Can feminist psychoanalytic theory reshape the concept of schizophrenia?

I find it hard to tell you

I find it hard to take

When people run in circles it’s a very, very

Mad world

Mad world

(Andrews and Jules, 2001)

Introduction

The concept of Schizophrenia is probably one of the most popular and more misrepresented mental health concepts in our society (Frith and Johnstone, 2003). The ‘mad’ have changed shape and locus in Western society over the centuries, and are now either among ‘us’, or in institutions. As will be argued in this essay, these individuals remain cast out and othered.

This paper will attempt to assert if there is a different way of considering the concept of Schizophrenia through the lenses of feminist psychoanalytic discourse.

First of all, the concept of schizophrenia will be considered, from its dubious beginnings with Kraeplin and Bleuler (Boyle, 1998; Read, 2004a, 1990). Subsequently, modern psychoanalytic concepts of intersubjectivity and also existential phenomenology will be used to see if there can be a different way to look at the concept of schizophrenia. Finally, this essay will delve into feminist theory and will try to asses if it could reshape the way schizophrenia is looked at, as a way of social control and oppression of minorities by the medical and capitalist ‘male’ gaze.

I acknowledge that in this essay the works referenced are limited and that there are many more ways of looking at schizophrenia: in this essay, the main avenue of interest is that of social control, stigmatisation, and objectification. I also wish to state that the purpose of this essay is by no means to diminish the reality of the experience that has been labelled ‘schizophrenia’ and the pain and suffering it can bring to the affected individuals and their families. I would also like to note that throughout the essay I will refer to ‘schizophrenia’ in inverted commas to highlight my scepticism at the validity of the concept.

The creation of schizophrenia?

Authors like Read (2004a), Boyle (1990) and many others have pointed out the dubious beginnings of the concept of ‘schizophrenia’ in the research and observations conducted by Kraeplin and Bleuler, even referring to its ‘invention’ (Read, 2004a) and ‘non-discovery’ (Boyle, 1990). They point out discrepancies such as the fact that ‘Kraeplin and Bleuler were…describing a totally different population from that called schizophrenic today, and one, moreover, which would not now be called schizophrenic’ (Boyle, 1990, p. 15) and also that the concept lacks empirical evidence when the author accuses Kraeplin and Bleuler of fitting their ‘evidence’ into their ‘concept’, one can argue to make sure there was a ‘disease’ to ‘cure’ with new drugs. Although they might have saved psychiatry from its crisis, they created a ‘scientifically meaningless and socially devastating label’ (Read, 2004a, p. 34).

This premise is key to begin looking at ‘schizophrenia’ with different eyes, and possibly update the concept, its treatment, and the prejudices associated with it: ‘schizophrenia’ is not as reliable a diagnosis as might be thought.

It has been pointed out before by many authors that the medical profession has always exercised power and authority as men of knowledge. I would go as far as to agree with Foucault’s (1965) concept of medical ‘gaze’, which objectifies the patient (which I would argue is exactly Kraeplin and Bleuler did by observing, classifying and ultimately stigmatising people with mental health issues into the strange box of ‘schizophrenia’). Doctors are trusted to care for their patients just as parents are trusted by their children to take care of them. It is no wonder that psychiatry, with its medical orientation, has benefited from the same status. Additionally, some authors (Read, 2004b; Pilgrim, 1992) have suggested that psychiatrists have been expected to exercise ‘social control’, as they took care of the ‘mad’, those individuals whose behaviours was deemed different and inappropriate for society. It is no wonder that it has been found that people of colour and women are diagnosed with ‘schizophrenia’ at a higher rate that white men (Frith and Johnstone, 2003). One could argue that, over the centuries, whether it be the church, the community or the psychiatrists, the ‘mad’ have always been cast out in one way or another, and that nowadays this has been made much easier by the fact that we can hide ‘them’ away in institutions (Foucault, 1965). I would argue that this is indicative of the same social oppression that the concept of ‘schizophrenia’ exercises, which feminist theorists like De Beauvoir (1997), Mitchell (1990) and many others have pointed to with regards to women. We only need to look at Laing and Esterson’s Sanity, Madness and Family (1990). Their work on ‘schizophrenia’ can be considered progressive and innovative, and has been very influential in changing the way ‘madness’ is viewed, for the simple reason that they assume an existential phenomenological stance when considering ‘schizophrenics’ and their ‘schizophrenia-inducing’, psychotic families, which was an immense shift from the previous studies which blamed either biology, or the developments failures of the individual. However, it would be a mistake to ignore the fact that ‘all Laing’s detailed accounts are of ‘schizophrenic’ women’ and ‘centre around the mother-child relationship’ (Mitchell,1990, p. 285) and furthermore that in these accounts ‘the mother fares rather badly’ (ibid., p. 290). Greenwald (1992) and Mitchell (1990) both point out that for a very long time the ‘schizophrenogenic’ mother has been blamed for the child’s schizophrenia, and that only recently has the focus shifted to biology, genetics, environment, and the wider family. On the same note, Mitchell (1990, p. 281) points out that ‘if ‘madness’ is, as Laing claims, a false description in the malign pursuit of differentiation, it is no ‘truer’ to label a parent ‘psychotic’ than it is to do this to its child’. The assumption remains that ‘schizophrenia’ is a maladaptive and abnormal development, which someone or something must take the blame for. The fact remains that someone (or a gene) must be cast out. Is there no way of accepting ‘madness’ as part of the human experience, and not as something that needs to be controlled and expelled?

