![]() It is now clear that the simple biomedical approach to serious psychiatric illnesses has failed in turn. “Tell them,” he said, “that schizophrenia is no one’s fault.” I asked him what he would want non-psychiatrists to know about psychiatry. I remember talking to a young psychiatrist in the late 1990s, back when I was doing an anthropological study of psychiatric training. In psychiatry it is now considered not only incorrect but morally wrong to see the parents as responsible for their child’s illness. The pain of this mistake still reverberates through the profession. Such mothers, they realized, had not only been forced to struggle with losing a child to madness, but with the self-denigration and doubt that came from being told that they had caused the misery in the first place. Psychiatrists came to see the assignment of blame to the schizophrenogenic mother as an unforgivable sin. ![]() Schizophrenia became a poster child for the new approach, for it was the illness the psychoanalysis of the previous era had most spectacularly failed to cure. ![]() Psychiatry would focus on real disease, and psychiatric researchers would pinpoint the biochemical causes of illness and neatly design drugs to target them. To signal how much psychiatry had changed since its tweedy psychoanalytic days, the National Institute of Mental Health designated the 1990s as the “decade of the brain.” Psychoanalysis and even psychotherapy were said to be on their way out. ![]() The 1980s saw a revolution in psychiatric science, and it brought enormous excitement about what the new biomedical approach to serious psychiatric illness could offer to patients like Susan. It became standard practice in American psychiatry to regard the mother as the cause of the child’s psychosis, and standard practice to treat schizophrenia with psychoanalysis to counteract her grim influence. She was “schizophrenogenic.” She delivered conflicting messages of hope and rejection, and her ambivalence drove her child, unable to know what was real, into the paralyzed world of madness. Such patients were unable to reconcile their intense longing for intimacy with their fear of closeness. When psychoanalysis dominated American psychiatry, in the mid-20th century, clinicians believed that this terrible illness, with its characteristic combination of hallucinations (usually auditory), delusions, and deterioration in work and social life, arose from the patient’s own emotional conflict. They had learned to reject the old psychoanalytic ideas about schizophrenia, and for good reasons. Twenty years ago, most psychiatrists would have agreed that Susan had a brain disorder for which the only reasonable treatment was medication. That apartment was the most effective antipsychotic she had ever taken. Yet she had not been hospitalized since she got her own apartment, even though she took no medication and saw no psychiatrists. She felt those rays pressing down so hard on her head that it hurt. Sometimes she thought she was part of a government experiment that was beaming rays on black people, a kind of technological Tuskegee. She thought that people listened to her through the heating pipes in her apartment. All this was striking because Susan clearly met criteria for a diagnosis of schizophrenia, the most severe and debilitating of psychiatric disorders. She was a big, imposing black woman who defended herself aggressively on the street, but she had not been jailed for years. She did not drink, at least not much, and she did not use drugs, if you did not count marijuana. ![]() She had her own apartment, and she kept it in reasonable shape. She was a student at the local community college. By the time I met her, Susan was a success story. ![]()
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