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I.
Introduction, General Discussion, Steps to Thinking
About Schizophrenia
 In
"Minimal Requirements for a Theory of
Schizophrenia," Gregory Bateson (1972: 244-70
[1955]) argued that explanatory
perspectives on schizophrenia that depended on the
boundaries of the individual (in a "Newtonian"
perspective) or conversely on a view of the
condition as entirely socially constituted (in a
"Berkeleyan" perspective) could not hope to
encompass the condition. For Bateson and many
others who were to follow him, schizophrenia did
not merely manifest itself in communication
troubles, but existed at the level of basic
inter-human communication. Thus, models fashioned
on individual problems in communicating or
thinking, or models taking the condition as
strictly between persons in a 'schizophrenic
context' fail to take into account the entire
communicative system. As Bateson noted,
schizophrenia, as a condition, seemed to be of a
communicative nature both in origins,
manifestation, and substance, and should thus be
examined as taking place in the active perceiver,
and in the perceiver's interaction with a context,
including other active perceivers.
For
Bateson and the subsequent "family therapy"
movement, this view suggested the researcher seek
out communicative systems that seemed to engender
schizophrenic patterns of communication.
Simultaneously, there was a move to locate
schizophrenia in biological roots (Barrett
ms.:39-43), each side being drawn to discover the
origins of a condition describable only as an
amalgamated set of behavioral symptoms. In
Bateson's terms, each side was being drawn to
Berkeleyan or Newtonian extremes in pursuit of
schizophrenia's origin; in Robert Barrett's terms,
they were each being drawn to these poles in
pursuit of an essentially indefinite wild goose, a
cultural category the form of which varies in
accordance with social configurations of power,
category, and symbol. This paper seeks to examine
schizophrenia as a condition of communication writ
large, in Ruesch and Bateson's (1968) sense of
communication as perception, gestalten encoding and
decoding, value hierarchy, and conceptual category
(1968:168-211).
As
such, a look at those behaviors taken as
paradigmatically schizophrenic and those behaviors
of patients taken as confirming the diagnosis of
"schizophrenia" can lead us to a conception of
schizophrenia as a cultural condition, in all
senses of the phrase.
In
calling schizophrenia "a cultural condition" or
even "a condition of culture," I mean to both
acknowledge that schizophrenia manifests in a given
society as a cultural category and in the persons
so categorized as a condition relating to their
fundamental divergence from certain kinds of
"normal" cultural understandings. This paper's
viewpoint diverges significantly from such writers
as Barrett and Ian Hacking in that, while it
acknowledges that schizophrenia's outline as a
condition does exist as a culturally-constructed
category, its manifestation is a problematic mode
of dealing with cultural categories, modes, and
practices. This is to say that schizophrenia is
such a slippery item for researchers because it
manifests as an aberration in, and difficulty with,
precisely the same fabric on which its form is
viewed. Schizophrenia can thus be seen as
essentially cultural in that it manifests as an
apparently different cultural perspective from the
'norm,' presenting both the "schizophrenic" and
surrounding society with a "schism" between their
(culturally presumed) grounds for communication,
and leading to a basing of the category
"schizophrenic" on those problematic, contemporary
cultural grounds for communication --
communication, again, in Ruesch and Bateson's
sense.
Barrett's
essay provides a useful perspective on the
development of the diagnosis as one resting
ultimately on a particularized perception of the
social unit, the individual, in modern Western
society. He notes that Pitted against the Western
concept of the individual as bounded and discrete,
is the concept of schizophrenia as unbounded or
diffused individuality. This principle of
permeability pervades twentieth century discourse
on schizophrenia, both at the level of the category
and the realization of that category in the
referent, the patient (ms.: 33).
Barrett
argues that not only the creation of the category,
but its actual realization in the 'patient'
conforms to this idea of identity-breaking that is
fundamentally Western. Barrett claims to avoid
making any conclusions as to whether the conditions
termed schizophrenia have, indeed, any basis
outside their cultural construction, and seems to
disagree with Szasz's (1973) denunciation of most
mental illness as constructed as power games
between psychiatrists and patients, patients and
their families, patients and society (Barrett
ms.:58). However, he wants to present the category
"schizophrenia" as a problematic of Western
culture, a gestalt figure which may be interpreted
against the background of Western concepts of the
person and [has] argued that 'the
schizophrenic' emerges as a marginal and ambiguous
category, both an agent of meaningful action and
not an agent of meaningful action - a person and
not a person (Barrett ms.:70).
