4 - Grandeosity [unedited]
by chastity vale
Doctors love to talk about their interest and fascination with the subject of their study. This is particularly notable when they are not a member of the group that they study, but they are nevertheless taken with the obsession. This leads, often, to a rather toxic combination of identification with but with notable, and important, distance from the subject. As an example, this is extremely common with transness, particularly with doctors who work with trans women. A lot of the sexology which still provides the foundations of the treatment protocols that trans women have to suffer through for care come from researchers who were or are fascinated by us, but view us as freaks or curiosities. Famously, significant parts of the research into trans womanhood is based on our perceived attractiveness by researchers obsessed with our sexuality, who then use their assumptions to make sweeping pronouncements about who we are and why we are, often speaking over us in the process.
This construction usually occurs because we, as trans women, are structurally locked out of the institutions of meaning-making which then create the doctors and scientist who deign to look at us and judge us. But this structure is not unique to transness. Autistic researchers have the same issue, and for years most of the cutting edge research on autism was being done in small communities of autistic people speaking among themselves, outside of the prying eyes of the academics. The same structure exists with schizophrenia.
In his book Malady of the Mind, psychiatrist Jeffrey Lieberman begins with the story of one of his patients who simply went too far, and got away from him. That patient, known to us as Jonah, is presented as doomed from the start from Lieberman’s perch as his psychiatrist, with perfect hindsight. Jonah is described as ill, but then well under Lieberman’s care, and then sick again as he rejects care. Jonah’s story is interleaved with Lieberman’s, as we go through Lieberman’s childhood, through his early years seeing the inside of an asylum (presented, of course, with the representation of the mad as less than human, and as an object of fascination for the young Lieberman), then three paragraphs later his time at Mt Sinai Hospital in New York City with “emergency rooms would be filled with violently deranged people on the drug PCP, and Son of Sam—a serial killer named David Berkowitz, who was found to suffer from schizophrenia”. Lieberman’s close linking with 1970’s NYC, the violence that was rife in the city, and of course the ever present evil of schizophrenia makes the argument for him that he doesn’t have to.
Lieberman describes Jonah’s failure at treatment, and then eventually his slipping into treatment resistance. Lieberman once gives a passing reference that perhaps the medication side effects were what lead Jonah to getting off the meds, but doesn’t follow up on this. Jonah’s eventual treatment resistance is reacted to with the same hardheartedness that Lieberman himself critiques. Never once do we hear even Lieberman’s memory of Jonah’s voice. Never once is Jonah allowed to speak for himself.
On YouTube, there’s a video that has been viewed 27 million times called “Psychiatric Interview Series Patient No. 18 Evaluation for Diagnosis Produced for the Department of Psychiatry, School of Medicine, by the Motion Picture Division, Theatre Arts Department, University of California, Los Angeles, All Rights Reserved 1961”. In it, a young man sits in a chair and listens to a doctor ask him demeaning questions. i can listen to it and understand his position, where he is, who is speaking to him, and understand the tightness in his voice. Before him sits the torturous arm of the state. The doctor speaks to him and ardent refuses to hear what he says. The doctor says, “Why are you here?” The young man respond with, “because…”, pauses, looks for words, continues, “I am not completely like other people.” The doctor asks him again and he repeats himself. The doctor asks him again.
The comments to this video are filled with people imagining a backstory for this young man. Some occasionally mention the doctor, describing him as rude. But the young man under autopsy here is an ancient tragedy. Commenters talk about their uncle who looked so similar, about what a tragedy it is to lose so much so young. They talk about how much he must have lost, how much he must have suffered. Several comments talk about the extreme suffering of his friends and family. Prayers for his family (not for him) follow. What does this video do? It’s not usable as an educational piece, it’s too out of date. As a media experience, though, its a freakshow. Its a view across time and space into this poor man’s life, as he fights for legibility under the violence of the state. He fails, of course, over and over, because the freak in the freakshow is not allowed that legibility. Instead, the audience files in, recoils at the idea of a different experience, and leaves thinking “what just happened to me?”
