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COMMENT: Schizophrenic: the violated, degraded soul —Humair Hashmi

The hallucinations of a socially degraded person lead to his being labelled a schizophrenic and the hallucinations of a socially exalted person lead him to be labelled a “creative person” or a “mystic”

Schizophrenia is a most serious mental disorder characterised by delusions, hallucinations, disorganised speech, and extremely disorganised behaviour.

Delusions are false ideas. For example, if some one thinks that he is the most handsome man in the world while that is not the case, he is suffering from a delusion. In psychosis, i.e. the severe form of mental disorder, delusions are persistent, and the patient is convinced of their truth. A hallucination, on the other hand, is a perception without sensation. If someone hears sounds, or smells odours, when in reality there are no sounds or smells, the person is hallucinating. Hallucinations, too, are signs and symptoms of serious mental disorder.

Delusions and hallucinations should not, however, be confused with illusions which are honest errors of perception. If sees a twig, for example, while walking in a lawn in the evening and thinks that it is a snake, it is an error of perception — an illusion. Illusions happen frequently in every one’s life and need to be distinguished from delusions or hallucinations. The former belong in the “normal” and the latter in the “abnormal” category of perception.

Schizophrenia is characterised by the presence of delusions and hallucinations. The most recent classification of mental diseases, Diagnostic and Statistical Manual of Mental Diseases IV (DSM VI), outlines five major sub-types of the disease: the paranoid type, when hallucinations and delusions are frequently present; the disorganised type, marked by extreme speech and behavioural disorganisation; the catatonic type, characterised by motoric immobility; the undifferentiated type where bizarre symptoms are manifest but may not be included in the above three categories; and the residual type, where none of the above symptoms exist but there is a “continuing evidence of a deep disturbance in a patient, such as odd beliefs, or unusual perceptual experiences”. A belief, for example, that ants can communicate with humans is considered odd. A patient’s ability to listen to ants through an antenna made of sugar is, similarly, regarded an unusual perceptual experience.

The disease, at present classified under five major heads in the DSM IV, was classified under seven major heads about thirty years ago; and under eleven head about fifty years ago. It was then called an omnibus disease because its sub-classes were broad and diversified.

The “otherness” of the construct of schizophrenia has been, and still is, that whatever symptoms the doctors, psychiatrists and health workers do not understand, and find “odd” or bizarre in a person, gets lumped in the general category of schizophrenia. So that the “other” view of schizophrenia is that it may not be a disease in the conventional sense, or it may actually be a number of diseases that diagnosticians lump together. It is believed that the tools of diagnosis and measurement are crude, ineffective and lacking in precision. This crudeness and lack of precision of the diagnostic tools leads frequently to misdiagnosis and its attendant problems.

In the late sixties the British psychiatrist RD Laing put forward the view that there is no such disease as schizophrenia; and that the schizophrenic adopts a certain mode of behaviour that is a reaction to the violence that the patient suffers at the hands of the family in particular and the society in general. The family and the society label a weak or a meek person as a schizophrenic, send him to a hospital and start “treating” him. Laing believed that in labelling a person as schizophrenic, a number of people join in a “conspiracy” against the person. They include the person’s family members, the family doctors, psychiatrists, and the hospital staff. Labelling someone a schizophrenic, Laing argued, deprives a person of his rights as a human being. He is confined to a hospital against his will.

David Cooper in the seventies also put across a similar view on schizophrenia. His view was that while whether or not schizophrenia is a disease was debatable, the fact remained that the procedure generally followed in diagnosing and labelling a schizophrenic was a subtle method of unleashing violence on a weak person. A weak or a vulnerable person is first selected by the family to be the target of violence. He is first isolated and separated from the family, then marked as “odd” and finally labelled a schizophrenic by doctors and psychiatrists.

In the late seventies, A Esterson presented the case study of a young girl named Sarah Denzig who was branded a schizophrenic by a number of diagnosticians. Esterson showed that Sarah was labelled a schizophrenic because she had figured out that her family, her doctors and their staff showed love and affection to her only because she fulfilled some of their needs and desires. The moment she stopped catering to their needs they unleashed various types of latent and overt violence against her. She also saw that she had become a threat to her family because she had figured out that the real reason for their affection for her was her acquiescence to their needs and not her person. Esterson thought that the only way that the family could neutralise Sarah after her insight into the family politics was to label her a mad person, a schizophrenic.

In the eighties, DL Rosenhan and his associates conducted an interesting and prolonged experiment in order to check if the “mad”, or the schizophrenic were significantly different from the “normal”. They formed a group of eight people, three of them women. The group had a student of psychology, three trained psychologists, a psychiatrist, a child specialist, a painter and a house wife. The eight people visited twelve mental institutions across the United States of America. All of them told the hospital admission room staff that they heard voices but otherwise described their life situations honestly. All of them were admitted to hospitals and labelled schizophrenics. After the first day of their admission they reported that they no longer “heard” the voices and behaved as they normally did in their homes. However, they continued to be labelled as schizophrenics and “treated”. Rosenhan reported that these “patients” remained in various hospitals from a maximum of fifty-two days to a minimum of nineteen days before the hospital staff agreed to release them. It is pertinent to recall that none of them was a schizophrenia patient to begin with, and that they truthfully reported their life situations, with the only exception of the report that they heard voices, which they reported that they no longer heard after their first appearance at the hospital. Rosenhan showed with this real-life experiment that the diagnosis of schizophrenia is an extremely delicate and difficult task, if not impossible.

Theodore Sarbin in the nineties undertook a meta-analysis of three hundred and seventy four research studies “designed to illuminate the concept of schizophrenia”. Based upon his analyses of these studies he found that “most schizophrenics cannot be differentiated from the normals, on a wide variety of experimental tasks”. He found that hidden variables, such as the socio-economic status and education of the protagonist, played an important role in determining the presence or absence of the disease.

Based upon his own investigations, he made three points: that schizophrenia is diagnosed mainly on the basis of presence or absence of hallucinations and that the nature of the hallucinations is judged on a predetermined moral standard. Some hallucinations are judged to be “good” and others “bad”. Only that person is judged to be a schizophrenic who has “bad” hallucinations; so that if the hallucinatory experience of the protagonist is not judged to be “bad” then he is not labelled a schizophrenic, but instead a poet, a painter, a sculptor, a novelist or even a mystic! Sarbin concludes therefore that the hallucinations of a socially degraded person will lead to his being labelled a schizophrenic and the hallucinations of a socially exalted person would lead him to be labelled a “creative person” or a “mystic”. The social position that a person occupies therefore is a strong independent variable in the diagnosis of schizophrenia. If the violated and the socially degraded are more prone to be judged as schizophrenics in the so-called advanced and developed societies of Europe and America, one can well imagine the extent of misdiagnosis in the so-called Third World societies. No wonder our mental hospitals are so full of “schizophrenics”!

Humair Hashmi is a professionally certified psychotherapist who teaches at Imperial College Lahore

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