Memoir and the Diagnosis of Schizophrenia: Reflections on The Centre Cannot Hold; Me, Myself, and Them; and the ‘Crumbling Twin Pillars’ of Kraepelinian Psychiatry

Abstract

Purpose – Over 100 years ago, Emil Kraepelin revolutionised the classification of psychosis by identifying what he argued were two natural disease entities: manic depressive psychosis (bipolar disorder) and dementia praecox (schizophrenia). Kraepelin's discoveries have since become the “twin pillars” of mainstream psychiatric thinking, practice, and research. Today, however, a growing number of researchers, clinicians, and mental health service users have rejected this model and call for a symptom-led approach to prioritise subjective experience over diagnostic category. The purpose of this paper is to ask: how can the published first-person accounts of experts by experience contribute to these debates? Design/methodology/approach – This paper analyses the representation of psychiatric diagnosis in two prominent autobiographies: Kurt Snyder's Me, Myself, and Them: A Firsthand Account of One Young Person's Experience with Schizophrenia (2007) and Elyn Saks' The Center Cannot Hold: My Journey Through Madness (2007). Findings – As well as providing a prognosis and a plan for treatment, the psychiatric diagnosis of schizophrenia gives shape and meaning to the illness experience and ultimately becomes the pivot or platform from which identity and memoir unfold. Practical implications – The paper introduces two popular autobiographical accounts of schizophrenia which may be useful resources for mental health service users and clinicians. Social implications – The paper highlights the complex ways in which people interpret and make meaning from their psychiatric diagnosis. Originality/value – The paper demonstrates that first-person accounts make an important, if frequently overlooked, contribution to debates about psychiatric diagnosis.