of p s y c h i c h e a l t h . It is n o w n o t u n c o m m o n f o r D e l e u z e a n d G u a t t a r i ' s use of s c h i z o p h r e n i a t o b e d i s m i s s e d o u t o f h a n d as d e e p l y m i s g u i d e d o r e v e n s o m e t h i n g of a n e m b a r r a s s m e n t . 2 E x a m i n i n g t h e p o r t r a y a l o f s c h i z o p h r e n i a in Anti-Oedipus
in t h e
d e t a i l it d e s e r v e s , h o w e v e r , e n a b l e s u s t o i d e n t i f y t w o m a j o r t e n s i o n s in t h e i r a c c o u n t o f its s u b v e r s i v e p o t e n t i a l . T h e first c o n c e r n s t h e r e l a t i o n s h i p b e t w e e n t h e r e v o l u t i o n a r y f o r m o f s c h i z o p h r e n i a d i s t i n c t f r o m its clinical c o u n t e r p a r t . D e l e u z e a n d G u a t t a r i ' s thesis d e p e n d s u p o n d r a w i n g a h a r d a n d fast d i s t i n c t i o n b e t w e e n a r e v o l u t i o n a r y f o r m o f s c h i z o p h r e n i a ( ' t h e s c h i z o ' ) a n d its p a t h ological correlates ('the p a r a n o i d ' a n d 'the schizophrenic'). Focusing on the i n t e r n a l c o n t r a d i c t i o n s p r e s e n t in D e l e u z e a n d G u a t t a r i ' s r e a d i n g of S c h r e b e r ' s Memoirs
( 1 9 5 5 ) , I will a r g u e t h a t b e c a u s e t h e d i f f e r e n t i a t i o n o f t h e s e t h r e e
f o r m s of a n o e d i p a l s u b j e c t i v i t y is in fact h i g h l y u n s t a b l e , it is a l m o s t i m p o s s i ble to safeguard d y n a m i c m o d e s of schizophrenic (non)subjectivity f r o m d e s c e n d i n g i n t o paralysis o r p a t h o l o g y . T h e s e c o n d area o f t e n s i o n is f o u n d at t h e level of m e t a t h e o r y , in t h e w a y D e l e u z e a n d G u a t t a r i m a k e t h e i r m o d e l of agency contingent u p o n schizophrenia's association with the sublime. Schizophrenia's political efficacy—its capacity n o t simply to represent capitali s m b u t t o d e s t r o y i t — i s f o r D e l e u z e a n d G u a t t a r i a f u n c t i o n of its s u b l i m i t y , of b e i n g o u t s i d e a n d b e y o n d r e p r e s e n t a t i o n , c a p i t a l i s m , O e d i p u s , i d e n t i t y , a n d p s y c h o a n a l y t i c r e a c h . T h e key q u e s t i o n h e r e is h o w effective a politics f o u n d e d o n t h e s u b l i m e c o u l d b e . In w h a t follows, t h e n , m y a i m is t o d e m o n s t r a t e t h a t in its p r o x i m i t y t o clinical a c c o u n t s of p s y c h o s i s , D e l e u z e a n d G u a t t a r i ' s m o d e l of a r e v o l u t i o n a r y f o r m of s c h i z o p h r e n i a is d o u b l y p r o b l e m a t i c : first b e c a u s e it c a n n o t be d e f e n d e d against b e c o m i n g ' m e r e ' pathology, a n d secondly because its p o l i t i c a l e f f i c a c y is d e p e n d e n t o n , a n d I s u g g e s t l i m i t e d by, its a s s o c i a t i o n with the sublime.
2
Although the launch of a new journal, Deleuze Studies, and two publications of Deleuze and Guattari's work from this period may well reverse this trend. As the name suggests, The Anti-Oedipus Papers (Guattari, 2006) is primarily a collection of the letters and notes sent by Guattari to Deleuze during the course of writing the book. Deleuze annotated and returned the letters, which read at times as a veritable collage of ideas. One of the highlights of Two Regimes of Madness (Deleuze, 2006) is the brief piece 'Schizophrenia and Society', written in 1975 for the Encyclopaedia Universalis. It is undoubtedly the most succinct and accessible account of their view of schizophrenia, and, in my view, puts an end to many of the misconceptions surrounding their attitude towards the term.
Introducing schizophrenia and capitalism A l t h o u g h their critique of psychoanalysis o wes m u c h to M i c h e l F o u c a u l t ' s Madness
and Civilization
(1993), Deleuze and Guattari eschew trans-historical
t e r m s like m a d n e s s , u n r e a s o n , a n d e v e n p s y c h o s i s , i n s t e a d s t a k i n g t h e i r claim on that quintessentially twentieth-century psychopathology: schizophrenia. T h e authors' a t t a c h m e n t to psychiatric t a x o n o m y belies their irreverence t o w a r d s t h e p s y c h i a t r i c e s t a b l i s h m e n t — u n p a c k i n g t h e t e r m ' s c h i z o p h r e n i a ' in Anti-Oedipus
r e q u i r e s n o t t h a t w e u n d e r s t a n d n e u r a l c i r c u i t r y o r t h e o r i e s of
heredity, b u t the d o u b l e or paradoxical operation of capitalism. According to D e l e u z e a n d G u a t t a r i , t h e c a p i t a l i s t m a c h i n e is c o n s t a n t l y b r e a k i n g d o w n c o d e s a n d d i s m a n t l i n g h i s t o r i c a l l y m e a n i n g f u l social s t r u c t u r e s t o p e r m i t t h e f r e e f l o w of c a p i t a l a n d l a b o u r . At t h e s a m e t i m e , in o r d e r t o f u n c t i o n , it m u s t r e t e r r i t o r i a l i z e t h e social s p h e r e , r e - e s t a b l i s h ' a r t i f i c i a l ' c o d e s a n d r e - c h a n n e l desire. Deleuze and Guattari identify t w o poles of libidinal investment possible u n d e r capitalism—one paranoid molar (the drive to restore or re-impose m e a n i n g , c o d e s , a n d s t r u c t u r e s ) , t h e o t h e r a ' m o l e c u l a r s c h i z o p h r e n i c line o f e s c a p e ' ( D e l e u z e a n d G u a t t a r i , 1982, p . 3 1 5 ) . S c h i z o p h r e n i a , t h e n , is t h e p r o c ess of p s y c h i c a n d social d e t e r r i t o r i a l i z a t i o n u n l e a s h e d b y c a p i t a l i s m ; it is c a p i t a l i s m ' s ' d e e p e s t t e n d e n c y ' b u t its a b s o l u t e limit, 'its d i f f e r e n c e , its d i v e r g e n c e , a n d its d e a t h ' ( D e l e u z e a n d G u a t t a r i , 1982, p . 2 4 5 ) . 3 B e c a u s e it k n o w s n o T a n d n o ego, s c h i z o p h r e n i a is s y n o n y m o u s w i t h a t r u e o r o r i g i n a l desire, w h i c h p r e c e d e s t h e O e d i p a l c o n f i g u r a t i o n of m o t h e r - f a t h e r - c h i l d . S c h i z o p h r e n i a is d i s j u n c t i o n as o p p o s e d t o s y n t h e s i s , reality as o p p o s e d t o r e p r e s e n t a t i o n , a n ' e i t h e r . . . o r . . . o r ' of s e e m i n g l y u n l i m i t e d possibilities ( D e l e u z e a n d G u a t t a r i , 1982, p p . 12, 76, ellipses in t h e o r i g i n a l ) . D e l e u z e a n d G u a t t a r i o u t l i n e t h r e e f i g u r e s p r o d u c e d b y o r in r e l a t i o n t o schizophrenia-as-process: 'the schizo', 'the paranoid', a n d 'the schizophrenic'. ' T h e s c h i z o ' is t h e r e a l i z a t i o n o r e m b o d i m e n t of t h e p r o c e s s o f s c h i z o p h r e n i a .
3
'What we are really trying to say', write Deleuze and Guattari (1982, p. 34), 'is that capitalism, through its process of production, produces an awesome schizophrenic accumulation of energy or charge, against which it brings all its vast powers of repression to bear, but which nonetheless continues to act as capitalism's limit. For capitalism constantly counteracts, constantly inhibits this inherent tendency while at the same time allowing it free rein; it continually seeks to avoid reaching its limit while simultaneously tending towards that limit. Capitalism institutes or restores all sorts of residual and artificial, imaginary, or symbolic territorialities . . . ' , which is why the boundary-less schizophrenia functions as its absolute limit. As Jean-Francois Lyotard (1977, p.25) notes, 'Schizophrenia is called the absolute limit, because if it ever happened, it would be force undistributed in a libidinal network, pure liquid inflexion'.
H e ( f o r in Anti-Oedipus,
' t h e s c h i z o ' is always a s s i g n e d t h e m a s c u l i n e p r o n o u n )
is t h e ' u n i v e r s a l p r o d u c e r ' ; a n a t h e i s t , n o m a d , a n d o r p h a n ; a f i g u r e w h o e x p l o d e s t h e ' O e d i p a l g e n e a l o g y ' a n d t r a v e r s e s d e t e r r i t o r i a l i z e d space w i t h a n i d i o s y n c r a t i c set o f c o - o r d i n a t e s ( S e e m , i n t r o d u c t i o n t o D e l e u z e a n d G u a t t a r i , 1982, p. xxi). Because the ' c o d e of d e l i r i u m o r of desire p r o v e s t o h a v e a n e x t r a o r d i n a r y f l u i d i t y ' , ' t h e s c h i z o ' , like a digital v i r u s , is s u b v e r s i v e a n d c o n t i n u a l l y o n t h e m o v e ; ' h e d e l i b e r a t e l y scrambles
all the codes', p a r o d y i n g , p a r -
r o t i n g , a n d b r e a k i n g a p a r t t h e social s y s t e m s h e i n h a b i t s ( D e l e u z e a n d G u a t t a r i , 1982, p. 15, italics in t h e o r i g i n a l ) . R e v o l u t i o n is ' t h e s c h i z o ' s ' p r e r o g a t i v e : h e ' d e l i b e r a t e l y seeks o u t t h e v e r y l i m i t o f c a p i t a l i s m : h e is its i n h e r e n t t e n d e n c y b r o u g h t t o f u l f i l m e n t , its s u r p l u s p r o d u c t , its p r o l e t a r i a t , a n d its e x t e r m i n a t i n g a n g e l ' ( D e l e u z e a n d G u a t t a r i , 1982, p . 35). D e l e u z e a n d G u a t t a r i c o n t r a s t this dynamic, r o m a n t i c figure with two f u r t h e r anoedipal subjects: 'the p a r a n o i d ' a n d 'the schizophrenic'. ' T h e p a r a n o i d ' directly o p p o s e s the process of schizop h r e n i a b y o v e r c o d i n g d e s i r e , v i e w i n g t h e e n t i r e w o r l d t h r o u g h t h e p r i s m of a n i n d i v i d u a l ego, a n d r e i n s t a t i n g a m a s t e r o r ' d e s p o t i c ' signifier as t h e s o u r c e o f all m e a n i n g . A l t h o u g h f r o m t h e p e r s p e c t i v e o f p s y c h i a t r y s c h i z o p h r e n i a h a s always e n c o m p a s s e d p a r a n o i a as a s u b t y p e , Anti-Oedipus
shares the psycho-
analytic t e n d e n c y to differentiate p a r a n o i a f r o m schizophrenia, b u t goes f u r t h e r in p o s i t i o n i n g t h e t w o in d i a m e t r i c o p p o s i t i o n . W h a t , t h e n , o f ' t h e s c h i z o p h r e n i c ' , t h e ' a r t i f i c i a l ' , o r t h e ' s i c k ' schizo? F o r D e l e u z e a n d G u a t t a r i , ' t h e s c h i z o p h r e n i c ' is t h e interruption
of schizophrenia-as-process; the o u t -
c o m e o f t r y i n g a n d failing t o b r e a k t h r o u g h social a n d p s y c h i c r e p r e s s i o n . ' T h e h o s p i t a l schiz, t h e great a u t i s t i c o n e , t h e clinical e n t i t y t h a t " l a c k s " O e d i p u s ' , is like a n ' i m m e n s e t r a n s f i x e d h i p p o p o t a m u s w h o will n o t c o m e b a c k u p t o t h e s u r f a c e ' ( D e l e u z e a n d G u a t t a r i , 1982, p. 136). C a t a t o n i c , a b o d y w i t h o u t o r g a n s , 4 i m p a s s i v e , a n d w i t h d r a w n , ' t h e s c h i z o p h r e n i c ' is ' t h e s c h i z o ' w h o h a s b e e n r e - a b s o r b e d o r t r a p p e d in t h e c a p i t a l i s t s y s t e m ( D e l e u z e a n d G u a t t a r i , 1982, p . 2 4 5 ) . 5 4
For Deleuze and Guattari, 'The full body without organs is the unproductive, the sterile, the unengendered, the unconsumable' (Deleuze and Guattari, 1982, p. 8). It is not a body as such, or the image of a body, but designates a 'zero-degree of intensity, a moment of antiproduction fed back into the process of production' (Bogue, 1989, p. 93). Deleuze and Guattari borrow the term from Antonin Artaud's 1946 poem 'To Have Done with the Judgement of God' (Artaud, 1976).
5
It is seldom acknowledged that Deleuze and Guattari were not the first to emphasize a structural continuity between schizophrenia and capitalism. Joseph Gabel's False Consciousness, first published in French in 1962, synthesized clinical psychiatry and Marxism to draw a 'sociopathological parallelism' between schizophrenia and false consciousness. Drawing on the work of his mentor Eugene Minkowski (an existentialphenomenological psychiatrist who was an important influence also for R.D. Laing and
Sidelining and sanitizing schizophrenia Broadly speaking, the academic establishment has r e s p o n d e d to the concept of s c h i z o p h r e n i a a n d its clinical c o n n o t a t i o n s in Anti-Oedipus
fleetingly o r w i t h
m a r k e d d i s c o m f o r t (see B r a i d o t t i , 2005; C o l e b r o o k , 2 0 0 2 , 2006; P a t t o n , 2 0 0 1 ) . D e l e u z e a n d G u a t t a r i ' s critics h a v e d i s m i s s e d t h e i r u s e o f p s y c h i a t r i c t e r m i n o l o g y as ' u n c r i t i c a l , illegitimate, a n d s i m p l y i m p r e c i s e ' ( R a j c h m a n , 1977, p. 4 6 ) ; ' i r r e s p o n s i b l e a n d i n s e n s i t i v e t o t h e h u m a n c o s t s o f t h i s illness' (Glass, 1993, p . 15) a n d p l a u s i b l e o n l y as m y t h o r f a n t a s y (Elliott, 2 0 0 2 , p p . 1 5 7 - 6 3 ; F r a n k , 2001, p. 1272).6 T h o s e m o r e s y m p a t h e t i c to Deleuze a n d Guattari's project h a v e e s c h e w e d l i t e r a l i s m in f a v o u r of a t r o p i c r e a d i n g of t h e i r w o r k , i n s i s t i n g that the schizophrenia Deleuze and Guattari write about has nothing to do w i t h t h e s c h i z o p h r e n i a t h a t a f f e c t s o n a v e r a g e o n e in o n e h u n d r e d p e o p l e . Sylvere L o t r i n g e r , w h o d e v o t e d a n e n t i r e issue of Semiotext(e)
to
Anti-Oedipus,
t h e r e f o r e d e f i n e s s c h i z o p h r e n i a 'loosely, a n d n o t clinically, as t h e u n c o n t r o l lable, p o l y m o r p h o u s m o v e m e n t of desire' ( L o t r i n g e r , 1977, p. 8), w h e r e a s B r i a n M a s s u m i sees it as ' t h e e n l a r g e m e n t s of life's l i m i t s t h r o u g h t h e p r a g m a t i c p r o l i f e r a t i o n o f c o n c e p t s ' ( M a s s u m i , 1992, p p . 1, 9 2 ) . E u g e n e H o l l a n d ' s o t h e r w i s e a u t h o r i t a t i v e w o r k o n Anti-Oedipus
g o e s f u r t h e s t in t h i s f i g u r a t i v e
t r a d i t i o n (see H o l l a n d , 1 9 8 5 - 1 9 8 6 ; 1988; 1998; 1999). D e s p i t e D e l e u z e a n d Guattari's m a n y references to psychiatric, psychoanalytic, antipsychiatric,
Louis Sass), Gabel argued that: 'Schizophrenia ... in fact clearly represents a form of reified consciousness, characterized on the existential level by a deterioration of dialectical praxis, and on the intellectual level by a de-dialecticization of cognitive functions, a phenomenon described long ago by E. Minkowski as morbid rationalism [1927], The appropriate rationality of false consciousness, characterized by a loss of the dialectical quality of thought is therefore clearly a social form of morbid rationalism; inversely, I consider the onset of schizophrenia as an individual form of false consciousness. The mental state therefore constitutes a real bridge between the areas of social and clinical alienation; it is a form of alienation both in the Marxist sense and in the psychiatric meaning of the term' (Gabel, 1976, p.xx-xxi). Deleuze and Guattari reference one of Gabel's independently published case studies but curiously do not refer to False Consciousness, even though Gabel's use of schizophrenia to show the congruence between psychiatric and social forms of alienation resonates with their account o f ' t h e schizophrenic' as described above. For a comprehensive introduction to Gabel's work, see Sica (1995). 6
If anything, Gabel's work, though much less widely read, was even more vehemently rejected: 'Gabel's identification of schizophrenia, reification, ideology, and false consciousness is ultimately ludicrous (.. and it is a travesty of Marxist thought to conflate the highly complex notion of ideology with such an extreme form of mental illness as schizophrenia' (Swingcwood, 1977, p. 224).
fictional,
a n d a u t o b i o g r a p h i c a l a c c o u n t s of s c h i z o p h r e n i a , 7 H o l l a n d argues
t h a t a b e t t e r a n a l o g y f o r this d e t e r r i t o r i a l i z i n g p r o c e s s is i m p r o v i s a t i o n a l jazz. ' W h e n r e f e r e n c e s a r e m a d e . . . in Anti-Oedipus
. . . t o s c h i z o p h r e n i a as t h e
principle of f r e e d o m ' , H o l l a n d writes, ' r e a d e r s s h o u l d t h i n k of jazz, w h i c h r e p r e s e n t s a f u l f i l m e n t o f t h e p r o c e s s of s c h i z o p h r e n i a ' a n d ' a n ideal i n s t a n c e of h u m a n r e l a t i o n s a n d i n t e r p e r s o n a l d y n a m i c s ' ( H o l l a n d , 1999, p. xi). A l t h o u g h H o l l a n d ' s m e t a p h o r is n o t w h o l l y i n c o m p a t i b l e w i t h t h e s p i r i t o f s c h i z o p h r e n i a - a s - p r o c e s s ( e v e n if it is, as h e a c k n o w l e d g e s , i n s u f f i c i e n t l y p o l i t ical), it c o m p l e t e l y m i s s e s t h e specificity, a n d h e n c e t h e c o m p l e x i t y , o f D e l e u z e a n d Guattari's account of schizophrenia's different manifestations. If t h e r e is o n e c o m p e l l i n g r e a s o n i m m e d i a t e l y t o b e w a r y of e f f o r t s t o sanitize s c h i z o p h r e n i a in Anti-Oedipus,
a n d o f critics s e e k i n g t o divest t h e t e r m of its
p o t e n t i a l l y u n p l e a s a n t clinical c o n n o t a t i o n s , it is Félix G u a t t a r i (see G u a t t a r i , 1996c). B e y o n d his c o l l a b o r a t i o n w i t h D e l e u z e , G u a t t a r i is p e r h a p s b e s t k n o w n as a m i l i t a n t a n t i p s y c h i a t r i s t a n d a f o r c e f u l critic of t h e r e s i d u a l h u m a n i s m a n d perceived political weaknesses of t h e a n t i p s y c h i a t r y m o v e m e n t . A l t h o u g h s y m p a t h e t i c t o Laing, G u a t t a r i saw in his r e t r e a t t o m y s t i c i s m a f a i l u r e t o realize t h e p o t e n t i a l o f h i s earlier t h e o r e t i c a l i n s i g h t s , a n d d i s m i s s e d t h e K i n g s l e y Hall e x p e r i m e n t as m i s g u i d e d in its r e i n s t a t e m e n t o f O e d i p a l s t r u c t u r e s a n d its e m p h a s i s o n d e c o d i n g t h e secrets of p s y c h o s i s ( G u a t t a r i , 1996a, d ) . H e writes: Let's hope that Laing, who has sought to dissociate himself in an exemplary fashion from the traditional role of the psychiatrist, returns to the concrete struggle against the repression of the mentally ill and that he will be able to define more rigorously the conditions of a revolutionary psychiatric practice, that is, of a non-utopian psychiatry that is susceptible to being taken up en masse by the avant garde of mental health workers and by the mentally ill themselves. (Guattari, 1996d, p. 51) G u a t t a r i a d m i r e d aspects of the institutional r e f o r m s achieved by Italian a n t i p s y c h i a t r i s t F r a n c o Basaglia, b u t t h o u g h t it i m p o r t a n t n e v e r t o lose sight of t h e m a d n e s s of m a d n e s s a n d the d a n g e r s of r e d u c i n g m e n t a l alienation to social a l i e n a t i o n ( G u a t t a r i , 1996b, p . 4 4 ) . A c c o r d i n g t o G a r y G e n o s k o , G u a t t a r i c o n s i d e r e d G e r m a n y ' s r a d i c a l S P K (Sozialistisches Patienten
Kollektiv)
exem-
p l a r y o f t h e i d e a l s of a n t i p s y c h i a t r y b e c a u s e t h e y ' e s t a b l i s h e d a n i n e x t r i c a b l e 7
These include references to the psychiatric textbooks of Kraepelin and Bleuler; the work of Freud, Lacan, Tausk, Jung, Klein, and others in the psychoanalytic tradition; the antipsychiatric case studies and political treatises of Laing and Cooper; the 'schizophrenic' style and sensibility of the Beat poets, DH Lawrence, Henry Miller, and Samuel Beckett; and finally, to the autobiographical accounts of schizophrenia published by Antonin Artaud, Vaslav Nijkinsky, and Daniel Paul Schreber. It is perhaps little wonder that 'the schizo', in Anti-Oedipus, should bear the masculine pronoun.
link b e t w e e n political s t r u g g l e a n d m e n t a l illness, m a k i n g m a d n e s s t h e c o n c e r n of e v e r y o n e ' ( G e n o s k o , i n t r o d u c t i o n t o G u a t t a r i , 1996c, p p . 4, 7). In a d d i t i o n t o h i s i n v o l v e m e n t in t h e a n t i p s y c h i a t r y m o v e m e n t , G u a t t a r i ' s c o n c e r n f o r m a d n e s s also e n c o m p a s s e d a s t r o n g t h e r a p e u t i c d i m e n s i o n , f o r as a p r a c t i s i n g L a c a n i a n analyst, h e s p e n t a l m o s t 4 0 y e a r s w o r k i n g w i t h p s y c h o t i c p a t i e n t s at t h e C l i n i q u e d e la B o r d e . In a n i n t e r v i e w in t h e y e a r Anti-Oedipus
was p u b -
l i s h e d , G u a t t a r i w e n t s o f a r as t o i d e n t i f y o n e o f h i s f o u r m a j o r i n t e l l e c t u a l i n f l u e n c e s as ' " a s o r t of s c h i z o i d b a c k g r o u n d o r d i s c o u r s e ' " . ' " I ' d always liked s c h i z o p h r e n i c s , b e e n d r a w n t o t h e m ' " , h e said, ' " Y o u h a v e t o live w i t h t h e m t o u n d e r s t a n d this. S c h i z o p h r e n i c s d o at least, u n l i k e n e u r o t i c s , h a v e real p r o b l e m s ' " ( G u a t t a r i q u o t e d in D e l e u z e a n d G u a t t a r i , 1990, p p . 1 4 - 1 5 ) . W i t h o n e half of cultural t h e o r y ' s m o s t d y n a m i c d u o so i n t i m a t e l y involved w i t h the ' p r o b l e m ' o f s c h i z o p h r e n i a , it b e c o m e s d i f f i c u l t t o s u s t a i n t h e c l a i m t h a t t h e y u s e t h e t e r m a r b i t r a r i l y o r r e m a i n w h o l l y i n s e n s i t i v e t o its lived reality, r e g a r d less o f h o w s h o c k i n g t h e i r u s e o f t h e t e r m ' s c h i z o p h r e n i a ' m a y n o w a p p e a r to some. Guattari's extensive clinical experience with a n d a c a d e m i c attraction to s c h i z o p h r e n i a s h o u l d a l s o p r o m p t u s t o s u s p e c t t h a t ' t h e s c h i z o ' — a n d its a n o e d i p a l ' o t h e r s ' , ' t h e p a r a n o i d ' a n d ' t h e s c h i z o p h r e n i c ' — d o n o t f l o a t as f r e e f r o m clinical d i s c o u r s e as m a n y a D e l e u z o g u a t t a r i a n m i g h t suggest (see B o g u e , 1989, p. 8). I n d e e d , it is a r g u a b l e t h a t t h e t h r e e f o r m s of a n o e d i p a l s u b j e c t i v i t y i d e n t i f i e d b y D e l e u z e a n d G u a t t a r i a r e in f a c t l o o s e l y a d a p t e d f r o m s c h i z o phrenia's three original diagnostic categories—hebephrenia, paranoia, and catatonia. The similarities between Deleuze a n d Guattari's process of schizop h r e n i a a n d h e b e p h r e n i c ( n o w called 'disorganised' or ' u n d i f f e r e n t i a t e d ' ) s c h i z o p h r e n i a a r e p a r t i c u l a r l y suggestive. K r a e p e l i n i d e n t i f i e d h e b e p h r e n i a as t h e m o s t c o m m o n f o r m o f s c h i z o p h r e n i a , p a r t i c u l a r l y p r o m i n e n t in y o u n g e r p e o p l e w h o 'exhibit a m a r k e d restlessness', 'leave their w o r k , stroll a b o u t or travel f r o m place t o p l a c e ' , a n d ' i n d u l g e in illicit a n d p r o m i s c u o u s i n t e r c o u r s e ' ( K r a e p e l i n , 1981, p . 2 3 1 ) . A l t h o u g h K r a e p e l i n ' s t o n e h e r e is d i s a p p r o v i n g r a t h e r t h a n c e l e b r a t o r y , it is n o t d i f f i c u l t t o see h o w t h i s d e s c r i p t i o n of h e b e p h r e n i a resonates with the antics o f ' t h e schizo': In conduct and behavior, the most characteristic symptom is that of childish silliness and senseless laughter . . . At one moment patients are increasingly headstrong, at the next as supremely tractable. They neglect their personal appearance, perform all sorts of outlandish and foolish deeds, such as prowling about all night, setting fire to buildings, throwing stones to break windows, and travelling about without evident purpose. [. . .] The patients are very often seen to converse with themselves, sometimes aloud, while associated with this there is almost always silly laughter. (Kraepelin, 1981, p. 234)
If the s y m p t o m a t o l o g y is a m a t c h with 'the schizo', so t o o is t h e h e b e p h r e n i a p a t i e n t ' s f a i l u r e t o b e p r o d u c t i v e in a c a p i t a l i s t e c o n o m y , f o r even if t h e y recover, ' t h e p a t i e n t s fail to e m p l o y themselves p r o f i t a b l y . T h e y s p e n d m u c h t i m e in r e a d i n g , e v o l v i n g i m p r a c t i c a l s c h e m e s , a n d p o n d e r i n g o v e r a b s t r a c t a n d useless q u e s t i o n s ' (Kraepelin, 1981, p. 240). W i t h t h e s e clinical a n t e c e d e n t s in m i n d , a n d in o r d e r t o d e v e l o p a m o r e accurate a n d n u a n c e d u n d e r s t a n d i n g of the m u l t i p l e f o r m s of s c h i z o p h r e n i a in Anti-Oedipus,
o u r f o c u s n o w t u r n s t o D e l e u z e a n d G u a t t a r i ' s direct engage-
m e n t w i t h c o m p e t i n g clinical a c c o u n t s of p s y c h o s i s . It s h o u l d c o m e as n o s u r p r i s e t h a t t h e key f i g u r e h e r e is again D a n i e l P a u l S c h r e b e r . Deleuze a n d G u a t t a r i i n t r o d u c e u s t o Schreber in the first p a r a g r a p h of Anti-Oedipus
and
r e t u r n to h i m repeatedly: he is at the f o r e f r o n t of their efforts to explain schizo p h r e n i a a n d at t h e h e a r t o f t h e i r q u a r r e l w i t h p s y c h o a n a l y s i s . T r a c k i n g S c h r e b e r t h r o u g h t h e l a b y r i n t h of Anti-Oedipus,
w e can see t h a t t h e p o i n t at
w h i c h t h e d i s t i n c t i o n s b e t w e e n ' t h e s c h i z o ' , ' t h e p a r a n o i d ' , a n d ' t h e schizop h r e n i c ' s h o u l d b e m o s t o b v i o u s is in fact t h e p o i n t at w h i c h t h e y b e g i n t o collapse.
Deleuze, Guattari, Schreber D e l e u z e a n d G u a t t a r i ' s e n g a g e m e n t w i t h Memoirs
of My Nervous
Illness is as
m u c h a strategic r e p u d i a t i o n of psychoanalytic a c c o u n t s of psychosis as it is a close r e a d i n g of S c h r e b e r ' s a u t o b i o g r a p h y . In C h a p t e r 2 , 1 discussed at length the detail of F r e u d ' s a n d Lacan's i n t e r p r e t a t i o n of t h e case of Schreber; here, a brief s u m m a r y of their positions will suffice. In his r e a d i n g of Memoirs,
Freud
s i n g l e d o u t S c h r e b e r ' s feelings o f p e r s e c u t i o n , a n d his belief t h a t G o d w a s t r a n s f o r m i n g h i m i n t o a w o m a n , as the t w o m o s t salient facets of a vastly c o m plex delusional system. In Schreber's case, writes F r e u d , ' T h e exciting cause of his illness . . . w a s a n o u t b u r s t of h o m o s e x u a l libido; t h e object of this libido w a s p r o b a b l y f r o m t h e v e r y first his d o c t o r . . . a n d [ S c h r e b e r ' s ] s t r u g g l e s against the libidinal i m p u l s e p r o d u c e d t h e conflict w h i c h gave rise t o the s y m p t o m s ' (Freud, 1981, p. 43). Freud goes o n to argue t h a t Schreber's a s s u m p t i o n of a f e m i n i n e a t t i t u d e t o w a r d s G o d ' h a d its r o o t s in a longing, intensified to an erotic pitch, for his f a t h e r a n d b r o t h e r ' (Freud, 1981, p. 5 0 ) — i t is, in short, the father c o m p l e x , w h i c h gives rise to psychosis. For Lacan, b y contrast, the origin of psychosis lies n o t with h o m o s e x u a l longing, b u t w i t h t h e subject's failure t o e n t e r t h e r e a l m o f phallic s i g n i f i c a t i o n . T h e c h i l d ' s e n t r y i n t o l a n g u a g e a n d Oedipal d e v e l o p m e n t d e p e n d s o n the symbolic intervention of the N a m e - o f - t h e Father in the imaginary m o t h e r - c h i l d dyad. For psychotic patients, this intervention has failed: 'It is an accident in [the symbolic] register', 'the foreclosure of t h e
N a m e - o f - t h e - F a t h e r ' a n d ' t h e failure of t h e p a t e r n a l m e t a p h o r t h a t . . . gives p s y c h o s i s its e s s e n t i a l c o n d i t i o n , a n d t h e s t r u c t u r e t h a t s e p a r a t e s it f r o m n e u r o s i s ' (Lacan, 1966, p. 215). Lacan suggests t h a t S c h r e b e r ' s early p r o m o t i o n a n d his failure to have child r e n raised the q u e s t i o n of w h e t h e r o r n o t he w o u l d b e c o m e a father (Lacan, 1993, p p . 3 2 0 - 1 ) . O n c e a s k e d , t h i s q u e s t i o n w a s u n a b l e t o b e a n s w e r e d ; it e x p o s e d a h o l e w h e r e t h e N a m e - o f - t h e - F a t h e r w o u l d o t h e r w i s e have b e e n , a hole which flagrant psychotic s y m p t o m s try unsuccessfully t o fill. Lacan astutely o b s e r v e d t h a t ' e v e r y a u t h o r h a s . . . a t t e m p t e d t o e x p l a i n t h e o n s e t o f S c h r e b e r ' s d e l u s i o n w i t h r e f e r e n c e t o t h e f a t h e r ' ( L a c a n , 1993, p. 2 1 2 ) . T h e relevance of p a t e r n i t y a n d p a t e r n a l a u t h o r i t y t o the S c h r e b e r case w a s in t h e 1950s given a n e w twist b y W i l l i a m N i e d e r l a n d , w h o revealed that Schreber's f a t h e r advocated a n a u t h o r i t a r i a n , disciplinarian, a n d deeply patriarchal p e d a gogical p r o g r a m m e , r e g u l a t i n g h i s c h i l d r e n ' s p o s t u r e , s l u m b e r , a n d p l a y t h r o u g h s t r a p s , b r a c e s , a n d o t h e r restrictive devices (see N i e d e r l a n d , 1984; S c h a t z m a n , 1973). W e r e Schreber's delusions of p e r s e c u t i o n n o t so delusional after all? By the time Anti-Oedipus
s was published, the p a t e r n a l - p a r a n o i d read-
ing of Schreber had reached its zenith in Elias Canetti's
Crowds and Power (1962).
C a n e t t i persuasively a r g u e d t h a t S c h r e b e r ' s e x t r e m e psychic d i s t u r b a n c e s — c o r p o r e a l miracles, e n s l a v e m e n t b y a d e s p o t i c G o d , b u t m o s t significantly, his drive for p o w e r — w e r e a n a k e d revelation of the psychology of fascism. F r e u d , Lacan, N i e d e r l a n d , a n d C a n e t t i all o f f e r e d c o m p e l l i n g r e a d i n g s of S c h r e b e r ' s p a r a n o i d s y m p t o m a t o l o g y , b u t as we have seen, t h e issue of h o w best to a c c o u n t f o r t h e greater c o m p l e x i t y of S c h r e b e r ' s d e l u s i o n a l system is still far f r o m resolved. In C h a p t e r 2 , 1 a r g u e d that the psychoanalytic e m p h a s i s o n t h e s y m b o l i c s i g n i f i c a n c e of p s y c h o t i c s y m p t o m s — a p r a c t i c e n o w h e r e m o r e clearly d i s p l a y e d t h a n in s t u d i e s of Memoirs—produces
schizophrenia
itself as a s u b l i m e t e x t s u b j e c t t o e n d l e s s r e - i n t e r p r e t a t i o n . D e l e u z e a n d G u a t t a r i ' s i n t e r v e n t i o n in t h e Schreber d e b a t e is c e n t r a l t o Anti-Oedipus
and
s h o r t - c i r c u i t s t h e t e x t u a l s u b l i m e in t w o ways. First, in r e f u s i n g t o cast t h e f a t h e r in t h e p r i n c i p a l p a t h o g e n i c role, Deleuze a n d G u a t t a r i claim to rescue Schreber f r o m b e i n g ' p o s t h u m o u s l y oedipalized' (Deleuze a n d Guattari, 1982, p. 57) at the h a n d s of Freud, Lacan, a n d o t h e r psychoanalysts. ' H o w does o n e d a r e r e d u c e t o t h e p a t e r n a l t h e m e a d e l i r i u m so r i c h , so d i f f e r e n t i a t e d , so " d i v i n e " as t h e J u d g e ' s . . .?' t h e y ask ( D e l e u z e a n d G u a t t a r i , 1982, p. 5 6 ) . D o g m a t i c in its a d h e r e n c e t o o r t h o d o x y , psychoanalysis, . . . continues to ask its questions and develop its interpretations from the depths of the Oedipal triangle as its basic perspective, even though today it is acutely aware that this frame of reference is not adequate to explain so called psychotic phenomena.
The psychoanalyst says that we must necessarily discover Schreber's daddy beneath his superior God, and doubtless also his elder brother beneath his inferior God. (Deleuze and Guattari, 1982, p. 14, italics in the original) D e l e u z e a n d G u a t t a r i n o t o n l y c r i t i q u e as n a r r o w a n d repressive t h e O e d i p a l f r a m e w o r k at o p e r a t i o n h e r e , b u t m o r e r a d i c a l l y , at a m e t a t h e o r e t i c a l level, t h e y r e j e c t t h e p s y c h o a n a l y t i c a p p r o a c h t o p s y c h i c p h e n o m e n a as e n c o d e d texts. T o i n t e r p r e t d e l u s i o n s as l i t e r a t u r e , t h e y a r g u e , m i s s e s t h e p o i n t . 8 R a t h e r t h a n s c r u t i n i z e d e l u s i o n for p r o o f of a n u n d e r l y i n g t r a u m a s u s t a i n e d in i n f a n cy, o r a i m t o u n c o v e r t h e p s y c h o s e x u a l s y m b o l i s m o f a p a r t i c u l a r h a l l u c i n a tion, the schizoanalyst acknowledges what 'Judge Schreber would not deny', n a m e l y , t h a t ' e v e r y d e l i r i u m is first o f all t h e i n v e s t m e n t o f a field t h a t is social, e c o n o m i c , political, cultural, racial a n d racist, pedagogical, a n d religious' (Deleuze a n d G u a t t a r i , 1982, p. 274). S c h r e b e r c a n n o t be u n d e r s t o o d via O e d i p u s , t h e f a t h e r c o m p l e x , o r t h e N a m e - o f - t h e - F a t h e r b e c a u s e h e is, f o r t h e a u t h o r s of Anti-Oedipus,
' t h e s c h i z o ' p a r excellence.
S c h r e b e r ' s s t a t u s in Anti-Oedipus
as t h e e x e m p l a r y ' s c h i z o ' is clear f r o m t h e
playful a n d irreverent o p e n i n g paragraph: Judge Schreber has sunbeams in his ass. A solar amis. And rest assured that it works: Judge Schreber feels something, produces something, and is capable of explaining the process theoretically. Something is produced: the effects of a machine, not mere metaphor. (Deleuze and Guattari, 1982, p. 2, italics in the original) T h i s is ' s c h i z o ' as u n i v e r s a l p r o d u c e r — o u t f o r a stroll ( n e v e r m i n d t h a t it is within the g r o u n d s of the Sonnenstein asylum), plugged into the world, diss o l v i n g t h e b o u n d a r i e s b e t w e e n self a n d o t h e r , i n t e r i o r a n d e x t e r i o r . T h i s is ' t h e s c h i z o ' w h o s e s o m a t i c h a l l u c i n a t i o n s w e m u s t view literally, n o t as literature, for: ' T h e breasts o n the judge's n a k e d torso are neither delirious n o r hall u c i n a t o r y p h e n o m e n a : t h e y d e s i g n a t e , first of all, a b a n d o f i n t e n s i t y , a z o n e o f i n t e n s i t y o n h i s b o d y w i t h o u t o r g a n s ' ( D e l e u z e a n d G u a t t a r i , 1982, p. 19). Deleuze a n d Guattari continue: Nothing here [i.e. in the case of Schreber] is representative; rather, it is all life and lived experience: the actual, lived emotion of having breasts does not resemble breasts, it does not represent them . . . Nothing but bands of intensity, potentials, thresholds, and gradients. A harrowing, emotionally overwhelming experience, which brings the schizo as close as possible to matter, to a burning, living centre of m a t t e r . . . (Deleuze and Guattari, 1982, p. 19) 8
Although Deleuze and Guattari's references to Schreber make it appear as though he is personally known to them, they fail to acknowledge here that, like Freud, they can only know Schreber through/as the text of Memoirs.
T h e f r a g m e n t e d b o d y l a s h e d b y s e n s o r y i n t e n s i t i e s d o e s n o t s t a n d for a n y t h i n g , j u s t as S c h r e b e r ' s ' n e r v e - c o n t a c t ' w i t h ( a m o n g o t h e r s ) ' t h e P o p e ' , ' 2 4 0 B e n e d i c t i n e M o n k s ' , ' a V i e n n e s e n e r v e s p e c i a l i s t ' , ' a b a p t i z e d Jew a n d S l a v o p h i l e ' ( S c h r e b e r , 1955, p. 70) h a s n o t h i n g t o d o w i t h t h e closed c i r c u i t o f the domestic Oedipal d r a m a a n d everything to d o with history. Before 'being c r u s h e d in t h e p s y c h i a t r i c a n d p s y c h o a n a l y t i c t r e a d m i l l ' , 'all d e l i r i u m p o s sesses a w o r l d - h i s t o r i c a l , p o l i t i c a l , a n d racial c o n t e n t , m i x i n g a n d s w e e p i n g a l o n g races, c u l t u r e s , c o n t i n e n t s , a n d k i n g d o m s ' ( D e l e u z e a n d G u a t t a r i , 1982, p p . 2 7 4 , 88, see also 352, 3 6 2 , 3 6 5 ) . T h e p s y c h o l o g i c a l i n t e r p r e t a t i o n o f p s y c h o t i c s y m p t o m s is t h e r e f o r e m i s g u i d e d , as G u a t t a r i e l s e w h e r e suggests, . . . it is illusory to hope to recover raw desire, pure and simple, by embarking on a search for the knots hidden in the unconscious and the secret keys of interpretation. Nothing can unravel, by the sole magic of the transference, the real micropolitical conflicts in which the subject is imprisoned; no mystery, no hidden universe. There is nothing to discover in the unconscious. The unconscious is something to be built. (Guattari, 1996d, pp. 51-2) 9 S c h r e b e r , like S a m u e l B e c k e t t ' s c h a r a c t e r s a n d t h e n a r r a t o r s of Beat f i c t i o n , lives o u t t h i s d e - p e r s o n a l i z e d , d e - p s y c h o l o g i z e d d e s i r e in a n u n t r a m m e l l e d f o r m . Forget the confines of the nursery or the Greek a m p h i t h e a t r e ; 'the schizo' is c o n n e c t e d t o t h e w o r l d . It is n o l o n g e r a q u e s t i o n of fin de siècle G e r m a n y o r e v e n of m o d e r n i t y p e r se: ' N o o n e h a s ever b e e n as d e e p l y i n v o l v e d in h i s t o r y as t h e schizo, o r d e a l t w i t h it in this w a y . H e c o n s u m e s all o f u n i v e r s a l h i s t o r y in o n e fell s w o o p ' ( D e l e u z e a n d G u a t t a r i , 1982, p. 2 1 ) . Deleuze a n d Guattari pitch 'schizo' Schreber against the oedipalized paran o i d S c h r e b e r of F r e u d a n d L a c a n , b u t d o t h e y s u c c e s s f u l l y r e c o n c i l e S c h r e b e r ' s f a n t a s t i c a l l y rich d e l u s i o n a l s t r u c t u r e w i t h his a c c o u n t o f y e a r s o f i n c a r c e r a t i o n , w i t h his p e r i o d s o f c a t a t o n i c s t u p o r , a n d w i t h his o w n e x p e r i e n c e of m u t ism a n d autistic withdrawal? Rhetorical questions regarding the relationship b e t w e e n ' t h e s c h i z o ' a n d ' s c h i z o p h r e n i c ' are p o s e d n o less t h a n e i g h t t i m e s in Anti-Oedipus
( D e l e u z e a n d G u a t t a r i , 1982, p p . 24, 6 7 - 8 , 88, 91, 123, 130, 136,
319, 362), h i n t i n g at a n e l e m e n t o f a u t h o r i a l a n x i e t y o n this s c o r e . ' S c h i z o ' a n d ' s c h i z o p h r e n i c ' a r e c e r t a i n l y p o r t r a y e d as p o l a r o p p o s i t e s : t h e f o r m e r is a ' f r e e m a n , i r r e s p o n s i b l e , solitary, a n d j o y o u s . . . a d e s i r e l a c k i n g n o t h i n g , a flux t h a t overcomes barriers a n d codes, a n a m e that n o longer designates any ego whate v e r ' ( D e l e u z e a n d G u a t t a r i , 1982, p. 130); t h e latter, t h e sick ' s c h i z o p h r e n i c ' , is a n i m m e n s e t r a n s f i x e d h i p p o p o t a m u s , a static d e a d - e n d , a p i t i a b l e c r e a t u r e c o n f i n e d t o a n a s y l u m . ' T h e s c h i z o p h r e n i c ' is t h e i n t e r r u p t i o n o r b l o c k a g e of t h e p r o c e s s of s c h i z o p h r e n i a ; s o m e o n e w h o s e a t t e m p t e d p s y c h i c b r e a k t h r o u g h
9
But riot built through the acts of representation or interpretation.
c u l m i n a t e d in p s y c h i c b r e a k d o w n . Is it possible, t h e n , even b y D e l e u z e a n d G u a t t a r i ' s o w n criteria, t o say with c e r t a i n t y t h a t S c h r e b e r is all ' s c h i z o ' a n d n o t at all ' s c h i z o p h r e n i c ' ? Such a claim, as I discussed at length in C h a p t e r 2, c a p t u r e s o n l y a f r a c t i o n of S c h r e b e r ' s e x p e r i e n c e . In Memoirs,
Schreber himself spares no detail
in r e c o u n t i n g h i s m e n t a l a g o n y a n d a n g u i s h , m a n i f e s t e d at t i m e s in l o n g p e r i o d s w h e n h e m a d e ' a b s o l u t e passivity' his d u t y ( S c h r e b e r , 1955, p. 145). F u r t h e r m o r e , despite t h e o b v i o u s l i m i t a t i o n s of t h e psychoanalytic e m p h a s i s o n paternity, S c h r e b e r ' s delusional system is n e i t h e r as diverse n o r as a r b i t r a r y as Anti-Oedipus
implies. C e n t r a l t o Schreber's p a r a n o i d w o r l d - v i e w is an u n r e -
l e n t i n g a t t e m p t t o r e - c h a n n e l desire in a heavenly d u t y t o w a r d s G o d , a n d to p r o v e t o a sceptical scientific a n d psychiatric e s t a b l i s h m e n t t h e validity of his divinity a n d t h e t r u t h of his m a s t e r code. A d d r e s s i n g t h e n - c o n t e m p o r a r y legal a n d p s y c h i a t r i c issues, S c h r e b e r ' s d e l i r i u m is also n o t as universally valid as Deleuze a n d G u a t t a r i w o u l d suggest, b u t is f r a m e d within a m o d e r n positivist logic. In a d d i t i o n , at d i f f e r e n t stages of his ' n e r v o u s illness', Schreber displays m a n y if n o t all o f t h e s y m p t o m s of h e b e p h r e n i a , p a r a n o i a , a n d c a t a t o n i a , K r a e p e l i n i a n p s y c h i a t r y ' s t h r e e s u b t y p e s of d e m e n t i a p r a e c o x . D e l e u z e a n d G u a t t a r i posit a r e s o l u t e d i s t i n c t i o n b e t w e e n ' t h e s c h i z o ' — t h e i r h e b e p h r e n i c h e r o — t h e proto-fascistic ' p a r a n o i d ' a n d t h e c a t a t o n i c 'autistic rag'. However, if S c h r e b e r can s i m u l t a n e o u s l y be t h o u g h t of as s c h i z o - r e v o l u t i o n a r y , p a r a noid-fascist, and as a c a t a t o n i c h i p p o p o t a m u s , it b e c o m e s virtually impossible t o sustain t h e idea of a radical d i s c o n t i n u i t y b e t w e e n 'schizo', ' s c h i z o p h r e n i c ' , a n d ' p a r a n o i d ' . T h e s e a n o e d i p a l figures n o t o n l y seem far less r e m o v e d f r o m t h e clinic t h a n t h e i r critics c l a i m , b u t also far m o r e closely c o n n e c t e d t h a n Deleuze a n d Guattari allow. A n d , as we shall see, if t h e b o u n d a r i e s between revolution a n d catatonia are potentially so p o r o u s , the political efficacy Deleuze a n d Guattari attribute the process of schizophrenia is in t u r n called into question.
A politics of the sublime If the first a n d h i t h e r t o u n a c k n o w l e d g e d p r o b l e m w i t h Deleuze a n d G u a t t a r i ' s a c c o u n t of r e v o l u t i o n a r y s c h i z o p h r e n i a is its i n t e r c o n n e c t e d n e s s w i t h (distinctly n o n - r e v o l u t i o n a r y ) p a r a n o i a a n d c a t a t o n i a , t h e s e c o n d m a j o r t e n s i o n can be f o u n d at t h e level of m e t a t h e o r y . A l t h o u g h t h e r e are of c o u r s e significant m e t h o d o l o g i c a l a n d theoretical divergences b e t w e e n a n d within the fields of psychiatry, psychoanalysis, a n d m a n y f o r m s of antipsychiatry, all a p p r o a c h s c h i z o p h r e n i a as an a b e r r a t i o n , an exception to t h e n o r m that is the result of a neurological, p s y c h o b i o g r a p h i c a l , o r sociological p r o b l e m . 1 0 By a r g u i n g that it
111
The exception here is l.aingian autipsyi lii.it ry, whit h I discuss in more detail later.
is t h e d i r e c t o r u n f e t t e r e d e x p r e s s i o n of a n a t u r a l l y r e b e l l i o u s d e s i r e , D e l e u z e a n d G u a t t a r i d e p a t h o l o g i z e t h e p r o c e s s of s c h i z o p h r e n i a a n d i m p l y t h a t t h e s e a r c h f o r its o r i g i n s as pathology
is n o l o n g e r n e c e s s a r y . In t h e m o s t g e n e r a l
s e n s e , t h e c l a i m t h a t s c h i z o p h r e n i a is a d e t e r r i t o r i a l i z i n g p r o c e s s a n a l o g o u s as well as a n t a g o n i s t i c t o t h e o p e r a t i o n of c a p i t a l i s m swiftly d i s m i s s e s t h e i n t e r d i s c i p l i n a r y d e b a t e c o n c e r n i n g its aetiology. Assuming rather than d e m o n s t r a t i n g the obvious inadequacy of psychiatry's a c c o u n t s of s c h i z o p h r e n i a , D e l e u z e a n d G u a t t a r i , as t h e title of t h e i r b o o k s u g gests, i d e n t i f y p s y c h o a n a l y s i s a n d n o t p s y c h i a t r y as t h e d i s c o u r s e w o r t h y o f a t t a c k . G u a t t a r i ' h a d always l i k e d ' ' s c h i z o p h r e n i c s ' , F r e u d h a d always ' h a t e d ' t h e m ( D e l e u z e a n d G u a t t a r i , 1982, p . 2 3 ) , " a n d it is p o s s i b l e t h a t t h i s p e r ceived hostility t o s c h i z o p h r e n i a i m m e d i a t e l y q u a l i f i e d it as a n o b j e c t of t h e o retical interest. Deleuze a n d G u a t t a r i use S c h r e b e r — w h o was for Freud a n d L a c a n t h e p a r a d i g m a t i c case o f p s y c h o s i s — t o e x p o s e t h e s t r u c t u r a l l i m i t a t i o n s of psychoanalysis o n multiple fronts. Theoretically, they reject O e d i p u s (the i d e a t h a t t h e f a t h e r c o m p l e x o r N a m e - o f - t h e - F a t h e r plays a d e t e r m i n i n g p a r t in psychosis); m e t a t h e o r e t i c a l l y , they challenge the very a s s u m p t i o n that s c h i z o p h r e n i c s y m p t o m s a r e a m e n a b l e t o the k i n d of l i t e r a r y analysis so i m p o r t a n t t o p s y c h o a n a l y s t s . P s y c h o a n a l y s i s , b y its o w n a d m i s s i o n , c a n o n l y offer to psychotic patients an Oedipal interpretation of p a r a n o i d s y m p t o m a t o l o g y ; s c h i z o a n a l y s i s , as t h e case of S c h r e b e r m a k e s clear, h a s n o t r u c k w i t h i n t e r p r e t a t i o n ( p s y c h o b i o g r a p h i c a l o r o t h e r w i s e ) o r w i t h t h e p r o d u c t i o n of s c h i z o p h r e n i a - a s - t e x t . 1 2 B u t t h e r e is yet a n o t h e r layer h e r e : t h e f a c t t h a t t h e p r o c e s s of s c h i z o p h r e n i a is b e y o n d t h e t h e r a p e u t i c , a n d t o s o m e e x t e n t analytic, r e a c h of p s y c h o a n a l y s i s is, I w o u l d a r g u e , p r e c i s e l y w h a t m a k e s it p o l i t i c a l l y attractive to Deleuze a n d Guattari.13 Exceeding the theoretical a n d therapeutic
11
Freud, in a letter to Istvan Hollos in 1928 (quoted in Dupont, 1988, p.251) wrote '"I did not like those patients . . . They made me angry and I find myself irritated to experience them so distant from myself and from all that is human. This is an astonishing intolerance which brands me a poor psychiatrist'". Guattari in an interview observed that '"Many inner struggles in the psychoanalytic movement would be understood if Freud's fundamental hostility toward psychosis were finally acknowledged'" (Guattari and Munster, 1977, p. 79).
