A Diagnosis and Its Damages: Orna Ophir’s “Schizophrenia: An Unfinished History”

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I got an advanced reviewer copy of Schizophrenia: An Unfinished History by Orna Ophir (Polity, 2022) because I wanted to see if the conversation around “mental illness,” especially such a stigmatizing diagnosis like schizophrenia, had changed among the professionals of the mental health industry. Ophir is a New York State-licensed psychoanalyst in private practice and also a historian, which proved to be a fascinating combination as far as her latest book was concerned. The first four chapters are full of a historical overview of how priests, philosophers, politicians, “patients” and people in general have wrestled with the set of experiences the DSM has labeled “schizophrenia.”

Such overviews, especially if you’re starting as far back as the Bible, are notoriously difficult to pull off as each topic—from psychoanalysis to religion to each historical figure that plays a key role in the evolution of this diagnosis—could be a book on its own. Ophir covers this ground skillfully, piquing the interests of readers coming from many different backgrounds and disciplines. As a Christian, I would have loved a deeper exploration of “mental illness” and spirituality, particularly because the mainstream seems to think “exorcism” when they hear religion and “mental illness” in the same sentence. Ophir emphasizes that many people who today’s culture would slap a diagnosis on and get into “treatment” were actually considered wiser and/or closer to God than those who did not experience what we today call “symptoms.” She does not go into depth about why such conclusions were drawn then or explicitly explore why our current culture has nearly eliminated such beliefs from its repertoire of explanations for “mental illness,” which is understandable since tomes could be written on this subject alone.

It is worth noting, however, that, while it might be expected for an ever-more secular society would sluff off “overly” spiritual concepts, even modern-day Christianity has largely abandoned the idea that someone who would be diagnosed with a DSM label today might be seen as special or chosen by God in biblical times. The church eventually did start to use “mental illness” as a way to demonize and silence people—mostly women—that threatened their power, like Joan of Arc and Julian of Norwich, but our culture lacks the knowledge that what we call “mental illness” in modern times was at any point associated with wisdom or closeness to God at all. So that was a gem to find in Ophir’s work. And perhaps it’s my job as someone who earned a degree in Christian theology to take that up as a consideration; I’d be really interested in a historian’s perspective as well since the Church does not exist in a vacuum. But I credit Ophir for my realization that the Church, when it comes to “mental illness,” is almost indistinguishable from the culture in terms of wholesale acceptance of the secular mental health “treatment” model, and, as a theologian, I do not see that as self-evident.

Ophir provides a history of schizophrenia as it appears in another “bible,” the diagnostics bible also known as the DSM. She includes the philosophies that shaped each of the five editions of the “diagnostics bible,” which make evident why each edition included and excluded the various diagnoses that it did, but her seeming neutrality toward the DSM and its pathologizing more and more of the human experience comes off as advocacy. It’s also quite a notable omission to not mention anything about the various DSM committee members’ increasing ties to the pharmaceutical industry. It left me curious as to why she wouldn’t mention that at all: did she have to stay silent on the question of Big Pharma in order to get her book published? Did she really not know about these conflicts of interest?

There was very little about medication in this book in general, which is, among other things, revealing of just how taut and fraught the conversation around medication is. Psych meds have known iatrogenic risks, yet it seems that anytime the subject of medication comes up in relation to mental health, disclaimers about not giving medical advice and people need to keep taking their meds as prescribed, etc. are quick to follow. It’s highly unlikely that Big Pharma hasn’t made bank on the diagnosis of schizophrenia in particular since it’s marketed in the United States as well as many other Western countries as lifelong, incurable and thus in need of “management” with medication for decades. Yet there are few peeps from Ophir about the drug industry’s deep influence on the DSM, clinicians’ training and treatment skills, and the broader culture’s understanding of “mental illness.”

Ophir does acknowledge culture differences in how people who hear voices understand and experience those voices. She quotes a “radical” interpretation of the claims of the Hearing Voices Movement (HVM): “if we listen, voices may be heard to tell us more about broken societies than broken brains.” Ophir does not explore “broken societies” further: why do voice hearers in developing countries have less adversarial, even friendly, relationships with their voices while the voices of people who grew up in the American West are more likely to be violent, command violence and berate the voice hearer? Why do voice hearers from developing countries report their voices keeping them safe while voice hearers from Western countries experience their voices telling them to hurt or kill themselves? Similarly, though Ophir states that voice hearing used to be socially valued throughout much of history and the West made it a first-order symptom of disease, she does not delve into why that might be. Of course these are generalizations, but the fact that we can make them, and the reasons why, are arguably more important than what mental health industry experts vote on to include in the DSM, whatever their philosophy or training is.

