Stanley Diamond

At the 1972 meeting of the National Academy of Sciences, the Chief of the Psychology Laboratory of the National Institute of Mental Health (NIMH) estimated that 60 million Americans1 would be classifiable as ambulatory schizophrenics if the methods of his research team in Denmark were extended to the United States2. This statistic would include about one-half the population, if one excluded children under ten and adults over 65. Nonetheless, he obviously finds the extrapolation appropriate.

Certain serious questions, some of which are acknowledged by the author, are raised by this imaginary statistic and its assumed cosmic definition. How, for example, does one define schizophrenia and differentiate it from border-line schizophrenia, or isolate the schizoid personality and distinguish that from normality? And how are we to respond to categories such as "cold, distant and inadequate" or, "odd and eccentric," terms used to define schizophrenia in the report. What do these adjectives mean? If every family in the United States has managed to create at least one officially diagnosable locus of a schizophrenic spectrum disorder – a fair deduction from the imaginary statistic – what are we to think about the "normal" members of such families? What role did they play in the creation and selection of the patient? Are we dealing with a familial dynamic, a so-called genetic entity or both? Was the announcement in question a desperate attempt to recognize a social reality, even if within the confines of a clinical language, or was it the sound of the mental health establishment reducing, itself to absurdity? Or does the report reflect exactly the opposite of its intention, namely, that schizophrenia is a social process of such dimensions that it cannot be reduced to a clinical entity.

This essay is an attempt to answer these questions. Certain observations can be made at once. Schizophrenia is the most prevalent, malignant and intractable of mental illnesses; officially designated schizophrenics occupy one quarter of all hospital beds in the United States, approximately 250,0003, just as one infers, for example, potential or undiagnosed heart cases from the actual incidence, it follows that there are many times the official number of potential schizophrenics in the population. But these projections could hardly justify an estimate of 60 million. Therefore, one must take into consideration the current theoretical tendency to assimilate psychopathology in general to the spectrum of schizophrenic or potential schizophrenic reactions; schizophrenia, usually qualified by the term paranoid, shows every sign of becoming a synonym for mental illness in our society. It certainly defines the basic process as Harry Stack Sullivan was perhaps the first to understand. But this theoretical tendency contradicts the established and orthodox diagnostic categories of custodial psychiatry. Therefore, the actual commitment or prevalence figures for schizophrenia are no indication of the opinion of the more theoretically inclined, research-oriented mental health establishment.

The figure of 60 million is an extreme manifestation of the contradiction between custodial orthodoxy and theoretical speculation. But in the latter case, the impulse to diagnose schizophrenia as a clinical entity is no less conventional than in the former; the implication that schizophrenia is subject to clinical analysis, definition and handling remains constant. And it is, I believe, tragically wrong. What is the source of this impulse?

One must recognize that the mental health establishment, which the National Institute represents, assumes (a conventional assumption in this society) that the expenditure of vast sums of money on so-called research will eventually reveal the "causes of mental illness" – that money in research can reveal the cause and cure of anything. This is not merely a scientific idea, but is deeply related to the fact that the tragic contradictions of life have little or no standing in our society. We seek to cure people of everything; we tinker with the machine. All the ills that the flesh and spirit of man are heir to, are reduced to abstractions. We are dedicated to the proposition that pain can be eliminated. An instrumental, hyper-civilized, consumer and clinically oriented culture such as ours generates, and simultaneously avoids acknowledging the contradictions that are the occasions for tragedy. Moreover, we are led to confuse the merely pitiful with the tragic. We perceive the crack-up of the individual in society as we would an automobile accident: hardly as a struggle for awareness that is at once moribund and transcendent. In the broadest sense, schizophrenia is the process through which the inadequacy of the culture is concretized in the consciousness of individuals; and that in-adequacy may be as deeply sensed, without being named, as it is reflected in "pathological" behavior. Yet the tragic struggle for awareness remains a catastrophic, insurmountable challenge because it cannot be located in a culture which fails to serve as the ground for the development of the self. But it is precisely the tragic experience which is the hallmark of the healthy culture, where persons have not been converted into objects, and where the struggle for meaning is a drama enacted and re-enacted in the decisions confronted during the ordinary course of life.

In reducing schizophrenia to a problem for research, one must assume that its essence can be analyzed (that it is an "it"), that knowledge is attainable, and, above all, that the problem can be confined in a laboratory or quasi-laboratory environment. Con-verting schizophrenia into a research problem, while indentifying it with psychopathology in general (which the report quoted does by the sheer magnitude of its figures) has the effect of converting all psychopathology into a series of discoverable essences. By calling something or other schizophrenia we conspire linguistically to establish an entity, a mental construct that pre-judges, presumes the "reality" (actually multiple realities) to which we seek to address ourselves. NIMH and the mental health establishment generally, is a latter-day Platonic academy enfranchised by the society it represents to search out the essences that are hidden behind what are taken as the signs of mental disease. Thus, NIMH is symptomatic of civilization’s investment in the expert, who, segregated in specialized institutions, works on problems that are necessarily isolated from the contexts that generate and define them. Such problems inevitably take on the character of reifications. ·

More specifically, bureaucratic research manufactures the idea of research as a product; that product is then falsely concretized in a series of objects, "the objects of research." These objects – "schizophrenia," "juvenile delinquency," "aging" – are further subdivided, and have the ultimate effect of justifying the continued existence of the bureaucracy. At the same time each bureaucratic sub-division struggles to make the object of its research primary by converting it into a major problem of society at large. But in fact the bureaucracy becomes the custodian, not the resolver of such problems; converted into entities, the problems are somehow administered or researched out of existence without the basic changes in society having been achieved. For, above all, the bureaucracy must not be self·liquidating. Its latent function is to freeze the society from which it has emerged and on which it depends. Therefore, not only is the bureaucracy incapable of solving the problems generated by the society, but it must not solve them; the logic of the culture forbids it. It is in this sense that all professions, linked through the particular bureaucratic establishment to the bureaucratic structure of civilization as a whole, maintain a stake in the very afflictions they are supposed to heal. The medical profession, for example, has a stake in disease; the average physician is under great pressure to become a pill-pusher for the pharmaceutical industry, a pressure increased by the expectations and demands of the patient. Thus, the average physician knows and cares little or nothing about preventive medicine, or, if he does, his approach to it is inevitably restricted. He is bounded by the limits of his society and must adapt both himself and his patient to its structure; the reactionary character of the American Medical Association amply reflects these cultural compulsions on a broader scale.

