or Psychosis? A Cultural Look at Schizophrenia
by Michael B. Scher
(c) 1994 Michael B. Scher This document may be freely distributed by electronic media solely for
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I. Introduction, General Discussion,
Steps to Thinking About Schizophrenia
In "Minimal Requirements for a Theory of Schizophrenia," Gregory Bateson (1972: 244-70 ) argued that explanatory perspectives on schizophrenia that depended on the boundaries of the individual (in a "Newtonian" perspective) or conversely on a view of the condition as entirely socially constituted (in a "Berkeleyan" perspective) could not hope to encompass the condition. For Bateson and many others who were to follow him, schizophrenia did not merely manifest itself in communication troubles, but existed at the level of basic inter-human communication. Thus, models fashioned on individual problems in communicating or thinking, or models taking the condition as strictly between persons in a 'schizophrenic context' fail to take into account the entire communicative system. As Bateson noted, schizophrenia, as a condition, seemed to be of a communicative nature both in origins, manifestation, and substance, and should thus be examined as taking place in the active perceiver, and in the perceiver's interaction with a context, including other active perceivers.
For Bateson and the subsequent "family therapy" movement, this view suggested the researcher seek out communicative systems that seemed to engender schizophrenic patterns of communication. Simultaneously, there was a move to locate schizophrenia in biological roots (Barrett ms.:39-43), each side being drawn to discover the origins of a condition describable only as an amalgamated set of behavioral symptoms. In Bateson's terms, each side was being drawn to Berkeleyan or Newtonian extremes in pursuit of schizophrenia's origin; in Robert Barrett's terms, they were each being drawn to these poles in pursuit of an essentially indefinite wild goose, a cultural category the form of which varies in accordance with social configurations of power, category, and symbol. This paper seeks to examine schizophrenia as a condition of communication writ large, in Ruesch and Bateson's (1968) sense of communication as perception, gestalten encoding and decoding, value hierarchy, and conceptual category (1968:168-211).
As such, a look at those behaviors taken as paradigmatically schizophrenic and those behaviors of patients taken as confirming the diagnosis of "schizophrenia" can lead us to a conception of schizophrenia as a cultural condition, in all senses of the phrase.
In calling schizophrenia "a cultural condition" or even "a condition of culture," I mean to both acknowledge that schizophrenia manifests in a given society as a cultural category and in the persons so categorized as a condition relating to their fundamental divergence from certain kinds of "normal" cultural understandings. This paper's viewpoint diverges significantly from such writers as Barrett and Ian Hacking in that, while it acknowledges that schizophrenia's outline as a condition does exist as a culturally-constructed category, its manifestation is a problematic mode of dealing with cultural categories, modes, and practices. This is to say that schizophrenia is such a slippery item for researchers because it manifests as an aberration in, and difficulty with, precisely the same fabric on which its form is viewed. Schizophrenia can thus be seen as essentially cultural in that it manifests as an apparently different cultural perspective from the 'norm,' presenting both the "schizophrenic" and surrounding society with a "schism" between their (culturally presumed) grounds for communication, and leading to a basing of the category "schizophrenic" on those problematic, contemporary cultural grounds for communication -- communication, again, in Ruesch and Bateson's sense.
Barrett's essay provides a useful perspective on the development of the diagnosis as one resting ultimately on a particularized perception of the social unit, the individual, in modern Western society. He notes that Pitted against the Western concept of the individual as bounded and discrete, is the concept of schizophrenia as unbounded or diffused individuality. This principle of permeability pervades twentieth century discourse on schizophrenia, both at the level of the category and the realization of that category in the referent, the patient (ms.: 33).
Barrett argues that not only the creation of the category, but its actual realization in the 'patient' conforms to this idea of identity-breaking that is fundamentally Western. Barrett claims to avoid making any conclusions as to whether the conditions termed schizophrenia have, indeed, any basis outside their cultural construction, and seems to disagree with Szasz's (1973) denunciation of most mental illness as constructed as power games between psychiatrists and patients, patients and their families, patients and society (Barrett ms.:58). However, he wants to present the category "schizophrenia" as a problematic of Western culture, a gestalt figure which may be interpreted against the background of Western concepts of the person and [has] argued that 'the schizophrenic' emerges as a marginal and ambiguous category, both an agent of meaningful action and not an agent of meaningful action - a person and not a person (Barrett ms.:70).
