‘For many years I treated a patient in this building, a gentle, tormented creature called Olivier, after whom, for a long time we named the disease that Professor Bleuler now proposes to call “schizophrenia”. I cannot describe to you the torments of that man’s life or the profundity of his illness. Sometimes I fancied I could hear his voices in my own head, so real were they to him, so attentive was he to their commands, even as I tried to reach him with my own voice, offering him . . . Well, what did I offer him – what could I? – beyond consolation, the occasional sedative, the hope of better things?
‘I had no cure. I still have none, though I have some thoughts that I will come to in a minute. When Olivier and his kind are ministered to, one day, when we can make them well again, it will be one of the great moments in the history of medicine. In the meantime, I cannot quite describe to you the indignation that I feel at the Viennese proposition that the experience of Olivier – a man I saw cut the “devils” from his forearm with a knife – was something caused by the behaviour of his mother to her child and should be cured therefore not by medicine but only by a system based – among other scientific non-sequiturs – upon what one small boy did not remember whether he had seen (or not seen), felt (or not felt) one night, on a train.’
Thomas, shaking with indignation, sweating beneath his black coat, paused and drank some water. In the quiet, he heard a chair being pushed back, candid footsteps and the main door being noisily closed: it was more than an exit, it was a marked departure, though he did not see who had left.
Realigning the papers on the lectern, he coughed and gathered his thoughts.
‘I need now to explain to you my interest in the disease which, out of respect for current usage, I am going to call “schizophrenia”. My fundamental position can be put quite clearly. Schizophrenia is a disease unique to humans, neurological in its base; in other words it is like Parkinson’s or Huntington’s diseases, where a brain or spinal column lesion causes tremor in the dependent outlying area. A schizophrenic patient has a lesion in the part or parts of the brain that allow us to imagine. Its supreme interest is as follows: it is not just a human disease, it is the human disease.’
Thomas paused and looked at the audience. He was aware that his style was much more polemical and informal than that of any of his mentors; it was not like the speech of John Hughlings Jackson with its stiff grammar; but he was a modern man of the twentieth century, speaking to laymen, and he must make himself clear.
‘Let us look at what distinguishes Homo sapiens from other species. Some years ago, in Africa, I gave a rather excited speech to my colleague Herr Regensburger about what divided Mr Darwin and Mr Wallace, the co-discoverers of natural selection. It was the faculty of awareness, or consciousness.’
Thomas then gave a shorter account of the theory he had offered Regensburger, of how man, after he had learned language, had been able to conjure instructive voices in his head; and of how, after the invention of writing and under the influence of huge population upheavals, the ability to summon such voices had become rarer.
‘What it left,’ Thomas continued, ‘was this heart-rending desire in humanity for something it has lost: its gods, its vanished Eden. Which of us can deny that at some level we are afflicted by a sense that our human lives are incomplete and that there lies, just beyond the reach of our perceptions, a paradise that once was ours?
‘But that is not quite all that was left. The old mechanisms for hearing voices remained in some neural patterns; and these patterns continued to be transmitted through our breeding – like the bat’s blind eye and the whale’s vestigial arms – long after we had ceased to need them. The neurophysiology of our consciousness is by no means set for all time. It is forever developing. We are not, ladies and gentlemen, the finished article. I am going to support my opinion now by reading a short extract from the father of English neurology, John Hughlings Jackson.’
Thomas then took the British Medical Journal and read the passages that Faverill had marked; and he seemed to feel his old employer’s hand on his shoulder as he did so.
‘So,’ he resumed, ‘I submit that in schizophrenia, the modern man or woman becomes something very like the earlier human I described to you. He hears external voices, and he loses the edges of himself because he cannot see his own identity and tell stories about it in the model version of the real world that normal people have – that which constitutes what I earlier called our “sixth sense”, our self-awareness, the very thing that distinguishes us from the beasts. I watched Olivier, my friend and patient, try to conjure up this inner world, I saw him struggle with all the information that bombarded him, and he could not shut it out for long enough to see himself.