What
Barrett has exposed is on the one hand the banal
idea that any category is ultimately arbitrary, and
tied together by some set of selected, gestalten
points of reference--that all categories are
ultimately cultural categories. On the other hand,
he concludes that schizophrenia's particular
shifting, and ever- receding nature, its apparent
reconstitution as a problem with every medical
paradigmatic shift, suggests that "schizophrenia is
a socially organized moral category" and therefore,
"useful insights can be gained into this disorder
by cultural analysis" (Barrett ms.:70). I would
augment this position by adding that not only is
schizophrenia a "socially organized moral category"
and a "plurivocal symbol" of "nature overwhelming
culture" (Barrett ms.: 70), but that as a cultural
category, it is a category about cultural
categories; schizophrenia may therefore be seen as
problematic because it is a cultural category about
people's employment of cultural category. It is a
clinical and colloquial metadiscourse describing
the unusual divergence of some persons from a
cultural communicative order--an order that seems
transparent and given to those in it.
II.
Approaching a Perspective on Schizophrenia
As
we have discussed, theories about schizophrenia
that seek its 'origins' or causes enter into an
irreducible paradox between schizophrenia
constituted as a cultural category describing
certain modes of behavior, and schizophrenia as a
condition of differentiated cultural categorization
at a basic level. R. D. Laing unintentionally
captured the paradox neatly when he noted
that
To
regard the gambits of Smith and Jones as due
primarily to some psychological deficit is rather
like supposing that a man doing a handstand on a
bicycle on a tightrope 100 feet up with no safety
net is suffering from an inability to stand on his
own two feet. We may well ask why these people have
to be, often brilliantly, so devious, so elusive,
so adept at making themselves unremittingly
incomprehensible (Laing 1967:85).
Laing's
quote was meant to describe schizophrenia theories
based primarily on biological 'deficits,' but
applies as well to the anti-psychological position
that schizophrenic patients are compensating for
particularly problematic social situations.
Subsuming the whole of schizophrenic experience
under the notion of a social strategy, even an
unwitting one, is easily as extreme a position; as
Barrett notes, the more rigorous the study of
social context and schizophrenia, the less the
condition seems connected with any particular kind
of social stress and the more theories of it seem
politically inspired (Barrett ms.:67). Theorizing
about schizophrenic origins has led to various
perspectives both of what the condition is and what
causes it. These questions of locus and origin
remain unresolved, and perhaps as Barrett asserts,
unresolvable, in the morass of the paradox I
described and the politicization of social
categories that affect one's social relations and
volition. Recent theories about schizophrenia have
tended to question the presumptions that the
disease is debilitating, permanent, necessary, or
even abnormal. Thus, we find such researchers as R.
D. Laing calling the condition, "a special strategy
that a person invents in order to live in an
unlivable situation" (Laing 1967:95), in an
anti-psychiatric position in which the patient is
seen to be no less normal than anyone else,
adopting a particularly sensical solution to
peculiar problems. Laing also supposed that the
episode might be a sort of natural process of
passage brought on in certain kinds of social
conditions, biological or not in nature, that
something curtails, derails or reroutes into
permanent liminality. Laing does not mention Victor
Turner's notion of the ritual as entry, liminality,
and reintegration stages, but his description
mirrors it perfectly, and he wonders whether the
"illness" is little more than a natural human event
being over analyzed, and ultimately interfered with
in a culture that has developed norms against such
things (Laing 1967:106-7).
Viewing
a condition or even "disease" as natural or normal
is itself, however, a matter of contextualized
cultural judgment. As Bateson points out, the
pathologies of a system "arise precisely
because
the constancy and survival of some larger system is
maintained by changes in the constitutive
subsystems" (1972:339). This position is not
functionalist, but rather cybernetic, based on the
tendency of massive numbers of interacting
components (limitless, really) to reach an
equilibrium state, which, while it changes, does so
in a generally oscillating fashion that can be
described from a sufficiently external perspective
(itself indescribable from its own vantage). Thus,
"illness" of a mental or physical, biological or
genetic sort can be viewed as natural or normal and
can be seen to have a function within a higher
order. The schizophrenic patient "is" adaptive to
problematic family life; the plague of typhoid
"moderates" the over-concentration of human
societies.
Labeling
it "normal" or not brings us no closer to
understanding fundamentally what is going on in
those people whose behaviors are such that we apply
the category schizophrenia to them or their
context. For typhoid, we might want to ask what, if
anything, is there in the condition of some people
that makes us want to place their conditions
together in a diagnostic category, and second,
what, if anything, in those persons' socio-cultural
contexts has made this commonality of symptom
possible. Similarly, for schizophrenia, we should
be asking first what, if anything, is there in the
behavior of some people that makes us want to place
them together in a diagnostic category, and second,
what, if anything, in their socio-cultural contexts
makes this categorization possible. Perhaps desire
to "cure" people of their "condition" overran
understanding what actually constituted that
condition, fundamentally, and founded the discourse
about schizophrenia's causes. Whatever the case,
before one can begin to examine what "causes
schizophrenia," one should examine the general
nature of the conditions placed in the
socially-constituted category "schizophrenia."
