Something strange is happening with the word schizophrenia, something that makes it unlike any other word in the English language.
It starts with metaphor. Occasionally words drift from the language of a disease into the language of everyday things, and this path is almost always through metaphor. A symptom of the diseased body maps onto a common target and eventually it sticks; dangerous ideas become cancers, cities become blighted, pay raises become measly, and moldy stone façades become leprous.
A metaphorical use of schizophrenic endures in this way, defined as having “contradictory or antagonistic qualities or attitudes.” Thus a stock market can be schizophrenic when volatile, a politician when breaking from party lines, a composer when dissonant, a tax code when contradictory, weather when inclement, or a rapper when headlining as a poet.
There is a problem, though: This metaphorical use has nothing to do with the symptoms of actual schizophrenia. If the metaphor maps to anything, it most resembles multiple personality disorder—a disease that likely doesn’t exist and definitely is not schizophrenia.
The metaphorical use of schizophrenic suggests a rapid and unexpected switch from one extreme state to another, something like an embattled other self breaking through and taking over. But schizophrenia is not some unexpected polarity, nor is it a disease of fugue-like dissonance or a Jekyll-and-Hyde struggle for control.
As a casual misnomer, the misuse of schizophrenia would be of little interest. But metaphors invite their logical extensions, and these entailments can seamlessly influence thought. In this case, such entailments—“He could erupt any minute”—skew the ongoing discussion of the role of mental illness in violence. According to a 2003 report by a presidential commission on mental health, an alarming “61 percent of Americans think that people with schizophrenia are likely to be dangerous to others.” The report continues: “However, in reality, these individuals are rarely violent. If they are violent, the violence is usually tied to substance abuse.”
Why is there this disparity between the perceived and the believed?
We cannot know how many of these 61 percent are influenced by entailments, but almost two-thirds of those asked also thought schizophrenia had to do with “split or multiple personalities.” The fact that the metaphorical definition of schizophrenic implies extreme, unpredictable behavior and that this is likely confused with violence furthers the misunderstanding of an already deeply stigmatized illness. The continued use of schizophrenia as a metaphor for multiple personalities is a linguistic and journalistic failure.
History shows that language changes how those afflicted with stubborn illnesses view themselves and, importantly, how they are treated by others. Before antibiotics, to be tuberculin meant to be weakly resigned to one’s fate—a relationship so strong that Franz Kafka blamed his tuberculosis on his own “moral bankruptcy.” Susan Sontag, in her 1978 Illness as Metaphor, strongly objected to the then pervasive idea that one could have a cancerous personality, a kind of weakness of spirit thought to both give entry to the cancer and allow it to proliferate.
Of course, the bacteria that cause tuberculosis have nothing to do with moral bankruptcy, nor do the genetic mutations that cause cancer have anything to do with personal weakness. And whatever contributes to schizophrenia—a genetic predisposition, prenatal developmental problems, or as yet undiscovered risk factors—it has nothing to do with multiple personalities. Yet schizophrenia today, as tuberculosis and cancer before it, is spoken about as a disease of constitution (one does not have a schizophrenia as one has a fever or a tumor, but instead one is schizophrenic). This is not a quality of the disease but instead a reflection of our lack of scientific understanding of what causes it and what fixes it.