What mental illness tries to destroy others


Initial questions

The text presents a number of theses on the connection between modern culture and certain mental illnesses for discussion. It is only marginally about the real, found and suffered disorders, far more about their potential for meaning and their role as media in processes of social self-understanding. The theses primarily concern schizophrenia; in the end I try to expand and differentiate with regard to other disorders.

Schizophrenia is neither a simple nor a "normal" disease - which is proven by the never-ending debate about the appropriateness of the concept of disease (see Keupp, 1979). It is a disease that has something "to say" and "mean" or "to show" something. Schizophrenia leads to falling out of social relationships, to breaking with history and tradition, to leaving the territory of the common language and common meanings. What is true of the affected individual seems to resemble, in a certain way, the fate of modern humans. Kraepelin characterized schizophrenia as "a peculiar destruction of the inner connection of the psychic personality" (1913, p. 668). The more recent diagnoses of the time concerning the inner constitution of modernity - senseless acceleration of life, fragmentation, arbitrariness, disruption of the context of meaning - reveal certain parallels to the characterization of schizophrenia. "... The dissolution of a narrative context; the destruction of the spatiotemporal continuum; the suspension of the principle of causality; the confusing play with ... perspectives; ... the lack of contours and fragmentation of the people; ... the collage of the most diverse .. . Styles. " (Kuhlmann 1994, p. 8) - these predicates should not characterize the state of a mental disorder, but rather the music channel MTV. Jameson (1986) characterized this type of modern, medially conveyed form of experience as "schizophrenic" because the individual is no longer able to appropriate reality as a coherent text. This is just a recent example of the consistently observed convergence of schizophrenic expressions and certain phenomena of modern culture. Many of the "modern heroes" (artists, pop stars, etc.) were mentally ill or at least had serious problems. In the case of these "heroes," the disease obviously made it easier to develop a language and expression that met with resonance in the modern age. In art, since the time of Expressionism, these echoes of mental illness, despite all changes in the conception of art, have always remained topical, even though they are tied to completely different phenomena today than they were 80 or 40 years ago (then: Wildness, informality and purity of expression; then: freedom from associativity, combination of different meaning particles; today: more the random, fragmentary, playing with the possibilities of loss of meaning). Modern art is sometimes referred to as "sick" and schizophrenia, on the other hand, is judged according to aesthetic criteria. Sass (1992) has shown a number of these and other parallels between modernity and schizophrenia, also in relation to philosophy (e.g. Derrida). For him, schizophrenia is not a regression to earlier, archaic stages of phylo- or ontogenetic development, but rather a progression that consists of hyperreflexivity, over-abstraction and an alienation - especially not from rationality - but from the emotional and physical foundations of life. Here Sass sees the "modernity" of schizophrenia and at the same time the "schizophrenia" of certain powerful tendencies in modern culture.

It is not least this proximity of certain forms of self-experience and expression of modern man and schizophrenic experiences of being that make it seem justified to call schizophrenia one, if not the disease of modernity (such as Deleuze and Guattari: "It is our 'disease 'that of modern man. "1974, p. 169). The connecting element here could be the modern subject and its illness ’- the uncertainty and despair about one's own existence, which is more and more cut off from cultural roots and traditions.

The following theoretical considerations apply to this correspondence between the modern model of subjectivity and the schizophrenic constitution. They also apply to their consequences, which fluctuate between imaginary identification and total rejection. It is also an attempt to explain the Janus face of the modern way of dealing with mental illnesses: marginalization, devaluation, exclusion, up to physical annihilation on the one hand, privilege, aestheticization up to sacralization on the other.

We will ask ourselves: (1) What does schizophrenia "do" for society - and (2) what, in turn, does society "do" for schizophrenic people? The reciprocity indicated in this question is essential for the question.

Let us first turn to the first part of the question:

(1) The connection between mental illness and society, according to the thesis, is not causal, but results from the convergence of fields of meaning. Society neither goes mad, nor does it create madness, but it does need madness in order to understand itself in a certain way. What she wants to understand is the uprooted, set free subjectivity. She "is interested" in the madness and she "sympathizes" with it because and insofar as she meets herself in the madness and recognizes a moment of her being in it. This thesis goes further than the cultural thesis, according to which the respective conceptions of illness and health are an expression of culture; also further than a conception such as: "What is considered to be sickness and healing in a culture is just a self-documentation of the culture" (Scharfetter 1986, p. X).

