Schizophrenia and context: A response to Sass

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SCHIZOPHRENIA

AND CONTEXT: JAMES

A RESPONSE TO SASS*

WALKUP

Department of Psychiatry, State University of New York, Health Science Center at Brooklyn, 450 Clarkson Avenue, Box 88, Brooklyn, NY 11203-2098, U.S.A.

In the second book of Robert Musil’s The Man Without Qualities (1953), after the main character Ulrich breaks off with his mistress, he is thrown into one of his frequent states of psychic disengagement from life, a moment of “baroque superabundance,” when “the current and heart-beat ceaselessly flowing through all the things of our environment had for a moment stopped.” While in this mental state, his experience seems to speak to him: “I don’t look essentially different from a face marred by lupus if I am regarded without prejudice, beauty confessed” (p. 148). Ulrich’s experience tells him that any differences between the flushed face of a woman’s beauty and the butterfly shaped facial redness of a person with an illness can only be attributed to prejudice of the viewer. This communication is labeled a “confession,” one supposes, because beauty has given away the game. It has confessed that it must rely on prejudice to distinguish itself from illness. I frequently found myself wondering if Sass, in his two articles on schizophrenia, had extracted a similar confession from modernism. Certainly he shows that modernism has more in common with madness than one might suspect. Or, more precisely, he shows that there are quite specific structural similarities to be found in the experience of radical alienation reported by certain schizophrenic persons and experiences described in certain modernist texts from the early decades of this century. These texts include not only the literary descriptions of alienation found in Sass’s first essay (“The Land of Unreality”), but also ‘how-to’ guidebooks for inducing alienation written by avant-gardists bent on escaping from the everyday, found in his second essay (“Surrealism and Schizophrenia”). Sass’s evidence is impressive and his case well argued. Since I am entirely convinced of the similarities he demonstrates, 1 want to say a few words about how it is that, in spite of the clear parallels, we in fact regularly distinguish between the flushed face of modernism and the rash of schizophrenia. If we shift our gaze from Sass’s focus on impressive affinities and analogies to the ways in which our ‘prejudices’ allow us to avoid confusing the two, I think we will be able to understand a danger which awaits these two fine articles. I fear that, at every turn, an over-eager reader is tempted to go beyond what Sass has said, to transform his careful description of a likeness into a mystifying identification of the forced exile of psychiatric illness with the creative (if often distressing) *Commentary on L. A. Sass (1988) The land of unreality: On the phenomenology of the schizophrenic break, Vol. 6, No. 2, pp. 223-242, and L. A. Sass (1990) Surrealism and schizophrenia: Reflections on modernism, regression, and the schizophrenic break, Vol. 8, No. 3, pp. 275-297.

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contemplative retreat of modern art. In these two essays, as in other papers by Sass, this misreading seems always to wait in the wings, ready to upstage his more sober thesis. In this comment, I speculate why Sass’s elaborate care may fail to protect him from the careless reader. I can think of several factors that contribute to the danger of misinterpretation. First, Sass’s points are often subtle. A telling bit of evidence is often found in the turn of a patient’s phrase. An attentive, intensely watchful attitude toward experience, for example, is uncovered in some psychiatric patients’ tendency to introduce sentences with “I noticed particularly . . ..” Second, despite the prominence given to detail in Sass’s overall thesis, and despite the sheer volume of detail that is accumulated in these articles, much of his reasoning is at a very abstract level. To engage with his opponents, Sass must constantly make clear that the target of his challenge is less a specific argument than a whole way of thinking about schizophrenia. He warns, for example, that a psychoanalytic willingness to agree with him that modernism and madness are similar is not a sign of genuine accord. Rather, Sass believes that the similarity endorsed by the psychoanalyst is only a sign that psychoanalysis misunderstands both modernism and madness because it wrongly says that both modernism and madness express ‘regressed’ or primitive mental functioning. Only when the madnessmodernism similarity is understood in terms more Apollonian than Dionysian can it be endorsed. (For Sass, madness resembles modernism not because both are unrestrained, but because both are hyperreflective.) Both the subtlety of his evidence and the pronounced abstraction of his logic seem to come from a deep incompatibility between his hypotheses and common sense. I want to dwell on this last point for several reasons. I think it is a fundamental one and needs to be made clearer. I suspect that once this point has been properly formulated, it may shed some light on the method of proceeding that Sass has chosen. To bring together the flush of modernism and the rash of schizophrenia, Sass must free our eyes of prejudice. He is obliged to use a method that detaches the two from their practical contexts. He must strip the gears of our habitual ways of thinking--or avoiding thought-about the differences. ‘1‘0 do so, he concentrates on phenomenological descriptions. 7‘rue to this methodological tradition, he concentrates on the experiences themselves, bracketing questions about their value, truth, source, OI- consequences. Also, he frequently (if’ implicitly) invites the reader to read an aesthetic or literary text as if it were heard in the intake 01 screening office. With this powerful device, he brings home his point about the similarity. Nevertheless, I do not see how one can avoid the plain Fact that, for all the affinities between madness and modernism, we do not often confuse the two. Even if the insurance companies allowed me to list “modernist” as a possible alternative diagnosis to schizophrenia, 1 would not do so. Perhaps it is pre~judic-e prejutlgthat stays my hand, but, if so, we must decide if it is the distorting and inevitable prement condemned by the Enlightenment or a helpful a store of inherited assumptions that make possible our understanding, understanding, the more sympathetic image of prejudice described by Edmund Burke of Gadamer.

