Talk:Schizophrenia: Difference between revisions

not sure what this means or how to integrate it: "Nowadays medical treatment is the mainstay of antipsychotic treament. Although drugs that are in use are better tolarated sometimes patients show signs of extrapyramidal side-effects." --KQ

Well I found a description of various EPSE but wasn't sure whether to paraphrase the material or link to it, so I linked to it.

Another article or a subpage with info for more scientifically minded ?
--Kpjas

I don't understand your question. Sorry. Is that a request for one or the other? Do you think the article is too general? Personally I have to admit I like it how it is, so that the average reader can understand it, but I see nothing at all wrong with adding more information. If you'd like to add more, by all means go ahead; I've just reached the limit of what I can do without having to research. I don't think it should be replaced entirely though. --KQ

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Very nice entry. Thanks!

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Added Julian Jaynes because I think people reading The Origin of Consciousness will be looking for more info on schizophrenia.

I think your qualification is quite mild. Indeed, historians of early periods do more than not support it - they scoff at his use of sources. His psychology may or may not be useful, but his understanding of early civilization is not, particularly. I think there's room for him in the entry, but only with a stronger sentence of qualification. --MichaelTinkler

I was shooting for very NPOV there. If you think Jaynes info should be different, please edit at will! Thanks.

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Added mention of types of schizophrenia in West and sluggishly progressing schizophrenia in the Soviet Union.

Daniel C. Boyer

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Added some clarfication on antipsychiatry.

Daniel C. Boyer

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Removed duplicated material from Emil Kraepelin article, which seems to be about Kraepelin, not schizophrenia:

According to the eminent psychologist H. J. Eysenck, Kraepelin not only deserves credit for the discovery of schizophrenia and manic-depression--he is also the founder of modern scientific psychiatry, psychopharmacology and psychiatric genetics. Kraepelin postulated that psychiatric diseases are principally caused by biological and genetic disorders and in this respect are no different from Alzheimers disease or the then very common general paresis of the insane, or cerebral syphilis. Kraepelin's psychiatric and diagnostic methods completely dominated the field of psychiatry worldwide at the begining of the twentieth century. He vigorously opposed the approach of Freud who regarded and treated psychiatric disorders as caused by mysterious psychological forces. Though Kraepelin's contribution was largely ignored through most of the twentieth century due to an uncritical adoption of Freudian speculations, Kraepelin's basic approach now once again dominates psychiatric research on the psychoses and academic psychiatry, and today the published literature in the field of psychiatry is overwhelmingly biological and genetic in its orientation. Largely for political reasons, Kraepelin's great contribution in discovering schizophrenia and manic-depression remains relatively unknown to the general public and his work is little read, despite the recent widespread adoption of his fundamental theories on the etiology and diagnosis of psychiatric disorders which form the basis of all major diagnostic systems in use today, especially the American Psychiatric Association's DSM-IV and the World Health Organization's ICD system.

For a complete bibliography of English translations of Kraepelin's works see: http://www.kraepelin.org/_wsn/page3.html

For a complete bibliography of works by and about Kraepelin's including those in the original German: http://www.med.uni-muenchen.de/psywifo/Kraepelin.htm

For detailed information on Emil Kraepelin who first discovered schizophrenia, manic depression and co-discovered Alzheimers disease including biographical, bibliographical and historical information, as well as contact information for answers to specific questions about the disease and its history, visit the International Kraepelin Society at: http://www.kraepelin.org/

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Added mention of Lawrence Stevens and link to his article.

Daniel C. Boyer

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If a religious believer sees a vision or hears voices, are they by definition psychotic? Or does psychiatry make provision for genuine revelation? Think Joan of Arc. --Ed Poor

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No. According to DSM-IV, in order for there to be a diagnosis of psychosis, the visions must not be cultural sanctioned. I.e. if seeing visions is within a person's cultural background, seeing them is not considered psychosis.

