“Owing to my illness,” Schreber wrote, “I entered into peculiar relations with God”—relations that, at first, seemed an awful lot like immaculate conception. “I had a female genital organ, although a poorly developed one, and in my body felt quickening like the first signs of life of a human embryo…in other words fertilization had occurred.” Schreber’s gender had transformed, he said, and he had become pregnant. While he might have felt touched by grace, Schreber instead felt violated. God was Dr. Flechsig’s willing accomplice, “if not the instigator,” of a plot to use his body “like that of a whore.” Schreber’s universe was, much of the time, an intense and frightening place, filled with horrors.
He had one grand ambition. “My aim,” Schreber reflected, “is solely to further knowledge of truth in a vital field, that of religion.” It didn’t turn out that way. Instead, what Schreber wrote contributed far more to the emerging, provocative, and increasingly contentious discipline of psychiatry.
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IN THE BEGINNING—BEFORE anyone turned the study of mental illness into a science and called it psychiatry—being insane was a sickness of the soul, a perversion worthy of prison or banishment or exorcism. Judaism and Christianity interpreted the soul as something distinct from the body—an essence of one’s self that could be spoken to by the Lord, or possessed by the devil. In the Bible, the first portrait of madness was King Saul, who lost his mind when the spirit of the Lord departed him and was replaced by an evil spirit. In medieval France, Joan of Arc heard voices that were considered heretical, the work of Satan—an impression that was revised the other way, to be the voice of a prophet, after Joan’s death. Even then, insanity’s definition was a moving target.
For those looking even a little carefully, it was plain to see that madness sometimes ran in families. The most conspicuous examples involved royalty. In the fifteenth century, King Henry VI of England first became paranoid, then mute and withdrawn, and finally delusional. His illness formed the pretext for the power struggle that became the Wars of the Roses. He came by it honestly: His maternal grandfather, Charles VI of France, had the same condition, as did Charles’s mother, Joanna of Bourbon, and Charles’s uncle, grandfather, and great-grandfather. But it took until Schreber’s lifetime for scientists and doctors to start talking about insanity as something biological. In 1896, the German psychiatrist Emil Kraepelin used the term dementia praecox to suggest that the condition started at an early age, unlike senility (praecox also being the Latin root of precocious). Kraepelin believed that dementia praecox was caused by a “toxin” or “connected with lesions of an as yet unknown nature” in the brain. Twelve years later, the Swiss psychiatrist Eugen Bleuler created the term schizophrenia to describe most of the same symptoms that Kraepelin had lumped into dementia praecox. He, too, suspected a physical component to the disease.
Bleuler chose this new word because its Latin root—schizo—implied a harsh, drastic splitting of mental functions. This turned out to be a tragically poor choice. Almost ever since, a vast swath of popular culture—from Psycho to Sybil to The Three Faces of Eve—has confused schizophrenia with the idea of split personality. That couldn’t be further off the mark. Bleuler was trying to describe a split between a patient’s exterior and interior lives—a divide between perception and reality. Schizophrenia is not about multiple personalities. It is about walling oneself off from consciousness, first slowly and then all at once, until you are no longer accessing anything that others accept as real.
Regardless of what psychiatrists began to believe about the biology of the disease, its precise nature remained hard for any of them to fathom. While it seemed enough, at first, to say that schizophrenia could be inherited, that failed to account for cases—including, it seemed, Schreber’s—where it seemed to appear all by itself. This essential question about schizophrenia—does it run in families or emerge fully formed out of nowhere?—would consume theorists and therapists and biologists and, later, geneticists, for generations. How can we know what it is until we know where it comes from?
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WHEN SIGMUND FREUD finally cracked open Schreber’s memoir in 1911, eight years after it was published, what he read took his breath away. The Viennese analyst