What I have attempted to show in this paragraph is the link that can be made between the forms ‘social control’ and oppression that are inherent both in the concept of ‘schizophrenia’ and in the place of women in society, as seen in the microworld of the family, and just how ingrained they are in Western society. Not only is the label of ‘schizophrenia’ dubious and damaging, it also perpetuates the oppression that society exercises on all minorities, be it youth, women, people of colour, or gay people.

Intersubjectivity – a new hope?

Not all is doom and gloom. In recent years, there has been a clear shift in psychoanalysis towards intersubjectivity (Benjamin, 2017). No longer is the focus only on the intrapsychic dynamics of the patients, or on their past relationships only: the role of the patient-analyst relationship has increased in importance and is used by intersubjective analyst as a model to understand the patient. No only this, but Benjamin (2017) and others argue that there is co-creation in the unique relationship between the analyst and the patient, which is never the same with a different patient or a different therapist, and is key to understanding the relationship. Unfortunately, there is too much to say about intersubjectivity which cannot be discussed within the limits of this essay. What I want to draw attention to is the greater sense of subjectivity that is given to the patient and much greater involvement of the analyst in the transference and counter-transference (in the relationship). I believe this to be a very important step forward, which can also be applied in the treatment of ‘schizophrenia’ – if the patient is no longer a puppet manoeuvred by drives and objects, then surely the same can be said about those people described as ‘schizophrenic’. I believe than an important step was taken when Laing and Esterson (1990) started to look at the milieu of the family for answers, but now it is time to use the person of the analyst in therapy with ‘schizophrenic’ individuals. In the work of Searles (1965), it is encouraging to see how he uses his own person in the relationship, in the counter-transference, and in finding a way to communicate authentically with the ‘schizophrenic’, for example when his patient, Edith, refers to a feather as a symbol for understanding that she is not the only one, she is not alone, and Searles (1965, p. 703) admits to feeling guilty that he never told her that he ‘too, had a feather’. Subsequently, this then helps Edith to ‘find that the therapist possesses in reality essentially the same qualities which she has come to know in herself’ (Searles, 1965, p. 704). What a momentous change! The patient is human like the analyst! The ‘mad’ no longer is reduced to an object of madness!

Although it can be argued that we, the ‘sane’, cannot ever know what it’s like (Frith and Johnstone, 2003; Hinshelwood, 2004) to experience ‘schizophrenia’, do we not sometimes get the feeling that there is something ‘mad’ in all of us? Can it not be that we fear ‘losing our minds’ so much, that we must split and displace such fear on ‘scapegoated’ (Mitchell, 1990, p. 277) individuals, i.e. ‘schizophrenics’? I will argue now that the concepts of objectification, recognition, and domination (as found in feminist theory) can be very helpful in our understanding of ‘schizophrenia’.

Feminist theory

Before the third wave of feminism had even started in the 60s, De Beauvoir (1997) had already developed, informed by existential philosophy, the woman as the absolute, objectified Other. Just as ‘one is not born, but rather becomes, a woman’ (De Beauvoir, 1997, p. 301), one can argue that one is not born, but rather becomes, a ‘schizophrenic’. Just as the male gaze objectifies woman, is it not fair to say that the medical (white, male) gaze objectifies the ‘schizophrenic’ (mad, other, minority), perpetuating the infinite spiral into ‘madness’? If I am told continuously that my experience is not normal, that I am mad, I might start to believe it, and I might behave in such a way as to make the experts’ conclusions true. 