Similarly, the mental health establishment is a pathological symptom of the society that created it; it is part of a fragmented social process within which the alienated study the alienated. Theoretically one might leam from a reified and academic social science which examines both itself and the object of study, and transforms the results into politics, but that is precisely what is not being done. On the contrary, the conventions of our civilization conceal our social fragmentation while supressing the insights that might conceivably be generated by its exposure. It is only in such misconceived but understandable statements as that of the Chief of Psychology Laboratory of the NIMH that one gets a sense of the frustrated effort to move beyond the artificial boundaries of the research object and, perhaps unwittingly, include the observer among the alienated.

But the fact remains that after decades of research, the behavioral science experts in the mental health establishment, including the NIMH, have failed to discover either the cause or the cure of schizophrenia. Nor have they defined the elusive essence which they have been committed to understand. Every approach that can be adopted within a laboratory or simulated within an experimental or quasi-experimental setting continues to be pursued. Latitudinal and longitudinal studies of intrafamilial phenomena ranging from birth trauma to birth order have failed, or generated so many possible interpretations that even a clear-cut statement appears as an infinitely regressive possibility. The manipulation of crosscultural data in the effort to identify and determine the cause and rate of incidence of schizophrenia has been inconclusive; the same holds for involved statistical formulations of presumed genetic continuities. The scrutiny of schizophrenic patients and their families through one-way mirrors while in group therapy, the endless tapes of patients speaking to psychiatrists, of psychiatrists speaking to each other, and of the latter being further analyzed by panels of behavioral scientists have created endless activity but accomplished little. A whole industry has arisen in pursuit of schizophrenia. But the artifacts it has produced, the recordings, the papers, the books, the lectures, only make work for the archivist. No research scientist could possibly familiarize himself with the vast store of available information, but it is just that possibility which keeps the research mills grinding toward their infinitely regressive goal. And periodically we are informed that the problem of schizophrenia (not to speak of the incidence) is greater, more prevalent and more subtle in the clinical sense than ever before.

The problem is indeed so great that a crisis in what is called the "management" of mental illness has developed proportionately. The predictable reflex in our culture when faced with a person identified as mentally ill is to commit him to a custodial institution. This may be a mental hospital; as psychiatrists know, it may also tum out to be a jail. In the ordinary course of events there is simply no place for such persons in a class·structured, urban society, cross-sected by a highly technical subdivision of labor. Nor can the shrunken nuclear family or its quasi-kin network accommodate people who make extraordinary demands upon their day to day resources. Custodial commitment of the mentally ill is, therefore, socially expedient, while the compulsion to commit is fully in accord with the nature of our culture. Commitment may even be aided and abetted by the patient in search of shelter, care and community.

And that defines the paradox. Despite the expectations of an occasional, naive patient, or the nominal intentions of psychiatrists, the mental hospital cannot be turned into an authentic community. It cannot rise above its source; it must eventually replicate the problems and patterns of the society that sustains and populates it. Since the mental hospital cannot be turned into a community of reciprocating, autonomous, working and loving persons, the alternative, adopted by the mental health establishment, is to convert the wider society into a mental hospital through the expanding list of psychoactive drugs. In the psychoactive drug, research literally finds a product, an analyzable object and a proven result. Therefore, one understands why their discovery, synthesis and sale is widely considered as the most fruitful and pragmatic sign of the advance of psychopathology during the past several decades.

By means of these drugs, patients are released into society at large, while using the hospital and other out-patient centers as clinics. This seems progressive. But it marks the failure to achieve authentic community in our society. On the one hand, the number of patients in mental hospitals is drastically reduced while those remaining are rendered malleable by the use of drugs. Thus the hospital’s function as a rehabilitation center seems to have been discharged, or as is sometimes said, "The revolution in drugs has rendered the hospitals obsolete." On the other hand, the patient is returned to the society, to his web of relationships, sufficiently immobilized by drugs to give the impression that society’s resources are being constructively used to alter the sorrowful trajectory of his life. But the latent function of the drug-based community mental health movement is economic, in the broadest use of the term. That is, the society generates more breakdowns than its institutions can handle, more "inadequacy" than it can absorb. The mental health movement has the paradoxical effect of deflecting attention from the source of the problem in the society itself, while it solves the economic dilemma of the over-crowded, inadequately staffed, and costly custodial institution. Of course, the mental health movement appeals to the resources of the"community" continuously, giving the impression that a real effort at therapy has actually been made; but that effort, is merely ameliorative, particularly when it focuses on limited aspects of what are called "interpersonal relationships." But no analysis of the deep structure of the society is, or can be undertaken. Moreover, the drug-based mental health movement masks the rate of breakdown, so that in any given year the admissions for this or that clinically defined syndrome may shift relative to another, while the official rate of admission may fluctuate without reflecting the reality of overall social pathology. Finally, the drug-based mental health movement also stops custodial institutions from replicating themselves to the point at which they would represent, in their numbers and archaic nature, an indictment of the society which created them. Thus, the whole system of mental care becomes a self-reinforcing social loop, a cultural feedback which leads us to deny social reality. We seem to be controlling mental illness, but our social pathology deepens.

Although the achievement of pseudo-community through the artificial raising, lowering or dulling of consciousness was systematically resorted to by the psychiatric establishment for a generation prior to becoming an alternative for the disaffected, the dependence upon drugs or their equivalent is a growing and general characteristic of modern civilization. It is not a specific, bounded, researchable "social problem," confined to a particular segment of the population, just as people in revivalistic movements whose cultures have been shattered by imperial civilizations may acquire a related dependence on drugs in order to stimulate fantasies of the past and future, pursue lost dimensions of experience4, and to make cultural defeat bearable in the present, so chronic use of drugs is one way of achieving parallel ends for people who have been blocked by vicarious experience, and civilized associations inadequate in range and depth. Drugs literally cool the victim. It is, therefore, in accordance with the logic and limitations of our culture that methadone, almost as destructive a drug as heroin, be substituted for another, in a tautological therapeutic effort. Drugs have become a surrogate for the experience of culture itself; the culture is reduced to the drug ("the drug culture")5 and the person is converted into a physical/chemical object, an irresponsible system of responses. This passivity and this complex of illusions have the effect of adapting the person to any social arrangement which ensures the gratification pursued. The dialectic between the person and society is broken: a creative politics becomes less and less possible. It is, of course, difficult to locate the source and locus for a failure of such dimensions directly in our own society; we are too involved in its dynamic, too much the product of our cultural shortcomings. We can only understand ourselves through cross-cultural contrast, by learning to perceive another society or another cultural situation which resonates with our own. That is what defines the anthropological perspective. And it is, I believe, the only way that we can penetrate to the social origins, the definition of pathological behavior. But I prefer to be as concrete as possible.