Thus, R. D. Laing's approach, which begins with
finding the 'cause' of 'schizophrenia' in the
"whole social context in which the psychiatric
ceremonial is being conducted" (1967:86) has jumped
the gun in failing to first establish what exactly
the condition is. If anything, for Laing, the
condition "schizophrenia" is a myth built around
some normal behavior responses to difficult
situations; but he fails to ask what is it to
ordinary people that makes the schizophrenic so
profoundly strange--and what in schizophrenic
behavior exactly is different?
In
describing his views, Laing cites Garfinkel's work
on degradation ceremonies, making it the more
peculiar that he doesn't look into what "the
schizophrenic" does phenomenologically. Instead,
Laing describes the condition causally--he may be
"correct," but it leaves him to play in the
confused definitional game we discussed above,
perhaps giving him a useful perspective that may
help some people to live happier lives, but
bringing him no sharper an understanding of what
about the people he is dealing with is itself
different from others. While providing a delimited
set of behavioral criteria through which to
classify patients, the Diagnostic and Statistical
Manual III-R (DSM III-R) accomplishes little more
than Dr. Laing in defining any criteria that form
the essence of the condition. The DSM III-R does,
however, attempt to separate "prodromal" or
superficially occurring symptoms from those that
may be elicited from interaction and conversation
with the patient. Barrett would likely note that
these primary diagnostic symptoms are an outgrowth
of, and remain dependent on, a psychiatric practice
in which certain kinds of patient-doctor
interactions occur; here we will note that they,
too, are prodromal, and like the DSM III-R's
prodromal list, should be seen as the manifestation
of some underlying situation. As far as the DSM
III-R, and most psychiatrists are concerned, that
underlying condition is "schizophrenia," and
"schizophrenia" is either "environmentally,"
"biologically," or "genetically"-caused; or caused
by some combination of them, never reaching the
question of what this underlying condition is in
terms of the mindset of a person from some
particular socio-cultural milieu (Hurlburt
1990:259).
Nevertheless,
the DSM III-R provides a useful guide to those
superficial behaviors that, when coinciding, are
considered the hallmark of the "schizophrenic."
Among these are :
A.
Presence of characteristic psychotic symptoms in
the active phase: either (1), (2), or (3) for at
least one week (unless the symptoms are
successfully treated):
(1)
two of the following:
(a) delusions
(b) prominent hallucinations [. . .]
(c) incoherence or marked loosening of
associations
(d) catatonic behavior
(e) flat or grossly inappropriate affect
(2)
bizarre delusions (i.e., involving a phenomenon
that the person's culture would regard as
totally implausible [...])
(3)
prominent hallucinations [...] of a
voice with content having no apparent relation
to depression or elation, or a voice keeping up
a running commentary on the person's behavior or
thoughts, or two or more voices conversing with
each other
B.
[lessened functionality in social
contexts]
C.
[not another disorder]
D.
Continuous signs of the disturbance for at least
six months [requiring ONLY a one-week active
phase with or without residual or prodromal
phases]
Residual
and prodromal phases are followup or lead-in
periods in which the patient evidences any of:
role-fulfillment problems, social isolation,
"markedly peculiar behavior," "marked impairment in
personal hygiene and grooming," flat or strange
affect, "digressive, vague, overelaborate, or
circumstantial speech, or poverty of content of
speech," "odd beliefs or magical thinking," unusual
perceptual experiences, and a loss of drive. In
glossing the DSM III-R's list, one might say the
schizophrenic is one who perceives and reacts in
strange ways, evidences peculiar causal and
categorical associations, and generally fails to
live up to community standards of behavior.
