I've started a new post here because I didn't want to hijack unity's thread about raising awareness. But Rupert specifically asked me about evidence for a throwaway comment regarding schizophrenia. I'll try to answer it in this thread.
The comment was about the lack of evidence to support the syndrome of schizophrenia as a diagnostic category. Let me try to be more comprehensive. However I'm intentionally avoiding throwing reams of information into one post - that way lies exhaustion for one thing. Instead I'll offer overview and invite you Rupert, or anyone else to ask for further clarification on anything that seems not to make sense.
first of all - I'm not saying that psychotic symptoms don't exist - they clearly do and they clearly have significant impact upon people. So I'm not suggesting that hallucinations, delusions and thought disorders aren't real. What I'm saying is that the diagnostic concept of schizophrenia doesn't really seem to hold water in explaining what they mean or even how they fit together. It's all too arbitrary for one thing.
Diagnosis only has value if it does one of two things:
1 Predict outcome
2 Inform treatment
The diagnosis if schizophrenia does neither. Treatment varies and in fact there is very good evidence (WHO International Study of Schizophrenia for example) that medically-based Western approaches to schizophrenia are much less successful than some socially-driven approaches from elsewhere.
Additionally - the prediction usually associated with schizophrenia is a deteriorating course with progressive fragmentation of the personality. In short, the psychiatric equivalent of a death sentence. And yet many people diagnosed with schizophrenia recover. The work of Professor Marius Romme and Sondra Escher in Holland in the 1980s sparked off an international movement known as 'Hearing Voices' aimed at helping people to deal with their experiences instead of pathologising them.
The prime medical model explanation of schizophrenia is the dopamine hypothesis. This is the hypothesis that most anti psychotic medication is based upon. The idea is that too much dopamine equals psychosis whilst too little dopamine equals parkinsonian symptoms. If this hypothesis were accurate it shouldn't be possible to have parkinsonian side effects (too little dopamine) and at the same time experience psychosis (too much dopamine). There is a reason why it's still known as the dopamine hypothesis and not the dopamine fact or even the dopamine theory.
The pharmaceutical industry has looked for decades at specific dopamine receptors to try to explain this anomoly but have never managed to do so. At least not yet. they might come up with an explanation one day but as yet there's very little evidence to support antipsychotics in favour of any other form of major tranquiliser.
The other main argument is the 'enlarged ventricle' research. The idea is that people with schizophrenia have larger ventricles (holes) in the brain than other people. Interstingly though we also know that antipsychotic medication causes the ventricles to increase in size so the most promising evidence of a biological cause for schizophrenia seems in fact to be a side effect of the medication.
In short, the medical model notion of schizophrenia tells us that schizophrenia is a biological brain disorder. This assumption was made around the turn of the twentieth century and yet there is still no convincing evidence of any physiological correllate. Interestingly, if it was a brain disorder as the medical model diagnosis suggests, then drugs would fix it. In fact, recovery from schizophrenia invloves increasing coping skills, developing social networks and reducing (ultimately discontinuing) medication in order that the person regains the capacity to think. Tranquilisers such as antipsychotics just slow thinking down and therefore prevent people from thinking through their experiences - a vital aspect of recovery.
When the most effective interventions involve precisely the opposite of what the diagnosis suggests shouldn't that raise a few alarm bells.
But don't just take my word for it. Google terms like:
Marius Romme
Sondra Escher
Rufus May
Patsy Hagen
Critical Psychiatry Network
Stress and Vulnerability
Psychosocial Interventions
International Study Of Schizophrenia (ISoS) (World Health Organisation)
Ron Coleman
That's as much as I'm saying for now - I could write a book about this but nobody would read a post that long so I'll shut up.
Over to you Rupert - what do I need to clarify?
Cheers,
Stuart
Visit my blog at http://stuartsorensen.wordpress.com/
Hi Stuart
I know my comment probably isn't relevant for your debate but I just wanted to mention a fellow student on my course who has really struggled with recognising schitzophrenia as a medical condition.
This student is from Somalia and describes Mental Health Services in her country as none existance. Her own Mother has schitzophrenia type symptoms, however, it is more treated by her local tribe leaders and family interventions such as staying with the person 24/7 until the episode reduces/stops, chanting sections of the Koran and performing excorcism rituals.
She describes herself as having a foot in both camps - British ideas of schizophrenia being medicalised, Somalian ideas of being personality and spiritual.
Sue B
Ps. Hope you don't mind me commenting.
Hi Suzie,
Thanks for that. And no, I don't object at all. I moved this here to avoid hijacking the other thread - not to make it exclusive.