12
Even if this move, as I suggested earlier, belies the fact that Schreber is known to Deleuze and Guattari only as and through texts. Derrida makes a similar observation with regard to Foucault's choice of focus in Madness and Civilization: 'If F o u c a u l t . . . mentions, under the name of madness, only schizophrenia and psychosis, it is because psychoanalysis most often approaches these only in order to acknowledge its own limit: a forbidden or impossible access. This limit defines psychoanalysis. Its intimacy with madness par excellence is an intimacy with the least intimate, a nonintimacy that relates it to what is mod heterogeneous, to that which in no
13
p a r a m e t e r s of psychoanalysis is evidence that s c h i z o p h r e n i a - a s - p r o c e s s is n o t ( p e r h a p s can n o t b e ) c o - o p t e d by t h e social o r d e r ; p r o o f of its d i s r u p t i v e a n d h e n c e r e v o l u t i o n a r y p o t e n t i a l . T h e schizoanalytic valorisation
of t h e a n o e d i -
pal, d i s c o n n e c t e d , ego-less n a t u r e of the s c h i z o p h r e n i c p r o c e s s d e p e n d s in p a r t , I a m s u g g e s t i n g , o n its s t a t u s as s u b l i m e w i t h i n t h e p s y c h o a n a l y t i c discourse Deleuze a n d G u a t t a r i seek to contest. Deleuze a n d G u a t t a r i ' s 'schizo' is e x e m p l a r y as a r e v o l u t i o n a r y figure only in so far as ' h e ' exists o u t s i d e t h e s t r u c t u r e s of psychic a n d social repression. In t h e b r o a d e s t sense, their s c h i z o - a s - o u t s i d e r radicalizes R.D. Laing's m o d e l o f s c h i z o p h r e n i a as an e x p e r i e n c e of t h e s u b l i m e , a t r a n s c e n d e n t e x p e r i e n c e , a voyage into i n n e r psychic space. 'I a m aware', w r o t e Laing in The Divided
Self,
' t h a t the m a n w h o is said to be d e l u d e d m a y be in his d e l u s i o n telling m e the t r u t h , a n d this in n o equivocal o r m e t a p h o r i c a l sense, b u t q u i t e literally, a n d t h a t t h e c r a c k e d m i n d o f t h e s c h i z o p h r e n i c m a y let in light w h i c h d o e s n o t e n t e r the intact m i n d s of m a n y sane p e o p l e w h o s e m i n d s are closed' (Laing, 1990, p. 27). P u r s u i n g t h e t h e m e of s c h i z o p h r e n i a as e n l i g h t e n m e n t , Laing f a m o u s l y asserted in The Politics of Experience
that ' w h a t we call " s c h i z o p h r e -
n i a " was o n e of t h e f o r m s in w h i c h , o f t e n t h r o u g h q u i t e o r d i n a r y people, the light b e g a n t o b r e a k t h r o u g h t h e cracks in o u r a l l - t o o - c l o s e d m i n d s ' (Laing, 1967, p. 129). T h e p o t e n c y , agency, a n d o p p o s i t i o n a l i t y assigned to t h e 'schizo' b y Deleuze a n d G u a t t a r i testifies to the influence of Laing's a c c o u n t of schizop h r e n i a as a f o r m o f e m a n c i p a t i o n , a m o d e of b e i n g closer t o t h e t r u t h o f h u m a n existence ( o r d e s i r e ) t h a n so-called n o r m a l i t y , a n d a subjective state which c o n t a i n s w i t h i n it the potential to d i s m a n t l e t h e codes of capitalism. So, D e l e u z e a n d G u a t t a r i e x t e n d t h e a n t i p s y c h i a t r i c c e l e b r a t i o n of schizop h r e n i a as a s u b l i m e experience, while s i m u l t a n e o u s l y utilizing a n d challenging t h e a c c o u n t o f s c h i z o p h r e n i a as a s u b l i m e text s u b j e c t t o p s y c h o a n a l y t i c i n t e r p r e t a t i o n b u t n o t t h e r a p e u t i c i n t e r v e n t i o n . T h e ' s c h i z o ' works as a p a r a d i g m for r e v o l u t i o n a r y d e s i r e — t o t h e e x t e n t t h a t it does—because of schizop h r e n i a ' s a s s o c i a t i o n w i t h t h e s u b l i m e in clinical d i s c o u r s e s . H o w e v e r , as I have a r g u e d , the p o r o u s o r u n s t a b l e b o u n d a r i e s b e t w e e n t h e 'schizo', ' p a r a n o i d ' , a n d c a t a t o n i c ' s c h i z o p h r e n i c ' m a k e a politics b a s e d o n s c h i z o p h r e n i a highly p r o b l e m a t i c . If every ' s c h i z o ' is in d a n g e r of b e c o m i n g an ' i m m e n s e t r a n s f i x e d h i p p o p o t a m u s ' , t h e n escaping O e d i p u s a n d e m b r a c i n g t h e flux of d e s i r e is n o t w i t h o u t s i g n i f i c a n t risks. T h e a g e n c y o f ' t h e s c h i z o ' c a n n o t b e g u a r a n t e e d . It is n o t clear, u l t i m a t e l y , what exactly i n t e r r u p t s t h e p r o c e s s of s c h i z o p h r e n i a — t r a n s f o r m i n g 'schizo' i n t o ' s c h i z o p h r e n i c ' — a n d c o n s e q u e n t l y
way lets itself be interiorized, nor even subjectified: neither alienated, I would say, nor inalienable'(Derrida, 1978, p. 107).
it r e m a i n s u n c l e a r w h e t h e r a n y t h i n g c a n b e d o n e t o f o r e s t a l l o r a v o i d t h i s . 1 4 Like sides o f a m o b i u s s t r i p , ' s c h i z o ' a n d ' s c h i z o p h r e n i c ' a r e t o o closely c o n nected, too intimately interlinked to be meaningfully separated. E v e n if t h i s t e n s i o n w e r e a b l e t o b e r e s o l v e d , s c h i z o p h r e n i a ' s a s s o c i a t i o n with the sublime presents f u r t h e r significant p r o b l e m s for the radical politics Deleuze and Guattari espouse. Schizophrenia m a y be capitalism's 'deepest t e n d e n c y ' b u t m o r e i m p o r t a n t l y it is also, a c c o r d i n g t o D e l e u z e a n d G u a t t a r i , ' i t s d i f f e r e n c e , its d i v e r g e n c e , a n d its d e a t h ' ( D e l e u z e a n d G u a t t a r i , 1 9 8 2 , p . 2 4 5 ) . T o gain a n d m a i n t a i n t h i s r e v o l u t i o n a r y a g e n c y , s c h i z o p h r e n i a m u s t in s o m e s e n s e r e m a i n r e s o l u t e l y e x t e r i o r t o c a p i t a l i s m ; it m u s t e x c e e d t h e b o u n d a r i e s of social a n d p s y c h i c o r g a n i z a t i o n , r e f u s e i n t e r p r e t a t i o n a n d i n t e r p r e t i v e c l o s u r e , resist t h e r a p e u t i c i n t e r v e n t i o n a n d t h e o r e t i c a l r e p r e s e n t a t i o n . T h i s is c e r t a i n l y a n a n t i - f a s c i s t m o d e o f b e i n g , as F o u c a u l t f a m o u s l y d e c l a r e d in t h e p r e f a c e t o Anti-Oedipus,
b u t it is a n t i a l m o s t e v e r y t h i n g else as well. T h i s
m o d e l takes the concept of micro-politics to n e w extremes, radically u n d e r m i n i n g all f o r m s o f c o l l e c t i v e a n d i n d i v i d u a l p o l i t i c a l a c t i o n . A s A n t h o n y Elliott n o t e s , at t h e m o s t b a s i c level ' b l u e p r i n t s f o r social a n d political t r a n s f o r m a t i o n will b e u n s u c c e s s f u l b e c a u s e s u c h activity a n d p l a n n i n g will necessarily i n v o l v e a p a r a n o i a c e n c o d i n g of d e s i r e ' (Elliott, 2 0 0 2 , p. 160). Similarly, R e i d a r D u e w o r r i e s t h a t t h e idealized ' s c h i z o ' is ' s o radically i m m a n e n t w i t h i n its o w n c i r c u i t s o f d e s i r e t h a t it c a n h a r d l y b e g i v e n t h e p o l i t i c a l t a s k o f c h a l l e n g i n g existing f o r m s of p o w e r ' ( D u e , 2007, p. 115). H e n c e the c o n u n d r u m : t o be revolutionary, the process of schizophrenia m u s t be sublime, b u t to be p o l i t i c a l l y e f f e c t i v e a n d n o t s i m p l y a n a r c h i c , it m u s t — e v e n if p a r t i a l l y a n d p r o v i s i o n a l l y — r e c o n s t i t u t e social, psychic, a n d o r g a n i z a t i o n a l b o u n d a r i e s . S c h i z o p h r e n i a , in Anti-Oedipus,
d o e s n o t f u n c t i o n as a single n o t i o n , a t h i n g
t o b e a p p r a i s e d in i s o l a t i o n . It is, r a t h e r , a c o n c e p t t h a t c o n n e c t s a n e w v i s i o n of s u b j e c t i v i t y t o c a p i t a l i s m , t o t h e r e v o l u t i o n , t o t h e a n t i p s y c h i a t r i c politics o f the day, a n d t o a psychoanalysis f o u n d w a n t i n g o n m u l t i p l e fronts. Deleuze a n d G u a t t a r i ' s w o r k is d i s t i n c t i v e in w h a t w e m i g h t b r o a d l y t e r m ' p o s t m o d e r n '
14
This is a point worth emphasizing. 'What makes the schizophrenic ill, since the cause of the illness is not schizophrenia as a process? What transforms the breakthrough into a breakdown?' (Deleuze and Guattari, 1982, p. 362) The answer, for Deleuze and Guattari, is that 'capitalist production is constantly arresting the schizophrenic process and transforming the subject of the process into a confined clinical entity' (Deleuze and Guattari, 1982, p. 245). Or, as Buchanan puts it, 'it is not the schizophrenic process that makes the schizo ill. . . but the environment in which he or she finds himself in' (Buchanan, 2008, pp. 35-6). In my mind, the failure to specify what, precisely, in the capitalist environment causes 'the schizo's' breakthrough—sometimes but not always—to end in schizophrenic breakdown, is the most pressing unanswered question to be addressed to Anti-Oedipus.
t h e o r y : t h e y a l o n e assign t h e ' s c h i z o ' a h e r o i c r o l e as t h e o n e w h o e s c a p e s psychic repression, r e m a i n s t r u e t o desire, a n d has t h e p o t e n t i a l to p u s h capitalism t o a n d past its limits. H o w e v e r , their m o d e l r e m a i n s free f r o m c o n t r a diction o n l y o n t h e c o n d i t i o n that any a n d all p r e v i o u s n o t i o n s of h o w radical political action m i g h t f u n c t i o n effectively are c o m p l e t e l y r e i m a g i n e d . Sublimity, they imply, is t h e p r e c o n d i t i o n of political action a n d n o t , in fact, an i n d i c a t i o n of its impossibility. It is precisely this c o n t r a d i c t i o n t h a t s u b s e q u e n t p o s t m o d e r n theorists challenge t h r o u g h their claim t h a t ' t h e s c h i z o p h r e n i c ' is n o t t h e h e r o b u t the casualty of t h e p o s t m o d e r n . Anti-Oedipus
played a crucial role in
the d e v e l o p m e n t of s c h i z o p h r e n i a as a t o p o s in p o s t m o d e r n cultural t h e o r y b y linking schizophrenia to capitalism a n d focussing attention o n the
fragmentation
of t h e m o d e r n self. A n d , as we will see in C h a p t e r 6, as Deleuze a n d G u a t t a r i ' s ' s c h i z o ' b e c o m e s t h e v i c t i m of late capitalist p o s t m o d e r n i t y , s c h i z o p h r e n i a d r i f t s f u r t h e r f r o m its clinical origins a n d its a n t i p s y c h i a t r i c o p p o s i t i o n a l i t y , r e n d e r i n g p a r a d o x i c a l its o n g o i n g association w i t h t h e s u b l i m e .
Chapter 5
Schizophrenia, modernity, postmodernity
Only the real conflict of the conditions of existence may serve as a structural model for the paradoxes of the schizophrenic world. (Foucault, 1976, p. 84) P a r t T w o of t h i s b o o k has so far i d e n t i f i e d t h r e e f a r - r e a c h i n g e f f e c t s o f t h e a n t i p s y c h i a t r i c p r o j e c t , b r o a d l y c o n c e i v e d . First, it issued a m u l t i f a c e t e d crit i q u e of the psychiatric a n d psychoanalytic a p p r o a c h e s t o s c h i z o p h r e n i a : Laing, Szasz, Deleuze, G u a t t a r i , a n d o t h e r s c o n t e s t e d n o t only t h e m e t h o d o l o g y a n d t h e r a p e u t i c practices of these disciplines b u t also their theoretical f o u n d a t i o n s . T h e s e c o n d a n d p e r h a p s less o b v i o u s effect of t h e a n t i p s y c h i a t r y m o v e m e n t w a s t o leave u n c h a l l e n g e d e l e m e n t s of p s y c h o l o g i c a l m e t a t h e o r y . As I h a v e a r g u e d , w i t h the e x c e p t i o n of T h o m a s Szasz's w o r k , a n t i p s y c h i a t r i c a c c o u n t s o f s c h i z o p h r e n i a as s u b l i m e e x p e r i e n c e r e m a i n c o m p l i c i t w i t h , a n d c o n s e q u e n t l y fail t o c o n f r o n t , t h e p s y c h i a t r i c a n d p s y c h o a n a l y t i c p r o d u c t i o n of s c h i z o p h r e n i a as a s u b l i m e object a n d text. Finally, a n d p e r h a p s m o s t significantly, t h r o u g h the figure o f ' t h e schizophrenic' or 'schizo', antipsychiatric theorists radically politicized s c h i z o p h r e n i a , highlighting its aetiological, structural, a n d symbolic associations with capitalist society a n d c u l t u r e . A l t h o u g h his w o r k evinces n o antipsychiatric p o l e m i c o r s e n t i m e n t , the p h e n o m e n o l o g i c a l p s y c h o l o g i s t Louis Sass has r e c o n c e p t u a l i z e d s c h i z o p h r e n i a a n d its symbolic significance in n o less radical a fashion. In his m a g n u m o p u s , Madness
and Modernism:
Thought
(1992), as well as in n u m e r o u s p u b l i c a t i o n s in psychological, philo-
Insanity
in the Light of Modern
Art, Literature
and
sophical, a n d literary j o u r n a l s , Sass has repeatedly highlighted the limitations of c o n v e n t i o n a l p s y c h i a t r i c , p s y c h o a n a l y t i c , and a n t i p s y c h i a t r i c ( i n c l u d i n g w h a t he calls ' a v a n t - g a r d e ' ) a c c o u n t s of s c h i z o p h r e n i a . W o r k i n g in t h e p h e n o m e n o l o g i c a l t r a d i t i o n p i o n e e r e d b y Karl J a s p e r s , E u g e n e M i n k o w s k i , W o l f g a n g B l a n k e n b u r g , a n d K i m u r a b i n , Sass's w o r k is d r i v e n by an ethical i m p e r a t i v e to r e i n s t a t e t h e h u m a n i t y of s c h i z o p h r e n i a a n d ' t o d i s s i p a t e t h e
a t m o s p h e r e o f u n u t t e r a b l e m y s t e r y a n d p r o f u n d i t y ' t h a t s u r r o u n d s it (Sass, 1994b, p. 9). H i s o w n m o d e l f o c u s e s ' o n c e r t a i n f o r m a l o r s t r u c t u r a l aspects o r p e r v a s i v e i n f r a s t r u c t u r e s of e x p e r i e n c e ' r a t h e r t h a n t h e aetiological, s o m a t i c , o r p s y c h o l o g i c a l e x p l a n a t i o n o f s y m p t o m s (Sass, 2 0 0 4 b , p . 75, see also Sass, 2001, p. 266), a n d e m p h a s i z e s exigent introspection, hyperreflexivity, ipseity d i s t u r b a n c e , a n d o t h e r s o - c a l l e d n e g a t i v e s y m p t o m s as d e f i n i n g f e a t u r e s o f s c h i z o p h r e n i a . Sass's w o r k is d i s t i n c t i v e o n a n u m b e r of g r o u n d s , b u t f o r t h e p u r p o s e s of this b o o k m e r i t s detailed analysis for t w o reasons. First, Sass's a c c o u n t of s c h i z o p h r e n i a o p e r a t e s outside t h e logic o f t h e s u b l i m e t h a t prevails in c l i n i c a l a n d a n t i p s y c h i a t r i c t h e o r y a n d s o p r o v i d e s a v a n t a g e p o i n t f r o m w h i c h t o i l l u m i n a t e t h e o p e r a t i o n of t h e s c h i z o p h r e n i c s u b l i m e . S e c o n d l y , Sass c l a i m s t h a t t h e p h e n o m e n o l o g y o f s c h i z o p h r e n i a o f f e r s special i n s i g h t i n t o t h e s t r u c t u r e s of modern
subjectivity, a n a r g u m e n t t h a t will again h e l p i l l u m i n a t e ,
if n o t challenge, t h e p o s t m o d e r n c u l t u r a l t h e o r y d i s c u s s e d in t h e n e x t c h a p t e r . T h e f i r s t t a s k o f t h i s c h a p t e r is t o d i s c u s s t h e r e l a t i o n s h i p b e t w e e n Sass's c r i t i q u e of p s y c h i a t r y , p s y c h o a n a l y s i s , a n d a n t i p s y c h i a t r y , a n d m y r e a d i n g o f the schizophrenic sublime. I then elaborate the theoretical and metatheoretical o r i g i n a l i t y o f h i s a c c o u n t o f s c h i z o p h r e n i a . 1 A s I will a r g u e , Sass's n u a n c e d analysis resolutely resists r e p e a t i n g o r r e i n f o r c i n g a n y association b e t w e e n schizophrenia and sublimity; rather than merely opposing or inverting the d o m i n a n t p a r a d i g m , his m o d e l r e m a i n s e x t e r i o r t o its logic. W e t h e n r e t u r n t o a n issue f o r e g r o u n d e d b y t h e a n t i p s y c h i a t r y m o v e m e n t , n a m e l y , s c h i z o p h r e n i a ' s r e l a t i o n s h i p t o m o d e r n c u l t u r e a n d s u b j e c t i v i t y . Sass's a r g u m e n t — t h a t there are s t r o n g affinities b e t w e e n m a d n e s s , m o d e r n i s m , a n d m o d e r n i t y — i s certainly persuasive, b u t his assertion of a c o n t i g u o u s relationship b e t w e e n m o d e r n i s m a n d p o s t m o d e r n i s m , m o d e r n i t y a n d p o s t m o d e r n i t y , is, I suggest, less so. D r a w i n g o n Z y g m u n t B a u m a n ' s sociological s t u d i e s of t h e s u b s t a n t i v e structural differences between modernity and postmodernity (or 'liquid m o d e r n i t y ' ) , in p a r t i c u l a r his analysis o f t h e s h i f t f r o m a p a n o p t i c t o a c o n s u m e r i s t r e g i m e o f t h e self, I will a r g u e t h a t t h e a f f i n i t i e s Sass i d e n t i f i e s b e t w e e n m o d e r n i t y a n d s c h i z o p h r e n i a invite r e a s s e s s m e n t a n d r e c o n c e p t u a l i z a t i o n f o r the p o s t m o d e r n era.
Dementia, regression, Dionysus: three tropes of madness Sass b e g i n s h i s s u r v e y o f t h e o r i e s o f s c h i z o p h r e n i a w i t h t h e t w o a c c o u n t s p s y c h i a t r y a d v a n c e s o f its p r i z e d o b j e c t — t h e d o c t r i n e o f ' t h e a b y s s ' a n d t h e 1
Sass does acknowledge the method's practical limitations and ongoing difficulties in establishing a psychiatric research programme applicable to large patient populations (Sass and Parnas, 2001, pp. 347-8).
p a r a d i g m of t h e ' b r o k e n b r a i n ' (Sass, 1992, p p . 1 6 - 1 9 ) . T h e idea of t h e b r o k e n b r a i n h a s b e e n if n o t a l w a y s t h e f o r e m o s t t h e n c e r t a i n l y t h e m o s t e n d u r i n g e x p l a n a t i o n of s c h i z o p h r e n i a . K r a e p e l i n ' s d e m e n t i a p r a e c o x , as t h e n a m e s u g gests, m a d e m e n t a l d e t e r i o r a t i o n t h e d e f i n i n g f e a t u r e of t h e d i s e a s e m o d e l o f s c h i z o p h r e n i a , a n d c o n t e m p o r a r y biological p s y c h i a t r y c o n t i n u e s t o a p p r o a c h s c h i z o p h r e n i a as a d e f i c i e n c y o r d e c l i n e in c o g n i t i v e a n d n e u r o l o g i c a l f u n c t i o n i n g . 2 As w e s a w in C h a p t e r 1, Karl Jaspers w a s t h e earliest e x p o s i t o r o f t h e d o c t r i n e o f t h e a b y s s , t h e i d e a t h a t s c h i z o p h r e n i a is b y d e f i n i t i o n b e y o n d e m p a t h e t i c u n d e r s t a n d i n g . Both accounts attribute this ' u n u n d e r s t a n d a b l e ' d i s o r d e r a n as yet i n e x p l i c a b l e b i o l o g i c a l aetiology. D o u b l y i n c o m p r e h e n s i b l e , s c h i z o p h r e n i a a c q u i r e s a special s t a t u s w i t h i n this p s y c h i a t r i c classification: it is ' n o l o n g e r p s y c h o l o g i c a l l y u n d e r s t a n d a b l e like t h e m o o d d i s o r d e r s , b u t n o t yet n e u r o p a t h o l o g i c a l l y e x p l i c a b l e like t h e d e m e n t i a s ' ( B a r r e t t , 1998c, p. 4 7 6 ) . W h e r e R o b e r t B a r r e t t r e a d s this ' f e n c e p e r c h i n g ' as e v i d e n c e of t h e social c o n s t r u c t i o n of s c h i z o p h r e n i a as a l i m i n a l category, Sass m o r e p e r s u a s i v e l y a r g u e s t h a t it r e n d e r s t h e s c h i z o p h r e n i c p a t i e n t ' p s y c h i a t r y ' s q u i n t e s s e n t i a l o t h e r — t h e p a t i e n t w h o s e e s s e n c e is i n c o m p r e h e n s i b i l i t y itself (Sass, 1987a, p. 4; 1992, p . 19). Sass d o e s n o t d i s p u t e t h e idea t h a t b i o l o g i c a l a n d g e n e t i c f a c t o r s m a y well b e i n f l u e n t i a l in d e t e r m i n i n g t h e o n s e t a n d d e v e l o p m e n t of s c h i z o p h r e n i a ; 3 however, he strenuously o p p o s e s the 'interpretive nihilism' that results f r o m d e f i n i n g s c h i z o p h r e n i c s y m p t o m s in p u r e l y s o m a t i c t e r m s o r classifying t h e m m e r e l y as b i z a r r e (Sass, 1992, p . 7; 2 0 0 4 b , p. 7 3 ) . In h i s t h o u g h t f u l a n d p r o v o k i n g a r t i c l e ' T a x o n o m y a n d O n t o l o g y in P s y c h i a t r y ' , M a t t h e w B r o o m e cites a p p r o v i n g l y t h e a n t i - e s s e n t i a l i s t v i e w t h a t 2
According to Sass, the 'deficit view of schizophrenia' promotes 'a condescending, sometimes denigrating attitude that sees schizophrenia, the prototypical form of madness, entirely in terms of the loss of higher or more quintessentially human capacities of mind and spirit' (Sass, 2000-2001b, p. 56). In his later work, Sass is particularly critical of this model as it applies to the so-called negative symptoms of, for example, flatness of affect, autism, and anhedonia. Viewing these symptoms exclusively in terms of a decline, deficit, or diminishment is not only 'mechanistic and reductionistic', it also fails to account for the presence of additional and altered forms of experience (Sass, 2003, p. 154; 2001).
3
In his 'Epilogue: Schizophrenia and Modern Culture' Sass points out that 'After nearly a century of research, schizophrenia can still be said to be "a condition of obscure origins and no established aetiology, pathogenesis and pathology", without even any clear disease marker or laboratory test by which it can readily be identified. Currently available evidence is insufficient to allow us to do more than endorse, with a sense of real certainty, a few very general statements: for example, that some structural or physiological abnormalities of the brain are probably implicated in the pathogenesis of many (perhaps most) cases of schizophrenia (though not necessarily as a primary or sufficient cause); that many cases have a significant gcnctic component; and that some as yet unspecilicd psychological or social factors are important in the maintenance and shaping, and perhaps also in the
p s y c h i a t r i c classification s h o u l d b e first a n d f o r e m o s t o f ' p r a c t i c a l , p r a g m a t i c , a n d h e u r i s t i c v a l u e ' a d d i n g t h a t 'if it reveals a n y t h i n g i m p o r t a n t o n t o l o g i c a l l y o r e p i s t e m o l o g i c a l l y t h a t is a r e m a r k a b l e c o i n c i d e n c e a n d n o s o l o g i c a l l y irrelev a n t ' ( B r o o m e , 2007, p. 312). T h e q u e s t i o n of w h e t h e r s c h i z o p h r e n i a a n d o t h e r m e n t a l d i s o r d e r s a r e n a t u r a l k i n d s h a s b e e n e x t e n s i v e l y a n a l y s e d (see B o l t o n , 2 0 0 8 ; C o o p e r , 2 0 0 5 , 2 0 0 7 ; H a c k i n g , 1999), b u t in t h e c o n t e x t o f t h e c u r r e n t d i s c u s s i o n t h e n o t i o n of e s s e n c e s h i g h l i g h t s a s u r p r i s i n g c o n v e r g e n c e b e t w e e n Sass's w o r k a n d t h e p s y c h i a t r y o f w h i c h h e is so critical. As B r o o m e ( 2 0 0 7 , p. 3 1 0 ) a r g u e s : Contemporary phenomenological psychiatry and psychopathology, at least conceptually, share strong similarities with the realism of biological psychiatry. Both methods of investigation seek to find the defining characteristic of a mental illness. For phenomenology, this characteristic is some essential feature of subjective experience, whereas for biological psychiatry it may be a particular activation of neural circuitry or a discrete genetic polymorphism. Furthermore, the investigations of both fields may be complementary... A s w e will see, in S a s s ' s p h e n o m e n o l o g i c a l a c c o u n t , s c h i z o p h r e n i a d o e s d e s c r i b e a n e s s e n t i a l o r f u n d a m e n t a l t r a n s f o r m a t i o n in t h e self (Sass, 2 0 0 7 ) ; h o w e v e r , as I h o p e t o m a k e c l e a r , it is t h e q u e s t i o n o f u n d e r s t a n d i n g t h a t s h a r p l y d i s t i n g u i s h e s Sass's w o r k f r o m m a i n s t r e a m p s y c h i a t r y , as it is t h e issue of comprehensibility rather than essences which underlies schizophrenia's association with the sublime. Incomprehensibility a n d interpretive nihilism are certainly not charges that c o u l d b e levelled a g a i n s t t h e p s y c h o a n a l y t i c a p p r o a c h t o p s y c h o s i s , b u t if a n y t h i n g , Sass s u b j e c t s t h e s e i n t e r p r e t a t i o n s o f p s y c h o t i c s y m p t o m a t o l o g y t o a critique even m o r e stringent than that m o u n t e d against biological psychiatry. P s y c h o a n a l y s t s , Sass a r g u e s , h a v e u n d e r s t o o d s c h i z o p h r e n i a as t h e r e g r e s s i o n t o o r f i x a t i o n at t h e e a r l i e s t s t a g e s o f p s y c h i c d e v e l o p m e n t , a s t a t e t h a t is pre-Oedipal, pre-ego, a n d pre-civilization. This teleological narrative locates s c h i z o p h r e n i a at o r p r i o r t o t h e b i r t h o f s u b j e c t i v i t y ; it ' w e l c o m e [ s ] t h e s c h i z o p h r e n i c b a c k i n t o t h e h u m a n fold, b u t o n l y in t h e s u b o r d i n a t e p o s i t i o n of t h e c h i l d ' (Sass, 1992, p . 2 0 ) . If m y analysis of s c h i z o p h r e n i a as t h e s u b l i m e o b j e c t of p s y c h i a t r y s h a r e s m u c h in c o m m o n w i t h Madness
and Modernism's
account
o f p s y c h i a t r y ' s d o c t r i n e of t h e abyss a n d b r o k e n b r a i n , m y r e a d i n g of t h e s t a t u s of s c h i z o p h r e n i a in p s y c h o a n a l y t i c d i s c o u r s e d i v e r g e s significantly f r o m Sass's 'regressive h y p o t h e s i s ' . In C h a p t e r 2 , 1 a r g u e d t h a t p s y c h o a n a l y t i c w r i t e r s s i n c e F r e u d h a v e p r o d u c e d s c h i z o p h r e n i a as a s u b l i m e t e x t . S e v e r i n g t h e c o n n e c t i o n , e s s e n t i a l t o t h e t r e a t m e n t of n e u r o s i s , b e t w e e n t h e i n t e r p r e t a t i o n a n d alleviation o f s y m p t o m s , p s y c h o a n a l y s t s find m e a n i n g in s c h i z o p h r e n i c d e l u s i o n s a n d h a l l u c i n a t i o n s b u t suggest l h a t t h e s c h i z o p h r e n i c p a t i e n t h e r s e l f is
b e y o n d analytic reach. M y close reading of key psychoanalytic a c c o u n t s of psychosis—offered by A b r a h a m , Jung, Freud, Lacan, a n d n u m e r o u s c o m m e n tators o n the Schreber c a s e — f o r e g r o u n d s texts w h i c h , f r o m a literary a n d c u l t u r a l s t u d i e s p e r s p e c t i v e , h a v e h a d t h e i r greatest i n f l u e n c e b e y o n d a strictly clinical c o n t e x t . 4 Sass, b y c o n t r a s t , m e n t i o n s F r e u d o n l y briefly a n d Lacan n o t at all; h e c o n c e n t r a t e s i n s t e a d o n s o m e of t h e m o s t i n f l u e n t i a l figures in A m e r i c a n e g o p s y c h o l o g y a n d Kleinian analysis (Sass, 1992, p p . 4 1 2 - 3 ) . It w o u l d a p p e a r , t h e n , t h a t o u r findings a r e n o t so m u c h i n c o m p a t i b l e as i n c o m p a r a b l e . In the absence of a close o r s u s t a i n e d e n g a g e m e n t with t h e f o u n d a t i o n a l analyses of s c h i z o p h r e n i a (in p a r t i c u l a r t h e w o r k of A b r a h a m a n d J u n g ) , Sass o v e r l o o k s t h e c o n c e r t e d e f f o r t m a d e b y early p s y c h o a n a l y s t s t o r e d e f i n e schizo p h r e n i a as a p s y c h o n e u r o s i s , e f f o r t s t h a t p r e d a t e t h e texts h e suggests i n a u g u r a t e d t h e regressive h y p o t h e s i s . 5 M o r e surprising, c o n s i d e r i n g t h e e x t r a o r d i n a r y b r e a d t h of m a t e r i a l c o v e r e d in Madness
and Modernism,
a n d t h e m a n y references
t o M a r g u e r i t e S e c h e h a y e ' s analysis of R e n e e ' s Autobiography
of a
Schizophrenic
Girl, is t h a t Sass also neglects t h e m u c h - c e l e b r a t e d w o r k o f a n o t h e r star o n t h e p s y c h o a n a l y t i c stage: F r i e d a F r o m m - R e i c h m a n n . F r o m m - R e i c h m a n n is h i g h ly r e g a r d e d f o r h e r p i o n e e r i n g w o r k at t h e C h e s t n u t L o d g e clinic in t h e 1930s a n d 1940s, a n d h e r b e l i e f , r a r e in A m e r i c a at t h a t t i m e , t h a t p s y c h o a n a l y s i s could have positive o u t c o m e s for people diagnosed with schizophrenia ( H o r n s t e i n , 2 0 0 0 ) . I n t h e 1960s a n d 1970s, J o a n n e G r e e n b e r g ' s b e s t - s e l l i n g a u t o b i o g r a p h i c a l n o v e l , I Never Promised
You a Rose Garden
(1964), together
w i t h its film a d a p t a t i o n ( P a g e , 1 9 7 7 ) , gave a p a t i e n t ' s - e y e v i e w o f F r o m m R e i c h m a n n ' s p s y c h o t h e r a p e u t i c practices a n d elevated h e r t o a n almost-celebrity s t a t u s . 6 If, as Sass c l a i m s , o n e o f t h e m o s t t r o u b l i n g a s s u m p t i o n s o p e r a t i v e in 4
5
6
For example, although it seems to have attracted little clinical attention, especially in America, Lacan's model of psychosis is a huge influence on Deleuze and Guattari's antiOedipal model of schizophrenia, and, as I will discuss in the next chapter, on models of postmodern 'schizophrenic' subjectivity. At first Sass suggests it is Freud's analysis of the Schreber case, but later he credits Victor Tausk's 1919 paper 'On the origin of the "influencing machine" in schizophrenia' (1950) as playing the decisive role in inaugurating the psychoanalytic approach to psychosis (Sass, 1992, pp. 20,218). Hornstein writes that to the surprise of many, 'Rose Garden gained a huge following and has been continuously in print for thirty-five years. It has sold 5.7 million copies, been translated into a dozen languages, and been transmuted into a movie, a pop song, and a cultural cliché. Mental patients hailed Rose Garden, psychiatrists denounced it, and it became the lightning rod for controversy about schizophrenia and its treatment. Eventually Joanne's and Frieda's identities were revealed, and they become one of those couples— like Freud and Dora . . . —that psychoanalysts revere like martyred saints' (Hornstein, 2000, p. xiv). Rose Garden's psychological sophistication is also praised by Jeffrey Berman (1985).
t h e regressive h y p o t h e s i s o r ' p r i m i t i v i t y i n t e r p r e t a t i o n ' is t h a t it s e e m s ' i n h e r e n t l y c o n d e s c e n d i n g ' (Sass, 1987a, p . 7) a n d u l t i m a t e l y u n h e l p f u l in t h e t r e a t m e n t of s c h i z o p h r e n i a , F r o m m - R e i c h m a n n ' s w o r k is s u r e l y a s i g n i f i c a n t a n d i n f l u e n t i a l e x c e p t i o n t o t h e rule. Last b u t n o t least, Sass t u r n s t o t h e a n t i p s y c h i a t r i c a n d a v a n t - g a r d e c e l e b r a t i o n o f s c h i z o p h r e n i a as a j o y o u s l i b e r a t i o n f r o m t h e c o d e s a n d c o n v e n t i o n s o f society, self, a n d r a t i o n a l i t y . T h e ' D i o n y s i a n ' m o d e l of m a d n e s s p r o m o t e d b y Laing, F o u c a u l t , D e l e u z e , a n d G u a t t a r i i n v e r t s t h e v a l u e s of t h e p s y c h o a n a l y t i c n a r r a t i v e b y c e l e b r a t i n g t h e loss o f e g o b o u n d a r i e s as t h e f r e e d o m of u n f e t t e r e d desire: ' T h e a v a n t - g a r d i s t s a n d a n t i p s y c h i a t r i s t s h a v e e m p h a s i z e d t h e p o s i t i v e side [of p s y c h i c " r e g r e s s i o n " ] — e x c e s s e s o f p a s s i o n , vitality, a n d i m a g i n a t i o n — yet t h e y , n o less t h a n t h e t r a d i t i o n a l a n a l y s t s , a s s u m e t h a t t h e s c h i z o p h r e n i c lacks t h e s e l f - c o n t r o l , a w a r e n e s s of social c o n v e n t i o n , a n d reflexivity of "civil i z e d " c o n s c i o u s n e s s ' (Sass, 1992, p. 22; see also 1987a, p. 8; 1996, p p . 7 3 - 5 ) . Sass is j u s t l y critical o f a n t i p s y c h i a t r i c r o m a n t i c i s m a n d r e a d s t h e ' D i o n y s i a n ' d i s c o u r s e o r b e h a v i o u r o f m a n y p s y c h o t i c p a t i e n t s ' n o t as e x p r e s s i o n s o f a n a t u r a l l y o v e r f l o w i n g v i t a l i t y b u t as d e f e n s e s against
the devitalization and
d e r e a l i z a t i o n ' t h a t is s c h i z o p h r e n i a (Sass, 1992, p. 2 3 8 , italics in t h e o r i g i n a l ) . H o w e v e r , as w e h a v e s e e n in t h e p r e c e d i n g t w o c h a p t e r s , t h e a n t i p s y c h i a t r i c v a l o u r i z a t i o n o f t h e s c h i z o is m o r e c o m p l e x t h a n p e r h a p s it first a p p e a r s . Sass, clearly, is n o D e l e u z e a n d G u a t t a r i e n t h u s i a s t , b u t h e is also n o t a close r e a d e r o f Anti-Oedipus.
F o r e x a m p l e , h e a r g u e s t h a t D e l e u z e a n d G u a t t a r i see m a d -
ness as 'a s p o n t a n e o u s , n a t u r a l , a n d pre-civil m o d e o f b e i n g w h i c h c o m e s t o b e o p p r e s s e d o r c o n s t r a i n e d b y t h e f o r c e s of society a n d s e l f - c o n t r o l ' (Sass, 1992, p . 106), b u t in so d o i n g o v e r l o o k s t h e i r c l a i m t h a t s c h i z o p h r e n i a is also c a p i t a l i s m ' s ' d e e p e s t t e n d e n c y ' ( D e l e u z e a n d G u a t t a r i , 1982, p. 2 4 5 ) . Sass's d i s c u s s i o n of a n t i p s y c h i a t r i c a n d a v a n t - g a r d e m o d e l s o f s c h i z o p h r e n i a d r a w s a t t e n t i o n t o t h e i r m e t a t h e o r e t i c a l c o n n e c t i o n t o p s y c h o a n a l y s i s , b u t d o e s n o t investigate t h e antipsychiatric critique of psychiatric and psychoanalytic p a r a d i g m s and practices, n o r c o n s i d e r t h e sociopolitical a i m s a n d o u t c o m e s o f t h e i r r e v i s i o n i n g o f m a d n e s s . It is also t h e case t h a t Sass o v e r l o o k s s o m e s t r i k i n g similarities b e t w e e n his o w n a n d D e l e u z e a n d G u a t t a r i ' s analysis of s c h i z o p h r e n i a . 7
7
For example, as Deleuze makes particularly clear in 'Schizophrenia and Society', he and Guattari are opposed to models of schizophrenia that fixate on regression, deficiency, or dementia, and agree that 'the real difficulty is to give an account of schizophrenia as something with positive traits, and as such, not to reduce it to the lacunal or destructive traits it engenders in a person'. The idea that 'If schizophrenia seems like the sickness of today's society, wc should not look to generalizations ahout our way of life, hut to very precise mechanisms of a social, polltlcnl, and economic nature' (Deleuze, 2006, pp. 23,28) is also
P s y c h i a t r y is c h a r g e d w i t h ' i n t e r p r e t i v e n i h i l i s m ' , p s y c h o a n a l y s i s w i t h c o n descension, the antipsychiatric avant-garde with the failure to account for the c o m p l e x i t y of s c h i z o p h r e n i c s y m p t o m a t o l o g y a n d s u f f e r i n g . At the deepest level, then, all three of these models—psychiatric, psychoanalytic, and avant-gardist—share the assumption that schizophrenic pathology must involve a loss of what, in the West, has long been assumed to be the most essential characteristics of mind or subjectivity: the capacities for logic and abstract thinking, for self-reflection, and for the exercise of free will. (Sass, 1992, p. 23) Sass i d e n t i f i e s t h e c o m m o n t h e o r e t i c a l g r o u n d o c c u p i e d b y t h e s e d i s c o u r s e s ( s c h i z o p h r e n i a as a loss o f r a t i o n a l i t y ) b u t d o e s n o t i n q u i r e as t o t h e i r m e t a theoretical inter-relationship.81 have argued that these models articulate s c h i z o p h r e n i a t h r o u g h t h e logic of t h e s u b l i m e , s i t u a t i n g s c h i z o p h r e n i a at t h e limits of psychological, rational, therapeutic, and e m p a t h e t i c understanding. Significantly, a l t h o u g h t h e w o r d is m e n t i o n e d , t h e s u b l i m e d o e s n o t a p p e a r in Madness
and Modernism
s t r u c t u r a l l y o r as a critical c a t e g o r y . So, a l t h o u g h Sass
d o e s n o t p u t it in t h e s e t e r m s , I w o u l d a r g u e t h a t it is t h i s i d e a o f a s u b l i m e s c h i z o p h r e n i a — r a d i c a l in its e s s e n t i a l u n u n d e r s t a n d a b i l i t y — t h a t Sass s e e m s t o find w h o l l y i n a d e q u a t e t o t h e t a s k of a p p r o a c h i n g s c h i z o p h r e n i c e x p e r i e n c e . W i t h o u t d i s r e g a r d i n g t h e psychopathology
of s c h i z o p h r e n i a ( p s y c h i c u p h e a v -
als a n d p r o f o u n d t r a n s f o r m a t i o n s in t h e u n d e r s t a n d i n g of self a n d w o r l d ) , Sass e n d e a v o u r s t o u n d e r s t a n d t h e full g a m u t of p s y c h o t i c e x p e r i e n c e in its clinical, as well as c u l t u r a l , c o n t e x t .
Schizophrenia and hyperreflexivity Madness
and Modernism
e x t e n d s t h e c e n t r a l a r g u m e n t s o f Sass's i n f l u e n t i a l
a r t i c l e ' I n t r o s p e c t i o n , S c h i z o p h r e n i a a n d t h e F r a g m e n t a t i o n of t h e S e l f , a n d lays t h e f o u n d a t i o n f o r m u c h o f his s u b s e q u e n t w o r k o n t h e ' n e g a t i v e ' s y m p t o m s , d e l u s i o n s , s e l f - d i s t u r b a n c e s , a n d creativity o f s c h i z o p h r e n i a . A n a l y s i n g t h e full arc of p s y c h o t i c e x p e r i e n c e — f r o m t h e schizoid p e r s o n a l i t y to the
8
clearly shared by Sass in his detailed analysis of the relationship between schizophrenia and specific mechanisms of modernity. Similarly, Robert Barrett, focusing on the themes of degeneration, disintegration, and division, has argued that although all three disciplines 'might like to have seen themselves as poles apart, their differences were superficial, for they reproduced, in their own respective technical idioms, the same underlying construction of schizophrenia. This is a case of a deep cultural structure producing three apparently different surface forms' (Barrett, 1998b, p. 631). Building on the work of Sass and of Barrett, my analysis of the 'schizophrenic sublime' is an attempt to explore the nature and effects of this 'deep cultural structure'.
p r o d r o m a l a n d acute phases of psychosis—Sass d e m o n s t r a t e s 'that m u c h of w h a t h a s b e e n p a s s e d o f f as p r i m i t i v e o r d e t e r i o r a t e d is f a r m o r e c o m p l e x a n d i n t e r e s t i n g — a n d s e l f - a w a r e — t h a n is u s u a l l y a c k n o w l e d g e d ' (Sass, 1992, p . 9). H i s c e n t r a l t h e s i s is n e a t l y s u m m a r i z e d in t h e f o l l o w i n g q u e s t i o n : ' W h a t if m a d n e s s , i n at least s o m e of its f o r m s , w e r e t o d e r i v e f r o m a h e i g h t e n i n g rather than a d i m m i n g of conscious awareness, a n d an alienation not f r o m r e a s o n b u t f r o m t h e e m o t i o n s , i n s t i n c t s a n d t h e b o d y ? ' (Sass, 1992, p . 4). T h e s c h i z o p h r e n i c d i s s o l u t i o n of self, h e a r g u e s , is n o t t h e r e s u l t o f t h e d i s i n t e g r a t i o n of t h e ego; r a t h e r it is c a u s e d b y a n u n a b a t i n g a n d a c u t e s e l f - a w a r e n e s s . S c h i z o p h r e n i c e x p e r i e n c e , h e a r g u e s , ' m a y b e c h a r a c t e r i s e d less b y f u s i o n , s p o n t a n e i t y , a n d l i b e r a t i o n of desire t h a n b y s e p a r a t i o n , r e s t r a i n t , a n d a n exagg e r a t e d c e r e b r a l i s m a n d p r o p e n s i t y f o r i n t r o s p e c t i o n ' (Sass, 1992, p. 10). A n d if h y p e r r e f l e x i v i t y is s c h i z o p h r e n i a ' s ' m a s t e r t h e m e ' (Sass, 1992, p. 11), t h e p a r a d o x is c e n t r a l t o its a r t i c u l a t i o n : Schizophrenics can be hypersensitive to human contact but also indifferent. They can be pedantic or capricious, idle or diligent, irritable or filled with an all-encompassing yet somehow empty hilarity. They can experience a rushing flow of ideas or a total blocking; and their actions, thoughts and perceptions can seem rigidly ordered or controlled (exhibiting a 'morbid geometrism'), but at other times chaotic and formless. They will sometimes feel they can influence the whole universe, at other times as if they can't control even their own thoughts or their own limbs—or, in what is one of the supreme paradoxes of this condition, they may have both these experiences at the same moment. (Sass, 1992, p. 26; see also Sass, 1987a, p. 9; 1994b) I n his l a t e r w o r k , Sass b r i n g s t o g e t h e r t h e k e y t h e m e s of e x a g g e r a t e d c e r e b r a l i s m , e x i g e n t i n t r o s p e c t i o n , h y p e r r e f l e x i v i t y , a n d ' " i n t r a p s y c h i c a t a x i a " (a s e p a r a t i o n of c o g n i t i o n a n d e m o t i o n ) ' (Sass, 1992, p. 109) i n t o a m o r e s u c c i n c t d e f i n i t i o n of s c h i z o p h r e n i a as 'a d i s o r d e r of s e l f - e x p e r i e n c e ( a n ipseity d i s t u r b a n c e ) i n v o l v i n g h y p e r r e f l e x i v i t y a n d d i m i n i s h e d s e l f - a f f e c t i o n (i.e. h e i g h t e n e d a w a r e n e s s o f a s p e c t s o f e x p e r i e n c e t h a t w o u l d n o r m a l l y r e m a i n tacit o r p r e s u p p o s e d a n d d e c l i n e i n t h e f e e l i n g o f e x i s t i n g as a s u b j e c t of a w a r e n e s s ) ' (Sass, 2001, p. 251, e l a b o r a t e d at 253; Sass a n d P a r n a s , 2 0 0 3 ) . F o u r f u r t h e r f e a t u r e s o f Sass's p h e n o m e n o l o g i c a l m o d e l a r e i m p o r t a n t t o n o t e . First, h e r e p e a t e d l y stresses t h e i m p o r t a n c e o f s o - c a l l e d n e g a t i v e s y m p t o m s in d e f i n i n g s c h i z o p h r e n i a a n d s c h i z o p h r e n i a s p e c t r u m d i s o r d e r s , a r g u i n g t h a t t h e s e ' a r e n o t , in f a c t , s t r a i g h t f o r w a r d d e f i c i t s t a t e s , b u t i n v o l v e t h e p r e s e n c e o f " p o s i t i v e " a b e r r a t i o n s o f v a r i o u s k i n d s ' (Sass a n d P a r n a s , 2 0 0 1 , p. 350; see also Sass, 1996, 2000, 2003, 2 0 0 4 a ) . I n s t e a d of l i m i t i n g his i n t e r p r e tive e n e r g i e s t o ' d e c o d i n g ' t h e h a l l u c i n a t i o n s a n d d e l u s i o n s o f t h e a c u t e p h a s e , Sass a d v o c a t e s a holistic a p p r o a c h that f o r e g r o u n d s t h e less r e m a r k a b l e , b u t n o
less s i g n i f i c a n t , d i m e n s i o n s o f s c h i z o p h r e n i c e x p e r i e n c e . S e c o n d , Sass is also k e e n t o d i s t a n c e h i m s e l f f r o m t h e view, a d v a n c e d b y R . D . L a i n g a m o n g o t h e r s , t h a t s c h i z o p h r e n i a is a n i n t e l l i g i b l e o r s t r a t e g i c r e s p o n s e t o , f o r e x a m p l e , u n b e a r a b l e i n t e r p e r s o n a l r e l a t i o n s h i p s . H e states clearly t h a t w h i l e h e p o r t r a y s s c h i z o p h r e n i a as s o m e t h i n g of a ' m e t a p a t h o l o g y ' (Sass, 2 0 0 0 , p. 3 2 2 ) — a state o f excessive self-reflexivity, s e l f - c o n s c i o u s n e s s , a n d s e l f - a l i e n a t i o n — t h i s d o e s n o t i m p l y t h a t s c h i z o p h r e n i c s y m p t o m s a r e v o l i t i o n a l o r in a n y w a y willfully e n g a g e d (Sass, 1992, p. 2 4 0 ) . 9 Sass f u r t h e r a v o i d s a n o t h e r pitfall of e m p a t h e t i c i n q u i r y : t r a n s l a t i n g t h e s e e m i n g l y u n u n d e r s t a n d a b l e i n t o t h e p e r f e c t l y intelligib l e . 1 0 I l l u m i n a t i n g t h e s t r o n g affinities b e t w e e n m o d e r n i s m a n d s c h i z o p h r e n i a — e s p e c i a l l y in s u c h a d e t a i l e d a n d s o p h i s t i c a t e d m a n n e r — r u n s t h e r i s k o f e q u a t i n g o n e w i t h t h e o t h e r ; h o w e v e r , Sass n e v e r loses s i g h t o f t h e a l i e n n e s s a n d p s y c h o p a t h o l o g i c a l s e v e r i t y o f s c h i z o p h r e n i a . Like J a s p e r s , h e v i e w s t h e ' p r a e c o x feeling' as its d e f i n i n g f e a t u r e , b u t suggests t h a t t h e c l i n i c i a n ' s sense o f a l i e n a t i o n in fact gives h i m o r h e r g r e a t e r i n s i g h t i n t o t h e d i s o r i e n t i n g e x p e r i e n c e of s c h i z o p h r e n i a ' s p s y c h i c u p h e a v a l s . 1 1 Finally, a n d , f r o m t h e p e r s p e c t i v e o f t h i s i n q u i r y i n t o s c h i z o p h r e n i a ' s s t a t u s in c u l t u r a l as well as clinical c o n texts, p e r h a p s m o s t s i g n i f i c a n t l y , Sass explicitly b r a c k e t s t h e q u e s t i o n of schizo p h r e n i a ' s a e t i o l o g y . 1 2 T h e c l a i m t h a t s c h i z o p h r e n i a is a d i s o r d e r o f t h e self s t a n d s a p a r t f r o m a n d s o c a n n o t b e easily c o n t r a d i c t e d b y a n y h y p o t h e s i s r e g a r d i n g its g e n e t i c , n e u r o c h e m i c a l , o r e n v i r o n m e n t a l o r i g i n s (Sass, 1992, p . 388; P a r n a s a n d Sass, 2 0 0 1 , p. 102). I n s h o r t , Sass d o e s n o t s i m p l y q u e s t i o n t h e findings a n d m e t h o d o l o g i e s o f the d o m i n a n t theories of psychosis: he looks b e y o n d psychiatric, psychoanalytic, a n d a n t i p s y c h i a t r y m e t a t h e o r y t o d e v e l o p a n o r i g i n a l a n d c o m p e l l i n g a c c o u n t o f s c h i z o p h r e n i a t h a t d o e s n o t h a v e r e c o u r s e t o t h e logic of t h e s u b l i m e . A l t h o u g h t h e r e a r e m o m e n t s in Madness
and Modernism
w h e n Sass uses
t h e l a n g u a g e of t h e s u b l i m e , w r i t i n g , f o r e x a m p l e , of a n i n n e r w o r l d ' m a r k e d
9
'For, what patients like those we have been considering cannot seem to control is selfcontrol itself; what they cannot get distance from is their own endless need for distancing; what they cannot be conscious of is their own hypertrophied self-consciousness and its effect on their world' (Sass, 1987, p. 27).
10
As an example, we might think of Morton Schatzman's (1973) essentially reductive claims about the aetiology and symbolic significance of Schreber's delusions. Sass notes that 'the observer's alienation may not, in fact, indicate a total failure of empathy: it may be a shared alienation, a feeling evoked by accurate intuitions of what the patient is actually going through. Could it be, then, that the dizzying abyss we feel in the presence of certain schizophrenic patients is connected with the mise en abyme into which they themselves are falling?' (Sass, 1992, p. 240)
11
12
Actiological issues are discussed in depth only in IIx- epilogue and the appendix of Madness and Modernism.
b y . . . the u n c a n n i n e s s of i m m e n s e spaces a n d the e n i g m a s of gleaming surf a c e s a n d b r i l l i a n t l i g h t ' ( S a s s , 1992, p . 5 ) , 1 3 t h e s e a r e n o i n d i c a t i o n o f a n u n d e r l y i n g b e l i e f in s c h i z o p h r e n i a ' s f u n d a m e n t a l i n c o m p r e h e n s i b i l i t y . T h i s p o i n t is w o r t h e m p h a s i z i n g . T h e s u b l i m e , as I u n d e r s t a n d a n d a m u s i n g t h e t e r m , d i r e c t s o u r a t t e n t i o n t o w a r d s c o m p r e h e n s i b i l i t y r a t h e r t h a n o n t o l o g y ; it is t h e idea of a n essential m y s t e r y , r a t h e r t h a n a n e s s e n c e p e r se, w h i c h is c e n tral t o t h e o p e r a t i o n o f t h e d i s c i p l i n a r y s u b l i m e in p s y c h i a t r y . A g a i n s t t h o s e w h o w o u l d p r e f e r t h a t k e y aspects of s c h i z o p h r e n i a necessarily
r e m a i n inacces-
sible t o i n t e r p r e t a t i o n ( R e a d , 2 0 0 3 ) , Sass d r a w s s c h i z o p h r e n i c e x p e r i e n c e i n t o t h e f o l d of u n d e r s t a n d a b i l i t y . A g a i n s t t h o s e w h o w o u l d a r g u e t h a t s c h i z o p h r e n i a is a s t a g e t h r o u g h w h i c h w e all p a s s ( K l e i n , 1 9 5 2 ) , o r w h i c h c a n b e d i s m i s s e d as m e d i c a l i z e d m a l i n g e r i n g (Szasz, 1976), Sass i n s i s t s t h a t it i n v o l v e s s i g n i f i c a n t , b u t n o t i n c o m p r e h e n s i b l e , t r a n s f o r m a t i o n s in t h e s t r u c t u r e o f experience.14
Schizophrenia, modernism, and modernity It is t h e s e t r a n s f o r m a t i o n s , Sass a r g u e s , t h a t can i l l u m i n a t e c e n t r a l t e n d e n c i e s w i t h i n m o d e r n i s m . T h e i n t e r p r e t i v e s t r a t e g y o f Madness
and Modernism
is
carefully a n d clearly outlined: rather t h a n establish a causal relationship b e t w e e n m a d n e s s a n d m o d e r n i s m , h i s analysis h i g h l i g h t s t h e i r a f f i n i t i e s a n d p o i n t s of c o n v e r g e n c e (Sass, 1992, p p . 9, 3 3 9 ) . Sass's p r i m a r y i n t e r e s t is in h i g h m o d e r n i s m , 'the m o s t a d v a n c e d art a n d literature of the twentieth century', a n d h e c o m p a r e s s c h i z o p h r e n i a to a diverse r a n g e of literary, artistic, a n d p h i l o s o p h i c a l w o r k s u n i t e d b y t h e i r u n d e r l y i n g i n t e r e s t in, o r m a n i f e s t a t i o n of, f o r m s o f a l i e n a t i o n a n d s e l f - c o n s c i o u s n e s s (Sass, 1992, p p . 9, 37). M o d e r n i s m is t h u s d i s t i n g u i s h e d n o t o n l y f r o m r e a l i s m , r o m a n t i c i s m , a n d p o p u l a r c u l t u r e , b u t also f r o m m o d e r n i t y , h e r e c o n c e p t u a l i z e d as t h e m a t e r i a l c o n d i t i o n s o f e x i s t e n c e . I n a n a r g u m e n t t h a t c a n o n l y b e d e s c r i b e d as itself b i z a r r e , R o b e r t
13
14
Here, it appears as though Sass is referring to Renee's description of the 'Land of Light' (Renee, 1970, p. 44). A similar argument is mounted by medical anthropologist Janis Hunter Jenkins (2004), who endeavours to show 'how the experiences of people with schizophrenia can be quintessentially extraordinary just as they can be exquisitely ordinary' (Jenkins and Barrett, 2004a, p. 11). Like Sass, she cautions that 'A single-minded focus on the similarities between those who have schizophrenia and those who do not carries the risk of negating what is so extraordinary about this illness, underestimating the intensity of suffering it entails, and overlooking the resilience of those who grapple with it. But if the focus is restricted to understanding differences between abnormal and normal, the risk is one of devaluing the person with schizophrenia. I )ifference may lead to diminution and decomposition of the person into an object' (Ibid.).
B a r r e t t ( 1 9 9 8 c , p. 4 8 4 ) h a s t a k e n Sass t o t a s k o v e r t h e p o t e n t i a l l y n e g a t i v e e f f e c t s of t h i s c o m p a r i s o n : Likening the 'schizophrenic' to modernism, itself such an odd fish, may have the effect of pasting another layer of bizarreness onto this cultural category. [...] For individuals defined as 'schizophrenic', it may not be helpful to be compared with a movement that is so bizarre and alienating as to make you believe your experiences were more bizarre than you first thought, or make you feel typecast as an alien. As Sass r i g h t l y o b s e r v e s in his r e j o i n d e r t o B a r r e t t , t h e c o m p l e x i t i e s of m o d e r n i s m — l i k e s c h i z o p h r e n i a — m a y appear
difficult to c o m p r e h e n d but
this does not m e a n that they are u n k n o w a b l e or w i t h o u t m e a n i n g . O n the c o n t r a r y , t h e d e p t h a n d r i c h n e s s o f m o d e r n i s t e x p r e s s i o n is s u c h t h a t s c h i z o p h r e n i a is, if a n y t h i n g , ' v a l o r i z e d r a t h e r t h a n d e n i g r a t e d b y b e i n g c o m p a r e d w i t h m a n y of t h e d i f f i c u l t b u t h i g h l y v a l u e d p r o d u c t s o f m o d e r n i s t c u l t u r e ' (Sass, 1998, p. 5 0 0 ) . Madness
and Modernism
discusses m a n y of the t w e n t i e t h c e n t u r y ' s m o s t
e s t e e m e d w r i t e r s a n d artists; h o w e v e r , Sass in t h i s text a n d e l s e w h e r e a c c o r d s p r i d e o f place t o D a n i e l P a u l S c h r e b e r a n d A n t o n i n A r t a u d , w h o m h e d e s c r i b e s n o t as typical b u t e x e m p l a r y m o d e r n m a d m e n (Sass, 1992, p . 246; 1996). 1 5 T h e g e n d e r s p e c i f i c i t y h e r e is t e l l i n g a n d w o r t h y o f a b r i e f d e t o u r . W o m e n , in Madness
and Modernism,
a r e c o n s p i c u o u s l y f e w a n d far b e t w e e n ; 1 6 t h e o v e r -
w h e l m i n g m a j o r i t y o f ' e x e m p l a r y ' m o d e r n i s t s a n d schizophrenic patients are E u r o p e a n m e n , as a r e t h e i n t e n s e l y c r e a t i v e s c h i z o i d a n d s c h i z o t y p a l intellect u a l s m e n t i o n e d in his l a t e r w o r k (Sass, 2 0 0 0 - 2 0 0 1 b , p. 7 2 ) . M y p o i n t h e r e is n o t t o accuse Sass o f b i a s o r o v e r s i g h t ; r a t h e r , it is t o suggest t h a t t h e r e m a y b e affinities n o t just b e t w e e n s c h i z o p h r e n i a a n d m o d e r n i s m , b u t also b e t w e e n s c h i z o p h r e n i a , m o d e r n i s m , a n d m a s c u l i n i t y as it h a s b e e n c o n c e p t u a l i z e d in t h e i n d u s t r i a l i z e d W e s t . M e t z l ' s ( 2 0 0 9 ) p o w e r f u l s t u d y o f t h e r a c i a l i z a t i o n of s c h i z o p h r e n i a in t h e civil r i g h t s e r a is clearly also a p p o s i t e h e r e . Sass states in t h e p r o l o g u e t o Madness
and Modernism
t h a t in t h e h i s t o r y o f m a d n e s s ' N e a r l y
15
I discussed Sass's analysis of the panoptic and solipsistic Schreber at length in Chapter 3. Artaud's autobiographical writing and his theatre of cruelty are at the forefront both of Sass's analysis of'negative' symptoms and of creativity and schizophrenia. Analysing the writing of the early twentieth century's two most celebrated psychotic patients also serves a strategic function in so far as it enables him to refute explicitly the regressive and Dionysian models of madness and to demonstrate the superiority of his phenomenological model in accounting for the totality of their schizophrenic experience.