What Barrett has exposed is on the one hand the banal idea that any category is ultimately arbitrary, and tied together by some set of selected, gestalten points of reference--that all categories are ultimately cultural categories. On the other hand, he concludes that schizophrenia's particular shifting, and ever- receding nature, its apparent reconstitution as a problem with every medical paradigmatic shift, suggests that "schizophrenia is a socially organized moral category" and therefore, "useful insights can be gained into this disorder by cultural analysis" (Barrett ms.:70). I would augment this position by adding that not only is schizophrenia a "socially organized moral category" and a "plurivocal symbol" of "nature overwhelming culture" (Barrett ms.: 70), but that as a cultural category, it is a category about cultural categories; schizophrenia may therefore be seen as problematic because it is a cultural category about people's employment of cultural category. It is a clinical and colloquial metadiscourse describing the unusual divergence of some persons from a cultural communicative order--an order that seems transparent and given to those in it.
II. Approaching a Perspective on
As we have discussed, theories about schizophrenia that seek its 'origins' or causes enter into an irreducible paradox between schizophrenia constituted as a cultural category describing certain modes of behavior, and schizophrenia as a condition of differentiated cultural categorization at a basic level. R. D. Laing unintentionally captured the paradox neatly when he noted that
To regard the gambits of Smith and Jones as due primarily to some psychological deficit is rather like supposing that a man doing a handstand on a bicycle on a tightrope 100 feet up with no safety net is suffering from an inability to stand on his own two feet. We may well ask why these people have to be, often brilliantly, so devious, so elusive, so adept at making themselves unremittingly incomprehensible (Laing 1967:85).
Laing's quote was meant to describe schizophrenia theories based primarily on biological 'deficits,' but applies as well to the anti-psychological position that schizophrenic patients are compensating for particularly problematic social situations. Subsuming the whole of schizophrenic experience under the notion of a social strategy, even an unwitting one, is easily as extreme a position; as Barrett notes, the more rigorous the study of social context and schizophrenia, the less the condition seems connected with any particular kind of social stress and the more theories of it seem politically inspired (Barrett ms.:67). Theorizing about schizophrenic origins has led to various perspectives both of what the condition is and what causes it. These questions of locus and origin remain unresolved, and perhaps as Barrett asserts, unresolvable, in the morass of the paradox I described and the politicization of social categories that affect one's social relations and volition. Recent theories about schizophrenia have tended to question the presumptions that the disease is debilitating, permanent, necessary, or even abnormal. Thus, we find such researchers as R. D. Laing calling the condition, "a special strategy that a person invents in order to live in an unlivable situation" (Laing 1967:95), in an anti-psychiatric position in which the patient is seen to be no less normal than anyone else, adopting a particularly sensical solution to peculiar problems. Laing also supposed that the episode might be a sort of natural process of passage brought on in certain kinds of social conditions, biological or not in nature, that something curtails, derails or reroutes into permanent liminality. Laing does not mention Victor Turner's notion of the ritual as entry, liminality, and reintegration stages, but his description mirrors it perfectly, and he wonders whether the "illness" is little more than a natural human event being over analyzed, and ultimately interfered with in a culture that has developed norms against such things (Laing 1967:106-7).
Viewing a condition or even "disease" as natural or normal is itself, however, a matter of contextualized cultural judgment. As Bateson points out, the pathologies of a system "arise precisely
because the constancy and survival of some larger system is maintained by changes in the constitutive subsystems" (1972:339). This position is not functionalist, but rather cybernetic, based on the tendency of massive numbers of interacting components (limitless, really) to reach an equilibrium state, which, while it changes, does so in a generally oscillating fashion that can be described from a sufficiently external perspective (itself indescribable from its own vantage). Thus, "illness" of a mental or physical, biological or genetic sort can be viewed as natural or normal and can be seen to have a function within a higher order. The schizophrenic patient "is" adaptive to problematic family life; the plague of typhoid "moderates" the over-concentration of human societies.
Labeling it "normal" or not brings us no closer to understanding fundamentally what is going on in those people whose behaviors are such that we apply the category schizophrenia to them or their context. For typhoid, we might want to ask what, if anything, is there in the condition of some people that makes us want to place their conditions together in a diagnostic category, and second, what, if anything, in those persons' socio-cultural contexts has made this commonality of symptom possible. Similarly, for schizophrenia, we should be asking first what, if anything, is there in the behavior of some people that makes us want to place them together in a diagnostic category, and second, what, if anything, in their socio-cultural contexts makes this categorization possible. Perhaps desire to "cure" people of their "condition" overran understanding what actually constituted that condition, fundamentally, and founded the discourse about schizophrenia's causes. Whatever the case, before one can begin to examine what "causes schizophrenia," one should examine the general nature of the conditions placed in the socially-constituted category "schizophrenia." Thus, R. D. Laing's approach, which begins with finding the 'cause' of 'schizophrenia' in the "whole social context in which the psychiatric ceremonial is being conducted" (1967:86) has jumped the gun in failing to first establish what exactly the condition is. If anything, for Laing, the condition "schizophrenia" is a myth built around some normal behavior responses to difficult situations; but he fails to ask what is it to ordinary people that makes the schizophrenic so profoundly strange--and what in schizophrenic behavior exactly is different?