‘Now, what else do we know of this condition? Well, we know that it appears to run in families. An American doctor called Isaac Ray, as long ago as 1863, noted that relatives of people with this ailment tended to display milder forms of it themselves; in 1878 the German psychiatrist Richard von Krafft-Ebing estimated that twelve out of nineteen such patients had family histories of the illness. Thomas Clouston, the great Edinburgh mad-doctor, assiduously documented family patterns more than ten years ago.
‘And if it runs in families, what does that mean? Well, that a predisposition to it is inherited, of course. Another compatriot of mine, Henry Maudsley, wrote much of “degeneration” – an idea he had borrowed from a Frenchman called Morel. The idea was that not only would an individual inherit the traits of insanity, but that the way he lived his own life – in drink and dissolution, for instance – would aggravate the characteristic when his children inherited it.
‘This idea of accumulated inheritance was made popular by the French naturalist Jean-Baptiste Lamarck, and a version of it, alas, was accepted by Darwin. (I believe it even informs some of the novels of Monsieur Emile Zola.) However, we now know that this is not how inherited traits are passed on. Very simple experiments have proved that an individual’s accumulated experience is not transmissible through breeding. To put it crudely, if you cut off a mouse’s tail, its child is still born with one. The actual way in which characteristics are passed on is through units of inheritance. The mother donates half these units, the father half. Some American gentlemen named Sutton, Boveri and Morgan have recently established that these units are transmitted through the chromosomes. But they do not blend or mix: when the embryonic cell forms, either one unit is chosen, or the other. The one not chosen, however, is still carried by the child, but mute, as it were; and then it may be transmitted in the child’s own breeding to take its chance of self-expression again, in the next generation. This process is absolutely vital, and, as I said, has only recently been explained. My own knowledge of these things is limited; I am not a botanist or a biologist, so, ladies and gentlemen, when I wanted to know a little more about the subject, I did what any good schoolboy would do:I looked up the Encyclopaedia Britannica. And there, under the entry for ‘hybridisation’, in the 1881 edition, I found listed, among others, the name of Gregor Mendel, a Moravian monk, who discovered the principle of the “either/or” in the units of inheritance. I read his papers, and was impressed by them. I am not going to explain to you now his work with garden peas; but I am going to introduce you to a new word for the units themselves. It is not a very good word: it is etymologically ill-bred (a nice irony) and, like “schizophrenia”, I feel sure it will in due course be replaced by a better. But I do not wish to appear an old cuss, so I will go along with the Swede Wilhelm Johannsen, who has recently christened it a “gene”.
‘The point is, to recap for a moment, that the idea of inherited madness has been loud in psychiatry for more than 50 years. I am saying nothing very new here, I do assure you. It is just that now at last we may be in a position to understand better the mechanism of such inheritance.
‘What else do we know of “schizophrenia”? The second important thing is much harder for me to prove to you and I may as well be honest and say to you straight away that it is a s
peculation on my part – at this time. I believe that schizophrenia is found in all human populations, regardless of climate, race or nutrition; and I believe that it occurs at roughly the same level of incidence all over the world. In Europe it seems that we can estimate that perhaps one in a hundred people will develop the disease, and I believe that one day, when we deal more often and more constructively with doctors in other countries, we shall find a similar figure.
‘I would like to quote Shakespeare to you now, but I fear my time is already running short. Suffice to say that Shakespeare has descriptions in his plays of such madness and many odd details that, it seems to me, can only have been drawn from his observation of people we would now call “schizophrenic”. I profoundly believe that it is a universal condition.