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If this does not make everyone see that DSM-IV is a book about social control rather than medicine, I can't help you. Tell me about another disease that would be defined this way -- this severely undermines currently fashionable claims that schizophrenia is a biological disease like any other! Would one not diagnose diabetes because it was within one's cultural background to have a blood sugar of 170?

Daniel C. Boyer

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Damned if you do. Damned if you don't. If DSM-IV listed objective characteristics of delusions, people would also claim that it was a tool of social control. Note that there is nothing that says the culture has to be mainstream.

This is interesting. Is your point that if the "cultural background" is a subculture this would pass muster? I am concerned how this justification of delusions would work vis a vis involuntary commitment.

Daniel C. Boyer

The way psychiatrists use "cultural background" is that anything which makes sense from the point of view of the patients cultural background is not considered delusional (even if it is a subculture). This is an important point in that most people who see devils and angels are as alarmed by it I would be if Satan popped out of the computer screen right now. If it were part of a patients belief system that is it "normal" to see Satan pop out of a computer screen, then it's not considered a delusion.

As far involuntary commitment. Bizarre beliefs are ***NOT*** grounds for commitment. The criteria used for commitment is danger to self or others.

Thomas Szasz has repeatedly explained in his writings that this magic phrase, "danger to self or others," really has no clearly-defined meaning, though we know in fact it is only used against certain people (he gives the example of trapeze artists, astronauts and race-car drivers, clearly dangers to themselves, who receive public admiration, and on the other hand the would-be suicide and the polysurgical addict). As someone who has had legal training the least I would like to see is the standard "danger to self or others," presently basically completely open-ended, more precisely defined. We may think we know what is meant by "danger to self or others" but this and similar phrases used in involuntary commitment laws have no clear definition, and this creates the risk of those who are not insane being subjected to involuntary commitment. Furthermore, the claim "the criteria [sic] is danger to self or others" is patently false. Someone planning murder, who nobody claims is insane, is obviously a severe danger to another or others, yet that person will not be involuntarily committed. "Bizarre beliefs" would have to be the first step in a two-tier process.

Daniel C. Boyer

"danger to self or others" is no more vague than other legal terms such as "due process", "reasonable person", "criminal intent" In order the avoid abuse, the standard procedure in involuntary commitment, as in the rest of the legal world, is to have legal counsel argue over these things. There are lots of gray areas, but that shouldn't prevent one from pointing out that there are lots of areas where there isn't grounds for much dispute.

You can argue this about some of these other legal standards as well, but the problem with "danger to self or others" is that the entire thing is a "gray area." Where do we draw the line with respect to danger to self? Snowboarding? Reckless driving? Eating foods that contain too much "bad cholesterol"? Being overweight? Working for the bomb squad? There is no indication that it is limited to what we tend to assume it is, and in fact, many psychiatrists might argue that the behaviour of some "at risk" teenagers is caused by a "mental illness." The range of "diseases" in the DSM is so broad as to cover nearly the entire range of human behaviour.

Daniel C. Boyer

A person standing harmlessly in a street corner who is minding his own business talking to angels would *not* be subject to commitment under the laws of most states. Involuntary commitment is used only when the angels start telling that person to kill people. In practice, involuntary commitment is used only when there is violence or the threat of violence or suicide.

And the definition isn't unreasonable. How do you know what a normal blood sugar is? Answer: You test a whole bunch of people and then look at the norm.

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in the former Soviet Union, was added a fifth, "[sluggishly progressing schizophrenia]?". Particularly in the RSFSR (Russian Soviet Federated Socialist Republic), political dissidents were diagnosed with "sluggishly progressing schizophrenia" and confined to psychiatric hospitals for the purpose of silencing them or getting them to recant their ideas. The first four, widely varying, forms of schizophrenia have led some to pose the controversial question, "Is schizophrenia one illness, or different illnesses that have been mistakenly classified under one heading?" Others (including Lawrence Stevens in his article on the World Wide Web "Schizophrenia: a nonexistent disease"; see link at end of article) have maintained that schizophrenia does not exist

