Well into the 20th century, family members of people with mental health problems had little choice but to place their loved ones in asylums. And with little hope of their ever coming out again. Despite the occasional success story, most patients were often forgotten by the outside world and simply left to vegetate. Though some medications were already available (including early tranquilizers such as chloral hydrate), people in asylums received little real help. While medical advances were being slowly made (along with horrendous innovations such as shock therapy and lobotomies), only the most remarkable patients managed to earn their release. A few remarkable patients would write about their experiences in a way that provided the outside world with a rare glimpse into their illness as well as what they experienced in the asylums.
One of these patients was Daniel Paul Shreber...
Born in Leipzig in 1842, Daniel Schreber was the third of five children. His father, Daniel Gottlieb Moritz Schreber was a physician and an authority on raising children, particularly in terms of how they should be disciplined. Moritz wrote more than thirty books highlighting the need for controlling the "crude nature" of children through discipline, order, cleanliness, correct posture, and muscle- 
building. He also had a fanatical opposition to masturbation which he viewed as a vile practice that needed to be suppressed at all costs. Moritz even developed a series of machines intended to correct posture and encourage right thinking. One of these machines, the "coccyx miracle", was designed to ensure that children remained upright at all times while sitting, Other innovations prevented prevents masturbation by extreme means. To ensure that the lessons being taught were properly learned, children had their successes and failures reviewed in front of the entire family. Physical punishments were used to reinforce the need for order and children were required to accept these punishments "without spite or discipline."
Despite his father's authoritarian ideals, it's still open to debate whether Daniel's early upbringing may have contributed to his later mental illness. What little information there is on his early childhood comes from Daniel's own Memoirs as well as letters written by his sisters, all of which tended to downplay how they were raised by their parents. In weighing the impact of Moritz' disciplinary practices had on his children, it should probably be pointed out that many of his five children later developed psychiatric problems later in life (including Daniel Paul).
The entire family was apparently rocked by Moritz' sudden death in 1861 although the greatest burden apparently fell on the oldest son, Daniel Gustav, who was already borderline psychotic (he would later commit suicide in 1877). By the time of his father's death, Daniel Paul was studying law and he would go on to establish himself as a lawyer and politician after passing the state bar exam. A year after his brother's suicide, Daniel married Sabine Behr in 1878 and was appointed Landgerichtsdirektor (administrative director) of the District Court in Chemnitz. Though he and Sabine never had children (only one of the five Schreber children ever did), his life seemed stable enough until he decided to run for public office during the Reichstag elections of 1884.
Running as a candidate for the National Liberal party, it was his humiliating loss to a socialist, Bruno Geiser, that triggered Daniel's first nervous breakdown. This led to a six-month hospitalization at the Psychiatric Hospital of Leipzig University where he was treated by the clinic director, Dr. Paul Flechsig. As Daniel would later describe in his memoirs, his chief symptom at the time was severe hypochondria which, as he later noted in his Memoirs, faded "without any occurrences bordering on the supernatural."
After his release from the clinic, he returned to his legal career and held a number of prominent judicial positions. Aside from Sabine suffering a series of miscarriages which ended any hope of their having children of their own, Daniel's life seemed happy enough. At least at first...
In 1893, Schreber was appointed to the Supreme Court of Appeals and he also began developing new psychiatric symptoms. As he would later write:
During this time I had several dreams to which I did not then attribute any particular significance, and which I would even today disregard … had my experience in the meantime not made me think of the possibility at least of their being connected with the contact which had been made with me by divine nerves. I dreamt several times that my former nervous illness had returned…. Furthermore, one morning while still in bed (whether still half asleep or already awake I cannot remember), I had a feeling which, thinking about it later when fully awake, struck me as highly peculiar. It was the idea that it really must be rather pleasant to be a woman succumbing to intercourse.
Despite being disturbed by the possibility of his old problems returning, he still carried out his new duties. And then the problems began.
Along with insomnia, he also became aware of strange noises which kept him from sleeping. Though he initially believed that a mouse in the walls was causing the noises, he eventually concluded that the sounds were "divine miracles." The insomnia, as well as the noises he thought he was hearing, led him to believe that he was the target of a deliberate conspiracy intended to disturbed his sleep. By November 9, the day before the anniversary of his father's death, he was disturbed enough by his thoughts of suicide to consult Flechsig. He was then readmitted to Flechsig's clinic
Not only did his insomnia not improve but his suicidal thoughts became worse as well. Of that time, he noted that, "I was completely ruled by the idea that there was nothing left for a human being for whom sleep could no longer be procured by all the means of medical art, but to take his life." His condition became even worse after Sabine left on a four-day visit to her family home. Not only was he convinced that he was the target of a conspiracy, but he suspected that Flechsig was involved. He became convinced that "divine rays" were being focused on him by countless souls which were transforming him into a woman. Along with fantasizing about having sex as a woman, he also interacted with voices only he could hear. The voices were of people he knew, famous people he never met, animals, and various religious figures, all focusing on him and his special role in life.