The modernization of societies produces the conditions (uprooting, de-traditionalization, subjectification) through which certain mental illnesses (of the schizophrenic type) are discovered and the development of a kind of sympathy is promoted (Leferink, 1997).

I would like to go so far and claim that engagement and solidarity, e.g. a certain "lobbyism for those affected" (Dörner & Plog, 1978), are generated by cultural images and discourses in which culture tries out a certain self-description.

If schizophrenia is not in opposition to, but in agreement with society, then the thesis says, paradoxically, that schizophrenia today could become an affirmative model of future normality - as a special variant of a general tendency according to which deviation (provocation, rebellion, avant-gardism, breaking taboos ) has become a successful model for establishing new discourses. This consideration is based on the general idea that social models that appear "deviant", "avant-garde" or "provocative" at a certain point in time can become affirmative at a later point in time.

If sympathy can generate commitment and rejection in equal measure, then the social and cultural conditions that caused an explosive increase in psychiatric hospitals all over Europe in the 19th century must be questioned in terms of this sympathy as well as the conditions that are conducive to questioning, criticism and limitation of this "treatment model" - a similar regularity with which almost everywhere in Western societies since the 1960s the disease model and the treatment of mental illnesses have been questioned. It seems to be the case that the same society in its development, partly simultaneously, partly time-shifted, in one produces exclusion and solidarity, rejection and reintegration. (For the theorist it should be added that by assuming processes of social self-understanding and thus adopting a "dialogical" model with saying and contradiction, we bring the dialectic back to where it belongs, namely in the area of ​​communication).

Antipsychiatry, incidentally, has only seen the one, the dark side of schizophrenia in bourgeois society and dismissed its equally existing esteem, to which it itself in a certain way testified, as a mere ideological reflex. Many psychiatrists, like Arieti (1985, p.29f.), Express their "admiration" for schizophrenics. Other authors, such as Hartung (1980, p. 8), speak of a "secret envy" of the schizophrenic (and also hope that dealing with the fate of the crazy will provide information about one's own life "; ibid. P. 8) ? The crazy are considered by some to be the "good people" - "too good for this world" (for example Alexander and Selesnik, 1969, p. 140). The psychiatric institutions therefore perhaps do not serve so much to protect society from the mad, as rather, in the form of asylum, to protect the mad from society, an idea that is repeatedly found in modified form (also in Laing or Dörner).

The ("semiotic") thesis formulated here differs from the classic question in the social science thematization of mental illnesses, which aimed at how societies deal with deviant behavior and how they organize its treatment. The changed question relates to the character of mental (and physical) illnesses, to the importance that mental illnesses can gain for societies, their role as media for the discussion (and modernization) of these societies.

(2) The other side of the question concerns the offers of meaning and definition possibilities offered by society to those affected. - Those affected, professionals and laypeople are seen as users of offers of social meaning. The culture contains a repository of different models and ideologemes (Kristeva), which can be understood as material as utensils that the users use in the construction of their identities. The users are at the same time players in a game in which the meanings of the concepts used (such as "illness", "reality") and the associated practices are constantly being renegotiated (e.g. when must the terms be enclosed in quotation marks and when not ? When is distance, when identification is the order of the day?)

When asked about the connection between culture and illness, from the side of those affected, the decisive concept is that of identity. Identities can be understood as psychosocial structures at the interface between people and their social environment. In identity, cultural codes ("illness") and individual subjectivity (goals, wishes, ideas, etc.) meet. Identities unite what is external to the human being with what is deeply inside. Identities, however, are not given or assigned, they are rather something that the individual works out by dealing with the social environment, that he tries to preserve, secure or reconstruct in crisis situations. Just as people use certain social codes and transparencies when telling their biography, along which they organize their construction, so too is the development of an identity taking into account certain social pre-formations.

On the one hand, to summarize the theses, mental illnesses provide models and metaphors for the change in identity assumed in the course of modernization; on the other hand, modern identity offers enable those affected to develop new forms of self-image. Put simply, it is about exploring the discursive potential of mental illnesses for society and, on the other hand, about the possibilities that social change brings with it to build a new identity. This leads to the further question, namely how the identity of the mentally ill is related to our own identity.


