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by John Modrow
Writers Club Press, 1996
Review by Matt Lee on Feb 28th 2001

How to Become a SchizophrenicIf you have any opinion whatsoever on the subject of schizophrenia, then this book is to be strongly recommended. Written by a schizophrenic, I hesitate to use the phrase 'recovered schizophrenic', the book is a powerful and moving contribution to the debate over arguably the most important psychiatric condition in existence. Like no other mental health issue, the diagnoses of schizophrenia has for decades now been subject to fierce and controversial debate. Modrow's work is part of precisely such a debate.

The book divides into three sections, the first providing a short succinct introduction to the position that Modrow takes in the debate. He has been through the psychiatric process and speaks, therefore, from the inside, perhaps unsurprisingly coming down against the dominant model now operative within psychiatric practice, the 'medical model'. Modrow operates from within the broad region of opinion that locates the root of schizophrenia within a schizophrenogenic environment. This approach is combined with a model derived in part from Bateson's account of the communicative 'double bind' as a causal factor within the pathological processes of schizophrenia. The main difficulty with the first section of the book is its brevity, which means that a positive account of schizophrenia is less present that it could or should have been. This criticism is not particular to Modrow, however, but is a feature of the debate, whose terms are set, for the most part, by the psychiatrists and the 'medical models' of treatment.

The second section of the book is a personal account of Modrow's own history, a case history if you like, given from early childhood to his psychotic breakdown. As it happens I read this section last, and the strength of Modrow's work is in the willingness he shows within this personal account to be brutally honest. At times the account seems confused, even contradictory, and inconsistencies appear in the same way in which inconsistencies appear whenever someone tells you their life history. These glitches and the odd veering off onto tangents display a lot of Modrow, perhaps more than he intended. At times the voice within these passages was clearly akin to the voice of a schizophrenic. This was both reassuring and moving but also troubling. A schizophrenic, one 'identified' as schizophrenic, is always going to be faced with the situation whereby their words lose their power because of their diagnoses. To thus, as Modrow does, clearly self-identify with the term pushes his account into dangerous but necessary territory. The lingering worry, perhaps, is whether the obsessive thought patterns of religiosity, through which Modrow entered his psychosis, are now being structurally reproduced with the new focus on 'psychiatry'. It is all too easy to see how the psychiatrist and the schizophrenic can enter incommensurable paradigms of argument such that the communication vital to any doctor-patient relationship is lost. Modrow's book, in this sense, is trapped within this communicative disaster that is the debate on schizophrenia.

Despite such difficulties the book is a valuable contribution to the debate and its third section provides a clear and strong reason for the book to be read widely. The third section consists of a 'technical survey' of the medical model, operating over its fifty pages as a review of the literature. Its' strength is a clear, precise and for the most part dispassionate account of the various theories and research work, presented in a roughly chronological manner. The ease with which Modrow moves across the huge field of research material speaks of long hours in the books and the benefit to anyone reading is in the way Modrow cuts a path through such a vast literature enabling others to at least begin exploring the details of the debate. The strength of Modrow's book for the debate lies in his having cleared a path through the forest, enabling us to begin to see the development of the current practice and relocate ourselves historically and socially. In my own mind Modrow provides more than reasonable doubt as to the medical model and given the increasing importance that the diagnoses of schizophrenia has within the judicial system, such reasonable doubt has widespread consequences.

Psychiatrists hate the way in which their practice is threatened with the charge of oppression and violence. Ignoring such charges as operating within a social agenda that is irrelevant to a scientific analysis may be justified when such scientific analysis is physical but medicine increasingly has to face the social issue of 'health'. In the struggle to become healthy the issue of schizophrenia must be resolved. If the anti-psychiatrists are correct then we are living with a practice abhorrent to all but the most heartless utilitarians. If the medical model is capable of sustaining itself it, as a rational scientific model should be, then it is beholden on psychiatrists to deal with the social implications of that model and that means finding answers to the questions raised by schizophrenics such as John Modrow.

Matt Lee, University Of Sussex (PhD researcher, Philosophy)

Note that this book is now back in print in its third edition.