Orna Ophir - Schizophrenia

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Schizophrenia: краткое содержание, описание и аннотация

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Throughout the world, schizophrenia is a diagnosis now in decline, representing a radical shift in our historical and medical understanding of madness and mental distress. But what does this medical term, first coined by a Swiss psychiatrist in 1908, mean? And why is it increasingly unpopular among patients and the medical establishment?
Historian and clinician Orna Ophir unearths the stories of patients and doctors as they struggle to make sense of this debilitating condition. At different times, patients have been depicted as possessed by demons, or simply “inspired,” as hearing voices, suffering from a “split-mind,” or merely having difficulty in “integrating” experiences. Now, a century after its birth, schizophrenia is increasingly viewed not as a radical, abnormal disease defined by an ever-changing cluster of symptoms, but the extreme end of a spectrum on which we are all located.
The story Ophir tells is a hopeful one: As patients and doctors sought to overcome stigma and improve therapeutic outcomes, they have shown ever-greater sensitivity to diversity and difference.
gestures toward a future in which clinicians and patients will collaborate in the search for better outcomes.

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Prophets or Beasts? Madness in the Bible

And the Spirit of God came upon him, and he prophesied among them. And it came to pass, when all that knew him beforetime saw that, behold, he prophesied among the prophets, then the people said one to another, what is this that is come unto the son of Kish? Is Saul also among the prophets? (1 Samuel 10:10–11)

Although schizophrenia is a diagnosis used in psychiatry, the term “madness” was not always understood, or used, as a medical concept. In fact, as Madalina Vârtejanu-Joubert, an expert on madness in Ancient Near East History and the Hebrew Bible, argues, when it comes to the early Hebrew tradition, madness is not part of the history of medicine but of political, religious, and legal anthropology. 13In the Hebrew Bible, madmen are characterized either as human beings who have been degraded to the level of beasts, or as select individuals who are elevated towards the presence of the divine. In both cases, men who behave in strange ways seem incomprehensible to their fellow human beings, having become something other than merely recognizably human. Whether they belong to the animal kingdom or the divine realm, mad people are deemed to be, so it seems, of an entirely different, unique kind.

The first time the word “madness” appears in the Hebrew Bible, in the Book of Deuteronomy, it is presented as a form of divine punishment. As Moses delivers the Lord’s words to the people of Israel (recounting all the blessings He shall grant them should they follow His words, and listing the numerous curses He will bring upon them should they not hearken to His voice), he says: “The Lord will smite you with madness and with blindness and with bewilderment of heart.” 14As Vârtejanu-Joubert shows, the Hebrew word for madness, “shigaon” resembles expressions with a similar root in other ancient Semitic languages, implying that to be mad is to be “like a bear with a sore head,” or “to squeal like a pig .” 15In fact, in the later story of Nebuchadnezzar, the king of Babylon, who is punished with madness for his pride, we clearly see this degradation of the monarch to a bestial, lower form of life. Nebuchadnezzar’s human heart (which was considered the seat of the higher faculties of reason, will, and judgment) is changed into that of an animal; he “eats grass as oxen , and his body is wet with the dew of heaven, until his hairs were grown like eagles’ feathers, and his nails like birds’ claws.” 16

Another depiction of madness as a degradation of the human spirit can be found in the gospels, in the New Testament. In Mark 5, Jesus is reported to visit the country of the Gerasenes and is confronted by “a man with an unclean spirit.” 17Here as well, the madman is compared to the wolves and the dogs that roam around naked, without shelter or clothing, screaming at the graveyard. The fearful villagers try to restrain the madman with chains and fetters, and feed him as if he were an animal. When Jesus is called to intervene and asks him for his name, the man replies: “My name is Legion; for we are many.” 18Jesus then sends the “legion,” the “unclean spirits” into a passing herd of swine which, having been transformed, run into the water and drown. As a result of this miracle, the demoniac (the man who had been possessed by demons) conducts himself as a human once again, “sitting and clothed and in his right mind.” 19

In these early traditions, however, madness does not always involve changing into a lower form of life. The word “mad” or meshuga is also used to designate the transformation into a higher form of being, namely that of the prophet, the navi . For example, in the famous case of King Saul’s bizarre gestures and nudity, the question arises of whether Saul should be counted “also among the prophets?” 20Indeed, in Hebrew, “to behave like a prophet” can also mean “to rave,” “to act like one who is beside himself,” or “to behave in an uncontrolled manner.” 21People who displayed behavior such as King Saul’s were seen as strange. As we saw in the words from 1 Samuel, cited in the epigraph to this section, those who knew him before noticed that he had changed:

And he stripped off his clothes also, and prophesied before Samuel in like manner, and lay down naked all that day and all that night. (1 Samuel 19:24)

They thus had to ask themselves what had happened to him and, indeed, whether he had become a raving prophet, from then on belonging to a different category of humans.

Yet not only bystanders or contemporaries, who all too often mocked and isolated those who were thus afflicted, questioned the transformation of those who, in fact, behaved like prophets. The latter themselves also acknowledged their alteration. Such individuals clearly experienced themselves as being different from the rest of society, with its firmly established customs and well-circumscribed, sanctioned forms of conduct.

That said, the prophets of the Bible are depicted in ways that make it difficult, even for their contemporaries, to know whether they are divinely inspired or, on the contrary, gravely deluded. Indeed, the prophets claimed that when the divine spirit seized them, they had visions and could not help but behave strangely. As emissaries of the divine, Hebrew prophets such as Isaiah, Jeremiah, Elijah, and Ezekiel are said to conduct themselves in eccentric and irrational ways. In fact, Ezekiel, more than others, has been retroactively diagnosed as a schizophrenic. 22

In these ancient depictions, madness is defined as a different spiritual quality that opposes the mad individual to those considered sane. Madness is seen as the result of possession (having an unclean spirit or being haunted by demons), as a consequence of “in-spiration” (that is, of being in the spirit of God that came “mightily upon” the individual in question) or as a departure of the good spirit, followed by torment by an evil substitute: 23

Now the spirit of the Lord departed from Saul, and an evil spirit from the Lord tormented him. (1 Samuel 16:14)

In Saul’s story, madness is a matter of “another heart,” 24while in the punishment of King Nebuchadnezzar, it is a change from a “man’s heart” to a “beast’s heart.” 25In these ancient texts, a qualitative , rather than quantitative , difference thus exists between the mad and the sane. If the work of the prophet is to communicate the word of God, who is so very different from humans, then it is possible that he, too, will be unintelligible. Since the work of God is seen as foreign or alien (in biblical Hebrew: “strange is his deed, and foreign is his act”), his messengers may very well be judged the same. 26The seemingly “mad” conduct of prophets is the irruption of God’s alterity into the world of humans, his strange otherness, which manifests itself in “deviant” and unexpected conduct and language. 27Mad persons are considered and shown to be different and outlandish, precisely due to this otherness.

The representation of madness in late antiquity (notably in the Jewish tradition known as the Halacha and the Aggada) is consistent with the depiction of its “strangeness” and “alterity” in the Bible. In these texts too, if not divinely foreign, the madman is perceived as other than human: he is said to walk alone at night, roaming like a dog or a wolf , sleeping in cemeteries, tearing off his clothes. 28The madman is also compared to an “ ox goring another ox,” a camel , or an ass . 29And, indeed, more generally, in both the Old and New Testaments (the Hebrew Bible and the Christian gospels), as well as in later Jewish Talmudic writings and rabbinical commentaries, madness, even when it is considered to be a temporary condition, most often connotes a categorically different kind of existence, with its own distinct and unique pattern of conduct and mental qualities.

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