‘Now, if I am right that the capacity to pass on and inherit the gene, or, more likely, combination of genes, for this illness is steady throughout mankind, then it seems to me inevitable that it must have entered the human make-up before we spread ourselves around the world. Only if it existed before the great diaspora could it be constant; it could not have sprung up by simultaneous, identical mutation in different peoples – now in India, now in Peru. No, it must be fundamentally human and it must have arisen before the first Homo sapiens began to migrate from Africa, where Darwin and others better qualified than I, believe us to have originated.
‘In this context, what does “originate” mean? Quite simply, a chance mutation in the inherited matter, probably brought about by the simple molecular inaccuracy in cell reproduction, will cause an individual to be born who differs from his parents in some respect. And that is usually the end of it. But very rarely, that difference is so helpful to him and to his children that they can outsurvive those who lack it; they dominate; they preponderate; they live alongside the less endowed until those forerunners, failing in the competition for resources, become extinct – or are killed off by the new mutants. This is what the fossil record clearly, unambiguously tells us.
‘Homo sapiens “originated”, like all the others, alongside his precursor species, cheek by jowl. Now, I want you to imagine a picture. We are somewhere in Africa, many tens of thousands of years ago. Here, beside a pleasant stream, are two primitives, or “proto-humans” as some call them; let us call them He and She. For thousands, tens of thousands, perhaps hundreds of thousands of years they have not changed. Then suddenly, one day, a mutation occurs and out of nowhere He and She look up to see just there, on the other side of the stream . . . Adam and Eve. Let us leave the four of them there, just for the moment. But do not worry, we shall return to them.
‘What I want to find out is what exactly was this tiny change that opened the door for Adam and Eve. What was in Adam that was not in He?
‘I have cut up many brains to try and see, and, fortunately, I have not been alone. Many psychiatrists have noted something odd about the human brain. It looks symmetrical, but it is not. It is symmetrical in appearance, but not in function. Behind me – if Hans would be so kind as to switch on the projector. Thank you – is a large illustration of the human brain. All its parts, as you can see, are duplicated, mirror images, and for many years, that lovely duplication was taken as a sign of mankind’s superiority – a sort of divine symmetry, one might almost say.
‘Then, about forty years ago, a Frenchman called Paul Broca, when treating a patient who had lost the ability to speak – an “aphasic” in doctor’s terms – showed that the capacity for speech was located just here, on the left. The corresponding area on the right had no such function. Then a German called Carl Wernicke showed that another left-only area, further back and down, just here, was also implicated in speech and understanding. Again, the matching area on the right had no such function. It appeared that not only were the two halves of the brain not doing the same things, but that one faculty – language, the very thing that made us better than the apes and little lower than the angels – was resident exclusively on one side!
‘This is how Broca himself put it more than thirty years ago: “Man is, of all the animals, the one whose brain in the normal state is the most asymmetrical. He is also the one who possesses the most acquired faculties. Among these faculties – which experience and education developed in his ancestors and of which heredity hands him the instrument but which he does not succeed in exercising until after a long and difficult individual education – the faculty of articulate language holds pride of place. It is this that distinguishes us most clearly from the animals.”
‘So, clearly in Monsieur Broca’s view, this is what made Adam different from He. That is not to say that Adam spoke at once; on the contrary, I should say the all-important change between the two was an earlier mutation which enabled the hemispheres of Adam’s brain to develop differentially; and it was that mutation that gave us essentially two brains, which can both complement and back up one another, whose sum is greater than their parts and led to the vastly increased intellectual capacity of Homo sapiens over his precursor being; and thence to language, which opened the door to the development of “consciousness” – and to all that we now think of as characteristically human.
‘Including, unfortunately, schizophrenia and the related psychoses.