Schizophrenia and its pictures

Why schizophrenia and not other mental disorders? There are several possible answers to this: (1) Because schizophrenia poses considerable problems in economic, social and, ultimately, scientific terms. (2) Perhaps more importantly, because schizophrenia is a disorder that affects the very essence of what we consider to be a subject. It is a change that takes place in the center of the person. It affects thinking, feeling and intentions, the experience of the body, language and finally the entire construction of reality in which a person lives. (3) Because schizophrenia moves with the times. It is by no means "autistic" in the sense that those affected would live apart from social issues and discourses. Rather, in the hallucinations and delusions of those affected, the currents of the time intersect in partly absurd, partly also illuminating syntheses. What reason or norm would like to see kept apart enters into unexpected connections (for example the connection between crucifixes, swastikas and hammers and sickles in August Walla's pictures). Schizophrenia is like a mirror in which the known or the unspoken thoughts of an era are reflected. (4) Another reason: "The less reliable knowledge there is about a subject area, the more susceptible it becomes to ideological theories." (Wulff, 1983, p. 530). It is precisely these "ideological theories" and, together with them, the images, the stories, the typical gestures and signs with which the madness is thought of, form their "social representation". In other words, the less an object is scientifically clarified, the more it promises to provide access to deep structures of social consciousness.

When we address schizophrenia as a cultural production, we ask which images, ideas, metaphors etc. the culture makes available in order to "grasp" or "model" the phenomenon. It's no secret that everyone, including every scientific writer, makes schizophrenia their own thing. The schizophrenias of Sechehaye, Hanna Green, S. Freud, G. Bateson, K. Conrad or E. Bleuler, the sober and factual models of Brenner (1986) or Nuechterlein and Dawson (1984), the dark delirium of Artaud and the stories of those experienced in psychosis (Bock et al. 1992) are phenomenologically and psychologically very different constructions. In addition to the ideas that can be assigned to certain authors, there are countless general cultural images or narratives of madness. The image of the dangerous, unpredictable madman (for example Jack Nicholson in 'Shining'), the image of the sensitive rebel suffering from society in 'März', the image of the "poor victim" who is only exploited and disenfranchised in the literature on concern, the story of "innocent in the clutches of psychiatry and only then really driven crazy", the construction of the "actually completely normal and very talented young person, in whom certain biochemical processes go crazy" in biological psychiatry . Or one ascribes a deep irrationality to culture, which the schizophrenic person - "on behalf of us all" - carries out - "brings it closer to Christ" (Scharfetter, 1986, p. X). Or the schizo is a variant of Nietzsche's Übermensch, a person of desire: "like Zarathustra": "They know unexpected ailments, dizziness and illnesses. They have their ghosts. They have to reinvent every gesture. But such a person creates himself as freer , more irresponsible, as a lonely and happy person who is finally able to say and do something simple on his behalf without permission, wish that is nothing wrong ... He just stopped being afraid of going mad. " (Deleuze and Guattari, 1974, p.169). The two authors at least emphasize that this image of the schizophrenic has nothing to do with the real, empirically found schizo. The madness of the real patients is a bad one, in no way "the true madness" (ibid., P. 170). In other words, the real madmen are always "elsewhere", utopian people.

All these different images, constructions or narratives grow on the soil of modern culture; it is precisely the diversity that is characteristic of this culture.

This game also apparently includes the view that only the constructions of the other are culturally conditioned (and thus "distorted"), while one's own view is obviously free of any cultural conditioning. For example Scharfetter: "In our culture, experiences of extraordinary states of consciousness are prematurely pathologized as abnormal ..." (1986, p. 193, emphasis added KL). Anyone who says this and distances himself from it implicitly says that he is "somewhere else". The author could just as well and just as correctly have said: ‘In our culture, the hasty pathologization is recognized as problematic ...’. This would have put his own statement up for discussion as - likewise - a cultural production. A more consistent knowledge-sociological reflection of the cultural conditions can, in my opinion, lead to the (sometimes unpleasant) realization that we live in a culture of diversity, for which the self-reflective reference, the reflection in various media, is essential. This relationship is constantly being re-established in us as observers and speakers. Acknowledging this connection could lead to a view that we do not live in a world of "distorted views", but in a culture that at the same time creates and denies normality, creates and dissolves stereotypes, etc.

The reality of schizophrenia is characterized by cultural models - and these are very similar models and metaphors to those that are supposed to describe the state of modernity. They include the simultaneous occurrence of productivity and deficit, positivity and negativity, freedom and enslavement, creativity and spiritual impoverishment. One and the same phenomenon, such as "schizophrenic language", can sometimes be viewed as the "realization of language" (Cooper, 1978), sometimes as the "destruction of language".


