Did Christianity lead to schizophrenia? Psychosis, psychology and self reference

Abstract

Both geographically and historically, schizophrenia may have emerged from a psychosis that was more florid, affective, labile, shorter lived and with a better prognosis. It is conjectured that this has occurred with a reflexive self-consciousness in Western and globalising societies, a development whose roots lie in Christianity. Every theology also presents a psychology. Six novel aspects of Christianity may be significant for the emergence of schizophrenia—an omniscient deity, a decontexualised self, ambiguous agency, a downplaying of immediate sensory data, and a scrutiny of the self and its reconstitution in conversion.

Paul, you are beside yourself, too much study is sending you mad.

(Acts 26.24)

This paper proposes that schizophrenia has not been universal, either culturally or historically, but that nevertheless its current near ubiquity would argue for some approximately universal predisposition. This we would seek in Christian monotheism’s reflexive consciousness and in its later secular successors. We have previously argued that the possibilities of religion and of psychosis have evolved together, through a common evolutionary trajectory (Dein & Littlewood, 2011),¹ but what in modern times and Westernised societies has got us from the human possibility of schizophrenia (“proto-schizophrenia”) to frank schizophrenia?

Before considering evidence for the nonuniversality of schizophrenia, we have to bear in mind that any attempt to search for the illness beyond its current perspective leads to the obvious objection that overt schizophrenic symptoms, though present elsewhere, may be apparent only within an already modern and Westernised perspective. Thus when C.G. Seligman, a physician and anthropologist, argued that severe mental illness was unknown in early contact New Guinea except in situations of considerable Westernisation (Seligman, 1929), he was criticised by anthropologists for ignoring psychosis which might be “concealed” in local patterns of ritual performance (apart from the likelihood that any cases of severe mental illness which came to colonial medical attention were only likely to be already in a situation of considerable contact and dominance by the Europeans—and thus “contact” was oversalient). Similar objections make the popular argument that shamanism or possession ritual conceals or “compensates” schizophrenia (cf. Fabrega, 1982).

Fabrega has argued in a caveat that the “first rank symptoms” of schizophrenia, taken in modern comparative psychiatry as an accurate manifestation of unequivocal schizophrenia, really necessitate “basic Western assumptions about human action and social reality,” particularly cultural conventions of the autonomous self (Fabrega, 1982, p. 56). He cites such conventions that persons are independent beings whose minds and bodies are separated from each other and function autonomously; that under ordinary conditions external influences do not affect an individual; that thoughts are recurring inner happenings that the self “has”; that thoughts and feelings are rather different things but that both are silent and private; that one’s body is independent of what one feels or thinks; and that body and feelings have a purely naturalistic basis and cannot be modified by external suprahuman agents (Fabrega, 1982). Barrett (2004), finding the Iban of Borneo have difficulty understanding his questions about two first rank symptoms, thought insertion and thought broadcasting, argues in a related way. His three Iban individuals (contrasted with 39 European Australians in a matched psychotic sample) who experience these symptoms are all converts to Christianity. He suggests an association with education and reading, and a familiarity with the idea of an omniscient God who can tell what is in one’s mind. (But equal numbers of Iban and Australians experienced auditory hallucinations.) Traditional Iban notions of thinking, he proposes, are much more embodied, tied closely to emotion, will, and desire: their word for “thought” also denotes “speech.”

Given the absence of any objective measures of the psychobiology of “proto-schizophrenia,” are we then compelled to go round in circles when considering the universality of schizophrenia in other societies and historical epochs? In this paper, we propose a fairly broad perspective of what the “eventual” symptoms of schizophrenia might be, taking into account the apparent overlap with other patterns such as mania or delirium: and thus in intention at any rate avoiding the category mistake of assuming that all the manifestations of schizophrenia are and have been universal. Nevertheless, past commentators have inevitably made judgements in relation to their own categories of illness, and putting their own conclusions together can never be fully persuasive: we have to move in and out of presumed uniformity and less certain family resemblances.

Cultural variation

The idea that Westernisation resulted in a higher incidence of schizophrenia was common in the 19th and 20th centuries and was discussed by Kraepelin in 1919/1971. In 1810 Richard Powell had noted insanity was “considerably on the increase” whilst Andrew Halliday (1828) wrote “we seldom meet with insanity among the savage races of men; not one of our African travellers remark their having seen a single madman” (as cited in Hunter & Macalpine, 1963, pp. 821–822). We can take these comments with a degree of caution. Not only colonial prejudice and Victorian anxieties: the travellers were hardly looking for mental illness, nor were the early modern doctors attempting to methodically search out and register all insane people in any community. Imperial psychiatrists in Africa like Tooth and Carothers (as, more recently, Lopez in Brazil, Beaglehole in Hawaii, and Dhunjibhoy in India) later commented on the infrequency of schizophrenia among communities relatively untouched by colonialism or Westernisation (as reviewed by Torrey in 1979) but on the high frequency of toxic, confusional, or organic symptoms found in apparent schizophrenia (the primary illnesses here may of course have been an infection), but we have to be aware of their fairly prejudicial colonial mindset. Yet the Nigerian psychiatrist Adeoye Lambo (1965) agrees that schizophrenia among nonliterate Yoruba is less likely to be associated with systematised chronic delusions and is more confusional, anxious, transitory, and affective, whilst urban Yoruba have the same pattern of schizophrenia as educated modern Europeans.

