The Theater of the Brain

The play of consciousness.

Reflections on Geel: Schizophrenia Is Not a Medical Disease

Human beings with schizophrenia do best with care and respect.

Thank you Charles Triance for sending me this beautiful article, “The Geel question: For centuries, a little Belgian town has treated the mentally ill. Why are its medieval methods so successful?”, by Mike Jay. He depicts a caring, human environment where individuals with schizophrenia have been taken in by the families of this village for 700 years. They are called boarders and often stay as members of their adopted families for life, where they work on the farms and live as members of the families and community, albeit with their idiosyncrasies.

We have had enlightened periods in our own otherwise sorry history with schizophrenia. The 1890s and early twentieth century was such a period. Our state hospitals were built, here in Massachusetts, on acres of beautiful landscape. The idea was for individuals with schizophrenia to get out of the city and heal in a pastoral setting. Later, when the money ran out, and ideas changed, these state hospitals turned into the snake pits that we are all familiar with. These horrendous mental hospitals remained oddly situated in the same beautiful landscapes. Now that they have been emptied, the bucolic grounds were sold off to developers for peanuts. And unfortunately, we did not live up to our promises to these deinstitutionalized patients. They did not end up in Geel. Far too many ended up on the streets, abandoned to harsh urban landscapes, and prisons.

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I did a fellowship in the early 70s in Adams House. It was the first private mental hospital in the United States built during this enlightened period and influenced by Geel. It was situated in a very homey mansion that occupied the back acres of Boston’s most beautiful nature tract, the Arboretum. One day when rummaging through the basement I found some old large wooden boxes that were used as a water cure. The patient would lie in the box while hundreds of spouts or warm water would flow around his entire body. I wouldn’t mind a session of that water cure right about now.  

Harry Stack Sullivan set up Chestnut Lodge where the environment was stripped of any hospital or institutional ambience. The staff was chosen on the basis on their human responsiveness and compassion. He provided a caring and healing environment for these distressed and sensitive people, not a diagnostic, medical, dehumanizing one. This too was unfortunately all too short lived.

Because people with schizophrenia in general are unable to represent their own humanity, others have all too easily treated them as “Its”, and labeled them at first religiously, and then psychiatrically as things, as objects of derision and fear. Today schizophrenia sits at the top of the disease model for psychiatry. Yes, schizophrenic psychosis is major and the most terrifying state of human experience. Yes, unlike all the rest of psychiatry, there is a brain element in schizophrenia. It does have a genetic or epigenetic element. It does break people. But that is just part of the story. This article reminds us that schizophrenia like all the rest of psychiatric issues is a human story. People with schizophrenia are people and they remain people even if they cannot be completely whole. We must learn from this article that people who are broken with psychotic characters can be loving, productive members of family and society when treated well.

Yes, drugs are a useful tool in reigning in psychotic terror, but this should not be seen as the treatment for some brain disease. It is but an aid to the human process of care, respect, along with the psychotherapy of character, yes, even a psychotic character. They are simply human like you and me. I have treated many schizophrenic individuals who are wonderful, loving, wise people. They often struggle with psychotic pulls on a daily basis that you or I couldn’t begin to handle.

Robert A. Berezin, MD is the author of “Psychotherapy of Character, the Play of Consciousness in the Theater of the Brain”

 www.robertberezin.com

Robert Berezin, M.D., is the author of Psychotherapy of Character. He taught psychiatry at Cambridge Hospital, Harvard Medical School for thirty years.

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