SCHIZOPHRENIA AS NEURODIVERSITY

The term ‘schizophrenia’ stems from the from Greek words skhizein, which means ‘to split’, and phrēn, meaning ‘mind’. The initial thought was that the mind splits in some sense: not, as is sometimes thought, into multiple personalities; but rather into a single fragmented and alienated personality, usually beginning in late adolescence or early adulthood. Beyond this, the condition is most centrally characterised largely in light of psychosis, hearing voices, paranoia, a general sense of apathy, and flat or fluctuating moods and emotions.

In general, these traits are almost universally though to be inherently harmful deviations from the norm, and together they are taken to somehow destroy or at least radically damage the previously existing person. Given this, schizophrenia (and related ‘schizophrenic spectrum’ conditions such as schizoaffective disorder) are taken within both institutional psychiatry, and society more broadly, to be something terrible — tragic medical diseases to be combated with pharmaceutical drugs, institutionalization, and perhaps, one day, genetic engineering.

But the rise of the neurodiversity movement, which until now has focused mostly on the autism spectrum and other cognitive disabilities, gives reason to challenge this view of the schizophrenic spectrum. What neurodiversity movement proponents claim is that, even though the underlying neuro-cognitive differences captured by psychiatric labels indicate meaningful ways of being, the harm associated with these conditions is caused by society and ideology rather than due to anything like innate medical pathology. In light of this, neurodiversity movement proponents argue that what they call ‘neurominorities’ — autism, dyslexia, and so on — are natural and legitimate, albeit oppressed or excluded, ways of being in the world.

Given this, neurodiversity proponents stress the need to embrace one’s neuro-type as an inherent part of one’s identity, instead of seeing it as an external pathology that is separate from one’s essential selfhood. Autistic neurodiversity proponents, for example, find the notion that you can have autism, rather than be autistic, highly problematic — much in the way that it is problematic to speak of gay people as ‘people with sexual orientation disturbance’, which was precisely how homosexuality was characterized within institutional psychiatry until the 1980s. In short, the point in rejecting person-first language (e.g. ‘person with autism’) in favour of identity-first language (e.g. ‘autistic person’), is that, in order to genuinely accept oneself, and in turn live a good flourishing life, seeing one’s neurocognitive style as an essential and valuable part of one’s selfhood, rather than an added pathology, seems vital.

Notably, although some groups of schizophrenic persons have resisted instituaitonal psychiatry in various ways, for example by trying to demedicalise hallucinations, the neurodiversity movement calls into question whether schizophrenic selfhood too, might be re-conceptualised and reclaimed in this way. That is, it points towards the possibility of not just demedicalising schizophrenia’s associated traits, as the ‘hearing voices’ and ‘mad pride’ movements have already started to work towards, but rather towards a more radical and affirmative embrace of the categorization as part of the personal and political identities of schizophrenic persons.

Of course, on the face of it, I realise, it might seem utterly bizarre to claim that schizophrenia could be seen as a kind of neurodiversity rather than a disorder. After all, there is nothing good about hearing harsh and invasive voices, or thinking that people are out to get you. And we have all heard tabloid stories of schizophrenic spectrum persons harming themselves or others. In short, then — as many schizophrenic spectrum persons and their families will testify — those who end up being given this label do indeed encounter terrible amounts of distress, and many would do anything to return to their pre-schizophrenic selves.

Nonetheless, all this does not, in and of itself, necessarily mean that being on the schizophrenic spectrum is inherently harmful. It may still be both that the distress stems from cultural and social rather than neurological factors, and that we dismiss schizophrenic selfhood due to a particularly restricted conception of what it means to be a healthy person (or indeed have a self at all). If this is the case, then it may be that seeing schizophrenia as neurodiversity is better than seeing it as a medical disorder.

One recent scientific study which supports this hypothesis, for example, comes from the Stanford anthropologist Tanya Luhrmann and colleagues. By examining the experience of hearing voices (or auditory hallucinations) in different cultures, they found that the whether this was associated with distress varied hugely. More specifically, in North America, voices were experienced as harsh and invasive strangers, and so caused a huge amount of distress to those who heard them. By contrast, In Africa and India, voices were much more likely to be experienced as playful and friendly.

Very significantly, the key factor in this difference, Luhrmann and her colleagues note, was actually the socially constructed ideal of the self that dominated in each society. In North America (as with the rest of the West), an atomized, individualistic conception of self dominates, meaning that hearing outside voices was conceptualized and experienced as an external threat to autonomy and selfhood. By contrast, given that more collectivist conceptions of selfhood dominate in Africa and India, it did not matter if some internal voices are not one’s own, since others are already part of the self anyway — and so the voices were much less likely to be harmful, and were sometimes even helpful.

