A Critical History of Schizophrenia

Schizophrenia was 20th century psychiatry's arch concept of madness. Yet for most of that century it was both problematic and contentious. This history explores schizophrenia's historic instability via themes such as symptoms, definition, classification and anti-psychiatry. In doing so, it opens up new ways of understanding 20th century madness.

“Review 1 Thank you for the opportunity to review Dr. McNally''s book proposal. I know Dr. McNally''s previous published work on schizophrenia and have cited it in my own work. Also, some years ago, he was kind enough to send me his massive doctoral dissertation on this subject. Whereas, like most dissertations, it was unpublishable as a book, I was impressed with the range of materials that he had mastered on schizophrenia, including many concepts and publications that were unknown to me. I have found myself periodically dipping into my copy as a reference aid to my own work. Based on the research and thinking he has demonstrated in his dissertation and published work, I have no doubt that Dr. McNally will produce an interesting contribution to scholarship on a topic that, as he rightly points out, few scholars have dared to tackle. The sheer size and complexity of the topic has frightened off most other scholars who reached for safer low-hanging fruit. As he points out in his proposal, there is a history of dementia praecox which does touch on the rise of the schizophrenia concept, but it is limited only to the period prior to 1935. So what Dr. McNally is proposing is something that no scholar has done to date.I am recommending that it be accepted for publication as part of the Palgrave Studies in the Theory and History of Psychology series. It certainly meets the criteria in the ''Series Outline.'' However, let me offer some observations and suggestions that Palgrave and the author may want to consider with respect to this project:My primary concern resides with the decisions he will make as a writer communicating to a reader. These structural decisions of ''the writer''s craft'' make all the difference in the world between a scholarly book that is merely cited versus one that is actually read and enjoyed by readers. These decisions also reflect sales - an instructor is more likely to assign a book that young, digitally distracted students can easily read. Libraries are also more likely to buy such books. The world is flooded with dry, safe monographs. The history of schizophrenia is a fascinating topic, but much will depend on how the author organizes and presents this massive amount of material in an optimal way to allow the expression of his expertise. Dr. McNally''s dissertation suffered (as do so many . . . ) from a weak organizational spine and a lack of discrimination between what was relevant and what was irrelevant to the greater story he wanted to tell. He tried to pack in too much material, and his interpretive framework could not support it. He has had a few years after finishing that project to reflect on its strengths and weaknesses, but it is critical for him to give considerable thought as to how his book project can be better organized and tightened up.The author''s organizational thread for the history of schizophrenia is ''thematically examining schizophrenia through metaphor, definition, mnemonic and classification.'' Ultimately, any scholar who wrestles with schizophrenia ultimately comes back to these threads. However, approaching the topic in this manner might - and I emphasize might - ignore transnational differences or other idiosyncratic localized interpretations of schizophrenia and seem ahistorical, or seem to be merely a literary theory approach to the elite psychiatric literature. Will French, Japanese, Russian/Soviet, Spanish, Brazilian or other neglected reframings of schizophrenia be part of the proposed history, or only German- and English-language framings?These then are my only concerns. I know Dr. McNally''s work and have faith that he can produce a major contribution to a topic that has been woefully ignored. Review 2 - There is undoubtedly not only a demand but also a need for this book, in that the concept of schizophrenia is extremely problematic--possibly because ''schizophrenia'' doesn''t actually exist. By acting as though it does, researchers can lose themselves in blind alleys, and clinicians can end up harming their patients.- Depending on how it is thought through and written, the market for this book is actually quite large: as well as schizophrenia researchers, the book could appeal to psychiatrists, psychologists, psychotherapists, mental health nurses and social workers, schizophrenia sufferers and their relatives, and, of course, the general public. For the book to become a ''classic'', its message has to be original, clear, and forceful: think, for example, of Eric Berne''s ''Games People Play'', which has sold millions of copies. Dr McNally has to resist the temptation of effectively rewriting his thesis, and re-imagine and re-engineer this book from scratch. - If the book is to appeal to a wide audience, the working title just won''t do. It would be better to use the working title as a subtitle and come up with a more striking, literary title such as (off the top of my head), Dungeons and Dragons: A History of Schizophrenia. Often, the title will suggest itself during the writing.- A book like this one can all too easily end up in abstract and meaningless ivory tower waffle. In fact, I am already detecting some of this in the publishing proposal, for instance, ''The analysis nevertheless cautions against overstating the importance of fluctuating definitions in assessing the ontological status of contemporary interpretations of schizophenia.'' Dr McNally must aim at concision and clarity, and, while it is fine to avoid detailed case studies, stories and anecdotes would go a long way in improving readability and reader experience. The same goes for reported conversations, opinions, feelings, revelations, illustrations, tables, and so on.- My main gripe with this book is that it seems to start with Bleuler. But schizophrenia (or at least psychosis) is as old and universal as mankind. What about ancient conceptions of ''madness''? For example, madness features in the Bible and is insightfully discussed by such luminaries as Plato and Cicero, who were far greater men than poor Bleuler. In traditional societies, it is often the case that the madman is seen as ''touched by the gods'', and, rather than being stigmatized and drugged, comes to occupy the high status function of shaman (the historical equivalent of doctor and priest). It is dangerous to begin the analysis of the modern, Western concept of schizophrenia with no other reference point than the modern, Western concept of schizophrenia itself. Also, where did that concept come from, and why? - A related question is this: what are the consequences of exporting the modern, Western concept of schizophrenia to the rest of the world through, in particular, the influential ICD-10 and DSM-IV classifications? It is very important to consider cross-cultural psychiatry and culture-bound syndromes: the idea that psychic distress is expressed in different forms in different cultures. Thus, schizophrenia may well exist in the UK and Germany, but maybe not in the Amazonian rainforest. Psychotic experiences such as auditory hallucinations are so common in normal populations that one wonders whether ''schizophrenia'' is not just the dysfunctional extreme of a spectrum of normal and mostly adaptive human experiences.- My other gripe with this book is that it does not seem to consider the deeper reasons underlying the modern concept of schizophrenia, for example, subconscious factors and processes such as fear and scapegoating, and vested interests such as those of the pharmaceutical industry and medical profession.- My final point is this: psychiatrists ''own'' the field of schizophrenia by virtue of their combination of long training and extensive clinical experience. Anything written by a non-psychiatrist will not have the backing of the psychiatric profession and therefore lack in perceived credibility. One way to get around this is to take on a psychiatrist as an editorial advisor. If Dr McNally is genuinely sympathetic to the ideas that I have expressed in this reader report, I could consider acting as said editorial advisor.- In conclusion, I support the publication of the book, but I think Dr McNally ought to be much more ambitious about what he aims to achieve.”