This is an extraordinarily confusing paragraph. Does "sluggishly progressing schizophrenia" exist at all, or was it, as the article seems to imply, only a political invention used to repress dissidents? Could this be made clear in the article? Going on to question whether schizophrenia is one disease or a number of miscategorized conditions is interesting, but conflating that issue with political repression and Lawrence Stephens' mildly-tinfoil-hat assertions seems like a poor idea. There's already a section on anti-psychiatry lower down in the article. Perhaps this would be a better place for Mr. Stephens' doubts? I'm loath to mess with the article myself because I don't know enough about the subject. -D

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Perhaps it could be better edited -- the point is that "sluggishly progressing schizophrenia" (of very doubtful existence, to say the least) was one of the varieties of schizophrenia recognized in the RSFSR, and this, combined with the four other extremely divergent types of schizophrenia, might lead some people to question: is schizophrenia one disease? several diseases? another type of phenomenon/a miscategorized as an illness? even anything at all? and is it entirely impossible that at least some individuals diagonsed with schizophrenia in the West are misdiagnosed as a form of political repression?

You call Stephens' article "mildly-tinfoil-hat" but have not undermined any of his points or proven in any way anything he said is untrue. I would argue that many of the generally accepted beliefs about schizophrenia are more "tinfoil-hat," have far less to support them, than what Mr. Stephens says.

Really, that's not my intent here. I'm not trying to "disprove" what Stephens is saying. In fact, I don't think you can "disprove" what he's saying because he he's not exactly offering affirmative evidence that one can disprove. All he does is cast doubt on existing evidence, and point out that we don't understand the causes of the disease. That's all true, and worth pointing out. But his conclusion, that schizophrenia isn't a brain disease at all, is just wild conjecture.

As is, I would maintain, the existence of schizophrenia as a brain disease, given that we don't know what it is.

Daniel C. Boyer

And given the lack of affirmative psychological evidence provided, and the existence of various (non-conclusive) physiological evidence (such as PET scans and drug results)

How can you maintain that schizophrenia is a brain disease because certain drugs can, perhaps most of the time, lessen the speech or behaviour identified as a disease? Would it not be possible to identify (with more or less justification) any set of behaviours as a disease, and then create a drug which will when ingested will make people exhibit that set of behaviours less? Have you heard of LSD therapy? This really doesn't prove anything.

Daniel C. Boyer

It's a disease because people who see devils flying around, don't want to see devils flying around,

But for those who are subjected to involuntary commitment it obviously isn't a question of "not wanting to see the devils flying around." Your argument would seem to suggest that if you want to see the devils flying around, it's not an illness.

Yes it is. One thing that you are ignoring is here is that it many perhaps most cases where involuntary commitment is used, the patient in question does not have an opinion about where they want to be. If you have a patient who is seeing devils and doesn't care about anything else, you need a legal mechanism to get them into a hospital if they don't have the ability to check themselves in.

But if this is the case it is practically a non-issue -- if they do not object to the commitment or initiate or support procedures to contest the commitment the commitment is involuntary only in a very technical sense; indeed it becomes voluntary when the patient waives his right (even if simply by failing to exercise it) to contest the commitment. The argument only becomes important if the patient contests the commitment; only here would there be "legal counsel [to] argue over these things."

Daniel C. Boyer

Also, yes, I would argue that someone who is functional in society,

Here again the issue of social control raises its ugly head. Society demands that people behave in certain ways or they are considered "non-funcitonal."

Daniel C. Boyer

who sees devils, and who wants to see them should indeed not be regarded as ill.

This fundamentally undermines your claim about the biochemical basis of schizophrenia. Either schizophrenia is biochemically based, and any time a certain biochemical factor or combination of factors act in a particular way on a given individual, that individual has schizophrenia, or schizophrenia can be "opted-out-of" if the individual is willing to accept the symptoms of these biochemical causes! Yet you cannot simply opt out of influenza, diabetes melitus, or a cold.