In describing his views, Laing cites Garfinkel's work on degradation ceremonies, making it the more peculiar that he doesn't look into what "the schizophrenic" does phenomenologically. Instead, Laing describes the condition causally--he may be "correct," but it leaves him to play in the confused definitional game we discussed above, perhaps giving him a useful perspective that may help some people to live happier lives, but bringing him no sharper an understanding of what about the people he is dealing with is itself different from others. While providing a delimited set of behavioral criteria through which to classify patients, the Diagnostic and Statistical Manual III-R (DSM III-R) accomplishes little more than Dr. Laing in defining any criteria that form the essence of the condition. The DSM III-R does, however, attempt to separate "prodromal" or superficially occurring symptoms from those that may be elicited from interaction and conversation with the patient. Barrett would likely note that these primary diagnostic symptoms are an outgrowth of, and remain dependent on, a psychiatric practice in which certain kinds of patient-doctor interactions occur; here we will note that they, too, are prodromal, and like the DSM III-R's prodromal list, should be seen as the manifestation of some underlying situation. As far as the DSM III-R, and most psychiatrists are concerned, that underlying condition is "schizophrenia," and "schizophrenia" is either "environmentally," "biologically," or "genetically"-caused; or caused by some combination of them, never reaching the question of what this underlying condition is in terms of the mindset of a person from some particular socio-cultural milieu (Hurlburt 1990:259).
Nevertheless, the DSM III-R provides a useful guide to those superficial behaviors that, when coinciding, are considered the hallmark of the "schizophrenic." Among these are :
A. Presence of characteristic psychotic symptoms in the active phase: either (1), (2), or (3) for at least one week (unless the symptoms are successfully treated):
(1) two of the following:
(b) prominent hallucinations [. . .]
(c) incoherence or marked loosening of associations
(d) catatonic behavior
(e) flat or grossly inappropriate affect
(2) bizarre delusions (i.e., involving a phenomenon that the person's culture would regard as totally implausible [...])
(3) prominent hallucinations [...] of a voice with content having no apparent relation to depression or elation, or a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other
B. [lessened functionality in social contexts]
C. [not another disorder]
D. Continuous signs of the disturbance for at least six months [requiring ONLY a one-week active phase with or without residual or prodromal phases]
Residual and prodromal phases are followup or
lead-in periods in which the patient evidences any of:
role-fulfillment problems, social isolation, "markedly
peculiar behavior," "marked impairment in personal
hygiene and grooming," flat or strange affect,
"digressive, vague, overelaborate, or circumstantial speech,
or poverty of content of speech," "odd beliefs or
magical thinking," unusual perceptual experiences, and a
loss of drive. In glossing the DSM III-R's list, one might say
the schizophrenic is one who perceives and reacts in strange
ways, evidences peculiar causal and categorical associations, and
generally fails to live up to community standards of behavior.
Barrett describes the psychiatric description of schizophrenia as "located on and generated by" the "deeply seated" paradox of the person as biological isolate and social being (Barrett ms.:9), essentially indicating for our purposes that the psychiatric view of the underlying "symptoms" assembles them into a category, "schizophrenia" already mediated through a discourse about social and individual persons. We, however, must admit, something is going on when a person can "speak a different diction" in their own view and be "delusional" in another's (Hurlburt 1990:195); when a person begins to deviate wildly from social and cultural norms and understandings that others not only take as given, but to which others always refer their behavior, we must wonder why these people are no longer persuaded back into alignment with such a wide array of behaviors. Perhaps these people are not merely adopting a strategy, or acting a certain way, but instead are experiencing, "a way to be crazy, at least in an industrial/romantic, Protestant society" (Hacking 1991:844). We should wonder not only why them, but also, which kinds of behaviors are different. What is that way? Any attempt to answer that question must take into account what is known about human behavior and biology in order to describe what behaviorally and chemically is taken as setting "the schizophrenic" apart from others in the culture. For example, while a genetic 'source' is suspected, none has been found, and indeed, the simple one-gene-wrong notion that may work with some ailments seems to not hold in schizophrenia, as studies on heredity and twins has begun to show. More complex biochemical models may also take into account social factors, triggers, etc. (Barrett ms.:41-2). Nevertheless, "schizophrenics" do respond to certain classes of "anti-psychotic" medications which allow them to act in manners that we would class as more normal, i.e.,the evidencing fewer of the factors taken as indicative of the condition. Among these is Sandoz product "Clozaril" famed forschizophrenics bringing some of the most severely affected (thoseothers) into completely unable to interact in what is taken as a "meaningful" way by astonishingly "normal" modes. Such a markedthe former difference, subjectively, is noticed by symptomaticallergic to the schizophrenic, that a class of them who have turned out to be fatally drug (it acts as an immune systemto continue depressant on them) are suing Sandoz for the right taking the medication.