In pursuing this problem further, then, I shall use as an example the paranoid schizophrenia diagnosis of a. patient who was the subject of a cross-cultural case conference in which I participated several years ago at the Upstate Medical Center, Syracuse, New York. The person involved was identified as an "immigrant alien" from an exotic society, Laos. Actually, he turned out to be South Vietnamese, a fact which was less important in 1963 than it would be now. Nonetheless, the fact that he was an exchange student, necessarily middle class, from a country torn with conflict would have further sharpened the conflicts that could ordinarily have been anticipated in his career in the United States. When first invited to participate in the conference, I composed, for my own benefit, a list of questions of the following order:

  1. What was the social and economic background of the patient? Was he born and bred in an urban or rural area? This is particularly significant in relating to people from archaic civilizations in economically disadvantaged areas.
  2. How fluent was he in English? What were the details of his formal education? What was his capability, for example, in French?
  3. How traditional was the family structure? How severe, relatively, was the conflict between tradition and the drive toward modernity? What were the cultural signals and concrete metaphors of this conflict?
  4. What was the class and occupational status of the critical members of the family and their friends?
  5. What was the cultural significance of birth order and of other relationships within the immediate family?
  6. Had the patient traveled before and under what conditions?

    Before inquiring into the available details, I then drew up a list of circumstances conducive to a reaction that could be interpreted as schizophrenic in a person undergoing certain kinds of cultural experience.

First, the visiting Vietnamese was a member of a darker race among a white majority. Residual feelings of inferiority or disadvantage would be deepened in the race-conscious American milieu. There might also be a shift from a feeling of cultural inferiority (or disadvantage) vis-à-vis the European generally and the French in particular, to the new problem of racial division; or rather, the old problem presented itself in a novel and nuanced form. The strategy of race relations in an American city would have had to be absorbed rather quickly by this Oriental patient. It should be noted that no matter how good his intentions, a white American physician would have great difficulty in exploring this area.

Second, the patient’s native language was considered exotic and was rarely encountered in his new environment.

Third, the patient found himself in a Western urban situation, one which was mechanized, impersonal and elaborated beyond the archaic market-ceremonial-commercial towns that he experienced in his homeland.

Next, his extended family orientation, with particular reference to status expectations of aid and support, routine duties and rights, was not being fulfilled. The configuration of the [comparatively – ed] "anarchic", less cohesive family encountered in the United States was unfamiliar to him. Relationships between the sexes and between the generations were particularly bewildering.

Forms of public deference and service, including terms and modes of address, were underdeveloped or not apparent in the culturally (but not socially) egalitarian American society.

Women probably were inaccessible, or, if accessible, did not take the patient seriously. He was not considered really a man, even by the women who did sleep with him, since his command of the environment was inept and they could anticipate no future with him. This led to the practical impossibility of relating either sex and tenderness or sex and social obligations. Sex became a segregated, obsessive, detached and, in both reality and fantasy, autistic activity. It is in this phase of his journey to the hospital that the patient might appear to be a severe "psychoneurotic." He encountered a minimum of familiar cultural landmarks, either in the form of artifacts or signs and symbols. Everything, from food and clothing to the significance of yellow as the color of caution and cowardice was strange to him.

He experienced a physical climate that is peculiar and harsh. The responses of his body may be unexpected (an actual example turned out to be the flow of mucous in his nose, about which he became obsessive). Ordinary routinized activities, such as dressing properly required a careful effort.

Finally, his knowledge of the United States was probably gleaned from the cinema, assorted popular books and gossip.

In sum he felt like a visitor from another planet; he lived in a dream projected by an unknown author; he split into subject and object or object-subject-object, he monitored himself very carefully and may even have mediated his various selves. These effects would have been intensified, of course, if the patient were a man in transition in the first place, that is, if he were not firmly grounded in his native milieu.

The anticipated result of the patient’s experience was traumatic cultural shock, not the tourist’s malady celebrated by the anthropologists, but an acute identity crisis. In such a situation suicide is possible, and might be threatened (as in the instance of "psychapathic" personality), resulting from a turning-inward of hostile feelings in the service of their ultimate social expression (at which point the patient might give the appearance of a "depressive"). But the likely result, then, is a chain of related "schizophrenic" responses that exhaust the definition of psycho-pathology. These would probably include the following:

These general responses did, in fact, constitute the paradigm of the patient’s illness; they were clinically defined as his symptoms. But a cross-cultural or situational perspective dissolves the clinical diagnosis. For example, a hallucination may be understood as a visualized (heard) and interpreted (projective) memory or anticipated happening based on past experience, cunningly constructed from personal or cultural symbols or both. Hallucinations are dream work; in moments of severe stress, perhaps following on prolonged sleeplessness, the "repressed" material may burst into consciousness in a new form, as the organism seeks a creative resolution. But we all, so to speak, see (hear) what is in our brains. When a Blake sees a tree full of angels, he does it as a transcendent artist. It cannot be reduced to a clinical symptom. When a painter sees a painting he is about to paint this is also in a sense a hallucination.

On the cultural level, when New Guinea natives in the area of Port Moresby see a spirit witch in a tree, the phenomenon is not psychopathological. When an Anaguta of the Northern Nigerian plateau says that whirlwind is a spirit, we cannot make a clinical interpretation. As a matter of fact, among primitives generally, spirits are concretized, individuated; they are persons and they exist. Even death, among certain people of the lower Niger, is a person and exists. This is not psychopathological, nor is it the same as a Freud postulating unconscious forces6. Of course, if a New Guinea native saw a pig jumping over the moon his people would look askance, since the vision would be idiosyncratic, not culturally anticipated. But, and this is the important point, they would not necessarily consider him crazy, only privy to a type of information inaccessible to others. Such a person might, indeed, become a shaman.

One could go on in this vein trying to illustrate the danger of assuming that certain phenomena are ipso facto psychopathological or somehow qualitatively removed from our ordinary human experiences. The point is that the predictable symptoms in the schizophrenic reaction constitute an effort at adaptation to a series of experiences that are perceived as discontinuous and absurd, contrary to expectations and destructive of hope; the future disappears. On the aesthetic level, these discontinuous experiences destroy the sense of life as a drama of meanings, as a tragedy that can be endured. This is equivalent to a failure of socialization, a failure which can probably be modified within fairly inflexible cultural boundaries, given great effort throughout the life cycle. The experience of culture shock is, then, a schizophrenic or, if you will, a schizoid reaction. In either case, it exposes the schizophrenic process both within our society and cross-culturally – process, not essence; for schizophrenia is a dynamic, not a category. Let me put it this way: the schizophrenic reaction among ourselves is a type of home-grown experience of culture shock. There is, of course, this difference: the "exotic" patient may have the memory, at least, of an altemative life pattern to which he may retum or perhaps just the knowledge that such an alternative has existed. For this reason, the expression "schizoid reaction" may be appropriate in that the process it describes may be readily reversible.