Daniel C. Boyer

In practice, this situation doesn't come up often in schizophrenia, but it does come up more often in other mental illnesses. I know people who could be diagnosed with depression who I wouldn't consider ill because the moods are part of who they are and they manage their mood swings.

Daniel C. Boyer

and antipsychotic drugs stop the devils. It's not only a matter of behavior, it's a matter of perception. It's a great misconception that people with schizophrenia are inarticulate. Many if not point people with schizophrenia can tell you exactly what they are seeing and what the world looks like when they are on or off medication.

Person sees devils and believes that people are reading their mind. 300 mg of clozapine makes the devils go away and the world looks normal and people stop reading their mind. Stop taking the medication and the devils and mind readers reappear. In addition, if you give a high enough dose of methamphetamine to you or I, we will go into psychosis and have pretty much exactly the same symptoms as someone with schizophrenia. The logical conclusion here is that there is some biochemical basis for what is going on.

from schizophrenia patients, Stephens' conclusions are even less supportable than the prevailing wisdom he's so eager to attack (not that Mr. Stephens really demonstrates a detailed knowledge of psychiatry or physiology in this article-- he seems more inclined to jump on terminology and spotlight some conflicting quotes from medical professionals.)

Another problem with Mr. Stephens is that his not-very-well-spelled-out conclusions can be interpreted as anything from "schizophrenia is a psychiatric condition" to "people with schizophrenia aren't really sick at all, doctors just don't like they way they're acting" to "they're all faking it." Some of those conclusions are deeply offensive and disturbing to people who have first-hand experience with the conditions classified as schizophrenia. -D

I don't think the point is the feelings of those who self-identify as schizophrenics. The main purpose of Mr. Stephens writings here and elsewhere is to challenge the practice of coercive psychiatry. I don't think anywhere in his article it denies that people can suffer mentally or emotionally; it just questions, what is the origin of that suffering, and maintains that is something other than a disease, "schizophrenia." That some may take offence at any conclusion is not evidence that the conclusion is untrue.

But the fact that Mr. Stephens shows no evidence that he has first hand experience with people who have schizophrenia suggests to those of us who do that he doesn't know what he is talking about. Bashing psychiatrists is not the issue here. Most everyone who has dealt with schizophrenia has dealt with incompetent psychiatrists.

I don't object to challenging coercive psychiatry.

If you don't object to challenging coerceive psychiatry, do you support the practice of involuntary commitment? Because involuntary commitment is coercive psychiatry per se; to deny this is to engage in doublespeak.

Daniel C. Boyer

When someone lunges at me with a knife with intent to kill me (i.e. while they are screaming that I must die), yes I think they need to be locked up for a while. Part of the reason I don't object to involuntary commitment laws so much is that in the cases I've had to face the involuntary commitment laws are *FAR* less harsh or coercive than the alternative. If you lunge at me with a knife with intent to kill me, that's several years in prision. If my friend does it when she is off her medication that's several weeks in a mental hospital as they get her back on her meds. If the knife actually hits and someone dies, we would be looking at the death penalty or life in prision without possibility of parole rather than several years in a mental institution with some hope at least of getting out at some point in her life. I respect your experiences, but you need to respect mine. My experience is that the laws as designed seem to work well and do a good job preventing abuse.

There are some know-it-all psychiatrists who think they are God and know best and aren't willing to listen. But getting rid of incompetent psychiatrists is something which is altogether different from denying the existence of schizophrenia.

Daniel C. Boyer

Daniel C. Boyer

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Frankly, having gone what I've been through. I find Mr. Stephen's article which denies the existence of schizophrenia as offensive and morally repulsive and downright ***disgusting*** as a Holocaust extermination camp survivor would find an article which denies the Holocaust.

Well, I find your drawing parallels between positions I hold and Holocaust denial offensive and morally repulsive and downright ***disgusting***. But neither of our feelings proves or disproves anything.