Something besides a "strategy" or "ritual" is going on, certainly, but we must also take into account that human thought, emotion, and whatever other human state of being we want to describe has or manifests a chemical component. Even R. D. Laing tempered his socio-strategic position and said "that the biochemistry of the person is highly sensitive to social circumstance" (Laing 1967:94), and so it would be no surprise to him if a social "cause" produced a chemical "result" curable with another chemical, an "anti-psychotic" drug. "Happy," we should note, is a chemical as well as emotional state, and can be "cured" (i.e. changed) by the introduction of another chemical substance (which we can for our purposes here call an "anti-jubilant"). In Bateson's view, there is a naive artificiality in viewing the emotional or psychic state as separate in any way from the chemical; the division of human into sub-systems of mental versus chemical, or individual versus social, is artificial, and dependent primarily on the classifying observer's purposes (Bateson 1973:319). What we are left "knowing" then are the characteristics by which we select out those we will term "schizophrenic" and the behaviors evidenced by those persons themselves: our society's cultural categories and the evidence we have for theirs.
III. Schizophrenia as a Communicative (Dis)order
When Robert Barrett notes that "schizophrenia" is a multi-faceted symbolic category dependent on certain cultural preconceptions (ms.:70), he is referring to the symptoms taken as constituting the "condition." He is not saying that some underlying disorder cannot exist, nor is he saying one must. This section will show how what constitutes the symptoms depends on certain cultural preconceptions precisely because schizophrenia is a condition affecting such preconceptions. One who is "schizophrenic" is one who does not perceive, act, conceive, or interact as others expect they should, on a certain kind of level; and one who does not perceive, act, conceive, or interact as others expect they should, on a certain kind of level, is termed a schizophrenic. It is not merely the giving of surprise or appearance of eccentricity; and yet there is a range of degree, one end of which could well be termed "merely eccentric." Once we examine critically what differentiates schizophrenic behavior fromwe 'normal' behavior in those societies that recognize it as a condition, can begin to discuss what is at the core of thatsome kind of behavior deviance, and perhaps why cultures do not recognize "it" as a condition.
One approach to examining "schizophrenic" behavior is to begin with linguistic behavior. Language, since Saussure's Course, has been studied in intricate detail, and a wealth of tools, methods, and terms come to the researcher. Wrobel's Language and Schizophrenia criticizes the "classical" approach to schizophrenia in which the patient is held to be making a confused use of the langue in the formulation of confused parole. The problem under general thinking about schizophrenia, is that the patient's thinking, for whatever reason (biological, environmental), has become confused, and it evidences itself in language confused in both subject matter and formulation. Wrobel takes the position that schizophrenic speech, and quite probably most other behavior, adheres to a langue particular to the schizophrenic, and often, differing from their host culture's langue in predictable ways (Wrobel 1989:5). Wrobel's view is consistent with Hurlburt's (1990) study of schizophrenic and "normal" inner experience, in which it was found many people experienced thinking without precise words, and speaking without preformulative thought. If some difference occurs at a deeper level, of "langue," which may be taken in this context as the internalized preconscious formal aspects of symbolic activity within a culture, then the "schizophrenic" would be acting according to a partially independent cultural logic, causing both others and self communicative distress and possibly leading to withdrawn, frustrated, angry, paranoid, or other secondary--but "symptomatic"--behaviors. Wrobel starts from John Cutting's (1985) Psychology of Schizophrenia conclusions that schizophrenic speech is less predictable than that of "normals" (and they have a hard time predicting "normal" speech), that their primary disturbances are at the pragmatic level of speech, and that they otherwise employ language "normally" (though there is some evidence that their division of phonemes may drift) (Wrobel 1989:9). From there, Wrobel moves in "an 'antipsychological' direction . . . toward an anthropological approach" (1989:10).To Wrobel, as with Bateson, the realm of communication is one of active perception, in which speech is the active alteration of context by an actor who is both part of that context and a vehicle for its change. For Bateson, communication included perception, an at-least partially acquired mode of divvying experience through gestalt value systems that "encode" raw experience into cognizable experience. From the traditional approaches to schizophrenia, Wrobel desires only to take the notion that "the schizophrenic experiences differently" (ibid.); but this is not a viewpoint like Laing's, in which the condition is understood as an outcome of some causality. Rather, Wrobel seeks to understand schizophrenia by examining those behaviors taken to be characteristic of it. A conclusion he draws is that
Although logic categories of schizophrenics are often not any less rational than ours, they do not enjoy our acceptance . . . [because] schizophrenic attitudes go beyond the expectations of "normal" men (1989:11 italics mine).