It is perhaps better to rely on anthropologists (taking into account the local concepts of personhood and illness) who draw rather similar conclusions. Ackernecht (1943) cites some early field studies. In Ghana, Field (1960) however argues the association between education and schizophrenia is simply that the former makes the illness more visible, but Fortes in 1969 in a different and more administratively remote area, argues rather differently. He carried out his initial fieldwork among the Tallensi of northern Ghana in the 1930s, and then revisited them with his wife, a doctor and medical psychologist, in the 1960s. The Tallensi recognised a chronic pattern called galuk characterised by unintelligibility, confused, and erratic behaviour, an incapacity to carry out normal social and productive tasks, yet clearly distinguished from eccentricity or “other forms of abnormality.” Among the local population of around 5,000, Fortes identified in the 1930s only one instance of galuk amidst plenty of eccentrics, mentally handicapped, and senile individuals. He thinks there were no others and that early death or social concealment by the generally tolerant Tallensi were unlikely. By contrast, among the same villages in the 1960s, with local missionisation and some primary education, Fortes and Mayer find 13 cases, and more in neighbouring areas: “I had to refuse to see any more…” (1969, p. 53). Most of the 13 had previously worked in urban Southern Ghana for a period, either as domestic servants or unskilled labourers.

Firth (1973, p. 224), without citing specific instances, maintains that nonindustrial societies are more tolerant of the symbolisations of mental illness and are more likely to enter into a successful dialogue with them. Reviewing data from Ireland and Istria, Murphy (1982, p. 70) argues high rates of schizophrenia occur in situations of “conflicting or unduly complex demands”; considering the low rates among Tongans and Taiwanese, he speculates that their culture is less individualistic. Devereux proposes schizophrenia as a psychose ethnique, a product of violent processes of acculturation and oppression (Devereux, 1970, p. 248), and identifies as causal psychological detachment and fragmented or specialised lives amongst other factors. Communities in the early stages of Westernisation are less common now, but the World Health Organisation’s various studies on schizophrenia have found in developing countries a lesser incidence, better prognosis, shorter episodes, and a more affective presentation (Hopper, 2008). Leff (1981, p. 156) argues that the relationship of schizophrenia to the acute transient psychoses of the sort commonly described in the Third World (the bouffées délirantes of Franco-Cuban psychiatry: Littlewood & Lipsedge, 1981) “remains unsolved.” Working from contemporary Western symptoms, he argues that there has been a shift from bodily to psychological modes of expression; thus the bodily equivalents of delusions of control are the symptoms of catatonia (waxy flexibility, mitgehen, echopraxia, and echolalia) more common in developing and rural societies. Jablensky (1987) argues that schizophrenia is more severe and chronic in modernised societies and with industrialisation (similarly Cooper and Sartorius [1977] who favour aspects of social response); Hopper (2008) provides a critical review of such “culture” explanations.

Historical variation

Early Babylonian, Egyptian, Hebrew, and Indian texts refer to what we may take as insanity: “impulsive, uncontrolled and unreasonable behaviour” (Rosen, 1968, p. 32; also B. Clarke, 1975) but not in any systematic way; there is simply a general recognition of irrational behaviour along with a demonological explanation. Ideally the term used for this by physicians or other experts in earlier eras should be supplemented by popular lay perceptions (Macdonald, 1987) and by detailed biographical descriptions (Macdonald, 1987), but the early experts did not amplify their diagnoses with the sort of description we need. Without such evidence we cannot easily accept such statements as this by Zilborg (1941, p. 45) about the classical Greeks: “There were certain mental disturbances, obvious even to the lay person of our day, which continued to remain unrecognised.” Were Socrates’s “voices” really schizophrenia (1941, p. 41)? How can we know? It appears likely that the Greeks did not clearly distinguish “madness” (μανία, μαινομɛνοus) as psychosis from “delirium” (παράνοια, παράϕρονɛοντοus). The Hippocratic corpus (1923/1981, pp. 140, 174) often places the two together and uses both to refer to something in the course of a fever. There is no word for, or description of, chronic psychosis here unless this was subsumed into acute madness or delirium, and both Simon (1978) and Evans, McGrath, and Milns (2003) state there is no mention of anything like schizophrenia in Greece, and that μανία (mania) simply connotes “frenzy.” Madness in myth, epic, and tragedy relies on extremes of passion (Padel, 1981), with associated temporary illusions (mistaken perceptions; Rosen, 1968, Chapter 3). However, there is some idea of chronic madness in tragedy (Padel, 1981), and Jeste, Del Carmen, Lohr, and Wyatt (1985) argue that these are historical descriptions of something like schizophrenia but that the symptoms have changed over time, whilst Devereux (1970, p. 274) confidently identifies an increase during the decline of Rome. Certainly something happens here. It is in the later Roman period that Philo recounts an actual case of a quiet and chronic madman (Rosen, 1968) as does Aretaeus (Zilborg, 1941, p. 77), and Galen and Soranus, in the early Christian era, both note that mania then occurred without fever (Diethelm, 1971); by the first century C. E. Celsus refers to a “third type” of insanity, characterised by false images or disordered judgement (as cited in Jeste et al., 1985) but it was often associated with inappropriate laughter and “foolish amuse[ment]” and thus might correspond to modern mania (Evans et al., 2003).