Daniel C. Boyer

We are not talking personal feeling. We are talking personal experience. The most important piece of evidence that a Holocaust survivor can give to refute a Holocaust denier is simply to say "I was there." I personally have had face to face daily contact with a schizophrenia patient, enough to say that Mr. Stephen is talking total garbage. His facts are just plain wrong.

Please identify the specific facts Stevens cites that are "just plain wrong."

Daniel C. Boyer

Among other things. He seems to imply that the notion that dopamine is related to schizophrenia has been rejected, when in fact it is widely accepted. I will check his quotes, but I'm pretty sure that they are

either obsolete or wildly out of context. He states that schizophrenia is simply a catch-all for behavior that the psychiatrist such doesn't like (which isn't true) (see the above discussion on cultural factors).

But isn't this just another way of putting it? Isn't this just saying that rather than "the psychiatrist... doesn't like" a certain set of behaviours the culture "doesn't like" a certain set of behaviours? Therefore not just the psychiatrist enforcing his personal preference but the societal norm. This is pretty obvious in the Stevens article. I think it's a pretty legitimate question, moreover, how many advancements for the future, in technology, in social-political understanding, in medicine, etc., etc. have been shut off because they were too far a leap from what came before, and if the innovator has not been quiet enough about them, has been psychiatrically repressed. Antonin Artaud with his "theatre of cruelty" and "theatre of the plague" is a good example of this. The culture may not be ready to accept something but it may be the wave of the future, even the distant future. In his time it was "Fulton's Folly" but a steam-boat is a completely banal object today.

I'm sitting in a room. Someone hits me because they see a devil next to me that tells them to kill me. I'm not in the mood to engage in an abstract discussion about cultural norms.

So would you admit that I have won this point?

Daniel C. Boyer

Daniel C. Boyer

The other thing is that he seems to be

under the impression that schizophrenia is only defined in terms of behavior when it is also defined in terms of perception. Stevens also makes some glaring omissions. For example, no where does he mention that to be defined as schizophrenia, the symptoms have to last for six months.

He says that my friend doesn't exist when she does. If schizophrenia doesn't exist them why is **** dead?

I haven't touched the link because quite frankly I do not have the emotional energy to get into an argument about it, just as a survivor of Auschwitz would probably rather not be in a situation where he has to defend the existence of the Holocaust, and in any event I do not have the energy to maintain anything like NPOV regarding his claims.

I would question your right to critique an article you have not read.

Daniel C. Boyer

I read the article. Emotionally I want to delete the link, but the feeling is so strong that I think it is better for someone with more emotional detachment to decide what to do.

But suffice to say, that the Andrea Yates situation is not that uncommon. These situations are usually quietly handled, but situations in which a person with schizophrenia does not take medication and kills family members, themselves or both are not that infrequent.

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Whilst I have neither the time or expertise to do a detailed refutation of the article you quote, I would merely add that I have personally met a few schizophrenics, and know people who work with them regularly. *They*, along with virtually the entire medical profession, have absolutely no doubt that schizophrenia is a real disease.

Surely it cannot have escaped you that in the past there were things that "virtually the entire medical profession" accepted, yet were totally wrong. "Virtually the entire medical profession" initially rejected germ theory, yet most would now accept that Pasteur was right. Many conceptions of the nature of physical illness, and many more harebrained conceptions of why people think and act differently from others, or differently from how the others would like them to, have risen and fallen over the course of history. People would like to forget that before "mental illness" the same phenomena were ascribed to witchcraft, tertiary stage syphillis, hysteria, moonbathing, &c. This does not mean that mental illness and its "star witness" (schizophrenia) do not exist, but neither does it mean that they do. It is extremely possible that in the future schizophrenia will be exposed to be as completely ridiculous as the previous paradigms. Maybe it will not be, but we cannot exclude that it will. The present is not some priviledged time with a unique angle on the truth.