The analogues to the traumatic cross-cultural experience in our own society are inadequate socialization both instrumentally, relative to sparsity, trivialization and overspecialization in development of skills; and affectively, relative to the separation between the generations or the inertness of interaction between the generations and the resultant mechanical quality of peer interaction, and the failure to celebrate the person at critical psycho·physiological points in the culturally derived life cycle.

The result is the tendency to reduce the person occupationally and emotionally, in work and love, to a category or function based upon a principle of mechanical performance in an increasingly secular milieu. Therefore, affective, cognitive and instrumental functions are separated from each other, in turn related to the extreme division or subdivision of labor. It is only in this context that schizophrenia can be labled a cognitive disorder, an impairment in thinking: for on the one hand, cognition stripped of affect or work in the world must be distorted, and on the other hand, the social fragmentation of the person leads to partial and alienated conceptions of reality. The self is not only split, it is subdivided and hardly has the chance for organic development through a life cycle of normal range, and work of a socially integrating character.

Thus the ordinary psychopathology of everyday life in our society is, on the deepest and broadest levels of our personalities, a series of alienating reactions to social imperatives reflected in, and in turn reflecting the structure and function of the family. This familiar condition makes all of us some of the time and some of us most of the time feel like visiting Vietnamese drifting through a world full of strangers, a world without landmarks, in which we endlessly reify ourselves and others. In other words, schizophrenia, as we know it, gives every indication of being a protest against and a response to the problem of learning how to be human in contemporary society7. Two complementary aspects of that response can be isolated. The first is exemplified in the "underachieving,” socially thwarted and therefore "mock-creative” person, who makes redundant efforts to control the environment by complex symbolic evasions. But the goals of our society are not consciously questioned; the manipulation of persons is substituted for the command of things. The structure of suffering, which inheres in the manipulation of persons, can be glimpsed in the case of a schizophrenic family that served, on the obvious assumption that familial dynamics are implicated in schizophrenia, as the object of research for a number of years in a project at the National Institute of Mental Health.8

In these pilot studies schizophrenic families were, without their knowledge, observed during group therapy through one-way mirrors by interdisciplinary teams. The family member who had been officially designated as a schizophrenic was a voluntary patient in the elite, custodial unit of the Institute, an experimental hospital. At the inception of the program, the families of patients were also quartered in the clinical center, all expenses paid, but this practice was eventually discontinued because of economic and other difficulties. Moreover, certain families tried to convert the experiment into a way of life, thus generating intolerable tensions among the staff. The therapeutic sessions were conducted by at least one therapist, usually an analyst, together with a psychiatric social worker who served as a resource for background and day to day information about the patient’s behavior. The sessions included as many members of the immediate biological family as could be gathered on a given occasion. The group observing them through the mirrored windows of darkened observation booths consisted of psychoanalysts, psychiatrists, psychologists, and in this particular instance, myself, an anthropologist, serving as the cultural anchor for the psychodynamic team. From time to time extemal consultants – sociologists, philosophers, a novelist – were invited to join. The weekly sessions of the family in therapy and the elaborate discussion that took place directly afterwards were recorded. After each session, the observers subjected each therapist to a searching critique of his performance, suggested alternative interpretations of family behavior, argued endlessly, ventilated their prejudices and sometimes their pathology, in the tautological attempt to penetrate to the essence of schizophrenia. The therapist being observed was under extraordinary pressure – every aspect of his relationship to the patient and the patient’s relatives was explored. Each involution of transference, counter-transference, projection, introjection, and rejection was traced, noted and analyzed. Several analysts could not stand this sort of exposure. One deeply experienced senior analyst, for example, began to arrive late or miss appointments completely. He finally conceived the family as conspiring against him, a conclusion that resonated with certain critical aspects of his then current personal life. But there were grounds for his suspicion. For several months, he had been trying to penetrate the individual and group defenses and reach what he assumed were the repressed feelings of family members towards each other and also towards himself. The more persistent he became the more evasive was their response. They handled him with an almost exquisite finesse, passing him along the circuit from husband to wife to son and back again, deflecting his attention from any reaction that seemed promising, baiting him. There were moments when the analyst under observation simply stopped dead in his tracks, surrendering in confusion to the false cue, the contradictory signal employed to throw him off the scent. Occasionally, father and son might exchange an identical smile across his line of vision, or the mother would look down, modestly amused at some riposte of her husband. Gradually, unable to bear the isolation, the analyst began to ally himself with this or that member of the family in specific situations.

Altemately, his hostility focused on the father and he found himself wooing the mother. This contest for dominance, which was rationalized by the analyst as necessary to establish his credibility, that is, his authority, culminated in a frank outburst (beginning in the therapy room, and finishing in the observation booth) to the effect that "the old son-of-a-bitch was exactly the kind of man my father was – incorrigible, dishonest, impossible to relate to." Shortly thereafter he resigned from the project.

In the perspective of the analyst shuttling between therapy room and observation booth, the project provided no exit into reality, not much material compensation, and no apparent progress in the presumed condition of the patient. In private practice, or in an ordinary mental hospital, such negative consequences can be masked or diffused. Even if under supervision the therapist is not subject to such direct observation and wide-ranging analysis; his link with the patient is partial, he is usually paid well, and, above all, he is not obliged to define theoretically a pathology or to question assumptions, but to alter or confine behavior. He is, therefore, less subject to paranoid or depressive reactions.9

In the course of the project it became clear that unless the psychotherapist can attain a commanding position vis-à-vis the patient, he is likely to lose confidence in himself very quickly. If he cannot define himself as representing normality, reality, competence, the world, in sum, the establishment – and the patient as seriously inadequate – his professional armor disintegrates. A split develops between the professional ego, or "status personality" and the self. The analyst may then become nakedly manipulative in order to maintain his status as he and others conceive of it. The self is revealed as underdeveloped and conflicted. The research project then had the unintended consequence of revealing a basic social dynamic of schizophrenia: investment in and pursuit of the chimerical status ego at the expense of the potential self, a dynamic as evident among the psychiatrists as among the patients. The pragmatic, self-reinforcing distinction between these two categories of persons was that the patient had little or no status, and had become habituated to the notion that he was incompetent in critical respects.