In fact, if the mental health industrial complex or the clinicians it employs were truly interested in “treating” and “helping” people, wouldn’t they want to know why Americans and those in Western societies have violent voices while the dispossessed world has friendlier, more supportive, even life-saving relationships with theirs, so they could develop more effective treatments? While Ophir’s history of the schizophrenia diagnosis and the DSM’s role in that is interesting, cultural criticism is essential when discussing “mental illness,” especially with such glaring differences in the experiences of voice hearers. Ophir’s book is stronger and richer in terms of the history, which is odd since Ophir is also a clinician, but culture is inextricably tied with history.

But that brings up an even bigger problem: the divide between clinicians and “patients” continues to persist and even deepen, even as the conversation about “mental illness” has started to shift culturally to be more acceptable, even trendy—only for certain diagnoses, of course. Anxiety and depression are trendy to identify as having, people are parading their ADHD on TikTok by the hundreds, and we think we’re “talking about mental health” as a culture. Who’s not in the room? People with stigmatized labels: borderline personality disorder, Autism still to a degree, and schizophrenia. Even in Ophir’s book, people with the label schizophrenia are marginalized just as they are in the culture: their voices show up mostly only in the epigraphs that start each of the seven chapters. And even then, it seems like their voices and experiences are being used as examples of clinical symptoms rather than stand-alone experiences for what they are.

Ophir does acknowledge the importance of shifting from “expertise” to voice hearers themselves, which is already underway and which she attributes largely to the Hearing Voices Movement. She includes a quote from the founder of the movement that provides as accurate a summary of the history she covers in her book as one quote can: “Those of us who hear voices are probably living in the wrong century.” Of course the mainstream medical/psychiatry establishment discredits HVM by claiming it needs more “empirical research.” Why?

She credits HVM with “Caution[ing] against the tendency to systematically medicalize individuals with unique experiences to directly or indirectly force them to change into what they are not (i.e. non-voice-hearers), often with the full weight of the psychiatric, medical and even political institutions backing these questionable efforts.” In its typical pattern of discrediting anything that threatens its business model, the mental health industry unsurprisingly has yet to fully recognize HVM’s claims that voice-hearer is a fully valid identity totally apart from any diagnosis, including schizophrenia.

Ophir acknowledges that HVM has not been “fully validated” but doesn’t sufficiently challenge the system doing the validating, or the cultural influences of this system and the feedback loops that are keeping it in place: the mental health field signals authority by telling us it’s “dangerous” to rely on anyone but an “expert,” making people “earn” official-sounding titles like psychologist/clinician/therapist, requiring higher education and degrees to perform certain tasks they call “treating” “patients” with “mental illness.” Then the mainstream culture, in turn, questions anything outside this realm of what we are taught is “expertise” (which, notably, still involves very little #ownvoices of the people whose experiences are being debated, labeled and, most importantly for the people in charge, medicated and monetized). I again have the question about why there wasn’t much time spent on these dynamics pinning the stigmatization, marginalization, and silencing of people with the label of schizophrenia firmly in place even in a book that does call out stigma and considers ways to reduce it.

Ophir emphasizes the ways race compounds and deepens the stigma of diagnosis in general, and in particular ones that are still seen as “dangerous,” like schizophrenia. She also calls out the weaponization of diagnosis to silence political dissenters, similar to how the church framed those that challenged its power as “mentally ill.” What she doesn’t state is how the DSM has increasingly been creating “spectrums” of diagnosis, which serves to pathologize more and more of the human experience and capture more and more people who may be threats to existing power structures, funneling them into “treatment” and dismissing their legitimate complaints against these very structures. She simply states “spectrumizing” disorders as a fact, missing another opportunity to challenge the structures that use “mental illness” to enforce division and suffering while keeping current power structures firmly in place. She goes into great depth about how various countries have changed the name of schizophrenia; while acknowledging that language is important, changing the conversation is not sufficient and can actually backfire. And she’s right when she says that we can change the name all we want, but what matters is changing how people are treated—if “treated” is not limited to what the mental health industrial complex does but what society as a whole does.