16
Renee's Autobiography (1970) and Natalija's delusion of the influencing machine (Tausk, 1950) are the two most referenced examples of female schizophrenic experience; in the case of modernism, the writing of Virginia Wool! ami Natalie Sarrautc receive the most attention.
always i n s a n i t y i n v o l v e s a s h i f t f r o m h u m a n t o a n i m a l , f r o m c u l t u r e t o n a t u r e , f r o m t h o u g h t t o e m o t i o n , f r o m m a t u r i t y t o t h e i n f a n t i l e a n d t h e a r c h a i c ' (Sass, 1992, p. 4). H a s it also i n v o l v e d a shift f r o m ' m a s c u l i n e ' t o ' f e m i n i n e ' ? A n d if s o , h o w d o e s Sass's m o d e l r e v e r s e t h i s t r e n d ? In h e r h u g e l y i n f l u e n t i a l b o o k The Female
Malady,
Elaine Showalter argues that traditionally w o m e n have
b e e n s i t u a t e d ' o n t h e side o f i r r a t i o n a l i t y , silence, n a t u r e , a n d b o d y , w h i l e m e n a r e s i t u a t e d o n t h e s i d e o f r e a s o n , d i s c o u r s e , c u l t u r e , a n d m i n d . [. . .] T h u s , m a d n e s s , e v e n w h e n e x p e r i e n c e d b y m e n , is m e t a p h o r i c a l l y a n d s y m b o l i c a l l y r e p r e s e n t e d as f e m i n i n e ' ( S h o w a l t e r , 1 9 8 7 , p p . 3 - 4 ) . I n h i s a n a l y s i s o f t h e S c h r e b e r case, Sass explicitly raises t h e q u e s t i o n of a n o p p o s i t i o n b e t w e e n t h e h y p e r r e f l e x i v i t y o f s c h i z o p h r e n i a a n d t h e ' f e m i n i n e ' e x p e r i e n c e of e m b o d i e d s u b j e c t i v i t y , 1 7 s o is h i s c l a i m in Madness
and Modernism
t h a t s c h i z o p h r e n i a is
'an alienation not f r o m reason b u t f r o m the emotions, instincts and the body' (Sass, 1992, p. 4 ) , m o r e suggestive t h a n h e p e r h a p s allows? A l t h o u g h p u r s u i n g this line of i n q u i r y is, u n f o r t u n a t e l y , b e y o n d t h e s c o p e o f this c h a p t e r , as I h a v e d i s c u s s e d e l s e w h e r e ( W o o d s , in p r e s s ) Sass's w o r k clearly p o i n t s t o w a r d s n e w directions for research into the relationship between schizophrenia, gender, race, a n d p o s t m o d e r n c u l t u r a l p r o d u c t i o n s . W h a t is m o r e c e n t r a l t o this s t u d y of s c h i z o p h r e n i a in clinical a n d c u l t u r a l t h e o r y is Sass's d i s c u s s i o n of p o s t m o d e r n i s m as a c o n t i n u a t i o n of m o d e r n i s m , an i n t e n s i f i c a t i o n o f t h e m o d e r n i s t interest in hyperreflexivity a n d self-alienation. Sass's r e f e r e n c e s t o p o s t m o d e r n i s m as a m o v e m e n t e m p h a s i z e his view t h a t it is m e r e l y a s u b t y p e o f m o d e r n i s m , o r , b e t t e r still, a k i n d of h y p e r - m o d e r n i s m . C i t i n g , a m o n g o t h e r s , J e a n - F r a n ç o i s L y o t a r d , Julia Kristeva, F r a n k K e r m o d e , a n d F r e d e r i c k Karl as a d v o c a t e s of t h e c o n t i n u i t y thesis, Sass s o m e w h a t c o n troversially identifies poststructuralist theorists Jacques Derrida a n d Paul de M a n as e x e m p l a r y p o s t m o d e r n i s t s a n d , w i t h t h e e x c e p t i o n o f A n d y W a r h o l , does n o t discuss p o p u l a r p o s t m o d e r n i s m s of any kind. His preference for postr o m a n t i c m o d e r n i s m o v e r t h e ' f u r t h e r t u r n of t h e s c r e w of s e l f - c o n s c i o u s n e s s called p o s t m o d e r n i s m ' is c l e a r l y s t a t e d (Sass, 1992, p . 3 7 ) . 1 8 C o n c e n t r a t i n g 17
Sass interprets Schreber's delusional transvestism as a culturally determined way of working through the duality between subject and object: 'For Schreber, transformation into a woman implies losing in the competition of consciousness, ceding one's epistemological centrality and becoming a mere object defined by the other's sovereign awareness'. Sass continues: 'The experience of feminization was, in fact, Schreber's major antidote to the intellect, his palliative for the self-torturing mind. Though on one level a sign of persecution and defeat, it also had soothing and reassuring effects, allaying the restlessness and insidious self-undermining by his compulsive thinking and selfconsciousness'(Sass, 1994b, pp. 123, 126).
18
References to 'so i ailed' postmodernism, and to postmodernism as a distinct category, frequently appear 111 liraiktlx m footnotes (lor example Sass, 1987, p. 13; 1992, pp. 8,29).
o n aspects of p o s t m o d e r n i s m t h a t e x t e n d or exaggerate m o d e r n i s m ' s antir o m a n t i c i s m , Sass q u e s t i o n s e v e n t h e r e l e v a n c e of t h e t e m p o r a l d i s t i n c t i o n , a r g u i n g t h a t ' t h e s t y l i s t i c f e a t u r e s a n d a e s t h e t i c a t t i t u d e s i d e n t i f i e d as p o s t m o d e r n (e.g. a n e m p h a t i c s e l f - r e f e r e n t i a l i t y , p r o f o u n d r e l a t i v i s m a n d u n c e r tainty, e x t r e m e irony, a n d t e n d e n c i e s t o w a r d s f r a g m e n t a t i o n ) have in fact b e e n w i t h u s t h r o u g h o u t t h e t w e n t i e t h c e n t u r y ' (Sass, 1992, p. 4 1 8 ) . F o r Sass, s c h i z o p h r e n i a i l l u m i n a t e s t h e h y p e r r e f l e x i v e a n d s e l f - a l i e n a t i n g t e n d e n c i e s in h i g h m o d e r n i s m t h a t a r e also p r e s e n t a n d , if a n y t h i n g , m o r e p r o n o u n c e d in postmodernism. I n t r o d u c i n g a t h i r d p i e c e in t h e p u z z l e — n a m e l y , a n u n d e r l y i n g m a t e r i a l reality, o r the c o n t e x t in w h i c h b o t h s c h i z o p h r e n i a a n d m o d e r n i s m are m a n i f e s t — S a s s in t h e e p i l o g u e of Madness
and Modernism
c o n s i d e r s t h e issue
of an association, affinity, and aetiological link between schizophrenia a n d m o d e r n i t y (see a l s o Sass, 1 9 9 4 a ) . 1 9 H e r e , a l t h o u g h h e d o e s n o t r e f e r e n c e it d i r e c t l y , h e e x t e n d s t h e a n a l y s e s u n d e r t a k e n in D a v i d M i c h a e l L e v i n ' s e d i t e d c o l l e c t i o n Pathologies
of the Modern
Self ( L e v i n , 1 9 8 7 b ) . L e v i n ' s f o u n d i n g
p r e m i s e is o n e w i t h w h i c h Sass w o u l d s u r e l y agree: t h e self is s u b j e c t ' t o afflict i o n s t h a t a r e specific m a n i f e s t a t i o n s o f its h i s t o r i c a l s i t u a t i o n ' , p a t h o l o g i e s o f i n d i v i d u a l will t h a t ' a r e a l s o p a t h o l o g i e s c o l l e c t i v e l y w i l l e d i n t o b e i n g , p r o d u c e d b y o u r i n s t i t u t i o n s , c u s t o m s a n d p r a c t i c e s ' ( L e v i n , 1 9 8 7 b , p p . 1, 16). R e f l e c t i n g o n t h e r e l a t i o n s h i p b e t w e e n s c h i z o p h r e n i a a n d m o d e r n i t y , Joel Kovel a r g u e s t h a t it ' t a k e s o n especially severe, d e h u m a n i z e d p r o p o r t i o n s ' in t h e t e c h n o c r a t i c W e s t (Kovel, 1987, p . 334; see also B r a u n , 1995); J a m e s Glass t h a t it testifies t o ' t h e p o w e r of society in d e f i n i n g , e n c l o s i n g , a n d t e r r o r i z i n g t h e self (Glass, 1987, p . 4 0 6 ; 1993); a n d Levin asks: What if the truth in schizophrenia is one that, because of its distinctively greater vulnerability to what is craziest in civilization, speaks to the needs of its time, and speaks very clearly, considering the pain, attempting to call attention, at this time and for us, to the terror of self-destructiveness and the horror of nihilism, which rage in resonance with one another like an epidemic in our civilization? What if schizophrenia is the painful truth about a world that our metaphysics both founds and reflects? (Levin, 1987a, p. 523, italics in the original) Like Levin, Kovel, a n d Glass, Sass f i n d s c o m p e l l i n g e v i d e n c e t o suggest t h a t 'whether considered f r o m a historical or cross-cultural standpoint, m o d e r n W e s t e r n civilization d o e s seem t o have a statistical association w i t h s c h i z o p h r e n i a ,
19
On postmodernism as anti-romanticism see Sass, 1992, pp. 344, 39-40, 417-8; 1998, p. 499; 2000-200la, p. 81. Sass includes postmodernity in his definition of modernity, an issue to which we will return.
o r at least with its severely c h r o n i c o r autistic f o r m s ' (Sass, 1992, p. 366; 1997, p. 2 1 7 ) . T h e m a t i c a l l y l i n k e d t h r o u g h t h e m a s t e r t h e m e of h y p e r r e f l e x i v i t y , m a d n e s s a n d m o d e r n i s m are also historically a n d materially e n t w i n e d . Is this coincidence? D o e s m o d e r n culture m a k e p e o p l e m a d , o r d o m a d people m a k e m o d e r n culture? O r s h o u l d we view b o t h m a d n e s s a n d m o d e r n i s m as 'conseq u e n c e s o r reflections' of m o d e r n i t y (Sass, 1992, p. 357)? Sass clearly f a v o u r s t h e last of these f o u r i n t e r p r e t i v e o p t i o n s . D r a w i n g o n t h e w o r k of A n t h o n y G i d d e n s , Peter a n d Brigitte Berger, a n d a b o v e all F o u c a u l t , Sass argues t h a t m o d e r n i t y p r e c i p i t a t e s h u g e c h a n g e s in t h e s t r u c t u r e of e x p e r i e n c e a n d selfk n o w l e d g e . T h e i n c r e a s e d ' b u r e a u c r a t i z a t i o n , t e c h n o l o g i z a t i o n , secularization, a n d r a t i o n a l i z a t i o n ' of society (Sass, 1997, p. 219); t h e p r o d u c t i o n of the epistemological subject b o t h as an object of knowledge a n d as constitutive of the world; the p h i l o s o p h i c a l e m p h a s i s o n ' d i s e n g a g e m e n t a n d self-consciousness' a n d t h e p s y c h o l o g i z a t i o n o f h u m a n e x p e r i e n c e — t h e s e a r e j u s t s o m e of t h e t e n d e n c i e s in m o d e r n civilization w h i c h are n o t s i m p l y reflected in the c o n t e n t of s c h i z o p h r e n i c s y m p t o m s b u t c o n t r i b u t e t o t h e v e r y a p p e a r a n c e a n d t h e s t r u c t u r e of t h e d i s o r d e r itself (Sass, 1992, pp. 3 6 9 - 7 1 ) . W e are at last in a position to pose to Madness and Modernism
the key question
with which t h e rest of this b o o k is c o n c e r n e d : if, c o n t r a Sass, p o s t m o d e r n i t y is n o t simply t h e intensification of m o d e r n i t y , b u t a n era m a r k e d b y a n e w r e g i m e of t h e self, w h a t c a n w e say a b o u t t h e r e l a t i o n s h i p b e t w e e n s c h i z o p h r e n i a , p o s t m o d e r n culture, a n d society? If w e agree w i t h Sass that ' t h e psychotic p e r son m a y at t i m e s live o u t , in exaggerated, almost literal f a s h i o n , t h e ontological a n d e p i s t e m o l o g i c a l a s s u m p t i o n s of his o r h e r age' (Sass, 1997, p. 222), h o w m i g h t a ' p o s t m o d e r n s c h i z o p h r e n i a ' differ f r o m a s c h i z o p h r e n i c e x p e r i e n c e c o n s i d e r e d e x e m p l a r y of m o d e r n i t y ? In t h e n e x t c h a p t e r I e x a m i n e in m o r e d e p t h v a r i o u s a c c o u n t s of t h e figure o f ' t h e s c h i z o p h r e n i c ' as b r o a d l y r e p r e sentative of t h e p o s t m o d e r n subject; h o w e v e r , in o r d e r t o t h i n k t h r o u g h h o w Sass's analysis m i g h t b e b r o u g h t t o b e a r o n t h e q u e s t i o n of s c h i z o p h r e n i a ' s s y m b o l i c r e l a t i o n s h i p t o t h e p o s t m o d e r n , w e n e e d first t o e x a m i n e in m o r e detail t h e a r g u m e n t s in f a v o u r of identifying t h e shift f r o m m o d e r n i t y to postm o d e r n i t y as a f u n d a m e n t a l change in t h e material c o n d i t i o n s of existence.
The question of postmodernity P o s t m o d e r n i t y , as Barry S m a r t observes, is a t e r m t h a t generates c o n t r o v e r s y across a b r o a d r a n g e of fields a n d disciplines a n d i n s p i r e s r e a c t i o n s t h a t are 'rarely sober, m e a s u r e d o r t h o u g h t f u l ' ( S m a r t , 1993, p p . 1 1 - 1 2 ) . T h i s is clearly not the place t o survey c o m p r e h e n s i v e l y c o m p e t i n g d e f i n i t i o n s of p o s t m o d e r nity, n o r canvass t h e e n t i r e range of a r g u m e n t s for a n d against its existence. Sass, as we have seen, lullows A n t h o n y ( i i d d e n s a n d o t h e r s in e m p h a s i z i n g the
l a s t i n g s i g n i f i c a n c e o f t h e m o d e r n p r o j e c t : t h e i d e a t h a t , as t h e r e h a s b e e n n o d e m o n s t r a b l y s i g n i f i c a n t s h i f t in social a n d e c o n o m i c o r g a n i z a t i o n , p o s t m o d e r n i t y is, at m o s t , s o m e t h i n g like ' m o d e r n i t y w i t h bells o n ' ( G a u n t l e t t , 2 0 0 2 ) . T h e c l a i m t h a t t h e r e h a s b e e n n o t o n l y a s i g n i f i c a n t , b u t also a radical, shift in late t w e n t i e t h - c e n t u r y W e s t e r n society h a s i n m y v i e w b e e n m o s t c o n v i n c i n g l y a r g u e d b y socialist, M a r x i s t , a n d p o s t - M a r x i s t t h i n k e r s w h o u s e t h e c o n c e p t of p o s t m o d e r n i t y to identify a n d interpret an economically a n d technologically d i s t i n c t h i s t o r i c a l p e r i o d . F r e d r i c J a m e s o n a n d Jean B a u d r i l l a r d , w h o s e w o r k is t h e c e n t r a l f o c u s o f t h e n e x t c h a p t e r , a r e a m o n g t h e l e a d i n g a d v o c a t e s of t h e idea of a radically a l t e r e d m a t e r i a l a n d c u l t u r a l reality, b u t t h e y a r e s u p p o r t e d in t h i s a r g u m e n t b y a d i v e r s e c h o r u s o f c r i t i c a l v o i c e s . D o n n a H a r a w a y , f o r e x a m p l e , in h e r f a m o u s c y b o r g m a n i f e s t o , p o i n t s t o n e w b i o t e c h n o l o g i e s , p r o liferating c o m m u n i c a t i o n systems, a n d an exploitative m u l t i n a t i o n a l h o m e w o r k e c o n o m y as k e y i n d i c a t o r s t h a t o l d e r h i e r a r c h i c a l social s t r u c t u r e s h a v e b e e n r e p l a c e d b y t h e ' s c a r y n e w n e t w o r k s ' of t h e ' i n f o r m a t i c s of d o m i n a t i o n ' ( H a r a w a y , 1985, p . 8 0 ) . G i l l e s D e l e u z e s t a t e s u n e q u i v o c a l l y t h a t F o u c a u l t ' s d i s c i p l i n a r y society h a s given w a y t o c o n t r o l society c h a r a c t e r i z e d b y ' u l t r a r a p i d f o r m s of a p p a r e n t l y f r e e f l o a t i n g c o n t r o l ' t h a t o p e r a t e t h r o u g h a viral, d e c e n t r a l i z e d logic (Deleuze, 2002, p. 318). David H a r v e y , the influential M a r x i s t g e o g r a p h e r , p i n p o i n t s 1972 as t h e y e a r t h e w o r l d c h a n g e d : f l e x i b l e m o d e s of capitalist a c c u m u l a t i o n a n d n e w social s t r u c t u r e s b e g a n decisively t o t r a n s f o r m t h e e x p e r i e n c e o f space a n d t i m e ( H a r v e y , 1990, p . vii). T h e society o f m a s s m e d i a , t h e spectacle a n d s i m u l a c r a ; t h e global village; a n i n f o r m a t i o n a g e t h a t is c y b e r n e t i c , d i g i t a l , a n d p o s t h u m a n — t h e s e a r e o n l y s o m e o f t h e ways p o s t m o d e r n i t y h a s b e e n d e s c r i b e d . T o f o c u s o n t h e issue at h a n d — n a m e l y , t h e q u e s t i o n o f h o w Sass's m o d e l o f s c h i z o p h r e n i a m i g h t i l l u m i n a t e a d i s t i n c tively p o s t m o d e r n c o n d i t i o n — I w a n t t o t u r n n o w t o t h e w o r k of o n e of t h e m o s t f a m o u s sociologists o f t h e p o s t m o d e r n , Z y g m u n t B a u m a n . F o r B a u m a n , p o s t m o d e r n i t y r e f e r s n o t t o t h e e n d of m o d e r n i t y b u t s i m p l y t o ' p a r t i c u l a r f e a t u r e s o f t h e " w o r l d o u t t h e r e ' " . ' W e are', h e suggests, 'as m o d e r n as ever, o b s e s s i v e l y " m o d e r n i z i n g " e v e r y t h i n g w e c a n lay o u r h a n d s o n ' , b u t m a j o r s h i f t s in social a n d e c o n o m i c o r g a n i z a t i o n j u s t i f y s p e a k i n g n o w of a n e w era ( B a u m a n a n d Tester, 2001, pp. 9 6 - 8 ) . 2 0 B a u m a n has published m a n y a n a l y s e s of t h e p o s t m o d e r n c o n d i t i o n d e t a i l i n g t h e t r a n s i t i o n f r o m ' s o l i d ' t o ' l i q u i d ' m o d e r n i t y ( B a u m a n , 1 9 9 1 , 1 9 9 3 , 1 9 9 6 , 2 0 0 0 , 2 0 0 6 ) . As B a u m a n explains, l i q u i d m o d e r n i t y is at o n c e c o n t i n u o u s w i t h solid m o d e r n i t y (as it is ' m e l t i n g ' a n d ' d i s e m b e d d i n g ' ) a n d d i s c o n t i n u o u s w i t h it (as t h e r e is ' n o s o l i d i f i c a t i o n o f
20
Bauman rejected the terms postmodernism and postmodernity h a a u s c tliey were both fraught and all too-fashionable.
the melted, n o r e - e m b e d d i n g ' ) ( B a u m a n and Tester, 2001, pp. 97-8). The d i s t i n c t i o n is n o t o n e b e t w e e n t w o s u b s t a n t i v e l y d i f f e r e n t s t a t e s c o m p r i s i n g radically d i s s i m i l a r e l e m e n t s , b u t r e f e r s t o t h e s t r u c t u r e , p r o c e s s , a n d o r g a n i z a t i o n of society. In t h e e r a of g l o b a l i z a t i o n , t h e m a r k e t , m o r e so t h a n t h e state, d e t e r m i n e s t h e p a c e , flexibility, a n d m u t a b i l i t y o f s o c i a l life. ' W e live t o d a y u n d e r c o n d i t i o n s o f permanent
revolution,
w r i t e s B a u m a n , a n d so ' c o n s t a n t
c h a n g e is . . . t h e s u p r e m e n o r m of b e h a v i o r , a d v e r t i s e d a n d p r o m o t e d as t h e recipe of survival in t h e t u r b u l e n t a n d n o m o r e p r e d i c t a b l e w o r l d ' (ibid.). Liquid m o d e r n i t y ' s effects o n the subject are m a n y , b u t f o r e m o s t a m o n g t h e m is t h e l o o s e n i n g of t h e s t r u c t u r e s of c o m m u n i t y a n d h e n c e of social identities. B a u m a n t h e r e f o r e suggests t h a t : Perhaps instead of talking about identities, inherited or acquired, it would be more in keeping with the realities of the globalising world to speak of identification, a neverending, always incomplete, unfinished and open-ended activity in which we all, by necessity or by choice, are engaged. (Bauman, 2001, p. 129, italics in the original) B o u n d a r i e s , in l i q u i d m o d e r n i t y , are d i s s o l v e d as q u i c k l y as t h e y a r e r e s u r r e c t e d ; anxieties a r e a r o u s e d a n d a s s u a g e d in a n e v e r - a c c e l e r a t i n g cycle; i d e n t i ties a r e easily a d o p t e d a n d d i s c a r d e d ; t h e r e is, in s h o r t , n o p o s s i b i l i t y of a f i x e d o r stable self. T o l o o k m o r e p r e c i s e l y at B a u m a n ' s a c c o u n t o f t h e m e c h a n i s m s o f s u b j e c t f o r m a t i o n , w e c a n c o n c e n t r a t e o n h i s Work,
Consumerism
and the New
Poor
(2005). A c c o r d i n g to B a u m a n , the industrialization a n d rapid e x p a n s i o n of capitalist p r o d u c t i o n in t h e n i n e t e e n t h c e n t u r y w e r e p r e d i c a t e d o n a ' s u p r e m e r e g u l a t o r y p r i n c i p l e ' , t h a t of t h e w o r k e t h i c ( B a u m a n , 2 0 0 5 , p . 37). T h i s e t h i c p r o m o t e d t h e v a l u e of w o r k as 'a n o b l e a n d e n n o b l i n g activity' ( B a u m a n , 2 0 0 5 , p. 5), a n d p r e a c h e d t h e v i r t u e s of l i f e - l o n g p l a n n i n g a n d c o m m i t m e n t , o f savi n g as o p p o s e d t o s p e n d i n g , o f c h o o s i n g t h e d i g n i t y o f l a b o u r o v e r t h e s h o r t t e r m p l e a s u r e s o f c o n s u m p t i o n . I n d u s t r i a l i s t s , c l e r g y m e n , g o v e r n m e n t officials, a n d military officers e n c o u r a g e d m o d e r n m e n ( m o r e so t h a n w o m e n ) to view w o r k as t h e m o s t i m p o r t a n t a s p e c t o f t h e i r lives: t h e c e n t r e o f p s y c h i c a n d social o r i e n t a t i o n ( B a u m a n , 2005, p. 17). H o w e v e r , at t h e c e n t r e o f m o d e r n i t y , B a u m a n finds a p a r a d o x : ' T h e w o r k e t h i c called p e o p l e t o choose a life d e v o t e d t o l a b o u r ; b u t a life d e v o t e d t o l a b o u r m e a n t n o c h o i c e , inaccessibility of c h o i c e a n d p r o h i b i t i o n of c h o i c e ' ( B a u m a n , 2 0 0 5 , p . 19, italics in t h e o r i g i n a l ) . A n d at t h e h e a r t o f t h i s p a r a d o x , B a u m a n , like Sass a n d F o u c a u l t , f i n d s t h a t t r u l y m o d e r n m e c h a n i s m : the panopticon. For all t h r e e t h i n k e r s , t h e p a n o p t i c o n is t h e key t o u n d e r s t a n d i n g h o w ' t h e i n d i v i d u a l i z e d , sell s c r u t i n i z i n g , i n t e r i o r i z e d s u b j e c t of m o d e r n W e s t e r n cult u r e ' c a m e i n t o b e i n g (Sass, 1997, p. 2 0 6 ) . F o u c a u l t f a m o u s l y i n t e r p r e t e d t h e
s t r u c t u r e o f J e r e m y B e n t h a m ' s p a n o p t i c o n as a s y m b o l f o r t h e o p e r a t i o n o f m o d e r n d i s c i p l i n a r y p o w e r . T h e i n m a t e s i n t h e cells o f t h e p a n o p t i c o n a r e p e r m a n e n t l y v u l n e r a b l e t o t h e w a t c h f u l gaze o f t h o s e in t h e c e n t r a l t o w e r , a n a r r a n g e m e n t t h a t fosters in t h e m a f o r m of s e l f - s c r u t i n y w h i c h f u n c t i o n s regardless of w h e t h e r o r n o t t h e y a r e in fact b e i n g w a t c h e d . As Sass p u t s it: The panoptical arrangement makes individuals feel constantly exposed to an external, normalising gaze, therefore subjecting them to the dictates of an authority that must ultimately be internalized. Foucault sees this arrangement as the essential manifestation of modern power relationships instantiated in many institutions and social practices. It fosters forms of disciplinary self-control that eradicate spontaneity, increase inwardness and isolation, and instil the inner divisions of a relentlessly self-monitoring mode of consciousness. (Sass, 1997, p. 206; 1992, pp. 251-8) A s I d i s c u s s e d in C h a p t e r 2, Sass a r g u e s t h a t s c h i z o p h r e n i a c a n b e seen b o t h as a n e x a g g e r a t i o n o f a n d a n e s c a p e f r o m t h e relentless s e l f - m o n i t o r i n g i n s p i r e d b y m o d e r n i n s t i t u t i o n s (Sass, 1992, p . 3 7 2 ) . So it is t h e p a n o p t i c S c h r e b e r w h o reveals n o t t h e s y m b o l i c s t r u c t u r e s o f m o d e r n i t y ( a n a r g u m e n t m a d e b y Eric S a n t n e r ) , b u t t h e v e r y s t r u c t u r e o f its c o n s c i o u s n e s s : ' m a d n e s s , at l e a s t in S c h r e b e r ' s case, t u r n e d o u t t o b e o n e o f t h e m o s t e x t r e m e e x e m p l a r s of t h i s c i v i l i z a t i o n — a s i m u l a c r u m o f t h e m o d e r n w o r l d in t h e m o s t p r i v a t e recesses o f t h e s o u l ' (Sass, 1992, p. 373, italics in t h e o r i g i n a l ) . F o r B a u m a n , h o w e v e r , t h e k e y p o i n t t o e m p h a s i z e is t h a t b y i m p o s i n g ' o n e , u n i f o r m pattern of regular and predictable behaviour u p o n a variegated and e s s e n t i a l l y u n r u l y p o p u l a t i o n o f i n m a t e s ' ( B a u m a n , 2 0 0 5 , p . 14), p a n o p t i c p o w e r u l t i m a t e l y f u n c t i o n s t o e l i m i n a t e c h o i c e . It is t h e issue o f c h o i c e , a n d its p a n o p t i c regulation, that he claims underlies the twentieth century's most r a d i c a l s o c i o l o g i c a l u p h e a v a l . B a u m a n a r g u e s t h a t s o c i e t y is n o l o n g e r r e g u l a t e d t h r o u g h t h e p a n o p t i c a l logic o f t h e w o r k e t h i c b u t o r g a n i z e d a r o u n d a n a e s t h e t i c of c o n s u m p t i o n . W h e t h e r w e call it l i q u i d , late-, s e c o n d - , o r p o s t m o d e r n i t y , society t o d a y a d d r e s s e s , e n g a g e s , a n d c o n s t r u c t s its m e m b e r s p r i m a rily as c o n s u m e r s , a n d ' t o e m b r a c e t h e m o d a l i t y of t h e c o n s u m e r m e a n s first a n d f o r e m o s t falling in love w i t h c h o i c e ' ( B a u m a n , 2 0 0 5 , p p . 24, 30). T h e cycle o f c r e a t i n g , f u l f i l l i n g , r e c r e a t i n g , a n d r e - f u l f i l l i n g d e s i r e is c r u c i a l t o t h e s u c c e s s f u l o p e r a t i o n o f a c o n s u m e r society. R e d u c i n g t h e lag b e t w e e n t h e satisfact i o n o f d e s i r e a n d its r e a c t i v a t i o n 'is b e s t a c h i e v e d if t h e c o n s u m e r s c a n n o t h o l d t h e i r a t t e n t i o n n o r f o c u s t h e i r d e s i r e o n a n y o b j e c t f o r l o n g ; if t h e y a r e i m p a t i e n t , i m p e t u o u s a n d restive, a n d a b o v e all easily e x c i t a b l e a n d e q u a l l y susceptible to losing interest' ( B a u m a n , 2005, p. 25). ' T h e everyday w o r l d of t h e p o s t m o d e r n h a b i t a t is', as D e n n i s S m i t h o b s e r v e s in h i s c o m m e n t a r y o n t h e w o r k of B a u m a n , ' e p i s o d i c , h a p h a z a r d , i n c o n s i s t e n t a n d c o n t i n g e n t ' ( S m i t h , 1999, p. 1 5 8 ) . C o n s e q u e n t l y , c o n s u m e r s h a v e little i n c e n t i v e t o b e
Mil QUESTION Of POSIMODtKNIIY | 179
i n t e r e s t e d in l i f e - l o n g a m b i t i o n s , c o m m i t m e n t s , o r even identities: e v e r y t h i n g is e m b r a c e d lightly, partially, a n d p r o v i s i o n a l l y , t o be r e p l a c e d o r d i s p l a c e d as fashion a n d circumstance dictate. O n e of t h e m o s t salient f e a t u r e s o f c o n s u m e r society o n t h i s analysis is ' t h e retreat of the panoptical techniques of d o m i n a t i o n ' ( B a u m a n a n d Tester, 2001, p. 90): The kind of drill in which the panoptical institutions excelled is hardly suitable for the training of consumers. Those institutions were good at training people in routine, monotonous behaviour, and reached that effect through the limitation or complete elimination of choice; but it is precisely the absence of routine and the state of constant choice that are the virtues (indeed, the 'role prerequisites') of a consumer. (Bauman, 2005, pp. 24-5, 29) W h e r e a s t h e w o r k e t h i c r e q u i r e d p e o p l e t o c h o o s e a lack o f c h o i c e ( w o r k w a s the only conscionable o p t i o n ) , c o n s u m e r society f u n c t i o n s to m a x i m i z e a n d v a l o u r i z e c h o i c e a n d h a s n o n e e d of d i s c i p l i n a r y m e c h a n i s m s t h a t w o u l d r e i n state n o r m s o r l i m i t s . A c c o r d i n g t o B a u m a n , it is n o t t h e p a n o p t i c o n b u t t h e s y n o p t i c o n , w h i c h s u p p l i e s t h e ' p a t t e r n o f e x i s t e n c e ' in c o n s u m e r s o c i e t y ( S m i t h , 1999, p . 153). A s M a t h i e s e n ( 1 9 9 7 , p . 2 1 9 ) e x p l a i n s , t h e s y n o p t i c o n r e f e r s t o ' a s i t u a t i o n w h e r e a large n u m b e r f o c u s e s o n s o m e t h i n g in c o m m o n w h i c h is c o n d e n s e d ' . I n s t e a d o f t h e f e w w a t c h i n g t h e m a n y in a n e n v i r o n m e n t o f s u r v e i l l a n c e a n d c o n t r o l , t h e m a n y w a t c h t h e few: c o n s u m e r s a r e t r a i n e d b y a celebrity elite w h o s e every m o v e is d o c u m e n t e d b y t h e m a s s m e d i a ( B a u m a n , 2 0 0 5 , p p . 5 2 - 4 ) . W h e r e a s t h e p a n o p t i c o n is a r e p r e s s i v e m e c h a n i s m — c u r t a i l i n g c h o i c e , c o m m a n d i n g a d h e r e n c e t o t h e w o r k e t h i c — t h e s y n o p t i c o n , as T o n y Blackshaw notes, 'needs n o coercion' a n d f u n c t i o n s simply to p r o m o t e ' n e w ' a n d ' c o o l ' w a y s o f living a life o b e d i e n t o n l y t o d e s i r e ( B l a c k s h a w , 2 0 0 5 , p. 129). B a u m a n is r i g h t , I t h i n k , t o associate p o s t m o d e r n i t y w i t h a s y n o p t i c r e g i m e , b u t his c l a i m t h a t ' W h a t e v e r else t h e p r e s e n t stage in t h e h i s t o r y o f m o d e r n i t y is, it is a l s o , p e r h a p s a b o v e all, post-Panoptical',
s e e m s t o fly in t h e f a c e o f
e m p i r i c a l f a c t ( B a u m a n , 2 0 0 0 , p. 11). 2 1 W h e t h e r t r a v e l l i n g , s h o p p i n g , b a n k ing, driving, i n t e r n e t - s u r f i n g , o r s i m p l y m e a n d e r i n g t h r o u g h p u b l i c space, ' N o w m o r e t h a n e v e r , w e a r e u n d e r s u r v e i l l a n c e ' ( L e v i n et al., 2 0 0 2 , p . 10). P o s t m o d e r n i t y sees n o t t h e d e c l i n e of p a n o p t i c i s m b u t its radical p r o l i f e r a t i o n , p r i v a t i z a t i o n , a n d d e c e n t r a l i z a t i o n ; as D a v i d L y o n s u g g e s t s , s u r v e i l l a n c e a n d ' s u r v e i l l a n c e t e c h n o l o g i e s a r e vitally i m p l i c a t e d in t h e p r o c e s s e s of p o s t m o d e r n i t y ' a n d a r e c r u c i a l , n o t p e r i p h e r a l , t o t h e s m o o t h f u n c t i o n i n g of c o n s u m e r
21
Indeed, surveillance studies has emerged as a new trans-disciplinary academic field, complete with a peer-reviewed online journal Surveillance anil Society.
s o c i e t y ( L y o n , 2 0 0 3 , p . 165). In h i s article, ' T h e K i n d l e r , G e n t l e r G a z e o f Big B r o t h e r : Reality T V in t h e Era of Digital C a p i t a l i s m ' , M a r k A n d r e j e v i c m a k e s a c o m p e l l i n g a r g u m e n t r e g a r d i n g t h e role o f s u r v e i l l a n c e - b a s e d reality television in ' t r a i n i n g v i e w e r s a n d c o n s u m e r s f o r t h e i r r o l e in a n " i n t e r a c t i v e " e c o n o m y ' ( A n d r e j e v i c , 2 0 0 2 , p. 2 5 1 ) . S u r v e i l l a n c e , as it a p p e a r s o n s h o w s like Big
Brother,
t o n a m e b u t t h e m o s t o b v i o u s , is n o t , as i n G e o r g e O r w e l l ' s d a y , a s s o c i a t e d with totalitarian control b u t with sensation, f u n , a n d self-expression. The kind o f s u b j e c t i v i t y ' c o n s o n a n t w i t h a n e m e r g i n g o n l i n e e c o n o m y ' is o n e t h a t 'equates submission to comprehensive surveillance with self-expression and s e l f - k n o w l e d g e ' ( A n d r e j e v i c , 2 0 0 2 , p. 2 5 3 ) . O b s e r v a t i o n is n o l o n g e r m e n a c i n g b u t e n t e r t a i n i n g ( W e i b e l , 2 0 0 2 , p. 2 1 5 ) . T o t h e p o s t m o d e r n c o n s u m e r / v i e w e r e a g e r t o p r o v e t h e i r a u t h e n t i c a n d h o n e s t selves, ' t h e p e r s i s t e n t gaze o f t h e c a m e r a provides o n e w a y of guaranteeing that "realness"' (Andrejevic, 2002, p . 2 6 6 ) . W h a t w e a r e w i t n e s s i n g , a c c o r d i n g to Slavoj 2 i z e k (2002, p. 225), . . . is the tragi comic reversal of the Bentham-Orwellian notion of the Panopticonsociety in which we are (potentially) 'observed always' and have no place to hide from the omnipresent gaze of the Power: today anxiety seems to arise from the prospect of NOT being exposed to the Other's gaze all the time, so that the subject needs the camera's gaze as a kind of ontological guarantee of his/her being. F o u c a u l t ' s m o d e r n p a n o p t i c o n , a c c o r d i n g t o Sass, ' f o s t e r s f o r m s o f disciplin a r y self-control that eradicate spontaneity, increase inwardness a n d isolation, a n d instil t h e i n n e r divisions of a relentlessly s e l f - m o n i t o r i n g m o d e of c o n s c i o u s n e s s ' (Sass, 1997; 1992, p p . 2 5 1 - 8 ) . Its p o s t m o d e r n e q u i v a l e n t r e p l a c e s self-control with self-expression. Here, self-consciousness might not tend t o w a r d s i n w a r d n e s s a n d i s o l a t i o n , b u t b e t h e v e r y p r e c o n d i t i o n f o r an i n t e r s u b j e c t i v e l y m e a n i n g f u l b e i n g . P o s t m o d e r n p a n o p t i c i s m d o e s n o t a d d r e s s its s u b j e c t s as p e o p l e o f d e p t h a n d c o n s c i e n c e , n o r i n c u l c a t e a d u t y t o c o n f o r m t o t h e n o r m ; r a t h e r it f o s t e r s p e r f o r m a t i v i t y , i n d i v i d u a l i s m , a n d t h e p u r s u i t o f h a p p i n e s s t h r o u g h c o n s u m p t i o n . In t h i s s e n s e , t h e n , p o s t m o d e r n c o n s u m e r society d o e s n o t s o m u c h a b a n d o n t h e p a n o p t i c r e g i m e as h a r n e s s its p r o d u c tion of self-monitoring subjects to different ends. T h i s idea of a seismic shift in t h e s t r u c t u r e a n d r e g u l a t o r y p r i n c i p l e s of m o d e r n i t y r e s o n a t e s w i t h m o s t if n o t all of t h e m a j o r a c c o u n t s of p o s t m o d e r n i t y , a n d t h u s p r o v i d e s s t r o n g g r o u n d s f r o m w h i c h t o i n q u i r e as t o p a r a l l e l t r a n s f o r m a t i o n s at t h e level o f o n t o l o g y (see a l s o Lee, 2 0 0 0 , p . x ) . H e r e , w e r e - e n g a g e Sass's a r g u m e n t in Madness
and Modernism:
if s c h i z o p h r e n i a 'installs
t h e p u b l i c w o r l d in t h e m o s t p r i v a t e recesses of t h e s o u l ' (Sass, 1992, p. 106, italics in t h e o r i g i n a l ) , h o w m i g h t it reflect s u c h u p h e a v a l s in t h e social realm? B e a r i n g in m i n d t h a t t h e s e c h a n g e s in n o w a y signal a r e t u r n t o p r e - m o d e r n , p r e - i n d u s t r i a l m o d e s o f life, we s h o u l d expect an affinity bet w e e n si h i / . o p h r e n i a
a n d p o s t m o d e r n i t y t o c o n t i n u e , if n o t i n t e n s i f y t h e a f f i n i t y b e t w e e n s c h i z o p h r e n i a a n d m o d e r n i t y . Sass's c o m m e n t h e r e is b r i e f b u t suggestive: Certain theorists who see Western societies as having moved to a stage of pos/modernity emphasize a somewhat different set of developments [from the rationality and reflexivity promoted by modern institutions], among them: the waning of affect, the dissolution of the sense of separate selfhood, the loss of any sense of the real, and the saturation by images and simulacra detaching from all grounding outside themselves; these, obviously, are more than a little reminiscent of certain schizoid and schizophrenic tendencies, and it is not difficult to imagine that such general cultural developments might also influence the modes of experience characteristic of such individuals. (Sass, 1992, p. 372) 22 In o r d e r t o e x p l o r e t h e r e l a t i o n s h i p b e t w e e n s c h i z o p h r e n i a a n d p o s t m o d e r n i t y in t h e light o f Madness
and Modernism
we need to introduce a third term
b a c k i n t o t h e e q u a t i o n , n a m e l y , p o s t m o d e r n i s m . Sass, as w e k n o w , i d e n t i f i e s a r e s e m b l a n c e b e t w e e n h i g h m o d e r n i s m , a m o v e m e n t r e n o w n e d f o r its i c o n o clasm, elitism, and intellectualism, and schizophrenia, the century's m o s t s e v e r e p s y c h o p a t h o l o g y , s u g g e s t i n g b o t h c a n b e s e e n as ' c o n s e q u e n c e s o r r e f l e c t i o n s ' of m o d e r n i t y . I m p l i c i t h e r e a n d h e n c e u n r e m a r k e d a r e t w o f u r t h e r c o r r e l a t i o n s b e t w e e n s c h i z o p h r e n i c p h e n o m e n o l o g y a n d h i g h m o d e r n i s m as t h e y a p p e a r in his analysis: b o t h a r e extreme o r exceptional
cases ( o p p o s e d t o t h e
' n o r m a l c y ' of mass or p o p u l a r culture), a n d b o t h articulate a n d reinvigorate models of psychic depth. P o s t m o d e r n i s m is c r e d i t e d w i t h c o l l a p s i n g t h e b o u n d a r y b e t w e e n h i g h a r t a n d l o w art, o r b e t w e e n h i g h m o d e r n i s m a n d p o p u l a r c u l t u r e ; e x t e n d i n g , as it were, high m o d e r n i s t techniques, t h e m a t i c concerns, a n d aesthetic strategies i n t o t h e c o m m e r c i a l l y d r i v e n r e a l m of m a s s c u l t u r e . It is a l s o — i n t h e w o r k of B a u m a n a n d m a n y o t h e r s — a s s o c i a t e d w i t h a d e c e n t r i n g of subjectivity, a r t i c u l a t e d e i t h e r as t h e loss o f ' m a s t e r f u l ' , m e a n i n g f u l , a u t o n o m o u s h u m a n self, o r t h e r e c o g n i t i o n t h a t s u c h a n e x p e r i e n c e of s e l f h o o d w a s o n l y ever a f i c t i o n . If schizophrenia has an affinity with p o s t m o d e r n i s m , we m i g h t hypothesize t w o t h i n g s : (i) t h a t t h e p h e n o m e n o l o g y of s c h i z o p h r e n i a will r e s o n a t e a c r o s s a l a r g e r n u m b e r o f c u l t u r a l sites, b u t (ii) t h a t it will n o l o n g e r s p e a k r e s o u n d ingly of psychic d e p t h . Exigent i n t r o s p e c t i o n , o r ' t h e d e s p e r a t e a t t e m p t t o l o c a t e a self as s o l i d as a t h i n g ' , will still l e a d ' t o t h e f e e l i n g of h a v i n g n o self, n o still p o i n t at t h e c e n t e r o f a t u r n i n g w o r l d ' (Sass, 1987a, p p . 2 3 - 4 ) b u t in
22
Here Sass references lameson's 'Postmodernism and Consumer Society' but somewhat surprisingly docs not engage Umison's i lalin to be discussed in the next chapter—that tlie figure ol 'the mhl/.ophrrnli is tin < mmplary postmodern subject.
p o s t m o d e r n i t y , I a m suggesting, p e r h a p s t h e experience of h a v i n g n o solid self is n o t o n l y m o r e c o m m o n p l a c e , b u t actually w h a t c o n s u m e r society e n c o u r ages in its subjects. In t u r n i n g n o w t o p o s t m o d e r n cultural theory, w e can see t h e figure of ' t h e s c h i z o p h r e n i c ' recast f r o m b e i n g t h e a p o t h e o s i s of m o d e r n subjectivity to t h e q u o t i d i a n , p r o t o t y p i c a l p o s t m o d e r n subject.
Chapter 6
Postmodern schizophrenia
P o s t m o d e r n c u l t u r a l t h e o r y of t h e late t w e n t i e t h c e n t u r y h a s u s e d t h e t e r m s c h i z o p h r e n i a t o e n d s far r e m o v e d f r o m t h e clinical d i a g n o s i s of i n d i v i d u a l suffering. By t h e early 1980s, Anti-Oedipus
a n d the a n t i p s y c h i a t r y m o v e m e n t
h a d i n t r o d u c e d n e w a n d politically c h a r g e d m o d e l s of s c h i z o p h r e n i a t o t h e a c a d e m i c e s t a b l i s h m e n t , greatly e x t e n d i n g its s y m b o l i c capacities a n d p o t e n tial. Since t h e n , virtually every aspect of late t w e n t i e t h - c e n t u r y aesthetic a n d cultural p r o d u c t i o n — i n c l u d i n g visual art, literature, television, c i n e m a , archit e c t u r e , a n d m u s i c — a s well as t h e generalized subjective e x p e r i e n c e of p o s t m o d e r n i t y , has b e e n u n d e r s t o o d t h r o u g h its lens. T h i s c h a p t e r is specifically c o n c e r n e d with t h e m a j o r theoretical w o r k s identifying t h e figure o f ' t h e schizo p h r e n i c ' as representative o r typical of t h e p o s t m o d e r n subject. A l t h o u g h this a r g u m e n t is a d v a n c e d in an array of d i f f e r e n t contexts, across a r a n g e of discip l i n e s , m y analysis c o n c e n t r a t e s o n k e y t e x t s b y J e a n B a u d r i l l a r d , F r e d r i c J a m e s o n , David Harvey, M a r k Currie, J o h n J o h n s t o n , a n d Steven Frosh. If, as R o b e r t Barrett suggests, ' P e o p l e categorized as " s c h i z o p h r e n i c " have l o n g b e e n e n t r u s t e d w i t h t h i s d u t y of s y m b o l i z i n g society, its s t r u c t u r a l e l e m e n t s , its d e f i n i t i o n of p e r s o n h o o d , its c o n t r a d i c t i o n s [ a n d ] its p a r a d o x e s ' ( 1 9 9 8 c , p. 484), w h a t is distinctive a b o u t these theorists' claim t h a t s c h i z o p h r e n i a can b e used, h o w e v e r (il)legitimately, to i n t e r p r e t specific aspects of p o s t m o d e r nity? A n d h o w c a n this b e u n d e r s t o o d w i t h i n t h e c o n t e x t of t h e a c c o u n t s of s c h i z o p h r e n i a discussed so far in this b o o k ? W e saw in t h e p r e v i o u s c h a p t e r t h a t Louis Sass's p h e n o m e n o l o g i c a l a p p r o a c h t o s c h i z o p h r e n i a situated it o u t s i d e the logic of t h e s u b l i m e that I have argued underscores psychiatric, psychoanalytic, antipsychiatric, a n d even anti-Oedipal a c c o u n t s of t h e d i s o r d e r . A t t e n t i v e t h r o u g h o u t t o p h e n o m e n o l o g i c a l detail, Sass d i s c u s s e s s p e c i f i c a l t e r a t i o n s in t h e s c h i z o p h r e n i c e x p e r i e n c e o f self a n d w o r l d , d r a w i n g o n clinical a n d c u l t u r a l e x a m p l e s t o s h o w t h a t schizo p h r e n i a b o t h is a n d is n o t w i t h i n t h e realms of e m p a t h e t i c u n d e r s t a n d i n g . By c o n t r a s t , in m o b i l i z i n g a c o m p a r a t i v e l y t w o - d i m e n s i o n a l m o d e l of s c h i z o p h r e n i a t o s t a n d for a general m o d e of W e s t e r n late t w e n t i e t h - c e n t u r y subjectivity, p o s t m o d e r n c u l t u r a l t h e o r i s t s r e t u r n t o t h e s u b l i m e , i n a u g u r a t i n g a f o u r t h m o d e of s c h i z o p h r e n i c s u b l i m i t y I call t h e p a r a d o x i c a l s u b l i m e .
T h e i d e a o f t h e p a r a d o x i c a l s u b l i m e is i n s p i r e d b y l i t e r a r y t h e o r i s t L i n d a H u t c h e o n ' s analysis o f p a r a d o x i c a l p o s t m o d e r n i s m , w h i c h s h e d e s c r i b e s as a ' p o s t m o d e r n i s m of c o m p l i c i t y a n d c r i t i q u e , of reflexivity a n d h i s t o r i c i t y , t h a t at o n c e inscribes a n d s u b v e r t s t h e c o n v e n t i o n s a n d i d e o l o g i e s o f t h e d o m i n a n t c u l t u r a l a n d social f o r c e s o f t h e t w e n t i e t h - c e n t u r y w e s t e r n w o r l d ' ( H u t c h e o n , 1989, p . 11). T o o p e r a t e p a r a d o x i c a l l y is, a c c o r d i n g t o H u t c h e o n , t o e x p l o i t a n d u n d e r m i n e , ' t o install a n d t h e n s u b v e r t ' . It is t h i s p r o p e n s i t y t o ' u s e a n d a b u s e ' critical a n d a e s t h e t i c c o n c e p t s a n d strategies w h i c h is f o r H u t c h e o n t h e m o s t p r o m i n e n t f e a t u r e of p o s t m o d e r n c u l t u r a l p r o d u c t i o n s ( H u t c h e o n , 1988, p. 101). M y s u g g e s t i o n h e r e is t h a t t h e s c h i z o p h r e n i c s u b l i m e is similarly ' u s e d a n d a b u s e d ' b y p o s t m o d e r n c u l t u r a l t h e o r i s t s . As I will a r g u e , t h e e f f i c a c y o f t h e t o p o s o f s c h i z o p h r e n i a in p o s t m o d e r n c u l t u r a l t h e o r y d e p e n d s u p o n its s u b l i m e s t a t u s in p s y c h i a t r i c , p s y c h o a n a l y t i c , a n d e s p e c i a l l y a n t i p s y c h i a t r i c discourse. However, using schizophrenia so capaciously redefines the disorder as q u o t i d i a n — t h a t is, as n o l o n g e r p a t h o l o g i c a l , b e c a u s e it is i l l u s t r a t i v e of c o n t e m p o r a r y s u b j e c t i v i t y p e r se. T h i s r e n d e r s t h e t e r m v i r t u a l l y e m p t y , ( o v e r ) i n f l a t e s its s y m b o l i c c a p a c i t y at t h e e x p e n s e o f its p h e n o m e n o l o g i c a l a n d p s y c h o l o g i c a l specificity, a n d c o n s e q u e n t l y c o n c e a l s s o m e of its m o r e t r o u b l i n g implications. P o s t m o d e r n theorists therefore d o not challenge or deconstruct s c h i z o p h r e n i a ' s s u b l i m e s t a t u s ; t h e i r s is n o t t h e r e p u d i a t i o n b u t t h e i n f l a t i o n a n d s u b s e q u e n t d e l i q u e s c e n c e of t h e s c h i z o p h r e n i c s u b l i m e . W o r t h n o t i n g f r o m t h e o u t s e t a r e t w o effects of t h e p a r a d o x i c a l s u b l i m e as it o p e r a t e s in p o s t m o d e r n c u l t u r a l t h e o r y . First, it p a t h o l o g i z e s i n s t e a d of m e r e l y describing the d e c e n t r i n g of subjectivity a n d the so-called e n d of subjective d e p t h . T h e W e s t e r n self is, as C l i f f o r d G e e r t z h a s s u g g e s t e d , c o n c e p t u a l i z e d ' " a s a b o u n d e d , u n i q u e , m o r e o r less i n t e g r a t e d m o t i v a t i o n a l a n d c o g n i t i v e universe, a d y n a m i c centre of awareness, e m o t i o n , j u d g m e n t , and action o r g a n i z e d i n t o a d i s t i n c t i v e w h o l e a n d set c o n t r a s t i v e l y b o t h a g a i n s t o t h e r s u c h w h o l e s a n d a g a i n s t its social a n d n a t u r a l b a c k g r o u n d ' " ( q u o t e d in Sass, 1992, p . 2 1 5 ; see a l s o F a b r e g a , 1 9 8 9 ; R o s e , 1 9 9 6 ) . ' P o s t m o d e r n
schizophrenia'
d e c l a r e s a n e n d t o t h i s h u m a n i s t m o d e l of t h e self. A s e c o n d c o n s e q u e n c e o f t h e p a r a d o x i c a l s u b l i m e is t h a t it r e p o s i t i o n s t h e m a r g i n a l as c e n t r a l ; t h e a p o t h e o s i s as t h e a v e r a g e ; t h e p a t h o l o g i c a l as n o r m a l , even u b i q u i t o u s . 1 In so
1
Alain Ehrenberg's The Weariness of the Self offers an interesting parallel to the argument! will present in this chapter. Despite significant differences (not least of which is that Ehrenberg's book-length study remains centrally focused on the changing clinical fortunes of depression), Ehrenberg, like Jameson, Baudrillard, and other theorists of'postmodern schizophrenia', uses a concept once understood to designate 'the exceptional' to interpret the general structure of subjectivity in the 'emancipatory' era of post l%H liberal individualism: 'In the sixteenth century, melancholia was the cl<\ live illness of the
d o i n g , d o e s t h e t o p o s of s c h i z o p h r e n i a in p o s t m o d e r n c u l t u r a l t h e o r y a c t u a l l y i l l u m i n a t e o r i n t e r p r e t t h e e x p e r i e n c e o f p o s t m o d e r n i t y ? C a n it h e l p u s t o investigate, r a t h e r t h a n s i m p l y d e s c r i b e , w h a t it is t o b e , in B a u m a n ' s t e r m i n o l ogy, 'a l i q u i d m o d e r n ' ? T h e s e q u e s t i o n s will b e b r o u g h t t o b e a r first o n Jean B a u d r i l l a r d ' s The of Communication
Ecstasy
(1988) a n d then Fredric Jameson's ' P o s t m o d e r n i s m , or the
C u l t u r a l Logic o f L a t e C a p i t a l i s m ' ( 1 9 8 4 b ) , a n essay t h a t a r g u a b l y d i d m o r e t h a n a n y o t h e r t o p o p u l a r i z e t h e i d e a o f s c h i z o p h r e n i a as t h e r e p r e s e n t a t i v e f o r m of p o s t m o d e r n subjectivity. Critics have for the m o s t part followed J a m e s o n in r e j e c t i n g as ' m o r b i d ' a n y a s s o c i a t i o n b e t w e e n his m o d e l o f ' s c h i z o p h r e n i a ' a n d its clinical a n a l o g u e s , b u t as w i t h D e l e u z e a n d G u a t t a r i ' s m o d e l of s c h i z o p h r e n i a - a s - p r o c e s s , a close r e a d i n g of h i s a r g u m e n t d e m o n s t r a t e s t h e o p p o s i t e . C o n c e n t r a t i n g o n t h e t h r e e texts t h a t m o s t d i r e c t l y i n f o r m J a m e s o n ' s a c c o u n t — L a c a n ' s w o r k o n p s y c h o s i s ( 1 9 6 6 , 1993), R e n e e ' s Autobiography Schizophrenic
Girl ( 1 9 7 0 ) , a n d Anti-Oedipus
of a
2
( 1 9 8 2 ) i t s e l f — I will l o o k at w h a t
exceptional man, of he who had nothing above him. During the Romantic period, it stood at the crossroads of creative genius and madness. Today, it is the situation of every individual in Western society. I want to provide a glimpse of this history while showing that contemporary depression is the marriage between the traditional melancholia of the exceptional person and the modern egalitarian idea that anyone can be e x c e p t i o n a l . . . . [I approach depression] as an attitude, a mindset heavy with multiple social practices and representations of ourselves in a society in which values associated with autonomy (e.g. personal choice, self-ownership, individual initiative) have been generalized . . . . Thus, depression brings together all the tensions of the modern individual' (Ehrenberg, 2010, p. xxx). 2
Curiously, there is no reference to Joseph Gabel's False Consciousness (1976) in Jameson's Postmodernism, or the Cultural Logic of Late Capitalism, or, as I have already noted, in Anti-Oedipus. Whether this book-length study of schizophrenia and false consciousness was simply unknown to Jameson, or represented precisely the kind of Marxist-psychiatric scholarship he sought to distance himself from, is difficult to judge. Certainly Gabel's Minkowski-influenced account of the phenomenology of schizophrenia (emphasizing morbid rationalism, the collapse of affect, a sense of social alienation, and a breakdown in the experience of lived time) is highly relevant to Jameson's Lacanian-inspired account of the temporal and linguistic collapse of subjectivity in 'postmodern schizophrenia'. Indeed, although he does not reference Jameson, Deleuze, or Guattari specifically here, Alastair Morgan suggests that post-1960s 'Schizophrenia no longer comes to be read as the incarnation of a generalized loss of life in terms of reification [Gabel's position], but is mapped on to the speeded-up nature of modern life in general. The instability of identity, the fluidity and speeding up of sensory inputs and perceptions, the inability to form lasting relationships; schizophrenia as psychosis becomes a mirror of the postmodern in a reversal of Gabel's original socio pathological parallelism' (Morgan, 2010, p. 184). A more comprehensive study of I nine Consciousness in connection with Anti-Oedipus and Postmodernism, oi llie < idlmal I ogn oj hilc (.n/iilalism is clearly warranted.
m u s t be d o w n p l a y e d , s i d e - s t e p p e d , o r even repressed in o r d e r f o r this m e t a p h o r t o f u n c t i o n , a n d a r g u e that it is J a m e s o n ' s analysis t h a t m o s t clearly d e m o n s t r a t e s w h a t I h a v e d e s c r i b e d as t h e p a r a d o x i c a l o p e r a t i o n o f t h e schizophrenic sublime. Following Jameson's lead—albeit with significant v a r i a t i o n s — D a v i d H a r v e y (1990), M a r k C u r r i e (1998), J o h n J o h n s t o n (1990), a n d S t e p h e n Frosh (1991) have all u s e d s c h i z o p h r e n i a as a heuristic device to e x p l o r e t h e e x p e r i e n c e o f p o s t m o d e r n i t y . In t h e final p a r t of this c h a p t e r I c o n s i d e r the strengths a n d l i m i t a t i o n s of these v a r i o u s d e p l o y m e n t s of schizop h r e n i a . Re-engaging Sass's analysis of s c h i z o p h r e n i a a n d m o d e r n i t y , I a r g u e t h a t t h e y are m o r e suggestive t h a n h a s p r e v i o u s l y b e e n a c k n o w l e d g e d , b u t suffer also f r o m t h e very p r o b l e m s t h e y diagnose.
