Jonathan Metzl, associate professor of Psychiatry at the University of Michigan, explains how schizophrenia's definition has shifted radically over time, becoming increasingly tied to racial politics.
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Schizophrenia's Identity Crisis So basically I have a split appointment at the University of Michigan. The majority of my time is spent teaching graduate and undergraduate courses on the history of psychiatry, the history of medicine, and also on gender and race politics in the United States. I also work as a psychiatrist at the university, so I also am an attending psychiatrist in the outpatient psychiatry clinic and I work in the psychiatric emergency room and other treatment sites. So in terms of present day psychiatry, I mean, as you mentioned there have been changes with every new version of the DSM, the Diagnostic and Statistical Manual that have come out, that have sharpened our understanding of what schizophrenia is, and so in the present day we think of schizophrenia as an illness that the main symptoms are delusions, hallucinations, most hearing voices, sometimes seeing things, kind of losing touch with reality, also paranoia, feeling like people are out to get you and social withdrawal, what are called negative symptoms, so cognitive withdrawal, social withdrawal, so it’s a very debilitating, very serious mental illness, but as you mentioned this definition has changed over time and it’s also changed in relation to changing popular perceptions about how people with schizophrenia act. Sure, so in my book that’s in part the story I tell, is how changing psychiatric definitions of schizophrenia and changing American cultural definitions of schizophrenia really have morphed in relation to each other over time and particularly in relation to histories about race in the United States, so one of the central narratives of the book is that in particularly the early 1920s, 1930s, 1940s when the idea of schizophrenia itself was first coming to the United States from Europe there was a general assumption that persons who suffered from schizophrenia were either shy or calm or they were geniuses. It was often represented as an illness that afflicted white novelists or poets and as I say, these were very often in popular and psychiatric representation assumed to be white people. Now this was a... you know a kind of gross generalization, but in part what was happening was that the illness itself was defined almost as a personality disorder, like a split personality, so it was taken up by psychoanalysts, used in psychoanalytic sessions and popular representation really picked that up. Two instances from this time period that I think are very important, one is a film that came out in 1948 called The Snake Pit, which was an Olivia de Havilland movie made from a book several years earlier of the same name and it really showed schizophrenia as being an illness that afflicted in particular white middle class women. Also when early versions of the Diagnostic Manual came out in the early 1950s it really was… It was called at that time schizophrenic reaction, and it was assumed to be mostly a personality condition. All of a sudden in the 1960s, American culture, newspapers, magazines, movies start to represent angry African-American men as in part being inflicted with a new form of this particular illness, so in the book I show some drug ads, for example, that actually show pictures of urban riots and race riots in the streets, and talk about how really the illness assumptions about the illness change and the other key thing that happens in the 1960s is that the official psychiatric definition changes. All of a sudden in 1968, the second version of the Diagnostic Manual comes out and there is new language that says aggression, hostility, projection. This is all added to the definition of paranoid schizophrenia, and what I show is that those terms were preferentially used not only to talk about these new kinds of patients, African-American men, but also to change our ideas about how violent people with schizophrenia are, how hostile they were, how they might act, which led to a lot of fear. Even the people who we might think of as being prob

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