Like Diethelm, Hunter and Macalpine (1963), in their selection of early modern and modern texts in British psychiatry, easily tag past descriptions with a label of “schizophrenia” but it seems wiser to refer to accounts where we have some more detailed contemporary description of the patients. And here we have a long gap between Hippocrates and Galen and the 17th-century English divine and astrologer, Richard Napier, who kept modestly detailed records and clinical descriptions of his patients. Napier (or, rather, his biographer who examined the casebooks statistically) finds a higher than expected proportion of young adults among those severely mentally disturbed, an association with villages with a transient population and those with a higher than average proportion of Puritans and Catholics (both presumably more religiously observant than moderate Anglicans; Macdonald, 1981, pp. 40, 61, 68–69). His “most flamboyant and recognisable kinds of insanity” (madness, lunacy, and distraction) are comparatively rare and account for 5% of consultations: they are characterised by incoherent speech and unpredictable suicides, by aimless wandering, sudden changes of mood, assaults, self-mutilation, and the destruction of others’ and their own property. These are all distinguished from melancholia and from what we would now term situational and neurotic complaints. Macdonald notes that it was only later that Locke’s emphasis on cognition and perception was to place delusions in madness rather than, as previously, in melancholy (thus suggesting that Napier might have underemphasised the amount of insanity by placing it under melancholia).²

Going back to less detailed accounts, the Anglo-Saxon literature now mentions instances of chronic insanity such as a four-year history (B. Clarke, 1975, p. 42) but those recorded are miraculous cures and hence presumably cases with a good prognosis. Cognitive changes are sometimes noted: “his powers of speech, discussion and understanding failed him utterly” (B. Clarke, 1975, p. 42). De Gordon in the 14th century mentions talking to oneself, failure to finish sentences or explain them, meaningless remarks and aimless wandering, affective lability and attempts to grasp the impossible and irrational with poor judgement (as cited in B. Clarke, 1975, p. 97). Clarke describes at length the case of the English King Henry VI: prudish, passive, religiously obsessed, and habitually dressed in black, at the age 31 he had an illness recalling catatonia which lasted for 6 months, plus two relapses, some one and a half years in all.³

B. Clarke (1975) favours such biographical data when we can get it, to avoid the emphasis on the obviously acute and frenzied cases which in the medieval period and later were dealt with by immediate physical restriction rather than observation. By the 16th century chronic madmen or their imitators (Tom O’Bedlams) were commonly seen around Britain (B. Clarke, 1975, Chapter 9). Thomas Willis in his Soul of Brutes (1674) said there was no need to give any illustrations but notes their “incongruous notions” (as cited in B. Clarke, 1975, p. 294; and Hunter & Macalpine 1963, p. 191): the pattern of severe mental illness was apparently well known. Lunacy (Latin insania, furor; Greek mania) now was generally distinguished from phrenyse which occurred only with a fever (B. Clarke, 1975, p. 259) but there was little psychological description: simply “like a wylde beast” (as cited in Hunter & Macalpine, 1963, p. 14). By the 19th century, it was common to remark psychological symptoms like “loss of affect” and detachment from surroundings (Hunter & Macalpine, 1963, pp. 879–880), and social and cultural explanations had appeared. Already in the 17th century, religious enthusiasm had been said to lead to insanity, and in the early 19th century it was recognised that there had been an increase in incidence in Western Europe, especially in the towns rather than the countryside, and especially in England (1963, pp. 823–841),⁴ although doubts were raised about selective bias in the statistics. In 1837, rates of insanity were approximately 1 in 1,000 in Europe (Scotland 1 in 574) as opposed to 1 in 262 in the United States in a survey that took into account bias and data selection. That until the 1700s delusions seem to have been included as melancholic rather than manic symptoms (Macdonald, 1981, Chapter 4), and that it was the florid and antisocial patterns which naturally came more readily to public notice may however of course both argue that recognition of schizophrenia or proto-schizophrenia was likely to have been reduced in the earlier period, to increase in the modern era when both facilities and diagnostic patterns resemble more closely our current procedures.

Reflexive self-consciousness and modernity

Nevertheless, we are left with some evidence that the transition to Western European modernity, both historically and culturally,⁵ has been associated with a pattern of psychosis which, compared with its predecessors, is less “affective,” less florid and confused, which is associated with lasting cognitive changes such as delusions, and is more chronic with a worse prognosis: in short, something resembling our current idea of schizophrenia. Among the cultural changes that have accompanied this, observers have attributed a variety of not unrelated patterns—“social change” in general, traumatic social change, urbanisation, industrialisation, modern education, literacy, Christianisation, individualism—and conscious self awareness. Most medical interest has focused on the social response to psychosis: here we want to emphasise by contrast the psychological schemata in a society which might propel proto-schizophrenia into schizophrenia. Now schizophrenia is usually thought of primarily as a biological pattern, so how might “soft” social and cultural changes affect the core symptoms (as opposed to altering prognosis through social responses like stigmatisation)? Jenkins (2004) suggests that it is the individual’s subjective attribution of the proto-symptoms (an attribution located in culture) which affects the eventual manifestation of the symptoms themselves—which are thus as cultural as they are biological. Given rather individualised and psychological thinking, the proto-voices⁶ have now to be externally located in another person (Morrison, 1999), to which we might add the obvious objection that psychopathologies (just like “normal functioning”) are a product of both biology and culture.

In this paper we focus on Christianity, not because Christianity is the single salient influence on the modern world, but because it is a significant one that has influenced (indeed it has made possible) the appearance of the industrialised and individualised world, so much so that a history of the West without Christianity would be meaningless. All (universal at least) religions provide not only an account of extramundane beings and our ultimate justification, with prescriptive norm, for social life, but also some account of the nature of humans and how they function. Though theology is obviously a social representation rather than an internal or external account of lived experience, it will be evident from the anguished quotations below (particularly those from St. Augustine’s Confessions) that the convert is constantly trying to align themself with the public dogma, reading and experiencing life through the new conceptions. We have emphasised conversion because here the discrepancy between lived experience and theology is especially salient. Initially: for if successful the convert’s ascribed role becomes his personal achievement.