I have found unexpectedly interesting and applicable the work of Benjamin on domination. In the Bonds of Love, Benjamin (1988) writes: ‘the subject fears becoming like the object he controls, which no longer has the capacity to recognize him’ (p.185) and, moreover, ‘as domination is rationalized and depersonalized, it becomes invisible, and seems to be natural and necessary’ (p. 186). In her description, I see the image of the oppressed: the ‘schizophrenic’, feared by fellow humans because of what they represent – the loss of one’s mind, the loss of one’s subjectivity to an all-consuming illness –  needs to be controlled, dominated, oppressed, and must be made invisible, just as the oppression must be made invisible. Foucault (1965) echoes the same sentiment when he points out how, when the ‘mad’ are locked away, society is more than happy not to know or see what happens behind closed doors, as long as it remains invisible: ‘now madness would never – could never – cause fear again; it would be afraid, without recourse or return, thus entirely in the hands of the pedagogy of good sense, of truth, and of morality’ (p. 245).

The ‘schizophrenic’ is reduced to a non-subject (by which I mean that it is stripped of subjectivity, becomes an it) which incarnates all that is feared, and thus can be disposed of; what it possesses is that which also belongs to us, but which is split off and displaced: ‘what we cannot bear to own, we can only repudiate’ (Benjamin, 1998, p. 95). Is splitting not the sign of a paranoid-schizoid personality? Are we not all of ‘us’ considered sane, mad? Maybe Laing and Esterson (1990) were right when they saw ‘schizophrenia’ as a normal reaction to a mad world.

The schizophrenic now having become a non-subject to the objectifying gaze and having been locked away out of sight, it is fair to say that ‘recognition’ (Benjamin, 1998) is missing in our relationship with ‘them’: here is ‘the breakdown of recognition into domination’ (Benjamin, 1998, p. 84), which is ‘not equivalent to mere negation’ (ibid., p. 96), as the negation of the ‘schizophrenic’s’ experience would at least mean that the is a valid experience to negate. 

Here, we find then that domination is the mode of relating; this is a violent stripping of subjectivity, where ‘violence is the outer perimeter of the less dramatic tendency of the subject to force the other to either be or want what it wants’ (Benjamin, 1998, p. 86). These other subjects, the mad, who, ‘not only in their mere existence as separate beings reflect our lack of control, but who also threaten to evoke in us what we have repudiated in order to protect the self: weakness, vulnerability, decay, or perhaps sexual otherness, transgression, instability’ (Benjamin, 1998, p. 95) must be repudiated and stripped of subjectivity, so that they may not threaten us.

As Benjamin (1998, p. 92) asks the reader ‘can we recognize her?’, I ask: ‘can we recognize them?’

This ties in again with the concept of social control, whereas the masculine scientific, the ‘experts step in to explain that there is something wrong with their brains, and condemn them to even greater depths of powerlessness, hopelessness and loneliness’ (Read, 2004b, p. 168). This becomes no longer a purely feminist issues, but the issue of ‘an inhuman and depersonalised capitalist world’ (Mitchell, 1990, p. 278), where the rich capitalists, who dictate the social norms, are white and male, and rule over the minorities. This is a social(ist) issue, which begs us to re-consider what we do when we thoughtlessly stick the label ‘schizophrenia’ on an individual: ‘if the predicament of women, children, gay people is just used as a battle-cry and its origins and functions in society not comprehended, it will never be overcome’ (Mitchell, 1990, p. 278).

A masculine scientific (Benjamin, 1988) has dominated the psychoanalytic and psychiatric field over the centuries. Mitchell (1990, p. 286) argues that ‘psychoanalytical theory is both less adequate on femininity and psychosis than it is on masculinity and neurosis’ as femininity and psychosis lie within the mysterious shadow world of the pre-Oedipal period, which Freud could never come to explain fully, as well as femininity. This shows in Laing and Esterson’s (1990) work too: Mitchell argues (1990, p. 291) that ‘the absence of the ‘absent’ father from Laing’s portrayal of schizophrenia is of particular importance to feminism’ which is ‘as absent…as it is from the pre-Oedipal phase within which the psychosis develops’ (ibid., p. 291).

The masculine scientific which created ‘schizophrenia’ fails, even in Laing, even in Searles, to go beyond the label of ‘schizophrenia’ and to realise the far-reaching implications of objectifying and oppressing those deemed unacceptable by society. It appears to me that intersubjectivity is not enough. Existential phenomenology is not enough. Feminism is not enough. What is needed is a true revolution of society’s perceptions of the ‘abnormal’, the ‘different’, the ‘other’.

In practice

What has been discussed here might not at first seem relevant for a trainee psychotherapist’s practice. ‘When would you even see a ‘schizophrenic’?’ – one might ask. However, I believe that I have presented some very applicable notions.

I must re-consider my role in the relationship – am I perpetuating a cycle of oppression, personified in the authority figure of the ‘doctor’? Am I using myself in the relationship, or do I just observe? Am I being with the client or just doing to?

Especially when it comes to clients from a minority background, I believe that the issue of oppression and objectification are very present and must be addressed for therapy to be real and useful. Sometimes, these issues can be so ingrained, so subtle, so unrecognizable (because accepted), that by not addressing them, we run the risk of perpetuating the problematic invisibility mentioned above.