Which is to say that they "go beyond" the communicative presuppositions, not only in their langue, but also in the pragmatics that turn langue into comprehensible parole. In Bateson's terms, they have somehow integrated a different encoding process from the norm at the perceptual and speaking levels (see Ruesch and Bateson 1968:169). Hurlburt's analyses of several "normal" and "schizophrenic" persons' descriptions of inner experience similarly leads him to the idea that schizophrenics may be perceiving and reconcepualizing the world in a manner different from others in their culture, but that they are doing so in an essentially comprehensible manner. Hallucination, for example, may be the perception of what we call recollected images as though they were as present as what we call "physical reality," an interpretation divergent from ours only in that it essentially recognizes that all our "real" perception occurs in our heads as well (Hurlburt 1990:162).
The development of a different set or partially different set of perceptual "values" (in Bateson's communicative/gestalt sense) might lead to subjective experience sufficiently divergent from others' that descriptions and talk about such things cannot bring the experiences into the general consensus of description, particularly when the perceptual values attached to communicative exercises also somewhat differ. With "inner experience" as examined by Hurlburt, the situation might be even more attenuated, as the interpretation of inner experience is rarely discussed, and idiosyncratic ways of thinking about it could well develop in "healthy" minds. Thus, we find one of Hurlburt's informants experiencing what we might call "feelings that he should keep social distance" as a "force field," what we would call continual verbal annoyance through asking irritating questions as "phasers," etc. (Hurlburt 1990:210).
Wrobel noticed that schizophrenics tend to class objects not by common "similarity" but instead by preference, even when asked to class by similarity (1989:28). Ordinarily, we take such similar characteristics to be in the objects, an aspect of them. For the people Wrobel studied, either such similarities were inaccessible to them, and so they classed by preference, which was accessible, or perhaps they found theunderstandable "similarities" by which "normal" people class to be arbitrary, when explained, but frustratingly unpredictablelocation, use, smell, or (class by color, shape, size, what? theythat is always grounded might ask), and so fall into the habit of selecting by one referent for them: their preference.apply, we begin to see how Whatever motivational theory one wants to schizophrenic communicative behaviorarbitrary, and is on the one hand random, incomprehensible, and on the other, asculture, albeit a ultimately comprehensible as any foreign culture of one.
Wrobel elucidates his statement that schizophrenic "attitudes go beyond the expectations" of ordinary interaction in his study of the pragmatics of schizophrenics' speech. He notes that a failure to satisfy the receiver's expectations of pragmatics pervades schizophrenics' speech. Essentially, the "schizophrenic" is one who communicates (Ruesch & Bateson's sense, including perception at its root levels) differently from those raised in similar contexts. For some reason or reasons, the person does not perceive, speak, or associate quite as others do, nor do they employ in the same way the ground upon which communication in the society rests. This has several levels, but primarily we find the behavior on the "pragmatic" rather than syntactic or phonological, in the involvement with, interpretation of, and application of social devices within contexts.
In Wrobel's terms, the schizophrenic employs a different ground for communicative understanding at the pragmatic, and often deictic, levels, particularly with regard to notions of time and the organization of stories. Similar general referents ("not much" "lots" "long ago" for examples) were regularly interpreted differently from "normal" usage, though specific referents ("six" "yesterday") were interpreted the same or in a radically metaphoric manner (1989:31-2). Schizophrenics tend not "to take into account the conventions applied in correspondence and the social role of the addressee" and exhibit a "destabilization of the main element (I) of the primary elements of reference," causing "a destabilization of the remaining elements (here, now)" (1989:40).
These differences in indexical referential grounding, social role and contextual conventions may well explain the "flat or inappropriate affect" the DSM III-R attributes to schizophrenia: a failure to recognize (or even perceive) contextual clues as to proper affect, as to the "kind" of context, would lead the schizophrenic to repeated errors of affect, eventually leading to a preference for no affect, for there is little social reward for proper affect, but extreme forms of punishment for inappropriate affect in the wrong kind of context. In his discussion of affect and context-recognition, Hurlburt notes that while the schizophrenics with whom he worked did exhibit flat affect, it is only the outward expression of emotion that is flat in some of our subjects, not its inner apprehension. Our schizophrenic subjects did have clear inner emotional experience (1990:260).
Thus, the schizophrenic flat affect is like disordered speech, the surface manifestation of an underlying inability to synchronize with the "normal" pragmatics of communication and perception in their society. This paradigmatic problem with social role, attributable to problems in interpreting context, can be taken to underlie the social/individual tension that Barrett sees as underlying most discussion of schizophrenia (ms.: 8).