The idea of the modern self famously provided by Geertz (1983, p. 59)—a “bounded, unique, more or less integrated motivational and cognitive universe, a dynamic centre of awareness, emotion, judgement and action organised into a distinctive whole and set contrastively both against other such wholes and against a social and natural background”—would be unintelligible in the absence of Christianity in which its sources may be located. A theology tells us what a person is, how people differ, how they act and are motivated, a theory of uniformity and difference; it offers a schema for the natural and ultrahuman worlds, for agency, and for influence; how appetites, emotions and cognitions arise, what they signify; and a schema of our ultimate destination as beings. Every theology involves its practical, everyday psychology of human life. We are not arguing that Christianity contains in embryo everything that we might characterise as “modern.” (Indeed, in the case under consideration, the onset of Christianity seems to have led to a temporary shift towards demonic explanations of what might otherwise be seen as illness.⁷) Nor that the original appearance of Christianity in a pagan world had exactly the same effects for a psychology as 20th-century missionisation; but that the secular modern world has involved certain psychological conventions of thinking which were strongly fortified by Christianity, as Marcel Mauss argued in 1938/1979.

Sass (2004), following the work of the phenomenologist Wolfgang Blankenburg, proposes that psychological hyper-reflexivity is significant in schizophrenia: reflective self-consciousness and other patterns in which the individual comes to focus on itself and on features of its own functioning, associated with a loss of the usual taken-for-granted experience of the local world (what, following Blankenburg, he terms a “loss of self evidence,” [2004, pp. 305–307], akin to the well known “delusional mood” of schizophrenia in which the environment is no longer normal for something odd is going on). The initially tacit, including the processes of personal psychological functioning, now becomes the focus of awareness: “a focused, introspective awareness that derealises sensations by detaching them from the unnoticed background whilst simultaneously subjecting these sensations to processes of externalisation and reification” (Sass, 2004, pp. 312–313). Aspects of the self are experienced as akin to external objects as the tacit becomes forced, artificial and awkward, and to be examined.⁸ Reflecting on this only further distances the person from any sense of naturalness or capacity for spontaneous action, thus exacerbating self-alienation (Sass, 2001). Living with this destabilising cognitive slippage and the loss of the tacit is made worse, says Sass,⁹ by those (modern) societies which encourage the same tendencies, in which everybody increasingly lives in a less stable external world and is plunged into idiosyncratic internalised experience, into a set of fragmented pluralistic alternatives in which the act of choice itself becomes problematic, and in which the individual self is increasingly restricted in that its processes, indeed it itself become an object for scrutiny. Sass describes this as “a shift from extraverted traditional societies in which emotional life, organised through myth and ritual, is at the center, to the more introverted modern societies in which intellectual processes are far more dominant” (2001, p. 318), to, as we might say, the triumph of psychology as the dominant mode of personal being. It is our argument that this “excessive” reflexive self-consciousness in part originated with Christianity and Christian conversion, and, reinforced by the Reformation and the development of popular everyday secular psychology, has grown in the modern era and is a concomitant of “Westernisation” (modernisation, internalisation) in non-Western societies.¹⁰ We will now offer six instances as to how Christian theology might have provided a route to this psychology.¹¹

Scrutiny of the self in the act of conversion

(a) A delocated and omniscient God addressed in an internal conversation

To forsake other gods is not so difficult when you can move away from them and their geographical sphere of influence—if they are gods of place and nation. The popular gods of later paganism, amoral and deceivable (Origen, 1869, p. 414), were still to be found in their place of origin, and continued their work in a local tradition, although they could relocate. While Christian universalism was to be characterised by belief, Greek and Roman religion had been orthopraxic, later with an idea that empirical knowledge of the gods was possible through divination, oracles or emergent fate: these had been generally orientated to the wellbeing of the collectivity and the gods did not communicate directly with one (Ando, 2008); there was “no proximate communication” with them (nullo inter se propinquo communicato) as Apuleius (1908, p. 11) had put it. But gods and humans were in a reciprocal relationship where the former could be benevolent when men practised the correct ritual or sacrifice: as the younger Pliny lamented, the Christians only had to burn a bit of incense and all would be well. Roman, like modern African, sacrifice was concerned with warding off disaster or to achieve practical benefits (Peel, 2000). Smith (1990) has made a distinction between these “locative cults” (which were often syncretic, subsuming one local god into another more powerful) contrasted with the new “utopian cults” such as the Hellenistic mystery religions¹² and Christianity which demanded a fundamental change in the individual and hence something like introspection. And “God is one,” insists the author of the early Shepherd of Hermas (Anonymous A, 2003): drawing on Judaism, the Christian God now denied the very existence of other gods (Origen, 1869, p. 429). Omnipresent, he controlled every bit of the world, not just the area around his place of origin. (Similarly the Hebrews who migrated from Palestine to Alexandria in the late Hellenistic period had had to do without a God in his Temple in Jerusalem; as they had to, more radically, after the destruction of the Temple and the expulsion of the Jews by Hadrian.) Communication with God was now not only by a ritual of place but by an obligatory internal personal conversation—prayer. For the 19th-century missionaries, “one of the proofs of the sincerity of our converts…. is the habit of prayer which they have acquired” (Peel, 2000, p. 256). This God was universal, omniscient, and omnipresent: “What torments my heart suffered in mental pregnancy, what groans, my God!… And though I did not know it, your ears were there,” says St. Augustine, “You knew what I endured; no human being knew” (Augustine, 2008, pp. 119–120). There was no escaping this God for He already knew what you were thinking, but one could try to plead with Him or placate Him in a silent conversation and he might respond personally: “The Lord did not leave us alone in our affliction” says a bereaved missionary in Yorubaland (Peel, 2000, p. 167). “The sacrifices of God are a broken spirit… and to obey is better than to sacrifice. God wants our hearts” an African convert is told (Peel, 2000, p. 185). Missionaries, evangelising the Yoruba in the 19th century, consciously modelled their work on the Acts of the Apostles (Peel, 2000, p. 155): “Her ori [personal deity] is made of cowries and only God who made them should be worshipped” (Peel, 2000, p. 157), just as St. Clement had stated that “We were maimed in our understanding, worshiping stones and pieces of wood… all of them made by humans” (Clement, 2003, pp. 165–166); and similarly Eusebius (Kofsky, 2000, passim). Christianity pushed the pagans into a universal linear time of redemptive history and away from their cyclical local history (Leach, 1961). Rather than, say, committing a particular crime in society, the Christian was born in universal sin (which could be redeemed). For the Yoruba, their concern with a deferral of death was transformed into the promise of eternal life (Peel, 2000)—or damnation.