I am female, I am not from this country – I, too, have a feather.

Conclusion

I hope to have started in this essay a conversation about the damaging implications of the concept of ‘schizophrenia’. I have shown how the concept itself, since its beginnings with Kraeplin (whose research was founded by Rockerfeller, who was hoping for a piece of the big pharma cake), is dubious and invalid to say the least. I have shown how ingrained the status of the ‘mad’ is in our society, even to the extent that existential phenomenological enquiry cannot but merely displace the ‘psychosis’ on the family and the society. I have argued that feminist theory might help us to understand more this epidemic of social control, through the concepts of the objectification of the Other, and the absence of recognition and negation in domination. I have touched then on the issues of minorities in society and how this is reflected in the treatment of ‘schizophrenics’. 

It seems clear that there are many ways to look at the issue, but what strikes me is that I cannot accept the concept of ‘schizophrenia’ as valid after inquiring into it. It really does seem to do more harm than good, perpetuating wider issues of social acceptance and control, and even of the struggle between the ‘male’ and the ‘female’, more generally between the ‘subject’ and the ‘other’. If the ‘sane’ are the only ones permitted a narrative, how we expect people with mental health issues, disabilities, minority backgrounds to have a voice and therefore to have a subjectivity?

The sartrian gaze that we (and I include myself) cast upon the other is damaging and problematic. A more integrated way of being with (as supposed to doing to) the other is needed, until there can finally be recognition.

For our practice as therapists, what has been discussed in this paper should make us reflect on the way we relate to our clients – do we gaze upon them or do we recognize them?

I do realise that what I have suggested might seem utopic (a society free of oppression?) but I believe that the issue of ‘madness’ is a very important issue which must be discussed and talked about openly and honestly, and maybe, if we just accepted the ‘mad’ in all of us, it might bring us closer to the other and enrich our experience.

Reference List:

Andrews, M. and Jules. G. (2001). ‘Mad World’. Lyrics by: Orzabal, R. (1982). In: Trading Snakeoil for Wolftickets. [Apple Music]. London: Sanctuary.

Benjamin, J. (1988). The Bonds of Love: Psychoanalysis, Feminism, and the Problem of Domination. New York, NY: Pantheon Books.

Benjamin, J. (1998). The Shadow of the Other: Intersubjectivity and Gender in Psychoanalysis. London: Routledge.

Benjamin, J. (2017). ‘Playing at the Edge: Negation, Recognition and the lawful world’, Beyond Doer and Done To. London: Routledge, pp. 181-214

Boyle, M. (1990). ‘The Non-Discovery of Schizophrenia? Kraeplin and Bleuler Reconsidered’. In: Bentall, R. P., ed., Reconstructing Schizophrenia. London: Routledge, pp. 3-22

De Beauvoir, S. (1997). The Second Sex. London: Vintage Classics.

Frith, C. and Johnstone, E. (2003). Schizophrenia: A Very Short Introduction. Oxford: Oxford University Press.

Foucault, M. (1965). Madness and Civilization: A History of Insanity in the Age of Reason. New York: Random House.

Hinshelwood, R. D. (2004). ‘What’s it like? Psychoanalytic Theories of Schizophrenia’, Suffering Insanity: Psychoanalytic Essays on Psychosis. London: Routledge, pp.  47-105

Greenwald, D. (1992). ‘Psychotic Disorders with Emphasis on Schizophrenia’. In: L. S. Brown and M. Ballou, eds., Personality and Psychopathology: Feminist Reappraisals. New York: Guilford Press, pp. 144-176

Laing, R. D. and Esterson, A. (1990). ‘The Danzigs’, Sanity, Madness and the Family. 3rd ed. London: Penguin Books, pp. 109-130

Mitchell, J. (1990). Psychoanalysis and Feminism. 3rd ed. London: Penguin Books

Pilgrim, D. (1990). ‘Competing Histories of Madness: Some Implications for Modern Psychiatry’. In: Bentall, R. P., ed., Reconstructing Schizophrenia. London: Routledge, pp. 211-233

Read, J. (2004a). ‘The Invention of ‘Schizophrenia’’. In: J. Read, L. Mosher and R. Bentall, eds., Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. London: Brunner-Routledge, pp.21-34

Read, J. (2004b). ‘Poverty, Ethnicity and Gender’. In: J. Read, L. Mosher and R. Bentall, eds., Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. London: Brunner-Routledge, pp.161-194

Searles, H. F. (1965) ‘Transference Psychosis in the Psychotherapy of Chronic Schizophrenia’, Collected Papers on Schizophrenia and Related Subjects. London: Maresfield Library, pp. 654-716

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