Schizophrenia and Society

Schizophrenia, as a diagnosis, also has a political dimension. For example, psychiatrist Thomas Szasz has called schizophrenia the “sacred symbol” of psychiatry, which is used to justify psychiatry’s status as a branch of medicine and the justification of coercive treatment measures that restrict the fundamental rights of those being treated and cause harm. According to Szasz, the term schizophrenia is so empty and vague that it can refer to almost any disruptive or unpleasant behavior or way of reacting in a person. The diagnosis of schizophrenia has also been used, for example, in the Soviet Union to suppress political opponents.

The treatment of schizophrenia has, from the beginning, had a strong social control aspect, not so much aimed at curing the patient but at making them more easily controllable. For example, the inventor of schizophrenia, Bleuler, did not consider the medication for psychotic symptoms as a medical treatment but rather as a kind of “chemical straightjacket,” designed to make patients more manageable. Since schizophrenia was primarily considered an inherited disorder, efforts were made to prevent its transmission, including compulsory sterilization of people diagnosed with schizophrenia. The eugenics movement, which gained popularity in the early 20th century, provided credibility to this idea, especially through American scientific journals like Eugenics Review and Eugenical News. Both Kraepelin, the developer of early dementia, and Bleuler, the inventor of schizophrenia, supported the compulsory sterilization and mass extermination of psychiatric patients to promote “racial hygiene.” The underlying assumption of eugenics was that deviations and diseases are largely hereditary and can be addressed mainly by preventing the reproduction of undesirable individuals and through mass euthanasia. In 1924, Bleuler wrote: “Those carrying the heaviest mental burdens should not be allowed to reproduce… If we do nothing but promote the ability of the mentally and physically sick to reproduce, and if the healthy population must reduce its reproduction to support them, if the mechanisms of natural selection are generally suppressed, then, if we do nothing, our race will quickly degenerate.”

Bleuler’s wishes were addressed in 1933, when Nazi Germany enacted compulsory sterilization for those suffering from schizophrenia and many other illnesses and disorders. During the same decade, similar sterilization laws were passed in countries like Sweden, Finland, and Norway. Before this, such laws had been enacted in many U.S. states. In 1938, sterilization in Europe shifted to mass murder when psychiatrists and other doctors starved and gassed an estimated 5,000 to 10,000 children suffering from psychological or physical abnormalities. These murders were commonly referred to as “euthanasia,” “mercy killings,” and “assisted death.” In Germany, an estimated 125,000 people diagnosed with schizophrenia were murdered. It is estimated that about 74% of all Germans diagnosed with schizophrenia were either sterilized or killed. For example, in Polish psychiatric hospitals, 4,000 people were killed in just three months in 1940. In French mental hospitals, an estimated 40,000 patients were starved. Most of the psychiatrists responsible for these mass murders and forced sterilizations continued their careers after World War II. For instance, Franz Josef Kallmann, a psychiatrist who proposed the compulsory sterilization of people diagnosed with schizophrenia and all their relatives in 1930s Germany, had his scientifically questionable views on the heritability of schizophrenia widely quoted in many psychiatric and psychology textbooks. These textbooks rarely address psychiatry’s significant role in the forced sterilizations and mass murders of people with schizophrenia.

The legacy of eugenics related to schizophrenia still persists in Western countries, although compulsory sterilizations have been abandoned. For example, in a 2008 survey, the majority of American psychiatrists expressed strong support for genetic testing of psychiatric disorders. Some perspectives suggest that individuals with schizophrenia should be informed about the strong heritability of their illness and offered special guidance on family planning and “genetic counseling.” On the other hand, in the 1990s, it was discovered that two-thirds of patients over 65 in Israeli mental hospitals were suffering from trauma caused by the Holocaust. In 1999, the Israeli government published a report, leading to the closure of three mental hospitals, and Holocaust survivors were transferred to other institutions to receive care for their psychological trauma. Many of these patients’ diagnoses of schizophrenia were changed to “long-term post-traumatic psychosis.” Their heavily medicated treatment, focused on medication, was criticized in the 2001 documentary Last Journey into Silence as ineffective and harmful. As a result of decades of heavy medication and isolation, many patients suffered from irreversible involuntary movements and had lost the ability to speak.