Introducing the figure of 'the postmodern schizophrenic' Edited b y H a l Foster a n d first p u b l i s h e d in 1983, The Anti-aesthetic
(1983) was
o n e of t h e earliest collections of essays o n p o s t m o d e r n c u l t u r e a n d has r e m a i n e d a m o n g t h e m o s t i n f l u e n t i a l . I n it, t h e p o s t m o d e r n s u b j e c t is d i a g n o s e d as s c h i z o p h r e n i c i n t w o s u c c e s s i v e s e m i n a l a r t i c l e s : F r e d r i c J a m e s o n ' s ' P o s t m o d e r n i s m a n d C o n s u m e r Society' a n d Jean Baudrillard's ' T h e Ecstasy of C o m m u n i c a t i o n ' . Baudrillard's essay w a s e x p a n d e d a n d r e - p u b l i s h e d as a slim S e m i o t e x t ( e ) F o r e i g n A g e n t s m o n o g r a p h in 1988. J a m e s o n ' s analysis of t h e p o s t m o d e r n was e x t e n d e d in his 1984 New Left Review article ' P o s t m o d e r n i s m , o r t h e C u l t u r a l Logic of Late Capitalism', w h i c h in t u r n b e c a m e t h e first c h a p ter of his 1991 b o o k of t h e s a m e n a m e . J a m e s o n w o u l d c o m e t o b e hailed as 'theorist s u p r e m e of the p o s t m o d e r n ' ( H a r d t a n d Weeks, 2000, p p . 1 - 2 ) ; Baudrillard as its p r o p h e t a n d high priest (Bailey, 2006). W r i t i n g in the afterm a t h of Anti-Oedipus,
J a m e s o n a n d B a u d r i l l a r d b o t h p r o p o s e d n e w ways of
c o n c e p t u a l i z i n g t h e association b e t w e e n capitalism a n d s c h i z o p h r e n i a , identifying t h e figure o f ' t h e s c h i z o p h r e n i c ' n o t as t h e r e v o l u t i o n a r y b u t t h e casualty of late capitalist p o s t m o d e r n i t y . P o s t m o d e r n s c h i z o p h r e n i a is d e f i n e d n o t as rebellious, c o u n t e r - c u l t u r a l , t r a n s c e n d e n t , o r even bizarre, b u t as a historically specific f o r m of subjective d i s i n t e g r a t i o n , a final f l a t t e n i n g of psychic d e p t h . T h e t r o p e f u n c t i o n s t o pathologize c o n t e m p o r a r y subjectivity a n d implicitly t o r e i n f o r c e t h e idea t h a t it is h e r m e n e u t i c a l l y inaccessible, t h a t t h e h e a p of fragm e n t s conceals n o latent m e a n i n g . W h a t w o r k s against this e m e r g i n g view of t h e s u b l i m i t y of p o s t m o d e r n s c h i z o p h r e n i a is s i m p l y t h a t it characterizes all c o n t e m p o r a r y subjects: n o longer e x c e p t i o n a l — o r even the clue to the ' t r u e ' o p e r a t i o n of d e s i r e — s c h i z o p h r e n i a is t h e u n i v e r s a l fate of t h e p o s t m o d e r n masses.
W e live, a c c o r d i n g t o B a u d r i l l a r d , in a n age c h a r a c t e r i z e d b y t h e p r o m i s c u o u s p r o l i f e r a t i o n of n e t w o r k s of c o m m u n i c a t i o n . It is a n e r a of s u r f a c e s w i t h o u t d e p t h ; a n e r a o f i m m a n e n c e in w h i c h t r a n s c e n d e n c e is n o l o n g e r possible; a n e r a of o b s c e n i t y : Obscenity begins when there is no more spectacle, no more stage, no more theatre, no more illusion, when every-thing becomes immediately transparent, visible, exposed in the raw and inexorable light of information and communication. We no longer partake of the drama of alienation, but are in the ecstasy of communication.
[...] It is no longer the obscenity of the hidden, the repressed, the obscure, but that of the visible, the all-too-visible, the more-visible-than-visible; it is the obscenity of that which no longer contains a secret and is entirely soluble in information and communication. (Baudrillard, 1988, pp. 21-2, italics in the original) W r i t i n g a t t h e d a w n of t h e digital age a n d b e f o r e t h e r a p i d rise o f m o b i l e a n d internet technologies, Baudrillard's e m p h a s i s o n the e p o c h - d e f m i n g signific a n c e o f i n f o r m a t i o n a n d its c i r c u l a t i o n is p r e s c i e n t . 3 In B a u d r i l l a r d ' s h i g h l y m e d i a t i z e d W e s t , t h e f l o w a n d f o r m of c o m m u n i c a t i o n c o n s t i t u t e t h e w h o l e of social space, collapsing a n y n o t i o n of interior a n d exterior. T h e n e t w o r k e n c o m p a s s e s e v e r y t h i n g a n d c o n c e a l s n o t h i n g ; it a b o l i s h e s r e p r e s e n t a t i o n , B a u d r i l l a r d a r g u e s , b e c a u s e t h e r e is n o l o n g e r a s p a c e o r e v e n a d i s t i n c t i o n b e t w e e n sign a n d r e f e r e n t . Earlier s c e n e s o r sites o f r e p r e s e n t a t i o n — t h e m i r r o r , t h e t h e a t r e , t h e stage, t h e p u b l i c a n d p r i v a t e s p h e r e — n o l o n g e r h a v e a n y m e a n i n g as w e exist n o t 'as p l a y w r i g h t s o r a c t o r s b u t as t e r m i n a l s of m u l t i p l e n e t w o r k s ' ( B a u d r i l l a r d , 1988, p . 16). B a u d r i l l a r d , like D e l e u z e a n d G u a t t a r i b e f o r e h i m , t u r n s t o ' m e t a p h o r s d r a w n f r o m pathology' to explain the impact of obscene c o m m u n i c a t i o n o n t h e s u b j e c t ( w h o is, a g a i n , a s s i g n e d t h e m a s c u l i n e p r o n o u n ) : If hysteria was the pathology of the exacerbated staging of the subject—of the theatrical and operational conversion of the body—and if paranoia was the pathology of organization—of the structuring of a rigid and jealous world—then today we have entered into a new form of schizophrenia—with the emergence of an immanent promiscuity and the perpetual interconnection of all information and communication networks. No more hysteria, or projective paranoia as such, but a state of terror which
3
Although, ironically, it could also be said to be 50 years too late. In 1937 a feature article in Harper's Magazine had already 'declared that Americans lived in an "Age of Schizophrenia", a "dazzling world of bright light and swift movement and flashing communications in wliii h the man of flesh and blood makes it impossible to make a home"' (quoted in Met/1, 2009, p, »7).
is characteristic of the schizophrenic, an over-proximity of all things, a foul promiscuity of all things which beleaguer and penetrate him, meeting with no resistance, and no halo, no aura, not even the aura of his own body protects him. In spite of himself the schizophrenic is open to everything and lives in the most extreme confusion. He is the obscene victim of the world's obscenity. The schizophrenic is not, as generally claimed, characterized by his loss of touch with reality, but by the absolute proximity to and total instantaneousness with things, this overexposure to the transparency of the world. Stripped of a stage and crossed over without the least obstacle, the schizophrenic cannot produce the very limits of being. He becomes a pure screen, a pure absorption and resorption surface of the influent networks. (Baudrillard, 1988, pp. 26-7) B a u d r i l l a r d m a y d r a w his m e t a p h o r s f r o m p s y c h o l o g y , b u t h e d o e s so o n l y t o p r o c l a i m t h e e n d o f t h e p s y c h e itself. E m p t i e d o u t , flattened i n t o t w o d i m e n s i o n s a n d existing in a state o f ' t o t a l i n s t a n t a n e o u s n e s s ' , ' t h e s c h i z o p h r e n i c ' is a non-self c o n n e c t e d to a n d constituted by decentralized networks; a screen across w h i c h t h e b i n a r y c o d e of i n f o r m a t i o n simply flickers. Baudrillard's v i s i o n is o n e o f final r e i f i c a t i o n — t h e s c h i z o p h r e n i c - a s - t e r m i n a l e f f e c t i v e l y signals t h e t e r m i n a t i o n of subjectivity. T h e ecstasy of c o m m u n i c a t i o n f u r t h e r r e s u l t s in a p o s t m o d e r n t r a n s u b s t a n t i a t i o n : flesh b e c o m e s c o d e , a n d t h e b o d y d e m a t e r i a l i z e s i n t o i n f o r m a t i o n . It is t h e s u b l i m e d i s s o l u t i o n o f t h e s e l f — e n g u l f e d b y t h e w o r l d , ' t h e s c h i z o p h r e n i c ' ' c a n n o t p r o d u c e t h e v e r y l i m i t s of b e i n g ' — b u t also t h e d i s s o l u t i o n of self w i t h i n t h e s u b l i m e , w i t h i n a s e e m i n g l y i n f i n i t e , d e c e n t r e d n e t w o r k of i n f o r m a t i o n t h a t itself d e f i e s r e p r e s e n t a t i o n . In o n e fell s w o o p , t h e m a s s e s a r e p o r t r a y e d as p a t h o l o g i c a l l y p a s s i v e , a n d t h e p r o g n o s i s is n o t g o o d : t h e r e is, it w o u l d a p p e a r , n o w a y of r e c o n s t i t u t i n g t h e self t h r o u g h , in spite o f o r in o p p o s i t i o n to, t h e i n e x o r a b l e flow o f i n f o r m a t i o n and communication. If, as I h a v e a r g u e d , t h e effect of B a u d r i l l a r d ' s analysis is t o p r o d u c e a p a r a doxically sublime schizophrenia, the question r e m a i n s ' W h y schizophrenia?' Baudrillard d o e s n o t refer t o specific psychiatric, psychoanalytic, antipsychiatric, o r even a u t o b i o g r a p h i c a l a c c o u n t s of psychosis in his d e s c r i p t i o n of the s u b j e c t - a s - t e r m i n a l , n o r c a n his ' s c h i z o p h r e n i c ' s c r e e n b e said t o e x h i b i t a n y t h i n g r e m o t e l y r e s e m b l i n g a specifically p s y c h o t i c s y m p t o m . Yet it w o u l d b e d i s i n g e n u o u s t o suggest, especially in t h e light of his c l a i m t o u n c o v e r a h i s t o r y o f p a t h o l o g y , t h a t t h i s u s e o f t h e t e r m is a r b i t r a r y o r i n c i d e n t a l , o r t h a t it is merely a m o r e sophisticated s y n o n y m for madness. B a u d r i l l a r d ' s a d m i t t e d l y brief e x c u r s i o n i n t o t h e t e r r i t o r y of d e t e r r i t o r i a l i z e d d e s i r e c o u l d n o t b e s a i d t o c o m p r i s e a c o n s i d e r e d e n g a g e m e n t , let a l o n e c r i t i q u e , o f D e l e u z e a n d G u a t t a r i ' s analysis o f c a p i t a l i s m a n d s c h i z o p h r e n i a , b u t it is n o t d i f f i c u l t t o s p o t Anti-Oedipus Ecstasy of Communication.
l u r k i n g in t h e b a c k g r o u n d of
The
Like D e l e u z e a n d G u a l t a r i ' s s i l i i / o , B a u d r i l l a r d ' s
' s c h i z o p h r e n i c ' is n o l o n g e r p o s s e s s e d of p s y c h i c d e p t h o r i n t e r i o r i t y . ' H e ' is c o n s t i t u t e d b y t h e f l u x e s of t h e w o r l d , o n l y h e r e t h e r e is n o c e l e b r a t i o n of t h e f r e e f l o w of d e s i r e b e c a u s e b e i n g p l u g g e d i n t o p o s t m o d e r n i t y i n d u c e s a state of paralysis, ' t e r r o r ' a n d ' e x t r e m e c o n f u s i o n ' m o r e akin to that suffered by the ' i m m e n s e t r a n s f i x e d h i p p o p o t a m u s ' . I n d e e d , if e x p l a i n e d in a n t i - O e d i p a l term i n o l o g y , B a u d r i l l a r d ' s ' s c h i z o p h r e n i c - a s - t e r m i n a l ' is a f u l l b o d y w i t h o u t o r g a n s : ' t h e u n p r o d u c t i v e , t h e sterile, t h e u n e n g e n d e r e d , t h e u n c o n s u m a b l e ' ( D e l e u z e a n d G u a t t a r i , 1982, p. 8). 4 The Ecstasy of Communication
can further
b e s e e n t o i n v e r t L a c a n ' s m o d e l of a s u b l i m e s c h i z o p h r e n i a . B a u d r i l l a r d r e p e a t s L a c a n ' s idea t h a t p s y c h o s i s is a p r o b l e m in t h e s y m b o l i c register, b u t i m p l i e s t h a t s c h i z o p h r e n i a r e s u l t s f r o m a n over-proximity immersion
to c o m m u n i c a t i o n , an
in i n f o r m a t i o n , r a t h e r t h a n e x p u l s i o n f r o m t h e p h a l l i c s y s t e m of
s i g n i f i c a t i o n . W h e r e f o r J u d i t h B u t l e r a n d Slavoj Z i i e k s c h i z o p h r e n i a m a r k s t h e l i m i t s of s u b j e c t i v i t y , 5 f o r B a u d r i l l a r d s c h i z o p h r e n i a is a state of b l a n k terr o r c a u s e d b y a n excess o f signifiers, a n d a n inability t o d i f f e r e n t i a t e o r d i s t a n c e self f r o m w o r l d . It is t h e s u b l i m e d i s s o l u t i o n o f s u b j e c t i v i t y i n t o ' t h e s m o o t h a n d f u n c t i o n a l s u r f a c e of c o m m u n i c a t i o n ' ( B a u d r i l l a r d , 1988, p . 12).
Schizophrenia and 'The Cultural Logic of Late Capitalism' If Anti-Oedipus
w a s t h e first a n d m o s t p o l e m i c a l analysis t o l i n k c a p i t a l i s m a n d
schizophrenia, Fredric J a m e s o n ' s ' P o s t m o d e r n i s m , o r the Cultural Logic of Late C a p i t a l i s m ' , allegedly t h e m o s t c i t e d article o f t h e 1980s ( K e l l n e r , 1989, p . 2), served e m p h a t i c a l l y t o r e c o d e a n d p o p u l a r i z e t h a t l i n k as p a r a d i g m a t i cally p o s t m o d e r n . A l t h o u g h it o w e s a clear, if a g a i n u n a c k n o w l e d g e d , d e b t t o Deleuze and Guattari's model o f ' i d e a l or heroic schizophrenia' (Jameson, 1991, p . 154), J a m e s o n ' s loosely L a c a n i a n a c c o u n t o f p o s t m o d e r n s c h i z o p h r e n i a d o e s n o t f o l l o w t h e s e earlier t h e o r i s t s in p o s i t i n g its t r a n s c e n d e n t p o t e n t i a l . R a t h e r , like B a u d r i l l a r d , h e s u g g e s t s t h e f i g u r e o f ' t h e s c h i z o p h r e n i c ' is b o t h p r o d u c t and s y m p t o m of late c a p i t a l i s m , a n d as s u c h h a s n o w a y of s u r m o u n t i n g t h e late c a p i t a l i s t p r e d i c a m e n t . A s w i t h Anti-Oedipus,
the overwhelming
m a j o r i t y of critics h a v e a c c e p t e d J a m e s o n ' s r e a s s u r a n c e t h a t h e is n o t o f f e r i n g ' s o m e c u l t u r e - a n d - p e r s o n a l i t y d i a g n o s i s of o u r society' in t h e m o d e of
4
Deleuze and Guattari describe this state of catatonic immobility as belonging to 'the realm of antiproduction': 'In order to resist organ-machines, the body without organs presents its smooth, slippery, opaque, taut surface as a barrier. [ . . . ] In order to resist using words composed of articulated phonetic units, it utters only gasps and cries that are sheer unarticulated blocks of sound' (Deleuze and Guattari, 1982, pp. 8-9).
5
Exiled to a 'psychotic abyss outside the symbolic domain,' 'the schizophrenic' designates that which is beyond the intelligible (Lacan, quoted in 2i?.ek 1999, p. 273; see also'Arguing with the Real' in Butler, 199)),
C h r i s t o p h e r Lasch ( 1 9 7 8 ) , 6 a n d h a v e c o n s e q u e n t l y r e f u s e d o r failed t o i n q u i r e i n t o t h e r e l a t i o n s h i p b e t w e e n p o s t m o d e r n s c h i z o p h r e n i a a n d its clinical a n t e c e d e n t s a n d i n s p i r a t i o n s . T h e s e d o m i n a n t r e a d i n g s s t r i k e m e as h i g h l y selective a n d s o m e w h a t c o u n t e r i n t u i t i v e , i g n o r i n g as t h e y d o J a m e s o n ' s r e f e r e n c e s t o clinical l i t e r a t u r e a n d t h e c e n t r a l i t y a c c o r d e d t o s c h i z o p h r e n i a in his overall a r g u m e n t . By c o n t r a s t , m y analysis o f ' T h e C u l t u r a l Logic of Late C a p i t a l i s m ' s e e k s t o r e d r e s s t h i s s c h o l a r l y o v e r s i g h t b y c o n c e n t r a t i n g o n w h a t is a b s e n t f r o m o r o m i t t e d in t h e t r a n s l a t i o n o f clinical c o n d i t i o n i n t o c u l t u r a l t h e o r y . C o g n i z a n t o f t h e d a n g e r s o f o v e r - r e a d i n g J a m e s o n ' s m o d e l of p o s t m o d e r n s c h i z o p h r e n i a , I will e n d e a v o u r t o d e m o n s t r a t e t h a t its c o m p l e x e n g a g e m e n t w i t h clinical a c c o u n t s of s c h i z o p h r e n i a is m o r e s u g g e s t i v e t h a n J a m e s o n a n d his critics h a v e p e r h a p s a l l o w e d , in t h a t it also, like B a u d r i l l a r d ' s w o r k , b e g i n s t h e o p e r a t i o n of t h e p a r a d o x i c a l s u b l i m e . W i t h t h i s e n d in m i n d , t h e first s t e p m u s t b e t o c o n s i d e r s c h i z o p h r e n i a ' s r o l e w i t h i n J a m e s o n ' s analysis of p o s t m o d e r n i s m as t h e c u l t u r a l d o m i n a n t o f t h e late t w e n t i e t h c e n t u r y . A c c o r d i n g t o J a m e s o n , the case f o r t h e existence of p o s t m o d e r n i s m d e p e n d s u p o n ' t h e h y p o t h e s i s of s o m e radical b r e a k . . . g e n e r ally t r a c e d b a c k t o t h e e n d of t h e 1 9 5 0 s o r e a r l y 1960s' ( J a m e s o n , 1991, p. l ) . T h e b r e a k in q u e s t i o n is t h e e m e r g e n c e of a n e w f o r m o f c a p i t a l i s m m o s t s t r o n g l y associated w i t h t h e rise o f m u l t i n a t i o n a l c o r p o r a t i o n s , b u t i n c l u d i n g also: The new international division of labor, a vertiginous new dynamic in international banking and the stock exchanges (including the enormous Second and Third World debt), new forms of media interrelationship (very much including transportation systems such as containerization), computers and automation, the flight of production to advanced Third World areas, along with all the more familiar social consequences, including the crisis of traditional labor, the emergence of yuppies, and gentrification on a now-global scale. (Jameson, 1991, p. xix) F o l l o w i n g M a r x i s t e c o n o m i s t E r n e s t M a n d e l , J a m e s o n a r g u e s t h a t late capit a l i s m is t h e ' p u r e s t ' f o r m o f c a p i t a l i s m b e c a u s e its ' p r o d i g i o u s e x p a n s i o n of c a p i t a l i n t o h i t h e r t o u n c o m m o d i f i e d a r e a s ' ( J a m e s o n , 1991, p p . 36, 4) signals t h e total i n t e r p é n é t r a t i o n of c o m m e r c e a n d culture. W h e r e a s Deleuze a n d G u a t t a r i a p p e a r e d d i s i n t e r e s t e d in t h e e m p i r i c a l analysis o f h i s t o r i c a l l y specific f o r m s of c a p i t a l i s m , 7 J a m e s o n ' s p e r i o d i z i n g h y p o t h e s i s t r e a t s p o s t m o d e r n i s m 6
7
Jameson states that 'there are . . . far more damaging things to be said about our social system than are available through the use of psychological categories' (Jameson, 1991, p. 26). However, as I will endeavour to show, he certainly uses schizophrenia to damaging effect. Anti-Oedipus posits three historical periods or phases—primitive territorial, despotic, and capitalist—but does not distinguish different forms of capitalism.
n o t o n l y as t h e c u l t u r a l m a n i f e s t a t i o n o f t h e specific t e c h n o l o g i c a l a n d s o c i o l o g i c a l u p h e a v a l s o f late c a p i t a l i s m , b u t as ' t h e i n t e r n a l a n d s u p e r s t r u c t u r a l e x p r e s s i o n o f a w h o l e n e w w a v e of A m e r i c a n m i l i t a r y a n d e c o n o m i c d o m i n a t i o n t h r o u g h o u t t h e w o r l d ' ( J a m e s o n , 1991, p. 5 ) . 8 F o r J a m e s o n , like B a u d r i l l a r d , p o s t m o d e r n i s m is c h a r a c t e r i z e d a b o v e all b y a loss of d e p t h . T h e eclipse of p a r o d y b y p a s t i c h e , t h e loss o f t h e h i s t o r i c a l referent, the
flattening
o f s p a c e i n t o s u r f a c e s , t h e rise o f s i m u l a c r a , a n d t h e
a b a n d o n m e n t o f t h e o r e t i c a l d e p t h m o d e l s a r e all s y m p t o m a t i c of 'a n e w k i n d o f f l a t n e s s o r d e p t h l e s s n e s s , a n e w k i n d o f s u p e r f i c i a l i t y ' t h a t h e i d e n t i f i e s as ' p e r h a p s t h e s u p r e m e f o r m a l f e a t u r e ' of t h e p o s t m o d e r n ( J a m e s o n , 1984b, p. 9). If w e f o l l o w t h e t r a j e c t o r y o f J a m e s o n ' s a r g u m e n t closely, it is clear t h a t t h i s a e s t h e t i c a n d i n t e r p r e t i v e d e p t h l e s s n e s s r e g i s t e r s a r e l a t e d m u t a t i o n in lived e x p e r i e n c e : t h e w a n i n g of a f f e c t a n d t h e d e c e n t r i n g of s u b j e c t i v i t y . R e f e r r i n g p r i m a r i l y t o e x a m p l e s in visual art ( V a n G o g h a n d M u n c h as t h e e x e m p l a r s of h i g h m o d e r n i s m , A n d y W a r h o l in t h e p o s t m o d e r n d o c k ) J a m e s o n a r g u e s t h a t t h e ' g r e a t m o d e r n i s t t h e m a t i c s of a l i e n a t i o n , a n o m i e , s o l i t u d e , social f r a g m e n t a t i o n a n d i s o l a t i o n ' n o l o n g e r r e s o n a t e in t h e p o s t m o d e r n e r a ( J a m e s o n , 1991, p . 11). E x i s t e n t i a l a n g s t a n d p s y c h i c c o m p l e x i t i e s h a v e d i s s o l v e d i n t o f r e e floating
feelings: depersonalized, discrete e m o t i o n a l intensities; isolated
m o m e n t s of e u p h o r i a , e x h i l a r a t i o n , a n d d i s o r i e n t a t i o n . W h e r e a s ' a n x i e t y is a h e r m e n e u t i c e m o t i o n , e x p r e s s i n g a n u n d e r l y i n g n i g h t m a r e state of t h e w o r l d ' , m o m e n t s o f a f f e c t i v e i n t e n s i t y s h o u l d n o t b e m i s c o n s t r u e d as m e a n i n g f u l responses to p o s t m o d e r n i t y because they bear n o relation to context (Jameson, q u o t e d in S t e p h a n s o n , 1988, p. 4 ) . T h e s c r e a m — a c r y f r o m t h e a b y s s of t h e s o u l — i s r e p l a c e d b y t h e h a l l u c i n o g e n i c h i g h , t h e flash o f p a n i c , t h e
fleeting
e u p h o r i a , t h e t w i n g e o f fear, t h e m o m e n t of e x h i l a r a t i o n . A s e m o t i o n a l n a r r a tive d i s i n t e g r a t e s i n t o e m o t i o n a l l y c h a r g e d m o m e n t s , t h e w a n i n g o f a f f e c t p o i n t s t o a p r o f o u n d c h a n g e in t h e e x p e r i e n c e o f s u b j e c t i v i t y : The notorious burn-out and self-destruction cases of the ending 1960s [sic], and the great dominant experiences of drugs and schizophrenia—these would seem to have little enough in common anymore, either with the hysterics and neurotics of Freud's own day, or with those canonical experiences of radical isolation and solitude, anomie, private revolt, Van Gogh-type madness, which dominated the period of high modernism. This shift in the dynamics of cultural pathology can be characterized as one in which the alienation of the subject is displaced by the fragmentation of the subject. (Jameson, 1991, p. 14)
8
Consequently, 'every position on postmodernism in culture—whether apologia or s o matization is also at one and the same time, and necessarily an implicitly or explicitly political statu c on the nature of multinational capitalism today' (Jameson, 1991, p. 3).
T h e t r a n s i t i o n f r o m t h e m o d e r n s e l f — a b o u n d e d ego o r psyche p r o j e c t i n g o u t w a r d s t h e d r a m a of i n n e r f e e l i n g — t o a f r a g m e n t e d , d e c e n t r e d p o s t m o d e r n subject is t r o p e d negatively as t h e collapse of subjective b o u n d a r i e s , t h e abolit i o n of d e p t h , t h e e v a c u a t i o n n o t o n l y o f a n x i e t y b u t also of all i n d i v i d u a l feeling. T h e d e c e n t r e d subject is for J a m e s o n t h e causal link b e t w e e n late capitalism a n d t h e p o s t m o d e r n aesthetic: t h e ' d i s a p p e a r a n c e of t h e i n d i v i d u a l s u b j e c t ' results in t h e i m p o s s i b i l i t y of i n d i v i d u a l style a n d t h e rise of an aesthetics of f r a g m e n t a t i o n (pastiche), t h e ' w a n i n g of t h e great h i g h m o d e r n i s m t h e m a t i c s of t i m e o r t e m p o r a l i t y ' , a n d the c o n s e q u e n t w e a k e n i n g of historicity ( J a m e s o n , 1991, p. 16). J a m e s o n ' s p o r t r a i t of t h e d e c e n t r e d subject so far resembles t h a t of fellow Marxist literary critic T e r r y Eagleton: a ' d i s p e r s e d , d e c e n t e r e d n e t w o r k o f l i b i d i n a l a t t a c h m e n t s , e m p t i e d of e t h i c a l s u b s t a n c e a n d p s y c h i c a l interiority, the e p h e m e r a l f u n c t i o n of this o r t h a t act of c o n s u m p t i o n , m e d i a experience, sexual relationship, t r e n d o r f a s h i o n ' (Eagleton, 1985, p. 71). W h y , t h e n , d o e s J a m e s o n go o n e step f u r t h e r in describing t h e d e c e n t r e d subject as s c h i z o p h r e n i c ? Is it t o d r a w a t t e n t i o n t o t h e fact t h a t late capitalism precipitates n o t a shift b u t a crisis in subjectivity? D o e s it, despite J a m e s o n ' s explicit d i s a v o w a l of a n y association w i t h t h e ' m o r b i d ' p s y c h i a t r i c reality of schizop h r e n i a , f u n c t i o n n o t o n l y to diagnose, b u t also t o pathologize, the p o s t m o d e r n self, as m o s t critics s e e m to suggest? O r is there s o m e t h i n g m o r e subtle at w o r k here? F o r J a m e s o n , i d e n t i t y is a f u n c t i o n of l a n g u a g e ; a c o h e r e n t sense of self is c r e a t e d a n d s u s t a i n e d t h r o u g h t h e t e m p o r a l o r g a n i z a t i o n of linguistic signifie s . O n his a c c o u n t , s c h i z o p h r e n i a is the disintegration of this 'objective m i r a g e of signification', s u c h t h a t ' w h e n t h e links of t h a t signifying c h a i n s n a p , t h e n w e have s c h i z o p h r e n i a in t h e f o r m of a r u b b l e of distinct a n d u n r e l a t e d signifies'.
'If we are u n a b l e t o u n i f y t h e past, p r e s e n t a n d f u t u r e of t h e sentence',
J a m e s o n argues, ' t h e n we are similarly u n a b l e t o u n i f y t h e past, p r e s e n t a n d f u t u r e of o u r o w n b i o g r a p h i c a l experience o r psychic life. W i t h t h e b r e a k d o w n of t h e signifying c h a i n , t h e r e f o r e , t h e s c h i z o p h r e n i c is r e d u c e d t o an experience of p u r e material signifiers, o r in o t h e r w o r d s of a series of p u r e a n d u n r e l a t e d p r e s e n t s in t i m e ' ( J a m e s o n , 1991, p. 2 6 ) . S c h i z o p h r e n i a is a f o r m of 'linguistic m a l f u n c t i o n ' t h a t p r o d u c e s a t e m p o r a l crisis: h i s t o r y a n d t h e f u t u r e collapse i n t o t h e p e r p e t u a l p r e s e n t . If t h e m o d e r n i s t self p r o j e c t e d o u t w a r d s t h e anxiety of t h e age, ' t h e p o s t m o d e r n s c h i z o p h r e n i c ' is r e d u c e d to perceiving a n d r e p r e s e n t i n g t h e w o r l d in f r a g m e n t s , m o m e n t s a n d isolated intensities. As J o h n O'Neill observes ' a c t i o n , p r o j e c t , a n d o r i e n t a t i o n collapse in the literal, n a u s e o u s , a n d real p r e s e n t ' ( O ' N e i l l , 1989, p. 148; see also J a m e s o n , 1991, p. 27).
T o c a p t u r e this experience, J a m e s o n q u o t e s a long passage f r o m of a Schizophrenic
Autobiography
Girl (in w h i c h R e n e e , u s i n g t h e l a n g u a g e of t h e s u b l i m e ,
describes 'the first a p p e a r a n c e of t h o s e e l e m e n t s w h i c h w e r e always p r e s e n t in later s e n s a t i o n s of unreality: illimitable vastness, brilliant light, a n d t h e gloss a n d s m o o t h n e s s of material things' (Renee, 1970, p p . 2 1 - 2 , q u o t e d b y J a m e s o n , 1991, p. 27). W e will r e t u r n t o the issue of s c h i z o p h r e n i c p h e n o m e n o l o g y later in t h e c h a p t e r ; here, it is sufficient t o n o t e t h a t this choice of e x a m p l e w o r k s against J a m e s o n ' s claim t h a t ' p o s t m o d e r n s c h i z o p h r e n i a ' bears n o r e l a t i o n s h i p to any f o r m of psychiatric d i s o r d e r . J a m e s o n ' s references t o a Lacanian view of psychosis f u r t h e r u n d e r m i n e this claim a n d are bedevilled b y c o n t r a d i c t i o n . 'I f o u n d L a c a n ' s a c c o u n t of s c h i z o p h r e n i a u s e f u l ' , h e w r i t e s , ' n o t b e c a u s e I h a v e a n y w a y of k n o w i n g w h e t h e r it h a s clinical a c c u r a c y b u t b e c a u s e — a s d e s c r i p t i o n r a t h e r t h a n diagnosis—it seems t o m e t o be a suggestive aesthetic m o d e l ' ( J a m e s o n , 1991, p. 26). In a f o o t n o t e , J a m e s o n t h e n directs t h e r e a d e r t o L a c a n ' s analysis of S c h r e b e r in Ecrits, w i t h t h e r i d e r t h a t ' M o s t of us h a v e received this classical view of psychosis b y way of Deleuze a n d G u a t t a r i ' s Oedipus'
Anti-
( J a m e s o n , 1991, p. 420). Yet there is n o t h i n g 'classical' a b o u t Deleuze
a n d G u a t t a r i ' s p o r t r a y a l of t h e process of s c h i z o p h r e n i a , n o r can
Anti-Oedipus
possibly be u n d e r s t o o d as a w h o l e h e a r t e d e n d o r s e m e n t of t h e Lacanian m o d e l of psychosis. So w h a t is t h e relationship b e t w e e n J a m e s o n ' s a c c o u n t of schizop h r e n i a , as o u t l i n e d earlier, a n d L a c a n ' s ' O n a Q u e s t i o n P r e l i m i n a r y t o a n y Possible T r e a t m e n t of Psychosis', a n d where, in t u r n , d o Deleuze a n d G u a t t a r i fit in? L a c a n ' s c o n v i c t i o n t h a t t h e ' d r a m a ' o f p s y c h o s i s is s i t u a t e d ' i n m a n ' s [sic] relation t o t h e signifier' (Lacan, 1966, p. 214) u n d e r s c o r e s J a m e s o n ' s c o n s t r u c t i o n of s c h i z o p h r e n i a as a crisis in t h e s y m b o l i c register, as a p r o b l e m of l a n g u a g e a n d n o t fantasy, of a self already c o n c e p t u a l i z e d as o p e r a t i n g i n d e p e n d e n t l y of o t h e r s . In an e c h o of his reluctance t o investigate t h e precipitating factors in t h e d e c e n t r i n g of subjectivity, J a m e s o n states: 'I m u s t o m i t t h e f a m i l i a l o r m o r e o r t h o d o x p s y c h o a n a l y t i c b a c k g r o u n d to this s i t u a t i o n ' , o r w h a t is f o r Lacan ' p a t e r n a l a u t h o r i t y n o w c o n s i d e r e d as a linguistic f u n c t i o n ' ( J a m e s o n , 1991, p. 2 6 ) . As I d i s c u s s e d at length in C h a p t e r 2, Lacan p o s i t e d t h a t ' t h e defect t h a t gives psychosis its essential c o n d i t i o n ' a n d s t r u c t u r e is ' t h e f o r e c l o s u r e of t h e N a m e - o f - t h e - F a t h e r in t h e place of t h e O t h e r , a n d in t h e failure of t h e p a t e r n a l m e t a p h o r ' (Lacan, 1966, p. 215). H o w t h e n s h o u l d w e i n t e r p r e t J a m e s o n ' s o m i s s i o n of t h i s ' e s s e n t i a l ' p o i n t ; his r e f u s a l t o see t h e s c h i z o p h r e n i c ' s linguistic crisis as t h e crisis of a symbolic o r d e r s t r u c t u r e d b y t h e phallus? W i t h o u t e l a b o r a t i n g o n its c o n s e q u e n c e s , S t e p h e n F r o s h h i g h l i g h t s s u c cinctly o n e ol tin- key p r o b l e m s of this a c c o u n t : ' W h a t is gained . . . is a set of
e n t i c i n g m e t a p h o r s ; w h a t is lost is t h e specificity of the original c o n c e p t . Here, t h a t m e a n s a failure t o e x p l o r e t h e n a t u r e of t h e L a c a n i a n p s y c h o t i c ' (Frosh, 1991, p . 160). J a c q u e l i n e R o s e is m o r e t a r g e t e d in h e r c r i t i q u e : ' J a m e s o n bypasses t h a t t r a u m a t i c p o i n t of sexual d i f f e r e n t i a t i o n at w h i c h t h e psychotic d e l u s i o n seizes t h e subject', a m o v e that allows h i m t o p r e s e n t the b r e a k d o w n of t h e signifying c h a i n 'exclusively in t e r m s of t h e p e r p e t u a l i n t e n s i t y of t h e signifier' (Rose, 1988, p. 242). She goes o n t o a r g u e t h a t 'if o n e p u t s b a c k t h e " N a m e - o f - t h e - F a t h e r " i n t o t h e a c c o u n t of p s y c h o t i c b r e a k d o w n t h e n — w i t h o u t celebrating the f o r m of that d i s t u r b a n c e — i t nonetheless b e c o m e s i m p o s s i b l e to i n v o k e it w i t h o u t r e c o g n i z i n g t h e f a r - r e a c h i n g i m p l i c a t i o n s in t h e f i e l d o f s e x u a l i t y o f t h i s crisis o f n a m i n g i t s e l f ( R o s e , 1988, p. 2 4 3 ) . J a m e s o n ' s o m i s s i o n certainly h a s i m p l i c a t i o n s for a f e m i n i s t ( r e ) a p p r a i s a l of t h e causes a n d c o n s e q u e n c e s of t h e ' p o s t m o d e r n s c h i z o p h r e n i c ' s ' d i s r u p t i o n of phallic discourse, b u t m y m o r e i m m e d i a t e c o n c e r n is w i t h t h e way J a m e s o n b o t h d r a w s o n a n d disavows s c h i z o p h r e n i a ' s status as s u b l i m e . It is clear t h a t in t h e w a k e of a s t r o n g c o u n t e r - c u l t u r a l a n t i p s y c h i a t r y m o v e m e n t , a n d t h e p u b l i c a t i o n of t h e e x u b e r a n t p o s t - M a r x i s t Anti-Oedipus,
s c h i z o p h r e n i a was
v e r y m u c h o n t h e a g e n d a of c u l t u r a l t h e o r y in t h e late 1970s a n d very early 1980s. J a m e s o n ' s r e t u r n to Lacan m u s t be read first a n d f o r e m o s t as a r e t u r n t o t h e realm of p s y c h o p a t h o l o g y ; a rejection of t h e 'ideal s c h i z o p h r e n i a ' p r o p o s e d b y D e l e u z e a n d G u a t t a r i ( J a m e s o n , 2002, p. 194) in f a v o u r of t h e idea of an irreparably d y s f u n c t i o n a l psychic s t r u c t u r e . J a m e s o n follows Lacan in suggesting w h a t is in effect a s u b l i m e s c h i z o p h r e n i a : it is an o n t o l o g y of dispersal f r o m w h i c h it a p p e a r s i m p o s s i b l e t o r e h a b i l i t a t e t h e m o n a d of m o d e r n i s m ; it is a state of such e x t r e m e psychic d i s i n t e g r a t i o n t h a t n o r e p r e s e n t a t i o n — w h e t h e r c o n s c i o u s o r p h a n t a s m a g o r i c — i s possible except in isolated f r a g m e n t s ; a n d c o n s e q u e n t l y , it is a subjective m o d e resolutely i m p e r v i o u s t o a n y h e r m e n e u t i c analysis, w h e t h e r psychological, psychoanalytic, o r otherwise. H o w e v e r — a n d this is c r u c i a l — b e c a u s e s c h i z o p h r e n i a is t h e fate w r o u g h t b y late capitalism o n all, because, in Rose's w o r d s , 'it b e c o m e s precisely the d r a m a of a l l . . . subjects' ( R o s e , 1988, p. 2 4 3 ) , s c h i z o p h r e n i a is e x t e n d e d a c r o s s t h e w h o l e of social space a n d loses its distinctiveness, its reference to specific p s y c h o p a t h o l o g y , its capacity t o designate difference. J a m e s o n uses clinical, a u t o b i o g r a p h i c a l , and p h i l o s o p h i c a l a c c o u n t s of s c h i z o p h r e n i a w h i c h e m p h a s i z e its sublimity, b u t b y calling u p o n s c h i z o p h r e nia t o d e s c r i b e (as well as t o d e s i g n a t e as h e r m e n e u t i c a l l y inaccessible) t h e d i s s o l u t i o n of m o d e r n i s t s u b j e c t i v i t y as a u b i q u i t o u s c o n d i t i o n , h e r e n d e r s p a r a d o x i c a l t h e s c h i z o p h r e n i c s u b l i m e . T h e i d e a t h a t s c h i z o p h r e n i a in ' T h e C u l t u r a l Logic of Late C a p i t a l i s m ' is paradoxically s u b l i m e finds f u r t h e r s u p p o r t in J a m e s o n ' s d i s c u s s i o n of the p o s t m o d e r n ' t e c h n o l o g i c a l ' s u b l i m e .
F o r J a m e s o n , as L a w r e n c e G r o s s b e r g n o t e s , t h e d i s i n t e g r a t i o n o f s u b j e c t i v i t y f u n c t i o n s as t h e p i v o t a l link b e t w e e n t h e m a t e r i a l c o n d i t i o n s o f p o s t m o d e r n i t y a n d t h e p o s t m o d e r n a e s t h e t i c : ' T e x t u a l f r a g m e n t a t i o n is a sign of t h e real f r a g m e n t a t i o n o f o u r s u b j e c t i v i t y ; w h i c h is itself a s i g n o f t h e i n t e n t i o n a l ( b o t h i d e o l o g i c a l a n d m a t e r i a l ) f r a g m e n t a t i o n of s p a c e in m u l t i n a t i o n a l c a p i t a l i s m ' ( G r o s s b e r g , 1988, p p . 1 7 3 - 4 ) . ' P o s t m o d e r n h y p e r s p a c e ' , as J a m e s o n calls it, . . . has finally succeeded in transcending the capacities of the individual body to locate itself, to organize its immediate surroundings perceptually, and cognitively to map its position in a mappable external world. It may now be suggested that this alarming disjunction point between the body and its built environment... can itself stand as the symbol and analogon of that even sharper dilemma which is the incapacity of our minds, at least as present, to map the great global multinational and decentered communicational network in which we find ourselves caught as individual subjects. (Jameson, 1991, p. 44) Physical d i s o r i e n t a t i o n in a m e d i a - s a t u r a t e d m e t r o p o l i s reflects a m o r e p r o f o u n d s p a t i a l d i s o r i e n t a t i o n : t h e d i s s o l u t i o n of s u b j e c t i v i t y in t h e ' i m p o s s i b l e t o t a l i t y ' o f late c a p i t a l i s m itself ( J a m e s o n , 1991, p. 37); ' s c h i z o p h r e n i a ' t h r o u g h e x p o s u r e t o w h a t J a m e s o n v a r i o u s l y calls t h e ' c a m p ' , ' h y s t e r i c a l ' , ' p o s t m o d e r n ' , o r ' t e c h n o l o g i c a l ' s u b l i m e . If e v e r y d i a g n o s i s is a p r o g n o s i s , t h i s is d i r e i n d e e d . In w h a t r e a d s as a v a r i a t i o n o n B a u d r i l l a r d ' s t h e s i s , w e are, it s e e m s , ' s c h i z o p h r e n i c ' b e c a u s e it is i m p o s s i b l e t o a c h i e v e c r i t i c a l d i s t a n c e f r o m t h e g l o b a l s y s t e m in w h i c h w e a r e i m m e r s e d ; t r a p p e d in t h e p e r p e t u a l p r e s e n t o f t h e global f l o w of c a p i t a l i s m , a n d d a z z l e d b y t h e m a t e r i a l i t y of t h e signifier in i s o l a t i o n , it is i m p o s s i b l e t o u n d e r t a k e t h e p r o j e c t o f ' c o g n i t i v e m a p p i n g ' t h a t J a m e s o n i d e n t i f i e s as t h e s o l u t i o n b o t h t o s u b j e c t i v e r e - o r i e n t a t i o n a n d t h e c u r r e n t r e p r e s e n t a t i o n a l crisis. 9
Beyond Jameson J a m e s o n ' s a n d B a u d r i l l a r d ' s vision of a p o s t m o d e r n s u b j e c t ' s c h i z o p h r e n i z e d ' b y late c a p i t a l i s t p o s t m o d e r n i t y h a s e n j o y e d a w i d e c i r c u l a t i o n a n d e x e r t e d c o n s i d e r a b l e i n f l u e n c e w i t h i n p o s t m o d e r n literary a n d c u l t u r a l t h e o r y . M a r x i s t g e o g r a p h e r D a v i d H a r v e y , f o r w h o m t h e p o s t m o d e r n c o n d i t i o n is s y n o n y m o u s w i t h t h e t i m e - s p a c e c o m p r e s s i o n e f f e c t e d b y flexible m o d e s of c a p i t a l a c c u m u l a t i o n , e n d o r s e s J a m e s o n ' s a c c o u n t of s c h i z o p h r e n i a as a n essentially
9
Jameson defines cognitive mapping as 'the coordination of existential data (the empirical position of the subject) with unlived, abstract conceptions of the geographic totality'. In the spatial and social confusion of postmodernity, it is the means by which 'we may again begin to grasp our positioning as individual and collective subjects and regain a capacity to act and struggle' (Jameson, 1991, pp. 51, 54).
a c c u r a t e p o r t r a i t of p o s t m o d e r n o n t o l o g y . A l t h o u g h h e criticizes J a m e s o n f o r d o w n p l a y i n g t h e p o t e n t i a l t e r r o r o f t h e s c h i z o p h r e n i c s t a t e of u n r e a l i t y , 1 0 H a r v e y a g r e e s t h a t t h e e x p e r i e n c e o f a p e r p e t u a l p r e s e n t is a d i r e c t c o n s e q u e n c e of a ' g e n e r a l s p e e d - u p in t h e t u r n o v e r t i m e of c a p i t a l ' , w h i c h a c c e n t u ates the 'volatility a n d e p h e m e r a l i t y of fa s hi ons , p r o d u c t s , p r o d u c t i o n t e c h n i q u e s , l a b o u r p r o c e s s e s , i d e a s a n d ideologies, v a l u e s a n d e s t a b l i s h e d p r a c t i c e s ' ( H a r v e y , 1990, p p . 3 5 1 , 2 8 5 , see a l s o 2 9 1 ) . M a r k C u r r i e h a s a l s o u s e d schizophrenia—as discussed by Jameson, Harvey, Deleuze, a n d Guattari—to e x p l a i n t i m e c o m p r e s s i o n in c o n s u m e r society. A c c o r d i n g t o C u r r i e , t h e t e m p o r a l s t r u c t u r e o f c u l t u r a l n a r r a t i v e s is i n d e x e d t o t h e c o m m o d i t y cycle o f late capitalism: the rapidity with which events are consigned to the past, only to be r e i n s t a l l e d in t h e p r e s e n t , m i r r o r s t h e s h o r t s h e l f - l i f e o f t h e c o m m o d i t y as d i c t a t e d b y t h e r a p i d t u r n o v e r o f capital. T h e m o m e n t of c o n s u m e r c h o i c e is a s u s p e n s i o n of n a r r a t i v e in t i m e , a n d closely r e s e m b l e s t h e t e m p o r a l a n d l i n g u i s t i c f r a g m e n t a t i o n of s c h i z o p h r e n i a . C u r r i e sees ' t h e s c h i z o p h r e n i c ' , . . . as an interpreter whose disorder is to multiply and destabilise meanings, to experience the world spatially as a theatre of signs and discourses which cannot exclude each other and which constitute a babble of voices: to experience selfhood not as an ordered narrative but as multiple identification amongst the babble of discourses. The schizophrenic is not so much nature's poststructuralist sociologist as the product of a schizoid culture which seems to aspire to the collapse of linear meaning into the compressed time of a perpetual present. (Currie, 1998, p. 103, my italics) In a n o w - f a m i l i a r g e n e r a l i z a t i o n , h e goes o n t o suggest t h a t ' T h e r e m a y t h e n b e a s e n s e in w h i c h w e a r e all m o v i n g t o w a r d s a s c h i z o p h r e n i c m o d e of c u l t u r a l e x p e r i e n c e , as o u r m i n d s c h a n g e in r e s p o n s e t o s p a c e - t i m e c o m p r e s s i o n ' ( C u r r i e , 1998, p . 103). T h i s is c e r t a i n l y a v i e w s h a r e d b y R o b b i e G o h , w h o a r g u e s t h a t ' c u l t u r a l s c h i z o p h r e n i a in t h i s s e n s e is a n i n a b i l i t y f o r t h e e v e r y d a y s u b j e c t t o step o u t side of a n d separate himself or herself f r o m the totalizing a n d disorienting processes of capitalist flows ( n o t m e r e l y of m o n e y , b u t also of related techn o l o g i e s , t i m i n g , i m a g e s a n d a s p e c t s ) ' ( G o h , 2 0 0 8 ) . J o h n J o h n s t o n , in h i s 'Ideology, Representation, Schizophrenia: T o w a r d a T h e o r y of the P o s t m o d e r n S u b j e c t ' , gives a u s e f u l o v e r v i e w of h o w s u c h a c h a n g e m i g h t b e e x p e r i e n c e d : Although the 'schiz' proclivity for discontinuous inscription and a textuality of surfaces problematizes the formation of typical themes, he or she will admit to a continuing
10
Harvey (1990, p. 351) accuses Jameson of'making it all seem like a well-controlled LSD trip rather than a succession of states of guilt, lethargy, and helplessness coupled with anguished and sometimes tempestuous dislocation'.
fascination with the logic of the simulacrum, with networks and circuitry, both informational and physical (as in the highway as semiotic system), with the body as site or screen, with space, sights, and sounds (not the modernist place), with speed-ups and slow-downs (not modernist simultaneity), with dispersions, dispossessions, becomings (not modernist archetypal recurrences and recenterings). Further, the 'schiz' has remarked that others find his or her behaviour a source of fascination, especially the looping and syncoped state of consciousness, the Lacanian 'fadings' and, above all, affects in extremis: either flat and toneless, or hallucinatory and delirious. (To these observers, neurotic styles of behavior now appear 'campy' and humorous.) (Johnston, 1990, p. 90) J o h n s t o n ' s d e s c r i p t i o n is e x e m p l a r y o f p o s t m o d e r n t h e o r y ' s t e n d e n c y b o t h t o n o r m a l i z e s c h i z o p h r e n i a a n d p a t h o l o g i z e ' n o r m a l ' s u b j e c t i v i t y as r a d i cally d e c e n t r e d a n d s p o k e n b y t h e ' t o n g u e s o f c o n s u m e r i s m ' ( F i n l a y , 1989, p. 4 5 ) . H a r v e y , C u r r i e , J o h n s t o n , a n d o t h e r s " f o l l o w J a m e s o n in e m p h a s i z i n g t h e links b e t w e e n s c h i z o p h r e n i a a n d t h e g e n e r a l s u b j e c t i v e e x p e r i e n c e of c o n t e m p o r a r y c a p i t a l i s m — e f f e c t i n g , as I h a v e a l r e a d y s u g g e s t e d , a n i n f l a t i o n o f t h e schizophrenic sublime wherein the pathological becomes representative and its p o t e n c y as a m a r k e r o f d i f f e r e n c e is n e u t r a l i z e d . O f c o u r s e , t h e s u g g e s t i o n t h a t t h e f i g u r e o f ' t h e s c h i z o p h r e n i c ' is r e p r e s e n t a t i v e o f all p o s t m o d e r n s u b jects h a s also a t t r a c t e d s i g n i f i c a n t c r i t i c i s m f r o m w i t h i n c u l t u r a l t h e o r y . H a r v e y cautions that the Deleuzoguattarian 'hyper-rhetoric', which extrapolates revol u t i o n a r y a g e n c y f r o m t h e e x p e r i e n c e s of p e o p l e w i t h severe m e n t a l illness ' c a n dissolve i n t o t h e m o s t a l a r m i n g i r r e s p o n s i b i l i t y ' ( H a r v e y , 1990, p. 351; see also Glass, 1993). C u r r i e , n o t i n g that ' t h e r e are few p o s t m o d e r n t h i n k e r s w h o believe in t h e idea of a n i n n e r life o r a p r i v a t e d o m a i n of s u b j e c t i v i t y ' , suggests that the claim that p o s t m o d e r n c o n s u m e r culture has a schizophrenic effect u p o n t h e s u b j e c t ' s h o u l d b e u n d e r s t o o d less i n t h e spirit of a n a n a l o g y b e t w e e n t h e m i n d a n d t h e w o r l d t h a n as a d i s m a n t l i n g of t h e b o u n d a r y b e t w e e n t h e m ' ( C u r r i e , 1998, p. 102). T w o o f t h e s t r o n g e s t c r i t i q u e s m o u n t e d a g a i n s t ' p o s t m o d e r n c o l o n i s t s o f t h e i m a g e r y of p s y c h o s i s ' ( F r o s h , 1991, p. 132) h a v e c o m e f r o m S t e p h e n F r o s h a n d A n t h o n y Elliott in t h e i r b o o k s o n p s y c h o a n a l y t i c a n d social t h e o r y . A l t h o u g h b r o a d l y s y m p a t h e t i c t o t h e i d e a t h a t s c h i z o p h r e n i a d o e s in s o m e s e n s e r e g i s t e r o r r e f l e c t a s p e c t s o f p o s t m o d e r n c u l t u r e , b o t h r e m a i n w a r y of t h e loss o f ' c r i t i c a l clarity' t h a t c o m e s w i t h ' b r a n d i s h i n g clinical
11
See my discussion in the previous chapter of essays collected in Pathologies of the Modern Self (Levin, 1987b) V r alsn the edited collection Pathology and the Postmodern: Mental Illness as I Hnnurte ami I \/>ri ieme I I ce, 2000), and analogous accounts of the 'multiphrenia' (Ctcrgcn, I »>•> I) and 'ti li pluenla' (Ciottidulk, 2000) of the self.
t e r m s as if t h e y w e r e w e a p o n s ' ( F r o s h , 1991, p. 5). A s F r o s h ( 1 9 9 1 , p. 128) r e m i n d s us: Remembering how to maintain the boundaries of a metaphor, commenting on psychotic discourse without ennobling it, knowing the difference between signifier, signified and real: these are tasks of a theory which are constantly under pressure when the object of that theory is the subversive theorisation implicit in psychotic thought. P o s t m o d e r n t h e o r i s t s , F r o s h a r g u e s , fail t o a c c o u n t f o r t h e specificity o f t h e p s y c h o t i c p r o c e s s , f o r d i f f e r e n c e s in class, race, a n d g e n d e r , a n d f o r d i f f e r e n c e s in t h e u n d e r l y i n g social p r o c e s s e s i n v o l v e d in s u b j e c t f o r m a t i o n ( F r o s h , 1991, p. 5). A s a c o n s e q u e n c e , t h e idea o f s c h i z o p h r e n i c s u b j e c t i v i t y c a n n o t a c c o u n t ' f o r r e s i s t a n c e , r e v o l u t i o n , o r e v e n j u s t s o m e f o r m s o f s a n i t y ' ( F r o s h , 1991, p. 149), a n d w e m u s t i n s t e a d l o o k t o i m a g i n a t i o n , f a n t a s y , a n d libidinal i n t e n sity t o u n d e r s t a n d t h e i m p a c t of p o s t m o d e r n i s m o n subjectivity (Elliott, 1996). T h e s e c r i t i c i s m s — i m p o r t a n t as t h e y a r e — a d d r e s s t h e s t r u c t u r a l l i m i t a t i o n s of t h e a n a l o g y b u t n o t its detail, as t h e y c o u l d easily e x t e n d t o t h e a p p r o p r i a t i o n of a n y p s y c h i a t r i c c o n c e p t . Staying f o r t h e m o m e n t w i t h i n t h e f r a m e w o r k of c u l t u r a l t h e o r y , w e c a n see t h a t a l t h o u g h J a m e s o n a n d B a u d r i l l a r d use schizo p h r e n i a explicitly to d r a w a t t e n t i o n t o psychic a n d linguistic d y s f u n c t i o n , i m p l i c i t l y t h e i r m o d e l s p o i n t t o a f u r t h e r c r i s i s in e m b o d i m e n t . W h e t h e r t h i s is s y m p t o m a t i c of a s i g n i f i c a n t c o n c e p t u a l b l i n d s p o t in t h e w o r k of these f i r s t - w o r l d w h i t e m a l e i n t e l l e c t u a l s , o r , o n a m o r e g e n e r o u s r e a d i n g , is a n u n a c k n o w l e d g e d b u t n o n e t h e l e s s suggestive d i m e n s i o n of their theories of s c h i z o p h r e n i c s u b j e c t i v i t y , t h e ' p o s t m o d e r n s c h i z o p h r e n i c ' a p p e a r s in t h e i r w o r k as a d i s e m b o d i e d s u b j e c t . 1 2 W h e r e a s A v i t a l R o n e l l ( 1 9 8 9 , p . 109) h a s a r g u e d p e r s u a s i v e l y t h a t ' t h e s c h i z o p h r e n i c gives u s e x e m p l a r y access t o t h e f u n d a m e n t a l s h i f t s in a f f e c t i v i t y a n d c o r p o r e a l o r g a n i z a t i o n p r o d u c e d a n d c o m m a n d e d b y t e c h n o l o g y , in p a r t b e c a u s e t h e s c h i z o p h r e n i c i n h a b i t s t h e s e o t h e r t e r r i t o r i a l i t i e s ' , B a u d r i l l a r d ' s ' p u r e s c r e e n ' s e e m s t o exist i n d e p e n d e n t of a n y fleshy reality, as d o e s J a m e s o n ' s syntactically f r a g m e n t e d ' s c h i z o p h r e n i c ' . F o r all o f J a m e s o n ' s d i s c u s s i o n of t h e q u a n t i f i a b l e m a t e r i a l m a r k e r s o f this n e w e p o c h , a r g u a b l y its m o s t b a s i c m a t e r i a l r e f e r e n c e p o i n t is a b s e n t . J a m e s o n d o e s c o n c e d e t h a t p o s t m o d e r n h y p e r s p a c e ' s t a n d s as s o m e t h i n g like a n i m p e r a t i v e t o g r o w n e w o r g a n s , t o e x p a n d o u r s e n s o r i u m a n d o u r b o d y t o s o m e n e w , as yet u n i m a g i n a b l e , p e r h a p s u l t i m a t e l y i m p o s s i b l e , d i m e n s i o n s ' ( J a m e s o n , 1991, 12
Kathleen Kirby (1996, p. 51) makes a similar point, arguing that these theorists construe schizophrenia as a temporal rather than spatial disorder: 'While nominally a dysfunction of time, schizophrenia equally represents a dysfunction of space: a failure to adhere to an external reality, to arbitrate the distinction between inside and outside, and to hold the surrounding world together in a meaningful totality. The perception of such a subject would be an unmediated barrage of disordered stimuli whose immediate presence assaults the surface of the exposed subject'.
p. 3 9 ) . H o w e v e r , a l t h o u g h g e s t u r i n g t o w a r d s t h e i m p o r t a n c e o f t h e b o d y in n a v i g a t i n g p h y s i c a l s p a c e , h e o v e r l o o k s its i m p o r t a n c e t o s u b j e c t i v e o r i e n t a t i o n in h i s t o r i c a l a n d c u l t u r a l s p a c e , m u c h less its r o l e in c o n s t i t u t i n g s e x u a l a n d racial identities. F o r J a m e s o n , it is class c o n s c i o u s n e s s , r a t h e r t h a n c o r p o r e a l i t y , w h i c h is e s s e n t i a l t o t h e c o g n i t i v e m a p p i n g o f t h e p o s t m o d e r n , b u t implicitly his m o d e l o f s c h i z o p h r e n i a s t a n d s as a n u r g e n t i m p e r a t i v e t o r e c o n c e p t u a l i z e e m b o d i m e n t r a t h e r t h a n s o m e h o w d o a w a y w i t h it a l t o g e t h e r . T h e l i m i t a t i o n s o f t h e s e a c c o u n t s o f p o s t m o d e r n o n t o l o g y s h o u l d b e clear b y n o w . U n a b l e t o a c c o u n t f o r d i f f e r e n c e o f a n y k i n d , ' t h e s c h i z o p h r e n i c ' as r e p r e s e n t a t i v e c a s u a l t y o f t h e p o s t m o d e r n is d i s e m b o d i e d a n d d e p r i v e d of a g e n c y ( W o o d s , 2 0 0 2 ) , a s p e c t r e o f d e p t h l e s s n e s s t h a t p e r h a p s says m o r e a b o u t t h e p e s s i m i s m of c u l t u r a l t h e o r y t h a n it d o e s a b o u t t h e e x p e r i e n c e of p o s t m o d e r n i t y . In t h e r e m a i n d e r of t h i s c h a p t e r , h o w e v e r , I w a n t t o a r g u e t h a t d e s p i t e these limitations, the analyses advanced by J a m e s o n , Baudrillard, a n d others a c t u a l l y lay t h e f o u n d a t i o n f o r a m o r e n u a n c e d a c c o u n t o f t h e s y m b o l i c relat i o n s h i p b e t w e e n s c h i z o p h r e n i a a n d p o s t m o d e r n i t y . T h e p r o b l e m , as I see it, is t h a t a t w o - d i m e n s i o n a l m o d e l o f s c h i z o p h r e n i a is d e p l o y e d t o d i a g n o s e t h e p o s t m o d e r n s u b j e c t as t w o - d i m e n s i o n a l . R e v i s i t i n g J a m e s o n ' s c l a i m s in t h e light of Sass's analysis of s c h i z o p h r e n i c p h e n o m e n o l o g y allows u s t o d e v e l o p a r i c h e r , m o r e c o m p l e x a c c o u n t o f a specifically p o s t m o d e r n s c h i z o p h r e n i a .
