and in the United States – especially recently at the Gallatin School of Individualized Studies at New York University (NYU), where I have been teaching a course on the history of madness since 2017, and at the Humanities Center at Johns Hopkins University, where I taught from 2015 to 2017 – challenged me, helping me clarify my ideas while offering their own insights, based on their experiences, those of their families, and extraordinarily diverse communities. I am deeply grateful to my Dean at NYU’s Gallatin School, Susanne Wofford, who welcomed me to this most unique academic institution and kindly offered a space to write when it was much needed.
Much of the work that will be discussed here is drawn from vast quantities of sophisticated scholarship, based on the research of the many psychiatrists, psychoanalysts, historians, anthropologists, philosophers, advocates, and service users, whose work I have encountered and came to admire over the years. It is truly inspiring – and deeply humbling – to see the magnitude and range of these efforts, not only to understand psychological pain on a theoretical level, but also to be of greater practical use to those who suffer, and, in so doing, to cultivate a vocation – an ethics, as I will call it – dedicated to alleviating and, where possible, preventing, psychic suffering. I have greatly learned – and continue to learn – from the extraordinary work of Roy Porter, Tanya Luhrmann, Greg Eghigian, Richard Noll, Ian Hacking, Elyn Saks, Kenneth Kendler, Nick Haslam, Kay Redfield Jamison, Andrew Scull, German Berrios, Josef Parnas, Susan Lamb, Peter Zachar, Kenneth Schaffner, Rachel Cooper, Jonathan Metzl, Assen Jablensky, Kieran McNally, Anne Harrington, Louis Sass, and Sander Gilman, to name but a few of those whose contributions to the history and philosophy of psychiatry in general – and of schizophrenia in particular – have been both formative and generative. Some of them have generously shared their latest insights with me, going beyond what is already available on the subject in print.
During my years of theoretical studies, practical training, and activist engagement for improved psychological understanding and treatment of those diagnosed with schizophrenia, I have come across brilliant minds, extraordinary clinicians, and committed citizens. I am especially thankful to Dr. Ann-Louise Silver and to the ISPS organization and its chapters, both in Israel and around the world. Our yearly conferences, reading groups, and work groups, bringing together service users, families, and mental health professionals, have always been inspiring and moving.
An in-depth study of the history of the field would not have been possible without the DeWitt Wallace Institute for Psychiatry, History, Policy and the Arts at Weill Cornell Medical College in New York City. Both its working groups, on the History of Psychoanalysis and on Psychoanalysis and the Humanities, have served as a supportive and facilitating intellectual environment. In my role as the director of the Richardson Seminar at the institute from 2016 to 2019, I was fortunate enough to invite many of the scholars whose work I found intriguing to discuss their research with us. I am immensely grateful to the mentorship and friendship of the director of the institute, George Makari, to its associate director Nathan Kravis, and to its members Rosemary Stevens, Ted Shapiro, Kathy Dalsimer, Bob Michels, Anne Hoffman, Aaron Esman, Nirav Soni, Larry Friedman, and Lenny Groopman. Larry, one of the most passionate and generous scholars of psychoanalysis I have ever met, has been instrumental in making helpful suggestions at a very early stage of this project. Lenny, a brilliant historian and a unique clinician, has always been an extraordinary teacher and a source of constant support and encouragement on this project and on others.
I also want to thank the members of the recently formed group of scholars that make up the Psychiatry, Psychoanalysis and Society working group at the DeWitt Wallace Institute for the History of Psychiatry: Kathryn Tabb, Thomas Dodman, Rachel Aviv, Dagmar Herzog, Alexandra Bacopoulos-Viau, Camille Robcis, Jonas Knatz, Stefanos Geroulanos, Jessica Kovler, Ben Kafka, and Larry McGrath, who provided invaluable comments and asked critical questions at various stages of this project. I especially thank Katie Tabb for her thoughtful contributions to the field overall, and for her specific recommendations for improvement and further reading regarding this specific project.
I am much obliged to Megan Wolf who quite literally runs the institute, and am infinitely in debt to Nicole Topich, the most resourceful librarian of the Oskar Diethelm Library, who never failed to provide me with the necessary sources, no matter how obscure they were.
Last but not least, I would like to pay special thanks to Lucy Bergeret. First as my teaching assistant at the Humanities Center at Johns Hopkins University and, more recently, as my research assistant and a wise editor, Lucy’s superb input and wise advice, especially during the last few months of finalizing this book, were indispensable. A philosopher, an intellectual historian, and a scholar of comparative literature, Lucy has made this book a whole lot better than it would have been otherwise.
Thanks to the editorial staff at Polity Press, Ellen MacDonald-Kramer and Stephanie Homer, for shepherding me through this project, and especially to the series editor, Pascal Porcheron, for his undiminished belief in this work, his patience, and his wise counsel. I also want to thank the two anonymous readers of the Polity Press for their thoughtful and rigorous feedback on this manuscript. Their invaluable input helped clarify my argument and improved this book.
The last year of working on this book took place during the COVID-19 pandemic and the barely veiled assault on democracy in the United States, where I was located and found a second home. I am thankful to my family and friends, whose steady stream of expressed interest, care, and concern, and whose blessed sense of humor, contributed to the finalization of this project, keeping me sane along the way.
No one can measure the embracing presence in my life of my mother, Aliza Ophir, my brothers Ori and Arnon Ophir, and my long-time dear friends Sigal Avin, Shiri Broza, Aya Seker Einbinder, Alon Hager, Maya Levi, Michal Kaplan Rokman, Efrat Shamgar, Daphna Spigelman, Gil Talmi, Antal Tzur, and Ruth Weinberg. I feel privileged to have found new neighbors and friends in a welcoming community, and especially the McCollum-Garlins, the Schindler-Schuls, the Kramers, and the Nicosias, all of whom were enormously supportive at the final stages of writing this book.
My most heartfelt gratitude goes to the loves of my life, Britt and Alma, who graciously awaited the completion of this manuscript, and were unbelievably tolerant. By the time its last pages were written and proofread, they had grown taller, more beautiful, and even more talented. As always, they kept their charming and funny traits intact! I cannot wait to spend much needed time with you again. You are my miracles, and thank you for insisting on getting us Tulip, our pandemic puppy, who quite literally pushed me off my desk chair when it was high time to do so, taking me on daily walks along the bay and in the city.
This book is dedicated to Hent, my toughest reader and my partner in all things worth living for. If it were not for you, it would not have been at all.
Introduction: The Ends of a Diagnosis
“It’s a word, that’s all, a word that covers a large, loose category,” the psychiatrist explained, “it’s like saying ‘tree.’ There are all kinds, firs, elms, pines. So there are many kinds and degrees of schizophrenia.” (Louise Wilson, This Stranger, My Son, 1968)1
If You Want a Label
When Tony was discharged from the hospital, his father, Jack Wilson (a surgeon by profession), had enough of the conflicting reports and wanted a “real diagnosis.” Dr. Brewster, the psychiatrist, who thought Tony’s parents surely realized he was “very sick,” concluded: “schizophrenia, if you want to label it. The boy is a paranoid schizophrenic.” Shocked by the doctor’s response, Tony’s mother, Louise, echoed the expert’s words: “schizophrenia, if you want a label,” thinking all the while about her son’s dark blue eyes, his beautiful, rare smile, but also about the “ugly contortions of his rage,” his terror and fear.
What was