Barrett
describes the psychiatric description of
schizophrenia as "located on and generated by" the
"deeply seated" paradox of the person as biological
isolate and social being (Barrett ms.:9),
essentially indicating for our purposes that the
psychiatric view of the underlying "symptoms"
assembles them into a category, "schizophrenia"
already mediated through a discourse about social
and individual persons. We, however, must admit,
something is going on when a person can "speak a
different diction" in their own view and be
"delusional" in another's (Hurlburt 1990:195); when
a person begins to deviate wildly from social and
cultural norms and understandings that others not
only take as given, but to which others always
refer their behavior,1
we must wonder why these people are no longer
persuaded back into alignment with such a wide
array of behaviors. Perhaps these people are not
merely adopting a strategy, or acting a certain
way, but instead are experiencing, "a way to be
crazy, at least in an industrial/romantic,
Protestant society" (Hacking 1991:844). We should
wonder not only why them, but also, which kinds of
behaviors are different. What is that way? Any
attempt to answer that question must take into
account what is known about human behavior and
biology in order to describe what behaviorally and
chemically is taken as setting "the schizophrenic"
apart from others in the culture. For example,
while a genetic 'source' is suspected, none has
been found, and indeed, the simple one-gene-wrong
notion that may work with some ailments seems to
not hold in schizophrenia, as studies on heredity
and twins has begun to show. More complex
biochemical models may also take into account
social factors, triggers, etc. (Barrett ms.:41-2).
Nevertheless, "schizophrenics" do respond to
certain classes of "anti-psychotic" medications
which allow them to act in manners that we would
class as more normal, i.e.,the evidencing fewer of
the factors taken as indicative of the condition.
Among these is Sandoz product "Clozaril" famed
forschizophrenics bringing some of the most
severely affected (thoseothers) into completely
unable to interact in what is taken as a
"meaningful" way by astonishingly "normal" modes.
Such a markedthe former difference, subjectively,
is noticed by symptomaticallergic to the
schizophrenic, that a class of them who have turned
out to be fatally drug (it acts as an immune
systemto continue depressant on them) are suing
Sandoz for the right taking the
medication.2
Something
besides a "strategy" or "ritual" is going on,
certainly, but we must also take into account that
human thought, emotion, and whatever other human
state of being we want to describe has or manifests
a chemical component. Even R. D. Laing tempered his
socio-strategic position and said "that the
biochemistry of the person is highly sensitive to
social circumstance" (Laing 1967:94), and so it
would be no surprise to him if a social "cause"
produced a chemical "result" curable with another
chemical, an "anti-psychotic" drug. "Happy," we
should note, is a chemical as well as emotional
state, and can be "cured" (i.e. changed) by the
introduction of another chemical substance (which
we can for our purposes here call an
"anti-jubilant"). In Bateson's view, there is a
naive artificiality in viewing the emotional or
psychic state as separate in any way from the
chemical; the division of human into sub-systems of
mental versus chemical, or individual versus
social, is artificial, and dependent primarily on
the classifying observer's purposes (Bateson
1973:319). What we are left "knowing" then are the
characteristics by which we select out those we
will term "schizophrenic" and the behaviors
evidenced by those persons themselves: our
society's cultural categories and the evidence we
have for theirs.
III.
Schizophrenia as a Communicative (Dis)order
When
Robert Barrett notes that "schizophrenia" is a
multi-faceted symbolic category dependent on
certain cultural preconceptions (ms.:70), he is
referring to the symptoms taken as constituting the
"condition." He is not saying that some underlying
disorder cannot exist, nor is he saying one must.
This section will show how what constitutes the
symptoms depends on certain cultural preconceptions
precisely because schizophrenia is a condition
affecting such preconceptions. One who is
"schizophrenic" is one who does not perceive, act,
conceive, or interact as others expect they should,
on a certain kind of level; and one who does not
perceive, act, conceive, or interact as others
expect they should, on a certain kind of level, is
termed a schizophrenic. It is not merely the giving
of surprise or appearance of eccentricity; and yet
there is a range of degree, one end of which could
well be termed "merely eccentric." Once we examine
critically what differentiates schizophrenic
behavior fromwe 'normal' behavior in those
societies that recognize it as a condition, can
begin to discuss what is at the core of thatsome
kind of behavior deviance, and perhaps why cultures
do not recognize "it" as a condition.
