Читать книгу Schizophrenia - Orna Ophir - Страница 21

Western history, since its early depiction in the Old Testament, had shown two fundamental ways of conceiving madness. While the first implies that health and illness exist on a spectrum as relative states of greater or lesser equilibrium, the second view implies that mental illness is categorically different from mental health.

The diagnosis of dementia praecox, which later gave way to schizophrenia, was born in the nineteenth century, a period that in the history of madness, mad people, and mad institutions was characterized by attempts on the part of the medical profession to create distinct categories of so-called disease entities as natural kinds. Just as botanists had shown that, based on their natural properties, pine trees were similar to each other and different from elm trees, psychiatrists, doctors, and other clinicians hoped to reveal the exact nature of mental disorders, and to differentiate between their distinct natural kinds in the clearest of terms. Unlike some of the earlier views of mental disorders, which saw the body and mind as constantly oscillating between health and illness, and considered health as a form of humoral and moral equilibrium, the mainstream view of alienists in the nineteenth century was that mental disorders were completely different in kind from normal mental states.

Nineteenth-century European medicine, with its laboratories and hospitals, supported the notion that diseases are specific, objective, physical entities that exist outside their unique manifestation in a particular human being.¹⁰³ Regardless of the place or person in which they are located, disease entities were believed to have typical symptoms, to follow specific courses, produce particular outcomes, and obey an underlying biological mechanism. These disease units were viewed not only as different from health, but also as having clear boundaries that separated them from one another. It is in the framework of this episteme, to cite Michel Foucault’s well-known term, that we see a general shift from “dis-ease” to diseases and from “mal-aise” (a state of discomfort) to malaise (an illness).¹⁰⁴ It is in the wake of this transformation of “dis-ease,” experienced as discomfort, into a disease, seen as an externally diagnosed separate entity, that the downright pessimistic diagnosis of dementia praecox, with its grim prognosis, and in its wake that of schizophrenia, came into being.