Paul Eugen Bleuler (1857-1939), a Swiss psychiatrist responsible for devising the contentious word “schizophrenia”
Many interesting issues were raised by our discussion with Paul Hammersley. Perhaps the most obvious concerns the extent to which we were persuaded by Paul of the urgent necessity to find an alternative to what he characterizes as the “appallingly stigmatizing diagnosis” of schizophrenia. That is to say, did we in the end feel that schizophrenia is a label with the awful capacity to ruin lives, and therefore agree with him that renaming it – whether with Paul’s preferred designation of “post-traumatic psychosis” or else some similar term such as that proposed by US-based psychiatrist Colin Ross, “dissociative psychosis” – would have great benefit with regard to the treatment and public perception of schizophrenic people?
It should be noted that, although Paul’s own position is a nuanced one, some of his colleagues go further in their detestation of the schizophrenia label, holding that to describe someone as “schizophrenic” is tantamount to foisting on them a subhuman status, and is a manifestation of the same dehumanizing logic that led ultimately to the atrocities of the Nazi concentration camps – schizophrenic patients are consequently, on this view, the Untermenschen of our societies, in the Nietzschean/National Socialist sense of the word. It’s claimed, moreover, that the “abolitionist” fight to free people from the label is of the same nature as the campaign to end slavery, or equivalent to the feminist struggle for women’s rights. While it may seem exaggerated, even absurd and tasteless, to compare on the one hand Auschwitz and Treblinka, and on the other the psychiatric institutions of the present day, we should nonetheless remember that psychiatric patients were among the first victims of Nazi forced sterilisation and murder, and thus that fascist Germany does indeed provide a limit case for the extremes to which prejudice against the mentally ill can lead. One might also recall the application of the label “sluggishly progressing schizophrenia” in the former USSR – by accredited state psychiatrists – as one permitting the gross ill treatment of dissidents by that regime, and note that in the UK schizophrenic persons can find themselves robbed of the freedom to refuse medication.
It would be foolish to deny that the schizophrenia tag is at least to some degree problematic, given its (almost entirely baseless) association with violence in the public mind, and the perhaps forgivable semantic confusion over a word which translates literally as “split mind” and hence evokes mistaken notions of a Jekyll and Hyde-type character (in other words, of what is today known either as dissociative identity disorder or multiple personality disorder, a quite different psychiatric condition). The latter misperception is an enduring one, with even so elevated an intellect as T.S. Eliot having fallen into its trap in a piece of writing of his from 1933, and seems difficult to eradicate. However, it remains to be demonstrated that merely replacing one word with another would provide a real solution to such problems. In Japan, in fact, following a concerted campaign there by service users and their families, “integration disorder” has recently displaced the word schizophrenia, but already there are indications that the old stigmas are attaching themselves to the new label. We should also observe that, as Paul Hammersley tends to dispute the very existence of schizophrenia as an illness – to quote him, “the claim that there is a medical condition called schizophrenia doesn’t stand up to scrutiny” – there would appear to be a logical inconsistency in his efforts to rename this allegedly phantom disorder. Since the umbrella label of schizophrenia shelters a highly diverse set of symptoms, it might actually be better, then, to break down a monolithic, undoubtedly culturally loaded appellation into a number of more precise ones. When the word “schizophrenia” was coined around a century ago, there was reference made by early advocates of the diagnosis to a group of schizophrenias (Eugen Bleuler, for instance, wrote an influential 1911 treatise entitled Dementia Praecox, or the Group of Schizophrenias), so it may be that psychiatrists since then have erred in being content to work with a single catch-all concept.
Among the members of our group diagnosed with schizophrenia, one, Steve, has expressed himself relatively happy with the word. David Sweetsur, by contrast, is far less reconciled to it and is sympathetic to Paul Hammersley’s arguments. No doubt vigorous debate on the topic will continue within the Pathways group, and among mental health professionals and the larger community of service users.
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