Schizophrenia: physical condition or political construct?

To mark Mental Health Action Week, mental health nurse Stuart Sorensen questions the ‘facts’ about schizophrenia

Ideas have power, especially ideas that seem to be supported by evidence. Such ideas, backed by highly trained professionals, quickly come to be accepted as facts.

One such idea concerns schizophrenia. The notion of a biological brain disorder causing long-term hallucinations, delusions and thought disorders is so familiar that most people simply accept it. But just how strong is the evidence?

The disorder was first identified by Eugene Bleuler a century ago. At that time it was known as ‘Dementia Praecox’ (dementia of the young). Bleuler’s early description was of psychological problems rooted in emotional trauma and far from incurable.

Most people intuitively understand the idea that overwhelming trauma and stress results in psychological difficulty. In fact the defence of ‘temporary insanity’ resulting from life events has long been accepted by the courts as well as popular culture. Most people also accept that, given time and the opportunity to put past experiences into perspective, this ‘insanity’ can be overcome.

How then did the original idea of reaction to trauma become a biological brain disease with little hope of recovery? The answer is not scientific but political.

Psychiatry is based in physical medicine. Psychiatrists train first as doctors within the medical model, treating physical ailments with physical cures. As doctors began to take over the care of mentally disordered people it seemed natural to assume that their problems were also physical in nature.

Several ineffective physical treatments have been tried as a result of this assumption, ranging from surgical removal of parts of the brain to insulin-induced coma ‘therapy’ and electroconvulsive therapy or ‘ECT’.

Then in the 1950’s a new type of treatment emerged. Now described as an ‘antipsychotic’, chlorpromazine was the earliest of a range of drugs used to combat the symptoms of schizophrenia. First prescribed to combat vomiting it was noted that, in larger doses, it calmed psychotic patients because of its tranquilising effect. It was classified originally as a ‘major tranquiliser’ because of this sedative action. But is tranquilisation really the best treatment?

Over the years, different types of drugs have been developed, mainly based upon the dopamine hypothesis which holds that psychosis results from over abundance of the chemical ‘dopamine’ in the brain. Unfortunately there is still little evidence to support this after literally decades of research.

So what alternatives might there be?

Few would argue that antipsychotics have no place at all. But they are over-used. Arguably. the tranquilisation they provide prevents people from thinking through their difficulties. Talking treatments, such as cognitive behavioural therapy, are having a huge impact on the effects of psychosis – but only if people are alert enough to engage in the process in the first place.

Perhaps psychiatry itself, with it’s reliance on tranquilizing medications, is actually preventing recovery? Perhaps schizophrenia is no more than a self-fulfilling prophecy caused by medical assumptions about biological causes when the problem is really not physical at all? Perhaps the treatment really is worse than the disease.

Stuart Sorensen is a mental health nurse, trainer and director of AMJ Socialcare Training & Consultancy Ltd.

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