End of "Schizophrenia"

[Dr_Evil_Mouse]

This from the BBC.

As an R.D. Laing junkie, seeing this story made me happy and wish he could have seen it. It's long overdue, imo, that people in the field look at some kinds of mental illness as having more fundamentally interpersonal (social) than intrapersonal (viz. biological) causes (however those might come to affect mental systems on a biological level). And it means that people in the field are finally getting fed up with the white-collar dealers at Eli Lilly et al., and all that shit that they peddle, which has had often nasty effects on people I've known and loved.

Schizophrenia Term Use "Invalid"

The term schizophrenia should be abolished, experts have said.

They claim the category falsely groups a wide range of symptoms and encourages over-reliance on anti-psychotic drugs rather than psychological intervention.

The academics also said the label stigmatised people as being violent, dangerous and untreatable.

But other scientists said the term should not be scrapped without finding another means of classifying patients with psychosis.

Schizophrenia represents a complex mental health disorder. Symptoms vary from person to person, but include delusions, hallucinations and disordered perceptions of reality.

It is estimated that one in 100 people will develop schizophrenia at some point in their lifetime.

But experts, speaking on the eve of World Mental Health Day, are calling for the term to be scrapped.

Richard Bentall, professor of experimental clinical psychology, from the University of Manchester, said: "We do not doubt there are people who have distressing experiences such as hearing voices or paranoid fears.

"But the concept of schizophrenia is scientifically meaningless. It groups together a whole range of different problems under one label - the assumption is that all of these people with all of these different problems have the same brain disease."

He said this can misinform treatment, and has encouraged the widespread use of "drastic biomedical interventions" as the first-line of treatment, rather than psychological help.

Although drugs were useful for some patients, too often they were given at extremely high doses and had some dangerous side-effects.

Professor Bentall said: "Overall, I think the concept is scientifically meaningless, clinically unhelpful and ultimately has been damaging to patients."

Stigmatising patients

Paul Hammersley, also of the University of Manchester, who is involved with the Campaign to Abolish the Schizophrenia Label (Castle), wants the term dropped.

He said: "It is associated with violence, dangerousness, unpredictability, inability to recover, constant illness, constant need for medication and an inability to work. I cannot emphasise enough how stigmatising this label is."

But the academics could not give a definitive answer to what should replace the term schizophrenia if it was eliminated.

They pointed to Japan, where the category schizophrenia was replaced with "integrated disorder" in 2004, as a possible model.

And Professor Bentall suggested patients should be treated on the basis of individual symptoms, as opposed to an overarching category.

Robin Murray, professor of psychiatry at the Institute of Psychiatry, London, said most psychiatrists accepted term schizophrenia was imperfect but warned that were it discarded another method of classification must be devised.

He said: "If we don't have some way of distinguishing between patients, then those with bipolar disorder or obsessional disorder would be mixed up with those currently diagnosed as having schizophrenia and might receive treatments wholly inappropriate for them.

"Most psychiatrists would still agree that the term schizophrenia is a useful, if provisional, concept. My personal preference would be to replace the unpleasant term schizophrenia with dopamine dysregulation disorder which more accurately reflects what is happening in the brain when someone is psychotic. "

Til Wykes, professor of clinical psychology and rehabilitation at the Institute Of Psychiatry, said: "We should be careful not to throw the baby out with the bath water, as despite its limitations, a diagnosis can help people access much needed services.

"What all of us have to remember is that these are people with a diagnosis of schizophrenia, not 'the schizophrenic'."

[Alexis]

i wouldn't say it's the end yet.

"It is associated with violence, dangerousness, unpredictability, inability to recover, constant illness, constant need for medication and an inability to work. I cannot emphasise enough how stigmatising this label is."

while that may be stigmatizing, for people who have an accurate diagnosis it's the truth.

There's still a lot of work to be done in the mental health field. I'm glad that the stigma associated with mental health itself is slowly being deconstructed.