One
approach to examining "schizophrenic" behavior is
to begin with linguistic behavior. Language, since
Saussure's Course, has been studied in intricate
detail, and a wealth of tools, methods, and terms
come to the researcher. Wrobel's Language and
Schizophrenia criticizes the "classical" approach
to schizophrenia in which the patient is held to be
making a confused use of the langue in the
formulation of confused parole. The problem under
general thinking about schizophrenia, is that the
patient's thinking, for whatever reason
(biological, environmental), has become confused,
and it evidences itself in language confused in
both subject matter and formulation. Wrobel takes
the position that schizophrenic speech, and quite
probably most other behavior, adheres to a langue
particular to the schizophrenic, and often,
differing from their host culture's langue in
predictable ways (Wrobel 1989:5). Wrobel's view is
consistent with Hurlburt's (1990) study of
schizophrenic and "normal" inner experience, in
which it was found many people experienced thinking
without precise words, and speaking without
preformulative thought. If some difference occurs
at a deeper level, of "langue," which may be taken
in this context as the internalized preconscious
formal aspects of symbolic activity within a
culture, then the "schizophrenic" would be acting
according to a partially independent cultural
logic, causing both others and self communicative
distress and possibly leading to withdrawn,
frustrated, angry, paranoid, or other
secondary--but
"symptomatic"--behaviors.3
Wrobel starts from John Cutting's (1985) Psychology
of Schizophrenia conclusions that schizophrenic
speech is less predictable than that of "normals"
(and they have a hard time predicting "normal"
speech), that their primary disturbances are at the
pragmatic level of speech, and that they otherwise
employ language "normally" (though there is some
evidence that their division of phonemes may drift)
(Wrobel 1989:9). From there, Wrobel moves in "an
'antipsychological' direction . . . toward an
anthropological approach" (1989:10).To Wrobel, as
with Bateson, the realm of communication is one of
active perception, in which speech is the active
alteration of context by an actor who is both part
of that context and a vehicle for its change. For
Bateson, communication included perception, an
at-least partially acquired mode of divvying
experience through gestalt value systems that
"encode" raw experience into cognizable experience.
From the traditional approaches to schizophrenia,
Wrobel desires only to take the notion that "the
schizophrenic experiences differently" (ibid.); but
this is not a viewpoint like Laing's, in which the
condition is understood as an outcome of some
causality. Rather, Wrobel seeks to understand
schizophrenia by examining those behaviors taken to
be characteristic of it. A conclusion he draws is
that
Although
logic categories of schizophrenics are often
not any less rational than ours, they do
not enjoy our acceptance...[because]
schizophrenic attitudes go beyond the
expectations of "normal" men (1989:11 italics
mine).
Which
is to say that they "go beyond" the communicative
presuppositions, not only in their langue, but also
in the pragmatics that turn langue into
comprehensible parole. In Bateson's terms, they
have somehow integrated a different encoding
process from the norm at the perceptual and
speaking levels (see Ruesch and Bateson 1968:169).
Hurlburt's analyses of several "normal" and
"schizophrenic" persons' descriptions of inner
experience similarly leads him to the idea that
schizophrenics may be perceiving and
reconcepualizing the world in a manner different
from others in their culture, but that they are
doing so in an essentially comprehensible manner.
Hallucination, for example, may be the perception
of what we call recollected images as though they
were as present as what we call "physical reality,"
an interpretation divergent from ours only in that
it essentially recognizes that all our "real"
perception occurs in our heads as well (Hurlburt
1990:162).
The
development of a different set or partially
different set of perceptual "values" (in Bateson's
communicative/gestalt sense) might lead to
subjective experience sufficiently divergent from
others' that descriptions and talk about such
things cannot bring the experiences into the
general consensus of description, particularly when
the perceptual values attached to communicative
exercises also somewhat differ. With "inner
experience" as examined by Hurlburt, the situation
might be even more attenuated, as the
interpretation of inner experience is rarely
discussed, and idiosyncratic ways of thinking about
it could well develop in "healthy" minds. Thus, we
find one of Hurlburt's informants experiencing what
we might call "feelings that he should keep social
distance" as a "force field," what we would call
continual verbal annoyance through asking
irritating questions as "phasers," etc. (Hurlburt
1990:210).
Wrobel
noticed that schizophrenics tend to class objects
not by common "similarity" but instead by
preference, even when asked to class by similarity
(1989:28). Ordinarily, we take such similar
characteristics to be in the objects, an aspect of
them. For the people Wrobel studied, either such
similarities were inaccessible to them, and so they
classed by preference, which was accessible, or
perhaps they found the understandable
"similarities" by which "normal" people class to be
arbitrary, when explained, but frustratingly
unpredictable -- location, use, smell, or (class by
color, shape, size, what? they that is always
grounded might ask), and so fall into the habit of
selecting by one referent for them: their
preference. Whatever motivational theory one wants
to apply, we begin to see how schizophrenic
communicative behavior is on the one hand
arbitrary, random, and on the other, and as
culture, incomprehensible, albeit as ultimately
comprehensible as any foreign culture of
one.
