The Racist Origins of the Modern Concept of "Schizophrenia"
The history of an unfortunate word.
Posted August 18, 2020 | Reviewed by Abigail Fagan
On Saturday mornings during the 1970s, when I was a teenager, my grandfather—a psychiatrist—used to give me what he called “seminars.” One thing he told me was that “to know the history of schizophrenia is to know the history of psychiatry.” Though the prevalence of schizophrenia is only about one percent in any population, he said it was the foundation of modern psychiatry. What he didn’t tell me was that the story of schizophrenia is also a story about how scientists sought to define race.
The first psychiatrists referred to what we today call schizophrenia as dementia praecox (“early dementia”), because it was characterized by a gradual deterioration in cognition beginning in early adulthood. They sought to explain its existence with two theories, generally known as degeneration and disintegration. Both of these concepts were integral to the unfortunate description of schizophrenia as a split mind and, ultimately, to the stigma of mental illnesses in general and schizophrenia among African-Americans in particular.
Degeneration and disintegration derived from the observations of eighteenth-century psychiatrists—like Philippe Pinel in France, Bénédict Augustin Morel in Austria, and John Haslam in England—who noticed that some men and women who did not seem to exhibit any worrisome behaviors as children began to deteriorate in their young adulthood rather than flower into productive citizens. Their emotions were blunted, they withdrew from social interaction, even with close family members, and were unable to maintain jobs.
At the same time, doctors also noticed that there was more crime and disease in the cities than in the countryside. Concerned that society as a whole was decaying, scientists proposed that the deterioration of individuals with dementia praecox was caused by widespread degeneration in cities from the pure form of humanity embodied by Adam and Eve and that because the afflicted were unable to work, dementia praecox represented the opposite of progress and economic achievement. As Australian psychiatrist Robert Barrett noted, “In as much as the ideal person (the adult Caucasian male) epitomized the pinnacle of evolution, development, power and strength, schizophrenia, like a negative photographic image, was characterized in terms of degeneration and weakness.”[i]
These scientists believed that degeneration could also explain why Africans and other nonwhite people still existed in the world. Perhaps, scientists thought, Europeans had evolved but had left non-Europeans behind in a state of arrested development at earlier stages of evolution—the people who still hunted with bows and arrows, who believed in multiple gods, and who practiced polygamy.
The second concept, disintegration, was fueled by the widespread nineteenth-century European belief that within each person there is an integrated assemblage of parts. Emile Kraepelin reflected this view by describing dementia praecox as the premature “loss of the inner unity of the activities of intellect, emotion and volition.”[ii] Later, in the 1920s, Swiss psychiatrist Eugen Bleuler popularized the word “schizophrenia” to refer to the “splitting of psychic functions” in dementia praecox; and over the next three decades “schizophrenia” gradually replaced the now-obsolete term “dementia praecox” and became popularly known as a “split personality.”
In all areas of intellectual inquiry, from philosophy to fiction to medicine, Europeans believed that within human beings there existed two selves, the light and the dark, the good and the evil, the sane and the insane. The well-known literary works Frankenstein (1823), Faust (1829), Dr. Jekyll and Mr. Hyde (1886), and The Picture of Dorian Gray (1890) are all examples of this view.[iii]
I cannot imagine any reputable twenty-first-century psychiatrist describing schizophrenia so simplistically as a split mind. Yet, remarkably, more than 150 years after Dostoevsky wrote about the “second self” as the sign of the disintegration of the mind in his book The Double (1846), current ads for antipsychotic pharmaceuticals still show images of young men breaking into two, or of the floor cracking beneath their legs.
Whereas schizophrenia had once been a disease of white middle-class men and women, in the civil rights era it became an African American disease. Well into the mid-twentieth century, white doctors described African American men as irritable, aggressive, relatively impervious to pain, and prone to the so-called negative symptoms of schizophrenia: monosyllabic speech, few gestures, lack of interest in the world, physical and verbal unresponsiveness, and lack of will, spontaneity, and initiative. American doctors started a tradition of misdiagnosing depressed and rightfully suspicious African American patients with schizophrenia.
