On the Diagnostic Term, “Schizophrenia”

Although it is generally taken for granted that there is a clear-cut, commonly understood definition of schizophrenia, unfortunately, such is not the case. Over 90 per cent of the patients admitted to Chestnut Lodge are diagnosed as schizophrenics by their referring psychiatrists or by a staff member of the hospital where they have previously resided for months or even years. Since all of these patients have been given tranquilizers, when first seen in the hospital, they appear “rational.” Yet, when the drug is discontinued, a variety of clinical pictures emerge.

Brief descriptions of three such patients are typical. (1) Patient A. was not unusually anxious (although before her admission she had been hospitalized elsewhere for two years, following a period of acute excitement during which she had shaved her hair and burned her cottage in response to “voices”). Her eating and sleeping patterns were not disturbed. She was witty, charming, very creative in art, and reasonably sociable. She was even able to establish a reasonable alliance with her therapist. Only after prolonged and careful observation was it evident that she exhibited an extreme tendency toward control—especially of her emotions and thought processes: she was never spontaneously gay or sad; nor would she allow free-associative thinking. (2) Patient B. became very active physically and rarely engaged in any relaxed conversation with anyone. (Prior to her admission, however, this patient had been hospitalized for over two years. The hospitalization had been precipitated by aimless wandering, following several years of life in communes.) During the therapy sessions, a marked disturbance in her thought processes was noted. She talked in highly abstract terms. After listening to her for five minutes, one might have concluded that she had a philosophical bent, but, after a bit longer one found oneself utterly confused and exhausted