The postmodern stimmung J a m e s o n t u r n s t o R e n e e ' s Autobiography
of a Schizophrenic
Girl t o d e s c r i b e t h e
schizophrenic experience engendered by the p o s t m o d e r n : I remember very well the day it happened. We were staying in the country and I had gone for a walk as I did now and then. Suddenly, as I was passing the school, I heard a German song; the children were having a singing lesson. I stopped to listen, and at that instant a strange feeling came over me, a feeling hard to analyse but akin to something I was to know too well later—a disturbing sense of unreality. It seemed to me that I no longer recognized the school, it had become as large as a barracks; the singing children were prisoners, compelled to sing. It was as though the school and the children's song were set apart from the rest of the world. At the same time my eye encountered a field of wheat whose limits I could not see. The song of the children imprisoned in the smooth stone school-barracks filled me with such anxiety that I broke into sobs. I ran home to our garden and began to play 'to make things seem as they usually were', that is, to return to reality. It was the first appearance of those elements which were always present in later sensations of unreality: illimitable vastness, brilliant light, and the gloss and smoothness of material things. (Renee (1970, p. 21) quoted by Jameson, 1991, p. 27) 13 13
Renee (1970, p. 22) continues: 'I have no explanation for what happened, or why. But it was during this same period that I learned my father had a mistress and that he made my
I h a v e a l r e a d y n o t e d t h a t t h e c h o i c e of a clinical e x a m p l e — r a t h e r t h a n , say, a n artistic p o r t r a y a l o f ' u n r e a l i t y ' — w o r k s a g a i n s t J a m e s o n ' s clinical a g n o s t i c i s m . H i s c l a i m t h a t t h e affective i n t e n s i t y ' h e r e d e s c r i b e d in t h e n e g a t i v e t e r m s of a n x i e t y a n d loss of reality', c o u l d b e i m a g i n e d ' j u s t as w e l l . . . in t h e p o s i t i v e t e r m s o f e u p h o r i a ' ( J a m e s o n , 1 9 9 1 , p p . 2 7 - 8 ) , a l s o a p p e a r s as a s o m e w h a t u n c o n v i n c i n g a t t e m p t t o n e g a t e t h e d e t a i l as well as t h e s i g n i f i c a n c e o f h i s c h o s e n e x a m p l e ( T a y l o r , 1987, p. 67). Pelagia G o u l i m a r i has a r g u e d t h a t b e c a u s e h e ' h a s eyes o n l y f o r t h e u n l i m i t e d w h e a t field' J a m e s o n fails t o r e c o g nize the i m p o r t a n c e of history within Renee's biographical
narrative.
E n c o m p a s s e d w i t h i n a clearly a r t i c u l a t e d p e r s o n a l h i s t o r y ('I r e m e m b e r well t h e d a y it h a p p e n e d ' ) is, a c c o r d i n g t o G o u l i m a r i , 'a g e n u i n e h i s t o r i c a l e x p e r i ence', a sudden flashback to a time of war, 'barracks' and 'prisoners' (Goulimari, 2 0 0 4 ) . 1 4 M o r e o b v i o u s l y , t h e f a c t t h a t R e n e e ' s is a n a u t o b i o g r a p h i c a l a c c o u n t o f h e r first s c h i z o p h r e n i c b r e a k — a n e n c o u n t e r w i t h t h e s u b l i m e t h a t w o u l d r e c u r in 'later s e n s a t i o n s o f u n r e a l i t y ' — s u g g e s t s t h a t m e m o r y a n d t h e c a p a c i t y f o r c o h e r e n t s e l f - r e p r e s e n t a t i o n s u r v i v e in s c h i z o p h r e n i a ; t h a t t h e self is n o t r e d u c e d to t h e i r r e d e e m a b l e state of psychic a n d t e m p o r a l f r a g m e n t a t i o n J a m e s o n d i a g n o s e s ; t h a t s c h i z o p h r e n i a d o e s n o t so m u c h a n n i h i l a t e b u t alter t h e self. B u t w h a t o f t h e e x p e r i e n c e itself? H e r e , w e c a n t u r n t o Sass's i l l u m i n a t i n g d i s c u s s i o n in Madness
and Modernism
of Autobiography
of a Schizophrenic
Girl.
A c c o r d i n g t o Sass, R e n e e ' s d e s c r i p t i o n of h e r first e x p e r i e n c e o f u n r e a l i t y is a n e x e m p l a r y a c c o u n t of t h e stimmung,
o r t h e a u r a of s t r a n g e n e s s t h a t signals a n d
precedes the psychotic b r e a k . 1 5 T h e b e g i n n i n g of this p h a s e — t h e
trema—is
l i k e n e d t o a n ' a n t i c i p a t o r y stage f r i g h t ' : At these moments the patient will be suspicious and restless, often filled with anticipation or dread. Normal emotions like joy and sadness will be absent, the mood veering
14
15
mother cry. This revelation bowled me over because I heard my mother say that if my father left her, she would kill herself. Needless to say, the psychosexual significance of this scene goes unremarked in Jameson's analysis. Goulimari is here drawing on Deleuze and Guattari's account of the suprapersonal (historical, political, religious, racial) significance of schizophrenic delusions. Unfortunately, she has her history wrong. Autobiography of a Schizophrenic Girl was published in 1951. Although it is unclear how much time elapsed between the events described in the book and its publication, Renee is at least in her early 20s by the end of the narrative, and says that she had her first experience of unreality (quoted earlier) at the age of 5. If her delusions register any impressions of the Second World War, they are clairvoyant rather than historical. Following Giorgio deChirico and Friedrich Nietzsche, Sass uses the 'untranslatable' German term stimmung to refer to this change in the subject's experience of the world (rather than the subject's response to this change) (Sass, 1992, pp. 44 5,424; see also I9HH).
instead between anxiety and a kind of electric exaltation. Generally the person has a sense of having lost contact with things, or of everything having undergone some subtle, all-encompassing change. Reality seems to be unveiled as never before, and the visual world looks peculiar and eerie—weirdly beautiful, tantalizingly significant, or perhaps horrifying in some insidious but ineffable way. (Sass, 1992, pp. 47, 44) T h e trema
in t u r n i n s p i r e s in p a t i e n t s a n i n t e n s e s c r u t i n y o f t h e w o r l d h e
calls t h e ' t r u t h - t a k i n g s t a r e ' . Sass c o n t i n u e s , d e s c r i b i n g this state in t e r m s t h a t evoke the sublime: This is a strange and enigmatic atmosphere, a mood that infuses everything yet eludes description almost completely. [ . . . ] Still, everything is totally and uncannily transformed: the fabric of space seems subtly changed; the feeling of reality is either heightened, pulsing with a mysterious, unnameable force, or else oddly diminished or undermined—or, paradoxically, things may seem (as one patient put it) both 'unreal and extra-real' at the same time. (Sass, 1992, p. 44) T h e trema,
a c c o m p a n i e d by the t r u t h - t a k i n g stare, has three aspects:
' U n r e a l i t y , w h e r e t h e w o r l d is d e v o i d o f f e e l i n g o r a u t h e n t i c i t y ; M e r e B e i n g , w h e r e t h e sheer fact o f e x i s t e n c e defies s p e e c h a n d u n d e r s t a n d i n g ; F r a g m e n t a t i o n , w h e r e details o r p a r t s o v e r w h e l m t h e s y n t h e t i c w h o l e ' (Sass, 1992, p. 50). It is s u c c e e d e d b y t h e apophany,
a state in w h i c h t h e p r e v i o u s l y d e - r e a l i z e d w o r l d is
s u d d e n l y a n d p e c u l i a r l y s a t u r a t e d w i t h m e a n i n g , a s t a t e in w h i c h s i g n i f i e r s a p p e a r o m i n o u s l y o p a q u e , p o i n t i n g n o t t o a n y p a r t i c u l a r o r specific m e a n i n g b u t ' t o t h e sheer p r e s e n c e of m e a n i n g f u l n e s s itself (Sass, 1992, p. 53). I h a v e q u o t e d Sass's d e s c r i p t i o n of t h e s c h i z o p h r e n i c stimmung
at l e n g t h
b e c a u s e it s e e m s t o m e t o s u p p l y t h e p h e n o m e n o l o g i c a l detail lacking f r o m ' T h e C u l t u r a l Logic of Late C a p i t a l i s m ' . Sass's d e s c r i p t i o n of t h e trema a n d c o r r e l a t e s w i t h J a m e s o n ' s analysis o f Autobiography
of a Schizophrenic
apophany Girl:
First the breakdown of temporality suddenly releases this present of time from all the activities and intentionalities that might focus it and make it a space of praxis; thereby isolated, that present suddenly engulfs the subject with undescribable vividness, a materiality of perception properly overwhelming, which effectively dramatizes the power of the material—or better still, the literal—signifier in isolation. This present of the world or material signifier comes before the subject with heightened intensity, bearing a mysterious charge of affect, here described in the negative terms of anxiety and loss of reality, but which one could just as well imagine in the positive terms of euphoria, the high, the intoxicatory or hallucinogenic intensity. (Jameson, 1991, pp. 27-8) T h e s e s u b l i m e m o m e n t s o f s c h i z o p h r e n i c d i s s o l u t i o n can be u n d e r s t o o d , a c c o r d i n g to J a m e s o n , .is ' u n c o n s c i o u s p o i n t s o f c o n t a c t with that e q u a l l y
u n f i g u r a b l e a n d u n i m a g i n a b l e t h i n g , t h e m u l t i n a t i o n a l a p p a r a t u s , t h e great s u p r a p e r s o n a l system of late capitalist t e c h n o l o g y ' ( J a m e s o n , 1988, p. 73). This s c h i z o p h r e n i c experience of t h e p o s t m o d e r n is «of o n e of hallucinations, delusions, o r even the so-called negative s y m p t o m s of a u t i s m a n d a n h e d o n i a . N o r d o e s it reverberate w i t h c o m p l e x i t y a n d psychic d e p t h : f o r J a m e s o n , t h e 'great m o d e r n i s t t h e m a t i c s of alienation, a n o m i e , solitude, social f r a g m e n t a t i o n a n d isolation' bear n o relationship to the enigmatic experience of'"intensities'" a n d ' p u r e material Signifiers', ' i n c o m p r e h e n s i b l e yet m e s m e r i z i n g f r a g m e n t [ s ] of language' ( J a m e s o n , 1991, p p . 11, 6, 28, 27). J a m e s o n ' s d e s c r i p t i o n of ' t h e s c h i z o p h r e n i c ' s ' p e r c e p t i o n of the m y s t e r i o u s affective charge a n d dazzling materiality of the isolated signifier s u p p o r t s B a u m a n ' s analysis of t h e c o n s u m e r as s e d u c e d b y t h e superficial allure of t h e c o m m o d i t y , as ' i m p a t i e n t , i m p e t u o u s a n d restive', d e v o t e d t o a p e r p e t u a l cycle of d e s i r e - s a t i a t i o n - d i s s a t i s f a c t i o n , a n d relentlessly p u r s u i n g n e w a n d pleasurable s e n s a t i o n s ( B a u m a n , 2005, p . 2 5 ) . It also r e s o n a t e s w i t h B a u d r i l l a r d ' s d e s c r i p t i o n of t h e ecstasy of c o m m u n i c a t i o n a n d t h e h y p e r - r e a l ; a w o r l d delu g e d b y i n f o r m a t i o n a n d images, s o u n d bytes a n d slogans. T h e social space envisaged alluded t o b y these theorists is i m m e d i a t e l y recognizable in typically p o s t m o d e r n ' n o n - s p a c e s ' w h e r e i n d i v i d u a l i d e n t i t y a n d n a r r a t i v e are susp e n d e d : t h e b r i g h t lights a n d c o m m o d i t y overload of t h e s h o p p i n g centre; t h e r a p i d flow of t h e freeway; t h e a d v e r t i s i n g - s a t u r a t e d d o m e s t i c spectacle of television ( M o r s e , 1990). F r o m t h e n e o n - f l o o d e d m e t r o p o l i s t o t h e plasticized e n v i r o n s of the international airport, p o s t m o d e r n i t y , 'pulsing w i t h a mysterious, u n n a m e a b l e force', p r o d u c e s in its subjects t h e p a r a d o x i c a l experience of t h e hyper-real 'as b o t h " u n r e a l a n d extra-real" at the same t i m e ' (Sass, 1992, p. 44). A p p r o a c h i n g J a m e s o n ' s m o d e l of s c h i z o p h r e n i a t h r o u g h Sass's analysis o f t h e stimmung
a d d s t o it a d i m e n s i o n of p h e n o m e n o l o g i c a l a n d psychological
s o p h i s t i c a t i o n , b r i n g i n g us closer, I w o u l d argue, t o a m o r e n u a n c e d a c c o u n t o f c e r t a i n ( b u t b y n o m e a n s all) e x p e r i e n c e s o f p o s t m o d e r n i t y . B u t c a n J a m e s o n ' s m o d e l in t u r n e n a b l e u s t o r e t h i n k Sass's c l a i m s in Madness Modernism?
and
If s c h i z o p h r e n i a ' p r o p e r ' can b e seen as t h e psychic i n t e r n a l i z a -
t i o n of p a n o p t i c m o d e r n i t y , c o u l d its preliminary
stages paradoxically illumi-
n a t e a m o r e general experience of p o s f m o d e r n i t y ? Despite their m a n y differences, t h e a r g u m e n t s of J a m e s o n a n d Sass can be f r u i t f u l l y d r a w n t o g e t h er in the idea of t h e p o s t m o d e r n stimmung;
a m o d e l of s c h i z o p h r e n i c experi-
ence, I suggest, that can help us t o i n t e r p r e t t h e effects o n p a r t i c u l a r subjects of a specifically p o s t m o d e r n w o r l d . T h e next c h a p t e r explores this idea f u r t h e r b y l o o k i n g at t h e p o r t r a y a l o f ' s c h i z o p h r e n i c ' subjectivity in Bret Haston Ellis's 1999 novel
Glamorama.
Chapter 7
Glamorama, postmodernity, and the schizophrenic sublime
W h a t m i g h t a ' p o s t m o d e r n s c h i z o p h r e n i a ' , o r a p o s t m o d e r n stimmung,
look
like, a n d h o w m i g h t it feel? A s w e s a w in t h e p r e v i o u s c h a p t e r , c u l t u r a l t h e o r i s t s like B a u d r i l l a r d a n d J a m e s o n u s e d t h e c o n c e p t of s c h i z o p h r e n i a t o t r y a n d d e s c r i b e s o m e t h i n g w e c o u l d call a p h e n o m e n o l o g y o f t h e p o s t m o d e r n . S c h i z o p h r e n i a , t h e y suggest, o f f e r s u s a n i n s i g h t i n t o t h e effects of late c a p i t a l i s m o n t h e s u b j e c t i v e e x p e r i e n c e of t i m e , ' e m p t i e d ' i n t e r i o r i t y , ( d i s ) e m b o d i m e n t a n d t h e ( i m ) p o s s i b i l i t y of p u r p o s e f u l a c t i o n . T h e l i m i t a t i o n s of this m o d e l — a n d its p a r a d o x i c a l d e p e n d e n c y o n t h e clinical a c c o u n t s of s c h i z o p h r e n i a f r o m w h i c h it is so e m p h a t i c a l l y d i s t i n g u i s h e d — h a v e a l r e a d y b e e n well c a n v a s s e d . T h e a i m of t h i s c h a p t e r is t o p u t p h e n o m e n o l o g i c a l flesh o n t h e b o n e s , as it w e r e , o f c u l t u r a l t h e o r y ' s s u g gestive b u t relatively t w o - d i m e n s i o n a l a c c o u n t o f ' p o s t m o d e r n s c h i z o p h r e n i a ' . T o d o this, w e m u s t v e n t u r e b e y o n d v e r i s i m i l i t u d e . T u r n i n g h e r e t o t h e clinical case h i s t o r y , o r e v e n t h e a u t o b i o g r a p h i c a l a c c o u n t , w o u l d b e t o m i s - r e a d cult u r a l t h e o r y as m a k i n g i n t e r v e n t i o n s in clinical reality. A s w e h a v e s e e n , c u l t u r a l t h e o r y u s e s t h e c o n c e p t o f ' s c h i z o p h r e n i a ' as a t r o p e , a m e t a p h o r , a s y m b o l . W h e r e b e t t e r , t h e n , t o tease o u t its c o m p l e x i t i e s t h a n in t h e i m a g i n e d w o r l d s of l i t e r a r y fiction? Using a literary text to u n p a c k theoretical m o d e l s of schizophrenia continu e s a s t r o n g t r a d i t i o n w i t h i n p s y c h o a n a l y t i c a n d c u l t u r a l t h e o r y . A s w e saw in C h a p t e r 2, it w a s n o t o n l y t h e s u b s t a n c e b u t also t h e m u c h - l a u d e d ' l i t e r a r i n e s s ' o f S c h r e b e r ' s a u t o b i o g r a p h y w h i c h m a d e it t h e f o c u s o f p s y c h o a n a l y t i c t h e o ries of p s y c h o s i s a n d in t u r n i n s t r u m e n t a l t o t h e o p e r a t i o n of t h e t e x t u a l s u b l i m e . F r e u d a n d L a c a n f r e q u e n t l y t u r n t o classical m y t h a n d o t h e r f i c t i o n s t o s u b s t a n t i a t e as well as t o i l l u s t r a t e t h e i r t h e o r i e s , a n d , as h a s b e e n well d o c u mented, their w o r k inspired a broader psychoanalytic interest and indeed i n v e s t m e n t in l i t e r a t u r e . 1 A v a n t - g a r d e a n d a n t i p s y c h i a t r i c t h i n k e r s h a v e also d i s c o v e r e d in fictional texts p o w e r f u l a r t i c u l a t i o n s of s c h i z o p h r e n i c e x p e r i e n c e .
1
Some of the mosl interesting analyses of the importance of literature to psychoanalysis are Literature and Psychoanalysis: The Question of Reading, Otherwise (Felman, 1982),
Deleuze and Guattari, for example, repeatedly point their readers to the operat i o n o f t h e d e s i r i n g m a c h i n e s in S a m u e l B e c k e t t ' s p l a y s a n d d e v e l o p f r o m A n t o n i n A r t a u d ' s p o e t r y t h e c o n c e p t of a b o d y w i t h o u t o r g a n s . J a m e s o n d r a w s o n t h e h i g h l y l i t e r a r y Autobiography
of a Schizophrenic
Girl t o c a p t u r e ' p o s t -
m o d e r n s c h i z o p h r e n i a ' at t h e e x p e r i e n t i a l level, t u r n i n g t h e n t o t h e l a n g u a g e o f p o e t B o b P e r e l m a n t o illustrate ' s c h i z o p h r e n i c d i s j u n c t i o n o r é c r i t u r e ' at t h e level o f t h e a e s t h e t i c ( J a m e s o n , 1991, p. 2 8 ) . H o w e v e r , b y f a r t h e m o s t c o m p r e h e n s i v e a n d a m b i t i o u s a n a l y s i s o f s c h i z o p h r e n i a t h r o u g h l i t e r a t u r e , a n d of l i t e r a t u r e t h r o u g h s c h i z o p h r e n i a , is Sass's Madness the Light of Modern
Art, Literature
c e n t r a l p r o j e c t o f Madness
and Thought.
and Modernism
and Modernism:
Insanity
in
T h e ' i n t e r p r e t i v e strategy' a n d
is t o c o m p a r e s c h i z o p h r e n i a a n d
t h e 'sensibility a n d s t r u c t u r e s of c o n s c i o u s n e s s f o u n d in t h e m o s t a d v a n c e d art a n d l i t e r a t u r e of t h e t w e n t i e t h c e n t u r y ' (Sass, 1992, p . 8). In a d d i t i o n t o r e f e r r i n g t o a w e a l t h o f l i t e r a r y e x a m p l e s , Sass w r i t e s in p r a i s e of t h e l i t e r a r y q u a l i t y o f a u t o b i o g r a p h y , s u g g e s t i n g R e n e e ' s Autobiography
of a Schizophrenic
Girl, f o r
example, offers s o m e of the 'best descriptions' of the schizophrenic
stimmung
b e c a u s e it is b o t h p s y c h o l o g i c a l l y i n t e r e s t i n g a n d aesthetically s i g n i f i c a n t (Sass, 1992, p. 4 6 ) . T h i s c h a p t e r will e n d e a v o u r t o s h o w t h a t if n o t t h e b e s t , t h e n c e r t a i n l y t h e m o s t c o m p l e x a n d c o m p e l l i n g , d e s c r i p t i o n s o f t h e p o s t m o d e r n stimmung t o b e f o u n d in B r e t E a s t o n Ellis's fin-de-millénaire
n o v e l Glamorama
are
(2000).2
Ellis is w i d e l y r e g a r d e d as o n e of t h e f o r e m o s t literary voices o f his g e n e r a t i o n ( B e c k e t t , 1999). A B r a t P a c k w r i t e r w h o s e ' b l a n k fiction' r e s o n a t e s w i t h ' t h e spirit of t h e a g e ' ( A n n e s l e y , 1998, p . 5), h e is t h e i n f a m o u s a u t h o r o f Psycho
American
( 1 9 9 1 ) , a n o v e l j u d g e d t o b e s o o b s c e n e t h a t f o r y e a r s it w a s s o l d in
A u s t r a l i a in p l a s t i c w r a p d e s p i t e w i d e s p r e a d critical a c c l a i m . Glamorama,
his
f o u r t h n o v e l , w a s p o p u l a r l y r e g a r d e d as a f a i l u r e , as t h i s r e v i e w in The
New
York Times m a k e s e m p h a t i c a l l y clear: Glamorama, as anyone can see, is a bloated, stultifyingly repetitive, overhyped book about an entire gang of fabulously good-looking and expensively dressed sociopaths who torture and dismember both women and men—and lots of them. [.. .] Ellis's satirical message is, essentially, a one-liner, and hardly an original one at that—celebrity culture is vapid, yes, and?—and isn't remotely worth the endless pages in which his vacuous and inconsequential characters talk vacuously and inconsequentially about vacuous and inconsequential things. (Mendelsohn, 1999; see also Blount, 1999; Richardson, 1999)
2
'Lacan: An Ethics of Speech' (de Certeau, 1983), Freud's Literary Culture (Frankland, 2000) and Literature in Psychoanalysis: A Reader (Vine, 2005). This quotation and all future quotations in this chapter are reprodiu ed from < ilamorama (Ellis, 2000). All page references will appear in parentheses altci the quotation.
Glamorama
s a c a d e m i c critics have, b y contrast, e m b a r k e d o n a m o r e r o b u s t
e n g a g e m e n t w i t h t h e aesthetics a n d politics of t h e v a c u o u s a n d t h e i n c o n s e quential. W i t h its excess of p o p cultural references, a n d its playfulness, a m b i g u i t y , s u p e r f i c i a l i t y , a n d s e l f - c o n s c i o u s n e s s , Glamorama
epitomizes a
p o s t m o d e r n a e s t h e t i c w h i l e t a k i n g as its n a r r a t i v e f o c u s t h e e f f e c t s o n t h e s u b j e c t of t h e t e c h n o l o g y , m e d i a n e t w o r k s , a n d p o l i t i c s of p o s t m o d e r n i t y . E n r i c h i n g t h e i m a g i n a t i v e p o s s i b i l i t i e s of t w e n t y - f i r s t - c e n t u r y v i o l e n c e , it serves as an 'apocalyptic p r e t e x t . . . crying o u t f o r a t r a n s l a t i o n i n t o a p r o p e r terrorist text' (Petersen, 2005, p. 144); e n r i c h i n g t h e imaginative capabilities of t w e n t y - f i r s t - c e n t u r y fiction, it i n t r o d u c e s ' w h a t a p p e a r s t o be an u n p r e c e d e n t ed f o r m of d o u b l e - v o i c e d
first-person
n a r r a t i v e ' (Nielsen, 2006, p. 20; see also
H e i n z e , 2008; N i e l s e n , 2004; P u n t e r , 2 0 0 3 ) . W i t h Sheli Ayers, w e m i g h t say t h a t Glamorama's
protagonist, Victor, and the ' e n c h a n t e d p a n o r a m a ' he
i n h a b i t s ' a r e s y m p t o m a t i c of a c u l t u r a l c o n d i t i o n ' (Ayers, 2000, p. 3); b u t a s t r o n g e r a n d I t h i n k m o r e persuasive line of a r g u m e n t sees
Glamorama—at
t h e level of textuality, narrative, s t r u c t u r e , t h e m e , pace, i n d e e d , in any a n d all of its literary d i m e n s i o n s — b r i n g t o life t h e ' p o s t m o d e r n s c h i z o p h r e n i a ' we have b e e n analyzing across t h e last t w o chapters. In Madness
and Modernism,
as in cultural t h e o r y m o r e b r o a d l y , literature is
certainly n o t a t t r i b u t e d t h e s a m e status as sociological o r psychiatric research; its f u n c t i o n as fiction is to illuminate, r a t h e r t h a n t o p r o v i d e empirical o r c o n clusive c o n f i r m a t i o n of a p a r t i c u l a r idea. F o l l o w i n g Sass's suggestion t h a t as ' t h e t o w n criers of m o d e r n consciousness, schizophrenics are in a dual relationship with m o d e r n i t y , existing n o t just as a p r o d u c t o / b u t also as reaction against t h e prevailing social o r d e r ' (Sass, 1992, p. 372), t h e first p a r t of this c h a p t e r a i m s to s h o w h o w Glamorama
p r e s e n t s V i c t o r as e x e m p l i f y i n g a specifically
p o s t m o d e r n c o n s c i o u s n e s s . In p a r t t w o I c o n t i n u e this p r o j e c t b y d r a w i n g o n the interdisciplinary discourse of Schreber studies. If Schreber has b e e n repeatedly h e r a l d e d as e m b o d y i n g a specifically modern schizophrenia, can we, using t h e s a m e i n t e r p r e t i v e f r a m e w o r k s , c o n s i d e r V i c t o r his f i c t i o n a l p o s t m o d e r n equivalent? T h e t h i r d a n d final part of this c h a p t e r m o v e s b e y o n d an analysis of t h e e v e n t s r e c o u n t e d in t h e n a r r a t i v e t o t h e logic of t h e text itself. In calling u p o n ' p o s t m o d e r n schizophrenia' to interpret p o s t m o d e r n i t y , does this literary text, like its theoretical c o u n t e r p a r t s , also call u p o n s c h i z o p h r e n i a ' s association with the sublime? D o e s it i m p o r t n o t only t h e detail of cultural theory's m o d e l of schizophrenia, b u t t h e metatheoretical baggage that goes with it?
The town crier of postmodern consciousness W r i t t e n p r e d o m i n a n t l y in the first p e r s o n a n d p r e s e n t tense, f r o m t h e perspective of New Yoik's latest 'It Hoy' (140), Glamorama
tells the story of a g r o u p of
white, A m e r i c a n model-slash-actors whose star status provides cover for terr o r i s t o p e r a t i o n s . O v e r f l o w i n g w i t h r e f e r e n c e s t o t h e celebrities, labels, locales, b r a n d s , m u s i c , a n d m e d i a of t h e 1990s, t h e b o o k is a d i z z y i n g p o r t r a y a l o f t h e d e p t h l e s s n e s s a n d d e t r i t u s of p o s t m o d e r n c o n s u m e r c u l t u r e . Its s e t t i n g is t h e p e r p e t u a l present of the celebrity modelling c i r c u i t — t h e 'apex of c o n s u m e r society' ( M c l n e r n e y , 1998, p. 3 6 ) — w h e r e t h e u n r e l e n t i n g i m p e r a t i v e t o b e h i p p r e s c r i b e s a c o n s t a n t s h i f t t o t h e n e x t c o m m o d i f i e d i n c a r n a t i o n o f cool. ' " O u t is i n . In is o u t ' " , V i c t o r p r o c l a i m s , a n d ' " I f y o u n e e d t h i s d e f i n e d f o r y o u , m a y b e y o u ' r e in t h e w r o n g w o r l d ' " ( 1 5 ) . F a s h i o n as a s y s t e m e x p l o i t s t h e fact ' t h a t a n i n f i n i t e n u m b e r of signifiers c a n b e a t t a c h e d t o an i n f i n i t e n u m b e r o f s i g n i f i e d s ' ( M a r s h a l l , 1997, p. 11), a n d in Glamorama
t h i s s e m i o t i c f r e e d o m is
t a k e n t o n e w a n d g r u e s o m e e x t r e m e s : 'I f i n i s h r e a d i n g a n a r t i c l e a b o u t n e w m a s c a r a s (Shattered a n d R o a c h are the season's m o s t p o p u l a r ) a n d hip lipsticks ( F r o s t b i t e , A s p h y x i a , B r u i s e ) a n d g l a m nail p o l i s h ( P l a q u e , M i l d e w ) a n d I ' m t h i n k i n g , g e n u i n e l y , W o w , p r o g r e s s ' ( 1 6 8 ) . T h e elite w o r l d of h i g h f a s h i o n h e r e f u n c t i o n s as a s y n e c d o c h e o f w h a t Z y g m u n t B a u m a n calls l i q u i d m o d e r nity: it b o t h s t a n d s in f o r a n d e p i t o m i z e s a c u l t u r e f i x a t e d o n t h e f l o w o f aest h e t i c i z e d c o m m o d i t i e s . Ellis is also c a r e f u l t o c a p t u r e stylistically its r e l i a n c e o n s u p e r f i c i a l i t y , excess, flux, a n d r e p e t i t i o n . T h e p o p r e f e r e n c e s t h a t c l u t t e r a n d date the novel constitute a 'dazzling textuality', which ' p r o d u c e s a kind of r e a l i t y - v e r t i g o - e f f e c t o n t h e r e a d e r ' (Ettler, 1999) b u t also e v o k e t h e logic a n d r a p i d p a c e of t h e cycle of c o n s u m p t i o n . A s J o h n C o n l e y ( 2 0 0 9 , p . 120) o b s e r v e s , 'it is n o t o n l y t h a t Ellis w r i t e s about
c a p i t a l i s m , b u t t h a t Ellis literally w r i t e s a
w o r l d m a d e of m o n e y , f o r his g r a m m a r a n d s y n t a x a r e f o r m e d in its i m a g e ; Ellis is t r u l y a w r i t e r o f c a p i t a l i s m b e c a u s e it is c a p i t a l i s m t h a t his s e n t e n c e s e x e m p l i f y ' . W e c a n g o s o f a r as t o a r g u e , via J a m e s o n , t h a t Glamorama
s pop-
c u l t u r a l s i g n i f i e r s a r e signs o f a n ' a b s o l u t e l y f r a g m e n t e d a n d a n a r c h i c social reality'; ' b r o k e n pieces of language', w h i c h 'litter t h e c o m m o d i t y landscape', l i t e r a r y a n d literal, ' o f a p o s t m o d e r n i s t late c a p i t a l i s m in full crisis' ( J a m e s o n , 1984a, p . 2 0 1 ) . 3
3
Ellis's most striking presentation of this 'absolutely fragmented and anarchic social reality' is the grisly tableau created by a bombed aircraft: 'cell phones and laptops and Ray-Ban sunglasses and baseball caps and pairs of Rollerblades tied together and camcorders and mangled guitars and hundreds of CD's and fashion magazines (including the YouthQiuike with Victor Ward on the cover) and entire wardrobes of Calvin Klein and Armani and Ralph Lauren hang from burning trees and there's a teddy bear soaked with blood and a Bible and various Nintendo games along with rolls of toilet paper and shoulder bags and engagement rings and pens and belts whipped off waists and Prada purses still clasped and boxes of Calvin Klein boxer-briefs and so many clothes from the < lap contaminated with blood and other body llukls and everything reeks of aviation fuel' (440 I),
Ellis h a s d e s c r i b e d Glamorama
s narrator—the ail-American
YouthQuake
c o v e r b o y — n o t as a p o s t m o d e r n e v e r y m a n b u t as t h e e p i t o m e of e v e r y t h i n g t h a t is ' a n n o y i n g a n d r e p e l l e n t ' a b o u t m e n of his g e n e r a t i o n (Ellis q u o t e d in B l u m e , 1999). 4 A m o d e l s t r u g g l i n g t o b e a n a c t o r , singer, a n d n i g h t c l u b e n t r e p r e n e u r , V i c t o r is p r e s e n t e d e a r l y o n as a ' N o b o d y , u p - a n d - c o m e r , s t a r , h a s b e e n . N o t necessarily in t h a t o r d e r ' (139). His m o d u s o p e r a n d i is t h e c u l t i v a t i o n of c o o l a n d his m a x i m ' " T h e b e t t e r y o u l o o k , t h e m o r e y o u s e e ' " (27, 56, 2 5 4 ) . V i c t o r is d e d i c a t e d t o t h e p u r s u i t of p l e a s u r e , f a m e , a n d s e n s a t i o n a n d h e t h e r e fore c o n t i n u o u s l y adapts a n d r e m o u l d s himself a c c o r d i n g to the vagaries, f l u c t u a t i o n s , a n d c o n t r a d i c t i o n s of f a s h i o n : 'The 90s are honest, straightforward. Let's reflect that', I say, moving around. 'I want something unconsciously classic. I want no distinctions between exterior and interior, formal and casual, wet and dry, black and white, full and empty—oh my god, get me a cold compress'. (50) T h r o u g h his e n c y c l o p a e d i c k n o w l e d g e of p o p m u s i c statistics a n d A-list c e l e b r i t i e s V i c t o r s p e a k s a ' b r a i n - d e a d b r i c o l a g e ' ( Y o u n g , 1999), a n d , as t h i s M T V i n t e r v i e w s u g g e s t s , a p p e a r s t o h a v e n o k n o w l e d g e of life b e y o n d Entertainment
Tonight:
MTV (after polite laughter): 'No. What really makes you mad? What really gets you angry?' ME (long pause, thinking): 'Well, recently, missing DJs, badly behaved bartenders, certain gossipy male models, the media's treatment of celebs . . . um . . . ' MTV: 'We were thinking more along the lines of the war in Bosnia or the AIDS epidemic or domestic terrorism. How about the current political situation?' ME (long pause, tiny voice): 'Sloppy Rollerbladers?... The words "dot c o m " ? . . . ' MTV (long pause): 'Anything else?' ME (realizing something, relieved): 'A mulatto, an albino, a mosquito, my libido'. MTV (long pause): 'Did you . . . understand the question?' (141-2, ellipses in the original) Even in a s c e n e h a r d l y r e n o w n e d f o r intellectual p r o f u n d i t y , V i c t o r is a c c u s e d b y his g i r l f r i e n d o f b e i n g p a r t i c u l a r l y b l a n k : ' " E v e r y o n e k n o w s a f u c k o f a lot m o r e t h a n y o u d o a n d it's not cute"' (158, italics in t h e o r i g i n a l ) . 5 Ayers ( 2 0 0 0 ) h a s a r g u e d t h a t ' d e s p i t e ( o r p e r h a p s b e c a u s e o f ) his v a c u i t y , V i c t o r e m e r g e s as a privileged k n o w e r . H i s ability t o g r a s p t h i n g s b y t h e i r s u r f a c e a p p e a r a n c e a n d h i s m a s t e r y o f f a s h i o n a n d p o p - c u l t u r e c o d e s e n a b l e h i m t o o p e r a t e in t h i s t e x t u a l w o r l d ' . B u t V i c t o r ' s v a c u i t y is a l s o his v u l n e r a b i l i t y : h e h a s ' a d a p t e d
4 5
Victor Ward is a minor character in Ellis's 1987 novel The Rules of Attraction. It is not difficult to identify similarities here between Glamorama and Ben Stiller's 2001 film y.oolatuh r, indeed, Ellis reportedly brought legal action against Stiller for copyright infringement in a i asr ilui was settled out of court.
w e l l ' t o life as a t e r r o r i s t p r e c i s e l y b e c a u s e h e t h i n k s ' t h a t t h e G a z a S t r i p is a particularly lascivious m o v e an erotic dancer makes' a n d 'that the PLO recorde d t h e singles " D o n ' t B r i n g m e D o w n " a n d "Evil W o m a n ' " (314, 3 1 5 ) . T h e n o v e l o p e n s as V i c t o r ' s life b e g i n s t o d i s i n t e g r a t e . A c c e p t i n g t h e m y s t e r i o u s o f f e r of a n e x p e n s e s - p a i d t r i p t o E u r o p e t o locate his e x - g i r l f r i e n d , J a m i e F i e l d s , V i c t o r finds h i m s e l f t h e n e w e s t r e c r u i t in a k i n d o f ' P r a d a M e i n h o f g a n g ( H o u e n , 2 0 0 4 , p. 4 2 7 ) . Spatial a n d t e m p o r a l c o - o r d i n a t e s a r e s c r a m b l e d b y t h e s u d d e n a p p e a r a n c e o f a film c r e w r e c o r d i n g a n d d i r e c t i n g V i c t o r ' s ' p e r f o r m a n c e ' . N o e x p l a n a t i o n is o f f e r e d , V i c t o r j u s t a c c e p t s c o n s t a n t l y c h a n g i n g s c r i p t s , f o r e i g n c i n e m a t o g r a p h e r s , a c t i n g c o a c h i n g , a n d s p e c i a l e f f e c t s as his n e w reality. A f t e r p l a n t i n g a b o m b o n t h e P a r i s M e t r o , f o r e x a m p l e , h e d i s p a s s i o n a t e l y o b s e r v e s : ' V a r i o u s s h o t s of p e o p l e b l o w n a p a r t , e x t r a s a n d s t u n t m e n t h r o w n off t h e l i g h t w e i g h t steel car a n d o n t o t h e t r a c k s . S h o t o f b o d y p a r t s — legs a n d a r m s a n d h a n d s , m o s t of t h e m r e a l — s k i d d i n g a c r o s s t h e p l a t f o r m ' ( 3 1 9 ) . A s t h e v i o l e n c e escalates a n d a n o t h e r , u n r e l a t e d c r e w a p p e a r s t o film t h e e x p l o s i o n s , V i c t o r b e c o m e s i n c r e a s i n g l y i n c a p a b l e of m a p p i n g his m u l t i p l y i n g filmic
realities, a n d t h e r e a d e r is t e t h e r e d t o his c o n f u s i o n . S c e n e s start b e i n g
shot w i t h o u t h i m a n d c o n t i n u e b e y o n d their scripted p a r a m e t e r s (311); plots c o n f l i c t ( 3 1 5 , 3 2 9 ) ; t h e first f i l m c r e w a b a n d o n s t h e p r o j e c t o n l y t o b e c o m e p a r t o f a n e x p l o s i o n filmed b y t h e s e c o n d ( 3 5 0 ) ; a n d finally, V i c t o r ' s n a r r a t i v e voice collapses with the inclusion o f ' o b j e c t i v e l y ' n a r r a t e d scenes ( f r o m 304) a n d t h e i n t r u s i o n of a n u n i d e n t i f i e d n a r r a t i v e v o i c e ( f r o m 3 4 0 ) . Glamorama
is
n o t , h o w e v e r , a realist n o v e l a b o u t t h e m a k i n g o f a t e r r o r i s t a c t i o n film; t o o m u c h o c c u r s ' o f f - c a m e r a ' f o r t h e p r e s e n c e o f t h e s e film c r e w s t o p r o v i d e a c o m p l e t e , o r a d e q u a t e , r a t i o n a l e f o r t h e t e r r o r i s t activities. T h i s is t h e n o v e l ' s i n t e r p r e t i v e i m p a s s e : n o o n e h a s yet a t t e m p t e d t o e x a m i n e — m u c h less e x p l a i n — E l l i s ' s l i t e r a r y a e s t h e t i c s o r t e r r o r i s t t h e m a t i c s in t h e c o n t e x t of t h e s e puzzling contradictions. T h e m o s t p e r s u a s i v e i n t e r p r e t a t i o n of t h e s e logical d i s j u n c t u r e s in t h e text is, I will a r g u e , t o see t h e m as m a n i f e s t a t i o n s of a n e x p e r i e n c e t h a t closely r e s e m b l e s t h e ' p o s t m o d e r n s c h i z o p h r e n i a ' w e h a v e e x p l o r e d in p r e v i o u s c h a p t e r s . A l t h o u g h h e is n o t c o n c e r n e d w i t h p s y c h i a t r i c v e r i s i m i l i t u d e a n d n e v e r uses t h e t e r m explicitly, Ellis i m p a r t s t o V i c t o r a r a n g e o f ' s y m p t o m s ' c o n s o n a n t w i t h t h e k i n d of states d e s c r i b e d as ' s c h i z o p h r e n i c ' in c u l t u r a l t h e o r y , ' s y m p t o m s ' l i n k e d a e t i o l o g i c a l l y t o specific a s p e c t s o f p o s t m o d e r n i t y . In his article ' B r o a d c a s t i n g a n d S c h i z o p h r e n i a ' , J o h n P e t e r s ( 2 0 1 0 , p . 134) a r g u e s t h a t t h e m a s s m e d i a creates a structural resemblance b e t w e e n celebrity a n d psychotic discourse: Celebrities engage in institutionally sanctioned forms of excess: money, sex, drugs and styles of communication. Broadcast celebrities are ritually permitted to carry on
schizophrenic discourse. (The mentally ill, Goffman argued, lack just this permission.) Celebrities are trained to monitor every single gesture they make as if it were rife with potential significance, to address sound and image machines in jumbled 'takes' that can be edited later, and to speak to absent strangers as if they were friends. V i c t o r ' s c e l e b r i t y i d e n t i t y , a n d i n t u r n h i s ' s c h i z o p h r e n i c d i s c o u r s e ' , is a f u n c t i o n o f s u r f a c e s r a t h e r t h a n a n e x p r e s s i o n of p s y c h i c d e p t h : o v e r e x p o s e d t o t h e s e n s o r y s t i m u l i of p o s t m o d e r n i t y a n d i m m e r s e d in its p e r p e t u a l p r e s e n t , h e is i r r e c o n c i l a b l y f r a g m e n t e d , s u b j e c t t o a f f e c t i v e f l u x e s a n d i n c a p a b l e o f m e a n i n g f u l s e l f - d e f i n i t i o n . P o s i t i n g t e r r o r i s m as if n o t a n i n e v i t a b l e , t h e n cert a i n l y a logical, e x t e n s i o n of t h e cult o f celebrity, 6 Glamorama
m a p s the inten-
s i f i c a t i o n of V i c t o r ' s p s y c h o s i s a g a i n s t his i n c r e a s i n g p r o x i m i t y t o t h e n e t w o r k s of p o w e r in late capitalist p o s t m o d e r n i t y . T h e r e is, f r o m t h e o u t s e t , h o w e v e r , a clearly d e l u s i o n a l d i m e n s i o n t o V i c t o r ' s p e r c e p t u a l m a c h i n e r y . Glamorama
opens with Victor f u m i n g about the pres-
e n c e of s p e c k s o n t h e walls of his s o o n - t o - b e - o p e n e d c l u b : 'Specks, man, look at these fuckers. They glow. They're glowing, JD', I whisper. 'Jesus, they're everywhere'. Suddenly I notice an entire new patch and yelp, gaping. 'And I think they're spreading. I don't think that patch was here before!' I swallow, then croak in a rush. 'My mouth is incredibly dry because of this—could someone get me an Arizona diet iced tea in a bottle, not a can?' (6) A s n o o n e else p r e s e n t is able t o c o n f i r m t h e i r e x i s t e n c e , V i c t o r a p p e a r s t o b e a t t a c h i n g a special s i g n i f i c a n c e (if n o t m a l e v o l e n t i n t e n t ) t o s o m e t h i n g o n l y h e p e r c e i v e s . T h e s p e c k s s u g g e s t t h a t V i c t o r lives i n ' a p i x e l a t e d a n d i n f i n i t e l y t r a n s f o r m a b l e u n i v e r s e ' (Ayers, 2000, p. 7), b u t they also evoke the schizop h r e n i c stimmung—a
p e r c e p t i o n of t h e w o r l d as s i m u l t a n e o u s l y m e a n i n g f u l
b u t devoid of m e a n i n g , affectless b u t highly charged, f r a g m e n t e d b u t overw h e l m i n g i n its t o t a l i t y . ' [ I ] n c o m p r e h e n s i b l e y e t m e s m e r i z i n g ' , t h e w o r l d a p p e a r s b e f o r e t h e s u b j e c t w i t h a ' h a l l u c i n o g e n i c i n t e n s i t y ' ( J a m e s o n , 1991, p p . 2 7 - 8 ) s u g g e s t i v e o f t h e s u b l i m e , b u t w h a t is a p a r t i c u l a r l y p o s t m o d e r n a b o u t t h i s e x p e r i e n c e , a c c o r d i n g t o J a m e s o n , is its e v e r y d a y n e s s . V i c t o r sees n o t j u s t t h e l u m i n o u s specks, b u t also t h e e n t i r e f a b r i c of social life, as s i m u l t a n e o u s l y o v e r l o a d e d w i t h m e a n i n g a n d as fleeting, trivial, t r a n s p a r e n t . It is a
6
As one character explains: '"How did [terrorist leader Bobby Hughes] recruit people? . . . It was only models . . . and famous m o d e l s . . . . He wasn't interested in anyone e l s e . . . . He would use the fact that as a model all you do all day is stand around and do what other people tell you to do He preyed on t h a t . . . and we listened . . . and it was an analogy that made sense . . . in the end . . . when he asked . . . things of u s . . . and it wasn't hard to recruit people . . . everyone wanted to be around u s . . . everyone wanted to be movie s t a r s . . . and in the end, basii ally, everyone was a sociopath . . . and all the girls' hair was chignoned . . . and the Who was always playing somewhere . . . " ' (309, ellipses in the original).
m o d e o f e x p e r i e n c e t h a t Ellis p r e s e n t s n o t as a r a d i c a l d e v i a t i o n f r o m t h e a c c e p t e d n o r m , b u t r a t h e r as t h e e x a g g e r a t i o n o r i n t e n s i f i c a t i o n o f a w i d e r experience of p o s t m o d e r n i t y ' s perpetual present. A s t h e n a r r a t i v e , a n d t h e stimmung,
p r o g r e s s e s , V i c t o r ' s p e r c e p t u a l faculties
b e c o m e i n c r e a s i n g l y d i s t o r t e d a n d his s y m b o l i c o r d e r a c h a o s of b r o k e n pieces o f reality. V i r t u a l l y all s p a c e s a r e f r e e z i n g ( f r o m 15); c o n f e t t i a p p e a r s e v e r y w h e r e ( f r o m 8 8 ) ; a n u n s e e n m a n w h i s t l e s ' T h e S u n n y Side o f t h e S t r e e t ' ( f r o m 114); flies c l u s t e r e v e r y w h e r e d e s p i t e t h e c o l d ( f r o m 172); his l i m b s start p e r i o d i c a l l y falling asleep ( f r o m 303); finally, t h e smell of shit b e g i n s t o o v e r w h e l m h i s fly-filled a n d f r e e z i n g c e l e b r i t y h a u n t s ( f r o m 3 1 6 ) . T h e s e a r e n o t clues b u t a d e l u g e of s e e m i n g l y r a n d o m signs, a ' r u b b l e of d i s t i n c t a n d u n r e l a t e d signifies'
( J a m e s o n , 1991, p . 26) w h o s e o m i n o u s o p a c i t y c o m p l e m e n t s t h e i r vivid
a f f e c t i v e c h a r g e . 7 V i c t o r , like t h e s c h i z o p h r e n i c s c r e e n i n B a u d r i l l a r d ' s Ecstasy of Communication,
The
s u f f e r s f r o m a n ' o v e r - p r o x i m i t y o f all t h i n g s ' ; t h i n g s
t h a t i n v a d e his field o f v i s i o n , his t h o u g h t s , ears, n o s t r i l s a n d a p p e n d a g e s , a n d f r o m w h i c h ' n o t even t h e a u r a of his o w n b o d y protects h i m ' (Baudrillard, 1988, p p . 2 6 - 7 ) . V i c t o r ' s f r a g m e n t e d b u t h i g h l y c h a r g e d c o r p o r e a l i t y — a l o n g w i t h t h e i n t e n s i t y o f his o w n physical r e a c t i o n s (tears, v o m i t , l a u g h t e r , i n s o m n i a , n u m b n e s s , a n d p a n i c ) — h e r e also recalls D e l e u z e a n d G u a t t a r i ' s a c c o u n t o f t h e ' b a n d s of i n t e n s i t y , p o t e n t i a l s , t h r e s h o l d s , a n d g r a d i e n t s ' , w h i c h c o n s t i t u t e for t h e schizo 'A h a r r o w i n g , e m o t i o n a l l y o v e r w h e l m i n g e x p e r i e n c e , w h i c h b r i n g s [ h i m ] as close as possible t o m a t t e r , t o a b u r n i n g , living c e n t r e of m a t t e r ' ( D e l e u z e a n d G u a t t a r i , 1982, p. 19). 8 V i c t o r ' s s u b j e c t i v e d i s i n t e g r a t i o n d o e s n o t , h o w e v e r , r e s u l t f r o m his p r o x i m i t y t o t h e ' b u r n i n g , l i v i n g c e n t e r o f m a t t e r ' , b u t f r o m h i s i m m e r s i o n in t h e technological s u b l i m e , the 'impossible totality' of late capitalism ( J a m e s o n , 1991, p. 3 7 ) . D e l e u z e a n d G u a t t a r i a r g u e t h a t 'all d e l i r i u m possesses a w o r l d h i s t o r i c a l , political, a n d racial c o n t e n t ' ( D e l e u z e a n d G u a t t a r i , 1982, p p . 274, 88, see also 352, 362, 3 6 5 ) , a n d V i c t o r ' s ' p o s t m o d e r n s c h i z o p h r e n i a ' s p e a k s o f a n e r a o f s i m u l a t i o n , s u r v e i l l a n c e , a n d digital m a s s m e d i a ; a c o n s u m e r c u l t u r e
7
John Conley (2009) offers an extended reading of one of these signifiers in his article on poverty in American Psycho and Glamorama. Noting that the olfactory is frequently missing from the Ellisian world, he argues that the smell of shit is one of the novel's most 'insistent' tropes and that it points among other things to the underlying putrescence of celebrity culture. This is a compelling and even seductive argument, but one which seems to overdetermine the meaning of one signifier while ignoring the less suggestive but no less insistent tropes identified above.