Is there a correct view of schizophrenia?

As early as the 19th century there was reports of the disappointment that typically afflicts the curious visitor to the insane asylum when confronted with the everyday reality of mental illness. Even then, "poetic and moralistic conceptions" were widespread ...

"Through them the lay people have been filled with pictures of mental illnesses which do not correspond in the remotest way to nature; if these pictures are not then they doubt whether there is mental illness Residents had thought so completely different! " (Griesinger 1964, p. 11)

Also infinite is the story of the visitor to a psychiatric clinic who triumphs with the observation that he could not distinguish the professionals from the patients. Countless other typical stories exist.

It is forbidden to simply play a truth of madness ("how madness really is") against the innumerable fictions ("what lay people imagine"). It is well known that even among seasoned practitioners, opinions can diverge greatly. The reality of the patient that is offered in the clinic is partly produced by the clinic itself. The intensive contact with the patient, which psychiatrists could refer to, cannot be the measure of all things. Rather, "objectivity" and "sobriety" are only one variant of cultural modeling. The "truth of madness" is not encoded in a particular picture, but in the multiplicity of pictures and discourses.


Is the modernization of societies the cause of mental disorders?

A view that is very widespread in our society is that mental disorders must have increased extremely in the last decades and centuries. Conversely, only 1% of those questioned in a study considered it plausible that mental disorders could have decreased in the last few decades (Angermeyer, 1991). So somehow you think that people are getting more and more crazy or mentally problematic.

Equally widespread is the view that people in premodern, archaic, "natural" societies are mentally healthier. An increase and spread of madness is apparently automatically associated with modern society, even by people who do not believe that everything was better in the past (an example could be W. Reich's fantasy about the spread of the "emotional plague"). Modern societies must therefore have something crazy about them or tend to be crazy about themselves.

This view appears to be a cultural a priori, i.e. a representation that comes before the experience and determines it in some ways. Many anthropologists (e.g. M. Mead and R. Benedict) were critical of civilization even before and not through contact with other cultures.

The assumption that psychological disorders have increased is based, as I say, on the fact that a semantic connection is reinterpreted into an empirical connection: the fields of meaning of modernity and madness overlap, with the result that modernity appears mad and madness appears modern .

What is the data saying? - From the available (and by no means sufficient) epidemiological data we can draw the conclusion that an estimated 20 to 30 percent of the population in Germany and other relatively developed countries have psychological problems that are of a kind of disorder. If we occasionally take the need for inpatient treatment (in addition to restrictions on the ability to love, work and communicate) as a criterion for "severe mental disorders", the proportion of the population is a few percent. The individual life risk for schizophrenia is approximately 1%.

Certain disorders are time- and culture-bound, others are obviously cross-cultural.

The first group seems to include the hysterical neuroses (especially conversion and dissociation phenomena) with which Freud and his contemporaries had to deal. They seem to have largely disappeared from the scene (although there have been signs of a revival recently). In their place, personality disorders of the narcissistic or borderline type seem to have spread. As I said: seem! It is unclear whether a change has really taken place here. The data situation does not allow a decision to be made as to whether the spectrum of disorders has actually shifted or the social perception, coding and evaluation of deviant behavior.

From what we know, schizophrenia is not epidemiologically linked to culture: it occurs with surprisingly similar frequencies all over the world (Jablensky 1989). Nor is there any evidence that schizophrenia has increased in incidence in recent decades and centuries. Instead, some epidemiologists consider a decrease in frequency and, above all, in severity to be plausible.

Thus schizophrenia appears as a universal, historically not fixable phenomenon. There is little to suggest that modern society created schizophrenia or caused it causally. A corresponding "logic" is, however, easy to construct (such as, for example, Gabel, 1967; "Increase in alienation = increase in mental illnesses", etc.) Neither speaks in favor of Torrey's bio-social theory (1980), according to which the conditions of modern civilization are for this ensured that the slow virus disease, which he believed to be schizophrenia, could spread since the 18th century - ultimately across the world.

Constitution of Schizophrenia

A third thesis that I would like to represent here is what I call the constitution thesis. Constitution, in Kant's concept of object constitution "the determination of sensible data for an object", is here the totality of the processes through which we learn to regard something as something, i.e. the totality of the processes through which a previously non-communicable phenomenon, the outside the linguistic world is made into a social reality. This is done by moving the phenomenon into the realm of symbolic communication.

