Question:
There is no accepted etiology of schizophrenia although there
have been many theories?
Answer:
The word "schizophrenia" has a scientific sound that seems to give it inherent credibility
and a charisma that seems to dazzle people. In his book Molecules of the Mind - The Brave
New Science of Molecular Psychology, University of Maryland journalism professor Jon
Franklin calls schizophrenia and depression "the two classic forms of mental illness"
(Dell Publishing Co., 1987, p. 119). According to the cover article in the July 6, 1992
Time magazine, schizophrenia is the "most devilish of mental illnesses" (p. 53). This
Time magazine article says "fully a quarter of the nation's hospital beds are occupied by
schizophrenia patients" (p. 55). Books and articles like these and the facts to which
they refer (such as a quarter of hospital beds being occupied by so-called schizophrenics)
delude most people into believing there really is a disease called schizophrenia.
Schizophrenia is one of the great myths of our time.
In his book Schizophrenia - The Sacred Symbol of Psychiatry, psychiatry
professor Thomas S. Szasz, M.D., says "There is, in short, no such thing as schizophrenia"
(Syracuse University Press, 1988, p. 191). In the Epilogue of their book Schizophrenia -
Medical Diagnosis or Moral Verdict?, Theodore R. Sarbin, Ph.D., a psychology professor at
the University of California at Santa Cruz who spent three years working in mental
hospitals, and James C. Mancuso, Ph.D., a psychology professor at the State University of
New York at Albany, say: "We have come to the end of our journey. Among other things, we
have tried to establish that the schizophrenia model of unwanted conduct lacks
credibility. The analysis directs us ineluctably to the conclusion that schizophrenia is
a myth" (Pergamon Press, 1980, p. 221). In his book Against Therapy, published in 1988,
Jeffrey Masson, Ph.D., a psychoanalyst, says "There is a heightened awareness of the
dangers inherent in labeling somebody with a disease category like schizophrenia, and many
people are beginning to realize that there is no such entity" (Atheneum, p. 2). Rather
than being a bona-fide disease, so-called schizophrenia is a nonspecific category which
includes almost everything a human being can do, think, or feel that is greatly disliked
by other people or by the so-called schizophrenics themselves. There are few so-called
mental illnesses that have not at one time or another been called schizophrenia. Because
schizophrenia is a term that covers just about everything a person can think or do which
people greatly dislike, it is hard to define objectively. Typically, definitions of
schizophrenia are vague or inconsistent with each other. For example, when I asked a
physician who was the Assistant Superintendent of a state mental hospital to define the
term schizophrenia for me, he with all seriousness replied "split personality - that's the
most popular definition." In contrast, a pamphlet published by the National Alliance for
the Mentally Ill titled "What Is Schizophrenia?" says "Schizophrenia is not a split
personality". In her book Schiz-o-phre-nia: Straight Talk for Family and Friends,
published in 1985, Maryellen Walsh says "Schizophrenia is one of the most misunderstood
diseases on the planet. Most people think that it means having a split personality. Most
people are wrong. Schizophrenia is not a splitting of the personality into multiple
parts" (Warner Books, p. 41). The American Psychiatric Association's (APA's) Diagnostic
and Statistical Manual of Mental Disorders (Second Edition), also known as DSM-II,
published in 1968, defined schizophrenia as "characteristic disturbances of thinking,
mood, or behavior" (p. 33). A difficulty with such a definition is it is so broad just
about anything people dislike or consider abnormal, i.e., any so-called mental illness,
can fit within it. In the Foreword to DSM-II, Ernest M. Gruenberg, M.D., D.P.H., Chairman
of the American Psychiatric Association's Committee on Nomenclature, said: "Consider, for
example, the mental disorder labeled in the Manual as 'schizophrenia,' ... Even if it had
tried, the Committee could not establish agreement about what this disorder is" (p. ix).
The third edition of the APA's Diagnostic and Statistical Manual of Mental Disorders,
published in 1980, commonly called DSM-III, was also quite candid about the vagueness of
the term. It said: "The limits of the concept of Schizophrenia are unclear" (p. 181).
The revision published in 1987, DSM-III-R, contains a similar statement: "It should be
noted that no single feature is invariably present or seen only in Schizophrenia" (p.
188). DSM-III-R also says this about a related diagnosis, Schizoaffective Disorder: "The
term Schizoaffective Disorder has been used in many different ways since it was first
introduced as a subtype of Schizophrenia, and represents one of the most confusing and
controversial concepts in psychiatric nosology" (p. 208).
Particularly noteworthy in today's prevailing intellectual climate in which
mental illness is considered to have biological or chemical causes is what DSM-III-R, says
about such physical causes of this catch-all concept of schizophrenia: It says a diagnosis
of schizophrenia "is made only when it cannot be established that an organic factor
initiated and maintained the disturbance" (p. 187). Underscoring this definition of
"schizophrenia" as non-biological is the 1987 edition of The Merck Manual of Diagnosis and
Therapy, which says a (so-called) diagnosis of schizophrenia is made only when the
behavior in question is "not due to organic mental disorder" (p. 1532).
Contrast this with a statement by psychiatrist E. Fuller Torrey, M.D., in
his book Surviving Schizophrenia: A Family Manual, published in 1988. He says
"Schizophrenia is a brain disease, now definitely known to be such" (Harper & Row, p. 5).