In Ruesch and Bateson's communications model, where perception is essentially gestalten, one's inability to interpret context leaves one with minimal knowledge of some 'thing' perceived, a negative case that will remain essentially undefined for the perceiver (1968:197-208). Further, taking their position that inter-personal communication is the active use of context as perceived with an assumed understanding of the other's view of the context, one can see how a person with some difficulty accessing not only what another means by some perhaps communicative action, but also difficulty predicting the other's reaction to anything, might come to see the world in a particularly peculiar way. Bateson also points out that the conventions of communication, "communication agreements," are of the same ilk as any social conditioning: forms of expectations of conditions prevailing in some gestalt-recognizable context (1968:212-27).
This communicative impasse can actually be described as a fundamental disparity between the manner in which the individual interprets (perceives) contexts and the way in which others of the same culture do. Wrobel quotes Anna Gruszecka's 1923 and 1924 works on schizophrenia with regard to this topic, in sum agreeing with her that schizophrenic communication is the result of differential perceptions pressed into different conceptions of the language. Gruszecka also discussed the remarkableways similarities between schizophrenic thinking and many other cultures' of thinking, relating many modes to "normal" modes in other cultures (Wrobel 1989:16-18). Neither she nor I mean to assert that schizophrenia does not "exist" as an underlying problem with one's own culture; only that it exists not as a particular kind of thinking but as a condition of a person who has not internalized the same perceptual/conceptual matrix of expectations and communicative precepts as his or her contemporaries.
Taking Gruszecka and Wrobel's perspective, we can examine the extreme paradigmatic "symptom of schizophrenia," the hearing of voices. The DSM III-R's definition of "hallucinations" taken to be schizophrenic almost exclusively covers verbal/auditory events; hallucinations of a visual nature are taken to be only the schizophrenic granting images in the mind more than the metaphoric presence they deserve. Our working thesis is that the schizophrenic condition is one of having a radically variant understanding of ordinary events from one's culture; if hallucination is to be taken into account, then we must find that the "normal" person in Western society also experiences voices, but gives them a different attribution than the "schizophrenic."
Hurlburt's study evidenced several "normal" persons who experienced inner voices, including two who had a set of voices, some of which had names by which they could be discussed. These people all "knew," however, that the voices were their own, despite their often spontaneous-seeming character, and despite "inner speaking sometimes [seeming to] have a mind of its own" (Hurlburt 1990:147). If the ordinary person can experience voices in their mind, whatever they choose to call it, or how they choose to perceive them, will be in part determined by their cultural conditioning; when someone interprets these differently, there is little social feedback to correct them, as one's inner experiences do not often come up as a topic of conversation. Taken as natural, these voices from outside the schizophrenic's head could well fundamentally be the same as "normal" experience, but will be perceived in a fundamentally different manner.
The separation of the schizophrenic from ordinary cultural modes of discussion was expressed by one inmate as his being a little inventive, and so a little misunderstood. I have to go through these things in order to get the proper concept, as they are concepts in my perceptions (Hurlburt 1990:224).
The notion that some extra effort is necessary either to make sense of the perceived world we take as given, or to communicate our ordinary perceptions to others is alien to us; is alien to most people in most cultures. Only when we talk with someone of a different cultural background do we find ourselves challenged, often in frustratingly subtle ways, to get our points across and to comprehend the deep meaning of what is being said to us. We meet as two context-manipulators with different ideas of how to do so, and of what any arrangement means. This experience is culture shock; in some sense, the title "schizophrenic" is given to those who continually experience a kind of culture shock in their own culture.
Wrobel describes this extra effort in his conclusory theses on schizophrenia, in particular noting that because schizophrenic perception of the world is different, the language structures of the "normal" person in a culture cannot adequately express the schizophrenic perceptions, and so its "inventive" use sounds deformed (Wrobel 1989:119-21). Language then becomes a source of frustration rather than expression, and non-communication seems the norm. Wrobel also suggests that the schizophrenics he has studied, from all over Europe, east and west, and the United States, have slipped out of their native langue understandings in similar ways (Wrobel 1989:121). Taking into account the notion that the condition is essentially one of growing culture-shock in one's own culture, the development of parallel experiences of communication surprise, confusion, frustration, persecution, and failure, might well lead to commonalities of schizophrenia cross-culturally; one should also note that Wrobel can only study schizophrenic speech in persons of cultures that recognize schizophrenia as a condition in the first place.
Nevertheless, in the same vein that one acquires cultural competence through sedimented experiences in various contexts, general communicative preconceptions can be viewed as the sedimented experiential impressions of social practice within a social context additionally permeated with physical signs of others' prior praxis. Thus, discussion of experience, as well as experience in certain contexts, may help shape our perceptions in the future. We may all verbalize thoughts in our heads, but we do not all count the thoughts as strictly our own, particularly when such inner speech may have "characteristics of being created anonymously, devoid of any direct connection to the experiencer's present activity" (Hurlburt 1990:147). Thus, we can see how social isolation could well play a factor in the formation of "the schizophrenic." However, whatever its causes, once the condition is seen as an essentially different impression upon the individual of what are presumed to be similar sedimented experiences, the significant aspect of schizophrenia is that continued interaction with the "normal" culture does not return the "sufferer" to "normal."