An earthquake (like the one in Lisbon) only becomes a social reality when it is understood as something, such as a "punishment from God" or a "blind natural phenomenon". Once such a constitution has taken place, communication can take place not only through the phenomenon but also with the phenomenon, in the sense of a medium.

One of the central discourses of modernity relates to the question of what the modern subject (the person, the individual) is, what the possibilities of this subject are, what its dangers are. How does it differ from other consciousness and social formations in other cultures? How did it get historically, how will it develop in the future? In what will it find its salvation - or its disaster? In connection with all these questions, mental disorders take on greater importance - as a medium of social discourse, i.e. as a sign.

The thesis is that modernity creates the conditions through which a previously only latent spectrum of mental disorders attains an explicit social meaning, and that schizophrenia is socially constituted as a disease of subjectivity only parallel to the development of the modern subject . The material and social prerequisites for this are increased social mobility and de-traditionalization in all areas, in particular the disintegration of traditional communities, the uprooting and internal isolation of modern people.

From the time before the 18th century there is hardly any evidence that could reliably prove the existence of schizophrenic experiences (cf. Jeste et al., 1985). We do not know how the premodern mentally ill fared in these communities. This, too, is a reason to beware of quick romanticizations. In premodern society, the disorder that we know today as schizophrenia is hardly noticed, or it is negotiated in discourse systems other than that of the disease (e.g. religious, demonological). In order for the disturbance of society to be socially important and to be symbolized as a separate entity, a subject first had to be present that could be destroyed by it (in a perceptible way). Among the cultural conditions of the constitution I count the recognition and problematization of the ego, the separation of private and public life, a culture of inwardness that created its respective media (such as the letter culture, the novel) in order to remain open to discourse.

Sympathy with schizophrenia

I have characterized the thesis of the connection between schizophrenia and modern society as "sympathy with schizophrenia". The concept of sympathy, which was originally borrowed from alchemy, means nothing more than "closeness", "translatability", "kinship". In medieval thinking (see Eco, 1995) it stood for a general form of relationship that affects those relationships of attraction, similarity and influence that cannot be grasped using the usual concepts of convention, causality, iconicity or analogy (see also Foucault, 1971 , P. 53ff.).

The assumed sympathy relationship between schizophrenia and modernity is the basis for society to be able to use schizophrenia to communicate with itself about its constitution: schizophrenia becomes important because it becomes a medium.

In making interpretations of the mental disorder, society interprets itself indirectly. The interpretations are thus a medium of self-interpretation.

Everyone knows certain socially typified "figures" - the criminal, the madman, the savage, the child, the saint, etc. - who represent the cognitive or moral state of the community in an emblematic way. This also applies to the fool and the madman. In the Middle Ages, the gate was incorporated into a moralizing discourse: "The‘ authentic ’gate, according to Matejovski, forms ... a model that is used to present certain behaviors as morally wrong, as nonsensical." (Matejovski 1996, 29). The moral didacticians used a "fool's terminology as an ethical-religious battle slogan" to criticize or propagate certain forms of lifestyle. Already here the fool enters into his function as an ideological figure. The fool is no longer just a special case of a socio-moral deviation, but is its model case, he stands for every form of social marginalization.

In modern times the madman is in a different but no less moral way such a "principle", "fundamental" figure, a figure to which something is fixed and measured, which is "indicative" of something. Mental illness enters into a "language" in which modern culture communicates with itself. Incidentally, Foucault (1968, 121) speaks of the fact that "a culture expresses itself positively in the phenomena it rejects"; madness therefore has "the value of a language" and culture is articulated in illness. Mental illness is welcomed by modern culture as one of its Achilles heels. The disease shows us that something is possibly wrong with our modern constitution, it confronts our life with other possibilities, serves as a mirror, forms a starting point for questioning normality. It is used to accuse and question (for example the family). As I said, all of this does not happen from a standpoint beyond culture, but is constitutive of culture.

Outlook: from displacement to inconsistency

Which mental illnesses are "modern" today, which are "old-fashioned"? What does she do about it? Which aspects of mental illness are "groundbreaking"? What determines the meaning and evaluation of mental illness in the present (and perhaps also future) modernity?

