Memoirs of My Nervous Illness
In 1903, Daniel Paul Schreber published Memoirs of My Nervous Illness, a dauntingly lengthy yet fascinating autobiographical account of psychosis. Originally confined in an institution for treatment of insomnia and hypochondriasis, Schreber experienced dramatic delusions and frightening hallucinations. As a learned gentleman of considerable social status, Schreber brought insight and articulation skills to the description of his descent into madness and the long journey back.
Robbins suggests that “Schreber’s psychosis is simultaneously a form of madness and spiritual breakthrough”. Certainly, the biographical account suggests considerable growth in the patient’s spiritual domain, even as psychosis turned his world – and his identity – upside-down. Schreber’s delusional system was complex, but perhaps the most fascinating aspect involved his belief that he was being “unmanned”. Early on, Schreber reported a semi-waking thought regarding the pleasure a woman must feel during copulation. Eventually, his delusion expanded to include his belief that he was actually being transformed into a woman by forces outside his control.
Related hallucinations were part of Schreber’s symptomology as well, as he saw himself developing a feminine body along with a “soul-voluptuousness” that was less tangible . Voices shamed him constantly, and he would sometimes lash out and call out in response. The patient felt that others saw the changes in his body as did he – another part of the delusional system. Confused and ashamed initially, Schreber became resigned to his transfiguration during the course of his illness.
At a certain point in time, Schreber opined that he sometimes had no stomach. His rational self recognized that such a situation would be untenable, and so he offered a bit of explanation related to how he was able to survive thus. In a way characteristic of the psychotic mind, however, he felt less compelled to address how he came to have no stomach and the mechanism by which the stomach was in existence at some times but not at others.
Schreber’s repeated references to bodily concerns and changes bring the somatoform disorders to mind initially. And the initial diagnosis of severe hypochondriasis might seem to offer support for this group of disorders. However, a careful reading of descriptions of the somatoform disorders proves disappointing in this regard. The most promising of the group might be body dysmorphic disorder (BDD). Though BDD typically involves imagination or exaggeration of some defect, such as obesity or scarring, an argument could be made for feminine qualities being perceived as defective in the misogynist, male-dominated world in which Schreber lived.