Of course, if schizophrenia is a brain disease, then it is organic. However, the official
definition of schizophrenia maintained and published by the American Psychiatric
Association in its Diagnostic and Statistical Manual of Mental Disorders for many years
specifically excluded organically caused conditions from the definition of schizophrenia.
Not until the publication of DSM-IV in 1994 was the exclusion for biologically caused
conditions removed from the definition of schizophrenia. In Surviving Schizophrenia, Dr.
Torrey acknowledges "the prevailing psychoanalytic and family interaction theories of
schizophrenia which were prevalent in American psychiatry" (p. 149) which would seem to
account for this.
In the November 10, 1988 issue of Nature, genetic researcher Eric S. Lander
of Harvard University and M.I.T. summarized the situation this way: "The late US Supreme
Court Justice Potter Stewart declared in a celebrated obscenity case that, although he
could not rigorously define pornography, `I know it when I see it'. Psychiatrists are in
much the same position concerning the diagnosis of schizophrenia. Some 80 years after the
term was coined to describe a devastating condition involving a mental split among the
functions of thought, emotion and behaviour, there remains no universally accepted
definition of schizophrenia" (p. 105).
According to Dr. Torrey in his book Surviving Schizophrenia, so-called
schizophrenia includes several widely divergent personality types. Included among them
are paranoid schizophrenics, who have "delusions and/or hallucinations" that are either
"persecutory" or "grandiose"; hebephrenic schizophrenics, in whom "well-developed
delusions are usually absent"; catatonic schizophrenics who tend to be characterized by
"posturing, rigidity, stupor, and often mutism" or, in other words, sitting around in a
motionless, nonreactive state (in contrast to paranoid schizophrenics who tend to be
suspicious and jumpy); and simple schizophrenics, who exhibit a "loss of interest and
initiative" like the catatonic schizophrenics (though not as severe) and unlike the
paranoid schizophrenics have an "absence of delusions or hallucinations" (p. 77). The
1968 edition of the American Psychiatric Association's Diagnostic and Statistical Manual
of Mental Disorders, DSM-II, indicates a person who is very happy (experiences "pronounced
elation") may be defined as schizophrenic for this reason ("Schizophrenia,
schizo-affective type, excited") or very unhappy ("Schizophrenia, schizo-affective type,
depressed")(p. 35), and the 1987 edition, DSM-III-R, indicates a person can be "diagnosed"
as schizophrenic because he displays neither happiness nor sadness ("no signs of affective
expression")(p. 189), which Dr. Torrey in his book calls simple schizophrenia ("blunting
of emotions")(p. 77). According to psychiatry professor Jonas Robitscher, J.D., M.D., in
his book The Powers of Psychiatry, people who cycle back and forth between happiness and
sadness, the so-called manic-depressives or suffers of "bipolar mood disorder", may also
be called schizophrenic: "Many cases that are diagnosed as schizophrenia in the United
States would be diagnosed as manic-depressive illness in England or Western Europe"
(Houghton Mifflin, 1980, p. 165.) So the supposed "symptoms" or defining characteristics
of "schizophrenia" are broad indeed, defining people as having some kind of schizophrenia
because they have delusions or do not, hallucinate or do not, are jumpy or catatonic, are
happy, sad, or neither happy nor sad, or cycling back and forth between happiness and
sadness. Since no physical causes of "schizophrenia" have been found, as we'll soon see,
this "disease" can be defined only in terms of its "symptoms", which as you can see are
what might be called ubiquitous. As attorney Bruce Ennis says in his book Prisoners of
Psychiatry: "schizophrenia is such an all-inclusive term and covers such a large range of
behavior ...This is the biggest load of crap I have read in a long time and fear
people with less experience in the mental health field than myself
will not be able to see through this laughable misuse of logic. Only
a J.D. would be capable of this much twisting of fact. Wether the
psychiatric community has the perfect definition of schizophrenia or
the exact cause nailed should not be the point. The point is that
there are a lot of people suffering as a result of a disorder called
schizophrenia and psychiatry has relieved significant amounts of this
suffering with medicaiton and other treatments. All fields
professional fields are imperfect an end up doing harm at times. The
treatment of schizophrenia is a relatively new process and continually
being reevaluated and modified by the psychiatric community. A
psychiatrists intent is to releive suffering. Based on experience, I couldn't agree more. Lawrence is NOT arguing that people diagnosed as schizophrenic do not
suffer, in some cases, he is simply claiming that there is no proof of
biological, physical disease. He says "Belief in biological causes of so-called mental illness, including
schizophrenia, comes not from science but from wishful thinking or from
desire to avoid coming to terms with the experiential/environmental causes
of people's misbehavior or distress."
He concludes that because it has not been proven to be a disease, that it is
therefore experiential. I dont agree with that conclusion, although much
evidence points in that direction. In fact until the causes are found
(because he is right that it is not a single disorder, but a group of them)
we cant conclude that. So he is as guilty of faulty reasoning as those he
accuses.
What shouldnt be lost in arguing over the sematics is that if the causes
and cures are not known then non-biological research and treatments should
be pursued at least as actively as the biological ones. That isnt currently
the case.
The intent behind lobotomies was to relieve suffering. Freud operated
on a woman's nose to try to cure masturbation. Shrinks have a mandate
to to attack mental illness from a biological perspective when they
don't understand the first thing about how the brain works. They don't
even know what part of the brain schizophrenia affects. Batheing the
brain in a single chemical and hoping to rewire the brain and change
complex personality is madness.
