Still from Symptoms in Schizophrenia film showing a doctor working with a masked male patient.

Symptoms in Schizophrenia

By Mark S. Micale ~

This essay was originally published in Hidden Treasure: The National Library of Medicine, 2011 and also available on Medicine on Screen: Films and Essays from NLM. Our knowledge of mental health has grown significantly over the past century due to advancements in psychological studies. But looking back about a hundred years, not much was known about one of today’s common disorders, schizophrenia, except that it was a newly coined term for a chronic mental disorder. One of the first of its kind, this short film introduces a deeper look into schizophrenic patients in 1930.

A four frame film strip showing a masked patient interacting with a man in a suit.Schizophrenia was a new diagnosis in interwar American medicine. Invented in 1911 by Swiss psychiatrist Eugen Bleuler (1857–1939), after World War I the term gradually supplanted “dementia praecox,” which was was associated too closely with German psychiatry. When Symptoms in Schizophrenia was shot, roughly twenty years later, the nature and origins of schizophrenia remained wholly unknown (as they still do today); the film’s intertitles declare the disorder “chronic” and make no reference to treatment, recovery, or cure. As a consequence schizophrenia could be “defined” only by observing and describing a set of diffuse psychic symptoms, none of which could be found in all cases.

James Daniel Page, professor of psychology at the University of Rochester, supervised the filming. Shot with only a stationary camera, his silent, twelve-minute film records eighteen patients in scenes of fifteen to forty-five seconds. The inmates, while adults of both sexes, stand or sit, mostly outdoors, at a redbrick institution with porches and well-kept lawns. An opening sequence depicts a large gathering of men socializing on park benches on hospital grounds.

Each patient performs a single symptom. Extravagant bodily symptoms predominate: gestures, tics, and postures. The longest scenes almost take the form of vaudeville skits: in “motor catatonia,” a staff member arranges the arms of patients in amusing poses; in “echopraxia,” a patient reflexively mimics the movements of the interviewing doctor. Page presumably made his film to provide in-house instruction about schizophrenia and its subtypes. A few written sentences are interspersed throughout, but there is no narrative coherence. The hospital and suited authority figures are unidentified. No patient names or pseudonyms are given. Viewers learn nothing about the cases or about schizophrenia as a psychological process. Eerily, the faces of many inmates are obscured: in some segments as a blindfold blocks the patient’s sight, as if he had been placed before a firing squad; in others holes have been cut out for the patient’s eyes. The patients perform for the camera and seem less crazy than comical. Their jerky, exaggerated movements are almost Chaplinesque.

A collection of 15 framed showing patient behaviors and descriptive intertitles.During the second quarter of the twentieth century the asylum was the preferred destination for those deemed insane; more than four hundred thousand people accumulated in mental hospitals across the country. A generation later, anti-psychiatric sentiment and the patients’ rights movement led to the emptying of the asylum: patients were “decarcerated” onto streets and into prisons and flophouses. Did Page’s subjects suffer this fate? How many underwent insulin coma therapy or were surgically sterilized for eugenic reasons, two widespread practices at the state asylums in the 1930s? How many were given electroshock or lobotomized in the 1940s and the 950s? And how many of them would endure until the advent of chlorpromazine (1950), the first antipsychotic compound, and the era of modern psychpharmacology?

This remarkable film, silent, mysterious, disjointed, and disturbing, doesn’t ask or answer these questions. Its abrupt ending—without credits, commentary, or closure—only adds to the feeling of psychic fragmentation it so powerfully documents.

Mark S. Micale received his Bachelor of the Arts at Washington College in Maryland in 1977. He then earned his master’s and doctoral degree at Yale University in 1980 and 1987, respectively. Micale has published an array of books on the history of psychoanalysis and psychiatry. He is now an associate professor of history at the University of Illinois and a specialist in the history of science and medicine. 

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