Daniel C. Boyer

I would like to add an example of this from Thomas Szasz' article CREATIVITY AND CRIMINALITY: The Two Faces of Responsibility: "While he was alive, the Hungarian obstetrician, Ignaz Semmelweis -- who discovered the microbial causation of puerperal fever before the discovery of microbes as pathogens -- was considered to be wedded to an erroneous belief, which he defended irrationally."

Daniel C. Boyer

It is found around the world in every culture in roughly the same proportion,

This assertion is to some extent false. Schizophrenia is more commonly diagnosed in the United States than in Western Europe, and in the late '80s was more commonly diagnosed in the U.S. and U.S.S.R. than the rest of the world. This might be a big fat coincidence, but it does make you wonder.

Daniel C. Boyer

and the symptoms are pretty much the same, and there are measurable physical effects in the brain. I have to say that this guy sounds right up there with the crackpots who claim AIDS isn't the result of HIV.

As it stands now, the article gives far too much prominence to a very small minority of people who think schizophrenia is not a real disease. --

I don't know what to do about this problem, if it is a problem. I think not, however, as I have tried in the writing I have done on this article to maintain NPOV and I also think it is important to give those who look it up the broadest possible range of information, even about challenges that are very controversial. The controversial nature of these challenges is repeatedly spelled out in the article.

Daniel C. Boyer

Robert Merkel

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There is no denying that many people have symptoms in the list of "symptoms associated with schizophrenia". These symptoms are often so distressing as to be a real problem for them.

What is at issue is what causes these symptoms. It may, as theorized, be due to a physical cause. It may, as also theorized, be due to faulty thinking. Another possibility, much less often considerd in these materialistic days, is spiritual influences.

Regardless of what really causes the problem, the problem still exists. Calling a diseases psychosomatic doesn't make the disease unreal.

The way you guys are going on is enough to drive me crazy (grin). -- Ed Poor

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Mr. Boyer,

Question: What is the basis of your beliefs? The reason I've come to the conclusions on schizophrenia that I have is from first hand experience with someone who has the disease. I've seen first hand the symptoms and how she reacts or doesn't react to treatment, and what I've seen clearly points to a biochemical basis for schizophrenia. There also appear to be a lot of other people here with similar first hand experience. It's not like seeing the Loch Ness monster. Schizophrenia is (unfortunately) rather common. I also (unfortunately) have lots of first hand experience dealing with the psychiatric and legal professions.

What I'm trying to figure out here is whether it is a waste of my time or not to argue with you. Is there any possibility that anything I say will convince you that Mr. Stevens is talking total non-sense?

Possibly, but I haven't heard anything close to it yet.

I'm pretty sure it has something to do with dopamine neurotransmission (and so do most psychiatrists). Also, I would take issue with

a definition that doesn't regarding seeing demons next to you as not a disease. One should also point out that an overdose of PCP or methamphetamine will cause most normal people to display symptoms of paranoid schizophrenia. It's not a huge jump to think that what is happening in the brains of people with schizphrenia is analogous to what happens in someone who has overdosed on PCP.

Mr. Boyer, have you had any first hand experience with anyone with schizophrenia?

You should say, "diagnosed with schizophrenia," but yes. They said he was unable to carry on a conversation but I carried on conversations with him, and so forth. Basically because they had already decided he was a schizoprenic his entire speech and behaviour -- that would have been accepted as normal in a person without the diagnosis -- had to be interpreted in light of the schizoprehnia.

But that's not necessarily unreasonable. The person I know appears perfectly normal when she is on her medication.

Maybe so, but the person I am talking about was supposed to be totally unresponsive to medication. I am talking about what he was like when he was supposed to be floridly schizophrenic.

Daniel C. Boyer

She's nice, intelligent, charming, articulate, and very few people knew she had schizophrenia. I would argue in fact that when she is on her medication, she *is* normal because the medication corrects the underlying biochemical defect. When the medication is removed, however, she starts seeing demons and the world literally turns into hell. Part of the reason *I* think schizophrenia is biochemical is because the people I know with the disease appear normal or only slightly odd when they are medicated, because when properly medicated they *are* normal or only slightly odd. It's when you take the medication away or when she gets stressed, that things literally fall apart.