The DSM III-R's diagnostic guidelines could be fulfilled by nearly anyone, except that the after-effects or primary phase must persist for six months. If we consider the active phase of the condition as a mind-shaking, frightening experience of seeing one's sense of reality challenged by one's senses, the six month "recovery period" becomes that recovery time in which "normal" people reassimilate. The normal after-shock experience is ultimately to slide towards the common mode again, often presenting the experiencer with the feeling the experience was unreal. We will call this the "oh, come on" device inherent in most humans; one might also term it enculturation or socialization behavior. What is peculiar about the schizophrenic is that, upon starting the trail off normal perception, they do not tend to return absent purposeful intervention. Instead, perhaps strong-willed, they deepen their particularized perspective and distance themselves from the "norm."
Certainly it is not odd behavior or bizarre understandings, actions, and practices, that gets one labelled as schizophrenic, at least not alone, or we would be labelling most foreign travelers within our culture "schizophrenic." We must remember that, while "schizophrenia" is a socially constituted diagnosis applied to someone, and not something "in them" (whatever may in fact underlie the diagnosis) (Laing 1967:99), and ask why funny-acting foreigners are not so diagnosed, even for hearing voices (note that only one of the three main DSM III-R diagnostic criteria for schizophrenia mentions that the symptom must be abnormal for one's culture). When we do so, we see that plainly, there is an understanding that schizophrenia is the differentiating of a member of a culture while within that culture. One who goes abroad and returns with bizarre ideas or practices reflective of the place they went, may be said to have been converted or to have "gone native" but they are not crazy; just not one of us.
One may even find within one's culture modes of practice, roles or self-definitions that allow one to exhibit what would otherwise be schizophrenic behaviors. But if the mystic or crazed genius in some culture is acting in a socially-understood role, then there are modes of communication through which, supposedly, their experiences can be traded with others' (and so they're not really schizophrenic). Thus, we find that not only must one become differentiated from the 'norm' of perception/communication in one's culture while in a culture where the new perceptual modes are not normal, one must also do so in a way that renders one undefined as a social actor, that places one beyond meaningful communication. Barrett's project to expose the paradigmatic roots of "schizophrenia" as a culturally bound classificatory becomes significant here in that we can see how projects to find and trace environmental causes of the condition are in a way projects to normalize schizophrenia, in the way a "foreigner," "mystic," or "eccentric" is normalized: by tracing a route through which apparently meaningful communication may occur.
However, we must not forget that Laing was foremost seeking to help "schizophrenics" communicate again with the 'normal' world. As such, the project of normalizing, even universalizing (see Laing 1967:103-07), schizophrenic experience is one of re-establishing lines of communication with the schizophrenic. In Laing's terms, it is going into the jungle to find the Dr. Livingstone lost and going more 'native' all the time, and discover how to talk with him again. In a fundamental way, researchers looking for causal explanations of schizophrenia are seeking to trace the path down which the schizophrenic lost communications with "normal" culture, whether that path can be retraced with restorative chemicals or discovering a key past event that makes translation possible.
IV. Conclusions without Frontiers
I proposed that in writing this paper, I would forward no particular origin for schizophrenia, and I will here reassert my ambivalence as to its biological basis, genetic factor, environmental trigger, double-bind origins, and so forth. The project I set out requires only that there be some manner in which one's basic perceptual/communicative preconfigurations might become differentiated from the norm. Nor do I necessarily disagree with R. Barrett's hypothesis that the category "schizophrenia" is a socio-political construct the form of which changes in a manner reflecting the underlying political milieu. Indeed, it may well do so. My project, however, was to ask, what, if anything, lies at the core of the category, and inspires us to arrange some kind of classification around it? In answering that question, I suggested we think about schizophrenia's underlying set of commonalities as some kind of orientation relative to one's particular cultural context.