A few final issues with Schizophrenia: 1) no mention of the insane toxicity of psych meds and the harm they cause and how the people experiencing brain-chip “delusions” might not, in fact, be experiencing “delusions.” Elon Musk’s Neuralink literally wants to implant chips into people’s brains in order to merge humans and machines and further the transhumanist agenda. Just saying. 2) Ophir advocates for “better treatment” instead of challenging the idea of treatment itself. This is unsurprising since she’s a clinician and treatment is part of the business model.

Overall, Schizophrenia is a worthwhile read, especially for those that are really interested in history and philosophy as it relates to mental health, if you take it as a pulse on the professional conversation around highly stigmatized labels. Every book has gaps, so, while reading, keep in mind questions like: Who are the people creating these labels that they would have the measuring stick for “normal?” Who benefits from labeling human beings the way the DSM-5 guides us to (or at all)? Why is “normal” a desirable quality even if it could somehow be measured or attained?

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

6 COMMENTS

  1. This article erroneously claims “The church eventually did start to use “mental illness” as a way to demonize and silence people—mostly women—that threatened their power, like Joan of Arc and Julian of Norwich”, which manages to get a number of issues wrong. At no point did the medieval Church accuse either Joan of Arc or Julian of Norwich of being “mentally ill” – a number of modern authors have claimed that, not the medieval Church – and historians have pointed out that English government records and eyewitness accounts prove that Joan of Arc was put on trial by a group of pro-English collaborators in order to discredit her for opposing the English. This is admitted in the internal records of the government, and described in detail by dozens of eyewitnesses who were at the trial. She was supported by many clergy of that era: Charles VII had her examined in March and April 1429 by clergy at Poitiers where she was approved by the Inquisitor for Southern France (Pierre Turelure), the Archbishop of Rheims, and other prominent theologians; and likewise other clergy wrote supportive treatises in the subsequent months (e.g., the Archbishop of Embrun (Jacques Gelu; the theologian Jehan Gerson (who was later beatified), Inquisitor Jehan Dupuy, and so on). When the English were driven out of Rouen toward the end of the war, there were three investigations into the trial conducted by the Church (in February 1450, May 1452, and November 1455 – July 1456) which resulted in a reversal of the verdict on 7 July 1456 by the Chief Inquisitor, Jehan Brehal.

    • Cee, you know much more about Joan of Ark than I. However, a modern day “partnership” does exist between my childhood religion and the “mental health” professions. The ladies in my childhood church actually freely confessed that “partnership” exists, to me. And had me go see that they are teaching the DSM “bible” in a local seminary school.

      But I already had written proof, in my medical records that, that “partnership” is used by pastors of my childhood religion to “to demonize and silence people—mostly women—that threatened their power.” So this is a real societal problem today, even if it wasn’t in Joan of Ark’s day.

      More specifically, in my former religion, the psychologists’ primary actual function – for the pastors – is covering up child abuse. And this is commensurate with not yet corrected, systemic, problems within the “mental health” professions, and is by DSM design.

      https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
      https://www.madinamerica.com/2016/04/heal-for-life/
      https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=
      gbs_ge_summary_r&cad=0#v=onepage&q&f=false
      https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

      And I know this is a problem in the Catholic religion as well, since I’ve met with Catholic child abuse survivors and their parents, and had to recommend Robert Whitaker’s ‘Anatomy of an Epidemic’ to them. Plus, a couple of honest Methodist pastors confessed to me this problem is known as, “the dirty little secret of the two original educated professions,” so this may be a problem within all mainstream religions.

      Thank you for the book review, Megan. I appreciate a psych survivor pointing out the glaring omissions regarding, for example, the psych drugs (“pharmakia,” which the Holy Bible speaks out against).

      And forgive me for mentioning again, that the “schizophrenia treatments” can create the positive symptoms of “schizophrenia,” via anticholinergic toxidrome. And they can also create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.

      https://en.wikipedia.org/wiki/Toxidrome
      https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome

      If the psychiatrists could just garner insight into these simple facts, then we could likely eliminate most so called “schizophrenia.”

