Being labeled “schizophrenic” was equivalent to XXe century to a life sentence. A study based on patient records shows that schizophrenics suffered from their illness, but also from the ideological prejudices and classification obsession of their time.
Rare are the books with such explicit titles and subtitles. The subject of Hervé Guillemain, a specialist in the cultural and social history of psychiatry, lies entirely there. Schizophrenics in XXe century indicates that this is not a story of schizophrenia, a disease in its symptoms and evolution, but of patients labeled schizophrenic.
Side effects of history immediately suggests an interpretation of their condition: objects of the classificatory obsession of science, schizophrenics would above all be the victims of the collateral political damage of the time. The cover image, showing a patient with a melancholic expression graphically enclosed in a light bulb, completes the circumscription of the subject – schizophrenia as a construction and ideological confinement of the XXe century.
The invention of schizophrenia
From the introduction, Hervé Guillemain explains his choices. “If it is neither a prosecution against THERE psychiatry (…), nor a monument dedicated to the unrecognized victims of science (…), this book undeniably falls into the category of circumspect observations of the classification process. » Schizophrenia, a new way of naming a sprawling and properly indefinable illness, could it not rather be a mirror of the political upheavals of history? If the answer is included in the question, the result of the investigation, based on a single material – the archives and files of patients across France – is fascinating.
Historically, the word “schizophrenia” was coined in 1899 by Kraepelin and taken up by Bleuler in 1911. But the development of the concept took place in the interwar period, when we moved from dementia praecox to schizophrenia proper, which became a real “social scourge” (p. 32). Today the leading reason for full-time hospitalization in France, it affects around thirty million people worldwide, according to figures from theWHO.
Could this spectacular development be, paradoxically, a sign of its obsolescence? In the short term, Hervé Guillemain assures us, the word, covering a reality without contours, is destined to disappear. Do we not already speak, as with autism, of “schizophrenia spectrum disorders” (p. 282), the gradation introducing a distancing?
The suspicion that weighs on schizophrenia, wrongly declared incurable, is not new. In the 1970s, at the height of antipsychiatry, we spoke of a “myth”, as the author recalls, who cites this exchange between Nicole Martin, a patient who came to testify at Apostrophes for her book, Survivor of a mythand the psychiatrist Henri Baruk:
Nicole Martin: I think that some patients in certain states of schizophrenia for example…
Henri Baruk: …which does not exist. There is no schizophrenia.
Nicole Martin: Yes, I agree with you, it is a myth, but I was treated as such. (p. 26)
This dialogue could have been placed as an epigraph to Hervé Guillemain’s book, which tackles the mythical, that is to say imaginary, dimension of a nosological entity as much as a classification system. This work of deconstruction is part of the critical historiography of psychiatry and, as such, confirms known structural traits – madness, the melting pot of individuals considered asocial – while reserving surprises.
Feminine/masculine
A pathology that was initially predominantly female, schizophrenia primarily targets women with an overly obvious or talkative desire for emancipation, domestic workers who have “moved up to the city”, whose attitude or dress does not meet the standards of their social environment. Certain “modern” professions pay the price: in 1940, “one schizophrenic woman in five worked as a shorthand typist” (p. 52), a highly skilled profession, initially male, which became more feminine in the interwar period.
Some are harassed by their boss, which causes a psychological breakdown, which is at least current:
The bosses don’t keep their distance, they tell things that are perhaps their story, but that married people shouldn’t say in public. So I didn’t know what to do. We don’t dare get angry, for fear of being thrown out. We don’t recognize ourselves in our work anymore. In short, it makes your head spin. (…) We can’t do everything at the same time: receive orders and caresses (p. 54).
Three-quarters female in the 1930s, at a time when women’s employment had expanded since the First World War, the pathology became predominantly male in the 1950s. Through the investigation, statistics and case studies, the historian demonstrates how schizophrenia fits into historical, political and social reality.
It affects uprooted immigrants, Poles, Russians, Czechoslovakians, Yugoslavs, Armenians, who sometimes have little command of French and are considered undesirable in the country. In the south of France, a majority of patients (up to two thirds) have Corsican or Italian names (p. 58). It affects widows and orphans (in the 1990s, the proportion of orphaned children among schizophrenics was still 15%), individuals stigmatized for believing in bewitchment, whether they come from the countryside or the colonies, inverts, rebellious adolescents.
Doctors delve into heredity and speculate endlessly on the theory of humors, seize the body of the schizophrenic and their soon-to-be lobotomized brain, where the “proof” of the illness is hidden, in a desperate effort by psychiatry to get closer to the methods of ” evidence based medicine “.
Anyone who has worked in psychiatric archives knows this rhetoric of the madman assimilated to the asocial, the marginal, the non-conformist, the “foreigner” or the “foreigner”. XIXe century, these a priori Ideological prejudices blacken entire volumes. Not a single patient escapes the prejudices of the doctor or of the era.
So what distinguishes schizophrenia from other pathologies? It is in Chapter 8, on “diagnostic mutability,” that Hervé Guillemain sheds light that gives meaning to the book, by detailing the shifts and surreptitious translations of melancholy and hysteria into the new, more “scientific” category of schizophrenia. The last part of his book, on the administrative management of schizophrenia, provides very useful information on the asylum mechanism and its transfers of patients to private institutions – most often to lighten hospital statistics.
Being schizophrenic at XXe century was tantamount to a life sentence, the diagnosis to a sentence. The invention of psychotropic drugs and chemotherapy in the 1950s managed to alleviate certain symptoms, at the cost of very disabling side effects. It still fails to overcome the “disease”, which must be named in one way or another, and whose definition and, above all, historical, political and social meaning are invited to be revisited in depth in Hervé Guillemain’s book.