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Lets scrap schizophrenia

Pat Bracken and Phil Thomas


Since the caustic critiques of Szasz and Laing in the 1960s, the concept of
schizophrenia has been attacked from a variety of quarters. The psychiatric
establishment has defended the diagnosis vigorously, and schizophrenia
continues as the dominant paradigm for psychosis. It continues to attract
huge sums of research money as biomedical scientists direct a broadside of
cognitive and molecular biological techniques in the hope of cracking the
problem. Yet the scientific basis of schizophrenia remains shakier than ever.
Psychologists like Bentall and Boyle have questioned the scientific validity of
the diagnosis, as has the evidence in support of the effectiveness of its
treatment with drugs. Thornley and Adams examined in detail 2,000 drug
trials in schizophrenia over the last 50 years, and concluded that that the
majority of these studies were of poor quality, and that this was likely to
have resulted in an overoptimistic estimations of the effects of (drug)
treatment. After a hundred years of study and investigation, schizophrenia
still refuses to yield its secrets to science, so why does psychiatry still attach
such great importance to the concept?
Psychiatry and schizophrenia were spawned in the same environment, the
huge asylums which sprung up across Europe in the mid nineteenth century.
In these institutions the medical model had some notable early successes in
discovering the pathological basis of some types of insanity. For example, it
found that one form of paranoia was caused by syphilitic infections of the
brain, and that vitamin B deficiency could cause a wide variety of
psychological disturbances, including acute confusion and dementia. This
fuelled the conviction that all forms of insanity would turn out to have
physical causes. Throughout the twentieth century the quest to unlock the
secret of schizophrenia became psychiatrys raison dtre, a search that left
no aspect of human experience untouched by biomedical research. But
there is an ever widening gulf between the unreal world of neuroscience
research, and the lives that are lived under the shadow of the label of
schizophrenia, lives dulled by drugs and blighted by stigma. For psychiatry,
schizophrenia remains a sacred relic. It has to attach a great deal of
importance to the concept, because it has invested so much time, effort and
prestige in a fruitless quest for its causes. Psychiatry claims to be scientific,
but scientific approaches to knowledge should be characterised by doubt
and scepticism. For psychiatry, schizophrenia is a dogma, an unquestionable
article of faith, and to question schizophrenia is to question psychiatry. The
failure of biomedical science to reveal the cause of schizophrenia is the
ultimate condemnation of the medical model in psychiatry.
It is essential that there is absolutely no ambiguity about our position in
attacking the concept of schizophrenia. Unlike the antipsychiatrists, we do
not deny the existence of psychosis, nor do we seek to romanticise it as a
journey of self-discovery. For most people psychosis is a terrifying,
perplexing experience. But the medical model has failed in its task to

account for psychosis, and in doing so it has wrenched the ownership of the
experience from the sufferers, denying them their own attempts to make
sense out of the experience. This is why we believe that there is a desperate
need for a different relationship between madness and medicine. How
should we go about redefining this relationship? First, medicine must
abandon psychopathology, the language whereby the experience of
psychosis is turned into symptoms of mental illness. Instead it must work
with those who experience psychosis, and their carers and supporters, to
define a more human way of talking about and describing the experience.
There have already been significant developments in this area, such as the
work of the Dutch psychiatrist Marius Romme who has turned verbal
auditory hallucinations back into hearing voices. The Psychosis Seminars
developed by Thomas Bock in Germany, described in this edition of Open
Mind, is another excellent example of this approach. Second, medicine must
accept that psychosis can be meaningful for many people, although these
meanings may be painful and difficult to face. Third, it must accept that
many people who experience psychosis want to make sense of it, and we
have a responsibility to help those who want to achieve this. Finally, making
sense out of psychosis means that we must be prepared to work with the
persons explanatory framework. This does not mean that we personally
have to accept this framework, but working with it is a prerequisite for
helping someone to make sense out of his or her own experiences.
As we have said before in these columns, this has implications for the way
psychiatrists are trained, and by whom. We do not need special skills to
work in this way, no rocket science or tricky therapies, just a willingness to
listen to and respect the other persons experiences. Neither does this mean
that we have to stop using medication many people find neuroleptic
medication helpful in the acute stages of psychosis but medication has
become an end in itself, not a means to an end. This new relationship
requires a fundamental shift in the power relationship between doctor and
patient. Psychiatry has to hand over responsibility for psychosis to those
who experience psychosis. Those who experience psychosis must be
prepared to accept that responsibility.