8
In a perverse 'literalisation' or materialization of Deleuze and Guattari's concept of the 'body-without-organs', Victor later watches helpless and hysterical as his ex-girlfriend Chloc's organs liquefy and gush out of her vagina.
n o t a b l e f o r t h e s p e e d a n d m o b i l i t y o f c a p i t a l ; a w o r l d in w h i c h f a s h i o n a n d v i o l e n c e c a n b e c o m e i n d i s t i n g u i s h a b l e , as: The catwalks seemed longer, the paparazzi were both more and less frantic, girls were wearing bones, bird skulls, human teeth, bloody smocks, they held fluorescent water pistols, there was serious buzz, there was zero buzz, it was the epitome of hype, it was wildly trivial (408). T h e ' i n d u s t r i e s ' o f f a s h i o n a n d t e r r o r b o t h o p e r a t e o u t o f t h e logic o f t h e s i m u l a c r u m , where the m a n i p u l a t i o n of the image can proceed indefinitely: Lips are digitally thickened, freckles are removed, an ax is placed in someone's outstretched hand, a BMW becomes a Jaguar which becomes a Mercedes which becomes a broom which becomes a frog which becomes a mop which becomes a poster of Jenny McCarthy (357). A n d its effects a r e n o t m e r e l y a e s t h e t i c : ' " Y o u c a n m o v e p l a n e t s w i t h this . . . Y o u c a n s h a p e lives. T h e p h o t o g r a p h is o n l y t h e b e g i n n i n g . [. . .] W e r e y o u t h e r e o r w e r e y o u n o t ? It all d e p e n d s o n w h o y o u a s k , a n d e v e n t h a t r e a l l y d o e s n ' t m a t t e r a n y m o r e ' " ( 3 5 8 ) . If, as Z i z e k ( 2 0 0 2 , p. 225) c l a i m s , t h e c a m e r a ' s gaze t o d a y p r o v i d e s f o r e a c h o f u s a n ' o n t o l o g i c a l g u a r a n t e e ' it is o n e w h i c h has, in Glamorama,
l o n g since e x p i r e d . 9
Like f a s h i o n , t h e t e r r o r i s t v i o l e n c e of Glamorama
operates without identifi-
able logic o r s t r u c t u r e ; it is 'crazy, viral [ a n d ] m e d i a t i o n l e s s ' b e c a u s e 'it n e v e r p a s s e s via t h e m e d i a t i o n of m e a n i n g ' ( B a u d r i l l a r d , 1993, p. 7 0 ) . T h e m o d e l t e r r o r i s t s t a k e t o e x t r e m e s t h e d e t e r r i t o r i a l i z i n g logic o f t h e s c h i z o ; h o w e v e r , t h e i r a n t i - O e d i p a l a g e n c y d o e s n o t t h r e a t e n b u t reinvigorates
t h e late capitalist
s y s t e m : ' W e ' r e at a d i n n e r p a r t y . . . a n d it's all r a t h e r s u b d u e d s i n c e a s m a l l p e r c e n t a g e of t h e i n v i t e d guests w e r e b l o w n u p in t h e Ritz y e s t e r d a y . F o r c o m f o r t , p e o p l e w e n t s h o p p i n g , w h i c h is u n d e r s t a n d a b l e e v e n if t h e y b o u g h t t h i n g s a little t o o e n t h u s i a s t i c a l l y ' ( 3 6 0 ) . Ellis, w i t h J a m e s o n a n d B a u d r i l l a r d , s e e m s u n c o n v i n c e d t h a t t h e ' s c h i z o p h r e n i c ' e m p t y i n g o u t o f s u b j e c t i v i t y serves a n y politically e m a n c i p a t o r y p u r p o s e ; it is, r a t h e r , p r e c i p i t a t e d b y a n d in t h e service o f capitalist p o w e r s t r u c t u r e s . Ontologically insecure, a d d i c t e d t o t r a n q u i l i z i n g d r u g s , a n d bereft of an i n t e l l e c t u a l a r s e n a l , V i c t o r ' s feeble g r i p o n reality l o o s e n s steadily as his i n v o l v e m e n t in v i o l e n c e increases. A n d y W a r h o l is said t o h a v e q u i p p e d , 'If it gets t o o i n t e n s e , j u s t p r e t e n d it's a m o v i e ' . It is advice V i c t o r h e e d s . A s I h a v e s u g g e s t e d ,
9
in his analysis of Glumorama, Waller Benn Michaels argues that as terrorism eclipses national and ideologic al forms of conflict, il signals a move from politics and belief to biopolitics and being, lithe 'discourse of terrorism' is the 'discourse of the replacement of ideology by ontology' (20111, p. 1111, c !i uly il both registers and heightens the ontological insecurity of an image addicted < ia
t h e r e a r e s u f f i c i e n t n a r r a t i v e i n c o n s i s t e n c i e s t o m a k e it clear t h a t
Glamorama
is n o t a realist n o v e l a b o u t t h e m a k i n g o f a t e r r o r i s t a c t i o n film. T h e p r e s e n c e o f successive f i l m c r e w s s h o o t i n g s o m e b u t n o t all of t h e s c e n e s o f t e r r o r i s m a n d t o r t u r e c a n b e m o r e p e r s u a s i v e l y i n t e r p r e t e d as a p o s t m o d e r n
stimmung
e x t e n d i n g into full-blown psychosis. T h e a p p e a r a n c e of the entire cinematic a p p a r a t u s — f r o m the technicians to their technical e q u i p m e n t — i s not simply narcissistic w i s h - f u l f i l m e n t b u t a d e l u s i o n a l p r o j e c t i o n o f V i c t o r ' s c o n s c i o u s n e s s of h i m s e l f as a star. T h e s e c o m p l e x a n d c o n t r a d i c t o r y d e l u s i o n s of g r a n d e u r in t u r n f u n c t i o n t o i n s u l a t e V i c t o r f r o m t h e r e a l i t y o f h i s a c t i o n s : ' I ' m s m i l i n g , c o n f u s e d , w e i r d e d o u t at h o w f o c u s e d B e n t l e y s e e m s a n d s h o c k e d at h o w gruesome a n d inauthentic the waxwork looks' (283). 'The shock, the sirens, t h e h u n d r e d w o u n d e d — i t ' s all s o f a m i l i a r . T h e d i r e c t o r is relying o n a really t o p - n o t c h e d i t o r to p u t the f o o t a g e t o g e t h e r ' (306). T h e m o r e wideranging the terrorist conspiracies, the m o r e extreme the violence, the greater t h e n u m b e r o f film c r e w s r e q u i r e d t o a c c o u n t f o r it, a n d t h e m o r e i n c o n s i s t e n t a n d d e s p e r a t e V i c t o r ' s d e l u s i o n a l s y s t e m b e c o m e s . G a p s a n d fissures a p p e a r ; c i n e m a t i c logic is e x c e e d e d ; t h e real r e - e n t e r s t h e p i c t u r e : The actor doesn't know anything. He memorized a different script. He's not delivering the performance that Bobby wants. He was miscast. He was wrong for this part. It's all over. Bobby instructs Bruce to pour acid on the actor's hands. Pain floods his face as he gazes at me, crying, and then his leg is sawed off. (359) If V i c t o r l o o k s t o t h e film c r e w s t o e x p l a i n his u l t r a v i o l e n t , h y p e r r e a l w o r l d , it is clear t h a t a n y s e c u r i t y t h e y o f f e r c a n o n l y b e fleeting; his is n o t a stable d e l u s i o n a l s t r u c t u r e b u t o n e t h a t is partial, p r o v i s i o n a l , a n d p e r p e t u a l l y in flux.
A postmodern Schreber? V i c t o r is n o t a m o d e r n i s t m o n a d b u t every i n c h a p o s t m o d e r n s u b j e c t ; h e is a n endlessly adaptive, even malleable, sensation-seeking 'tissue of quotations' ( B a r t h e s , 1977, p . 146) a n d m o r e t h a n fits t h e s y m p t o m a t o l o g i c a l p r o f i l e f o r ' p o s t m o d e r n s c h i z o p h r e n i a ' . O n e w a y of i n t e r p r e t i n g Victor's
first-person
n a r r a t i v e as specifically p o s t m o d e r n is, as I h a v e d e m o n s t r a t e d , t o r e a d h i m as a n e m b o d i m e n t of t h e ' s c h i z o p h r e n i c ' s u b j e c t i v i t y d e s c r i b e d b y c u l t u r a l t h e o rists. T h e r e is, h o w e v e r , a n o t h e r i n t e r p r e t i v e possibility, a n d t h a t is t o d r a w o n t h e i n t e r d i s c i p l i n a r y d i s c o u r s e o f S c h r e b e r s t u d i e s . Memoirs
of My
Nervous
Illness h a s b e c o m e s o m e t h i n g of a privileged u r t e x t in s c h i z o p h r e n i a d i s c o u r s e . S e t t i n g t o o n e side t h e p s y c h o a n a l y t i c a c c o u n t s o f S c h r e b e r ' s p s y c h o s i s , t h e r e a r e t h r e e d i s t i n c t w a y s in w h i c h h i s d e l u s i o n a l c o s m o l o g y h a s b e e n r e a d as q u i n t e s s e n t i a l l y m o d e r n : it is s e e n t o o f f e r i n s i g h t i n t o m o d e r n d i s c i p l i n a r y p o w e r , t o reveal t h e s t r u c t u r e s of m o d e r n c o n s c i o u s n e s s , a n d t o s y m b o l i z e a
h i d d e n h i s t o r y of m o d e r n i t y . E a c h of t h e s e w a y s of i n t e r p r e t i n g Memoirs I suggest, b e f r u i t f u l l y e n g a g e d in t h e analysis o f Glamorama.
can,
Although I am
w a r y o f o v e r s t a t i n g t h e c o m p a r i s o n b e t w e e n S c h r e b e r a n d V i c t o r , if t h e c o n t e m p o r a r y societal c o n d i t i o n is, as is w i d e l y c l a i m e d , o n e w h i c h calls i n t o q u e s t i o n t h e s t a t u s o f t h e real a n d d e c l a r e s a n e n d t o s u b j e c t i v e d e p t h , t h e m o v e f r o m a n a u t o b i o g r a p h i c a l t o a f i c t i o n a l text a n d f r o m t h e g e n i u s of a J u d g e t o t h e v a c u i t y o f a m o d e l - t e r r o r i s t is itself a l r e a d y s u g g e s t i v e o f a s h i f t f r o m m o d e r n i t y t o p o s t m o d e r n i t y . If t h a t is t h e case, a n d S c h r e b e r c a n b e seen as t h e ' c a n a r y in t h e m i n e s h a f t ' ( G i l m a n , 1996, p . 16) o f fin-de-siècle V i c t o r t h e I t - B o y o f s c h i z o p h r e n i z i n g fin-de-millénaire
m o d e r n i t y , is
postmodernity?
A s w e s a w i n C h a p t e r 2, L o u i s Sass a n d E r i c S a n t n e r h a v e b o t h f o u n d in Schreber's schizophrenic s y m p t o m a t o l o g y the effects of m o d e r n f o r m s of d i s c i p l i n a r y p o w e r . I n s t e a d of c a s t i n g S c h r e b e r ' s f a t h e r M o r i t z as t h e s a d i s t i c villain in a p s y c h o s e x u a l d r a m a , Sass a r g u e s t h a t : The techniques recommended by Moritz Schreber can, in fact, be said to involve the two great bulwarks of the modern disciplinary order of power/knowledge described by Foucault: namely, 'exercise', whose goal is the creation of docile bodies; and 'the examination', whose purpose is the monitoring—ultimately, the self-monitoring—of action and thought. (Sass, 1994b, p. 112) S a n t n e r ' s analysis o f d i s c i p l i n a r y p o w e r e x t e n d s f r o m t h e f a m i l y t o m e d i c o pedagogy a n d biological psychiatry: One might say, then, that the chronic state of emergency generating the bizarre array of symptoms and delusions described in Memoirs was inaugurated b y . . . the disciplinary power to which Schreber had been exposed since early childhood and to which he was exposed again, through a different form, in the psychiatric institutions of Flechsig and Weber; Schreber's soul m u r d e r becomes, f r o m this perspective, a sustained traumatization induced by exposure to, as it were, fathers who knew too much. (Santner, 1996, p. 86, italics in the original) In Glamorama
we f i n d t h e p r o b l e m of p a t e r n a l a n d paternalistic p o w e r /
k n o w l e d g e is explicitly t h a t of A m e r i c a n late capitalist p o s t m o d e r n i t y . M a p p e d a g a i n s t V i c t o r ' s o n t o l o g i c a l u n r a v e l l i n g is t h e s h a d o w y rise of his f a t h e r , S a m u e l J o h n s o n , w h o p l a n s t o leave t h e U S S e n a t e in a b i d f o r t h e p r e s i d e n c y . T o his h o r r o r , V i c t o r d i s c o v e r s t h a t his f a t h e r is i n v o l v e d w i t h t e r r o r i s t l e a d e r B o b b y I I u g h e s ( 4 2 3 ) , a n d t h e n o v e l ' s t w o e n d i n g s , t o w h i c h w e will t u r n in a m o m e n t , p l o t t w o r e s p o n s e s t o t h i s r e v e l a t i o n . In t h e first, V i c t o r r e c l a i m s t h e p a t r o n y m i c s u r n a m e J o h n s o n a n d gives his f a t h e r ' s election c a m p a i g n full t e r r o r i s t b a c k i n g ( 4 5 2 ) ; in t h e s e c o n d , w h e n V i c t o r W a r d sees f o o t a g e r e v e a l i n g h i s
f a t h e r t o b e t h e m a s t e r m i n d of all t h e h o r r o r s t h a t h a v e t a k e n place, h e h a s t o ' h o l d a h a n d o v e r [his] m o u t h t o s t o p t h e s c r e a m i n g ' ( 4 7 5 ) . Jameson has argued that the p o s t m o d e r n culture so painstakingly d o c u m e n t e d b y Ellis 'is t h e i n t e r n a l a n d s u p e r s t r u c t u r a l e x p r e s s i o n of a w h o l e n e w wave of American military and e c o n o m i c d o m i n a t i o n t h r o u g h o u t the world' ( J a m e s o n , 1991, p . 5; see also S t e p h e n s o n , 2 0 0 7 ) . B a u d r i l l a r d goes f u r t h e r in s u g g e s t i n g t h a t as t h e o n l y s u p e r p o w e r , A m e r i c a ' h a s f o m e n t e d all t h i s v i o l e n c e w h i c h is e n d e m i c t h r o u g h o u t t h e w o r l d , a n d h e n c e t h a t ( u n w i t t i n g l y ) t e r r o r i s t i c i m a g i n a t i o n w h i c h d w e l l s in all o f u s ' ( B a u d r i l l a r d , 2 0 0 2 , p. 4 ) . Is this m o d e l - t e r r o r i s t ' s ' s c h i z o p h r e n i a ' the result of his e x p o s u r e to the very s t r u c t u r e s of l a t e - c a p i t a l i s t c u l t u r e t h r o u g h a ' f a t h e r w h o k n e w t o o m u c h ' ? A n d is it a n e x p o s u r e t h a t h e , like S c h r e b e r , c a n only p r o c e s s t h r o u g h p s y c h o sis? T r u e t o t h e u n d e c i d a b i l i t y of t h e n o v e l , V i c t o r ' s t h r o w a w a y d e s c r i p t i o n of h i s f a t h e r as a m e r e ' c o n t r i v a n c e . . . [a] p l o t d e v i c e ' ( 3 6 ) also s u g g e s t s this is n o t h i n g m o r e t h a n a satirically O e d i p a l twist o n t h e c o n s p i r a c y - t h e o r y w o r l d v i e w . 1 0 H o w e v e r , if S a m u e l J o h n s o n is t h e N a m e - o f - t h e - F a t h e r f o r e c l o s e d b y Victor Ward, he and the socio-symbolic order he authorizes make a dramatic r e a p p e a r a n c e in t h e Real o f his ' s c h i z o p h r e n i c ' e x p e r i e n c e . O n e o f t h e e f f e c t s o f m o d e r n d i s c i p l i n a r y p o w e r is, a c c o r d i n g t o F o u c a u l t , t h e regulation of subjects t h r o u g h the p r o m o t i o n of an i n n e r p a n o p t i c i s m . Sass e x p l a i n s t h a t : The panoptical arrangement makes individuals feel constantly exposed to an external, normalising gaze, therefore subjecting them to the dictates of an authority that must ultimately be internalized. Foucault sees this arrangement as the essential manifestation of modern power relationships instantiated in many institutions and social practices. It fosters forms of disciplinary self-control that eradicate spontaneity, increase inwardness and isolation, and instil the inner divisions of a relentlessly self-monitoring mode of consciousness. (Sass, 1997, p. 206; see also Sass, 1992, pp. 251-8) F o r Sass, S c h r e b e r ' s s c h i z o p h r e n i a c a n b e r e a d as t h e i n t e n s i f i c a t i o n of this ' r e l e n t l e s s l y s e l f - m o n i t o r i n g ' m o d e o f m o d e r n c o n s c i o u s n e s s . In C h a p t e r 5 I argued that p o s t m o d e r n institutions p r o m o t e a substantively different p a n o p tic r e g i m e : c o n s u m e r society e n c o u r a g e s s e l f - s c r u t i n y n o t t o h o m o g e n i z e a n d d i s c i p l i n e its s u b j e c t s , b u t t o m a k e t h e m b e t t e r c o n s u m e r s . S e l f - c o n t r o l is in t h e service o f s e l f - e x p r e s s i o n , a n d , t o r e - e n g a g e B a u m a n ' s a n a l y s i s , u n d e r a s y n o p t i c a r r a n g e m e n t , t h e lives o f a c e l e b r i t y elite p r o v i d e t h e t e m p l a t e f o r h o w o t h e r s s h o u l d feel a n d act as well as w h a t t h e y s h o u l d b u y .
10
Glamorama
Or, in Jamesonian parlance, a degraded attempt at cognitive mapping (Jameson, 1991, p. 38; 1988, p. 356).
registers t h i s p a r a d i g m s h i f t in t h e p a n o p t i c r e g i m e of t h e self o n m u l t i p l e levels. Victor's use of filmic language ('Stills f r o m Chloe's loft' (39), 'But s o m e o n e ' s calling " C u t ! " ' (94), ' I ' m u n d e r g o i n g a s l o w - m o t i o n h i d d e n f r e a k - o u t ' (145)) e m p h a s i z e t h a t he i n t e r p r e t s himself, as a star, t h r o u g h t h e (actual a n d i m a g i n e d ) c i n e m a t i c gaze, just as he i n t e r p r e t s his w o r l d as a filmic text. T h i s p r o p e n s i t y is gradually concretized u n t i l he is s u r r o u n d e d b y t h e actors, extras, a n d c i n e m a t o g r a p h e r s w h o , for the rest of t h e novel, s h a d o w his every m o v e . W h e r e a s S c h r e b e r ' s p e r s e c u t i n g G o d d e m a n d e d t h a t he c o n t i n u a l l y p r o v e his r a t i o n a l i t y , t h e f i l m c r e w s relentlessly d e m a n d of V i c t o r a p e r f o r m a n c e , an o u t w a r d display of e m o t i o n s , a stereotyped p r e s e n t a t i o n of lines. M a n i f e s t a t i o n s of a p o s t m o d e r n p a n o p t i c i s m , t h e film crews a t t e n d o n l y t o surfaces, n o t t o psychic complexity, b u t d o so in a way that is as persistent as it is p e r n i c i o u s . S c h r e b e r ' s s u f f e r i n g h a s b e e n , as w e k n o w , r e p e a t e d l y r e a d as a s y m b o l i c revelation of t h e h i s t o r y of m o d e r n i t y . A c c o r d i n g to S a n t n e r , ' T o traverse, with S c h r e b e r , t h e f a n t a s y s p a c e of his o w n p r i v a t e G e r m a n y . . . is t o e n c o u n t e r E u r o p e a n m o d e r n i t y f r o m t h e perspective of t h o s e figures in w h o m m o d e r n E u r o p e a n society " s e c r e t e d " its d i s a v o w e d k n o w l e d g e of c h r o n i c s t r u c t u r a l crisis a n d d i s e q u i l i b r i u m ' (Santner, 1996, p. 144). For Santner, Schreber's hist o r y of m o d e r n i t y , precisely because it is 'secret history', invites a h e r m e n e u t i c a l r e s p o n s e , a p r o b i n g of its d e p t h s a n d s y m b o l i c possibilities. By c o n t r a s t , t h e 'obscenity' of Glamorama
s p o s t m o d e r n i t y is, to b o r r o w again f r o m Baudrillard,
' n o longer the o b s c e n i t y of the h i d d e n , t h e repressed, t h e o b s c u r e , b u t that of the visible, t h e all-too-visible, the more-visible-than-visible; it is the o b s c e n i t y of t h a t w h i c h n o longer c o n t a i n s a secret a n d is entirely soluble in i n f o r m a t i o n a n d c o m m u n i c a t i o n ' ( B a u d r i l l a r d , 1988, p. 2 2 ) . Glamorama's
YouthQuake
cover b o y is n o t o n l y 'more-visible-than-visible', b u t he is also m e a n t to be the e p i t o m e of all t h a t is desirable. In this narrative, disciplinary p o w e r n o longer c o n c e n t r a t e s its ' s c h i z o p h r e n i z i n g ' o p e r a t i o n in the d o m e s t i c sphere, t h e psychiatric clinic, o r even t h e c o u r t r o o m , b u t in t h e s y n o p t i c celebrity-obsessed m a s s m e d i a , t h e w o r l d of simulacra in w h i c h V i c t o r has a leading role. Victor's s c h i z o p h r e n i a d o e s n o t t h e r e f o r e e n c o d e ' t h e d r a m a of a l i e n a t i o n ' b u t flagrantly d r a m a t i z e s t h e 'ecstasy of c o m m u n i c a t i o n ' (Baudrillard, 1988, p. 22).
Glamorama and the schizophrenic sublime So far I h a v e a r g u e d t h a t Glamorama
e x e m p l i f i e s c u l t u r a l t h e o r y ' s m o d e l of
p o s t m o d e r n s c h i z o p h r e n i a a n d that Victor, like Schreber, can be seen t o 'live o u t , in exaggerated, almost literal fashion, t h e ontological a n d epistemological a s s u m p t i o n s of his . . . age' (Sass, 1997, p. 2 2 2 ) . W e c a n n o w c o n s i d e r t h e issue of h o w , in ils p r e s e n t a t i o n of s c h i z o p h r e n i a , t h i s literary text, like its
theoretical counterparts, negotiates the schizophrenic sublime. I d o n o t wish t o i m p l y h e r e t h a t t h e s u b l i m e m u s t n e c e s s a r i l y b e f o u n d in t h e s t r u c t u r e o f all r e p r e s e n t a t i o n s of s c h i z o p h r e n i a : as Sass's m o d e l o f s c h i z o p h r e n i a a m p l y d e m o n s t r a t e s , it is of c o u r s e p o s s i b l e t o t h i n k o u t s i d e t h e p a r a m e t e r s o f p s y c h i a t r i c m e t a t h e o r y . Ellis, I will a r g u e , d o e s n o t . O n t h e c o n t r a r y , far f r o m r e n d e r i n g t h e s c h i z o p h r e n i c s u b l i m e d e f u n c t , o r even p a r a d o x i c a l , Glamorama
returns to the
t r o p e s of late n i n e t e e n t h - c e n t u r y psychiatry, m o b i l i z i n g a m o d e l o f s c h i z o p h r e n i a as s o m e t h i n g t h a t is in essence u n k n o w a b l e , t h a t is b e y o n d c o m p r e h e n s i o n , a n d t h a t h a s at its c o r e a k e r n e l of u n r e a s o n resistant t o i n t e r p r e t a t i o n . F r o m t h e outset, w h a t w e m i g h t t h i n k of as Victor's ' s c h i z o p h r e n i c s y m p t o m s ' — his visual, tactile, olfactory, a n d a u d i t o r y h a l l u c i n a t i o n s (the specks, confetti, flies, a n d freezing feeling; t h e smell of shit; ' T h e S u n n y Side of t h e Street') a n d his d e l u sional s t r u c t u r e s (the c o n t r a d i c t o r y filmic p l o t s ) — f u n c t i o n as i n s c r u t a b l e signif i e s . T h a t t h e y c a n b e s y m b o l i c a l l y l i n k e d t o p o s t m o d e r n i t y , a n d s e e n as t h e e x p r e s s i o n of a s y n o p t i c p o s t m o d e r n c o n s c i o u s n e s s , d o e s n o t d i m i n i s h t h e i r s t a t u s as ' u n i n t e r p r e t a b l e ' b u t suggests t h a t u n i n t e r p r e t a b i l i t y is v e r y precisely a p o s t m o d e r n p h e n o m e n o n . Here, instead of u n d e r t a k i n g the h e r m e n e u t i c i n v e s t i g a t i o n o f p s y c h i c secrets, 'We'll slide down the surface of things'
(144,145,
146, 150, 152, 154, 157, 164, italics in t h e o r i g i n a l ) . V i c t o r ' s o b s e r v a t i o n , o r m o r e precisely, his q u o t a t i o n o f t h e U 2 s o n g ' E v e n B e t t e r T h a n t h e Real T h i n g ' , alerts u s t o t h e f u t i l i t y o f s e a r c h i n g f o r m e a n i n g t h a t m i g h t well b e inaccessible, if i n d e e d it is p r e s e n t at all. T h r o u g h o u t t h i s c h a p t e r I h a v e d r a w n a t t e n t i o n t o Glamorama's
o p a c i t y , its c o n t r a d i c t i o n s , a n d its d i e g e t i c d y s f u n c t i o n a l i t y . A s
t h e n a r r a t i v e p r o g r e s s e s , t h e realities o f this ' p o s t m o d e r n s c h i z o p h r e n i a ' m u l tiply t o the p o i n t w h e r e m a p p i n g this textual labyrinth b e c o m e s impossible. Glamorama's
final c h a p t e r s seem to play, provocatively, u p o n the reader's
disorientation. Will the mystery of Victor's 'schizophrenic' experience be r e s o l v e d , its a e t i o l o g y clearly e s t a b l i s h e d , its p a r a m e t e r s clearly d r a w n ? O r will it r e m a i n i m p e n e t r a b l e ? In a telling scene, at t h e h e i g h t of t h e terrorist plotting, V i c t o r is briefly r e u n i t e d w i t h his ex-girlfriend C h l o e a n d a t t e m p t s t o explain w h y h e fled N e w York: 'I thought it'd solve everything if I . . . just left', I tell her. 'I was just. . . directionless, y'know, baby?' 'Because?' A sigh. 'Because where I was going . . . ' I stop, my throat tightens. 'Yeah?' she whispers. 'Because where you were going . . . ' she coaxes. I breathe in and then I'm reduced. 'There was no one there', I whisper back. (409, ellipses in the original) T h i s is b o t h a lie ( V i c t o r is s e n t t o E u r o p e b y t h e m y s t e r i o u s M r P a l a k o n ) a n d a r a r e m o m e n t of insight. V i c t o r ' s i n t r o s p e c t i o n leads h i m t o realize t h a t
t h e r e is ' n o o n e t h e r e ' , a n d t h i s idea of a n o n - s e l f is m a n i f e s t e d in t h e text in t h e d o m i n a n t m o t i f o f i d e n t i t y c o n f u s i o n . V i c t o r is consistently
accosted by people
w h o swear t h a t t h e y h a v e seen h i m in places h e swears h e w a s n o t . 1 1 T h e q u e s t i o n , raised early o n , is w h e t h e r h e is t h e v i c t i m of a m n e s i a , d e c e p t i o n , m i s t a k e n i d e n t i t y , i n s i d i o u s h o a x , o r d i a b o l i c a l f a n t a s y . O r , if t h e r e is ' n o one t h e r e ' is it in fact b e c a u s e t h e r e a r e t w o ( o r m o r e ? ) V i c t o r s t h e r e , as t h e n o v e l ' s t w o c o n t r a d i c t o r y e n d i n g s clearly i m p l y ? 1 2 I n t h e f i r s t e n d i n g , V i c t o r r e - e s t a b l i s h e s h i m s e l f in N e w Y o r k as V i c t o r J o h n s o n , t h e s u c c e s s f u l s o n of a p r e s i d e n t i a l c a n d i d a t e . A l t h o u g h still a c c o s t e d b y flies, cold, a n d c o n f e t t i , h e h a s t a k e n u p a l e a d e r s h i p r o l e w i t h i n t h e t e r r o r i s t n e t w o r k a n d s e e m s b e t t e r e q u i p p e d t o c o p e w i t h its v i c i s s i t u d e s . 1 3 In t h e seco n d e n d i n g , t h e f i l m c r e w flies V i c t o r W a r d t o M i l a n , w h e r e h e is e f f e c t i v e l y i m p r i s o n e d — p s y c h o t i c , t e r r i f i e d , a n d killing t i m e — i n a h o t e l r o o m . D e s p e r a t e , h e calls his sister in W a s h i n g t o n : 'Sally, it's really me, please—' I gasp. 'It's for you', I hear her say. The sound of the phone being passed to someone else. 'Hello?' a voice asks. I don't say anything, just listen intently. 'Hello?' the voice asks again. 'This is Victor Johnson', the voice says. 'Who is this?' Silence. 'It'd be really cool if you stopped bothering my sister', the voice says. 'Okay?' Silence. 'Goodbye', the voice says. A click. I'm disconnected. (476) T h i s t r a n s - A t l a n t i c p h o n e call d o e s n o t c o n f o r m t o t h e c l i c h e d n o t i o n o f a split p e r s o n a l i t y , J e k y l l - a n d - H y d e t y p e m a d n e s s ; it is a c l i m a c t i c m o m e n t of
11
12
13
And, it should be noted, the confusion is not just visual. It reaches a climax in the scene quoted earlier, when although Victor has not left Paris in months, Chloe tells him that they conceived a child days ago in New York. Ellis toys with the reader in a scene where the terrorists' reliance upon digital image manipulation is revealed. The files are variously titled Victor and '"Victor"', suggesting that there is still a meaningful distinction between original and imitation, until upon closer inspection it becomes clear that there is no correlation between the use of scare quotes anil the images we assume to be surveillance of the 'real' Victor. Take for example this exchange with his newly appointed 'guru and spiritual advisor': 'Don't feat the reaper, Victor,' Deepak says, walking away. I'm nodding mindlessly, a vacant grin pasted on my face, until I turn around and mutter to myself, 'I am the fucking reaper, Deepak . , ( 4 4 . r i 6).
o n t o l o g i c a l r u p t u r e t h a t e m p h a t i c a l l y r e i n f o r c e s t h e s u b l i m i t y of Victor's ' s c h i z o p h r e n i a ' . So a l t h o u g h H e n d r i k S k o v N i e l s e n a r g u e s t h a t ' t h e d o u b l e takes o v e r n o t j u s t t h e i d e n t i t y a n d life o f V i c t o r W a r d b u t t h e n a r r a t i o n of t h e n a r r a t i v e , w h i c h itself b e c o m e s d o u b l e d a n d d o u b l e - v o i c e d ' ( N i e l s e n , 2 0 0 6 , p p . 2 4 - 5 ) , I a m i n c l i n e d t o a g r e e w i t h D a v i d P u n t e r ( P u n t e r , 2003, p. 72) t h a t t h i s ' u n c a n n y d o u b l i n g ' is in fact ' a n u n c a n n y a w a r e n e s s of m u l t i p l i c i t y ' , f o r in p o s t m o d e r n i t y ' t w o lives, as it w e r e , a r e n o t e n o u g h ' . V i c t o r ' s p s y c h i c s p l i t t i n g c a n n o t b e safely c o n t a i n e d b y t h e t r o p e of t h e d o u b l e , m u c h as w e m i g h t w i s h it, if o n l y b e c a u s e t h e r e a r e n o l i m i t s t o his digital o r c i n e m a t i c i n c a r n a t i o n s . As m u c h as N i e l s e n ( N i e l s e n , 2 0 0 6 , p. 26) w o u l d like t o p r o p o s e t h a t t h e d o u b l e s u b s u m e s a n d d e s t r o y s t h e n a r r a t o r o n t h e t h e m a t i c level, i n t h e n a r r a t e d u n i v e r s e and as ' t h e e n u n c i a t o r o f " I " ' , his a r g u m e n t r e s t s o n t h e c a p a c i t y t o d i s t i n g u i s h t h e ' r e a l ' o r p r i m a r y V i c t o r f r o m his d o u b l e , w h i c h is, in t h e logic o f Glamorama,
i m p o s s i b l e (see also H e l y e r , 2 0 0 9 , p . 2 9 5 ) . Just as b o t h o r e v e n
all V i c t o r s a r e e q u a l l y ( u n ) r e a l , so t h e t w o ' e n d i n g s ' a r e e q u a l l y ( i m ) p l a u s i b l e a n d neither offers any solution to the mystery of this experience. T h e last, s h o r t c h a p t e r of Glamorama
is t h e n o v e l ' s a e s t h e t i c h i g h p o i n t a n d
its m o s t u n a m b i g u o u s p r e s e n t a t i o n o f t h e s u b l i m e . Self a n d i m a g e m e r g e in t h e final d i s s o l u t i o n o f subjectivity: I'm drinking a glass of water in the empty hotel bar at the Principe di Savoia and staring at the mural behind the bar and in the mural there is a giant mountain, a vast field spread out below it where villagers are celebrating in a field of long grass that blankets the mountain dotted with tall white flowers, and in the sky above the mountain it's morning and the sun is spreading itself across the mural's frame, burning over the small cliffs and the low-hanging clouds that encircle the mountain's peak, and a bridge strung across a pass through the mountain will take you to any point beyond that you need to arrive at, because behind that mountain is a highway and along that highway are billboards with answers on them—who, what, where, when, why—and I'm falling forward but also moving up toward the mountain, my shadow looming against its jagged peaks, and I'm surging forward, ascending, sailing through dark clouds, rising up, a fiery wind propelling me, and soon it's night and the stars hang in the sky above the mountain, revolving as they burn. The stars are real. The future is that mountain. (481 ) 14
14
The final sentence refers back to an earlier conversation between Victor and his father: 'I'm staking out new territory, Dad.' 'Which is?' I stare straight ahead. 'The future.' (77) It also uncannily recalls a schizophrenic patient's description of the alternation of space and time: 'The past is the precipice. The future is the mountain' (quoted in Sass, 1992, p. 160).
These t h r e e sentences reverberate with a m b i g u i t y . First the m u r a l of a p a s t o ral s c e n e — s i g n i f i c a n t l y , a far cry f r o m t h e p o s t m o d e r n digital m e d i a s c a p e — e x t e n d s b e y o n d its f r a m e , a n d t h e n V i c t o r b e c o m e s a b s o r b e d i n t o t h e space a n d t i m e of t h e image. It is a p o s t h u m a n i s t b u t n e o r o m a n t i c scene: a s u r r e n d e r of the last vestiges of subjectivity i n t o t h e r e a l m of t h e sublime. Victor's 'schizo p h r e n i c ' self-dissolution reads as t h o u g h he is r e l i n q u i s h i n g the struggle over h i s i m a g e existence. H e t r a n s c e n d s t h e l a n d s c a p e of a d v e r t i s i n g ( ' b i l l b o a r d s with answers o n t h e m ' ) i n t o o n e u n c o n t a m i n a t e d b y t h e c o m m o d i f i e d clutter a n d violence of p o s t m o d e r n i t y . Here, are we n o l o n g e r o n t h e celebrity m o d e l l i n g c i r c u i t b u t b a c k in t h e t e r r i t o r y o f K r a e p e l i n ' s ' m e n t a l s h i p w r e c k s ' ( K r a e p e l i n , 1981, p. 275) left as r e a d e r s w i t h Jaspers's sense o f ' a gulf w h i c h defies d e s c r i p t i o n ' (Jaspers, 1972, p. 447)? In C h a p t e r 2 I a r g u e d t h a t Schreber can be said to have s u f f e r e d at the t h r e s h old of the s u b l i m e : f o r e v e r forced t o reassert his p o w e r s of reason t o an invasive a n d p e r s e c u t o r y G o d . Glamorama'
s final s c e n e c a n b e r e a d as V i c t o r ' s
r e s p o n s e t o t h e s a m e p r e d i c a m e n t : o n l y h e r e h e gives u p t h e struggle a n d is completely s u b s u m e d by the sublime e n c o u n t e r , t r a n s c e n d i n g ego a n d Oedipus, language and e m b o d i m e n t , time, and consciousness.
Glamorama
p u t s a p o s t m o d e r n spin o n psychiatry's s u b l i m e object b y suggesting t h a t t h e delusions a n d self-dissolution o f ' p o s t m o d e r n s c h i z o p h r e n i a ' are n o t psychic secrets awaiting d e c r y p t i o n , b u t revelations of a self evacuated of psychic d e p t h . If Memoirs
is a m o d e r n text about
a modern schizophrenia,
Glamorama's
' u n d e c i d a b i l i t y ' a n d h e r m e n e u t i c inaccessibility m a r k it as a p o s t m o d e r n text t h a t r e p r o d u c e s a ' p o s t m o d e r n s c h i z o p h r e n i a ' at t h e level of its textual logic. H e r e , in the a r e n a of c o n t e m p o r a r y literature, in a text t h a t m a k e s n o explicit reference to clinical theory, t h e s c h i z o p h r e n i c s u b l i m e a p p e a r s with s u r p r i s i n g force w h e r e we m i g h t least expect t o find it.
Conclusion
T e n y e a r s o r so a f t e r t h e p u b l i c a t i o n o f Glamorama,
the American professor
of c o m m u n i c a t i o n studies J o h n D u r h a m Peters has declared an e n d to o u r intellectual fascination with schizophrenia: Madness, especially schizophrenia, was once at the center of the intellectual agenda. A wide range of mid-20th-century thinkers . . . followed Sigmund Freud and Karl Jaspers in seeing psychopathology as the key to understanding modernity—and communication. The antipsychiatry movement of the 1960s and the general replacement of the talking cure with psychopharmacological treatment in the past couple of decades have shifted intellectual fascination largely away from schizophrenia. So perhaps have changing practices of communication. (Peters, 2010, p. 137) F o r P e t e r s (2010, p. 138), t h e s y m p t o m s o f s c h i z o p h r e n i a w e r e a ' f i t ' w i t h t h e t e c h n o l o g i e s a n d m o d e s o f a d d r e s s , t h e ' n o n v e r b a l c o d e s a n d s i m u l a t e d sociability' of r a d i o a n d television. C o m m u n i c a t i o n t h r o u g h o u t the t w e n t i e t h c e n t u r y d e p e n d e d f o r its intelligibility o n t h e d i s t i n c t i o n b e t w e e n t w o f o r m s of a d d r e s s — t h e i m p e r s o n a l d i s c o u r s e of b r o a d c a s t i n g a n d t h e p e r s o n a l d i s c o u r s e of t e l e p h o n y ; t h e p u b l i c s p e e c h of a p l u r a l i z e d self w i t h t h e p r i v a t e s p e e c h of a u n i t a r y self (Peters, 2 0 1 0 , p . 1 3 1 ) — a n d in s c h i z o p h r e n i a t h e s e d i s t i n c t i o n s are c o l l a p s e d . T h e ' t w i l i g h t o f b r o a d c a s t i n g ' , t h e n , also signals a n e n d t o s c h i z o p h r e n i a ' s i n t e l l e c t u a l allure, n o t b e c a u s e its s y m p t o m s h a v e n o t h i n g in c o m m o n with new and emerging c o m m u n i c a t i o n technologies, but rather because w h a t w a s o n c e c o n s i d e r e d p a t h o l o g i c a l is n o w a n u n r e m a r k a b l e f e a t u r e of t h e everyday: The divide between interpersonal and mediated communication is blurring. No longer is speaking into the air considered appropriate for broadcasting but tragic (or comic) for interpersonal relationships. People now 'broadcast themselves' on YouTube and accumulate 'friends' in social networking sites. They walk around in public, talking animatedly to an invisible partner and nobody thinks they are crazy. Anyone with a music player can simulate the radiohead experience of having voices and sounds emanating from the center of their skull. The new regime seems messier and more pragmatic; less delusional but more socially stunted. Who needs telepathy when you have texting? Or thought broadcasting when you have Twitter? [ . . . ] What was once mad or uncanny is now routine: hearing disembodied voices and speaking to nobody in particular . . . (Peters, 2010, p. 138)
Peters's a r g u m e n t h e r e resonates w i t h a claim we have already e x a m i n e d in s o m e detail, n a m e l y , t h a t ' s c h i z o p h r e n i a ' c a n s p e a k of a n d t o t h e e v e r y d a y experiences of p o s t m o d e r n i t y . But w h a t if o u r s is n o l o n g e r a p o s t m o d e r n era? D i d A m e r i c a ' s r e s p o n s e to the attacks of 11 S e p t e m b e r 2001 m a r k ' t h e c o m p l e t e t r i u m p h of p o s t m o d e r n i s m ' ( M i c h a e l s , 2 0 0 3 , p . 113), o r d i d t h e e v e n t a n d its a f t e r m a t h m a k e t h e p o s t m o d e r n impossible? Will global recession finish off w h a t e v e r vestiges of t h e p o s t m o d e r n r e m a i n e d in the first years of t h e t w e n t y - f i r s t century? These q u e s t i o n s are t o o b r o a d t o engage w i t h fully in t h e final m o m e n t s of a b o o k , b u t t h a t d o e s n o t m a k e t h e m u n i m p o r t a n t . M o d e l s of p o s t m o d e r n ' c u l t u r a l s c h i z o p h r e n i a ' still e n j o y a certain critical c u r r e n c y (see f o r e x a m p l e G o h , 2008), b u t will it be t h e case t h a t changes in t h e s t r u c t u r e s of c o m m u n i c a t i o n e x t i n g u i s h o u r 'intellectual f a s c i n a t i o n ' w i t h s c h i z o p h r e n i a , as Peters suggests? A n d m i g h t this p e r h a p s be m i r r o r e d b y an a t t e n d a n t decline in 'clinical fascination' w i t h t h e c o n c e p t of s c h i z o p h r e n i a , at least a m o n g s t those w h o believe t h a t t h e label itself is n o t h e l p f u l t o the analysis o r t r e a t m e n t of severe m e n t a l distress? It is, p e r h a p s , t o o s o o n t o tell. W i t h o u t a t t e m p t i n g t o predict the f u t u r e t r a j e c t o r y of o u r fascination, w h a t I have s o u g h t t o d o in this b o o k is t o s h o w h o w s c h i z o p h r e n i a has enthralled a n d e l u d e d t h e o r i s t s t h r o u g h o u t the t w e n t i e t h c e n t u r y . I h a v e n a v i g a t e d t h e wide, varied, a n d c o n f l i c t - r i d d e n t e r r a i n s of clinical a n d cultural t h e o r y using the c o n c e p t of t h e s c h i z o p h r e n i c s u b l i m e t o i n t e r p r e t t h e c o n n e c t i o n s b e t w e e n heterogeneous discourses and to identify the p o i n t s of divergence between theoretical positions. T h e s u b l i m e places its e m p h a s i s o n the ( i n c o m p r e h e n sibility of s c h i z o p h r e n i a — i t s s t a t u s as u n / k n o w a b l e , u n / i n t e r p r e t a b l e , u n / i n t e l l i g i b l e — a n d o n t h e role it plays in s u s t a i n i n g a p a r t i c u l a r d i s c i p l i n a r y field. So, as psychiatry's s u b l i m e object, a d i s o r d e r w h o s e cardinal f e a t u r e is its o p a c i t y , s c h i z o p h r e n i a h a s b e e n t h e k e y site o f d i s c i p l i n a r y e x p a n s i o n . Psychoanalysis t r a n s f o r m e d this u n k n o w a b l e o b j e c t i n t o an u n t r e a t a b l e text o p e n t o e n d l e s s r e i n t e r p r e t a t i o n . C u l t u r a l t h e o r y ' s a p p r o p r i a t i o n of schizop h r e n i a b e g a n as an i n t e r v e n t i o n in clinical t h e o r y a n d practice, a n d b e c a m e a r a d i c a l r e a p p r a i s a l o f s c h i z o p h r e n i a ' s r o l e in e x p l a i n i n g n o n - p a t h o l o g i c a l m o d e s of e n l i g h t e n e d , deterritorialized, m o d e r n , a n d p o s t m o d e r n subjectivity. T r a c i n g an arc f r o m m o d e r n p s y c h i a t r y t o p o s t m o d e r n c u l t u r a l t h e o r y , w e have m o v e d f r o m a clinical discourse, w h i c h u n a m b i g u o u s l y c o n s t r u c t s schizo p h r e n i a as its s u b l i m e object, t o a cultural discourse w h i c h r e n d e r s d i f f u s e o r p a r a d o x i c a l t h e s c h i z o p h r e n i c s u b l i m e . Psychoanalytic, a n t i p s y c h i a t r i c , a n d a n t i - O e d i p a l a c c o u n t s of s c h i z o p h r e n i a can be situated at v a r i o u s p o i n t s along this progression, a n d , .is we have seen, Louis Sass's w o r k offers a vantage p o i n t o u t s i d e t h e s u b l i m e f r o m w h i c h t o e x a m i n e in m o r e d e t a i l t h e idea, fully
realized in Ellis's n o v e l , t h a t s c h i z o p h r e n i a can i l l u m i n a t e t h e e x p e r i e n c e of postmodernity. O f course, this is b y n o m e a n s the only story t o be told a b o u t s c h i z o p h r e n i a in t h e twentieth c e n t u r y , n o r w o u l d all t h e theorists I have discussed even see t h e m s e l v e s as p r o t a g o n i s t s in t h e s a m e n a r r a t i v e . T h e texts a n a l y s e d h e r e — psychiatric textbooks, psychoanalytic seminars, antipsychiatric tracts, a n d theoretical w o r k s — a r e key sites in t h e discursive c o n s t r u c t i o n of s c h i z o p h r e nia, a n d in i d e n t i f y i n g t h e o p e r a t i o n of t h e s c h i z o p h r e n i c s u b l i m e in clinical a n d cultural theory, I have n o t a t t e m p t e d t o a c c o u n t for its a p p e a r a n c e b e y o n d t h e textual sphere. E m b o d i e d , i n t e r p e r s o n a l e n c o u n t e r s b e t w e e n i n d i v i d u a l s — t o take just o n e e x a m p l e — c l e a r l y have an e n o r m o u s l y i m p o r t a n t role t o play in the d e f i n i t i o n a n d m a n a g e m e n t of s c h i z o p h r e n i a , w h e t h e r in the contexts of psychiatric a n d p s y c h o a n a l y t i c t h e r a p y , m e n t a l health services, a d v o c a c y a n d s u p p o r t g r o u p s , o r s i m p l y in d a y - t o - d a y life. T h e q u e s t i o n of w h e t h e r t h e c o n cept of a s c h i z o p h r e n i c s u b l i m e w o u l d be of any value in u n d e r s t a n d i n g instit u t i o n a l a n d i n t e r p e r s o n a l e x c h a n g e s is t h e r e f o r e still a n o p e n o n e , b u t I certainly d o n o t wish t o a d v a n c e a n y a p r i o r i claims t o this effect. R e m a i n i n g resolutely in t h e textual sphere, m y i n t e n t has b e e n t o offer a historical analysis of s c h i z o p h r e n i a ' s r e p r e s e n t a t i o n t h a t it is h o p e d will e n r i c h o u r u n d e r s t a n d ing of h o w such striking experience could c o m e to be associated with n o t o n e b u t u p t o 100% of the p o p u l a t i o n . I w a n t t o c o n c l u d e , t h e n , b y i d e n t i f y i n g t w o f u r t h e r areas o f i n q u i r y suggested b y this a n a l y s i s — t w o b r o a d discursive fields in w h i c h t h e idea o f t h e s c h i z o p h r e n i c s u b l i m e m i g h t be constructively p u t t o w o r k . First, as of My Nervous
Memoirs
Illness has s h o w n , a u t o b i o g r a p h i e s a n d b i o g r a p h i e s have o c c u -
p i e d a privileged p o s i t i o n in theoretical analyses of s c h i z o p h r e n i a , a n d are an o b v i o u s starting p o i n t f o r c o n s i d e r i n g if, a n d if so h o w , t h e s u b l i m e is called u p o n t o describe s c h i z o p h r e n i c experience b y t h o s e it has affected m o s t intim a t e l y . P e r h a p s s u r p r i s i n g l y , given t h e p r e v a l e n c e of t h e d i s o r d e r , a n d t h e w e a l t h of m o r e g e n e r a l ' m a d n e s s ' m e m o i r s , i n - d e p t h a u t o b i o g r a p h i c a l a c c o u n t s of s c h i z o p h r e n i a are relatively few a n d far b e t w e e n . Elaine Showalter ( S h o w a l t e r , 1987, p. 204) has i d e n t i f i e d t h e t h r e e ' b e s t - k n o w n s t u d i e s of t h e i n n e r life of the s c h i z o p h r e n i c ' as Renee's Autobiography (1970), G r e e n b e r g ' s I Never Promised
of a Schizophrenic
Girl
You a Rose Garden (1964) a n d B a r b a r a
O ' B r i e n ' s Operators and Things: The Inner Life of a Schizophrenic
(1960)—texts
t h a t certainly r e w a r d d e t a i l e d e x a m i n a t i o n ( W o o d s , 2 0 0 7 ) . A n n e D e v e s o n ' s Tell Me I'm Here (1991), Lori Schiller's The Quiet Room: A Journey Out of the Torment
of Madness
Not Cured:
(Schiller a n d Bennett, 1994), Richard M c L e a n ' s Recovered
A Journey
Through
C a o u e t t e ' s f i l m Tarnation
Schizophrenia
(McLean, 2003), Jonathan
( 2 0 0 3 ) , K u r t S n y d e r ' s Me, Myself
and
Them
( S n y d e r et al., 2 0 0 7 ) , Elyn Saks's The Centre Cannot Fearne's Diary of a Schizophrenic
Hold ( 2 0 0 7 ) , a n d Paul
(2010) are a m o n g t h e m o s t interesting recent
p u b l i c a t i o n s . Against t h e b a c k g r o u n d of t h e rising interest in narrative m e d i cine ( C h a r o n , 2008), p h e n o m e n o l o g i c a l psychiatry, a n d qualitative studies of the subjective experience of m e n t a l distress ( D a v i d s o n , 2003; Geekie a n d Read, 2009; Lysaker a n d Lysaker, 2008;), l o o k i n g b e y o n d b o o k - l e n g t h a u t o b i o g r a phies t o o t h e r f o r m s of b i o g r a p h i c a l writing, such as Schizophrenia
Bulletin's
'First P e r s o n A c c o u n t s ' is, in m y view, an even m o r e p r e s s i n g task ( E s t r o f f , 2004; Geanellos, 2005; H a y n e a n d Yonge, 1997). N o c o m p r e h e n s i v e analysis of t h e r e l a t i o n s h i p b e t w e e n a u t o b i o g r a p h i c a l a n d b i o g r a p h i c a l a c c o u n t s of s c h i z o p h r e n i a a n d clinical a n d c u l t u r a l m o d e l s of t h e d i s o r d e r has yet b e e n u n d e r t a k e n , b u t a n e x a m i n a t i o n of t h e e x t e n t t o w h i c h t h e s e w o r k s engage, incorporate, or disavow the association between schizophrenia and the s u b l i m e could certainly b r i n g m e t a t h e o r e t i c a l f o c u s t o such a project. T h e s e c o n d t e x t u a l a r e n a t o w h i c h I w o u l d like t o d r a w a t t e n t i o n c o m e s m o r e w i t h i n t h e p u r v i e w of c u l t u r a l studies, sociology, history, a n d m e d i c a l a n t h r o p o l o g y . H o w have clinical a c c o u n t s of s c h i z o p h r e n i a b e e n t a k e n u p in the discourse of p a t i e n t s u p p o r t g r o u p s , in m e n t a l health policy, in t h e p r o m o t i o n of p s y c h o p h a r m a c e u t i c a l s , a n d in m e d i a d e p i c t i o n s of psychotic experience? Is t h e s u b l i m e h e r e in o p e r a t i o n , o r d o r e p r e s e n t a t i o n s of s c h i z o p h r e n i a in these contexts a d h e r e t o a d i f f e r e n t logic? W h a t are t h e key areas of contestat i o n , a n d h o w have these in t u r n i n f l u e n c e d b i o g r a p h i c a l a n d even theoretical a c c o u n t s of s c h i z o p h r e n i c experience? T h e capacity of o f t e n very partisan a n d passionate a c c o u n t s of s c h i z o p h r e n i a t o i m p a c t strongly u p o n public percept i o n s was m o s t clearly d e m o n s t r a t e d d u r i n g t h e a n t i p s y c h i a t r y m o v e m e n t of t h e 1960s a n d 1970s, b u t challenges t o biological psychiatry f r o m w i t h i n a n d b e y o n d t h e p r o f e s s i o n (Bracken, 2003; Crossley, 2006; J o h n s t o n e , 2000; Lewis, 2000; L a u g h a r n e , April 2002, 2004;), as well as p o w e r f u l studies of the role of culture in the experience of s c h i z o p h r e n i a (Jenkins a n d Barrett, 2004b) invite a reassessment of t h e relationship b e t w e e n clinical a n d non-clinical discourses of s c h i z o p h r e n i a f o r c o n t e m p o r a r y times. T o w h a t e x t e n t , t h e n , d o g e n e r i c a l l y a n d c u l t u r a l l y specific p o r t r a y a l s o f s c h i z o p h r e n i a r e p r o d u c e , extend, or challenge t h e clinical picture of the disorder? D o they articulate s c h i z o p h r e n i a t h r o u g h t h e v o c a b u l a r y of t h e s u b l i m e , a n d if so, how? A n d can they in t u r n reveal shifts in the h i s t o r y of r e p r e s e n t i n g p o s t / m o d e r n s u b j e c t i v i t y m o r e generally? T h e s e are t h e q u e s t i o n s I suggest c o u l d i n f o r m the analysis of r e p r e s e n t a t i o n s of s c h i z o p h r e n i a in t h e two disc u r s i v e c o n t e x t s just o u t l i n e d . T h e value, as I see it, of t h e k i n d o f analysis I h a v e u n d e r t a k e n t h r o u g h o u t this b o o k lies in f o c u s i n g a t t e n t i o n o n t h e r e l a t i o n s h i p s b e t w e e n t o n i p r l i n g m o d e l s of the d i s o r d e r while leaving o p e n
t h e q u e s t i o n of w h i c h h a s t h e s t r o n g e s t claim o n t h e t r u t h of s c h i z o p h r e n i c experience. As we h a v e seen, cultural theorists have b e e n c o m p e l l e d , w h e t h e r d i r e c t l y o r i n d i r e c t l y , t o n e g o t i a t e s c h i z o p h r e n i a ' s s t a t u s as s u b l i m e w i t h i n psychiatric a n d psychoanalytic discourse, t o stake a claim if n o t at the level of clinical t h e o r y t h e n certainly at the level of psychological m e t a t h e o r y . So let m e finish w i t h a q u e s t i o n : If t h e c a t e g o r y of t h e s u b l i m e p r o v i d e s a c o n s t r u c t i v e f r a m e w o r k t h r o u g h w h i c h t o analyse t h e c o n n e c t i o n s b e t w e e n clinical a n d cult u r a l theory, can it in t u r n illuminate the w a y in w h i c h o t h e r thinkers—artists, literary critics, b u r e a u c r a t s , journalists, advertisers, a n d p a t i e n t s t h e m s e l v e s — use clinical a c c o u n t s of schizophrenia?
References
Abbott, A. (2010). Schizophrenia: The drug deadlock. Nature, 468: 158-9. Abi-Rached, J. 8c Rose, N. (2010). The birth of the neuromolecular gaze. History of the Human Sciences, 23: 11-36. Abraham, K. (1972). The psycho-sexual differences between hysteria and dementia praecox. The Selected Papers of Karl Abraham.
London: Maresfield Library.
Aldhous, P. (2009). Psychiatry's civil war. New Scientist [Online]. Available: http://www. newscientist.com/article/mg20427381.300-psychiatrys-civil-war.html [Accessed 20 February 2010]. Aldhous, P. (2010). Psychiatry's draft new 'bible' goes online. New Scientist [Online]. Available: http://www.newscientist.com/article/dnl8508-psychiatrys-draft-new-biblegoes-online.html?full=true [Accessed 20 February 2010]. American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders. Washington: American Psychiatric Association. Andreasen, N. (2004). Brave New Brain: Conquering Mental Illness in the Era of the Genome. Oxford: Oxford University Press. Andrejevic, M. (2002). The kinder, gender gaze of big brother: Reality TV in the era of digital capitalism. New Media and Society, 4: 251-70. Angermeyera, M. C., Holzingerb, A., & Matschingerc, H. (2009). Mental health literacy and attitude towards people with mental illness: A trend analysis based o n population surveys in the eastern part of Germany. European Psychiatry, 24: 225-32. Annesley, J. (1998). Blank Fictions: Consumerism,
Culture and the Contemporary
American
Novel. London: Pluto Press. Appignanesi, L. (2008). Mad, Bad and Sad: A History of Women and the Mind Doctors from 1800 to the Present. London: Virago. Artaud, A. (1976). The Selected Writings of Antonin Artaud. New York: Farrar, Straus and Giroux. Ayers, S. (2000). Glamorama vanitas: Bret Easton Ellis' p o s t m o d e r n allegory. Postmodern Culture,
11.
Bailey, J. (2006). Postmodernism and the disappearance of the real (lecture). Postmodernism.
Parkville: University of Melbourne.
Baker, C., Crawford, P., Brown, B. J., Lipsedge, M., 8c Carter, R. (2010). Madness in Post-1945 British and American Fiction. London: Palgrave Macmillan. Barham, P. (1993). Schizophrenia
and Human
Value: Chronic Schizophrenia,
Science and
Society. London: Free Association Books. Barrett, R. J. (1996). The Psychiatric Team and the Social Definition of Cambridge: < .unbridle University Press.
Schizophrenia.
Barrett, R. J. (1998a). Conceptual foundations of schizophrenia: I. Degeneration. Australian and New Zealand Journal of Psychiatry, 32: 617-26. Barrett, R. J. (1998b). Conceptual foundations of schizophrenia: II. Disintegration and division. Australian and New Zealand Journal of Psychiatry, 32: 627-34. Barrett, R. J. (1998c). The 'schizophrenic' and the liminal persona in modern society. Culture, Medicine and Psychiatry, 22:465-94. Barthes, R. (1977). The death of the author. Image, Music, Text. London: Fontana. Baudrillard, J. (1983). The ecstasy of communication. In: Foster, H. (ed.) The Anti-Aesthetic: Essays on Postmodern Culture. New York: The New Press. Baudrillard, J. (1988). The Ecstasy of Communication. University.