In the classic sociological and social-psychological discussion, mental disorders were treated as a variant of social deviance (e.g. Parsons, Scheff, Becker), as "deviant behavior" (Keupp, 1972). In the perspective proposed here, it is not primarily the deviation from the norm or an underlying unresolved conflict between instinct and reality (as in the psychoanalytic model) that is decisive in the case of mental disorders, but rather the - social and individual - perception and evaluation of inconsistency. Displacement, so the thesis, is the procedural form of an older subject model. More modern forms of internal and external domination use the tolerance of inconsistency as a procedure.

Consistency resp. Inconsistency applies to those significant behaviors that underlie a person's social construction and also play a role in their identity formation. Inconsistency occurs when people produce words, actions, gestures, etc. that do not agree with each other and thus, at first glance, do not allow an integrative hypothesis of meaning or a centered interpretation. Something does not go together - and if one wants to speak of a deviation from the norm here, then it is in the sense of an internal deviation in the goodness-of-fit of the person, a deviation that can turn into a questioning of the reality of the person to the outside world. In other words, people are mentally disturbed to the social environment, not when they misbehave, but when they behave incomprehensibly.

The three basic forms of mental disorders, neuroses, personality disorders and psychoses, can be differentiated according to how they deal with inconsistency. I orientate myself to some extent on Kernberg's (1988) circular model of mental disorders.

Example: A patient who says he loves nothing more than his family and values ​​nothing more than their harmony feels an increasingly strong impulse to strangle his wife and child. There is an inconsistency between two messages here. On the one hand "I love my wife" and "I love my child", on the other hand: "I want to destroy her". The social construction of the person, for example in psychotherapy. has to do with the problem of a lack of authenticity and integrity. Who is the "real person"? Is the desired harmony "real"? Is it the cause of the aggression?

One can speak of the construction of a neurosis when both thoughts are taken into account and recognized as incompatible. The affected person ascribes the negative impulse to his own self and at the same time identifies it as incompatible with the self. In order to close the gap, it is considered possible to reconcile both ideas by constructing a superordinate hypothesis of meaning, so to speak a "healing" and reconciliation of the contradiction.The contradiction is I-dystonic; his recognition creates a certain pressure to change, a motivation and at the same time a "suitability" for psychotherapy.

The main mode of operation in narcissistic and borderline personality disorders is division or isolation. In this case, the objection is not even noticed or accepted. Two disparate thoughts or actions are carried out without being related. Kernberg cites the example of a feminist who works as a bunny in a Playboy club and doesn't have the slightest problem with it. Two components of an interpretation process are therefore radically split up. One does not look for superordinate hypotheses of meaning, does not localize the perceived problems in one's own life. Attempts to solve psychological difficulties do not refer to the self and its relationship to the environment, but to any external circumstances (UFOs, electrosmog, amalgam, etc.). The individual form of interaction finds social connection through the fact that the individual split is related to social forms of split.

Finally, in the case of psychoses, the inconsistency and contradiction are overcome by turning off reality testing. While there are two irreconcilable thoughts or intentions in personality disorder, each of which is attributed to himself by the person, in psychosis the contradiction is quasi externalized: the thought that is in me is not my thought at all, but it was given to me. "I don't think anymore, I am not the subject, I am thought."

The thesis states that in the construction of psychological disorders today division is increasingly taking the place of repression. If we assume at the same time that division and repression are internalized forms of external methods of social control, then this thesis could explain why modern society continues to function despite apparently increasing disintegration in the area of ​​norms and values ​​(as is known: a fundamental problem of the Sociology of deviance, for example in Parsons or Goffman). With extensive tolerance and permissiveness in modern societies, how is it possible to maintain social control? Social control, so the thesis, can continue to function - but not through repression or "repression", but through division, a form of domination and control that functions more through channeling and keeping certain elements apart than through exclusion.

In conclusion, I would like to contrast two subject models of modernity. In both models, the individual, subjective being of the person is something deeply problematic. They differ in how to deal with this problem. The decisive factor is, in turn, the recognition and evaluation of consistency or inconsistency.

a) On the one hand there is the classic model, the idealistic subject model of the Enlightenment: people have contradicting experiences, they sense heterogeneous demands that are directed at them; they have to deal with opposing instincts and goals. The subject works on his contradicting experiences and tries to overcome their contradictions and resolve conflicts - yes, overcoming them is a central development principle, a kind of catalyst. The subject is under constant pressure between wishes on the one hand and reality requirements on the other. If he fails to develop further, fear arises. But crises can also be experienced as opportunities for further development and redefinition.