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An abstract discussion of whether ‘prejudice’ is good or bad seems to me to be a waste of time, but some progress may be possible if we stay close to the specifics. At the very least, we can ask what practices accompany and give structure to this prejudice-this cognitively reliable way of classing similar things as differentso that we can think about the contribution of these practices to our distinction. On Monday mornings, when I listened to people seeking admission to the psychiatric unit where I worked, I acted as an agent of institutionalized medicine and as an allied professional called upon to render a service. So when I heard about some experience of hypersaturated significance-say ‘ideas of reference’-I placed it in the context of the work I was to do with the person who recounted it. It weighed on many decisions. Some of them were purely classificatory (paranoid vs. undifferentiated schizophrenia). Others were more narrative (acute vs. chronic). Still others were interpersonal (likeable vs. obnoxious). At the end of the day, I entered the subway, reached into my bag, and pulled out some piece of fiction. If I found on its pages an experience of hypersaturated significance, I probably did not think: ‘ideas of reference.’ If I was just relaxing, I might wonder if the character is cracking up or if he is about to be cast as a visionary. If an academic paper was in the back of my mind, I might wonder if the passage owed something to Emerson. The link between context (office or subway) and classification (madness or modernism) is of course not automatic. It requires that I cooperate, at least to some extent. Nor is it fully coercive, like a startle response to an unexpected noise. I can resist or alter the determining influence of a given context, either by listening with an aesthetic ear to a disturbed patient or by reading fiction with a my readiness to resist, my tendency to diagnostic eye. At the time, however, of the broader social listen in this way or that, can itself be a function psychological context in which I act. (Indeed the factors affecting these styles of listening can be studied experimentally.) My point is that the practical contexts in which the labels ‘madness’ and ‘modernism’ arise do much of the work needed to keep them apart. Perhaps they do the whole job, if we allow ‘context’ to include practices that have a cognitive, scientific component, such as the crudely (and unevenly) successful efforts to locate specific psychological features of schizophrenia within biomedical discourse (e.g., the differential effects of certain neuroleptics on positive vs. negative symptoms). This does not gainsay Sass’s phenomenological argument, of course. Nor does it take away from the importance of the lessons to be learned from it, for even if the contexts provided by my office at the hospital and the subway ride home keep me from confusing madness and modernism, they may also do so at a very high scientific and moral cost. Scientifically, a series of striking isomorphisms between the two are obscured; morally, the most deeply felt and personally meaningful experiences of a group of patients are cast into the oblivion of “incomprehensible” symptoms. Worst of all, the scientific and moral failings combine to produce the atmosphere of cognitive bad faith in which discourse about schizophrenia is now conducted: Specifically, the assumption that the easily available practical distinctions between madness and modernism are based

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upon structural differences between them that are so self-evident that they need not be articulated. One can only lfope that Sass will be read widely and carefully. The appearance of these two pieces in Nrw Ideas in Psychology seems to me especially fortunate. I suspect his work is already discussed among humanists. Rut I very much hope it will be taken up by scientifically-oriented psychiatrists and clinical psychologists, where new ideas are badly needed. In an age of increasingly biological psychiatry, we should keep in mind a remark made in class by Max Wertheimer, the Gestalt psychologist: One of the most powerful tools for investigating neurophysiological functioning is a careful phenomenology. REFERENCES Mud,

R. (1953).

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