No matter how modest the therapist, the patient was obliged to orient his sanity vis-à-vis the assumed health of the other, that is, the psychiatrist is officially defined as the custodian of health. His personal characteristics were as irrelevant as a surgeon’s. Moreover, the psychiatrist had the real world and his position in it as retreat. His habitual, reflexive competence, his ego saved him from "breakdown", that most deeply personal of protests against the throttling of self. The responses of the psychiatrist were not related to his manifest convictions or public temperament. He might be liberal, even radical in his view of mental illness, and sceptical of his own omniscience, but if relating to the family undermined his sense of his status in society, threatening what he took for granted, he would seek to evade, manipulate, and finally lose interest, that is, dissociate from the situation.10 The deeper one plumbs the psyche of the other, the more interchangeable we become. Individuation is the result of acting in the world.

The tactics of the psychiatrists, were also used by the patient and his relatives. In the particular family under consideration, whom we shall call the Dixons, the father was something of an adventurer, an odd job man, a distinguished looking hobo in the American grain. He was glib, apparently poised, knowledgeable about the inequities and iniquities of the system. In other times and places he had been a surveyor and a river boat pilot but had not found work for years, busying himself with schemes for getting rich quick. His wife, a meek·mannered, beautiful woman with a decaying body, was a generation younger than her husband (then past 70, he looked 50), and supported the family by working as a saleslady in a boutique. Her family of origin was southern, prestigious but money poor, and one had the impression that she had been swept off her feet by the energetic and plausible roustabout that her husband had been. When other impulses ran counter to her loyalty to her husband – or her fear of offending him – she became more passive, and her manner even more graceful, than usual.

They had three children. The oldest, a son, was at college in another state, the youngest, a daughter, was completing high school. The third, a young man in his early twenties was the patient. He had been introduced to that role in his late teens when conflict with his father over his lack of interest in school work and his penchant for motor bikes culminated in an attack by the son on the older man. His father, with the presumed consent of the mother, called in the police; they recommended a psychiatrist who referred the youth to a state hospital. There was no record of the severity of the attack on the father, and there were no witnesses except the mother. Nonetheless, the young man, whom we shall call Tom, was admitted to the hospital, and after brief observation was diagnosed as a paranoid schizophrenic.

Tom was tall, rangey, obviously intelligent. His tentative smile conveyed a certain distrust of self and others, and seemed to seek validation for his sense of the world as absurd. His career in the hospital, which lasted for more than six months, was undistinguished. Presumably, he discharged the role of paranoid schizophrenic with such force and clarity that the initial diagnosis persisted. That is, he may have hallucinated, proved hard to handle, acknowledged a peer group, and conspired with the staff to maintain his status. By the time the family had been admitted as an experimental case to the clinical center, the record of his previous hospitalization had largely "disappeared." The welcoming staff had little information about the initial diagnosis, the events leading up to it, or his first hospitalization. But it seems unlikely that a consistent case history was in the first instance even available. Such a history is always something of an illusion; psychiatrists come and go, "diagnoses" are complex and overlapping, individual perspectives differ, and the generic culture of the mental hospital must also be taken into account, along with the specific social personality of the given institution.11 But it was no illusion that the identification of Tom as a paranoid schizophrenic, his apparent compliance in the state asylum and his family’s acceptance of his condition recreated him as a social being.

This resolution was by no means uncongenial to the parties concerned. The removal of Tom from the scene served the needs of his father, since a myth, in accord with family politics, had been invented concerning Tom’s special relationship to his mother. Only his mother was said to be able to handle Tom, which meant, in reality, that she was permissive, gracious and, in contrast with her husband, never obviously punitive. Though Tom had no vocation he had an elaborate interest in automobile engines, intimating a creative interest in commanding things. jobless, he was frequently at home and was the only immediate male competitor for his mother’s affective energies; she was not much older than Tom than she was younger than her husband. It was also clear that Tom’s unconventional manner reminded the father of himself; thus any crisis in his self-esteem was translated into hostility towards Tom. When the conflict between them became, in the father’s view, insupportable, exiling Tom in the service of curing him was conceived as a sensible alternative. Of course, the negative identification between Tom and his father never became visible to either.

As far as the mother was concerned, by considering Tom a patient, that is, as a hopelessly dependent and irresponsible person, she reconverted him into an infant, she reconceived him. She could then safely deal with him, express her deep concern and sympathy, and act out the role of the mother without risking the displeasure of her husband. As a working woman in the retail trade, always mildly ill, under the thumb of her bosses, having to genuflect to customers and exhausted most of the time, she was in no position to act independently at home. Moreover, she valued the curiously courtly, almost chivalric relationship that she maintained with her husband, since it echoed the society in which she no longer moved and gratified her "romantic" longings. She appreciated her husband’s "sense of humor," which must really be defined as Schadenfreude, wit or amusement at the obvious expense of others while exempting oneself from the other’s predicament. Therefore, the removal and labelling of Tom could be readily rationalized by his mother.

So far as Tom was concemed, assuming the role of the patient was a logical altemative to the conflicts he faced at home and school. His new identity made him the center of ineffectual familial concem, and permitted him a latitude which would have been inappropriate in a normal situation. Tom had opted for the role of a literally "institutionalized deviant" in the civilized sense of the term, a deviant who had no standing in society at large, but was permitted to act out his problems and play with his identity, as a child is supposed to have the right to play, in a custodial situation. Society having failed him, he permitted the specialized institutions to take over. And in the logic of our civilization, the specialized institution crystallizes the negative aspects of society at large; they are, so to speak, the caricatures of our ordinary functions. Maximum "security" is, for example, attainable in a jail.

If Tom had felt that he was incapable of living conventionally, he was nonetheless able to shape his new environment to certain uses of his own. He was relieved of ultimate responsibilities for himself and avoided the necessity of making a conventional commitment to job, wife and so on. At the same time he was entitled as an institutionalized schizophrenic, to explore in fantasy other possibilities that the person sealed in some partial, ego-based identity in "normal" society, repressed, avoided or learned to condemn.

In Tom, then, this family was able to identify a pathological process. The family's anxieties, fears and conflicts were focused, personified, in a sense exorcised, in a being who was simultaneously of them yet alienated from them. Tom had become a willing sacrifice, analogous to what the Igbo-speaking people of southeastern Nigeria call an "Osu" slave – a holy, or untouchable person burdened with the guilt of his normal counterparts and therefore detested, dreaded, excluded from society at large, yet living invulnerably within an exclusive circle of his own. He was also a secular personification of the customarily sacred insane.