The subject tries to be in harmony with itself in various ways, to find its own language, to speak with its own, unmistakable voice. The criterion for the classical subject is integrity and straightforwardness, the consistency:

Internal parts correspondence; be in tune with yourself

Correspondence inside and out, being authentic

Matching words and deeds, being truthful

Matching feelings and thoughts, being real and congruent.

Agreement in biography: be straightforward, stay true to yourself.

These forms of integration correspond to the general values ​​and objectives of enlightened psychotherapy. Freedom is linked to truth in this model. It consists in giving oneself as one actually is, i.e. in truth. If inside and outside, what you say and what you feel, etc., do not match, then something is wrong and this inconsistency creates a potential for change.

b) In contrast, the postmodern subject model integrates certain "pathological" characteristics of subjective being. With reference to Marcia (1989), Kraus (1995) comes to the conclusion that "an identity result that would previously have been called pathological can now be culturally adaptive" (p. 55). One can also formulate it the other way round: In order to be culturally adaptive, individuals today have to construct identities that would previously have been called pathological. The waiver of the consistency criteria described above means a relief, a relief for the subject. Consistency is increasingly felt as a compulsion, as is truth and authenticity. One is not looking for liberation, but for relief. The characteristics of the post-subject include fragmentation, tolerance of contradictions, playing with surfaces, quotations and set pieces of roles, the fragmentation of identity, the unrelated coexistence of different models of reality. Everyone is granted their own reality in unrelated indifference - "it's ok" - without mutual understanding arising from it. Fear is no longer the ego's neurotic fear of being crushed to a certain extent between wish and reality, but rather the ego's fear of no longer feeling itself.

In practice this means for ("postmodern") psychotherapy that truth, freedom, interpretation, enlightenment and "healing" (in the sense of the unification of the disparate) are pushed back in favor of construction, experimentation, suggestion and functioning.

For the perception of schizophrenia, the change that is so hinted at means that, unlike in the past, the search for meaning can be consciously dispensed with. Older psychiatric critics wanted to prove that meaning and, consequently, comprehensibility, is also preserved in psychosis. The meaning is only encoded in a particularly poetic or private language way. Jaspers (1946), who doubted this, had therefore remained suspicious to them. The postulate of meaning was directed against biological psychiatry with its doctrine, the actions and statements of the patients were due to illness and therefore meaningless or vice versa, their meaninglessness is the best proof of illness. More recently, however, those aspects of schizophrenia that meet the stop-making-sense imperative of postmodernism, the "practice of the aimlessly heterogeneous, fragmentary and dependent on chance" (Jameson), appear more interesting.

While Freud still tried to justify the construction of the unconscious by making sense possible where there was nonsense, today's late modern age consciously flirts with the nonsense. It strives for a liberation from the demand for meaning if this is understood to mean the interpretative integration of different parts of behavior and experience.

I assume that the formation of problematic identities that are not in harmony with each other is the norm in society today. All are deviants, abnormality becomes the norm, the individuals form a community of eccentricities who sometimes aggressively defend their deviating and unhappy status. The relationship with the mentally ill thus becomes a double attitude of rejection and identification. There is also something beautiful in that. Adorno (1951, p. 78f.) Pointed out early on the modern gain in pleasure in one's own disorder, through which one no longer knows oneself as an outsider, but rather in accordance with the mainstream. "The approaching generation watches over the masochistic pleasure of no longer being an ego as jealously as over a few of its possessions".


* Colloquium on July 9, 1997


Adorno, T.W. (1951). Minima moralia. Reflections from the damaged life.
Frankfurt a.M .: Suhrkamp.

Alexander, F.G. and Selesnick, S.R. (1969). History of Psychiatry. Zurich: Diana

Angermeyer, M.C. (1991). "Too much stress!" - Concepts of patients with functional
Psychoses about the causes of their illness. In U. Flick (Ed.), Everyday knowledge about health and illness. Subjective theories and social representations (Pp. 116-126). Heidelberg: Asanger.

Arieti, S. (1985). Schizophrenia. Causes - course - therapy. Help for those affected.
Munich, Zurich: Piper.

Blankenburg, W. (1971). The loss of the natural matter of course. A contribution
on the psychopathology of asymptomatic schizophrenia
. Stuttgart: Enke.

Bleuler, E. (1911). Demetia praecox or group of schizophrenias. In G.
Aschaffenburg (ed.), Manual of Psychiatry Leipzig, Vienna: Deuticke.

