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Orna Ophir. Schizophrenia
CONTENTS
Figures
Guide
Pages
SCHIZOPHRENIA. An Unfinished History
Preface
Notes
Acknowledgments
Introduction: The Ends of a Diagnosis
If You Want a Label
Carving Nature at Its Joints
The End of a Diagnosis?
A Difference in Kind or in Degree?
Madness from Antiquity to the Present Day
Notes
Chapter 1 From the Bible to Bleuler
Prophets or Beasts? Madness in the Bible
Unsacred Brains and Untamed Horses: Madness in Greco-Roman Texts
Holy and Unholy Madness in Medieval Times
Early Modern Madness: God, Satan, Witches, and Poison
Modern Madness: A Disease Entity, a Natural Kind
Psychiatric Classification and the Making of Schizophrenia
Notes
Chapter 2 The Birth of “the Schizophrenias”
More than a “Renamer”: Paul Eugen Bleuler
Associations
Affectivity
Ambivalence
Autism
The Birth of the Schizophrenias
Notes
Chapter 3 Psychoanalysis and Schizophrenia
Freud’s Analysis of Schreber: Strangeness Made Familiar
Beyond the Schreber Case
Freud’s Dual Legacy
Melanie Klein and Her Legacy
Psychoanalysis in Psychiatric Hospitals
Notes
Chapter 4 A Moving Target
The Psychiatric Bible
DSM-I (1952): Schizophrenic Reactions
DSM-II (1968): From Reaction to Disease
DSM-III (1980): Narrowing Down the Concept of Schizophrenia
DSM-III-R (1987): Schizophrenia, in the Singular
DSM-IV (1994): Broadening the Concept of Schizophrenia
Transition Toward the Spectrum of Schizophrenia
DSM-5 (2013): Shifting the Paradigm, the Schizophrenia Spectrum and Other Psychotic Disorders
A Moving Target
Notes
Chapter 5 Hearing Voices
Hearing Voices in the Ancient World
Women and Voice-Hearing in Medieval Times
The Renaissance and Onward to the Protestant Reformation
Hearing Voices and Modern Psychiatry
The Role of Culture
Listening to the Voices
A New Identity: The Voice-Hearer
Notes
Chapter 6 Stigma and the Problem of Naming
Schizophrenia as “Life Unworthy of Life”: The Aktion T-4 Program
A Dangerous Diagnosis
Self-Stigma
“Schizophrenic Skins:” Racial Stigma
The Case of “Sluggish Schizophrenia” in the Soviet Union
Moving Forward: Possible Solutions
Minding Our Words: Considering a Name Change
From Split Mind to Integration Disorder: A Terminological Change in East Asia
From Schizophrenia to “Salience Disorder”: Renaming the Diagnosis in Europe and the United States
Dropping the Term “Schizophrenia”: The Case of the ISPS
Towards the Future: A Destigmatizing Story
Notes
Chapter 7 The Ethics of a Diagnosis
Notes
Index. A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
R
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T
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Orna Ophir
Five years after this visit, following a brief detour through the Bezalel Academy of Art in Jerusalem, I decided to become a clinician. As an undergraduate majoring in psychology, I volunteered in the adolescent ward at that very same hospital. For three years, I worked with children aged 12–18. Their stay was always involuntary, and always involved a high risk of suicide. I observed these terrified, haunted, confused kids, living in their own nightmarish universe, seeing things only they could see, and hearing voices no one else could hear. And I saw their brokenhearted, helpless parents. I witnessed many of them receiving help, gently cared for, and being heard. Many left the ward calmer and more organized. Some returned in a state of crisis.
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As will become apparent throughout these chapters, this book ultimately explores the suggestion that the fundamentally eccentric nature of what we have come to call schizophrenia lends itself to contrasting interpretations, which reveal much deeper structural oppositions, between continuity and discontinuity, equilibrium and disequilibrium, and, ultimately, vitalism and mechanism. As these distinctions are unavoidable yet revisable, it is a critical and clinical imperative to use them provisionally and prudently. Scholars and theorists, psychiatrists and psychologists, psychoanalysts and mental health advocates, must all keep the pragmatic aim of healing patients firmly in mind when using classifications that are just that: “labels.”
Instead of favoring one paradigm over the other, or slipping into relativism pure and simple, those who deal with mental illness must accept the paradox – even the aporia – of having two seemingly exclusive accounts of the disorder operating concurrently. Being “of two minds,”40 they can then see a rabbit or a duck, in the full awareness that both are a case of “now you see it, now you don’t,” that present us with an incomplete sketch of what is, in “essence,” a much more complex and intractable phenomenon.
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