Tom’s diagnosed schizophrenia enabled his family to find a place for him; having created him out of their own needs, Tom became the living reification of their conflicts. And, perhaps, for the first time they – father, mother, siblings – really felt connected to this creation of theirs, while reserving the right, because of his illness, to disengage when the situation became intolerable. On such occasions, in turning away from Tom, they evaded themselves, "understandably," and with full official sanction. Tom’s symbolic rebirth was the negation of the primary misconception into which his life had been converted. But his illness was not only a victimization, it was also a confession that no other resolution for his family through its network of associations and possibilities was feasible. For Tom, his parents, and his siblings accepted the society in which they were embedded. His father’s sophisticated griping did not deflect him from his hope of the main chance, or change his conventional standards of success and failure. His mother’s fatigue did not lead her to look for immediate personal altematives. His siblings, on the other hand, pursued only the most limited personal alternatives, moving cautiously away from home, watching their words, and preparing themselves for safe careers. To the extent that they could, they sought to adapt to society at large by manipulating each other to that end. Therefore, their schizophrenia can be defined as an adaptation mediated by a protest. It was a flight into an institution, an abdication of autonomy, a surrender to a social designation.

As a family, then, they were preadapted to the clinical experiment undertaken at the NIMH. The research interests of the NIMH coincided with their emotional and economic needs and resources. The Dixons were in search of maximum security and understanding; and the NIMH needed raw material. The tautology came full circle in the closed environment of the observation room, which obscured both the social dimensions and the potential of these experimental "objects," the people involved. Suspended in a laboratory situation, they could now be conceived as timelessly and essentially schizophrenic.

As the experiment progressed, the manipulation of people, including oneself, as a means of survival and fulfillment, intensified and became more visible. Two related events, one intermediate, the other final, epitomized this situation. The intermediate event (intermediate in a developmental, not a chronological sense) occurred several years after the family had been introduced to the project. And it consisted of a critical therapeutic session which Tom, the paranoid schizophrenic, completely controlled. Tom was usually withdrawn, but relatively attentive, and his appearance was characteristically unkempt. He had been for some months prior to the critical session engaged in finger painting as a combined therapeutic-vocational activity under the guidance of a psychiatric social worker. This, however, did not absorb or structure his energies. He had begun a flirtation with a fellow patient, a young woman from a "good" Washington family. His tentative and necessarily surreptitious attentions were not unwelcome and on one occasion Tom and the young woman were found in her room in a tete à tete that was interpreted as sexually compromising. The response of the staff was immediate. Tom was forbidden to go near the girl again, the rationalization being that his behavior would disrupt the routine and betray the function of the institution, not to speak of the damage he might do to himself and the girl. She, after all, could become pregnant; moreover, Tom would certainly be unable to channel his impulses in a conventional way, ("we can’t have screwing in the halls," said one psychoanalyst-administrator) and should such behavior spread, the primary aim of the experimental unit, namely, directed family therapy would be subverted. It was also tacitly assumed that the hospital remained responsible to the girl’s relatives, and they would hardly have sanctioned a liaison with Tom. Thus Tom developed a reputation for being hard to handle. (On one occasion he had struck a. nurse who had suggested that he get out of her right of way, and it was reported that he often made threatening gestures to the staff at large.)

Some weeks after the "sexual" episode, Tom’s family, on his birthday, presented him with a black suit and a new pair of shoes. Tom made an unexpected use of them. When the critical therapeutic session began, he appeared exactly on time (he was usually late), immaculately dressed in black suit, appropriate tie, white shirt and polished shoes. His posture (usually slouched) was erect, his step certain, and his manner confident. As he entered the room he nodded graciously to his parents, held out his hand to the therapist, acknowledged the presence of the psychiatric social worker and took his accustomed seat. At first he said very little, but closely followed the questioning and counter-questioning between the therapists and his parents. Then, at a certain point, he began to speak quietly, with conviction, yet never completely focussing on the person to whom his remarks were addressed. But what he said was taken as nonsense.

On other occasions, Tom had "lapsed" into idiosyncratic sounds or words, sometimes repeating them to himself, at other times contributing them to the general conversation. This was language moving toward poetry – but not yet iconic, not yet a world in itself, still a reification. But now, he strung together whole blocks of unfamiliar syllables, just sufficiently interspersed with other parts of speech, in a syntatically logical sequence, to hold the attention of the other people in the room. When he was asked to explain what he meant, he seemed even more eager to make himself understood, and would either continue to talk in his private pidgin or pause, apparently pondering the difficulties of human intercourse.

The analyst was particularly intrigued by this performance, and, by gesture and word, kept trying to elicit a consistently meaningful statement or at least an interpretation of his remarks from Tom. Now and then the analyst became impatient, even angry, but Tom remained cool, either falling silent, or lowering his voice further while making no effort to avoid the analyst’s gaze. In the background, Tom’s mother smiled continuously, bewildered but also pleased at her son’s manicured appearance. The father was quiet and actually nodded his head at one or two of Tom’s indecipherable remarks. Towards the close of the session, the analyst, truculent, made it clear that he considered such language meaningless. Tom responded with a graceful, non·commital sound. It was Tom who terminated the session. He rose from his chair with obvious dignity, kissed his mother lightly on the cheek, shook hands with his father, wished him well, and thanked him for the gift of the black suit. He then turned to the analyst, encircled his shoulder with a patronizing arm, made it clear that he had enjoyed the session immensely, hoped that the analyst had also, and looked forward to seeing him the following week. Without further comment, looking straight ahead, and striding briskly, he left the room to return to his quarters as if to an important meeting.

The initial comment by the civil servants in the observation booth following this performance was that Tom "ought to be dismissed from the hospital or promoted." He had, of course, been playing with his identity; he had used the suit, the analyst’s air of authority, the easy, endless and circular flow of language in the therapeutic sessions, his mother’s mild manner, his father’s courtly gestures and manipulated them to fit a momentary identity of his own. At the same time he had inverted his typical social presence – formerly untidy, withdrawn, passive, explosive, he had become immaculate, cooperative, active, controlled. This transformation, this easy exercise in the adoption of a status ego, not only caricatured role playing, but revealed the dilemma of both the psychiatrist and the family. Tom had finally permitted himself the luxury of revealing himself as the mediating and mediated schizophrenic, a field for cultural distortions. At the same time, the link between the psychopathic actor and the schizophrenic problem of the self (those two presumably polar syndromes) become evident; they are shown to be no more than arbitrary perspectives on a single basic process.

Shortly therafter a new therapeutic tactic was adopted by the project because of both a change in research personnel and the therapeutic stalemate that had been reached. Tom was encouraged to leave the hospital and live at home while efforts were made to find him some kind of unskilled work. Therapeutic contact was maintained but members of the family were seen individually, the assumption being that with privacy, more intimacy and candor, deeper "communication" would become possible. However, it quickly became evident that relating to one member of the family implied relating to all the others, whether or not they were physically present. The alternative, namely, shattering the inverted integrity of the family and dispersing its members was obviously out of the question, and if attempted, would have been tautological; the family already reflected society.