New York: Semiotext(e), Columbia
Baudrillard, J. (1993). The Transparency of Evil: Essays on Extreme Phenomena. London: Verso. Baudrillard, J. (2002). The Spirit of Terrorism and Requiem for the Twin Towers. London: Verso. Bauman, Z. (1991). Modernity and Ambivalence. Cambridge: Polity. Bauman, Z. (1993). Intimations of Postmodernity. London: Routledge. Bauman, Z. (1996). Postmodernity and Its Discontents. Cambridge: Polity. Bauman, Z. (2000). Liquid Modernity. Cambridge: Polity. Bauman, Z. (2001). Identity in the globalising world. Social Anthropology, 9: 121-9. Bauman, Z. (2005). Work, Consumerism and the New Poor. Maidenhead: Open University Press. Bauman, Z. (2006). Liquid Life. Cambridge: Polity. Bauman, Z. 8c Tester, K. (2001). Conversations with Zygmunt Bauman. Cambridge: Polity Press. Bebbington, P. 8c McGuffin, P. (eds.) (1988). Schizophrenia: The Major Issues. Oxford: Heinemann Medical Books. Beckett, A. (1999). Leader of the Bret pack. The Guardian, Saturday January 9. Beer, G. (1996). Forging the missing link: Interdisciplinary stories. Open fields: Science in cultural encounter. Oxford: Clarendon Press. Bentall, R. P. (ed.) (1990). Reconstructing Schizophrenia. London: Routledge. Bentall, R. P. (2004). Madness Explained: Psychosis and Human Nature. London: Penguin. Bentall, R. P. (2009). Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good? New York: New York University Press. Bentall, R. P., Jackson, H. F., 8c Pilgrim, D. (1988a). Abandoning the concept of 'schizophrenia': Some implications of validity arguments for psychological research into psychotic phenomena. British Journal of Clinical Psychology, 27: 303-24. Bentall, R. P., Jackson, H. F., 8c Pilgrim, D. (1988b). The concept of schizophrenia is dead: Long live the concept of schizophrenia? British Journal of Clinical Psychology, 27: 329-31. Berman, J. (1985). The Talking Cure: Literary Representations of Psychoanalysis. New York: New York University Press. Berrios, G. E. 8c Hauser, R. (1995). Kraepelin: Clinical section, part 2. In: Berrios, G. E. 8c Porter, R. (eds.) A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders. London: Athlone.
Berrios, G. E., Luque, R., 8c Villagran, J. M. (2003). Schizophrenia: A conceptual history. International Journal of Psychology and Psychological Therapy, 3:111-40. Blackshaw, T. (2005). Zygmunt Bauman. London and New York: Routledge. Bleakley, A. 8c Bligh, J. (2009). Who can resist Foucault? Journal of Medicine and Philosophy, 34: 368-83. Bleuler, E. (1950). Dementia Praecox or the Group of Schizophrenias. New York: International Universities Press. Blount, J. (1999). Glam Slam [Online]. Available: http://www.flagpole.com/Issues/02.17.99/ lit.html [Accessed 23 February 2003]. Blume, H. (1999). Portrait of the artist as a social satirist [Online]. Atlantic Unbound. Available: http://www.theatlantic.com/unbound/bookauth/ba990210.htm [Accessed 24 February 2003]. Bogue, R. (1989). Deleuze and Guattari. London: Routledge. Bolton, D. (2008). What is Mental Disorder? An Essay in Philosophy, Science, and Values. Oxford: Oxford University Press. Bortle, S. (Spring 2001). R. D. Laing as negative thinker. Janus Head, 4. Boyers, R. 8c Orrill, R. (eds.) (1972). Laing and Anti-psychiatry. Boyle, M. (1990). Schizophrenia—A
London: Penguin.
Scientific Delusion? London: Routledge.
Bracken, P. J. (2003). Postmodernism and psychiatry. Current Opinion in Psychiatry, 16: 673-7. Bracken, P. 8c Thomas, P. (2005). Postpsychiatry: Mental Health in a Postmodern World. Oxford: Oxford University Press. Bracken, P. 8c Thomas, P. (2010a). From Szasz to Foucault: On the role of critical psychiatry. Philosophy, Psychiatry, & Psychology, 17: 219-28. Bracken, P. 8c Thomas, P. (2010b). Is private (contract-based) practice an answer to the problems of psychiatry? Philosophy, Psychiatry, & Psychology, 17: 241-5. Bracken, P., Khalfa, J., 8c Thomas, P. (2007). Recent translations of Foucault on mental health. Current Opinion in Psychiatry, 20: 605-8. Braidotti, R. (2005). Schizophrenia. In: Parr, A. (ed.) The Deleuze Dictionary. Edinburgh: Edinburgh University Press. Braun, J. (1995). Schizophrenia: A transcultural view. In: Braun, J. (ed.) Social Pathology in Comparative Perspective: The Nature and Psychology of Civil Society. Westport, Connecticut: Praeger. Breggin, P. R. (1991). Toxic Psychiatry: Why Therapy, Empathy, and Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the 'New Psychiatry\ New York: St Martins Press. Broome, M. R. (2007). Taxonomy and ontology in psychiatry: A survey of recent literature. Philosophy, Psychiatry, and Psychology, 13: 303-19. Buchanan, I. (2008). Deleuze and Guattari's Anti-Oedipus: A Reader's Guide. London: Continuum. Buchanan, R. W., Kreyenbuhl, J., Kelly, D. L., Noel, J. M., Boggs, D. L., Fischer, B. A., Himelhoch, S., Fang, B., Peterson, E., Aquino, P. R., 8c Keller, W. (2010). The 2009 schizophrenia port psychopharmacological treatment recommendations and summary statements. Schizophrenia Bulletin, 36: 71-93.
Burke, E. (1987). A Philosophical Enquiry into the Origin of Our Ideas of the Sublime and Beautiful. Oxford: Basil Blackwell. Burston, D. (1996). The Wing of Madness: The Life and Work of R. D. Laing. Cambridge, MA: Harvard University Press. Burston, D. (Spring 2001a). R. D. Laing and the politics of diagnosis. Janus Head, 4. Burston, D. (Spring 2001b). Special issue: The legacy of R. D. Laing (editorial). Janus Head, 4. Busfield, J. (1996). Men, Women and Madness: Understanding Gender and Mental Disorder. London: Macmillan. Butler, J. (1993). Bodies that Matter: On the Discursive Limits of Sex. London and New York: Routledge. Canetti, E. (1962). Crowds and Power. London: Victor Gollancz. Caouette, J. (dir.) (2003). Tarnation. USA: Wellspring. Carpenter, W. T. (2009). Anticipating DSM-V: Should psychosis risk become a diagnostic class? Schizophrenia Bulletin, 35: 841-3. Castle, D. J. (2000). Women and schizophrenia: An epidemiological perspective. In: Castle, D. J., McGrath, J., & Kulkarni, J. (eds.) Women and Schizophrenia. Cambridge: Cambridge University Press. Charon, R. (2008). Narrative Medicine: Honoring the Stories of Illness. New York: Oxford University Press. Cheetham, M. A. (1995). Moments of discipline: Derrida, Kant, and the genealogy of the sublime. In: Rajan, T. & Clark, D. L. (eds.) Intersections: Nineteenth-Century Philosophy and Contemporary Theory. Albany: State University of New York Press. Chesler, P. (1972). Women and Madness. New York: Allen Lane. Chung, M. C„ Fulford, K. W. M. B„ Graham, G. (eds.) (2007). Reconceiving Schizophrenia. Oxford: Oxford University Press. Colebrook, C. (2002). Understanding Deleuze. Crows Nest, NSW: Allen and Unwin. Colebrook, C. (2006). Deleuze: A Guide for the Perplexed. London and New York: Continuum. Conley, J. (2009). The poverty of Bret Easton Ellis. Arizona Quarterly, 65: 117-37. Cooper, D. (1970). Psychiatry and Anti-psychiatry.
St Albans: Paladin.
Cooper, R. (2004). What is wrong with the DSM? History of Psychiatry, 15: 5-25. Cooper, R. (2005). Classifying Madness: A Philosophical Examination of the Diagnostic and Statistical Manual of Mental Disorders. Dordrecht: Springer. Cooper, R. (2007). Psychiatry and Philosophy of Science. Durham: Acumen. COPE Initiative. (2010). Campaign for the Abolition of the Schizophrenia Label [Online]. University of Manchester. Available: http://www.caslcampaign.com/ [Accessed 23 October 2009], Craddock, N. (2010). Robust empirical data and clinical utility: The only drivers of change, commentary on . . . the classification of mental disorder. Advances in Psychiatric Treatment, 16: 20-2. Craddock, N. & Owen, M. J. (2005). The beginning of the end for the Kraepelinian dichotomy. British Journal of Psychiatry, 186: 364-66. Craddock, N. 8< Owen, M. J. (2007). Rethinking psychosis: The disadvantages of a dichotomous classification now outweigh the advantages. World Psychiatry, 6: 84-91.
Craddock, N. & Owen, M. J. (2010a). Data and clinical utility should be the drivers of changes to psychiatric classification. British Journal of Psychiatry, 197: 158-9. Craddock, N. & Owen, M. J. (2010b). The kraepelinian dichotomy—going, going . . . But still not gone. British Journal of Psychiatry, 196: 92-5. Craddock, N., O'Donovan, M. C., & Owen, M. J. (2009). Psychosis genetics: Modeling the relationship between schizophrenia, bipolar disorder, and mixed (or 'Schizoaffective') psychoses. Schizophrenia Bulletin, 35:482-90. Craig, T. K. J. (2008). Recovery: Say what you mean and mean what you say. Journal of Mental Health, 17: 125-8. Crapanzano, V. (1998). 'Lacking now is only the leading idea, that is—we, the rays, have no thoughts': Interlocutory collapse in Daniel Paul Schreber's Memoirs of My Nervous Illness. Critical Inquiry, 24: 737-68. Cresswell, M. (2008). Szasz and his interlocutors: Reconsidering Thomas Szasz's 'myth of mental illness' thesis. Journal for the Theory of Social Behaviour, 38: 23^14. Crichton, P. (2000). 'A profound duplicity of life': Uses and misuses of'schizophrenia' in popular culture and professional diagnosis. Times Literary Supplement, March 31. Crossley, N. (1998). Transforming the mental health field: The early history of the national association for mental health. Sociology of Health and Illness, 20:458-88. Crossley, N. (1999). Fish, field, habitus and madness: The first wave mental health users movement in Great Britain. British Journal of Sociology, 50: 647-70. Crossley, N. (2002). Repertoires of contention and tactical diversity in the UK psychiatric survivors movement: The question of appropriation. Social Movement Studies, 1:47-71. Crossley, N. (2004). Not being mentally ill: Social movements, system survivors and the oppositional habitus. Anthropology & Medicine, 11: 161-80. Crossley, N. (2005). How social movements move: From first to second wave developments in the UK field of psychiatric contention. Social Movement
Studies,
4:21^8. Crossley, N. (2006). Contesting Psychiatry: Social Movements in Mental Health. Oxford and New York: Routledge. Crossley, N. 8c Crossley, M. (2001). 'Patient' voices, social movements and the habitus: how psychiatric survivors 'speak out'. Social Science and Medicine, 52: 1477-89. Crow, T. J. (1985). The two syndrome concept: Origins and current status. Schizophrenia Bulletin, 11:471-88. Crow, T. J. (1995). A continuum of psychosis, one human gene, and not much else—the case for homogeneity. Schizophrenia Research, 17:135^15. Crow, T. J. (2008). The emperors of the schizophrenia polygene have no clothes. Psychological Medicine, 38: 1681-5. Currie, M. (1998). Postmodern Narrative Theory. London: Macmillan. Cuthbert, B. N. 8c Insel, T. R. (2010). Toward new approaches to psychotic disorders: The NIMH research domain criteria project. Schizophrenia Bulletin, 36: 1061-2. Cutting, G. (1994). Foucault and the history of madness. In: Cutting, G. (ed.) The Cambridge Companion to Foucaidt. Cambridge: Cambridge University Press. Davidson, L. (2003). Living Outside Mental Illness: Qualitative Studies of Recovery in Schizophrenia. New York: New York University Press. Davidson, L. (2010). PORT through a recovery lens. Schizophrenia Bulletin, 36: 107-8. de Certeau, M. (1983). Lacan: An ethics of speech. Representations, 3:21-39.
de Certeau, M. (1988). The institution of rot. In: Allison, D. B., de Oliveira, P., Roberts, M. S. & Weiss, A. S. (eds.) Psychosis and Sexual Identity: Towards a Post-Analytic View of the Schreber Case. Albany: State University of New York Press. Deleuze, G. (1990). Letter to a harsh critic. Negotiations 1972-1990. New York: Columbia University Press. Deleuze, G. (2002). Postscript on control societies. In: Levin, T. Y., Frohne, U., & Weibel, P. (eds.) Ctrl [space]: Rhetorics of Surveillance from Bentham to Big Brother. Cambridge, Massachusetts: The MIT Press. Deleuze, G. (2006). Two Regimes of Madness: Texts and Interviews 1975-1995. New York: Semiotext(e). Deleuze, G. & Guattari, F. (1982). Anti-Oedipus: Viking Press.
Capitalism and Schizophrenia. New York:
Deleuze, G. 8c Guattari, F. (1987). A Thousand Plateaus: Capitalism and Minneapolis: University of Minnesota Press.
Schizophrenia.
Deleuze, G. 8c Guattari, F. (1990). Gilles Deleuze and Félix Guattari on Anti-Oedipus (conversation with Catherine Backès-Clément, l'arc 49 (1972)). Negotiations 1972-1990. New York: Columbia University Press. Derrida, J. (1978). Cogito and the history of madness. Writing and Difference. London: Routledge & Kegan Paul. Derrida, J. (1987). The Truth in Painting. Chicago: University of Chicago Press. Derrida, J. (1998). 'To do justice to Freud': The history of madness in the age of psychoanalysis. Resistances of Psychoanalysis. Stanford: Stanford University Press. Deveson, A. (1991). Tell Me I'm Here. Melbourne: Penguin. Dixon, L. B., Dickerson, F., Bellack, A. S., Bennett, M., Dickinson, D., Goldberg, R. W., Lehman, A., Tenhula, W. N., Calmes, C., Pasillas, R. M., Peer, J., 8c Kreyenbuhl, J. (2010). The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophrenia Bulletin, 36: 48-70. Dobbs, D. (2010). The making of a troubled mind. Nature, 468: 154-7. Donnelly, M. (1992). The Politics of Mental Health in Italy. London: Routledge. Due, R. (2007). Deleuze. Cambridge: Polity Press. Dupont, J. (1988). Ferenczi's 'madness'. Contemporary Psychoanalysis, 24: 250-61. Eagleton, T. (1985). Capitalism, modernism and postmodernism. New Left Review, 152: 60-73. Eagleton, T. (1990). The Ideology of the Aesthetic. Oxford: Basil Blackwell. Editor. (2010). Combating schizophrenia. Nature, 468: 133-4. Ehrenberg, A. (2010). The Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age. Montreal: McGill-Queen's University Press. Elliott, A. (1996). Subject to Ourselves: Social Theory, Psychoanalysis and Cambridge: Polity Press.
Postmodernity.
Elliott, A. (2002). The dislocating world of postmodernism. Psychoanalytic Theory: An Introduction. 2nd ed. Oxford: Blackwell. Ellis, B. E. (1987). The Rules of Attraction. New York: Vintage Books. Ellis, B. E. (1991). American Psycho. London: Picador. Ellis, B. E. (2000). Glatnorama. London: Picador.
Engstrom, E. J. (1995). Kraepelin: Social section. In: Berrios, G. E. 8c Porter, R. (eds.) A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders. London: Athlone. Engstrom, E. J. 8c Weber, M. M. (2007). Making Kraepelin history: A great instauration? History of Psychiatry, 18: 267-73. Esquirol, J. E. D. (1965). Mental Maladies, A Treatise on Insanity. New York: Hafner. Estroff, S. E. (1989). Self, identity, and subjective experiences of schizophrenia: In search of the subject. Schizophrenia Bulletin, 15: 189-96. Estroff, S. E. (2004). Subject/subjectivities in dispute: The poetics, politics, and performance of first-person narratives of people with schizophrenia. In: Jenkins, J. H. 8c Barrett, R. J. (eds.) Schizophrenia, Culture, and Subjectivity: The Edge of Experience. Cambridge: Cambridge University Press. Ettler, J. (1999). Rebels without a cause. Australian Book Review, 213. Evans, D. (1996). An Introductory Dictionary ofLacanian
Psychoanalysis. London and
New York: Routledge. Fabrega, H. (1989). The self and schizophrenia: A cultural perspective.
Schizophrenia
Bulletin, 15: 277-90. Farmer, A. E., McGuffin, P., 8c Bebbington, P. (1988). The p h e n o m e n a of schizophrenia. In: Bebbington, P. 8c McGuffin, P. (eds.) Schizophrenia: The Major Issues. Oxford: Heinemann Medical Books. Farrell, J. (1996). Freud's Paranoid Quest: Psychoanalysis and Modern Suspicion. New York: New York University Press. Fatemi, S. H. 8c Folsom, T. D. (2009). The neurodevelopmental hypothesis of schizophrenia revisited. Schizophrenia Bulletin, 35: 528-48. Fearne, P. (2010). Diary of a schizophrenic. Brentwood, Essex: chipmunkapublishing. Fee, D. (ed.) (2000). Pathology and the Postmodern: Mental Illness as Discourse and Experience. London: Sage. Felman, S. (ed.) (1982). Literature and Psychoanalysis: The Question of Reading,
Otherwise.
Baltimore: Johns Hopkins University Press. Felman, S. (1985). Writing and Madness: Literature/Philosophy/Psychoanalysis.
Ithaca:
Cornell University Press. Ferns, P., Barker, P., Beresford, P., Scott Blackman, P., Bracken, P., Christie, Y., CrepazKeay, D., Fernando, S., Gabriel, J., Henry, W . L., Kalathil, J., Keating, F., Moore, P., Stanley, J., Summerfield, D., Timimi, S., Vernon, P., Vige, M., Clear, P., Thompson, S., Gradwell, S., Martin, C., 8c Kollie, A. (2010). Poor research or an attack on black people? Letter f r o m mental health campaigners on the alleged 'epidemic' of schizophrenia a m o n g British African Caribbean groups. The Guardian [Online]. Available: http://www.guardian.co.uk/society/2010/feb/03/mental-health-bmeschizophrenia-letter [Accessed 11 February 2010]. Fine, R. (1979). A History of Psychoanalysis. New York: Columbia University Press. Fink, B. (1997). A Clinical Introduction
to Lacanian Psychoanalysis: Theory and
Technique.
Cambridge, Massachusetts: Harvard University Press. Finlay, M. (1989). Post m o d e r n i s i n g p s y c h o a n a l y s i s / p s y c h o a n a l y s i n g p o s t - m o d e r n i t y . Free
Associations,
16:43-80.
Foster, 11 (ed.) (I'M I), the Ami Aesthetic: Essays on Postmodern Culture. Port Townsend, Washington Hay Press.
Foucault, M. (1970). The Order of Things: An Archaeology of the Human New York: Random House.
Sciences.
Foucault, M. (1976). Mental Illness and Psychology. New York: Harper 8c Row. Foucault, M. (1977). Discipline and Punish: The Birth of the Prison. London: Allen Lane. Foucault, M. (1993). Madness and Civilization: A History of Insanity in the Age of Reason. London: Routledge. Foucault, M. (1996). Madness, absence of an oeuvre. In: Lechte, J. (ed.) Writing and Psychoanalysis. London: Arnold. Foucault, M. (2008). Psychiatric Power. New York: Macmillan. Foucault, M. (2009). History of Madness. Abingdon: Routledge. Fraguas, D. & Breathnach, C. S. (2009). Problems with retrospective studies of the presence of schizophrenia. History of Psychiatry, 20: 61-71. Frances, A. (2010). Opening Pandora's box: The 19 worst suggestions for DSM-5. Psychiatric Times [Online], 27. Available: http://www.psychiatrictimes.com/display/ article/10168/1522341 [Accessed 20 February 2010]. Frank, M. (2001). The world as will and representation: Deleuze's and Guattari's critique of capitalism as schizo-analysis and schizo-discourse. In: Genosko, G. (ed.) Deleuze and Guattari: Critical Assessments of Leading Philosophers. London and New York: Routledge. Frankland, G. (2000). Freud's literary culture. New York: Cambridge University Press. Freud, S. (1963a). Lecture XXVI the libido theory and narcissism. In: Strachey, J. (ed.) The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: The Hogarth Press and the Psycho-Analytic Institute. Freud, S. (1963b). Lecture XXVII transference. In: Strachey, J. (ed.) The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: The Hogarth Press and the Institute of Psycho-Analysis. Freud, S. (1981). Psycho-analytic notes on an autobiographical account of a case of paranoia (dementia paranoides). In: Strachey, J. (ed.) The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: The Hogarth Press and the Institute of Psycho-Analysis. Freud, S. (1985a). Letter of December 6 1896. In: Masson, J. M. (ed.) The Complete Letters of Sigmund Freud to Wilhelm Fliess 1887-1904. Cambridge, Massachusetts: The Belknap Press of Harvard University Press. Freud, S. (1985b). Letter of May 30 1986. In: Masson, J. M. (ed.) The Complete Letters of Sigmund Freud to Wilhelm Fliess 1887-1904. Cambridge, Massachusetts: The Belknap Press of Harvard University Press. Freud, S. (1995). An autobiographical study (1925). In: Gay, P. (ed.) The Freud Reader. London: Vintage. Freud, S. & Jung, C. (1974). The Freud/Jung letters: The Correspondence Between Sigmund Freud and C. G. Jung. Princeton: Princeton University Press. Frith, C. 8c Johnstone, E. C. (2003). Schizophrenia: A Very Short Introduction. Oxford: Oxford University Press. Frosh, S. (1991). Identity Crisis: Modernity, Psychoanalysis and the Self. London: Macmillan. Fusar-Poli, P. 8c Politi, P. (2008). Paul Eugen Bleuler and the birth of schizophrenia (1908). American Journal of Psychiatry, 165: 1407.
Gabel, J. (1976). False Consciousness: An Essay on Reification. New York: Harper and Row. Gauntlett, D. (2002). Media, Gender and Identity: An Introduction. London and New York: Routledge. Gawith, L. & Abrams, P. (2006). Long journey to recovery for Kiwi consumers: Recent developments in mental health policy and practice in New Zealand. Australian Psychologist, 41:140-8. Geanellos, R. (2005). Adversity as opportunity: Living with schizophrenia and developing a resilient self. International Journal of Mental Health Nursing, 14: 7-15. Geddes, J., Freemantle, N., Harrison, P., & Bebbington, P. (2000). Atypical antipsychotics in the treatment of schizophrenia: Systematic overview and meta-regression analysis. British Medical Journal, 321:1371-6. Geekie, J. 8c Read, J. (2009). Making Sense of Madness: Contesting the Meaning of Schizophrenia. London and New York: Routledge. Georgaca, E. (2001). 'Poor girl': A case of active psychosis. European Journal of Psychotherapy, Counselling and Health, 4:175-88. Gergen, K. J. (1991). The saturated self: Dilemmas of identity in contemporary life. New York: Basic Books. Gilman, S. L. (1988). Constructing schizophrenia as a category of mental illness. Disease and Representation: Images of Illness from Madness to Aids. Ithaca: Cornell University Press. Gilman, S. L. (1996). Judge dread (Daniel Paul Schreber's 'century'). Artforum International, 35: 15-7. Glass, J. M. (1987). Schizophrenia and rationality: On the function of the unconscious fantasy. In: Levin, D. M. (ed.) Pathologies of the Modern Self: Postmodern Studies of Narcissism, Schizophrenia and Depression. New York and London: New York University Press. Glass, J. M. (1993). Postmodernism and the multiplicity of self. Shattered Selves: Multiple Personality in a Postmodern World. Ithaca and London: Cornell University Press. Goffman, E. (1973). Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. London: Penguin. Goh, R. B. H. (2008). Myths of reversal: Backwards narratives, normative schizophrenia and the culture of causal agnosticism. Social Semiotics, 18: 61-77. Goldberg, A. (1999). Sex, Religion, and the Making of Modern Madness: The Eberbach Asylum and German Society, 1815-1849. New York: Oxford University Press. Goldstein, J. M. 8c Lewine, R. R. J. (2000). Overview of sex differences in schizophrenia: Where have we been and where do we go from here? In: Castle, D. J., McGrath, J. 8c Kulkarni, J. (eds.) Women and Schizophrenia. Cambridge: Cambridge University Press. Gordon, C. (1992). Histoire de la Folie: An unknown book by Michel Foucault. In: Still, A. & Velody, I. (eds.) Rewriting the History of Madness: Studies in Foucault's Histoire de la Folie. London and New York: Routledge. Gordon, C. (2007a). Extreme prejudice: Notes on Andrew Scull's TLS review of Foucault's History of Madness. Foucault Blog [Online]. Available from: http://foucaultblog. wordpress.com/2007/05/20/extreme-prejudice/ [Accessed 17 December 2009]. Gordon, C. (2007b). I listory of Madness (review). Notre Dame Philosophical Reviews [Online|. Available: http://ndpr.nd.edu/review.cfm?id=8904 [Accessed 17 December 2009].
Gottesman, I. (1991). Schizophrenia Genesis: The Origins of Madness. New York: W. H. Freeman. Gottschalk, S. (2000). Escape from insanity: 'Mental disorder' in the postmodern moment. In: Fee, D. (ed.) Pathology and the Postmodern: Mental Illness as Discourse and Experience. London: Sage. Goulimari, P. (2004). 'Myriad little connections': Minoritarian movements in the postmodernism debate. Postmodern Culture, 14. Green, M. F. (2003). Schizophrenia Revealed: From Neurons to Social Interactions. New York and London: Norton. Greenberg, J. (1964). I Never Promised You a Rose Garden, a Novel by Hannah Green. New York: Holt, Rinehart and Winston. Greene, T. (2007). The Kraepelinian dichotomy: The twin pillars crumbling? History of Psychiatry, 18: 361-79. Grigg, R. (1999). From the mechanism of psychosis to the universal condition of the symptom: On foreclosure. In: Nobus, D. (ed.) Key Concepts ofLacanian Psychoanalysis. New York: Other Press. Grinker, R. R. (2010). In retrospect: The five lives of the psychiatry manual. Nature, 468: 168-70. Grossberg, L. (1988). Putting the pop back into postmodernism. In: Ross, A. (ed.) Universal Abandon? The Politics of Postmodernism. Minneapolis: University of Minnesota Press. Guattari, F. (1996a). The divided Laing. In: Genosko, G. (ed.) The Guattari Reader. Oxford: Blackwell. Guattari, F. (1996b). Franco Basaglia: Guerrilla psychiatrist. In: Genosko, G. (ed.) The Guattari Reader. Oxford: Blackwell. Guattari, F. (1996c). The Guattari Reader. London: Blackwell. Guattari, F. (1996d). Mary Barnes's 'trip'. In: Genosko, G. (ed.) The Guattari Reader. Oxford: Blackwell. Guattari, F. (2006). The Anti-Oedipus
Papers. New York: Semiotext(e).
Guattari, F. 8c Munster, A. (1977). Psycho-analysis and schizo-analysis: An interview with Felix Guattari. Semiotext(e), II: 77-85. Hacking, I. (1999). The Social Construction of What? Cambridge, MA: Harvard University Press. Haghgooie, S., Lithgow, B. J., Gurvich, C., 8c Kulkarni, J. (2009). Quantitative detection and assessment of schizophrenia using electrovestibulography. 4th International IEEE/ EMBS Conference on Neural Engineering, 2009: 486-9. Haghighat, R. (2008). Schizophrenia as social discourse: How do people use their diagnosis for social action? European Psychiatry, 23: 549-60. Haghighat, R. 8c Littlewood, R. (1995). What should we call patients with schizophrenia? A sociolinguistic analysis. Psychiatric Bulletin, 19: 407-10. Hammersley, P. 8c McLaughlin, T. (2010). Introducing the Campaign for Abolition of the Schizophrenia Label [Online]. Asylum. Available: http://www.asylumonline.net/ [Accessed 17 November 2010]. Haraway, D. (1985). A manifesto for cyborgs: Science, technology and socialist feminism in the 1980s. Socialist Review, 80: 65-107.
Hardt, M. 8c Weeks, K. (eds.) (2000). The Jameson Reader. Oxford: Blackwell. Hare, E. (1983). Was insanity on the increase? [The fifty-sixth Maudsley lecture, delivered before the Royal College of Psychiatrists, 19 November 1982]. British Journal of Psychiatry, 142: 439-55. Hare, E. (1988). Schizophrenia as a recent disease. British Journal of Psychiatry, 153: 521-31. Harland, R., Antonova, E., Owen, G. S., Broome, M. R., Landau, S., Deeley, Q., 8c Murray, R. (2009). A study of psychiatrists' concepts of mental illness. Psychological Medicine, 39: 967-76. Harvey, D. (1990). The Condition of Postmodernity: An Enquiry into the Origins of Cultural Change. Oxford: Blackwell. Hayne, Y. 8c Yonge, O. (1997). The lifeworld of the chronic mentally ill: Analysis of 40 written personal accounts. Archives of Psychiatric Nursing, 11: 314-24. Healy, D. (2002). The Creation ofPsychopharmacology.
Cambridge, MA: Harvard
University Press. Heckers, S. (2008). Making progress in schizophrenia research. Schizophrenia
Bulletin,
34: 591-4. Heinze, R. (2008). Violations of mimetic epistemology in first-person narrative fiction. Narrative, 16: 279-99. Helyer, R. (2009). Glamorama, cinematic narrative and contemporary fiction. In: Carroll, R. (ed.) Adaptation in Contemporary Culture: Textual Infidelities. London: Continuum. Hill, P. (1997). Lacan for Beginners. New York: Writers and Readers Publishing. Hinshelwood, R. D. (2004). Suffering Psychosis: Psychoanalytic Essays on Psychosis. Hovel and New York: Brunner-Routledge. Hirsch, S. R. 8c Weinberger, D. R. (eds.) (2003). Schizophrenia. Maiden, MA: Blackwell. Hoenig, J. (1995). Schizophrenia—clinical section. In: Berrios, G. E. 8c Porter, R. (eds.) A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders. London: Athlone. Hoff, P. (1995). Kraepelin: Clinical section, part I. In: Berrios, G. E. 8c Porter, R. (eds.) A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders. London: Athlone. Holland, E. W. (1985-1986). The Anti-Oedipus: Postmodernism in theory; or, the post-Lacanian historical contextualization of psychoanalysis. Boundary 2, 14: 291-307. Holland, E. W. (1988). Schizoanalysis: The postmodern contextualization of psychoanalysis. In: Nelson, C. 8c Grossberg, L. (eds.) Marxism and the Interpretation of Culture. Chicago: University of Illinois Press. Holland, E. W. (1998). From schizophrenia to social control. In: Kaufman, E. 8c Heller, K. J. (eds.) Deleuze and Guattari: New Mapping in Politics, Philosophy and Culture. Minneapolis: University of Minnesota Press. Holland, E. W. (1999). Deleuze and Guattari's Anti-Oedipus: Introduction to Schizoanalysis. London and New York: Routledge. Hooke, A. E. (2009). A moral logic to the archives of pain: Rethinking Foucault's work on madness. Political Theory, 37: 432-41. Hornstein, (¡. A. (2000). To Redeem One Person is to Redeem the World: The Life of Frieda Frotnm Ucichmann. Now York: The Free Press.
Hornstein, G. A. (2009). Agnes's Jacket: A Psychologist's Search for the Meaning of Madness. New York: Rodale. Houen, A. (2004). Novel spaces and taking place(s) in the wake of September 11. Studies in the Novel, 26:419-38. Houston, R. A. (2000). Madness and Society in Eighteenth-Century
Scotland. Oxford:
Clarendon Press. Howes, O. D. 8c Kapur, S. (2009). The dopamine hypothesis of schizophrenia: Version III—the final common pathway. Schizophrenia Bulletin, 35: 549-62. Huffman, R. This Is Baader-Meinhof [Accessed 26 October 2004].
[Online]. Available: http://www.baader-meinhof.com
Hutcheon, L. (1988). A Poetics of Postmodernism. London: Routledge. Hutcheon, L. (1989). The Politics of Postmodernism. London and New York: Routledge. Insel, T. R. (2010). Rethinking schizophrenia. Nature, 468: 187-93. Jaaro-Peled, H., Ayhan, Y., Pletnikov, M. V., 8c Sawa, A. (2010). Review of pathological hallmarks of schizophrenia: Comparison of genetic models with patients and nongenetic models. Schizophrenia Bulletin, 36: 301-13. Jameson, F. (1983). Postmodernism and consumer society. In: Foster, H. (ed.) The Anti-Aesthetic: Essays on Postmodern Culture. Port Townsend: Bay Press. Jameson, F. (1984a). Periodizing the 60s. In: Sayres, S., Stephanson, A., Aronowitz, S., 8c Jameson, F. (eds.) The 60s Without Apology. Minneapolis: University of Minnesota Press. Jameson, F. (1984b). Postmodernism, or the cultural logic of late capitalism. New Left Review, 146: 53-92. Jameson, F. (1988). Pleasure: A political issue (1983). The Ideologies of Theory, Essays 1971-1986, Volume 2: The Syntax of History. London: Routledge. Jameson, F. (1991). Postmodernism, or the Cultural Logic of Late Capitalism. London: Verso. Jameson, F. (2002). A Singular Modernity: Essay on the Ontology of the Present. London: Verso. Jaspers, K. (1972). General Psychopathology. Manchester: Manchester University Press. Jenkins, J. H. (2004). Schizophrenia as a paradigm case for understanding fundamental human processes. In: Jenkins, J. H. 8c Barrett, R. J. (eds.) Schizophrenia, Culture, and Subjectivity: The Edge of Experience. Cambridge: Cambridge University Press. Jenkins, J. H. 8c Barrett, R. J. (2004a). Introduction. In: Jenkins, J. H. 8c Barrett, R. J. (eds.) Schizophrenia, Culture, and Subjectivity: The Edge of Experience. Cambridge: Cambridge University Press. Jenkins, J. H. 8c Barrett, R. J. (eds.) (2004b). Schizophrenia, Culture, and Subjectivity: The Edge of Experience. Cambridge: Cambridge University Press. Jervis, J. (1998). Sacred, secular, sublime: Modernity performs the death of God. Exploring the Modern: Patterns of Western Civilization and Culture. Oxford: Blackwell. Johnstone, E. C., Humphreys, M. S., Lang, F. H., 8c Lawrie, S. M. (1999). Schizophrenia: Concepts and Clinical Management. Cambridge: Cambridge University Press. Johnston, J. (1990). Ideology, representation, schizophrenia: Toward a theory of the postmodern subject. In: Shapiro, G. (ed.) After the Future: Postmodern Times and Places. Albany: State University of New York Press.
Johnstone, L. (2000). Users and Abusers of Psychiatry: A Critical Look at Psychiatric Practice. London: Routledge. Jones, E. (1948). Collected Papers on Psychoanalysis. London: Bailliere, Tindall and Cox. Judd, L. L. (1994). Introduction. In: Andreasen, N. C. (ed.) Schizophrenia: From Mind to Molecule. Washington: American Psychiatric Press. Jung, C. (1944). The Psychology of Dementia Praecox. New York: Nervous and Mental Disease Monographs. Kant, I. (1969). The Critique of Judgement. Oxford: Clarendon. Katan, M. (1949). Schreber's delusion of the end of the world. The Psychoanalytic Quarterly, 18: 60-6. Katan, M. (1950a). Schreber's hallucinations about the little men. International Journal of Psycho-Analysis, 31: 32-5. Katan, M. (1950b). Structural aspects of a case of schizophrenia. The Psychoanalytic Study of the Child, 5: 175-211. Katan, M. (1952a). Further remarks about Schreber's hallucinations. International Journal of Psycho-Analysis, 33: 429-32. Katan, M. (1952b). Schreber's prepsychotic phase. International Journal of Psycho-Analysis, 33:429-32. Kellendonk, C., Simpson, E. H., Polan, H. J., Malleret, G., Vronskaya, S., Winiger, V., Moore, H., & Kandel, E. R. (2006). Transient and selective overexpression of dopamine D2 receptors in the striatum causes persistent abnormalities in prefrontal cortex functioning. Neuron, 49: 603-15. Kellner, D. (1989). Introduction: Jameson, Marxism, and postmodernism. In: Kellner, D. (ed.) Postmodernism/Jameson/Critique. Washington: Maisonneuve Press. Kendler, K. S. (2005). 'A gene for ...': The nature of gene action in psychiatric disorders. American Journal of Psychiatry, 162: 1243-52. Kerr, J. (1993). A Most Dangerous Method: The Story of Jung, Freud, and Sabina Spielrein. New York: Alfred A Knopf. Kinney, D. K., Teixeira, P., Hsu, D., Napoleon, S. C., Crowley, D. J., Miller, A., Hyman, W., 8c Huang, E. (2009). Relation of schizophrenia prevalence to latitude, climate, fish consumption, infant mortality, and skin color: A role for prenatal vitamin D deficiency and infections? Schizophrenia Bulletin, 35: 582-95. Kirby, K. M. (1996). Re: Mapping subjectivity: Cartographic vision and the limits of politics. In: Duncan, N. (ed.) Bodyspace: Destabilizing Geographies of Gender and Sexuality. London and New York: Routledge. Kirk, S. A. 8c Kutchins, H. (1992). The Selling ofDSM: The Rhetoric of Science in Psychiatry. New York: Aldine de Gruyter. Kittler, F. (1990). Discourse Networks. 1800/1900. Stanford: Stanford University Press. Kleiman, R. (2003). Insane logic (lecture). Melbourne: The Freudian School of Melbourne. Kleinman, A. (2004). Preface. In: Jenkins, J. H. 8c Barrett, R. J. (eds.) Schizophrenia, Culture, and Subjectivity: The Edge of Experience. Cambridge: Cambridge University Press. Klein, M. (1952). Notes on some schizoid mechanisms. In: Riviere, J. (ed.) Developments in Psycho Analysis I ondon: I he Hogarth Press and the Institute of Psycho-Analysis.
Kotowicz, Z. (1997). R. D. Laingand Routledge.
the Paths of Anti-Psychiatry.
London and New York:
Kovel, J. (1987). Schizophrenic being and technocratic society. In: Levin, D. M. (ed.) Pathologies of the Modern Self: Postmodern Studies of Narcissism, Schizophrenia and Depression. New York and London: New York University Press. Kraepelin, E. (1981). Clinical Psychiatry. New York, Scholars' Facsimiles 8c Reprints. Kraepelin, E. (2000). Comparative psychiatry (1904). In: Littlewood, R. 8c Dein, S. (eds.) Cultural Psychiatry and Medical Anthropology. London: The Athlone Press. Kraepelin, E. (2010). About the surveillance ward at the Heidelberg clinic for lunatics (1895). In: Eghigian, G. (ed.) From Madness to Mental Heatlh: Psychiatric Disorder and Its Treatment in Western Civilization. New Brunswick, NJ and London: Rutgers University Press. Kreyenbuhl, J., Buchanan, R. W., Dickerson, F. B., 8c Dixon, L. B. (2010). The schizophrenia patient outcomes research team (PORT): Updated treatment recommendations 2009. Schizophrenia Bulletin, 36: 94-103. Lacan, J. (1966). On a question preliminary to any possible treatment of psychosis. Écrits: A Selection. New York and London: Norton. Lacan, J. (1993). The Seminar of Jacques Lacan: Book III The Psychoses 1955-1956. New York: W W Norton. LaCapra, D. (1992). Foucault, history and madness. In: Still, A. 8c Velody, I. (eds.) Rewriting the History of Madness: Studies in Foucault's histoire de la folie. London and New York: Routledge. Laing, A. C. (1994). R. D. Laing: A Biography. London: Peter Owen. Laing, R. D. (1967). The Politics of Experience. New York: Ballantine Books. Laing, R. D. (1985). Wisdom, Madness and Folly: The Making of a Psychiatrist. London: Macmillan. Laing, R. D. (1990). The Divided Self: An Existential Study in Sanity and Madness. London: Penguin. Laing, R. D. 8c Esterton, A. (1964). Sanity, Madness and the Family: Volume I, Families of Schizophrenics. London: Tavistock. Lasch, C. (1978). The Culture of Narcissism: American Life in an Age of Diminishing Expectations. New York: W W Norton. Laugharne, R. (April 2002). Psychiatry, postmodernism and postnormal science. Journal of the Royal Society of Medicine, 95: 207-10. Laugharne, R. (2004). Psychiatry in the future, the next 15 years: Postmodern challenges and opportunities for psychiatry. Psychiatric Bulletin, 28: 317-8. Lawrie, S. M., Hall, J., Mcintosh, A. M., Owens, D. G. C., 8c Johnstone, E. C. (2010). The 'continuum of psychosis': Scientifically unproven and clinically impractical. British Journal of Psychiatry, 197:423-5. Lee, M. J. (ed.) (2000). The Consumer Society Reader. Maiden, MA: Blackwell. Levin, D. M. (1987a). Clinical stories: A modern self in the fury of being. In: Levin, D. M. (ed.) Pathologies of the Modern Self: Postmodern Studies of Narcissism, Schizophrenia and Depression. New York and London: New York University Press. Levin, D. M. (ed.) (1987b). Pathologies of the Modern Self: Postmodern Studies of Narcissism, Schizophrenia and Depression. New York and London: New York University Press.
Levin, T. Y., Frohne, U., 8c Weibel, P. (2002). Editorial. In: Levin, T. Y., Frohne, U., 8c Weibel, P. (eds.) Ctrl [space]: Rhetorics of Surveillance from Bentham to Big Brother. Cambridge, MA: The MIT Press. Lewin, M. (2009). Schizophrenia 'epidemic' among African Caribbeans spurs prevention policy change. The Guardian [Online]. Available: http://www.guardian.co.uk/ society/2009/dec/09/african-caribbean-schizophrenia-policy [Accessed 9 December 2009]. Lewis, B. (2000). Psychiatry and postmodern theory. Journal of Medical
Humanities,
21: 71-84. Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins, D. O., Keefe, R. S. E., Davis, S. M., Davis, C. E., Lebowitz, B. D., Severe, J. 8c Hsiao, J. K. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353: 1209-23. Lothane, Z. (1992). In Defense of Schreber: Soul Murder and Psychiatry. Hillsdale, NJ: The Analytic Press. Lotringer, S. (1977). Libido unbound: The politics of'schizophrenia'. II: 5-10.
Semiotext(e),
Lotringer, S. 8c Cohen, S. (2001). Introduction: A few theses on French theory in America. In: Lotringer, S. 8c Cohen, S. (eds.) French Theory in America. London and New York: Routledge. Lyon, D. (2003). Surveillance technology and surveillance society. In: Misa, T. J., Brey, P., 8c Feenberg, A. (eds.) Modernity and Technology. Cambridge, MA: The MIT Press. Lyotard, J. -F. (1977). Energumen capitalism. Semiotext(e), II: 11-26. Lysaker, P. H. & Lysaker, J. T. (2008). Schizophrenia and the Fate of the Self. Oxford: Oxford University Press. Lysaker, P. H. 8c Lysaker, J. T. (2010). Schizophrenia and alterations in self-experience: A comparison of 6 perspectives. Schizophrenia Bulletin, 36: 331-40. Macalpine, I. 8( Hunter, R. A. (1955a). Discussion. Memoirs of My Nervous Illness. London: W M Dawson 8c Sons. Macalpine, I. 8c Hunter, R. A. (1955b). Introduction. Memoirs of My Nervous Illness. London: W M Dawson 8c Sons. MacDonald, A. W. 8c Schulz, S. C. (2009). What we know: Findings that every theory of schizophrenia should explain. Schizophrenia Bulletin, 35:493-508. Mann, S. (1994). Psycho-Analysis and Society: An Introduction. Sydney: UNSW Press. Mannoni, O. (1988). Writing and madness: Schreber als schreiber. In: Allison, D. B., de Oliveira, P., Roberts, M. S. 8c Weiss, A. S. (eds.) Psychosis and Sexual Identity: Towards a Post-Analytic View of the Schreber Case. Albany: State University of New York Press. Marini, M. (1992). Jacques Lacan: The French Context. New Brunswick, NJ: Rutgers University Press. Marshall, P. D. (1997). Celebrity and Power: Fame in Contemporary Culture. Minneapolis: University of Minnesota Press. Massumi, B. (1992). A User's Guide to Capitalism and Schizophrenia: Deviations from Deleuzeand Gnat tori, Cambridge, MA: MIT Press. Mathiesen, T. (1997). The viewer society: Michel Foucault's 'panopticon' revisited. Theoretical < riminology, I: 215-34.
McDonald, C., Schulze, K., Murray, R. M., 8c Wright, P. (eds.) (2004). Schizophrenia: Challenging the Orthodox. London and New York: Taylor and Francis. McGlashan, T. H. (2009). Psychosis as a disorder of reduced cathectic capacity: Freud's analysis of the Schreber case revisited. Schizophrenia Bulletin, 35:476-81. McGuffin, P. (2004). Foreword. In: McDonald, C., Schulze, K., Murray, R. M., 8c Wright, P. (eds.) Schizophrenia: Challenging the Orthodox. London: Taylor and Francis. Mclnerney, J. (1998). Model Behavior: A Novel and 7 stories. New York: Alfred A Kopf. McKenna, P. J. (1994). Schizophrenia and Related Syndromes. Oxford: Oxford University Press. McLean, A. (1995). Empowerment and the psychiatric consumer/ex-patient movement in the United States: Contradictions, crisis and change. Social Science and Medicine, 40: 1053-71. McLean, A. H. (2000). From ex-patient alternatives to consumer options: Consequences of consumerism for psychiatric consumers and the ex-patient movement. International Journal of Health Services, 30: 821-47. McLean, R. (2003). Recovered not Cured: A Journey through Schizophrenia. Melbourne: Allen and Unwin. McNally, K. (2007). Schizophrenia as split personality/Jekyll and Hyde: The origins of the informal usage in the English language. Journal of the History of the Behavioral Sciences, 43: 69-79. Mendelsohn, D. (1999). Lesser than zero [Online]. The New York Times. Available: http:// www.nytimes.com/books/99/0l/24/reviews/990124.24mendelt.html [Accessed 24 February 2003]. Mental Health Division (2009). New horizons: A shared vision for mental health. London: Department of Health, Her Majesty's Government. Metzl, J. (2009). The Protest Psychosis: How Schizophrenia Became a Black Disease. Boston: Beacon Press. Meyer-Lindenberg, A. (2010). From maps to mechanisms through neuroimaging of schizophrenia. Nature, 468: 194-202. Michaels, W. B. (2003). Empires of the senseless: (The response to) terror and (the end of) history. Radical History Review, 85:105-13. Miller, R. 8c Mason, S. E. (2002). Diagnosis: Schizophrenia: A Comprehensive Guide for Patients, Families and Helping Professionals. New York: Columbia University Press. Mitchell, A. 8c Michalczuk, R. (2010). Monetary incentives for schizophrenia. Schizophrenia Bulletin, 36: 24-5. Mitchell, N., Sadler, J., 8c Robertson, M. (2009). Thomas Szasz: Psychiatrists respond. All In the Mind. ABC Radio National. Mitchell, N. 8c Szasz, T. (2009a). Thomas Szasz speaks (part 1 of 2). All In the Mind. ABC Radio National. Mitchell, N. 8c Szasz, T. (2009b). Thomas Szasz speaks (part 2 of 2). All In the Mind. ABC Radio National. Moncrieff, J. (2009). The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. London: Palgrave Macmillan. Morgan, A. (2010). Schizophrenia, reification and deadened life. History of the Human Sciences, 23: 176-93.
Morgan, C. 8c Hutchinson, G. (2009). The social determinants of psychosis in migrant and ethnic minority populations: A public health tragedy. Psychological Medicine, 40(5): 705-9. Morse, M. (1990). An ontology of everyday distraction: The freeway, the mall, and television. In: Mellencamp, P. (ed.) Logics of Television: Essays in Cultural Criticism. London: BFI Books. Mueser, K. T. 8c Jeste, D. V. (eds.) (2008). Clinical Handbook of Schizophrenia. New York: The Guilford Press. Mullan, B. (1999). R. D. Laing: A Personal View. London: Duckworth. Nasrallah, H. (2003). A review of the effect of atypical antipsychotics on weight. Psychoneuroendocrinology, 28: 83-96. Nasrallah, H. (2008). Atypical antipsychotic-induced metabolic side effects: Insights from receptor-binding profiles. Molecular Psychiatry, 13: 27-35. Nelson, G., Ochocka, J., Janzen, R., 8c Trainor, J. (2006). A longitudinal study of mental health consumer/survivor initiatives: Part I—literature review and overview of the study. Journal of Community Psychology, 34: 247-60. Nelson, G., Ochocka, J., Janzen, R., Trainor, J., Goering, P., 8c Lomotey, J. (2007). A longitudinal study of mental health consumer/survivor initiatives: Part V—outcomes at 3-year follow-up. Journal of Community Psychology, 35: 655-65. Niederland, W. G. (1984). The Schreber Case: Psychoanalytic Profile of a Paranoid Personality. Hillsdale, NJ: The Analytic Press. Nielsen, H. S. (2004). The impersonal voice in first-person narrative fiction. Narrative, 12:133-50. Nielsen, H. S. (2006). Telling doubles and literal-minded reading in Bret Easton Ellis's Glamorama. In: Durand, A.-P. 8c Mandel, N. (eds.) Novels of the Contemporary Extreme. London: Continuum. Noll, R. (2006). The blood of the insane. History of Psychiatry, 17: 395-418. Noll, R. (2007). Kraepelin's 'lost biological psychiatry'? Autointoxication, organotherapy and surgery for dementia praecox. History of Psychiatry, 18: 301-20. O'Brien, B. (1960). Operators and Things: The Inner Life of a Schizophrenic. London: Elek Books. O'Hara, M. (2010). Fightback over claims on mental illness and its prevalence among black people. The Guardian [Online]. Available: http://www.guardian.co.uk/society/2010/ feb/03/mental-illness-bme-campaign [Accessed 3 February 2010]. O'Neill, J. (1989). Religion and postmodernism: The Durkheimian bond in Bell and Jameson. In: Kellner, D. (ed.) Postmodernism/Jameson/Critique. Washington: Maisonneuve Press. O'Tuathaigh, C. M. P., Kirby, B. P., Moran, P. M., 8c Waddington, J. L. (2010). Mutant mouse models: Genotype-phenotype relationships to negative symptoms in schizophrenia. Schizophrenia Bulletin, 36(2): 271-88. Page, A. (dir.) (1977). I Never Promised You a Rose Garden. USA. Parnas, J. 8c Sass, L. A. (2001). Self, solipsism, and schizophrenic delusions. Philosophy, Psychiatry, Psychology, 8: 101-20. Patientenkoilektiv(H), P. S. -S'/'K Homepage [Online]. Available: http://www.spkpfh.de/ [Accessed 26 October 2006).
Patton, P. (2001). Notes for a glossary. In: Genosko, G. (ed.) Deleuze and Guattari: Critical Assessments of Leading Philosophers. London and New York: Routledge. Paulson, R. (1985). Versions of a h u m a n sublime. New Literary History, XVI: 427-37. Pease, D. E. (1984). Sublime politics. Boundary 2, XII.3-XIII.4: 259-79. Peters, J. D. (2010). Broadcasting and schizophrenia. Media, Culture & Society, 32: 123-40. Petersen, P. S. (2005). 9/11 and the 'problem of imagination': Fight Club and Glamorama as terrorist pretexts. Orbis Literrarum, 60: 133-44. Plant, S. (2001). Nomads and revolutionaries. In: Genosko, G. (ed.) Deleuze and Guattari: Critical Assessments of Leading Philosophers. London and New York: Routledge. Poland, J. (2007). How to move beyond the concept of schizophrenia. In: Chung, M. C., Fulford, K. W. M. B., & Graham, G. (eds.) Reconceiving Schizophrenia. Oxford: Oxford University Press. Porter, R. (2002). Madness: A Brief History. Oxford, Oxford University Press. Porter, R. & Micale, M. S. (1994). Introduction: Reflections on psychiatry and its histories. In: Micale, M. S. & Porter, R. (eds.) Discovering the History of Psychiatry. Oxford: Oxford University Press. Postel, J. & Allen, D. F. (1994). History and anti-psychiatry in France. In: Micale, M. S. 8t Porter, R. (eds.) Discovering the History of Psychiatry. Oxford: Oxford University Press. Punter, D. (2003). E-textuality: Authenticity after the postmodern. Critical Quarterly, 43: 68-91. Rajchman, J. (1977). Analysis in power. Semiotext(e), II: 45-58. Ramon, S., Healy, B., 8c Renouf, N. (2007). Recovery from mental illness as an emergent concept and practice in Australia and the UK. International Journal of Social Psychiatry, 53: 108-22. Ratcliffe, M. (2008). Feelings of Being: Phenomenology, Psychiatry and the Sense of Reality. Oxford: Oxford University Press. Ratcliffe, M. (2010). Binary oppositions in psychiatry: For or against? Philosophy, Psychiatry, & Psychology, 17: 233-39. Read, R. (2003). On delusions of sense: A response to Coetzee and Sass. Philosophy, Psychiatry, Psychology, 10:135-41. Reaume, G. (2002). Lunatic to patient to person: Nomenclature in psychiatric history and the influence of patients' activism in North America. International Journal of Law and Psychiatry, 25:405-26. Renee. (1970). Autobiography of a Schizophrenic Girl, with an Analytic Interpretation by Marguerite Sechehaye. New York: Signet. Richardson, O. (1999). Glamorama [Online]. The Age. Available: http://www.theage.com. au/books/archives/easton.html [Accessed 5 November 2001]. Richardson, W. J. (1988). Lacan and the problem of psychosis. In: Allison, D. B., de Oliveira, P., Roberts, M. S. & Weiss, A. S. (eds.) Psychosis and Sexual Identity: Towards a Post-Analytic View of the Schreber Case. Albany: State University of New York Press. Robbins, B. D. (2000). Schreber's soul-voluptuousness: Mysticism, madness and the feminine in Schreber's memoirs. Journal of Phenomenological Psychology, 31:117-54. Roberts, M. S. (1996). Schreber as machine, technophobe, and virtualist. rJDR (Cambridge, MA), 40:31-47.
Romme, M. & Morris, M. (2007). The harmful concept of schizophrenia. Mental Health Nursing, 27: 8-12. Ronell, A. (1989). The Telephone Book: Technology, Schizophrenia, Electric Speech. Lincoln: University of Nebraska Press. Rose, J. (1988). 'The man who mistook his wife for a hat' or 'a wife is like an umbrella'—fantasies of the modern and postmodern. In: Ross, A. (ed.) Universal Abandon: The Politics of Postmodernism. Minneapolis: University of Minnesota Press. Rose, N. (1996). Inventing Our Selves: Psychology, Power and Personhood. Cambridge: Cambridge University Press. Rose, N. (2006). The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century. Princeton: Princeton University Press. Rosenhan, D. L. (1975). On being sane in insane places. In: Scheff, T. J. (ed.) Labeling Madness. New Jersey: Prentice-Hall. Roudinesco, E. (1997). Jacques Lacan. New York: Columbia University Press. Russell, D. (1995). Women, Madness and Medicine. Cambridge: Polity Press. Saks, E. (2007). The Center Cannot Hold: My Journey Through Madness. London: Virago. Samuels, A. (1997). Jung and the post-Jungians. In: Young-Eisendrath, P. & Dawson, T. (eds.) The Cambridge Companion to Jung. Cambridge: Cambridge University Press. Santner, E. L. (1996). My Own Private Germany: Daniel Paul Schreber's Secret History of Modernity. Princeton: Princeton University Press. Sartorius, N. (2010). Short-lived campaigns are not enough. Nature, 468: 163-65. Sass, L. A. (1987a). Introspection, schizophrenia and the fragmentation of the self. Representations, 19: 1-34. Sass, L. A. (1987b). Schreber's panopticism: Psychosis and the modern soul. Social Research, 54: 101-47. Sass, L. A. (1988). The land of unreality: On the phenomenology of the schizophrenic break. New Ideas in Psychology, 6: 223-42. Sass, L. A. (1992). Madness and Modernism: Insanity in the Light of Modern Art, Literature and Thought. Cambridge, MA: Harvard University Press. Sass, L. A. (1994a). Civilized madness: Schizophrenia, self consciousness and the modern mind. History of the Human Sciences, 7: 83-120. Sass, L. A. (1994b). The Paradoxes of Delusion: Wittgenstein, Schreber, and the Schizophrenic Mind. Ithaca: Cornell University Press. Sass, L. A. (1996). 'The catastrophes of heaven': Modernism, primitivism, and the madness of Antonin Artaud. Modernism/Modernity, 3: 73-91. Sass, L. A. (1997). The consciousness machine: Self and subjectivity in schizophrenia and modern culture. In: Neisser, U. & Jopling, D. A. (eds.) The Conceptual Self in Context: Culture, Experience, Self- Understanding. Cambridge: Cambridge University Press. Sass, L. A. (1998). Interpreting schizophrenia: Construal or construction? A reply to Robert J. Barrett. Culture, Medicine and Psychiatry, 22:495-503. Sass, L. A. (2000). Schizophrenia, self-experience, and the so-called 'negative symptoms': Reflections on hyperreflexivity. In: Zahavi, D. (ed.) Exploring the Self: Philosophical and Psychopathological Perspectives on Self-Experience. Amsterdam and Philadelphia: John Bejamins Publishing Company.