Bock, T., Deranders, J. E. & Esterer, I. (1992). Rich in votes. - Messages about madness.
Bonn: Psychiatrie Verlag.

Brenner, H.D. (1986). On the importance of basic disorders for treatment and rehabilitation.
In: W. Böker, and H.D. Brenner (ed.), Coping with schizophrenia (142-157). Bern and others: Huber.

Cooper, D. (1978). The language of madness. Explorations into the hinterland of the revolution.
Berlin: Red Book

Deleuze, G., Guattari, F. (1974). Anti-Oedipus. Capitalism and schizophrenia. Frankfurt a. M .: Suhrkamp.

Dörner, K. & Plog, U. (1978). To err is human or textbook of psychiatry / psychotherapy. Wunstorf: Psychiatrie Verlag.

Eco, U. (1995). The limits of interpretation. Munich: German paperback publishing house.

Foucault, M. (1968). Psychology and Mental Illness. Frankfurt a.M .: Suhrkamp.

Foucault, M. (1971). The order of things. Frankfurt: Suhrkamp.

Gabel, J. (1967). Ideology and Schizophrenia: Forms of Alienation. Frankfurt a.M .: Suhrkamp

Griesinger, W. (1964). The pathology and therapy of mental illnesses (orig.:1861). Bonset: Amsterdam.

Hartung, K. (1980). The new clothes of psychiatry. From anti-institutional struggle to guerrilla warfare against misery. Reports from Trieste. Berlin: Red Book.

Hoffman, R.E. (1986). Verbal hallucinations and language production processes inschizophrenia. The Behavioral and Brain Sciences, 9, 503-548 .

Jablensky, A. (1989). An overview of the World Health Organization multi-center studies of schizophrenia. In P. Williams & G. Wilkinson (Eds.), The scope of epidemiological psychiatry: Essays in honor of Michael Shepherd (Pp. 455-471). London: Routledge.

Jameson, F. (1986). Postmodernism - on the logic of culture in late capitalism .. In A.Huyssen and K. R. Scherpe,Postmodern. Signs of cultural change, 45ff. Reinbek b. Hamburg: Rowohlt.

Jaspers, K. (1946). General psychopathology. (4th edition). Berlin, Springer.

Jeste, D.V., Carmen, R.d., Lohr, J.B. & Wyatt, R.J. (1985). Did schizophrenia exist before the eighteenth century? Comprehensive Psychiatry, 26, 493-502.

Kernberg, O.F. (1988). Severe personality disorders. Theory, diagnosis, treatment strategies. Stuttgart: Velcro Cotta

Keupp, H. (1972). Mental disorders as deviant behavior. Munich: Urban & Schwarzenberg.

Keupp, H. (Ed.) (1979). Normality and deviation. Munich, among others: Urban & Schwarzenberg.

Kraepelin, E. (1913). Psychiatry. A textbook for students and doctors. III. Volume: Clinical Psychiatry (8th edition). Johann Ambrosius Barth.

Kraus, W. (1995). The narrative construction of identity projects in the late modern era. Theoretical approach and empirical exploration. Unpublished dissertation. Free University of Berlin

Kuhlmann, A. (1994). Introduction. In A. Kuhlmann, Philosophical views of modernity, (Pp. 7-29). Frankfurt / M .: Fischer.

Leferink, K. (1997). Sympathy with schizophrenia. The modern age and its mental illness. In M. Zaumseil and K. Leferink (eds.), Schizophrenia in the Modern Age - Modernization of Schizophrenia. (83-144). Bonn: Edition Narrenschiff in Psychiatrieverlag.

Marcia, J.E. (1989). Identity diffusion differentiated. In M.A. Luscz, T. Nettelbeck. Psychological development across the life span (Pp. 289-295). North-Holand: Elsevier.

Matejovski, D. (1996). The motif of madness in medieval poetry. Frankfurt a.M .: Suhrkamp.

Nuechterlein, K. and Dawson, M. (1984). Vulnerability and stress factors in the developmental course of schizophrenic disorders. Schizophrenia Bulletin, 10, 158-159.

Sass, L. (1992). Madness and modernism: Insanity in the light of modern art, literature, and thought. New York: Basic Books.

Scharfetter, C. (1986). Schizophrenic people (2nd revised edition) Munich: Psych. Verl. Union.

Torrey, E.F. (1980). Schizophrenia and civilization. London: Aronson.