Daniel C. Boyer

There's a difference between "I don't know what causes schizophrenia because the various hypotheses aren't consistent with first hand experiences" and "I don't know what causes schizophrenia because I haven't met anyone with schizophrenia." There's also a big difference between "I've known people diagnosed with schizophrenia and I don't think it's real" and "I believe what I do because I've read a lot of books." If the former is the case, I'm really interested in why your experiences are inconsistent with mine. If the latter is the case, I'll limit the amount of energy I'm spending on this. I've gone through hell because of schizophrenia, and engaging in a discussion with someone who thinks that I've imagined the last decade of my life is just not worth it.

Incidentally, if one wants to take a look at a disease for which there IS real debate over its existence. Look at multiple personality disorder.

Daniel C. Boyer

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I did it.

I moved Mr. Stevens article to anti-psychiatry. There is a good NPOV reason for doing so in that it puts his article in context with the work of Thomas Szasz and R.D. Liang, and that even judged from its own term Steven's article is not a good exposition of the anti-psychiatry position.

But Stevens' article is not intended as an exposition of the anti-psychiatry position and should more properly be put under schizophrenia which it directly addresses.

I was referring to the anti-psychiatry position on schizophrenia. Stevens' doesn't offer any original ideas or insights and is simply quoting others. It's better to bypass him and link directly to his sources. The notion of schizophrenia not being a disease was invented by Thomas Szasz and R.D. Liang, who quite frankly do a better job of defending it than Stevens' does.

Daniel C. Boyer

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I've added links to Thomas Szasz and R.D. Liang. Since they are the people who originated the claim that mental illness does not exist and are much better expositors for this position. Also check out this article by Ted Stevens [[1]] in which he takes the position that suicide is a civil right.

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The sentence

Mental illness exists.

should be broken down into two sentences:

1. People really do experience distressing mental symptoms.
2. These symptoms have a biological cause.

It is possible to agree with the first and say that some people are really mentally "ill" while disputing the second. I myself am unsure of what causes schizophrenia.

I am in firm agreement with 1. and with the statement "I myself am unsure of what causes schizophrenia." I would add that this shades into the possibility that there is no such thing as schizophrenia in the sense that, if certain reasons were the cause for the symptomatology it would not make sense to refer to the set of symptoms as a "disease." I don't agree that number 1. proves that people are mentally ill, because as Stevens would point out there could be many causes of distressing mental symptoms which were clearly not a disease, i.e. job loss, conflict with one's spouse.

Daniel C. Boyer

Do you not know because you haven't looked? Again, I ask you how much first hand experience with people with schizophrenia. Not having contact with the disease and then not knowing what causes it isn't proof of much of anything. Also, I disagree about your statement about the causes of the disease. The fact that someone thinks that everyone in the world is reading their thoughts and that they see a demon standing next to me that is telling them to kill me (and that this mental state lasts for over a week) is serious enough that I'd regard it as a disease, no matter what the cause. Fortunately, dopamine blockers stop this. Unfortunately, not taking dopamine blockers forces this to start up again.

I suspect that most of the people who think schizophrenia is not a disease have simply not talked to someone who is in this mental state. I very strongly suspect that this is the situation in your case and would be very interested if this were not the case.

Please do not define schizophrenia as "this set of symptoms, which are caused by a physical disease" and then complain when skeptics say that it does not exist. It's better to define schizophrenia as "this set of symptoms" and to show additionally (yet separately) the evidence for a physical cause.

If you don't understand the NPOV guidelines, please be aware that your contributions are apt to be mercilessly edited. Ed Poor, educated layman and all-around sympathetic guy.