‘To recap once more. We have already seen that these illnesses are in some way heritable and therefore that they must be related to the “genes” that we pass on. If the illness is evenly spread throughout the world, as we believe, then that gene or genes must have been acquired before the human diaspora from Africa. We know that the symptoms of the disease involve a loss of proper self-awareness or higher consciousness. It also seems likely that these symptoms are the result of improper communication between the left and right hemispheres: in other words, that in some way thoughts are being experienced as though they were external voices – the left hemisphere receiving too many signals in too crude a form from the right, and, in its typical anxiety to please, resorting to prehistoric methods of dealing with it. The only hypothesis that can make sense of all these data is this: that the key mutation that changed He to Adam was one that allowed him to become functionally lopsided in the brain; that that same mutation allowed him to develop language; that language enabled him to develop a primitive voice-hearing consciousness. When, however, he developed writing and so made his self-instructions portable and when, furthermore, his environment – and let us remember how the environment according to Darwin selects those best fitted to survive – made the voice-hearers less useful than the readers and the self-aware, they began to be selected against: to die out. From being the majority of the population, the voice-hearers dwindled down to about, in my estimate, fifteen per cent. Most of these people hear voices only occasionally, and are not troubled by the experience. They are not sick. I myself had such a voice as an adolescent; many others are ashamed to admit to it, or in some way manage not even to admit it to themselves. In a small minority, however, the hearing of voices is part of a wider pathology, and these are the schizophrenic patients. But the important point is that the voice-hearers, whether healthy or psychotic, did not, as you might expect, become extinct. And why, ladies and gentlemen?
‘Darwin published the Origin of Species fifty years ago; although his reputation fell towards the end of the last century, the argument for natural selection has long been won, and its basic tenet is that only that which confers an advantage on the species is continually selected by the environment and therefore, as we should presumably now say, perpetuated in the “genes”. Nature never selects against the benefit of the species; it cannot. Furthermore, these poor schizophrenic people have self-inflicted losses in reproduction. They kill themselves; they are mad; they are unattractive to others; they are sexually selected against. Yet they survive at a constant level in the population. How can this be? It breaks the first law of Darwin! It can only be that a variant of that inheritance – the same units, but differently combined, so that they do not express themselves as illness – confers huge advantages. So huge that th
ey compensate both for the misery of the illness, against the species’s interest, and the reproductive failure of the afflicted! And what are the advantages? They are superior brain power, language, creative ability; and, consequently, divine dissatisfaction, a yearning for the absolute . . . the very things that distinguish us from the animals. The same “genes” that drive us mad have made us human: in different combinations, I admit, but precisely, and in my view unarguably, the same particles of inheritance. You cannot have humanity without psychosis; they are indivisible. Both, ladies and gentlemen, stem from the same submicroscopic change that changed He to Adam.’
Thomas stopped to drink some more water. There was utter silence in the hall, though it was not appreciably a friendly one, he thought. His throat felt lacerated and his temples were pounding; he wished he had not drunk the brandy. He breathed in hard.
‘Before I go on to the concluding part of my talk,’ he said, ‘I want you to be clear about one more thing. Whatever that minute change was, from He to Adam, it could have been something else.’ He paused again. ‘As Darwin so memorably wrote: “What a chance it has been . . . that has made a man – any monkey probably might with such chances be made intellectual, but almost certainly not made into a man.” It might not have led to me and you and Carinthia and Brahms and the hall of the Schloss Seeblick tonight. It could have been one of a million changes with a million, million different outcomes. That is how precarious we humans are, and that is why it fits us to be humble.’
A man in the front row of the audience, known to Thomas as a lawyer in the local town, stood up noisily.
‘Dr Midwinter,’ he said. ‘I paid money at the door to hear a talk I was assured would be both enlightening and thought-provoking. Instead, you have told me in the last hour that there is no God, no creator, that we are the result of some microscopic accident beside an African stream, that we might just as easily not have been human beings but something else, and then, for heaven’s sake, that we are all insane! Well, I have had enough. Tomorrow I shall listen to a concert of Brahms, since you mention him, or Mahler or one of the others who has made a home in our beautiful province. I shall look at the stars in the sky and I shall read Goethe. I leave you to your “genes” and your African watercourse. Goodnight, Doctor.’