Interestingly, the claims of this anthropological study chimes with those of Rutgers psychologist Louis Sass, who has argued over the past three decades that post-modern Western societies hugely amplify the kinds of problems associated with the schizophrenic spectrum. For Sass, because postmodernism is, like the schizophrenic spectrum, characterized by a hyper self-reflexivity, fragmentation, alienation, and an ever increasingly individualistic yet decentered self, the two can accentuate each other in a way that makes the schizophrenic way of being manifest as more problematic than it otherwise would have. In other words, it may be pervasive aspects of our post-modern culture, and the conception of selfhood that accompanies it, that amplifies the problems schizophrenic spectrum persons seem to be prone to, rather than these problems being most centrally biomedical in nature.

If the claims of researchers like Sass and Luhrmann are even partially right, then it seems that it is social rather than neurological factors that are key in explaining the distress experienced by those on the schizophrenic spectrum. And in particular, it seems that historically contingent conceptions of selfhood — that is, pre-scientific, normative, and ideologically laden notions regarding what it means to be a person — are a key factor in the harm associated with being schizophrenic. Given this, it may be that learning to see schizophrenia as a natural part of neurodiversity may actually be better for schizophrenic persons in terms of the possibility of self-acceptance and living good, thriving lives.

Indeed, as the scientific medical literature itself indicates, it is precisely the case that schizophrenic spectrum persons tend to flourish, like everyone else, only when they come to accept and affirm themselves for who they are. As one schizophrenic man, Simon Champ, writes, it was precisely such an affirmative self-narration that ‘has given me the most precious thread, a thread that has linked my evolving sense of self, a thread of self- reclamation, a thread of movement toward a whole and integrated sense of self, away from the early fragmentation and confusion I felt as I first experienced schizophrenia.’

In contrast to seeing schizophrenia as a pathological destruction of the self caused by an internal dysfunction, then, it may help to consider working towards a more inclusive and diverse understanding what it means to be and develop as a self. In particular, we may need to acknowledge that for some manifestations of human neurodiversity more than others, it is natural for selfhood to fragment and then resynthesize in new and creative ways (and to be more active in generating images and voices, perhaps especially in response to often harmful social environments).

Indeed, we all do this to some extent: situations that cause a rupture in our existence — from life-changing tragedies to falling madly in love — can often cause selfhood to fragment, in some sense, and in turn to need some time before it can realign and grow. This is a natural reaction, and part of the human condition. In line with this, instead of automatically seeing them as deviations from ordinary selfhood, more schizophrenic kinds of fragmentation and self-other relations might also one day be seen as a natural ways for selfhood to adapt and relate to (sometimes extreme) circumstances — part of the continual path of an ever changing self existing in an imperfect world, rather than the destruction of one self replaced by a broken self.

Of course, I am not denying that those on the schizophrenic spectrum currently suffer terribly, nor even that this way of being comes with its own unique set of challenges and limitations. Clearly, many do experience terrible distress, and it is also important to acknowledge that in some extreme cases of, say, paranoid psychosis or severe depression, medication may be helpful (just as all humans need medication at some point in their lives). The point, rather, is that all human ways of being come with their own challenges and limitations: it is part of the human condition to suffer, to experiences crises of selfhood, and to change as life happens to us. And in the case of the schizophrenic spectrum, there is good reason to at least entertain the possibility that the most terrible distress might actually caused by life-events, society, and ideology, rather than due to some inherent medical pathology.

Indeed, once we add to these broader underlying ideological factors that, as anti-psychiatrists such as Thomas Szasz have long stressed, those given the schizophrenic spectrum labels are routinely stigmatized, institutionalized, drugged, and repeatedly told they are inherently sick and broken, it is no wonder that so many become paranoid, depressed, and apathetic. Just as with other oppressed or excluded minorities who are thereby more prone to experiencing mental distress, so too it should not be surprising that schizophrenic spectrum persons encounter similar issues in an equally systematic and terrible way.

What I am denying, then, is that those given these labels are obviously inherently broken, sick, or pathological; and I am also denying, vehemently, that it helpful to cast them as such. Rather than seeing the schizophrenic traits as something that destroys the self, we need to work towards understanding how, for some neurodivergent selves, this kind of self-relation is a natural reaction to the various struggles encountered in the human condition more broadly, as well as to more specific oppressive social conditions. The schizophrenic spectrum, in other words, must be welcomed into the arms of the already blossoming neurodiversity movement — making it, as with autism, a way of being with its own culture and affirmative political identity, rather than a medical disorder.


Originally published at intersectionalneurodiversity.wordpress.com on January 25, 2017.