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  • Print publication year: 2003
  • Online publication date: January 2010



Schizophrenia is the defining problem for psychiatry. In the nineteenth century, American psychiatry first projected onto schizophrenia the images of treatment that it inherited from European medicine: strait-jackets, hydrotherapy, bloodletting, herbal compounds, and, of course, the asylum. Then it was moral therapy, which held up until the ethnic mix of American society changed so significantly that America could no longer project a single moral world, and contesting multicultural influences that challenged the presumptions of this “our crowd” therapeutic approach. Latterly, social Darwinism, eugenics, and social science reinvigorated a fin de siecle organic image of the deranged mind based in the brain tainted by degeneracy.

The twentieth century was the hothouse of psychological models, with Freudianism coming to dominate the image of what mental illness was. Side by side with psychodynamic projections, somatic treatments evolved – if we can call such a stop-and-go, recursive, and controversial process by this term – from insulin shock and electroconvulsive therapies through psychosurgery to what we now think of as modern psychopharmacology. The broken brain has become the dominant professional (and popular) image in America. Today's world of biological psychiatry claims schizophrenia as its own, even though the genetic contribution to the transmission of schizophrenia has gotten more and more complex and uncertain, and there is still no biological marker in everyday clinical practice that can be used to diagnose and follow the course of the disorder.