Orna Ophir - Schizophrenia

The vote was cast, and the international association changed its name, deciding to remove “schizophrenia” from its very title. It was baptized as the International Society for Psychological and Social Approaches to Psychosis, at around the same time as the DSM-5 introduced a “schizophrenia spectrum” that replaced the earlier, more clear-cut, categorical classification of schizophrenia. Simultaneously, the American National Institute of Mental Health (NIMH) established the Research Domain Criteria (RDoC), which suggested an entirely new framework for the classification of mental illnesses, discarding the old psychopathological terms and searching for clues in genes, molecules, cells, and brain circuitry instead.

Given the personal and professional experiences recounted above, and with an eye on the recent trends in our disciplinary fields and institutions, when I was offered the chance to write a book about the history of schizophrenia, I thought of the many excellent, historical depictions of the “rise and fall” genre in this field. But the title of the book ended up being Schizophrenia: An Unfinished History , since its aim is not just to present a study of the appearance and possible disappearance of the term “schizophrenia,” or of the birth and the possible death of this diagnosis. Rather, its goal is, first and foremost, to inquire into the more perennial ways in which we define and respond to difference , mentally and conceptually, but also practically and institutionally.

1 1. The term “disease entity” or species morborum refers to a natural kind of disease. Just as there are species of animal or plants, and classes of chemical substance, there are also kinds or classes of disease. In the same way that biology constructs taxonomies or that chemistry arranges the elements in a periodic table, medicine arranges diseases in a systematic order by nosology.

2 2. I. F. Brockington, “Schizophrenia: Yesterday’s concept,” European Psychiatry 7, 5 (1992): 203–7.

3 3. Richard Bentall, Madness Explained: Psychosis and Human Nature (London: Penguin, 2004), 107.

4 4. Rina Dutta, Talya Greene, Jean Addington, et al., “Biological, life course, and cross-cultural studies all point toward the value of dimensional and developmental ratings in the classification of psychosis,” Schizophrenia Bulletin 33, (2007): 868–76.

5 5. Erik Simonsen, “Personality and psychosis,” in J. O. Johannessen, B. V. Martindale and J. Cullberg (eds.), Evolving Psychosis (London: Routledge, 2006), 37.

6 6. B. Martindale, “Response: A historical note,” in ISPS UK Newsletter June 12–13, 2007.

The work that I present here goes back to – and is deeply inspired by – my experience, which extended over two decades, as visitor, student, extern, intern, clinician, and teacher at Shalvata Mental Health Center, near Tel Aviv, in Israel. I owe profound and abiding thanks to the many patients and families, doctor and nurses, therapists and other health care workers I met there, who taught me more about the reality of extreme states of mind than I could possibly imagine and would not have found by consulting books alone. Over the years, the interns, residents, undergraduate, and graduate students in Israel and in the United States – especially recently at the Gallatin School of Individualized Studies at New York University (NYU), where I have been teaching a course on the history of madness since 2017, and at the Humanities Center at Johns Hopkins University, where I taught from 2015 to 2017 – challenged me, helping me clarify my ideas while offering their own insights, based on their experiences, those of their families, and extraordinarily diverse communities. I am deeply grateful to my Dean at NYU’s Gallatin School, Susanne Wofford, who welcomed me to this most unique academic institution and kindly offered a space to write when it was much needed.

Much of the work that will be discussed here is drawn from vast quantities of sophisticated scholarship, based on the research of the many psychiatrists, psychoanalysts, historians, anthropologists, philosophers, advocates, and service users, whose work I have encountered and came to admire over the years. It is truly inspiring – and deeply humbling – to see the magnitude and range of these efforts, not only to understand psychological pain on a theoretical level, but also to be of greater practical use to those who suffer, and, in so doing, to cultivate a vocation – an ethics, as I will call it – dedicated to alleviating and, where possible, preventing, psychic suffering. I have greatly learned – and continue to learn – from the extraordinary work of Roy Porter, Tanya Luhrmann, Greg Eghigian, Richard Noll, Ian Hacking, Elyn Saks, Kenneth Kendler, Nick Haslam, Kay Redfield Jamison, Andrew Scull, German Berrios, Josef Parnas, Susan Lamb, Peter Zachar, Kenneth Schaffner, Rachel Cooper, Jonathan Metzl, Assen Jablensky, Kieran McNally, Anne Harrington, Louis Sass, and Sander Gilman, to name but a few of those whose contributions to the history and philosophy of psychiatry in general – and of schizophrenia in particular – have been both formative and generative. Some of them have generously shared their latest insights with me, going beyond what is already available on the subject in print.

During my years of theoretical studies, practical training, and activist engagement for improved psychological understanding and treatment of those diagnosed with schizophrenia, I have come across brilliant minds, extraordinary clinicians, and committed citizens. I am especially thankful to Dr. Ann-Louise Silver and to the ISPS organization and its chapters, both in Israel and around the world. Our yearly conferences, reading groups, and work groups, bringing together service users, families, and mental health professionals, have always been inspiring and moving.

An in-depth study of the history of the field would not have been possible without the DeWitt Wallace Institute for Psychiatry, History, Policy and the Arts at Weill Cornell Medical College in New York City. Both its working groups, on the History of Psychoanalysis and on Psychoanalysis and the Humanities , have served as a supportive and facilitating intellectual environment. In my role as the director of the Richardson Seminar at the institute from 2016 to 2019, I was fortunate enough to invite many of the scholars whose work I found intriguing to discuss their research with us. I am immensely grateful to the mentorship and friendship of the director of the institute, George Makari, to its associate director Nathan Kravis, and to its members Rosemary Stevens, Ted Shapiro, Kathy Dalsimer, Bob Michels, Anne Hoffman, Aaron Esman, Nirav Soni, Larry Friedman, and Lenny Groopman. Larry, one of the most passionate and generous scholars of psychoanalysis I have ever met, has been instrumental in making helpful suggestions at a very early stage of this project. Lenny, a brilliant historian and a unique clinician, has always been an extraordinary teacher and a source of constant support and encouragement on this project and on others.

I also want to thank the members of the recently formed group of scholars that make up the Psychiatry, Psychoanalysis and Society working group at the DeWitt Wallace Institute for the History of Psychiatry: Kathryn Tabb, Thomas Dodman, Rachel Aviv, Dagmar Herzog, Alexandra Bacopoulos-Viau, Camille Robcis, Jonas Knatz, Stefanos Geroulanos, Jessica Kovler, Ben Kafka, and Larry McGrath, who provided invaluable comments and asked critical questions at various stages of this project. I especially thank Katie Tabb for her thoughtful contributions to the field overall, and for her specific recommendations for improvement and further reading regarding this specific project.