(b) A private self similarly independent of immediate physical context yet located in the individual

This new deity could be encountered anywhere—“Wherever two are gathered in my name” (Mathew 18.20)—for Christianity was universal and individual (“neither Jew nor Greek… bond nor free… male or female, for you are all one man in Christ Jesus” says St. Paul). And ultimate control rested with Him, Creator and Master of the whole universe, throughout the whole universe. No longer was there any point in threatening your recalcitrant (Egyptian) idol for not coming up with the goods (Cumont, 1911/1958, p. 93): as similarly in colonial Africa, at least according to the missionaries (Peel, 2000). If God was independent of social context and place, then so was the individual self at least in its conversations with God (as Dilthey argues). Religious status was no longer signalled by external signs (circumcision), or social position (the higher stages of the Roman priesthood had been occupied by aspiring politicians in the course of their career: “The internal status of the officiating person was a matter of… indifference to the celestial spirits” [Cumont, 1911/1958, p. 91]). “Now it is not our flesh that we must circumcise, we must crucify ourselves, exterminate and mortify our unreasonable desires” (John Chrysostom, 1979), “circumcise your heart” says “St. Barnabas” (2003, p. 45) for religion became internal and private. Like the African or Roman self (Mauss, 1938/1979), the Jewish self had been embedded in a functioning society, individually decentred and socially contextualised (Di Vito, 1999); it survived death only through its bodily descendants: “But Abram cried, what can you give me, seeing I shall die childless” (Genesis 15.2). To die without issue was extinction in both religious systems (Madigan & Levenson, 2008). But now an enduring part of the self, or an associate of it—the soul—had a connection to what might be called body and consciousness yet had some sort of ill defined association with them. In its earthly body it was in potential communication with God. Like God it was immaterial and immortal. (The associated resurrection of the physical body, though an essential part of Christian dogma, has played an increasingly less important part in the Church [cf. Stroumsa, 1990].) For 19th-century pagan Yoruba who already accepted some idea of a hereafter, each village has its separate afterlife which had to be fused by the missionaries into a more universal schema (Peel, 2000, p. 175). If the conversation with God was one to one, then each self-aware individual had then to make up their own mind on adherence—and thus the detached observer became the surveyor of the whole world (Dumont, 1985). Sacral and secular became distinct (separate “functions” as Dumont calls them), further presaging a split between psychological faculties. The idea of the self/soul as an autonomous unit facing God became the basis, via the stages Mauss (1938/1979) briefly outlines, for a political philosophy of individualism (MacFarlane, 1978). The missionaries in Africa constantly attempted to reach the inside of their converts, but bemoaned that the Yoruba did not seem to have any inward core to the self (Peel, 2000, Chapter 9). Lienhardt (1985), whilst broadly sympathetic to the idea of a precolonial African “collectivist” self, maintains that some aspects of individuality were of course already recognised (“said the king… it is only I who can see the dance of the tortoise: his dance is entirely inside him”—a folktale quoted in Lienhardt, 1985, p. 143); he agrees that Christian education has developed this private self as more distinct and more drastic.