This is one of the key dynamics that you can find on writing about schizophrenia. The psychotic is treated as the eternal other, and the rest of the world is cast as either its doctor, its victim, or its burden-bearer. Most books about psychosis are men writing about men, parents writing about children, doctors writing about patients. Very, very little is schizophrenics writing about schizophrenia, and what does exist is written from privilege. This pattern reproduces societal biases, obviously, but it also exists because of the dominant narrative about schizophrenia: to be schizophrenic is to make a victim of your family and community, to be a lost cause and a lost soul. Even writers writing from the position of the schizophrenic, like Esmé Wang, write about losing their soul. We cannot even see ourselves outside of this frame.
Lieberman’s book Malady of the Mind is designed to play an important role: it ignores the history of the treatment of the schizophrenic, that eternal other, in order to recast the history of schizophrenia not as a series of increasingly horrific treatments as the march of capitalism progresses, but as an earnest attempt by doctors at healing outside of the context of history. It casts the treatment of the mad not as decisions being mad by people, but as obvious decisions that had to be made for the sake of the schizophrenic. It keeps our critique and the lesson we learn from madness very small, local only to the schizophrenic. His chapter on deinstitutionalization, which closed a huge number of asylums which incarcerated the ill across america and was started and supported by huge masses of disabled activists for decades, ignores the contributions of those same disabled activists to turn the story into one of pure legislation.
To Lieberman, deinstitutionalization was simply the next good idea in a series of good ideas about how to treat schizophrenics. But like so many writers on this period, he cannot help but repeat what Liat Ben-Moshe calls the “new asylums thesis”. He is compelled to write that 16 percent of those in prison are mentally ill, a percentage far greater than the non-imprisoned population. Ben-Moshe’s critique of the “new asylums thesis” is significant. There is a chain of reasoning, which is that deinstitutionalization flooded the streets with the mad, who failed to adapt to free living, and are now in jail. Ben-Moshe, however, points out that significant closure of asylums occurred decades before the increase in the mentally ill in prison. The increase in mentally ill in prison came instead after years of increases in income inequality, as homeless rates started rising, and actually represents a response to Reagan-era politics. Finally, the increase in mentally ill in jail forgives the jails and prisons as a source of mental illness, imagining instead that the prison is completely non-effectual to those inside it.
There’s a few ways to tell the history of psychiatry. A very common one, used for example in Chapman’s Empire of Normality and Lieberman’s Malady of the Mind is to closely follow the history of madness by way of treatment of schizophrenia. This telling of history is useful for a number of purposes. Lieberman is able to use it to outline a history which demonstrates a constant conversation between the illness and treatment throughout time, with the wily schizophrenia weaseling out of treatment each time. Chapman is able to use it to build a history which calls for a radical neurodiversity (which they do while also gatekeeping schizophrenics out of that call; Chapman specifically uses the history of psychiatry’s war against the schizophrenic to provide energy for a construction of neurodiversity which includes autistics, ADHDers, and others, but not schizophrenics). There are alternative ways to tell the history of psychiatry, however. Owen Whooley’s On The Heels of Ignorance tells this same historical period, but focuses on the development of treatments and madness as a social issue. This frame allows Whooley to focus on the state side of the equation, and the development of knowledge coming from inside of the hospital and the academy.
Like Lieberman’s patient Jonah, my condition has changed and grown as i’ve grown older. It has become more difficult to treat, returning to remission from its flares has become more fraught, and it has followed a gentle but negative course. To Lieberman, i would maybe be unsurprising. Another madwoman, another schizoaffective. i wonder if Lieberman would be interested in me, if he would be interested in my case in isolation, able to separate it from the person i am. i wonder if he would be interested in the choices that i’ve made that have led me, like Jonah, to increasingly precarious situations. i wonder if he would care at all about the logic that leads to the decisions, and to the logics that flow from the decisions. i wonder if instead, he’s interested in schizophrenics abstractly, fascinated by our condition, but not interested in our lives.