This book is not another general exploration of Freud’s 1911 Schreber text or yet another account of newly discovered historical facts about Daniel Paul Schreber, still the most famous case in the history of psychiatry. It is a clinical study of what was distinctive about Freud’s 1911 conception of disposition to psychosis in relation to the views of his psychiatrist contemporaries and of psychoanalysts after him. What moved me to write the book was a growing conviction that psychiatry and psychoanalysis need to remember their common history, that they have much more in common than they realise.
My research has led me the conclusion that what Freud did was to reverse the order of priority in late nineteenth-century aetiologies of psychosis – objective-biological and subjective-biographical – but that if he privileged subjective causes, he did so without returning to the paradigms of early nineteenth-century Romantic psychiatry and without obviating the legitimate claims of psychiatry on inherited biological predisposition. Psychiatry students sometimes close their ears to Freud because they think that his theories are too subjective. The theories of Romantic psychiatry were certainly subjective in the negative sense. It related psychosis to immoral excesses, with Heinroth putting mental illness down to sin and Ideler holding the non-gratification of passions responsible. Its ties to literary and philosophical Romanticism had moved Griesinger to put an end to the poetic and philosophical conceptions of Romantic psychiatry. My book demonstrates that, unlike the likes of Feuchtersleben, Freud had no time for the subjective theories of Romantic psychiatry. On the other hand, students of psychoanalysis can be closed to the legitimate claims of biological psychiatry in relation to heredity. Therefore the book unearths the historical data which show that Freud did not do away with the claims of biological psychiatry and that he actually regarded heredity as an important predisposing factor even if he understood the specific causes to be subjective.
Why are these things important? What we often find in practitioners is an either/or approach, psychoanalysis or the DSM, Freud or Kraepelin. It’s time, in my view, to return to the history of psychiatry and psychoanalysis to discover support for a both/and approach. One can only hope that this more balanced perspective might lead to something of a rapprochement between the two sides. The book is addressed to psychoanalysts and psychiatrists, but there is also something here for patients and their families. Above all, the sub-text is that we need to listen to our patients as speaking subjects rather than another instance of a particular illness. In this regard the historical data are very interesting. They explain, for example, why Eugen Bleuler, the eminent Zürich psychiatrist, turned to psychoanalysis. Where Kraepelin could work in the Baltic city of Dorpat without understanding the languages his patients spoke, the dissatisfaction that Bleuler’s own family had experienced with the high-German speaking doctors at the Burghölzli made Bleuler set out to listen to his patients speaking in their own tongue. This is why this book begins with what Schreber said about his illness in his 1903 autobiography and the records of what he said in his patient files. Only then does it study Freud’s 1911 text and the aetiology of psychosis he develops there. Another sub-theme of the book is the extent to which his Schreber text aetiology has been accepted by psychoanalysts. There is an evaluation of the positions of Katan, Niederland, Macalpine, Lothane, Klein, Fairbairn and Lacan. If Freud’s relationships with his psychiatrist contemporaries demonstrate that he reversed the order of objective-biological and subjective-biographical conceptions of the causes of psychosis in favour of subjectivity, the book also attempts to make sense of the fact that psychoanalysts – with the exception of Lacan – have one-sidedly, for and against, stressed the homosexual component of his 1911 aetiology. Again this is a matter of setting the record straight and of challenging psychoanalysts to listen to what Freud actually said in his Schreber text.
This book is the fruit of years of research into historical documents. It has been enriched by numerous conversations with psychiatrists, psychoanalysts and historians. But there is nothing like the clinic to teach us. However, if Ida Macalpine was able to say that she and Richard Hunter had met so many Schrebers since they had published his memoirs in English, it is my hope that this book will lead practitioners to avoid the temptation to think that their patient is another Schreber. There is no set of Schrebers, no “all psychotic patients”. Every speaking subject is unique. And yet listening to patients with severe mental illness does give one some general coordinates as well as shedding light on ordinary neurosis.
How will this field evolve? More and more young psychiatrists are dissatisfied with simply prescribing medication. This wasn’t why they entered the profession. And service users are complaining that their doctors do not listen to them. Psychiatry needs to listen again as it did before the advent of neuroleptics. Psychoanalysts, on the other hand, have to recognise its limits, for example that it cannot do much with a hereditary burden although it is insufficient to cause an illness itself. As for my own current research, I have been granted the privilege of translating the newly-released letters of Freud to Bleuler into English. If the way forward today is not either Kraepelin or Freud, but Kraepelin and Freud, Bleuler remains a symbol. He is proof that the apparent gulf between psychiatry and psychoanalysis can be bridged over.