(c) Scrutiny of the self

If each separate person was now a potential temple for God (1 Corinthians 3.16), yet “be you transformed in the renewing of your mind” (Romans 12.2). Everyday mundane self and experience were suspect and had to be interrogated. Introspection had been previously recommended by Plotinus (“go into yourself” [1984: 1.8.9.7-8]), and Augustine (2008, p. 123) recalls that, “By the Platonic books I was admonished to return into myself.” Not without some struggle for “I did not wish to observe myself… And I looked and was appalled… Where shall I go to escape from myself?” (2008, pp. 44, 60). “Abase thee, abase thee, O my soul!” says Marcus Aurelius (1906, p. 14) similarly. Immoral acts now become a part of you rather than something circumscribed and past to be punished by illness or crop failure: “If we say we have no sin, we are deceiving ourselves” (1 John 1.8). Christian duty now prescribed for all a rigorous self-examination ever deeper; one had to reject the compromised past, but in doing that one inevitably doubted one’s earlier perceptions and memory as having been suspect (though once tacit) and fundamentally misconceived or false. “Renunciation and despair of it are our first steps in the direction of the truth,” says William James of the evangelical Victorian (1904/1964, p. 140). “I had become to myself a vast problem and I questioned my soul” (Augustine, 2008, pp. 57–58). “Le moi est haissable” observed Pascal (1910). “What is the attitude of our soul towards your neighbour?… Examine carefully whether your heart be sincere,” recommends St. Francis de Sales (1934, pp. 294–295, 296), “[a]fter each point of the examination you will find yourself to have failed.” And Thomas à Kempis (1952, p. 196) advises “Therefore carefully examine your conscience to the best of your ability, cleansing and purifying it by true contrition and humble confession.” “Depressed in spirit, felt my own depravity” similarly comments a 19th-century mission diary in Africa (Peel, 2000). There was a shift from practice to belief (emphasised yet again in the Reformation with its particular emphasis on self-control [Max Weber]), and thus a focus on how you could believe, how you knew that you believed, and what it was to be sure (Needham, 1972). (But there never could be any certainty, as Calvin notoriously noted.) Early Christianity appears to have been essentially a peasant protest movement (Horsley, 2005), and such introspection only seems to have come in after its more immediate political defeat (the leader’s execution) with gentile Christianity’s shift to a less politically engaged internalisation (compare the early modern Anabaptists and Quakers). Augustine quotes Galatians (5.17)—“you are unable to do what you wish”—to emphasise a compartmentalised and conflicted mind in which the elements are set against each other, unknowing, a conflict particularly salient at the period of conversion, and which William James (1904/1964) makes sense of using the idea of an unconscious. The point of self-examination was to achieve a new self mastery to conquer what were taken as the more bodily emotions. St. Colombanus writes in a 7th-century sermon: “Will you not beware of yourself, wretch, and have no confidence in yourself—you who are ensnared by yourself, but not set free by yourself” (as cited in Holder, 2000, p. 113). Early monastic accounts emphasise a constant monitoring of mood and the practical management of mood, in fighting the demons of anger (Goehring, 2000; Stewart, 2000): “do not let the sun go down on your anger” (Ephesians 4.26). One attempted such self-mastery away from others in secret (ένκpατια); similarly good deeds should be private and hidden (Mathew 6. 1-18). Secular introspective scrutiny in printed autobiographies (as well as in private letters) can be dated from the mid-16th century in England, emerging out of the religious confessional literature (Skura, 2008; Barker 1984; cf. Burckhardt, 1945): “In those days I would wreak mine anger altogether with pen and ink on paper”; “I… thought that to dissemble with a dissembler was no dissimulation” (c.1569); “as I have changed the inward affectes of my minde, so I have lured my wanton workes to effectuall labours” (1590; all three quoted in Skura, 2008).

(d) Everyday sense data is downplayed

If Hebrew salvation had been essentially this worldly, in Daniel 12 (and 1 Enoch 22) we do have some firmer intimations of a life to come (possibly under Zoroastrian influence; Madigan & Levenson, 2008). In Christianity there was now a clear Platonic separation between the world of everyday experience—mundane, temporary, and compromised—and the real other world which was beyond sensory perception. “Nothing that is visible is good” says St. Ignatius (2003, p. 273). Origen (1872, p. 462) comments that, “All the Christians therefore have the eye of the mind sharpened, and the eye of sense closed.” Estranged from God, we now had to find him by estranging ourselves from our everyday life however appealing: “Natural good is not simply insufficient in amount and transient, there lurks a falsity in its very being” describes William James for the Christian (1904/1964, p. 140). “Do not love the world nor the things which are in the world” (1 John 2.15). “Such [social] amusements,” comments Edward Gibbon acerbically (1993, p. 527), “were rejected with abhorrence, or admitted with the utmost caution, by the severity of the fathers”: Thomas à Kempis (1952, pp. 33, 88) recommends that “Man’s true spiritual progress depends on denial of the [bodily] self…. Live a dying life… dead to self.” St. Ignatius comments that, “I no longer desire to live like a human” (Ignatius, 2003, p. 281). Our current world was impermanent but we had been redeemed from the sin of Adam through the Incarnation: “Old things have passed away, all has become new” says a 19th-century American convert (cited in James, 1904/1964, p. 200). It is particularly the immediate material aspects of our current world—food, sex, comfort, anger—that must be downplayed through fasting and self-denial, and engagement with them deprecated (Origen, 1872, p. 460). This involved the individuals themselves who to an extent become questionable and unreal. In the 17th century John Bunyan recommended “I must first pass a sentence of death… upon everything that can properly be called a thing of this life, even to reckon myself, my wife, my children, my health, my enjoyment, and all, as dead to me” (as quoted in James, 1904/1964, p. 156). As the boundaries of possible experience passed beyond the human lifespan, they became separated from real life, extending on as a more abstract principle. “[Christians] live in their respective countries, but only as resident aliens” says the author of the Epistle to Diognetus (Anonymous B, 2003). What people actually could do in this extended life to come was left a little vague in experiential terms, but there were continued debates in the early church as to the activities and nature of the soul: was it purely intellectual as Origen (1869, pp. 137–142) avowed? Or did Resurrection involve the body as well as the soul (and the nature of the resurrected body was left open for medieval debate)? Like other religious systems but perhaps more so, Christianity used logical paradoxes to emphasise the value of the theorised spiritual over the experienced (the Folly of the Cross, Death of Death and Hell’s Destruction, three persons in one, “My power is made perfect in weakness,” “Credo quia impossibile est”). Taught the missionary when faced with materially inclined (and presumably mystified) Africans, “to die is to gain” (Peel, 2000, p. 166).