      • MAYBE WE DON’T NEED ANY PSYCHIATRISTS OR ANY PSYCHOLOGISTS…

        ..If a ‘Severely Diagnosed Person’ can come off the below drugs independently and Cost Nothing, and make Full Recovery:-

        THE IMPACT OF FLUPHENAZINE DECANOATE DISCONTINUATION –A RETROSPECTIVE COHORT STUDY
        [For Recent STUDY – copy and google above heading]

        …and if…

        “…Over 40% of Irish adults have mental health disorder, study finds…”
        Irish Times Mon Jun 27 2022 – 19:21

        “…The study, which was carried out by academics from Maynooth University, National College of Ireland and Trinity College Dublin…”

        BRIEF EXPLANATION
        I was placed on Disabling and Suicidally inductive Fluphenazine Decanoate in 1980.

        Following complaint, I was given permission in 1983, to abruptly withdraw from these drugs – and ended up in Galway University Hospial.

        By 1984 I was considered hopeless.

        I then decided to taper very carefully from these drugs. I also learned how to cope (through trial and error), with my drug withdrawal anxiety.

        I regained my ability to function and was no longer Suicidal as a result of successfully coming off these drugs; and have remained well since (1984 -2022).

        The original “diagnosis” had been “Schizophrenia”

  2. As a schizophrenic I have never had a label slapped on me. I diagnosed myself and later a friendly psychiatrist agreed with my assessment. An article this week on MIA (“trauma informed care left me more traumatized than ever”) about trauma informed care shows that not everyone wants to get rid of their useful diagnosis. I am not aware of ever being stigmatized because of my diagnosis, I quite like stigma, as an artist it helps me know I am not a puppet. It is a little known truth that people grow more reverential when you mention the schizophrenic diagnosis, either because they fear your ability to stigmatize them as wearing the wrong coat, or they fear causing a worsening of your miserable hallucinations.

    But what is this vogue for saying other countries with other governments “cause” schizophrenia-lite whereas the capitalist West “causes” schizophrenia-heavy with violent voices? For a start, in other countries the deranged and floridly psychoic are often left to go wander into a welcoming crocodile smooth river. Ooops!

    That leaves the biddable, gently crazy to pirhoutte around the village announcing fond quasi biblical sentiments. What’s not to love about those biblical voices. There is a fine line between being spellbinding and sounding demonic. I am not convinced of the hype around how people can influence schizophrenia. It is like when a cancer suffer says their tumour was “caused” by years of people being too assertive in their family. A “look what you did to me!” is often just a way to abdicate personal responsibility. What’s not to like about personal responsibilty. It used to be an ingredient in being a local hero.

    All these gripes said, I have to like your article Meghan, because it is “baby caring” towards the suffering and that is the main thing, that we offer as many ways of regarding schizophrenia as there are people with many different kinds of it. I like the biomedical model and I like the word schizophrenia immensely, because it annoys people. Always utter the words society says not to.

    But I must get off my hobby horse and go and get better. I have been ill for a long time and so am in the asylum getting that mended. You are right about how pharma ought to be mentioned more. But the hospital I am in is wonderful actually. And the nurses are genuinely saintly, the majority of them. This week a few very violently manic people came into the ward and needed several nurses to guard them from their impulse to jump out a window and hurt themselves or hurt the rest of us patients. Later in the day one of those manic patients, after thumping and kicking innocent patients and nurses was wandering and howling and a nurse dropped everything to give that sobber a welcome warm embrace that went on and on and on and on. The kind of genuine hugging scene as might be seen in Soteria. It would be nice if hospitals could be made more Soteria. It would not take much. Dream big.

    I must leave MIA now.

  3. Megan Ophir leaves out Big Pharma and the sad history of how psychoanalysts failed their patients labeled with Schizophrenia since the early 1940’s in the US. Bizarre theories and false claims of treatment success. The author is a transplant from Israel where she was a licensed psychologist and her exposure to these types of people with that label was only during her training.
    In NYS the guidelines call for a TEAM to treat certain people labeled with these “disorders” through a hospital outpatient and ACT team. Sole practitioners are not supposed to treat these people in private practice. Psychoanalysts and psychologists in NYC & L.I. charge $350 and hour and rarely take any insurance. Also non-medical practitioners in the mental health field are not allowed to comment or advise a patient regarding drugs. So they are silent bystanders who know that these drugs often are the cause of their patient’s demise and cannot comment or advise.

    She and others like to focus on the distant past and not the current situation that people labeled Schizophrenics have to endure because it is a hellish existence and quite depressing. Chemically lobotomize them and warehouse them. So lets go back to the Bible and Joan of Arc. It is safe and supposedly scholarly with a University press publisher able to charge $35 instead of $27 for a book for lay people.

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