Memoir and the Diagnosis of Schizophrenia: Reflections on The Center Cannot Hold, Me, Myself, and Them, and the 'Crumbling Twin Pillars' of Kraepelinian Psychiatry

Abstract

In 1896 Emil Kraepelin revolutionised the classification of psychosis by identifying what he argued were two natural disease entities: manic-depressive psychosis (bipolar disorder) and dementia praecox (schizophrenia). Kraepelin's twin pillars have governed psychiatric thinking, practice and research for over a century. However, a growing number of researchers, clinicians, and mental health service users argue contest the claim that there are fundamental differences between schizophrenia and bipolar disorder, and call for a symptom-led approach which prioritises subjective experience over diagnostic category. How can the published first-person accounts of experts by experience contribute to this debate? This short paper looks at the representation of psychiatric diagnosis in two much-lauded autobiographies: Kurt Snyder's Me, Myself, and Them: A Firsthand Account of One Young Person's Experience with Schizophrenia (2007) and Elyn Saks' The Center Cannot Hold: My Journey Through Madness (2007). As well as providing a prognosis and a plan for treatment, the psychiatric diagnosis of schizophrenia, for both these writers, gives shape and meaning to the illness experience and ultimately becomes the pivot or platform from which identity and memoir unfold. Saks and Snyder do not claim to speak for all people who receive a diagnosis of schizophrenia and it would be a mistake to read their texts in this way even if they did. But if the debate about the future of psychiatric nosology is going to respect subjective experience, the insights they and others offer in to the multiple meanings and effects of psychiatric diagnosis more than compel our attention.

Keywords: bipolar disorder; diagnosis; first-person perspective; memoir; schizophrenia.