Many doctors believed that African-Americans were much more likely to have schizophrenia than other populations, and in the 1970s advertisements in medical journals for the antipsychotic medicine Stelazine were targeted towards African-Americans. The ads included images of African masks or figurines, portraying schizophrenia as a “primitive” condition associated with African-Americans. Schizophrenia was what, in 1968, psychiatrists Walter Bromberg and Franck Simon termed the “protest psychosis,” a disease that afflicted civil rights activists.[iv] Only a few lonely voices, like the anthropologist Abram Kardiner, proposed that racial injustice itself caused the symptoms that doctors mistook for schizophrenia.
What’s more, in a racist society the misdiagnosed person believed he was inferior and so withdrew from a world he rightfully mistrusted, to become what Ralph Ellison called “the invisible man.”[v] This kind of internalized stigma is what W. E. B. Du Bois meant by a double consciousness—when one sees oneself, but only through the eyes of others. Schizophrenia had become a “black disease,”[vi] and one of the stigmata of racism. And in a cruel sleight of hand, psychiatrists justified their views on schizophrenia with W.E.B. Du Bois’s own words about double consciousness: “One ever feels his two-ness, an American, a Negro; two souls, two thoughts, two unreconciled strivings; two warring ideals in one dark body, whose dogged strength alone keeps it from being torn asunder.”[vii]
The tradition of preferentially diagnosing depression and other conditions as schizophrenia in African American men is still alive today. Although there is no evidence that schizophrenia is more likely in any particular ethnic group, one review of more than 130,000 files in the Veterans Administration showed that during the 1990s, African Americans were diagnosed with schizophrenia four times as often as their white counterparts, and other studies have found even more disproportionate rates.[viii] African American psychiatrists are also more likely to diagnose African American men with schizophrenia. Even Martin Luther King Jr. reiterated the resemblance between psychosis and African American identity when he said that “a persistent schizophrenia leaves so many of us tragically divided against ourselves.”[ix]
This view of schizophrenia is still with us in the name itself: “schizo,” from the Greek skhizein or “split,” and “phrenia,” from the Greek phren or “mind.” Perhaps it’s time to find a new word for schizophrenia, one that is freed from our racist past.
[i] Barrett, “Conceptual Foundations of Schizophrenia I,” p. 624.
[ii] Barrett, Robert. 1998. “Conceptual Foundations of Schizophrenia II: Disintegration and Division.” Australian and New Zealand Journal of Psychiatry 32 (5): 617–26, 630.
[iii] Other, lesser known, tales described people in whom one self had become estranged from the other self, or whose minds had separated from their bodies. For example, in his 1771 novel, The Sorrows of Young Werther, Goethe promoted the idea that madness could be comprehended by listening to those who are mad, and that within each person there can exist both a sane and an insane self. See Thiher, Allen. 1999. Neoclassicism, the Rise of Singularity, and Moral Treatment. Ann Arbor: University of Michigan Press. On the ubiquity of dual selves in English literature, see Miller, Karl. 1985. Doubles: Studies in Literary History. Oxford: Oxford University Press.
[iv] Bromberg, Walter, and Franck Simon. 1968. “The ‘Protest’ Psychosis: A Specific Type of Reactive Psychosis.” Archives of General Psychiatry 19 (2): 155–60.
[v] Kardiner, Abram. 2014 . The Mark of Oppression. New York: Martino.
[vi] Metzl, Jonathan M. 2009. The Protest Psychosis: How Schizophrenia Became a Black Disease. Boston: Beacon Press, p. 210.
[vii] Du Bois, W. E. B. 1903. The Souls of Black Folk. New York: Dover Publications, pp. 2–3.
[viii] Blow, F. C., et al. 2004. “Ethnicity and Diagnostic Patterns in Veterans with Psychoses.” Social Psychiatry and Psychiatric Epidemiology 39 (10): 841–51.
[ix] Metzl, p. xi.