- Wisdom, Madness and Folly: The Making of a Psychiatrist by R.D. Laing
Macmillan, 147 pp, £9.95, February 1985, ISBN 0 333 37075 9
Schizophrenia is now held to be one of the major illnesses of mankind, but its recognition as a clinical syndrome is of relatively recent origin. There is something very odd about the sudden arrival of the chronic schizophrenic on the stage of history at the end of the 19th century. One hypothesis which has been canvassed recently is that schizophrenia was a novel condition, unknown before the end of the 18th century, which spread as a slow, possibly viral epidemic across Europe and the United States in the 19th century, contributing in large measure to the vast increase in the population of asylums, and culminating in its recognition, under the name dementia praecox, as a definite syndrome by Emil Kraepelin in 1899. But a more historically-minded reading delivers a rather different interpretation of the coincidence between the identification of the chronic schizophrenic as a progressively deteriorating type and the transformation of the asylum into a custodial institution for the socially unproductive. On this view, the formulation of schizophrenia as a chronic condition was deeply implicated in a field of social forces in which people who suffered from mental tribulation came to be represented as lacking any semblance of social value.
To argue in this way is to espouse the kind of dynamic nominalism which Ian Hacking proposes as a way of understanding the dilemmas of the human sciences. ‘Categories of people,’ Hacking suggests, ‘come into existence at the same time as kinds of people come into being to fit those categories, and there is a two-way interaction between these processes.’ So, for example, the writings of Michel Foucault are to be understood as ‘in part stories about the connection between certain kinds of description coming into being or going out of existence, and certain kinds of people coming into being or going out of existence’. On this reading, the category of schizophrenia, and the authoritative description of the schizophrenic, came into being at a time when different kinds of people became available for diagnosis as chronic types and scientific operators stood prepared to identify them as such. What was offered was not an innocent reporting: under the institutionalised conditions of observation afforded by the asylum the chronic schizophrenic came more closely to resemble what others in any case already took him to be.
Recent studies of schizophrenic lives across the years of this century have lent a good deal of plausibility to arguments of this kind and demonstrated, among other things, the crucial role played by the individual’s sense of his own value – his assessment of his relation to moral community – in the outcome of schizophrenic illness. The lives of schizophrenics are certainly not devoid of causal properties, but the extraction of these from their historical context is a hazardous affair, and over the past century our understanding of schizophrenic predicaments has been greatly impeded by intellectual frameworks which have sought to disclaim the historical constitution both of schizophrenic lives and of the categories in which we attempt to describe schizophrenics.
The full text of this book review is only available to subscribers of the London Review of Books.