(e) Conflicted agency and divine grace

“And he is truly learned who renounces his own will for the will of God” (Thomas à Kempis, 1952, p. 32). One had to surrender to God—“break us, melt us, mould us and fill us with a love of God” as Methodists still appeal to the Holy Spirit (Heelas, 1981, p. 41); and personal agency was anyway less to be taken for granted—“I saw that when I acted against my wishes, I was passive rather than active” (Augustine, 2008, p. 114). Jewish salvation and divine punishment seem to have been this worldly and collective (Exodus 20.5) although there are hints of something more individual in Ezekiel 18.1–4 (Madigan & Levenson, 2008). Rather than their being natural and unremarked, the individual now had themself to focus on what it was to decide and act, and why. How did some people make the decision to reject God? Was it some malign external force yet within oneself (later to become codified as the Devil)? If God acted through you, was the active agent God or you, or somehow both? How could it have gone otherwise? How can I be sure I am saved? Can I be sure I am sure? Though the fuller development of these questions only occurred in late medieval theology, we can imagine how they pricked the minds of the more philosophical or nervous early converts like Augustine. And yet at the same time one was somehow finally responsible for one’s actions: Augustine opposed astrology because it located sin as external to him (Augustine, 2008, bk 4, Chapter 3). And yet the full weight of moral decision was ultimately externalised onto God as “grace,” his gratuitous and undeserved gift (Pitt-Rivers, 1992): “one of the symbolic ways of displacing personal responsibility” comments Firth unkindly (1970, p. 25). God comes to Augustine without his apparent intentions and does something to him: “I was astonished to find that already I loved you” (Augustine, 2008, p. 127); yet “fearing a precipitate plunge, I kept my heart from giving any assent” (2008, p. 94). But that final plunge is somehow involuntary and up to God’s grace for “the mind commands the body and is instantly obeyed. The mind commands itself and meets resistance” (2008, p. 47). In the second century, Origen (1869, p. 416) comments that some “may have been converted to Christianity, as if against their will.” The confusing idea of “grace” somehow implies that God acts, and yet doesn’t act obviously, allowing and encouraging something human to happen (and was it inevitable anyway?). If so, why was it previously blocked by our sin? Presumably this would lead to confusion over personal and divine agency in the individual: Augustine for instance is constantly uncertain as to whether God or he is the active agent of a decision or action. We might assume that for the average convert, this would have been guided and made easier by the clergy, but the internalised God/self/soul/mind relations continued to be ambiguous:

So I was in conflict with myself and was dissociated from myself. The dissociation came against my will; this was not a manifestation of an alien mind but the punishment suffered in my own mind … And so it was ‘not I’ that brought this about. (2008, pp. 148–149)

Augustine’s conversion does not seem to have resolved these experiential issues, but rather that they passed into relative insignificance when he surrendered, took shelter in God, and then passed the credit for all his new now approved actions and thoughts onto God’s grace.

(f) Decomposition and conflict of the self in conversion

Conversion (followed by exorcism and baptism) was a total transformation which entailed the introduction of a split in the self which was ideally resolved through God’s grace. You could be a Roman pagan, and a Neo-Platonist as well as a bit of a Manichee as was Augustine in a sort of “add on” process (or consider Apuleius’ Lucius who collected various different pagan initiations), in which maybe you emphasised bits of one more than the other but you did not have to totally discard the other. Christianity however demanded a total renunciation of the old: “Unless a man is born again, he cannot see the kingdom of heaven” (John 3.3). (We are here assuming a voluntary conversion, not the forced mass conversions of Saxon England or Germany, or later of Uganda, but the rationale of any conversion presumed some volition which all successful converts placed retrospectively on their past act.) In conversion, there are two of you recognised and experienced: the older unregenerate you which persists in memory (or backsliding) after the conversion, “our old self” (Romans 6.6), and the new self anticipated or imagined before conversion, whether to be then welcomed or not. In the 17th century, Sir Thomas Browne, speculating on salvation, similarly comments “There is another man within me” (Browne, n.d., p. 110). Pascal: “So man is always divided and opposed to himself” (Pascal, 1910, p. 190). “God grant me chastity and continence but not yet” the vacillating Augustine complains (2008, p. 148). His dilemma ended in his final conversion when he found an injunction from God (Romans 13: 13–14) to give up the erotic life: but God’s agency and grace not Augustine’s. At the actual moment of conversion you are in two minds (“the divided self” as William James [1904/1964, Chapter 8] called it¹³), at which point the operations of the other self may for a moment become more salient and problematic, and have to be momentarily considered for you are then that other self. “The winds blow first one way, then the other, pushing my heart to and fro” (Augustine, 2008, p. 106). There is a dialogue between the two selves: “Why then are you perversely following the teaching of your flesh?” he asks himself, and admonishes “Do not be vain my soul” (2008, pp. 62, 63). “Because we are of two minds… we do not realise that we are doing evil” says St. Clement (2003, p. 197). For Augustine the two selves were the older unregenerate self, dominated by the sensual appetites, opposed to the new spiritual self (“This weight was my sexual habit”: 2008, p. 137); and he finally rejected his philosophical background because it could not deal with this sort of conflict (2008, p. 131). The actual moment of passing over to the new self was more or less involuntary (see section Conflicted Agency and Divine Grace) and might be sudden (Origen, 1872, p. 148). At the end, although the conflict had been real, acceptance of Christianity will mean there should be no residual doubts: “the alternative for them will be to be converted to the true view and not to deny that in the process of deliberation a single soul is wavering between different views” (Augustine, 2008, p. 149). Through becoming a Christian, recognition of God’s Incarnation in Jesus cut short his unavailing quest for perfect Platonic forms (Stroumsa, 1990).¹⁴