[Dr_Evil_Mouse]

Granted, the title should have a "?" after it, but whether someone is violent, dangerous, unpredictable, unable to recover, constantly ill, constantly in need of medication, or unable to work, the diagnosis as "schizophrenic" doesn't, these folks agree, do much to help them on their way. It's an overdetermined category, and that makes any accuracy in diagnosis impossible while it's the driving category.

If anything, as the old argument goes, it's a term that comes out of a diagnostic ritual, where one person is socially invested with a "normal" view of the world, against which the other's is judged as "deviant".

This isn't to say that somebody can't, for a variety of reasons, have a distorted or disturbed picture of the world, and need help getting past it.

How many people turn to drugs to help them out of situations that a good (if uncompromising and challenging), sympathetic ear wouldn't help better with? And I don't necessarily mean those drugs from the good people at Glaxo Smith Kline.

[Alexis]

schizophrenics are not people who can be fixed with a few of the right pills and some therapy. and people who think the poor mentally ill person is being misconstrued by the normal world view person are completely wrong.

i get what you're saying, but i don't think you're right. a member of my immediate family has this disease and it's something that will never be cured. without his meds he's violent and unpredictable, a danger to himself and the public. with his meds he's a medicated blob that can try to have a normal life as best he can. it's a complex disease with no simple answers. every patient with this disease has a different set of contributing factors and environmental issues to deal with. i agree that a blanket diagnosis isn't right, i'm sure there are people misdiagnosed everyday despite how hard it is to be diagnosed with the disease....but that doesn't mean that it doesn't exist at all. drugs, whatever they are, whoever they come from and a sympathetic ear will not help you when you're attacking someone with an axe because you're dillussional. some problems and illnesses are bigger than a therapy couch and a pill.

[Dr_Evil_Mouse]

I don't think we're in disagreement. What I see the folks above saying is that whatever the label, the presenting symptoms will remain; abandoning that catch-all diagnosis in favour of diagnoses that better reflect the specifics of what's actually going on might better pinpoint more effective therapies.

There are certainly people in sustained distress, and those situations don't necessarily have much of anything to do with definitions of what's normal or not in society; where the arguments from Laing et al. (which are now being echoed above) took shape was in the recognition that those definitions can be misleading (and even disastrous) in the perceptions and therapeutic follow-up of the psychiatrist responsible for treatment, when they let the abstract term and generic treatment guide them rather than sensitivity to the actual person and situation. Sometimes dire measure are required.

I think, if I can try to say that more plainly (sorry, it's early), is that things are currently set up to dispense with people in crisis with nothing more than a couch and/or a pill.

It's both admirable and kind of sad how the diagnostic record (the DSM, chiefly) has evolved over the years - good, that it might be getting more accurate or useful, sad, in all the unfortunate diagnoses that have been acted on.

[ollie]

I don't think we're in disagreement. What I see the folks above saying is that whatever the label, the presenting symptoms will remain; abandoning that catch-all diagnosis in favour of diagnoses that better reflect the specifics of what's actually going on might better pinpoint more effective therapies.

If that were the case I would agree but it doesn't seem like they are there yet. The only suggestion at the moment is to rename "schizophrenia" to something more user friendly.

But I wonder if this would just confuse a public that already knows next to nothing about the disease. And while it might take away the stigma of having the disease it still doesn't do anything to address the disease.

I think the biggest problem right now with the mental health system is the lack of support services provided outside the hospital. And for the services that do exist, a lack of communication between agencies renders them mostly ineffective.

I'm in the same boat as you Alexis. My hope is that more people start talking about family members with the disease and that this will lead to a more open national dialogue on the issue. It's amazing how many people mental illness touches and yet we still don't talk about it.

[edger]

Yet stigma may be one of the most significant reasons for why we as a society don't talk about it much. While I agree wholeheartedly that simply renaming the disease is insufficient for improving the lives of those afflicted, I do believe minimizing stigma is crucial. Painting the diverse range of experience with one broad stroke is misleading, and counter productive to enhancing our understanding and tolerance.