Wrobel
elucidates his statement that schizophrenic
"attitudes go beyond the expectations" of ordinary
interaction in his study of the pragmatics of
schizophrenics' speech. He notes that a failure to
satisfy the receiver's expectations of pragmatics
pervades schizophrenics' speech. Essentially, the
"schizophrenic" is one who communicates (Ruesch
& Bateson's sense, including perception at its
root levels) differently from those raised in
similar contexts. For some reason or reasons, the
person does not perceive, speak, or associate quite
as others do, nor do they employ in the same way
the ground upon which communication in the society
rests. This has several levels, but primarily we
find the behavior on the "pragmatic" rather than
syntactic or phonological, in the involvement with,
interpretation of, and application of social
devices within contexts.
In
Wrobel's terms, the schizophrenic employs a
different ground for communicative understanding at
the pragmatic, and often deictic, levels,
particularly with regard to notions of time and the
organization of stories. Similar general referents
("not much" "lots" "long ago" for examples) were
regularly interpreted differently from "normal"
usage, though specific referents ("six"
"yesterday") were interpreted the same or in a
radically metaphoric manner (1989:31-2).
Schizophrenics tend not "to take into account the
conventions applied in correspondence and the
social role of the addressee" and exhibit a
"destabilization of the main element (I) of the
primary elements of reference," causing "a
destabilization of the remaining elements (here,
now)" (1989:40).
These
differences in indexical referential grounding,
social role and contextual conventions may well
explain the "flat or inappropriate affect" the DSM
III-R attributes to schizophrenia: a failure to
recognize (or even perceive) contextual clues as to
proper affect, as to the "kind" of context, would
lead the schizophrenic to repeated errors of
affect, eventually leading to a preference for no
affect, for there is little social reward for
proper affect, but extreme forms of punishment for
inappropriate affect in the wrong kind of context.
In his discussion of affect and
context-recognition, Hurlburt notes that while the
schizophrenics with whom he worked did exhibit flat
affect, it is only the outward expression of
emotion that is flat in some of our subjects, not
its inner apprehension. Our schizophrenic subjects
did have clear inner emotional experience
(1990:260).
Thus,
the schizophrenic flat affect is like disordered
speech, the surface manifestation of an underlying
inability to synchronize with the "normal"
pragmatics of communication and perception in their
society. This paradigmatic problem with social
role, attributable to problems in interpreting
context, can be taken to underlie the
social/individual tension that Barrett sees as
underlying most discussion of schizophrenia (ms.:
8).
In
Ruesch and Bateson's communications model, where
perception is essentially gestalten, one's
inability to interpret context leaves one with
minimal knowledge of some 'thing' perceived, a
negative case that will remain essentially
undefined for the perceiver (1968:197-208).
Further, taking their position that inter-personal
communication is the active use of context as
perceived with an assumed understanding of the
other's view of the context, one can see how a
person with some difficulty accessing not only what
another means by some perhaps communicative action,
but also difficulty predicting the other's reaction
to anything, might come to see the world in a
particularly peculiar way. Bateson also points out
that the conventions of communication,
"communication agreements," are of the same ilk as
any social conditioning: forms of expectations of
conditions prevailing in some gestalt-recognizable
context (1968:212-27).
This
communicative impasse can actually be described as
a fundamental disparity between the manner in which
the individual interprets (perceives) contexts and
the way in which others of the same culture do.
Wrobel quotes Anna Gruszecka's 1923 and 1924 works
on schizophrenia with regard to this topic, in sum
agreeing with her that schizophrenic communication
is the result of differential perceptions pressed
into different conceptions of the language.
Gruszecka also discussed the remarkableways
similarities between schizophrenic thinking and
many other cultures' of thinking, relating many
modes to "normal" modes in other cultures (Wrobel
1989:16-18). Neither she nor I mean to assert that
schizophrenia does not "exist" as an underlying
problem with one's own culture; only that it exists
not as a particular kind of thinking but as a
condition of a person who has not internalized the
same perceptual/conceptual matrix of expectations
and communicative precepts as his or her
contemporaries.
Taking
Gruszecka and Wrobel's perspective, we can examine
the extreme paradigmatic "symptom of
schizophrenia," the hearing of voices. The DSM
III-R's definition of "hallucinations" taken to be
schizophrenic almost exclusively covers
verbal/auditory events; hallucinations of a visual
nature are taken to be only the schizophrenic
granting images in the mind more than the
metaphoric presence they deserve. Our working
thesis is that the schizophrenic condition is one
of having a radically variant understanding of
ordinary events from one's culture; if
hallucination is to be taken into account, then we
must find that the "normal" person in Western
society also experiences voices, but gives them a
different attribution than the
"schizophrenic."