Conclusion: A psychology of self awareness

Putting these six influences of Christianity together, we have an implicit and experienced psychology of detachment from immediate embodied experience in the world, with an emphasis on scrutinising and questioning the convoluted workings of a hidden and immaterial self, seen as distinct from other similar selves and from the natural world, now with private communication with an omniscient presence who already knows one’s thoughts and emotions, and with ambiguous agency for personal actions and experience in the world which are no longer to be taken as tacit and unproblematic: all of which came to the fore in the process of conversion in which one has to disassemble one self and create another by carefully bringing one’s decisions to conscious awareness yet attributing the final shift externally to the omniscient grace. This involved identification and scrutiny both of the processes of memory and cognition, and of the relations between self and outside world, and between new entities (God, soul) which had a close relation with the self, in a way that was hardly necessary for the pagan. Indeed with the growth of the idea of heresy, to correctly align such personal cognitions with the dominant procedures became an issue of vital importance. Drawing on Hebrew religion (for instances a, b and e) and on the Hellenistic mystery religions and on Stoicism and Neo-Platonism (instances a, b, c and d),¹⁵ this new view could picture a more explicit hierarchy of deity, the moral soul, through the cognitive mind to animal impulses, which might all act in concert or, more usually, be in conflict.¹⁶ We find this psychological schema in Augustine: “I turned then to examine the nature of mind,” he says in a review of his conversion, “vicious acts only occur if obsession has captured the mind’s affective part which is at the root of the impulse to carnal pleasures” (Augustine, 2008, pp. 67–68). We are assuming that all of this gradually percolated down through theological texts and clerical training, to the sermons and homilies preached to the ordinary populace. And thus to the way they would understand and experience themselves. With literacy, even words and ideas became separate from the speaking individual and maintained an independent existence.

Unlike Greek philosophy, Christianity galvanises everybody. St. Gregory of Nyssa comments that,

Every corner of the city is thronged with men arguing on incomprehensible subjects. Ask a man how many obols a thing costs, and he dogmatises on generated and ungenerated essence. Inquire what is the price of bread and you are answered the Father is greater than the Son, the Son is subordinate to the Father. Ask about your bath and you are told the Son was created out of nothing. (Kellett, 1933/1962, p. 216)

Tertullian and Origen note that theology was as accessible to a workman as to a philosopher (e.g., Origen, 1872, pp. 156, 467).

The central issue in all of this seems to be the emphasis on a continued scrutiny of personal actions and inclinations amidst a multitude of alternatives, and on the downplaying of the everyday physical world, and on the problematisation of agency: in all, a new self awareness and self reference, a shifting of the centre of gravity of consciousness into the individual human being. Many habitual aspects of ourselves, and these we can presume are already enhanced in proto-schizophrenia—our bodily functioning, “chance” thoughts, sensations, impulses, and memories—can be attributed to some source external to the experiencing self (to physiology, memory, dreams, genes, passions, habits). We cannot however now attribute agency to them. As agency is withdrawn from the natural world, from others, from animals, plants, stars, and spirits, our individual agency appears enhanced and yet there remains the uneasy balance between the “is it me?” and the “is it something external?”¹⁷

Many external causes, spirits, and stars, not only no longer have agency but are no longer validated by our society, so any personal explanations of an external locus of control become increasingly idiosyncratic and divorced from our common social life (Tausk, 1919/1948).¹⁸ If the passage from proto-schizophrenia to schizophrenia is thus perhaps intelligible in social terms, does this offer any clues to the nature of proto-schizophrenia itself? If the attribution of agency is a general human characteristic, and is integral to both religion and psychosis (Dein & Littlewood, 2011), then this might suggest that both the proto-symptoms and their transformation into schizophrenia are concerned with this attribution, the transformation being related to the indigenous psychology we have considered here. This type of estrangement from experience (later reinforced by a number of secular and religious developments)¹⁹ fits well with Sass’ criteria for the reflexive self-consciousness that has perhaps propelled us into schizophrenia.

Biography

Roland Littlewood, BSc, MBBS, FRCPsych, DipSocAnthrop, D.Phil, D.Litt., DSc, is Professor of Anthropology and Psychiatry, and a Crabtree Scholar at University College London. He is an Honorary Consultant Psychiatrist, has carried out fieldwork in Trinidad, Haiti, Albania, Lebanon and Italy, and is a Past-President at the Royal Anthropological Institute.

Simon Dein, BSc, MSc, MBBS, PhD, MRCPsych, is a Senior Lecturer in Anthropology and Medicine at University College London. He is a part-time psychiatrist working in the NHS. He has written extensively on religion and health and on millennialism in Judaism and is the author of Religion and Healing Among The Lubavitch Community Of Stamford Hill: A Case Study in Hasidism. He is Chair of the Master's Degree Programme in Culture and Health at University College London and is Visiting Professor in Psychology at Glendwyr University, Wales. He is one of the editors of the journal Mental Health, Religion and Culture.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.