Like my colleague, Jo Higman, I recently completed an M.A. in Health Communication at the University of Nottingham. Many thanks to the support from Nottinghamshire Healthcare NHS Foundation Trust, the Clinical Research Network: East Midlands, and Learning Beyond Registration (LBR) funding.
The topic I chose for my dissertation was to closely examine the mechanisms by which the term ‘schizophrenia’ is frequently misrepresented in UK national newspapers. I will be sharing the main findings from my dissertation at a later point. However, for this short post I would like to restrict myself to making the suggestion that whilst journalists do bear a large responsibility for the grossly biased, negative picture of people diagnosed with schizophrenia that appears in the general media, they are not solely to blame for this situation.
The word ‘schizophrenia’ comes from the Greek words ‘schizein’ meaning ‘to split’ and ‘phren’ or ‘mind’. It can therefore be translated as “splitting of the mind”. It was first used by the Swiss psychiatrist, Eugen Bleuler in 1908. His intention in using it was not to suggest that people can experiences a ‘split personality’, but rather to describe the separation of function that occurs in the condition between personality, thinking, memory, and perception that can occur in some people. This condition had previously been referred to by a German psychiatrist, Emil Kraepelin, as ‘dementia praecox.’ Bleuler thought that this term was misleading because of the implied emphasis on the inevitable gradual degeneration and decline of people with this condition. Therefore he coined his own word to describe the patients he saw in his clinical practice.
However, right from the very outset Bleuler’s chosen word for this mental health condition caused confusion. McNally (2007) points out that nowadays normal everyday usage of schizophrenia does indeed equate schizophrenia with meaning someone with a ‘split’ personality or behaving like a ‘Jekyll and Hyde’. This is not a recent phenomenon but dates right back to when the word was first utilised. Indeed Bleuler himself sometimes records examples of his own clinical observations of patients ‘splitting’ their personalities. This leads McNally to boldly assert that ‘there can be no mistaking that the responsibility for the schizophrenia as split personality myth, and everyone else’s subsequent usage, lie with Bleuler.’ (McNally 2007: 71). Kieran McNally also provides later examples of American psychologists in the 1920’s referring to schizophrenia as meaning ‘split souls’ or ‘divided minds’. The subsequent adoption by journalists of these notions of splitting can therefore be seen to have their roots in ideas first expressed in the writings of clinicians themselves. This would suggest that the current everyday misusage of the term schizophrenia in the general media is partially a product of the clinical professions themselves. Journalists then quickly picked up on these ideas and spread them throughout the general population.
Subsequently the term ‘schizophrenia’ has become frequently used as a metaphor within wider society – far beyond its original meaning as a specific clinical diagnosis. As well as being associated with split or multiple personalities its everyday use has now been expanded to include being used as a description of changeable, chaotic situations or people. For instance, the headline in a news report by the BBC reads ‘MPs warn of ‘schizophrenia’ over climate change targets’. (BBC, 11th October 2011). However a more worrying association with schizophrenia and mental health in general, is that it is now become strongly linked in public consciousness with violent behaviour. Another BBC report, this time entitled ‘Asda and Tesco withdraw Halloween patient outfits’ illustrates how large UK companies attempted to sell ‘mental patient’ Halloween costumes that included ‘ragged clothing, fake blood, a mask and a fake meat cleaver’ (BBC, 26th September 2013). The rapid public outcry led by quick responses from mental health charities made the retailers withdraw the items from sale and issue hasty apologies. However, this recent story illustrates the perception in some parts of society that the link between mental and violence is so obvious the ‘mad axe man’ has now become a widely recognisable stereotype.
Susan Sontag (1991) is the writer who has now become most commonly associated with discussions about the metaphorical usage of illness. Her ground-breaking book ‘Illness as metaphor’ was originally published in 1978 and looked at the history of both tuberculosis and cancer. She argued that the myths and the metaphors that built up around these illnesses over time increased the suffering of patients and inhibited them from seeking treatment. Indeed the persons themselves were often seen to be at fault in some way for contracting their illnesses.
Similarly it could be argued that because schizophrenia still has a still largely unknown aetiology, it lends itself quite readily to metaphorical usage – and so is still culturally surrounded by a discourse of fear, stigma and despair.
A discourse can be defined as ‘a set of meanings, metaphors, representations, images, stories and so on that in some way together produce a particular version of events’ (Burr 1995: 48). Baker (2006) says that an important aspect of discourses is that they are not fixed. Indeed discourses are ‘constantly changing, interacting with each other, breaking off and merging’ (4). For a potentially contentious concept such as schizophrenia there is no fixed consensus of opinion. As with any discourse ‘there are likely to be multiple ways of constructing it’ (Baker 2006: 4). There is also the possibility of multiple discourses co-existing side by side. These include the viewpoints of the clinicians who diagnose the illness, the people who have the diagnosis placed upon them, their families and carers, politicians, media outlets and finally the general public.
Some groupings in society have greater access to the necessary social, economic and political power needed to influence which discourses are preferred over others. These groups include the medical profession, but also general media outlets such as newspapers and television programmes. Given that a large number of people in society gain most of their information about mental health conditions such as schizophrenia from what they view on television and read in newspapers and magazines (Pirkis, Francis, 2012), this makes it extremely important issue for those people currently diagnosed with schizophrenia and for their families and carers. The representation of schizophrenia in the general media also has a significant role to play in how the illness is perceived by politicians who ultimately decide on government health policies.
Perhaps now is the time to consign the term ‘schizophrenia’ to the history books and so help bring to an end the misconceptions and neo-gothic stereotypes that have dogged the term from its very inception.
David Kelly (David.Kelly@nottshc.nhs.uk)
Clinical Studies Officer – NIHR Clinical Research Network: East Midlands
Baker, P (2006) Using Corpora in Discourse Analysis. London: Continuum
BBC (2011) MPs warn of ‘schizophrenia’ over climate change targets. (11 October 2011) http://www.bbc.co.uk/news/uk-politics-15249089 (Last accessed 28/07/2015)
BBC (2013) Asda and Tesco withdraw Halloween patient outfits (26 September 2013). http://www.bbc.co.uk/news/uk-24278768 (Last accessed 28/07/2015)
Burr, V (1995) An Introduction to Social Constructionism. London: Routledge
McNally, K. (2007) Schizophrenia as split personality/Jekyll and Hyde: The origins of the informal usage in the English language. Journal of the History of the Behavioural Sciences 43(1), 69-79
Pirkis, J., Francis, C. (2012) Mental illness in the news and information media: A critical review. Commonwealth Department of Health and Aged Care. Canberra
Sontag, S. (1991) Illness as a metaphor / AIDS and its Metaphors. Harmondsworth: Penquin.