Schizophrenia's Identity Crisis | Jonathan Metzl | Big Think

Schizophrenia's Identity Crisis

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What is schizophrenia? As the psychiatrist and author of “The Protest Psychosis” explains, its definition has shifted radically over time, becoming increasingly tied to racial politics.

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Jonathan Metzl:

Jonathan M. Metzl, MD, PhD, is a psychiatrist who also has a Ph.D. in American Studies. He is Associate Professor of Psychiatry and Women's Studies and Director of Program in Culture, Health, and Medicine at the University of Michigan. In this capacity he works as a Senior Attending Physician in the adult psychiatric clinics and teaches courses in the areas of history of psychiatry, gender, and health at the undergraduate and graduate levels. He is the author of "Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs" (Duke University Press, 2003), and of "The Protest Psychosis: How Schizophrenia Became a Black Disease" (Beacon Press, 2010).

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TRANSCRIPT:

Question: What is schizophrenia, and what is schizophrenia not?

Jonathan Metzl: So in terms of present day psychiatry, I mean, as you mentioned there have been changes with every new version of the DSM, the Diagnostic and Statistical Manual that have come out, that have sharpened our understanding of what schizophrenia is, and so in the present day we think of schizophrenia as an illness that the main symptoms are delusions, hallucinations, most hearing voices, sometimes seeing things, kind of losing touch with reality, also paranoia, feeling like people are out to get you and social withdrawal, what are called negative symptoms, so cognitive withdrawal, social withdrawal, so it’s a very debilitating, very serious mental illness, but as you mentioned this definition has changed over time and it’s also changed in relation to changing popular perceptions about how people with schizophrenia act.

Question: How was schizophrenia originally defined, and how has this definition changed over time?

Jonathan Metzl: Sure, so in my book that’s in part the story I tell, is how changing psychiatric definitions of schizophrenia and changing American cultural definitions of schizophrenia really have morphed in relation to each other over time and particularly in relation to histories about race in the United States, so one of the central narratives of the book is that in particularly the early 1920s, 1930s, 1940s when the idea of schizophrenia itself was first coming to the United States from Europe there was a general assumption that persons who suffered from schizophrenia were either shy or calm or they were geniuses. It was often represented as an illness that afflicted white novelists or poets and as I say, these were very often in popular and psychiatric representation assumed to be white people. Now this was a... you know a kind of gross generalization, but in part what was happening was that the illness itself was defined almost as a personality disorder, like a split personality, so it was taken up by psychoanalysts, used in psychoanalytic sessions and popular representation really picked that up. Two instances from this time period that I think are very important, one is a film that came out in 1948 called The Snake Pit, which was an Olivia de Havilland movie made from a book several years earlier of the same name and it really showed schizophrenia as being an illness that afflicted in particular white middle class women. Also when early versions of the Diagnostic Manual came out in the early 1950s it really was… It was called at that time schizophrenic reaction, and it was assumed to be mostly a personality condition.

All of a sudden in the 1960s, American culture, newspapers, magazines, movies start to represent angry African-American men as in part being inflicted with a new form of this particular illness, so in the book I show some drug ads, for example, that actually show pictures of urban riots and race riots in the streets, and talk about how really the illness… assumptions about the illness change and the other key thing that happens in the 1960s is that the official psychiatric definition changes. All of a sudden in 1968, the second version of the Diagnostic Manual comes out and there is new language that says aggression, hostility, projection.

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