Studies on the behavior and perception of persons classed "schizophrenic" reveal a fascinating set of commonalities, particularly in their development of a pragmatics (even a langue) different from those employed by their cultural contemporaries. If the condition is fundamentally a category culturally-defined in essence as variance from certain pragmatic grounds of communication, one can see how debates over whether [social factors, biologic factors, genetic factors, formative- years factors, and so on] are [necessary, sufficient, combined, triggered, activated, suppressed, inherited, habituated, etc.], to cause the individual to [show symptoms, become schizophrenic, be formed as a schizophrenic], have proven fruitless (see Barrett ms.:25-7). The debates have not been productive because the particularized sets of behaviors that constitute the social category schizophrenia could conceivably be brought about by any of the causes in any combination of the causal manners discussed. This paper examined the "symptoms" of schizophrenia, and then discussed them in light of a theory of the condition as essentially one of culture. In calling schizophrenia "a condition of culture," I meant both that there is a cultural category "schizophrenia" and that persons placed in that category are so placed primarily for a particular kind of divergence from "normal" cultural understandings. "Schizophrenia" thus becomes an ever-receding category when placed under causal analysis, for its tell-tale signs are variations from the very class of cultural categorical understandings that includes the category "schizophrenia." Gregory Bateson was fond of noting Bertrand Russell's demonstration that paradox is generated whenever one has a "class of classes which are not members of themselves" (Bateson 1972:186). We can see the paradoxical aspects of schizophrenia existing as an aberration of our normal cultural categorical modes for which we have a normal cultural categorical mode. What we are left seeking to understand is that which we perceive in the condition that inspires us to categorically section it away from ordinary experience and in a way normalize it through labelling. I hope in its preliminary, somewhat schizophrenic in itself, way, this paper has moved us toward a greater depth of that understanding.
American Psychiatric Association (1986), Diagnostic and Statistical Manual III-R. Washington: American Psychiatric Association.
Barrett, R. J. (ms), "Schizophrenia and Personhood." Draft version of article to appear in Pollock, D. (ed.) Personhood and Illness, a special issue of Medical Anthropology Quarterly.
Bateson, G. (1972), Steps to an Ecology of Mind. New York: Ballantine.
Bateson, G. (ed.) (1961), Perceval's Narrative: a patient's account of his psychosis, 1830-1832. New York, N.Y.: William Morrow & Co.
Foucault, M. (1970), The Order of Things: an archaeology of the human sciences. New York, N.Y.: Vintage (Random House).
Hacking, I. (1991), "Two Souls in one Body," in Critical Inquiry vol. 17, no. 4 (Summer 1991), pp. 838-867.
Hurlburt, R. (1990), Sampling Normal and Schizophrenic Experience. New York: Plenum.
Laing, R. D. (1967), The Politics of Experience & The Bird of Paradise. Harmondsworth, Middlesex, England: Penguin.
Ruesch, J. & Bateson, G. (1968), Communication: the social matrix of psychiatry. New York, N.Y.: W. W. Norton.
Turner, V. (1967), The Forest of Symbols: aspects of Ndembu ritual. Ithaca, N.Y.: Cornell.
Watzlawick, P. (1976), How Real is Real? : confusion, disinformation, communication. New York, N.Y.: Vintage (Random House).
Wrobel, J. (1989) Language and Schizophrenia. Philadelphia: John Benjamins Publishing.
* * * * * * *
. Note that schizophrenia is not taken to be
social deviance. Deviance, unlike schizophrenia, is described in
reference to the social norm. In Foucault's (1970) terms, deviant
behavior is part of the same discourse as normal behavior;
schizophrenia, because "magical" or
"incomprehensible" is perhaps part of another
discourse, but certainly not part of "normal
discourse." In this, I differ from Laing, who feels that
schizophrenia is precisely a normal part of cultural events
because it is ultimately comprehensible, in that I would say that
its comprehensibility results from similar processes (of
enculturation, of perception and gestalt-creation) reaching
. Information is from personal communications with Ms. Heather A. Mueller, who worked as an executive assistant to a director at the New Brunswick, N.J. research division while the suit was in progress, 1992-1993. The story was sporadically covered in Newsweek, the New York Times, and other sources far less explicit as to the nature of the underlying problem than was my informant.
. Recall the DSM III-R's set of primary and residual characteristics, and note how many of them would be "normal" human reactions to the experience of not being able to communicate with others or interpret their behaviors and speech. Watzlawick discusses the differences between "normal" and "schizophrenic" reactions to supposed games that secretly are run on an arbitrary pattern: the "normals" are apt to think either that it is too hard or that there is no pattern; the "schizophrenic" is apt to decide someone has lied or that there is a conscious manipulation of the game taking place. Ironically, the schizophrenic, if taken as primarily experiencing a communicative schism with "normal" people, takes day to day experiences of frustration and apparent deception by others and reads it into such games as the most likely situation, and happens to more accurately capture the situation than the "normal person" (1976:53-4)
. See for example, M. Merleau-Ponty, Consciousness and the Acquisition of Language. Evanston, Ill.: Northwestern U. Press, 1973.
. I have, however, heard a quite believable story about the speaker of a near-extinct Native American language who was arrested for vagrancy, and nearly institutionalized with "schizophrenia" before someone recognized that his lingual peculiarities were a "real" language (i.e., belonging to an order of more than a single person).
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