On June 29, 1894, Daniel Paul Schreber was transferred to the Royal Public Asylum at Sonnenstein. During his stay, he was declared officially incompetent and Schreber submitted his own writ of appeal to the Supreme Court to reverse this decision. It was also during this period that he began writing his Memoirs though he would not publish them until after his release in 1902. Schreber's Memoirs would become a highly influential book in the history of psychiatry and psychoanalysis, largely due to the influence of Sigmund Freud.
As for Schreber himself, his mental health remained rocky even after his release. Despite a brief separation from his wife while he lived with his mother and sister, he and Sabine eventually moved into a house in Dresden. They also adopted a teenage girl, Fridoline, in 1906. It was Fridoline who would later report that Daniel was "more of a mother to me than my mother." He stayed active in legal work (though his career as a judge had been ended by his hospitalization) and also managed to keep his psychotic symptoms under control. Schreber was still prone to occasional shouting episodes and be was often bothered by hearing voices though he rarely talked about his symptoms with family members. Despite these symptoms, he continued to read avidly, spent time with his wife and adopted daughter, played chess and the piano, and generally lived as well as he could.
In November 1907, Sabine Schreber suffered from a serious stroke and her husband's mental condition declined rapidly soon afterward. He was hospitalized for the third and last time at a new state asylum near Liepzig. Among the different symptoms reported in the available records on Shreber were "outbursts of laughter and screaming, periods of depressive stupor, suicidal gestures, poor sleep, and delusional ideas of his own decomposition and rotting." He was also preoccupied with auditory hallucinations which he interpreted as being supernatural in origin. Though his condition fluctuated, he never really recovered and died in the asylum on April 14, 1911.
Schreber's Memoirs would have numerous fans over the years but it was the essay written by Sigmund Freud that would make Schreber internationally known. Never having actually met Schreber, Freud based his 1911 essay on Schreber's Memoirs. Since the patient, along with with many members of his family were still alive at the time the essay came out, Freud needed to be cautious in what he wrote. More familiar with neurotics than psychotics, Freud was introduced to the Memoirs by his then-pupil Carl Jung. In writing about Schreber, Freud hoped to make him a test case on his own theories about human libido and "the riddle of paranoia." It would be his most detailed essay on psychosis and, not surprisingly, attempted to explain the psychosis developed by Schreber as a defense against the homosexual urges that he had for his therapist, Dr. Flechsig. He focused on Schreber's sense of emasculation and his preoccupation with turning into a woman. Freud identifed Flechsig as being at the root of this delusion and that it reflected Schreber's inability to handle his homosexual libido.
While Freud's interpretation certainly had its critics, it ensured that more people read Schreber's Memoirs and also inspired numerous books on Schreber, his Memoirs, and his psychotic symptoms. For many Germans, Daniel Paul Schreber would be the most famous mental patient of the early 20th century. Perhaps more importantly, given the countless mental patients who vanished into asylums never to be heard from again, patients such as Schreber who managed to recover enough to write about their experiences ensured that mental patients weren't completely forgotten. That someone as highly placed as Daniel Paul Schreber could develop mental illness helped remind the rest of society of the need for better mental health care.
That reminder would be quickly forgotten however, especially following the collapse of Weimar Germany. This led to the rise of Nazism and the promotion of eugenic campaigns that condemned declared mental patients and other "hereditary defectives" such as people with physical and mental impairments. Representing them as dregs of society who were squandering resources better spent on "healthy" Germans, Aktion T4 was born to purge Germany of these problem patients.
Between 1940 and 1941, more than 13,000 people, most of whom were mental patients just like Schreber, were killed in gas chambers at the very institution where Schreber had been committed. Though Aktion T4 would eventually be officially abolished, one of the few instances where popular pressure forced the Nazis to scrap plans for mass murder, it still quietly continued, often as part of the far greater Holocaust that followed. For those patients who managed to survive, the horror would persist long after the end of World War II.
While improvements in the treatment of mental illness have largely reduced the role of the mental hospital in dealing with patients like Schreber, his Memoirs still provide a glimpse at the often-anonymous existence mental patients faced during the era. They also represent a last look of life in mental hospitals before the horrors of World War I and II, not to mention Aktion T4, would transform patient life forever.
Though putting a human face on mental illness is still important in combating the stigma that often surrounds mental illness worldwide, stories such as Schreber's are still far rarer than they need to be. Still, despite the quiet pressure on many mental patients to remain silent about their illness remaining strong even today, more mental patients are describing what they are experiencing and being far more open about their symptoms.
Daniel Paul Schreber's legacy lives on.