It was not possible to find Tom a steady job, but he helped in shopping, cleared the lawn, assisted around the house in other ways, and worked on his bike. It was no surprise when after several months an argument between Tom and his father led to another outburst. This time the father knocked Tom unconscious with a baseball bat, inflicting a severe wound in his scalp. The parents called in the police, who called in a psychiatrist, and following surgical treatment Tom was admitted to a state hospital, where, so far as I know, he remains.

If the mock-creative, manipulative aspect of the schizophrenic process (investment in the status ego at the expense of the self) is epitomized in the Dixon family and revealed in the psychiatric milieu, the authentic schizophrenic is linked with artists and criminals, and may, in our society, be an artist or a criminal. In the archetypal, contemporary instance of Genet, whose inverted dramas ring every conceivable change on the problem of split consciousness, the artist and the criminal fuse; they become facets of an aesthetic unity. The ordinary goals of the culture are flatly rejected and a creative alternative composed of personal and social meanings is constructed. After the disintegration of the civilized consciousness, after the social suicide of the artist, a reconstitution may take place, which, if achieved, is a devastating cultural critique. The self emerges, inevitably at the expense of status egos; the struggle is towards another reality.

Hans Arp, the surrealist poet, illuminates this arduously reintegrated consciousness in his own way.

life is the goal of art, art can misunderstand its means and merely reflect life instead of creating it. Such means are then illusionist descriptive academic. i exhibited along with the surrealists because their rebellious attitude toward "art" and their direct attitude toward life were as wise as dada. more recently the surrealist painters have been using illusionist descriptive academic means which would warm the cockles of rop’s heart.

neoplaticism is direct but exclusively visual it lacks all relationship to the other human faculties.

but finally i feel that man is neither a parasol nor a para-la-si-do nor a paramount for he is made up of two carnivorous cylinders one of which says white when the other says black.

assuring you of my very pressed dishes i remain

sincerely yours12

And further:

i was bom in nature, i was born in strasbourg. i was bom in a cloud, i was born in a pump, i was bom in a robe.

i have four natures. i have two things. i have five senses. sense and nonsense. nature is senseless. make way for nature. nature is a white eagle. make dada-way for dada-nature. i model out a book with five buttons, artis-tree of sculpture is a dark stupidity.


you know no one can prove to me that i am not an eagle, the eagle works hard at life, you know the eagle has five lives and four natures, you know the eagle also has a title. you know the general has five titles five buttons on his two senses and four holes in his joys. but nature and i are against these joys and things that are born, nature works hard at life whether sitting or standing. the black cloud in the white robe joyfully gives birth to a bird-thing.

It was the day of the Nativity, the first day of the month of May. Snowmen and tuns of thunder were falling from the sky. The last three caulked hearts were drifting across the world: Liberty, Equality, Fraternity. It was the last day of the new year. The tree of idealism, that sentimental tree in which the nests of materialist philosophers sway, came crashing down in one single stroke of helium thunder.

Men had changed into boiled onions, each with a toothpick clutched in his toes and the banner of sacred colors in the righthand buttonhole of the left trouser leg. ten minutes later, all men had vanished and the last woman was munching her Oriental pills while sitting on the extreme tip of the highest mountain on earth. She bore a certain resemblance to Noah’s Ark, although her beard was slightly longer and her male dove slightly shorter. However, the nose of her perfidious gaze bore a lovely olive branch (today, the olive tree it came from has become the tiepin of specialized short circuits).

As the reader must have realized by now, man has disappeared from the face of the earth, and in his place we can see the hermaphrometallic globule, svelte and elegant, no larger than half the ear of the evening angelus, no longer than the Greenwich meridian at 6:40 a.m.

This svelte and elegant creature is perfectly standardized, and anyone can obtain it for two and a half francs in any well-stocked store. Its living space is never more than 25 cubic centimeters. As soon as its respiration develops the slightest bit beyond that, the globule folds it in half or even in thirds, depending on the circumstances.13

As noted, the mock-creative and creative reactions overlap to such an extent that they can be considered two dialectically related aspects or phases of a single process, In the first instance, the self diminishes; in the second, the civilized position in the world collapses. In neither instance, is primitive integration possible.14 The manipulative aspect signifies the struggle with persons, including oneself. It exposes the need to dominate, control, to put the other and oneself in their places, to locate them, and, therefore, to solve the problem of the self. This endless struggle, this constant rearrangement of people vis-à-vis oneself cannot, of course, work. It does not represent an exploration, but a mechanical exploitation, the objectification or reification of self and others. Manipulation inevitably ends in frustration because its ulterior motive and goal, the search for an authentic and creative connection, cannot be achieved by the means adopted. The "art" of manipulation is a distortion of the creative process, so understood we can situate both the source of the process and its negation in the relations of society at large. And that permits us to understand why artists must live through, comprehend and finally transcend civilized associations if they are fully to realize or develop their gifts. Thus the modern (nonacademic) artist is likely to share certain aspects of the consciousness of the criminal – at the very least he will sympathize with the criminal who, like himself, is an outcast and a victim who refuses to be victimized.

The more general point is that the schizophrenic reaction is no more and no less than the ultimate pathology of modern society; that pathology may be seen in its actuality as a society-wide dynamic manifested in varying degrees and combinations in all individuals according to their temperaments, their talents and their precise circumstances.

But the unfortunate person who for one reason or another becomes publicly exposed may then be defined as a schizophrenic. This vicious, if unwitting, clinical habit of reducing the person to a class or category, mirroring the mechanisms of social identity generally, not only limits the possibilities of relating to the patient, but also makes it possible to locate the problem in our organization of society, articulated in the language of our cultural assumptions. This means, among other things, that although the episodic character of all psychosis may be recognized, it cannot be taken into account. Thus, when Antoine Artaud states that psychoanalysis was invented in order to destroy the visionary in man, he confuses a purpose with a consequence, or at least with a consequence that has not yet been intended; but his insight concerning the social functions of psychiatry remains sound. We are obliged to acknowledge that we have created the clinical entity that we have named. We have hypostatized, reified and converted it into a diagnostic category, reflected as a disease of the individual, genetic or otherwise. And we close the circle finally by claiming that schizophrenia is statistically predictable in its distribution at a rate of say 1 per 100 throughout the civilized world, and increasing in frequency. That, of course, is one way of defining society as fate and is perhaps our cruelest evasion of social reality, and human possibility.

