* * *
—
IN THE BEGINNING—BEFORE anyone turned the study of mental illness into a science and called it psychiatry—being insane was a sickness of the soul, a perversion worthy of prison or banishment or exorcism. Judaism and Christianity interpreted the soul as something distinct from the body—an essence of one’s self that could be spoken to by the Lord, or possessed by the devil. In the Bible, the first portrait of madness was King Saul, who lost his mind when the spirit of the Lord departed him and was replaced by an evil spirit. In medieval France, Joan of Arc heard voices that were considered heretical, the work of Satan—an impression that was revised the other way, to be the voice of a prophet, after Joan’s death. Even then, insanity’s definition was a moving target.
For those looking even a little carefully, it was plain to see that madness sometimes ran in families. The most conspicuous examples involved royalty. In the fifteenth century, King Henry VI of England first became paranoid, then mute and withdrawn, and finally delusional. His illness formed the pretext for the power struggle that became the Wars of the Roses. He came by it honestly: His maternal grandfather, Charles VI of France, had the same condition, as did Charles’s mother, Joanna of Bourbon, and Charles’s uncle, grandfather, and great-grandfather. But it took until Schreber’s lifetime for scientists and doctors to start talking about insanity as something biological. In 1896, the German psychiatrist Emil Kraepelin used the term dementia praecox to suggest that the condition started at an early age, unlike senility (praecox also being the Latin root of precocious). Kraepelin believed that dementia praecox was caused by a “toxin” or “connected with lesions of an as yet unknown nature” in the brain. Twelve years later, the Swiss psychiatrist Eugen Bleuler created the term schizophrenia to describe most of the same symptoms that Kraepelin had lumped into dementia praecox. He, too, suspected a physical component to the disease.
Bleuler chose this new word because its Latin root—schizo—implied a harsh, drastic splitting of mental functions. This turned out to be a tragically poor choice. Almost ever since, a vast swath of popular culture—from Psycho to Sybil to The Three Faces of Eve—has confused schizophrenia with the idea of split personality. That couldn’t be further off the mark. Bleuler was trying to describe a split between a patient’s exterior and interior lives—a divide between perception and reality. Schizophrenia is not about multiple personalities. It is about walling oneself off from consciousness, first slowly and then all at once, until you are no longer accessing anything that others accept as real.
Regardless of what psychiatrists began to believe about the biology of the disease, its precise nature remained hard for any of them to fathom. While it seemed enough, at first, to say that schizophrenia could be inherited, that failed to account for cases—including, it seemed, Schreber’s—where it seemed to appear all by itself. This essential question about schizophrenia—does it run in families or emerge fully formed out of nowhere?—would consume theorists and therapists and biologists and, later, geneticists, for generations. How can we know what it is until we know where it comes from?
* * *
—
WHEN SIGMUND FREUD finally cracked open Schreber’s memoir in 1911, eight years after it was published, what he read took his breath away. The Viennese analyst and theorist, already widely revered as a pioneering explorer of the internal workings of the mind, showed no interest in delusional psychotics like Schreber. He had seen such patients as a practicing neurologist, but he had never thought it was worth the trouble to put any of them on the analyst’s couch. Having schizophrenia, he argued, meant that you were incurable—too narcissistic to engage in a meaningful interaction with an analyst, or “transference.”
But this book by Schreber—sent to him by his protégé, the Swiss therapist Carl Jung, who had pleaded with Freud to read it for years—changed everything for Freud. Now, without leaving his armchair, Freud had intimate access to every single impulse of a delusional man’s mind. What Freud saw there confirmed everything he already thought he knew about the workings of the unconscious. In a letter thanking Jung, Freud called the memoir “a kind of revelation.” In another, he declared that Schreber himself “ought to have been made a professor of psychiatry and director of a mental hospital.”
Freud’s Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia (Dementia Paranoides) was published in 1911 (the same year that Schreber himself died, tragically enough, after reentering the asylum in the wake of his mother’s death). Thanks to Schreber’s book, Freud now was convinced that psychotic delusions were little more than waking dreams—brought on by the same causes as everyday neuroses, and interpretable in the very same way. All the same symbols and metaphors that Freud had famously noticed in dreams, he wrote, were all right there in the memoir, plain as day. Schreber’s gender switch and his immaculate conception, Freud argued, were about a fear of castration. Schreber’s fixation with his psychiatrist, Dr. Flechsig, he concluded, had to do with the Oedipus complex. “Don’t forget that Schreber’s father was a doctor,” Freud wrote, triumphantly connecting the dots. “The absurd miracles that are performed on him (Schreber) are a bitter satire on his father’s medical art.”
No one seemed more tied up in knots over what Freud wrote than Carl Jung. From his home in Burghölzli, Switzerland, Jung read an early copy and wrote his mentor at once, in March 1911, to say he found it “uproariously funny” and “brilliantly written.” There was just one problem: Jung fundamentally disagreed with him. At the heart of Jung’s objection was the question of the nature of delusional mental illness: Is schizophrenia something you’re born with, a physical affliction of the brain? Or is it acquired in life, after one has become scarred somehow by the world? Is it nature or nurture? Freud stood apart from most other psychiatrists of his time by being sure that the disease was entirely “psychogenic,” or the invention of the unconscious, which had most likely been molded or scarred by formative childhood experiences—quite often of a sexual nature. Jung, meanwhile, held a more conventional opinion: that schizophrenia was at least partially an organic, biological illness—a disease that was quite likely inherited from one’s family.
The protégé and his mentor had been sparring about this on and off for years. But for Jung, this was the last straw. He told Freud that not everything was about sex—that sometimes people go insane for other reasons, maybe because it is just something they’re born with. “In my view the concept of libido…needs to be supplemented by the genetic factor,” Jung wrote.
In several letters, Jung made that same case again and again. Freud never took the bait; he did not respond, which Jung found infuriating. By 1912, Jung exploded. He got personal. “Your technique of treating your pupils like patients is a blunder,” Jung wrote. “In that way you produce either slavish sons or impudent puppies….Meanwhile you remain on top as the father, sitting pretty.”