Hurlburt's
study evidenced several "normal" persons who
experienced inner voices, including two who had a
set of voices, some of which had names by which
they could be discussed. These people all "knew,"
however, that the voices were their own, despite
their often spontaneous-seeming character, and
despite "inner speaking sometimes [seeming
to] have a mind of its own" (Hurlburt
1990:147). If the ordinary person can experience
voices in their mind, whatever they choose to call
it, or how they choose to perceive them, will be in
part determined by their cultural conditioning;
when someone interprets these differently, there is
little social feedback to correct them, as one's
inner experiences do not often come up as a topic
of conversation. Taken as natural, these voices
from outside the schizophrenic's head could well
fundamentally be the same as "normal" experience,
but will be perceived in a fundamentally different
manner.
The
separation of the schizophrenic from ordinary
cultural modes of discussion was expressed by one
inmate as his being a little inventive, and so a
little misunderstood. I have to go through these
things in order to get the proper concept, as they
are concepts in my perceptions (Hurlburt
1990:224).
The
notion that some extra effort is necessary either
to make sense of the perceived world we take as
given, or to communicate our ordinary perceptions
to others is alien to us; is alien to most people
in most cultures. Only when we talk with someone of
a different cultural background do we find
ourselves challenged, often in frustratingly subtle
ways, to get our points across and to comprehend
the deep meaning of what is being said to us. We
meet as two context-manipulators with different
ideas of how to do so, and of what any arrangement
means. This experience is culture shock; in some
sense, the title "schizophrenic" is given to those
who continually experience a kind of culture shock
in their own culture.
Wrobel
describes this extra effort in his conclusory
theses on schizophrenia, in particular noting that
because schizophrenic perception of the world is
different, the language structures of the "normal"
person in a culture cannot adequately express the
schizophrenic perceptions, and so its "inventive"
use sounds deformed (Wrobel 1989:119-21). Language
then becomes a source of frustration rather than
expression, and non-communication seems the norm.
Wrobel also suggests that the schizophrenics he has
studied, from all over Europe, east and west, and
the United States, have slipped out of their native
langue understandings in similar ways (Wrobel
1989:121). Taking into account the notion that the
condition is essentially one of growing
culture-shock in one's own culture, the development
of parallel experiences of communication surprise,
confusion, frustration, persecution, and failure,
might well lead to commonalities of schizophrenia
cross-culturally; one should also note that Wrobel
can only study schizophrenic speech in persons of
cultures that recognize schizophrenia as a
condition in the first place.
Nevertheless,
in the same vein that one acquires cultural
competence through sedimented experiences in
various contexts, general communicative
preconceptions can be viewed as the sedimented
experiential impressions of social practice within
a social context additionally permeated with
physical signs of others' prior
praxis.4
Thus, discussion of experience, as well as
experience in certain contexts, may help shape our
perceptions in the future. We may all verbalize
thoughts in our heads, but we do not all count the
thoughts as strictly our own, particularly when
such inner speech may have "characteristics of
being created anonymously, devoid of any direct
connection to the experiencer's present activity"
(Hurlburt 1990:147). Thus, we can see how social
isolation could well play a factor in the formation
of "the schizophrenic." However, whatever its
causes, once the condition is seen as an
essentially different impression upon the
individual of what are presumed to be similar
sedimented experiences, the significant aspect of
schizophrenia is that continued interaction with
the "normal" culture does not return the "sufferer"
to "normal."
The
DSM III-R's diagnostic guidelines could be
fulfilled by nearly anyone, except that the
after-effects or primary phase must persist for six
months. If we consider the active phase of the
condition as a mind-shaking, frightening experience
of seeing one's sense of reality challenged by
one's senses, the six month "recovery period"
becomes that recovery time in which "normal" people
reassimilate. The normal after-shock experience is
ultimately to slide towards the common mode again,
often presenting the experiencer with the feeling
the experience was unreal. We will call this the
"oh, come on" device inherent in most humans; one
might also term it enculturation or socialization
behavior. What is peculiar about the schizophrenic
is that, upon starting the trail off normal
perception, they do not tend to return absent
purposeful intervention. Instead, perhaps
strong-willed, they deepen their particularized
perspective and distance themselves from the
"norm."
Certainly
it is not odd behavior or bizarre understandings,
actions, and practices, that gets one labelled as
schizophrenic, at least not alone, or we would be
labelling most foreign travelers within our culture
"schizophrenic."5
We must remember that, while "schizophrenia" is a
socially constituted diagnosis applied to someone,
and not something "in them" (whatever may in fact
underlie the diagnosis) (Laing 1967:99), and ask
why funny-acting foreigners are not so diagnosed,
even for hearing voices (note that only one of the
three main DSM III-R diagnostic criteria for
schizophrenia mentions that the symptom must be
abnormal for one's culture). When we do so, we see
that plainly, there is an understanding that
schizophrenia is the differentiating of a member of
a culture while within that culture. One who goes
abroad and returns with bizarre ideas or practices
reflective of the place they went, may be said to
have been converted or to have "gone native" but
they are not crazy; just not one of us.