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Much of the point of view of Thomas Szasz and R.D. Liang is that "illness" is the the not best way of describing the pheonmenon associated with schizopherenia. One analogy is that until rather recently what people call Alzheimer's disease was not considered an illness but rather a normal process of aging. There are those who argue that people who are deaf are not handicapped, but form their own culture. A lot of these came out of the 1960's and some of this sort of thinking did help correct some of the abuses of psychology.

However, one thing that has changed things is advances in neuroscience. For example, we think we know what neural pathways cause schizophrenia, and nowadays when people design new anti-psychotics, they create molecules which are designed specifically to block those neural receptors. The biochemical viewpoint explains a lot of things. Patient sees demons. Patient takes drug. Two weeks pass. Patient stops seeing demons and appears normal. Patient stops taking drug. Two weeks pass. Patient starts seeing demons. (This isn't second hand. I watched this happen to someone I know, and it's very painful.) The drug that is used has a known biological effect. It blocks dopamine receptors. Where it gets interesting is that you can cause someone who is "normal" to start seeing demons by giving him an overdose of amphetamine, which curiously enough has the biological effect of increasing dopamine transmission. It's lots of pieces of evidence like this that makes people believe that schizophrenia is largely the result of malfuction in neurotransmission. It also leads to some promissing avenues of research. It turns out that traditional anti-psychotics attach themselves to only one of the dopamine receptors, and most of the new drugs are working by attaching themselves to different receptors.

The supposed conflict between schizophrenia and individual choice is for that most part specious. If someone sees demons and angels, is happy with that, and can lead an independent life without bothering me. Fine. More power to them. However, it's not like that. Most untreated people with positive schizophrenia react to what they see and feel with the same reaction that you or I would if we suddenly started to see demons if we suddenly started to believe that there was a microtransmitter buried in our brain. Most untreated people with negative schizophrenia don't have the skills needed to function independently (i.e. it's difficult for them to have a conversation, much less drive a car or fill out a job application). If someone is happy with the way they are and can function independently. Fine. No problem. They can believe whatever they want as long as they don't bother me with it. However, most people with schizophrenia are miserable to the point that they want to commit suicide or are so convinced by the reality of what they are experiencing that they are compelled to commit homicide.

One other thing to note is that Szasz and Liang were products of the 1960's and there have been major changes in the treatment and legal situation of mental patients since then.

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The article looks pretty good as of March 14, 2002. I hope the conflict has subsided. I have kept my belief that some "schizophrenia" might be caused by actual spirits communicating with people on the earth, to myself for now. In my religion, we don't advocate giving the mentally ill spiritual treatment such as exorcism; it's not generally effective. We have some rituals akin to exorcism, but I should probably write a separate article on them, before I even think of linking here. Ed Poor

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Shouldn't there be a mention of Bleuler in the article?

Daniel C. Boyer

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It is believed by most researchers and clinicians that the basis of the disease is primarily biological and results from the malfunctioning of dopamine pathways in the brain (though the reasons why such malfunctioning causes schizophrenia symptoms is not clear).

For the most part I do not dispute the inclusion of this sentence in the article. But it might bear quoting what Kraepelin (the inventor of this disease) himself said: "It is true that, in the strictest terms, we cannot speak of the mind as becoming diseased."

Daniel C. Boyer

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Psychiatry and anarchy are obviously going to take opposite positions on this.

Psychiatry emerged as a way to justify mercy, of making persons "exceptional" and not deserving of the harsh punishment we would as a society wish to dole out to people who had extremely selfish or widely shared rationales for their actions. By definition extreme selfishness ("self-absorption") or broadly shared resentments (e.g. envy of the rich, hatred of another ethnic group) are infectious behaviors...

So, it's more that schizophrenia and other "mental illness" became defined into existence to protect those whose behaviors were *not* so infectious...

That's more or less according to Thomas Szasz... compiled down a lot...

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There is new material under the heading "New material: for review" that needs to be reviewed and edited for NPOV: I'm not aware if these views are generally accepted, controversial, or just idiosyncratic.