Sass, L. A. (2000-200 la). Romanticism, creativity, and the ambiguities of psychiatric diagnosis: Rejoinder to Kay Redfield Jamison. Creativity Research Journal, 13: 77-85. Sass, L. A. (2000-200lb). Schizophrenia, modernism, and the 'creative imagination': On creativity and psychopathology. Creativity Research Journal, 13: 55-74. Sass, L. A. (2001). Self and world in schizophrenia: Three classic approaches. Philosophy, Psychiatry, Psychology, 8: 251-70. Sass, L. A. (2003). 'Negative symptoms', schizophrenia, and the self. International Journal of Psychology and Psychological Therapy, 3:153-80. Sass, L. A. (2004a). 'Negative symptoms', commonsense, and cultural disembedding in the modern age. In: Jenkins, J. H. 8c Barrett, R. J. (eds.) Schizophrenia, Culture, and Subjectivity: The Edge of Experience. Cambridge: Cambridge University Press. Sass, L. A. (2004b). Some reflections on the (analytic) philosophical approach to delusion. Philosophy, Psychiatry, Psychology, 11: 71-80. Sass, L. A. (2007). 'Schizophrenic person' or 'person with schizophrenia'? An essay on illness and the self. Theory and Psychology, 17: 395-420. Sass, L. A. 8c Parnas, J. (2001). Phenomenology of self-disturbances in schizophrenia: Some research findings and directions. Philosophy, Psychiatry, Psychology, 8: 347-56. Sass, L. A. 8c Parnas, J. (2003). Schizophrenia, consciousness, and the self. Schizophrenia Bulletin, 29:427-44. Schatzman, M. (1971). Paranoia or persecution: The case of Schreber. Family Process, 10:117-207. Schatzman, M. (1973). Soul Murder: Persecution in the Family. London: Allen Lane. Scheff, T. J. (1975a). On reason and sanity: Some political implications of psychiatric thought. In: Scheff, T. J. (ed.) Labeling Madness. New Jersey: Prentice-Hall. Scheff, T. J. (1975b). Schizophrenia as ideology. In: Scheff, T. J. (ed.) Labeling Madness. New Jersey: Prentice-Hall. Schiller, L. 8c Bennett, A. (1994). The Quiet Room: A Journey out of the Torment of Madness. New York: Warner. Schreber, D. P. (1955). Memoirs of My Nervous Illness. London: W M Dawson 8c Sons. Schwarz, H. 8c Balsamo, A. (Spring 1996). Under the sign of 'semiotext(e)': The story according to Sylvere Lotringer and Chris Kraus. CRITIQUE: Studies in Contemporary Fiction, 37: 205-21. Scull, A. (1984). Was insanity increasing? A response to Edward Hare. British Journal of Psychiatry, 144: 432-6. Scull, A. (2007). The fictions of Foucault's scholarship: The frail foundations of the Foucaldian monument. Times Literary Supplement, May 21. Sedgwick, P. (1982). Psycho Politics. London: Pluto Press. Serres, M. (1994). The geometry of the incommunicable madness. In: Davidson, A. I. (ed.) Foucault and His Interlocutors. Chicago and London: Chicago University Press. Shaw, P. (2006). The Sublime. Abingdon: Routledge. Shean, G. D. (2004). What is Schizophrenia and How Can We Fix It? Lantham, MD: University Press of America. Shorter, E. (1997). A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: John Wiley 8c Sons.
Shorter, E. 8c Healy, D. (2007). Shock Therapy: A History of Electroconvulsive Treatment
in
Mental Illness. New Brunswick, NJ and London: Rutgers University Press. Showalter, E. (1987). The Female Malady: Women, Madness and English Culture London: Virago.
1830-1980.
Sica, A. (1995). Gabel's 'micro/macro' bridge: The schizophrenic process writ large. Sociological Theory, 13: 66-99. Simmons, P., Hawley, C. J., Gale, T. M., 8c Sivakumaran, T. (2010). Service user, patient, client, user or survivor: Describing recipients of mental health services. The Psychiatrist, 34:31-5. Smart, B. (1993). Postmodernity.
London and New York: Routledge.
Smith, A. C. (1982). Schizophrenia and Madness. London: George Allen 8c Unwin. Smith, D. (1999). Zygmunt
Bauman: Prophet of Postmodernity.
Cambridge: Polity Press.
Snyder, K., Gur, R. E., 8c Andrews, L. W. (2007). Me, Myself, and Them: A Firsthand Account of One Young Person's Experience with Schizophrenia.
New York: Oxford
University Press. Sontag, S. (1991). Illness as Metaphor and Aids and Its Metaphors. London: Penguin. Speed, E. (2006). Patients, consumers and survivors: A case study of mental health service user discourses. Social Science and Medicine, 62: 28-38. Speed, E. (2007). Discourses of consumption or consumed by discourse? A consideration of what 'consumer' means to the service user. Journal of Mental Health, 16: 307-18. Stanghellini, G. (2004). Disembodied Spirits and Deanimated
Bodies: The Psychopathology of
Common Sense. Oxford: Oxford University Press. Steele, R. S. (1982). Freud and Jung: Conflicts of Interpretation.
London: Routledge 8c Kegan
Paul. Stephan, K. E., Friston, K. J., 8c Frith, C. D. (2009). Dysconnection in schizophrenia: From abnormal synaptic plasticity to failures of self-monitoring. Schizophrenia
Bulletin,
35: 509-27. Stephanson, A. (1988). Regarding postmodernism—a conversation with Fredric Jameson. In: Ross, A. (ed.) Universal Abandon? The Politics of Postmodernism. Minneapolis: University of Minnesota Press. Stephenson, W. (2007). 'A terrorism of the rich': Symbolic violence in Bret Easton Ellis's Glamorama and J. G. Ballard's Super-Cannes. Critique, 48: 278-93. Stevens, A. (1994). Jung. Oxford: Oxford University Press. Strous, R. D. (2010). Psychiatric genocide: Reflections and responsibilities.
Schizophrenia
Bulletin, 36: 208-10. Swingewood, A. (1977). Review of False Consciousness. The American Journal of Sociology, 83:222-4. Szasz, T. (1972). The Myth of Mental Illness: Foundations of a Theory of Personal St Albans: Paladin. Szasz, T. (1976). Schizophrenia:
Conduct.
The Sacred Symbol of Psychiatry. New York: Basic Books.
Szasz, T. (2001). Pharmacracy: Medicine and Politics in America. Westport, CT: Praeger. Szasz, T. (2004). Reply to Kendell. In: Schaler, J. A. (ed.) Szasz under Fire: The Psychiatric Abolitionist Faces His Critics. Chicago: Open Court. Szasz, T. (2010). Psychiatry, anti-psychiatry, critical psychiatry: What do these terms mean? Philosophy, Psychiatry, & Psychology, 17:229-32.
Tai, S. & Turkington, D. (2009). The evolution of cognitive behavior therapy for schizophrenia: Current practice and recent developments. Schizophrenia
Bulletin,
35: 865-73. Tausk, V. (1950). On the origin of the 'influencing machine' in schizophrenia (1919). In: Fliess, R. (ed.) The Psycho-Analytic Reader: An Anthology of Essential Papers with Critical Introductions. London: The Hogarth Press and the Institute of Pyscho-Analysis. Taylor, B. (1987). Modernism, Post-Modernism, Realism: A Critical Perspective for Art. Winchester: Winchester School of Art Press. Theweleit, K. (1990). Object-choice (All You Need is Love...): Fragment of a Freud Biography. London: Verso.
On Mating Strategies &A
Thornton, T. (2007). Essential Philosophy of Psychiatry. Oxford: Oxford University Press. Thurschwell, P. (2000). Sigmund Freud. London and New York: Routledge. Torrey, E. F. (1988). Stalking the schizovirus. Schizophrenia Bulletin, 14: 223-9. Torrey, E. F. 8c Miller, J. (2001). The Invisible Plague: The Rise of Mental Illness from 1750 to the Present. New Brunswick, NJ: Rutgers University Press. Torrey, E. F. 8c Yolken, R. H. (1995). Could schizophrenia be a viral zoonosis transmitted from house cats? Schizophrenia Research, 21:167-71. Torrey, E. F. 8c Yolken, R. H. (2007). Editors' introduction: Schizophrenia and toxoplasmosis. Schizophrenia Bulletin, 33: 727-28. Torrey, E. F. 8c Yolken, R. H. (2009). Psychiatric genocide: Nazi attempts to eradicate schizophrenia. Schizophrenia Bulletin 36: 26-32. Tsuang, M. T., Nossova, N., Yager, T., Tsuang, M.-M., Guo, S.-C., Shyu, K. G., Glatt, S. J., 8c Liew, C. C. (2005). Assessing the validity of blood-based gene expression profiles for the classification of schizophrenia and bipolar disorder: A preliminary report. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 133: 1-5. Turner, T. (1995). Schizophrenia—social section. In: Berrios, G. E. 8c Porter, R. (eds.) A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders. London: Athlone. Ussher, J. (1991). Women's Madness: Misogyny or Mental Illness? Amherst: University of Massachusetts Press. van Os, J., Kenis, G., 8c Rutten, B. P. F. (2010). The environment and schizophrenia. Nature, 468: 203-12. Vatz, R. E. 8c Weinberg, L. S. (1994). The rhetorical paradigm in psychiatric history: Thomas Szasz and the myth of mental illness. In: Micale, M. S. 8c Porter, R. (eds.) Discovering the History of Psychiatry. Oxford: Oxford University Press. Velligan, D. I. (2009). Cognitive behavior therapy for psychosis: Where have we been and where are we going? Schizophrenia Bulletin, 35: 857-8. Vine, S. (ed.) (2005). Literature in Psychoanalysis: A Reader. New York: Palgrave Macmillan. Viskerr, R. (1995). Michel Foucault: Genealogy as Critique. London: Verso. Watters, E. (2010). Crazy Like Us: The Globalization of the American Psyche. New York: Free Press. Weber, G. (1955). Medical expert's report to the court. Memoir> of My Nervous Illness. London: W M Dawson 8c Sons.
Weibel, P. (2002). Pleasure and the panoptic principle. In: Levin, T. Y., Frohne, U., & Weibel, P. (eds.) Ctrl [space]: Rhetorics of Surveillance from Bentham to Big Brother. Cambridge, MA: The MIT Press. Wernicke, C. (1900). Grundriss der psychiatrie. Leipzig: Verlag von Georg Thieme. Westphal, M. (1993). Suspicion and Faith: The Religious Uses of Modern Atheism. Grand Rapids, MI: William B. Eerdmans Publishing Company. Whitaker, R. (2002). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally III. Cambridge, MA: Perseus Publishing. Williamson, P. (2007). The final common pathway of schizophrenia. Schizophrenia Bulletin, 33: 9 5 3 ^ . Willick, M. S. (2001). Psychoanalysis and schizophrenia: A cautionary tale. Journal of the American Psychoanalytic Association, 49: 27-56. Woods, A. (2002). Subjectivity 'in crisis': Masculinity and schizophrenia in David Fincher's Fight Club. antiTHESIS, 13: 76-95. Woods, A. (2007). Schizophrenia's multiple refusals. In: Hamilton, C., Kelly, M., Minor, E., & Noonan, W. (eds.) The Politics and Aesthetics of Refusal. Newcastle: Cambridge Scholars Publishing. Woods, A. (in press). Mathematics <> masculinity <> madness. In: Araoz, G. (ed.) Madness in Con-text: Historical, Poetic and Artistic Pesrpectives. Oxford: Interdisciplinary Press. Woods, S. W., Addington, J., Cadenhead, K. S., Cannon, T. D., Cornblatt, B. A., Heinssen, R., Perkins, D. O., Seidman, L. J., Tsuang, M. T., Walker, E. F., & McGlashan, T. H. (2009). Validity of the prodromal risk syndrome for first psychosis: Findings from the North American prodrome longitudinal study. Schizophrenia Bulletin, 35: 894-908. World Heath Organisation. (2007). International Statistical Classification of Diseases and Related Health Problems, 10th Revision [Online]. Available: http://www.who.int/ classifications/icd/en/[Accessed 13 January 2010]. Xia, J. & Grant, T. J. (2009). Dance therapy for people with schizophrenia. Schizophrenia Bulletin, 35: 675-6. Young, E. (1999). Life in the lottery of cool. The Guardian, 16 January. Zizek, S. (1999). The Ticklish Subject: The Absent Centre of Political Ontology. London: Verso. 2izek, S. (2002). Big Brother, or, the triumph of the gaze over the eye. In: Levin, T. Y., Frohne, U., & Weibel, P. (eds.) Ctrl [space]: Rhetorics of Surveillance from Bentham to Big Brother. Cambridge, MA: The MIT Press.
Author Index
Abbott, A. 58 Abi-Rached, J. 20 Abraham, K. 65, 66, 68-9, 71-2, 75, 80, 166 Abrams, P. 60 Acker, K. 9, 131 Aldhous, P. 34 Allen, D. F. 130 American Psychiatric Association 34, 54, 55, 64 Andreasen, N. 13 Andrejevic, M. 180 Angermeyera, M. C. 59 Annesley, J. 204 Appignanesi, L. 68 Artaud, A. 23, 149, 151, 172, 204 Ayers, S. 205,207,209 Bailey, J. 186 Baker, C. 9 Balsamo, A. 131 Barham, P. 43 Barrett, R. J. 5-6, 36, 40, 60, 84, 164, 168, 171, 172, 183, 223 Barthes, R. 212 Basaglia, F. 151 Bateson, G. 140 Baudrillard, J. 7, 8, 176, 183, 184, 185, 186, 187-9, 190, 191, 195, 198, 199, 202, 203, 210,211,214,215 Bauman, Z. 163, 176-7, 178-9, 181, 185, 202, 206,214 Bebbington, P. 61 Beckett, A. 204 Beckett, S. 151,156,204 Beer, G. 5 Bennett, A. 222 Bentall, R. P. 2, 14, 39, 47, 50, 58, 59 Bentham, J. 97, 178, 180 Berger, B. 175 Berger, P. 175 Berman, J. 166 Berrios, G. E. 20-1,35-6 Bin, K. 162 Binswanger, L. 70 Blackshaw, T. 179 Blankenburg, W. 162 Bleakley, A. 31 Bleuler, E. 1,6, 7, 16, 34, 46-50, 51-2, 53, 54, 55, 56, 57, 59, 65, 68, 69, 70, 80, 133, 151
Bligh,J. 31 Blount, J. 204 Blume, H. 207 Bogue, R. 149, 152 Bolton, D. 4, 131, 165 Boroughs, W. 131 Bortle, S. 136 Boyers, R. 131 Boyle, M. 38-9,48,50 Bracken, P. J. 17, 58, 60, 132, 223 Braidotti, R. 150 Braun, J. 174 Breathnach, C. S. 33 Breggin, P. R. 58 Broome, M. R. 164-5 Buchanan, I. 145, 160 Buchanan, R. W. 58 Burke, E. 26-7, 28, 29, 32, 44, 138 Burroughs, W. S. 9 Burston, D. 130,136 Busfield, J. 126 Butler, J. 189 Canetti, E. 91, 92-4, 101, 154 Caouette, J. 222 Carmichael, S. 130,144 Carpenter, W. T. 34 Castle, D.J. 14 Charon, R. 223 Cheetham, M. A. 8, 15, 28, 29, 45, 99 Chesler, P. 125 Chung, M. C. 14 Cohen, S. 131 Colebrook, C. 150 Conley, J. 206,210 Cooper, D. 130,131,140,151 Cooper, R. 55, 165 COPE Initiative 127 Craddock, N. 39 Craig, T. K. J. 61 Crapanzano, V. 84, 98, 101, 106 Cresswell, M. 132 Crichton, P. 47,49 Crossley, M. 6, 24, 127 Crossley, N. 6, 24, 127, 143-4, 223 Crow, T.J. 39,54,59 Currie, M. 183, 186, 196, 197 Cuthbert, B. N. 39 Cutting, G. 23
Davidson, L. 61,223 deCerteau, M. 82,94,204 deChirico, G. 200 deMan, P. 173 Delay, J. 130 Deleuze, G. 7, 9, 91, 131, 144, 145-61, 162, 166, 167, 176, 185, 187, 188-9, 190, 193, 194, 196, 200, 204,210 Derrida, J. 21, 22, 23, 24, 25, 29, 32, 158-9, 173 Deveson, A. 222 Dixon, L. B. 58 Dobbs, D. 34 Donnelly, M. 131 Due, R. 160 Dupont, J. 158 Eagleton, T. 27, 28, 192 Editor, Nature 14 Ehrenberg, A. 9, 184-5 Elliott, A. 150,160,197,198 Ellis, B. E. 8, 202, 204-19, 222 Engstrom, E. J. 35, 40 Esquirol, J. E. D. 37 Estroff, S. E. 6,40,223 Ettler, J. 206 Evans, D. 115,121 Fabrega, H. 40, 184 Farmer, A. E. 52 Farrell, J. 83,92 Fatemi, S. H. 60 Fearne, P. 223 Fee, D. 197 Felman, S. 23, 24, 25, 32, 203 Ferns, P. 6 Fine, R. 65,76,84 Fink, B. 110,112,119,120-1 Finlay, M. 197 Flechsig, P. E. 34, 76, 78-9, 90, 91, 94, 98, 102, 103, 113, 127-8,213 Fliess, W. 68 Folsom, T. D. 60 Foster, H. 186 Foucault, M. 9, 16-25, 29, 30-1, 32, 33, 34, 41, 97, 125, 129, 131, 136, 148, 158, 160, 162, 167, 175, 177-8, 180, 213, 214 Fraguas, D. 33 Frances, A. 34 Frank, M. 150 Frankland, G. 204 Freud, S. 7, 34, 63, 64, 65, 66, 67, 68, 69-70, 71, 72, 75, 76-84, 85-6, 87, 88, 89, 98, 99, 100-1, 104, 105, 108-10, 111, 113, 114, 116, 121, 133, 138, 145, 151, 153, 154, 155, 156, 158, 165, 166, 191, 203, 220 Frith, C. 33 Fromm-Reichmann, F. 166-7
Frosh, S. 183, 186, 193-4, 197-8 Fusar-Poli, P. 46 Gabel, J. 149-50, 185 Gauntlett, D. 176 Gawith, L. 60 Geanellos, R. 223 Geddes, J. 58 Geekie, J. 223 Geertz, C. 184 Genosko, G. 151-2 Georgaca, E. 112-13 Gergen 197 Giddens, A. 175 Gilman, S. L. 36, 46, 57, 95, 213 Ginsberg, A. 130 Glass, J. M. 150, 174, 197 Goffman, E. 42, 125, 126, 129, 135-6, 137, 140, 209 Goh, R. B. H. 196,221 Goldberg, A. 41,57 Goldstein, J. M. 53 Gordon, C. 16, 17, 23 Gottesman, I. 60 Gottschalk, S. 197 Goulimari, P. 200 Grant, T.J. 58 Green, M. F. 15,62 Greenberg, J. 166,222 Greene, T. 39 Grigg, R. 110-11,120 Grinker, R. R. 15 Grossberg, L. 195 Guattari, F. 7, 91, 131, 144, 145-61, 162, 166, 167, 185, 187, 188-9, 190, 193, 194, 196, 200, 204,210 Hacking, I. 165 Hagan, W. 97 Haghgooie, S. 14 Haghighat, R. 6 Hammersley, P. 2 Haraway, D. 176 Hardt, M. 186 Hare, E. 33 Harland, R. 59 Harvey, D. 176, 183, 186, 195-6, 197 Hauser, R. 35 Hayne, Y. 223 Healy, D. 35, 40, 46, 48, 54, 57, 58, 59, 61, 128, 130 Heckers, S. 39,40 Heinze, R. 205 Helyer, R. 218 Hill, P. 112 Hinshdwood, R. 1>. 65 Hirsch, S. R. 54 Hocnigt). M
Hoff, P. 37 Holland, E. W. 150-1 Hollos, I. 158 Hooke, A. E. 17 Hornstein, G. A. 61, 166 Houen, A. 208 Houston, R. A. 16 Howes, O. E. 59 Huffman, R. 131 Hunter, R. A. 76,81,85-6 Hutcheon, L. 184 Hutchinson, G. 14 Insel, T. R. 21, 39, 62 Israels, H. 87 Jaaro-Peled, H. 14 Jackson, H. 53 Jameson, F. 3, 7-8, 176, 181, 183, 184, 185, 186, 189-96, 198-200, 201-2, 203, 204, 206, 209,210,211,214 Jaspers, K. 7, 16, 43, 45, 48, 50-1, 52, 56, 60, 68, 75-6, 82, 116, 137, 138, 139, 162, 164, 170,219, 220 Jenkins, J. H. 40,60, 171,223 Jervis, G. 131 Jervis, J. 41 Jeste, D.V. 54 Johnston, E. C. 7, 33, 38, 47-8, 52, 53, 60 Johnston, J. 183, 186, 196-7 Johnstone, L. 223 Jones, E. 65 Judd, L. L. 13 Jung, C. 48, 65, 66, 67, 68-71, 72-5, 76, 83, 84, 110, 151, 166 Kahlbaum, K. L. 44 Kant, I. 15,27-8,29,30,31,51,84, 99, 107, 138 Kapur, S. 59 Karl, F. 173 Katan, M. 85, 100 Kellendonk, C. 14 Kellner, D. 189 Kendler, K. S. 59 Kermode, F. 173 Kerr, J. 70,71,72 Kinney, D. K. 14 Kirby, K. M. 198 Kirk, S. A. 55 Kittler, F. 90 Kleiman, R. 112 Klein, M. 117-18, 119, 137, 151, 166, 171 Kleinman, A. 15 Kotowicz, Z. 129, 131, 137, 142 Kovel, J. 174 Kraepelin, E. 7, 16, 34-46, 47, 48, 49, 50, 51, 53, 54, 56, 59, 60, 61, 62, 65, 66,
68, 69, 71, 80, 84, 102, 133, 151, 152-3, 157, 164,219 Kreyenbuhl, J. 58 Kristeva, J. 173 Kutchins, H. 55 Lacan, J. 3, 7, 63, 64, 67, 81, 108-20, 121, 138, 151, 152, 153-4, 156, 158, 166, 185, 189, 193, 194, 203 LaCapra, D. 24 Laing, A. C. 130 Laing, R. D. 6, 7, 9, 17, 18, 88-9, 125, 126, 129, 136-42, 143, 149, 151, 159, 162, 167, 170 Lasch, C. 190 Laugharne, R. 223 Lawrence, D. H. 151 Lawrie, S. M. 39 Lee, M.J. 180 Levin, D. M. 174, 197 Levin, T. Y. 179 Lewin, M. 14 Lewine, R. R. J. 53 Lewis, B. 223 Lieberman, J. A. 58 Littlewood, R. 6 Lothane, Z. 88-90, 91, 92, 93-4, 101, 128,129 Lotringer, S. 131,150 Luque, R. 20 Lyon, D. 179-80 Lyotard, J.-F. 131,148,173 Lysaker, J. T. 40,223 Lysaker, P. H. 40, 223 Macalpine, I. 76, 81, 85-6, 108 MacDonald, A. W. 54 Mandel, E. 190 Mann, S. 119 Mannoni, O. 103 Marcuse, H. 130 Marini, M. 108, 112, 114, 120, 121 Marshall, P. D. 206 Marx, K. 145 Mason, S. E. 59,121 Massumi, B. 150 Mathiesen, T. 179 McDonald, C. 13 McGlashan, T. H. 99 McGuffin, P. 15,61 Mclnerney, J. 206 McKenna, P.J. 35,52 McLaughlin, T. 2 McLean, A. H. 6, 127 McLean, R. 222 McNally, K. 47 Meinhof, U. 131 Mendelsohn, D. 204
Mental Health Division 61 Metzl, J. 3, 14, 144, 172, 187 Meyer-Lindenberg, A. 2 Micale, M. S. 128,129 Michaels, W. B. 211,221 Michalczuk, R. 58 Miller, H. 151 Miller, J. 14,33 Miller, R. 59, 121 Minkowski, E. 149, 150, 162, 185 Mitchell, A. 58 Mitchell, N. 132 Moncrieff, J. 58 Morel, B.-A. 35 Morgan, A. 185 Morgan, C. 14 Morris, M. 39 Morse, M. 202 Mueser, K. T. 54 Munch, E. 191 Munster, A. 158 Nasrallah, H. 58 Nelson, G. 127 Niederland, W. G. 86-8, 89, 99, 114, 154 Nielsen, H. S. 205,218 Nietzsche, F. 23,200 Nijkinsky, V. 151 Noll, R. 14,36 O'Brien, B. 222 O'Hara, M. 14 O'Neill, J. 192 O'Tuathaigh, C. M. P. 14 Orrill, R. 131 Orwell, G. 180 Owen, M.J. 39 Page, A. 166 Parnas, J. 163, 169, 170 Patientenkollektiv 131 Patton, P. 150 Paulson, R. 29 Pease, D.E. 31 Perelman, B. 204 Peters, J. D. 97, 208-9, 220-1 Petersen, P. S. 205 Pinel, P. 20 Plant, S. 146 Poland, J. 59 Politi, P. 46 Porter, R. 44, 128, 129 Postel, J. 130 Punter, D. 205,218 Rajchman, J. 150 Ramon, S. 61 Ratcliffc, M. 4
Read, J. 223 Read, R. 171 Renee 166, 171, 172, 185, 193, 199-201, 204,222 Richardson, O. 204 Richardson, W. J. I l l Robbins, B. D. 91-2 Roberts, M.S. 97 Romme, M. 39 Ronell, A. 74, 198 Rose, J. 194 Rose, N. 20, 41, 184 Rosenhan, D. L. 134 Roudinesco, E. 114 Rümke, H. C. 51 Russell, D. 126 Saks, E. 223 Samuels, A. 72 Santner, E. L. 87, 89, 91, 94-6, 114, 178, 213,215 Sarraute, N. 172 Sartorius, N. 59 Sass, L. A. 7, 8, 9, 33, 63, 65, 84-5, 91, 94, 96-8, 101, 150, 162-75, 176, 177-8, 180-1, 183, 184, 199, 200-1, 202, 204, 205,213,214,215-16,218, 221 Schatzman, M. 88, 89, 90, 91, 93-4, 121, 154, 170 Scheff, T. J. 126, 135-6, 137, 140 Schiller, L. 222 Schneider, K. 34,52,53 Schreber, D. G. M. 86-7, 88, 89, 91, 93, 94, 97, 98, 114, 121,213 Schreber, D. P. 5, 7, 34, 64, 65, 66-7, 68, 73, 75, 76-108, 110, 113-15, 118, 120, 121, 127, 128, 147, 151, 153-7, 158, 166, 170, 172, 173, 178, 193, 212-15, 219, 222 Schulz, S. C. 54 Schwarz, H. 131 Scull, A. 17,33 Sechehaye, M. 166 Sedgwick, P. 129, 130, 133-4, 135, 142 Serres, M. 22 Shaw, P. 25 Shean, G. D. 13 Shorter, E. 35, 37, 46, 57, 68, 128 Showalter, E. 173,222 Sica, A. 150 Smart, B. 175 Smith,A.C. 52 Smith, D. 178,179 Snyder, K. 222-3 Sontag, S. 4-5 Speed, E. 6 Spencer, II. I l l Stunghrllini, G. 4 Steele, R, S. 06
Stephan, K. E. 60 Stephanson, A. 191 Stephenson, W. 214 Stevens, A. 73 Stiller, B. 207 Strous, R. D. 46 Sullivan, H. S. 65 Swingewood, A. 150 Szasz, T. 7, 57, 62, 88-9, 125, 126, 129, 131, 132-6, 137, 142-3, 162, 171 Tai, S. 58 Tausk, V. 151,166,172 Taylor, B. 200 Tester, K. 176, 177, 179 Theweleit, K. 68 Thomas, P. 58,60, 132 Thornton, K. 4 Thurschwell, P. 82 Torrey, E. F. 14, 33, 46, 93 Tsuang, M. T. 14 Turkington, D. 58 Turner, T. 61 Ussher, J. 126 Van Gogh, V. 191 van Os, J. 2, 14 Vatz, R. E. 133 Velligan, D. I. 58
Villagrán, J. M. 20 Viskerr, R. 19,20 Warhol, A. 173,191,211 Watters, E. 15 Weber, G. 77, 78, 90, 91, 103, 127-8, 213 Weber, M. M. 40 Weeks, K. 186 Weibel, P. 180 Weinberg, L. S. 133 Weinberger, D. R. 54 Wernicke, C. 37, 44 Westphal, M. 92 Whitaker, R. 129 Williamson, P. 59 Willick, M. S. 65, 119 Wittgenstein, L. 96, 97 Woods, A. 173,222 Woods, S. W. 34, 199 Woolf, V. 172 World Health Organisation 15, 55 Xia, J. 58 Yolken, R. H. 14,46,93 Yonge, O. 223 Young, E. 207 2izek, S. 116,180,189,211
Subject Index
1968 student protests, Paris 130 advocacy groups 128 aetiology of schizophrenia 14, 46 antipsychiatry 129 biological accounts 59, 129, 164 Bleuler's writings 49 brain disease 36, 37, 49, 54, 59-60 defective filter theories 53-4 dopamine hypothesis 58-9 ego boundaries, loss of 55, 64 Freud's writings 78 heredity 36, 58, 59, 129, 164 homosexuality 79, 80, 81, 85-6, 91, 92, 93, 98, 100, 104, 108-9, 110, 113, 129, 153 impaired reality testing 55, 64 institutional neurosis theories 53 Jung's writings 70, 71 Kraepelin's writings 36, 37, 38, 49 parenting 119 paternal function, failure of the 120-1, 129 psychic structure 93, 112-13, 116-17, 119, 120, 121, 194 recency hypothesis 33 regressive hypothesis 64-5, 72, 117-18, 165, 166, 167 Sass's writings 170 toxin theory 65, 70, 71, 72, 73 trauma 155 and treatments 58-9 viral hypothesis 33, 129 alienation and schizophrenia 108, 140, 170 Anti-Oedipus: Capitalism and Schizophrenia (Deleuze and Guattari) 7, 145-7 Baudrillard's writings 188-9 capitalism 148-9 critical responses 150-3 Jameson's writings 189,193,194 politics of the sublime 157-61 postmodernism 183, 185, 186 Sass's writings 169 and Schreber's Memoirs 153-7 antipsychiatry 4, 125-31, 143-4,220,223 Deleuze and Guattari's Anti-Oedipus 146, 147, 159 Foucault's Madness and Civilization 17, 97, 131 Guattari 151-2 Laing 88-9, 136-43 literary texts 203-4 metatheory 162
postmodernism 183 Sass 163, 167, 168 Schreber's Memoirs 88, 89, 94 Szasz 88-9, 132-6, 142-3 apophany 201 asylums and psychiatric institutions antipsychiatry 127, 128, 135 Foucault's writings 19, 30-1 Goffman 135 Kraepelin's Clinical Psychiatry 41, 42, 44 records 33 Schreber 76, 77, 89, 90, 127 symptomatic behaviour produced by 42, 53, 135 autistic disorder 56 autobiographical accounts of schizophrenia 222-3 see also Autobiography of a Schizophrenic Girl (Renee); Memoirs of My Nervous Illness (Schreber) Autobiography of a Schizophrenic Girl (Renee) 166, 172, 185 Jameson's analysis 193, 199-200, 201-2, 204 Sass's analysis 200-1, 204 auto-eroticism 66 Abraham's writings 72, 80 Freud's writings 68, 81 Babette S. (Jung's patient) 73-4, 75, 76, 82, 83 Beat fiction 156 biographical accounts of schizophrenia 222-3 biological psychiatry see psychiatry: biological bizarre, schizophrenia as 52, 55, 56, 117, 139, 164 breakthrough and liberation, schizophrenia as 141, 167 Burgholzli clinic 68, 70, 71, 72, 73 capitalism 176 see also consumerism Ellis's Glamorama 206, 209, 211, 213, 214 and schizophrenia 129, 144, 197 Baudrillard 186, 195 Currie 196 Deleuze and Guattari 146, 147-9, 158, 160, 167, 190 Goh 196 Jameson 186, 190-2, 194, 195,202
catatonia see sub-types of schizophrenia: catatonia celebrity Ellis's Glamorama 204,210,215 and psychotic discourse, resemblance between 208-9 synopticon 179,214 chlorpromazine 57, 128, 130 cinematic representations of schizophrenia 203-4 civil liberties and psychiatry 134 class consciousness 199 clinical picture of schizophrenia 223 Kraepelin 36, 37-8, 39, 48, 49 Clinical Psychiatry (Kraepelin) 7, 16, 34-46 and Bleuler's Dementia Praecox 48, 49, 50 influence of 54 and Jaspers's General Psychopathology 50 clinical theory, defined 3-4 Clinique de la Borde 152 cognitive dysfunction 67 cognitive mapping 195,214 communication technologies 176, 187, 190,205 and schizophrenia 188, 220-1 see also media complexity of schizophrenia 1-2 comprehensible, schizophrenia as 165, 170, 171 consumer/survivor/ex-patient 6 consumerism 178-80, 182, 196, 197, 214 see also capitalism Ellis's Glamorama 206,210-11 consumers 6, 178-80, 202 contested language/vocabulary of schizophrenia 2, 3, 6, 126-7 continuum with normal experience, schizophrenia as on a 20, 39, 65 antipsychiatry 126, 137 Freud's writings 81 Klein's writings 118 crisis of signification, schizophrenia as 192, 193 cultural factors in schizophrenia 60, 175 cultural theory, defined 3-4 defective filter theories of schizophrenia 53-4 delusions see symptoms of schizophrenia: delusions/delusional schema degeneration 35-6, 168 dementia 47 Schreber's Memoirs 101, 104, 106 dementia praecox 65-6 Abraham 65-6,68-9,71-2,80 Freud 68,75,76-84 Jung 65,66,68-71,72-5,76 Kraepelin's Clinical Psychiatry 34-46, 48 language 6
mental deterioration 164 renaming as schizophrenia 34, 46-7 Dementia Praecox or The Group of Schizophrenias (Bleuler) 7, 16, 46-50 first appearance in print of'schizophrenia' term 1,46 and Jaspers's General Psychopathology 50 depression 90, 185 see also manic-depressive psychosis desire and schizophrenia 146 deterritorializing process, schizophrenia as a 158 Diagnostic and Statistical Manual (American Psychiatric Association) 34, 54-6, 62 aetiology of schizophrenia 59 and indeterminacy of schizophrenia 61 diagnostic criteria for schizophrenia 49, 53, 55-6 and indeterminacy of schizophrenia 61 Dialectics of Liberation Conference 130, 144 disordered speech see symptoms of schizophrenia: disordered speech disorganized schizophrenia see sub-types of schizophrenia: disorganized Divided Self The (Laing) 7, 126, 136-9, 140, 141, 143, 159 dopamine hypothesis of schizophrenia 58-9 dreams 70, 74 Ecstasy of Communication, The (Baudrillard) 8, 185, 186-9,210 ego antipsychiatry 142 Klein's writings 117-18 Lacan's writings 110 Laing 142 libido theory 80 Schreber's Memoirs 98, 104 word-association test 70 ego boundaries, loss of 167 ego-psychology 64, 65 Klein's writings 119 Schreber's Memoirs 98 electro-convulsive treatment 57 emancipation, schizophrenia as 159 embodiment and schizophrenia 144, 173, 198-9 enlightenment, schizophrenia as 159 epidemiology of schizophrenia 14-15, 53 exigent introspection 163,169,181 fantasy, feminine 79 fascism 92,93,95 see also psychiatry: and the Nazi regime feminist movement 125-6
foreclosure Ellis's Glamorama 214 Lacan's writings 110-11, 112, 113, 114, 117, 119, 120, 193 free association 70 frontal lobe lobotomy 57
International Classification of Diseases (WHO) 55 interpretive problem or puzzle, schizophrenia as 118 ipseity disturbance, schizophrenia as 163, 169
gender and schizophrenia 14, 53 Baudrillard's writings 187 Lacan's writings 119-21 Sass's writings 172,173 see also feminist movement General Psychopathology (Jaspers) 7, 16, 50-2, 138, 139 Glamorama (Ellis) 8, 202, 204-5, 220 postmodernism 205-15, 222 and the schizophrenic sublime 215-19 governess psychosis 57
Kraepelinian classification of the psychoses 35
hallucinations see symptoms of schizophrenia: hallucinations hebephrenia see sub-types of schizophrenia: hebephrenia hermeneutic approach to schizophrenia 36, 64, 82, 84 homosexuality 57 aetiology of schizophrenia 79, 80, 81,85-6,91,92, 93, 98, 100, 104, 108-9, 110, 113, 129, 153 Schreber's Memoirs 85, 91, 92, 93, 104 Freud's writings 80,81,86 hyperreflexivity and schizophrenia 163, 168-71, 173, 174,175 hypochondria 76, 86, 100, 101 hysteria 48, 64, 65, 120 Abraham's writings 71 Baudrillard's writings 187 and'the feminine' 121 Jung's writings 69-70 as privileged psychic disorder of psychoanalysis 68 idleness 19, 41 insanity 15, 33, 54 Esquirol's taxonomies of 37 Foucault's Madness and Civilization 16-25,32,41 Freud's career 66 Kraepelin's career 44 Laing's writings 139,142 laws, Germany 128 Morel 35 Sass's writings 173 Schreber 90, 127 institutional neurosis theories of schizophrenia 53 insulin coma therapy 57 interdisciplinary inquiry, importance of 2
label, schizophrenia as a 129, 135, 136, 140 labour and schizophrenia 19,40-1,42-3,56 work ethic 177,178,179 language, identity as a function of 192 language/vocabulary of schizophrenia, contested 3, 6, 126-7 latent schizophrenia 50, 55 liberation, schizophrenia as 141, 167 libido 69, 75, 79-80, 86, 94, 98, 104, 113 liquid modernity 163, 176-7, 18 Ellis's Glamorama 206 see also postmodernity literary representations of schizophrenia 203-4 literature, relevance to studies of psychopathology 203-4 lobotomy 57 loss of subjective depth, schizophrenia as 184 madness antipsychiatry 125, 129 Laing 136, 141, 142 crisis of representation 32 'Dionysian' model of 167, 172 feminist movement 126 Foucault's writings 17, 18, 21-5, 29, 32-3, 34 and gender 173 Guattari's writings 151-2 Lacan's writings 109 language 6 Sass's writings 96 Madness and Civilization (Foucault) 16-25, 29, 33, 97, 158-9 antipsychiatry 17,97,131 Madness and Modernism (Sass) 7, 162, 163-75, 176, 180-1, 200-1, 202 literary texts 204, 205 manic-depressive psychosis Bentall 39 Diagnostic and Statistical Manual 56 Heckers 40 Kraepelin 36,39,40,49 Marxism and post-Marxism 14, l76»149-50 musturbatory insanity/psychosis 36, 57
S< hreb< r'i Memoirs
85,100,101
media antipsychiatry 128 celebrity and psychotic discourse, resemblance between 208-9 Ellis's Glamorama 205,215 postmodernity 176, 179, 180, 202 synopticon 179,180,215 see also communication technologies medical gaze 30-1 mega-vitamins 57 melancholia 184-5 Memoirs of My Nervous Illness (Schreber) 5, 7, 64, 66-7, 84-5, 204 criticism of psychiatry 127 Deleuze and Guattari's Anti-Oedipus 147, 154-7 and Ellis's Glamorama 205, 212-15, 219 Freud's analysis 65, 66, 73, 75, 76-84, 121, 138,153 Klein's analysis 118 Lacan's analysis 108-9, 110, 113-15, 120, 153-4, 193 power and politics 91-100, 154 psychoanalytic and (psycho)biographical analyses 85-91, 154 sublime 100-8 mental health policy 60, 223 mental health service users 6 Mental Illness and Psychology (Foucault) 17-18,21,24 metatheoretical framework 8, 162 autobiographical and biographical accounts of schizophrenia 223 Deleuze and Guattari's Anti-Oedipus 147, 155, 157-8 Sass 163, 167, 168,216 see also sublime modernism 176 Jameson's writings 191,192 and schizophrenia 181 see also Madness and Modernism (Sass) modernity 220 Deleuze and Guattari's Anti-Oedipus 156 Foucault's Madness and Civilization 24 panopticon 97, 177-8 and postmodernity 176-7,180 Sass's writings 171,175 and schizophrenia 33, 174, 175, 181 recency hypothesis 33 Schreber's Memoirs 95-6, 213, 215 mood disorder 56 moral choice, schizophrenia as a 133 multiple personality disorder 57 mystery of schizophrenia 15 Name-of-the-Father Ellis's Gla mora ma 214 Jameson's writings 194
Lacan's writings 67, 111, 112, 113-14, 117, 119, 120, 153-4, 193 narcissism Ellis's Glamorama 212 Freud's writings 80, 81 Klein's writings 117 narratives 222-3 neologisms Jung's writings 73-4 Lacan's writings 111 Schreber's 83 neuroscience 59 neurosis 64, 65 Abraham's writings 71 and dementia praecox, comparison between 69, 76 Freud's 'Psycho-Analytic Notes' 66, 80, 81 Lacan's writings 109, 110, 111 New Horizons strategy 61 normal experience and schizophrenia see continuum with normal experience, schizophrenia as on a nosology Diagnostic and Statistical Manual 34 Foucault's Madness and Civilization 21 Freud's writings 81,85 Kraepelin's Clinical Psychiatry 35, 37, 39 Lacan's writings 109 psychoanalysis and biological psychiatry, differences between 68 object-relations theory 64,119 Oedipal complex Lacan's writings 111 Schreber's Memoirs 85-6 see also Anti-Oedipus: Capitalism and Schizophrenia (Deleuze and Guattari) Other to psychiatry, schizophrenia as 41, 164 over-diagnosis of schizophrenia 134 panopticon 177-8, 214 and consumer society 179 Ellis's Glamorama 215 and postmodernism 180, 202, 214 and schizophrenia 97 see also synopticon 'paranoid', figure of the 147, 148, 149, 152, 157, 159 paranoid-schizoid position 117, 119, 137 paranoid schizophrenia see sub-types of schizophrenia: paranoia paraphrenia 6, 63 Freud's writings 81, 108, 109, 121 pervasive developmental disorder 56 phenomenology of health and illness 5 of mental illness 18 of the postmodern 222
of psychopathology 4 of schizophrenia 3, 9, 181 GabePs writings 185 Jaspers' General Psychopathology 50-1, 138 Laing's The Divided Self 126, 137, 138 Sass's writings 163, 165, 172, 181, 183, 199,201 politics of psychoanalysis 67-8 of schizophrenia 66 antipsychiatry 130, 141 Deleuze and Guattari's AntiOedipus 157-61 Schreber's Memoirs 92-3 Politics of Experience, The (Laing) 7, 136, 138, 140-2, 159 popular imaginary of schizophrenia 27, 64 postmodernism 3, 163,221 Deleuze and Guattari's Anti-Oedipus 146, 160-1
Ellis's Glamorama 204-16, 218, 219, 222 paradoxical 184 Sass's writings 173-4 and schizophrenia 3, 181, 183-6, 195-202, 203 Ellis's Glamorama 205, 208, 209, 210-11, 212,216,219 figure of 'the postmodern schizophrenic' 186-9 Jameson's 'Cultural Logic of Late Capitalism' 189-95 stimmung 200-1, 202 Postmodernism, or the Cultural Logic of Late Capitalism (Jameson) 3, 7-8, 185, 186, 189-95, 196, 201-2 postmodernity 175-82 and schizophrenia 180-1, 186, 221 Sass's writings 173,175,181 see also liquid modernity postpsychiatry 60 praecox feeling 51,52,170 projection 79, 111-12 psyche Baudrillard's Ecstasy of Communication 188 Jaspers's General Psychopathology 51 origins of dementia praecox 72 psychiatry 34-46 antipsychiatry see antipsychiatry asylums see asylums and psychiatric institutions authority of 15 biological 46, 50, 68, 223 critiques 127-8 and phenomenology 165 Schreber's Memoirs 89, 90, 93, 94, 102-3 and civil liberties 132,134 clinical encounter 52
critiques of 4, 39, 127-9 see also antipsychiatry Deleuze and Guattari's Anti-Oedipus 148, 158 and the disciplinary sublime 8, 16, 29, 63, 67, 84, 137 history of 46 institutions see asylums and psychiatric institutions medical gaze 30-1 and the Nazi regime 46, 62, 72 Schreber's Memoirs 92, 93, 94, 95 philosophy of 4-5, 9 and psychology, distinction between 66 Sass's writings 168 schizophrenia as defining problem for 15 schizophrenia as Other to 41, 164 and scientificity 39, 40, 128 transcultural 60, 121, 174 psychic deterritorialization, schizophrenia as 146 psychoanalysis 118 antipsychiatry 128, 137, 138 Deleuze and Guattari's Anti-Oedipus 146, 147,154-5, 158-9 dementia praecox and neurosis, similarities between 68-9 Foucault's Mental Illness and Psychology 18 Freud's writings 67-8, 69, 77-84 hysteria 68, 75 Jaspers's writings 116 Jung's writings 69, 70, 73, 75, 76 Klein's writings 117-18 Lacan's writings 108, 114-15, 116, 117 Laing's writings 137, 138 politics 67-8 and psychiatry, distinction between 66 Sass's writings 165-6, 168 Schreber's Memoirs 77-93,99, 154-5 social significance in schizophrenia 122 textual sublime 63-4 'Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia' (Freud) 7, 66, 76-84, 85-6, 87, 88, 89, 99 Jung's influence 75 Lacanon 108-9,138 rationality, Schreber's crisis of 100-1 psychological accounts of schizophrenia 18, 47, 143, 144, 162, 224 Bleuler 46, 47, 50 Jaspers 51 Jung 65, 68, 69, 70, 73, 75 Kraepelin 35,45,49 Sass 163, 164, 175, 202, 204 Schreber 84, 92, 93, 97 Psychology of Dementia Praecox, The (lung) 65,69-71,73-4,76
psychopathology, relevance of literature to studies of 203-4 psychopharmacology 57-8, 59, 61, 220 antipsychiatry 128, 130 Psychoses, The (Lacan) 7, 108-17, 118 sublime 114, 116-17, 118-19 psychosexual development 64-5 'Psycho-Sexual Differences between Hysteria and Dementia Praecox' (Abraham) 65-6,71-2 psychosexual origins of paranoia 68 psychosis 65 Abraham's writings 71 antipsychiatry 125, 126, 134, 135, 140, 141 and celebrity 208-9,212 dementia praecox and neurosis, similarities between 69 Diagnostic and Statistical Manual 54-5 Ellis's Glamorama 209 Freud's writings 66,81-5, 109 hermeneutics 36 Jameson's writings 193, 194 Jung's writings 71 Klein's writings 118 Lacan's writings 63, 108-21, 193, 194 Laing's writings 126,138,140,141 language 6 and'the masculine' 121 psychoanalytic theory of 81, 83-4 Schreber's Memoirs 81-8, 90-1, 94-6, 101, 107-8,115, 120 substance-induced 56 Szasz's writings 134,135 psychosis risk syndrome 34 race and schizophrenia 3, 14, 96, 144, 172, 173, 199 rebellion, schizophrenia as 158 recency hypothesis of schizophrenia 33 recovery approach to schizophrenia 61 regressive hypothesis of schizophrenia 64-5, 72 Klein 117-18 Sass 165, 166, 167 relevance of literature to studies of psychopathology 203-4 religious interpretations of schizophrenia 92, 93, 102, 103, 104-7 repression 79-80, 81, 149 residual schizophrenia 34, 55 revolutionary, schizophrenia as 144, 146-7, 149, 159, 197 romanticizing of schizophrenia 15 schizo, in Deleuze and Guattari's AntiOedipus 145-9, 152, 155-7, 159-61, 188,210,211 schizoaffective disorder 56
schizoanalysis 158 Schizo-Culture 131 Schizo-Culture convention 131 schizoid states 137 Schizophrenia: The Sacred Symbol of Psychiatry (Szasz) 7, 132-5 schizophrenia aetiology see aetiology of schizophrenia alienation and 108, 140, 170 autobiographical account 222-3 as bizarre 52, 55, 56, 117, 139, 164 as breakthrough and liberation 141, 167 capitalism and see capitalism: and schizophrenia clinical picture 36, 37-8, 39, 48, 49, 223 communication technologies and 188, 220-1
as comprehensible 165,170,171 contested language/vocabulary of 2, 3, 6,126-7 as on a continuum with normal experience see continuum with normal experience as crisis of signification 192, 193 desire and 146 diagnostic criteria 49, 53, 55-6, 61 embodiment and 144, 173, 198-9 epidemiology 14-15, 53 gender and see gender and schizophrenia hyperreflexivity and 163,168-71, 173, 174, 175 as interpretive problem or puzzle 118 as ipseity disturbance 163, 169 as a label 129,135,136,140 labour and 19,40-1,42-3,56 literary and cinematic representations 203-4 as loss of subjective depth 184 modernism and 181 see also Madness and Modernism (Sass) modernity and 33, 174, 175, 181 as Other to psychiatry 41, 164 panopticon and 97 phenomenology see phenomenology: of schizophrenia politics of see politics: of schizophrenia popular imaginary 27, 64 postmodernism and see postmodernism and schizophrenia postmodernity and 173, 175, 180-1, 186, 221 as psychic deterritorialization 146 psychological accounts see psychological accounts of schizophrenia race and 3, 14, 96, 144, 172, 173, 199 religious interpretations 92, 93, 102,103, 104-7 as revolutionary 144, 146-7, 149, 159, 197
as scientific delusion 38 as social crisis 130 solipsism and 97-8 as sublime experience 8, 126, 136, 139-42, 143 sub-types see sub-types of schizophrenia symptoms see symptoms of schizophrenia temporality 196, 198 as theoretic topos 3 as ununderstandable 50, 51-2, 56, 139, 164, 170 'schizophrenic', figure of the 144 antipsychiatry 125, 127, 130, 131, 144 Laing 138 Szasz 133, 135 Deleuze and Guattari's Anti-Oedipus 147, 148,149, 152, 156-7, 159-60, 161 postmodernity 181, 183, 186-9, 196-7, 199 schizophrenogenic 64 antipsychiatry 130, 131, 140-1 Klein 119 Laing 140-1 Schreber's Memoirs 88 scientific delusion, schizophrenia as 38 scientificity and psychiatry 39, 40, 128 self 40, 164 modern 41, 43 Deleuze and Guattari's Anti-Oedipus 161 Schreber's Memoirs 91 postmodern 181-2 Semiotext(e) 131, 150, 186 sexuality 199 see also homosexuality shamanism, Schreber's Memoirs 91-2 signification, schizophrenia as crisis of 192, 193 simple schizophrenia 50, 55 social crisis, schizophrenia as 130 solipsism and schizophrenia 97-8 somatic symptoms 63, 67, 86, 87, 96, 97, 155, 164 Sonnenstein asylum 76, 90, 93, 105, 155 soul murder 78-9, 90, 94, 98, 127 speech, disordered see symptoms of schizophrenia: disordered speech SPK (Socialist Patients' Collective) 131, 151-2 stigma 1,15,20,47 antipsychiatry 127, 128 psychosis risk syndrome 34 public education campaigns 59 stimmung 200-1,202,203 Ellis's Glamorama 209,210,212 subjective depth, schizophrenia as loss of 184 subjectivity see self sublimation 66
sublime 15-16, 25-9, 61-2, 65, 224 antipsychiatry 125, 126, 131, 136, 162 Laing 136, 137-9, 141-2, 143, 159 Szasz 134, 135, 143 Bleuler's Dementia Praecox 50 definition 8 Deleuze and Guattari's Anti-Oedipus 147, 159, 160, 161 Diagnostic and Statistical Manual 56, 57 disciplinary sublime 8, 16,25-9,63, 64, 67, 84, 137 Jaspers's General Psychopathology 51 Kraepelin's Clinical Psychiatry 43-6 Lacan's The Psychoses 114, 116-17, 118-19,189 paradoxical sublime 8, 183-5, 186 Baudrillard's writings 188, 189 Jameson's writings 190, 194 postmodernism 183-4, 188, 197, 200 Ellis's Glamorama 205,209,215-19 Sass's writings 163, 165, 168, 170-1, 183, 201 schizophrenia as an experience of 8, 126 Laing 136, 139-42, 143 schizophrenic sublime 8, 29-34, 221, 222,223 Ellis's Glamorama 215-19 postmodernism 194, 197, 201 Schreber's Memoirs 84, 99-108, 118, 154 technological 194-5 textual sublime 8, 63-5, 67 Laing 137 Schreber's Memoirs 84 sublime experience, schizophrenia as 8, 126 Laing 136, 139-42, 143 sub stance-induced psychosis 56 sub-types of schizophrenia catatonia 3 4 , 3 6 , 4 9 , 5 5 Deleuze and Guattari's Anti-Oedipus 152 Freud 68 Jung 74 Laing 137 Schreber's Memoirs 157 disorganized 34, 55 Deleuze and Guattari's Anti-Oedipus hebephrenia 34, 36, 49, 55 Deleuze and Guattari's AntiOedipus 152-3 Freud 68 Jung 73, 74 Kraepelin 152-3 Laing 137 Schreber's Memoirs 157 latent 50,55 paranoia 34, 36, 49, 55 Deleuze and Guattari's Anti-Oedipus 152 Freud 6 8 , 7 5 , 7 9 , 8 0 - 3 , 8 7 Jung 74
sub-types of schizophrenia (cont.) Lacan 108, 109 Laing 137 Schreber's Memoirs 64, 68, 79-83, 87, 90-1, 92, 93, 107, 157 residual 34, 55 simple 50, 55 undifferentiated 34, 55, 152 suffering 1, 4, 6, 14, 24-5, 57, 134, 168 surveillance 179-80 symptoms of schizophrenia 14, 48, 52, 53, 84 antipsychiatry 125, 135 Babette S. 74,75 Bleuler's Dementia Praecox 48-9, 50, 52, 53 cognitive dysfunction 67 delusions/delusional schema 29, 36, 55, 56, 66, 73, 165, 220 Babette S. 74, 75 Deleuze and Guattari's Anti-Oedipus 155, 200 Ellis's Glamorama 209,212,216,219 Jameson 194 Lacan 111, 113, 116, 154 Laing 159 Sass 169, 173 Schreber 75, 77-80, 83, 85-8, 92-108, 113, 115, 121, 153, 154, 156, 157, 170, 173,212,213 disordered speech 22, 24, 55, 63, 73, 75, 76, 111, 115, 117, 137 first rank 52 fundamental/accessory 48, 52, 53 hallucinations 36, 48, 52, 55, 56, 66, 73, 81, 84, 166 Deleuze and Guattari's Anti-Oedipus 155 Ellis's Glamorama 216 Johnston 197,202 Lacan 111,116 Sass 169 Schreber 83, 155 Kraepelin's Clinical Psychiatry 41, 42 negative 48, 53, 163, 169
positive 53 primary/secondary 48, 52 Schreber 66, 75, 77-80, 83, 85-8, 92, 94-108, 113, 115, 121, 153-7, 170, 173,212,213 somatic 63, 67, 86, 87, 96, 97, 155,164 and technologies 220 textual approach 9, 64, 76, 77, 81, 84-5, 114,115, 138, 222-3 synopticon 179,214-15 Tarnation 222 temporarily of schizophrenia 196, 198 textual approach to schizophrenia 9, 64, 76, 77,81,84-5, 114, 115, 138, 222-3 see also hermeneutic approach to schizophrenia theoretical topos, schizophrenia as 3 therapeutic treatment see treatments and therapy for schizophrenia time-space compression 195-6 Time to Change campaign 61 toxin theory of schizophrenia 65, 70, 71,72,73 transference 66 transvestite fantasies, Schreber's Memoirs 90, 173 treatments and therapy for schizophrenia 38, 57-8, 129 see also psychopharmacology trema 200-1 undifferentiated schizophrenia 34, 55, 152 ununderstandable, schizophrenia as 50, 51-2, 56, 139, 164, 170 violence 29 in Ellis's Glamorama 205, 211, 212, 214 viral hypothesis of schizophrenia 33, 129 vocabulary of schizophrenia, contested 2, 3, 6,126-7 word-association test 70 word salad 74 work ethic 177, 178, 179 see also labour
Schizophrenia has been one of psychiatry's most contested diagnostic categories. It has also served as a metaphor for cultural theorists to interpret modern and postmodern understandings of the self.These radical, compelling, and puzzling appropriations of clinical accounts of schizophrenia have been dismissed by many as illegitimate, insensitive, and inappropriate. Until now, no attempt has been made to analyse them systematically, nor has their significance for our broader understanding of this most'ununderstandable' of experiences been addressed. The Sublime Object of Psychiatry is the first book to study representations of schizophrenia across a wide range of disciplines and discourses: biological and phenomenological psychiatry, psychoanalysis, critical psychology, antipsychiatry, and postmodern philosophy. In the first part of the book, Woods offers a fresh analysis of the foundational clinical accounts of schizophrenia, concentrating on the work of Emit Kraepelin, Eugen Bleuler, Karl Jaspers, Sigmund Freud, and Jacques Lacan. In the second part, she examines how these accounts were critiqued, adapted, and mobilized in the 'cultural theory' of R..D. Laing.Thomas Szasz, Gilles Deleuze, Félix Guattari, Louis Sass, Fredric Jameson, and Jean Baudrillard. Using the aesthetic concept of the sublime as an organizing framework, Woods explains how a clinical diagnostic category came to be transformed into a potent metaphor in cultural theory, and how, in that transformation, schizophrenia came to be associated with the everyday experience of modern and postmodern life. A s Susan Sontag once wrote,'Any important disease whose causality is murky, and for which treatment is ineffectual, tends to be awash in significance'. The Sublime Object of Psychiatry does not provide an answer to the question 'What is schizophrenia?', but instead brings clinical and cultural theory into dialogue in order to explain how schizophrenia became 'awash in significance'.