One
may even find within one's culture modes of
practice, roles or self-definitions that allow one
to exhibit what would otherwise be schizophrenic
behaviors. But if the mystic or crazed genius in
some culture is acting in a socially-understood
role, then there are modes of communication through
which, supposedly, their experiences can be traded
with others' (and so they're not really
schizophrenic). Thus, we find that not only must
one become differentiated from the 'norm' of
perception/communication in one's culture while in
a culture where the new perceptual modes are not
normal, one must also do so in a way that renders
one undefined as a social actor, that places one
beyond meaningful communication. Barrett's project
to expose the paradigmatic roots of "schizophrenia"
as a culturally bound classificatory becomes
significant here in that we can see how projects to
find and trace environmental causes of the
condition are in a way projects to normalize
schizophrenia, in the way a "foreigner," "mystic,"
or "eccentric" is normalized: by tracing a route
through which apparently meaningful communication
may occur.
However,
we must not forget that Laing was foremost seeking
to help "schizophrenics" communicate again with the
'normal' world. As such, the project of
normalizing, even universalizing (see Laing
1967:103-07), schizophrenic experience is one of
re-establishing lines of communication with the
schizophrenic. In Laing's terms, it is going into
the jungle to find the Dr. Livingstone lost and
going more 'native' all the time, and discover how
to talk with him again. In a fundamental way,
researchers looking for causal explanations of
schizophrenia are seeking to trace the path down
which the schizophrenic lost communications with
"normal" culture, whether that path can be retraced
with restorative chemicals or discovering a key
past event that makes translation possible.
IV.
Conclusions without Frontiers
I
proposed that in writing this paper, I would
forward no particular origin for schizophrenia, and
I will here reassert my ambivalence as to its
biological basis, genetic factor, environmental
trigger, double-bind origins, and so forth. The
project I set out requires only that there be some
manner in which one's basic
perceptual/communicative preconfigurations might
become differentiated from the norm. Nor do I
necessarily disagree with R. Barrett's hypothesis
that the category "schizophrenia" is a
socio-political construct the form of which changes
in a manner reflecting the underlying political
milieu. Indeed, it may well do so. My project,
however, was to ask, what, if anything, lies at the
core of the category, and inspires us to arrange
some kind of classification around it? In answering
that question, I suggested we think about
schizophrenia's underlying set of commonalities as
some kind of orientation relative to one's
particular cultural context.
Studies
on the behavior and perception of persons classed
"schizophrenic" reveal a fascinating set of
commonalities, particularly in their development of
a pragmatics (even a langue) different from those
employed by their cultural contemporaries. If the
condition is fundamentally a category
culturally-defined in essence as variance from
certain pragmatic grounds of communication, one can
see how debates over whether [social factors,
biologic factors, genetic factors, formative- years
factors, and so on] are [necessary,
sufficient, combined, triggered, activated,
suppressed, inherited, habituated, etc.], to
cause the individual to [show symptoms, become
schizophrenic, be formed as a schizophrenic],
have proven fruitless (see Barrett ms.:25-7). The
debates have not been productive because the
particularized sets of behaviors that constitute
the social category schizophrenia could conceivably
be brought about by any of the causes in any
combination of the causal manners discussed. This
paper examined the "symptoms" of schizophrenia, and
then discussed them in light of a theory of the
condition as essentially one of culture. In calling
schizophrenia "a condition of culture," I meant
both that there is a cultural category
"schizophrenia" and that persons placed in that
category are so placed primarily for a particular
kind of divergence from "normal" cultural
understandings. "Schizophrenia" thus becomes an
ever-receding category when placed under causal
analysis, for its tell-tale signs are variations
from the very class of cultural categorical
understandings that includes the category
"schizophrenia." Gregory Bateson was fond of noting
Bertrand Russell's demonstration that paradox is
generated whenever one has a "class of classes
which are not members of themselves" (Bateson
1972:186). We can see the paradoxical aspects of
schizophrenia existing as an aberration of our
normal cultural categorical modes for which we have
a normal cultural categorical mode. What we are
left seeking to understand is that which we
perceive in the condition that inspires us to
categorically section it away from ordinary
experience and in a way normalize it through
labelling. I hope in its preliminary, somewhat
schizophrenic in itself, way, this paper has moved
us toward a greater depth of that
understanding.
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