This brings us to the ultimate cross-cultural question of whether schizophrenia exists among primitive people.15 I believe that as an essence it does not, but the process is identifiable. That is, schizophrenia as a diagnostic category is irrelevant in authentically primitive societies. The reasons for this are as follows:

  1. The rights to food, clothing and shelter are completely customary; each person learns as an organic part of the socialization process the requisite variety of skills. Functionlessness is not a problem in primitive society.
  2. Rituals at strategic points in the bioculturally defined life cycle permit the person to change roles while maintaining, and expanding, identity. His ordinary humanity is celebrated in an extraordinary way. The life-cycle is a normal curve; it does not collapse in the middle, leaving the aged without wisdom, work or honor, their only altemative being the dissimulation of youth.
  3. Rituals and ceremonies permit the expression of ambivalent emotions and the acting out of complex fantasies in a socially prescribed fashion. It is customary for individuals or groups of people to "go crazy" for self-limiting periods of time without being extirpated from the culture.
  4. The ramifying network of kinship associations sets the developing person firmly in a matrix of reciprocal rights, obligations and expectations. Social alienation as we experience it in civilization is unknown.

The fact that there are no mental hospitals or asylums in primitive societies or, to my knowledge, any institutional equivalents, testifies to the social use and containment of the schizophrenic process, which is a generic human process. It does not become a clinical entity until a society which can erect no boundaries to the process and no creative channels for its expression, exiles those who are as a result incapacitated to specialized institutions, or otherwise immobilized. One may fairly conclude that although the schizophrenic process is identifiable, the structure, function and the psychodynamic character of primitive societies set cultural limits to the process and prevent it from becoming a diagnostic entity. Primitive cultures realize the major function of culture which is to make men human, and at the same time to keep them sane. That is what civilization, as we know it, is failing to do. Schizophrenia, then, is no less and no more than the subjective aspect of the socio-economic dynamic of alienation.



1. The usual figure projected by the NIMH is more modest and less specific. About 22 million Americans are said to become mentally ill in the clinical sense at one time or another in their lives. Perhaps half of these would be identified as "schizophrenic."

2. The paper in question is "Genetic Factors in Behavior Disorders" by David Rosenthal. Related essays are those by S.S. Kety, D. Rosenthal, P.H. Wender, and F. Schulsinger in The Transmission of Schizophrenia ed. D. Rosenthal and S.S. Kety (Loudon: Pergamon Press, 1968). Also, D. Rosenthal, P.H. Wender, S.S. Katy, J. Welner and F. Schulsinger, "The Adopted-Away Offspring of Schizophrenics," American journal of Psychi-atry, 1971.

3. This piece was written before the time of dumping the contents of hospital beds on the street to make way for the construction of call-centers and reduce the demographic statistics of "mental illness". [ – ed.]

4. "Mescaline,” wrote the distinguished French poet, Henri Michaux, after systematically experimenting with the drug, "is the enemy of poetry, of meditation, and above ull of mystery .... Images completely stripped of the pleasant fur of sensation . . . purely mental . . . abstract . . . [were] imposed on me by the drug . . . [I could] take no liberties with them [there were] no possible variations . . . [my] imagination was completely paralyzed. [Mesca-line] elaborates stupidity" (p. 32). And further "to the amateurs of one-way perspectives who might be tempted to judge all my writings as the work of a drug addict . . . I regret, but I am more the water drinking type. Never alcohol. No excitants .... [a little] wine. All my life, in . . . food or drink moderage .... Fatigue is my drug. The most unspeakable of all [is] alcohol" (p. 89) [Henri Michaux, Miserable Miracle, trans. Louise Varese (San Francisco: City Lights Books, 1967)].

Baudelaire would concur. And most recently Carlos Casteneda seems to have reached a similar, if less autonomous and esthetic conclusion.

5. According to the state-commissioned Fleischman report of October 1972, 45 percent of all high school students in New York City used one drug or another; the suburban rate was 25 percent. The figure estimated for junior high school students in the city was also 25 percent. But this sort of statistic is misleading. It divides the "psychotherapeutic" and socially sanctioned from outlawed drugs, reflecting the distinction between classes and ethnic groups. Yet social reality blurs the line; marijuana is so commonly used that it may become as legal as alcohol; tranquillizers are used by street gangs. In any case, drug control, whether permissive or restrictive, is one way of politically controlling a "drug society." This has the effect of evading the underlying reality; the drug becomes the focus of concern; "rehabilitatlon" of the victim becomes the presumed goal. And that poses no challenge to the existent social order - In fact, reinforces it.

6. Although the psychoanalyst, following the Greeks, personified love and death, he hardly considered love and death persons; they remained abstract, stereotyped conceptions.

7. Interestingly, schizophrenia is never diagnosed in children! [ – ed.]

8. In the narrative that follows, I have changed names, dates and identifying details in order to protect those involved.

9. But it should be noted that even in the ordinary course of events the suicide rate among psychiatrists is higher than among other professional groups.

10. For an official conception of the risks run by the psychiatrist in a mental hospital see a report on legitimate defense from the Annales medica-psycholagiques, in Manifesto of Surrealism, Andre Breton, (Ann Arbor: University of Michigan Press, 1972), pp. 119-123

11. For an Independent confirmation of this point see the remarkable article by D.L. Raunhan on "Belng Sane ln Insane Places." ln Science, vol. 179 (1978) pp. 250-255.

12. jean Arp, Arp on Arp: Poems, Essays, Memories, cd. Marcel jean (New York: The Viking Press, 1972), p. 35. ·

13. Ibid., pp. 47-49.

14. But even that integration cannot be understood in our language of ego psychology. It is, rather, as Radin puts it, "the recognition of (and insistence upon) multiple personality . . . the direct consequence of aboriginal man's unconquerable and unsentirnental realism and his refusal to assume fictitious and artificial unities." (This refusal, it should be added, is the result of the exploration and realization of the potential phases of the self during the course of the life cycle.) As Radin concludes: "the various elements [of the individual] become dissociated temporarily from the body and enter into relationship with the dissociated elements of other individuals. The nature of the impingement of individual upon individual and of the individual upon the external world is, thus, utterly different from anything that a Western European can possibly imagine. The medley of combinations and permutations it would permit is quite bewildering .... [Nevertheless] what prevents anarchy, independent as they are, is that they fall into a definite configuration within each man’s ego" (read self). The World of the Primitive, Paul Radin (New York: E.P. Dutton, 1971).

15. In 1939 George Devereaux observed: "Schizophrenia seems to be rare or absent among primitives. This is a point on which all students of comparative society and of anthropology agree." [George Devereaux, "A Sociological Theory of Schizophrenia,” Psychoanalytic Review 26 (1939):317.] see note 14.