“McNally’s overall goal—to analyze critically all attempts to define and delineate schizophrenia—is admirable. His attention to detail and his ability to reflect deeply on primary sources are clear strengths of his work. A Critical History of Schizophrenia will no doubt encourage greater awareness of the variability, inconsistency, and unpredictability of the concept of schizophrenia over time. This is a very important task, to which this book contributes a great deal.” (Bonnie Evans, ISIS, Vol. 108 (4), 2017)

“I have been gleefully reading Kieran McNally's book on the history of schizophrenia, which turns out to be a compendium of great detail and fascination. … It makes the book enormously valuable both as a treasure trove (in addition to an almost 30 page long reference section, there is a further 10 pages of recommended reading) and as a contribution to our understanding of this unwieldy but influential idea.” (Psychodiagnosticator, psychodiagnosticator.blogspot.de, December, 2016)

“This is a text that should be prescribed reading for all entering the mental health professions. It acts as a helpful antidote to the ahistorical certainty of many textbooks and many training courses.” (Pádraig Collins, PsycCRITIQUES, Vol. 61 (4), 2016) 

Kieran McNally previously studied and worked at the Institute of Psychiatry, London, UK. He is currently Adjunct Lecturer in Psychology at University College Dublin, Ireland, specializing in the history of psychiatry. He is also the author of the ecological and social history, The Island Imagined by the Sea.

Schizophrenia was psychiatry's arch concept of madness in the twentieth century. However, it was a concept that was both surprisingly problematic and contentious. This book explores schizophrenia's instability, as the concept changed across the 20th century. It moves beyond sensational accounts of kids on LSD and split personalities, to detail schizophrenia's historically problematic definition, diagnosis, and symptom profile. In doing so, Kieran McNally documents the social uses of the concept, its regional variations, and its fluctuating subtypes. And finally, the book explains how, and why, North American psychiatry sought to improve the concept in the Diagnostic and Statistical Manual of Mental Disorders (DSM), by introducing group sanctioned operational definitions. This book reveals a tradition of critical unease towards the concept of schizophrenia and it reveals that criticism of the concept was consistently voiced by many leading schizophrenia researchers - and not just by 'anti-psychiatrists'. It becomes clear that at no stage in its history was schizophrenia thought to be beyond improvement.

Schizophrenia was 20th century psychiatry's arch concept of madness. Yet for most of that century it was both problematic and contentious. This history explores schizophrenia's historic instability via themes such as symptoms, definition, classification and anti-psychiatry. In doing so, it opens up new ways of understanding 20th century madness.

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