also absent. The three of us sat outside on the lawn, next to the “adult semi-open ward” of Shalvata Hospital. Shalvata stands for serenity in Hebrew. The hospital looked like a kibbutz. The rural landscape, the wild monk parakeets in the trees, and the plain frugal architecture gave it the appearance of a utopian, peaceful place. As I observed the patients around us, an eerie feeling started to creep in. They seemed different. An older lady was conversing with an unseen other on a bench, a man in his fifties was picking up a cigarette butt, trying to light it, and then there was a deep loud roar, a bellow, that culminated in continuous, repetitive begging: “Get me out of here! Get me out of here!”
Five years after this visit, following a brief detour through the Bezalel Academy of Art in Jerusalem, I decided to become a clinician. As an undergraduate majoring in psychology, I volunteered in the adolescent ward at that very same hospital. For three years, I worked with children aged 12–18. Their stay was always involuntary, and always involved a high risk of suicide. I observed these terrified, haunted, confused kids, living in their own nightmarish universe, seeing things only they could see, and hearing voices no one else could hear. And I saw their brokenhearted, helpless parents. I witnessed many of them receiving help, gently cared for, and being heard. Many left the ward calmer and more organized. Some returned in a state of crisis.
The staff meetings in the director’s office, recounting the ups and downs of daily life on the ward, were fascinating. Interviews of patients by senior psychiatrists, followed by extensive discussions and deeply informed by psychoanalytic theory, were simply mesmerizing. In the adjacent room, dangerously agitated patients were restrained to their beds. It wasn’t a pleasant sight, and the sounds coming from it made a strong impression on me. Although I worked with the “kiddos” as we called them, every now and then I saw Orlean, who moved between the closed and the semi-open wards, between wearing a hospital gown and her own clothes. She had put on a lot of weight. Her teeth had darkened from the cigarettes she compulsively smoked.
A year later, I returned to the hospital, this time as a graduate student in clinical psychology, to fulfill the requirements of a practicum in the context of the semi-open, adult ward. There, I was assigned patients, offering them psychotherapy and psychodiagnosis. I viewed the – at times, miraculous – immediate effect of tranquilizers on agitated patients who were in severe mental pain, and I saw the deleterious effect of their chronic use. At the same time, I conducted extensive research for my Master of Arts (MA) thesis about schizophrenia and L-tryptophan, a natural amino acid found in many plants and animals that the body turns into the neurotransmitter serotonin. While most drugs for schizophrenia were based on the “dopamine hypothesis,” and the need to treat patients’ “mad” thoughts and behavior by blocking dopaminergic receptors, this new research offered to study substances that could help with the memory dysfunction many of these patients were suffering from.
Most of the patients I saw at the hospital were diagnosed with schizophrenia. Among them, Ms. M. who did not get out of her bed for three months fearing “the man from the radio” would harm her only son, if she dared to move; Mr. A. who believed he was on a mission with Mossad and insisted that I had the “codes”; and Mr. O. who had been involuntarily committed to the ward after he had tried to kill his mother, whom he believed was an Iraqi spy that had taken her place. It was not easy to establish a therapeutic relationship with these suffering patients, but once it happened, I found their stories to be both intriguing and excruciating. Every week, I saw Orlean, as she came for her treatment at the outpatient clinic. She had begun a relationship with another patient in the clinic (who was also diagnosed with schizophrenia) and told me that she was “doing well.”
A couple of years later, when I returned to the same hospital as an intern clinical psychologist, I was assigned one intensive case. Mr. N. was a 56-year-old man, diagnosed with disorganized schizophrenia, who lived with his psychotic mother, a survivor of the Nazi concentration camps, with whom he shared a delusional world in which he was still her little baby. I saw both of them together, as she gradually made the transition to a psychiatric nursing home. Mr. N. almost died due to complications related to his antipsychotic medication, and as a response to the upcoming separation from his mother. I met with him three times a week for an hour and wrote an extensive case study based on this treatment for the State Board exam. As it turned out, this was the first time that a patient diagnosed with schizophrenia was presented in this context. But it was not the last. When I returned to the hospital as a specialist in clinical psychology, I encouraged students, interns, and residents to carefully listen to these patients, as they try and find meaning and purpose in what otherwise sounded so unreasonable and, at times, plainly horrifying. Meanwhile, Orlean got married and the couple moved into a small apartment purchased by her parents. They attended a nearby psychiatric rehabilitation center on a daily basis, and I saw her once in a while when she came for her follow-up sessions at the clinic. Though she had prematurely aged, she seemed content with her relationship.
During the late 1990s, when the older cohort of dynamic psychiatrists was replaced by the younger generation of biologically oriented medical professionals, psychoanalytically informed discussions were gradually phased out, while studies on drugs and somatic psychiatry were more and more prevalent. This is when I witnessed how lethal serious mental illnesses could be: Mr. G., who was new to the ward and only 23 years old, was found hanged inside the greenhouse on the hospital grounds. Mr. Y., who was 35 years old, refused to consume the medications he was offered, and his treatment at the hospital was terminated. He hanged himself in his apartment, leaving a note explaining that he would be reborn and delivered by his real father, the Lord. Mr. S., who was 21 years old, was released from the ward after recovering from an acute catatonic state. He stopped taking his medication since he felt it “killed” his ability to write music and became very laconic in his psychotherapy follow-up sessions. He went missing, and on a frigid winter day, after 12 days of a major search for him, was found dead in a river, far away from where he started his aimless walk. Mr. J., who was 42 years old, set himself on fire in a car, after a young lawyer, an advocate of patients’ rights, managed to release him from an involuntary hospitalization. And, finally, Ms. A., a 27-year-old woman, who believed that she was responsible for the mass extinction of whales in the Indian Ocean, was found dead in the Judean desert, after she missed her appointment with an intern psychologist who had diagnosed her as extremely dangerous to herself, based on a battery of projective psychological tests. Orlean, to conclude this sad, long, yet far from complete list, died a few years ago from a complication related to her smoking and the antipsychotic medication she had consumed for years. She was 47 years old.
While continuing to work at the hospital with patients and their families, I went back to graduate school, this time to study the history of my field. More specifically, my interests focused on the shift I experienced firsthand in our thinking, theorizing, and treatment of patients we mostly diagnosed as “schizophrenics.” I joined the Cohn Institute for the History and Philosophy of Science and Ideas at Tel Aviv University, where I wrote my first book about the history of psychoanalysis, psychiatry, and psychosis in postwar United States. I also founded the Israeli chapter of ISPS, whose acronym at that time stood for the International Society for the Psychological Treatments of the Schizophrenias and other Psychoses. The name was a mouthful, but aptly defined the work of mental health professionals who were deeply committed to following the psychoanalytic idea of finding meaning in patients’ symptoms, not least by establishing a working relationship with them. Our local branch organized conferences in collaboration with the Sigmund Freud Center at the Hebrew University in Jerusalem, with the Israeli Psychoanalytic Society, and with psychiatric hospitals both in Israel and around the world.
As the 2009 international conference of ISPS in Copenhagen started to take shape, a discussion among members called for the removal of the term “schizophrenia” from the association’s name, given the stigma it both carried and imposed. Based not least on the failure to validate schizophrenia as a distinct disease entity,1 efforts to abolish its label and nomenclature mushroomed. Suggestions such as “bury the ‘schizophrenia’ construct,” “abandon the concept of schizophrenia,” “abolish schizophrenia,” etc., indicated the direction that the association was about to take.
In
