This year marks the bicentennial not only of Darwin and Lincoln, and of Edgar Allan Poe, but also of Nikolai Gogol (1809-1853), who will fittingly turn 200 on April Fools Day. In addition to his comic masterpieces "The Nose" and The Inspector General, he is remembered for his short story "The Overcoat" as well as the novels Taras Bulba and Dead Souls. And in "The Diary of a Madman" (1834) he produced an early description of what may be schizophrenia.
Compared to psychoses related to substances or to depression or mania, which are relatively common in historical and fictional accounts over many centuries, schizophrenia is relatively scarcely documented in past records before the 19th century. This has led some historians of psychiatry to argue that schizophrenia could in fact be a relatively novel disease, related perhaps to an as yet undiscovered virus or to modern society itself (a number of studies, although not all, have suggested the urban environment as a risk factor for schizophrenia). Or schizophrenia may just have had a lower profile because its unremitting, less forgiving course has afforded less historical opportunity for articulation in memoirs and literary works.
A summary of "The Diary of a Madman," as well as the historical speculations about schizophrenia, may be found here. The story is notable for being Gogol's only work written in the first person, as the remarkable account of the clerk Poprishchin, who hopelessly admires the daughter of the office director, comes to overhear the conversations of dogs in the street, and ends up convinced he is the King of Spain.
The story is an interesting amalgam, on the one hand a whimsical parody of the hapless functionary oppressed by the system, yet on the other a poignant treatment of a deteriorating mind. It ends as follows (trans. Pevear and Volkhonsky):
No I no longer have the strength to endure. God! what they're doing to me! They pour cold water on my head! They do not heed, do not see, do not listen to me. What have I done to them? Why do they torment me? What do they want from poor me? What can I give them? I have nothing. It's beyond my strength, I cannot endure all their torments, my head is burning, and everything is whirling before me. Save me! take me! give me a troika of steeds swift as the wind! Take the reins, my driver, ring out, my bells, soar aloft, steeds, and carry me out of this world! Farther, farther, so that there's nothing to be seen, nothing. Here is the sky billowing before me; a little star shines in the distance; a forest races by with dark trees and a crescent moon; blue mist spreads under my feet; a string twangs in the mist; on one side the sea, on the other Italy; and there I see some Russian huts. Is that my house blue in the distance? Is that my mother sitting at the window? Dear mother, save your poor son! shed a tear on his sick head! see how they torment him! press the poor orphan to your breast! there's no place for him in the world! they're driving him out! Dear mother! pity your sick child!...And do you know that the Dey of Algiers has a bump just under his nose?
It is telling that Gogol ended this harrowing passage with the grotesquely comic note at the end. It brought to mind the way that well-meaning folks outside of psychiatry, curious about the inscrutable, want to hear about the flamboyant absurdities of the truly around-the-bend, and end up disappointed that these are far outnumbered by sordid banalities. In the interest of understanding stigma, why is craziness so often found to be laughable, in life and in popular culture?
Three possibilities occur to me. One is the theory of humor as incongruity, as the sight of animate persons behaving as things or automata (thus slapstick and, potentially, psychosis; but it's not funny if someone really gets hurt, which is why real schizophrenia is not amusing).
Second is the theory of humor as a way to take down the powerful or pretentious. Oddly, all paranoia can be seen as massively self-centered or grandiose--in a clinical and not a moralistic sense--inasmuch as the target is implied to be sufficiently important as to mobilize intricate schemes of surveillance or hostility. Paranoia is not self-abnegating--quite the opposite. Pathologically this may be unconscious over-compensation for what is in fact the disintegration of the self, but to observers it may appear as self-aggrandizing, which may in turn inspire humor as a way to deflate the paranoia.
Third is the possibility that madness provokes massive anxiety of the there-but-for-the-grace-of-God-go-I variety, and humor is the way we manage this discomfiture.