- For other uses, see Schizophrenia (disambiguation).
Schizophrenia is a psychiatric diagnosis denoting a persistent, often
chronic, mental illness variously affecting behavior, thinking, and emotion. The term schizophrenia comes from the Greek words σχίζω (schizo, split or divide) and
φρενός (phrenos, mind) and is best translated as "shattered mind". Schizophrenia is commonly
confused with multiple personality
disorder, a different diagnosis.
Overview
Schizophrenia is most commonly characterized by both 'positive symptoms' (those additional to normal experience and behaviour)
and 'negative symptoms' (the lack or decline in normal experience or behaviour). Positive symptoms are grouped under the umbrella
term psychosis and typically include delusions, hallucinations, and thought disorder. Negative symptoms may include inappropriate or lack of
emotion, poverty of speech, and lack of motivation. Some models of schizophrenia include thought disorder and planning problems in a third grouping, the
'disorganization syndrome'. Additionally, neurocognitive
deficits may be present. These take the form of reduction or impairment in basic psychological functions such as memory, attention, problem solving, executive function and social cognition.
The onset is typically in late adolescence and early adulthood, with males tending to show symptoms earlier than females.
Psychiatrist Emil Kraepelin was first to make the distinction
between what he called dementia praecox and other forms of madness. This classification was later renamed 'schizophrenia'
by psychiatrist Eugen Bleuler in 1911 as it became clear Kraepelin's name was not an adequate description of the condition.
The diagnostic approach to schizophrenia has been opposed, most notably by the anti-psychiatry movement, who argue that classifying specific thoughts and behaviours as illness allows
social control of people that society finds undesirable but who have committed no crime.
More recently, it has been argued that schizophrenia is just one end of a spectrum of experience and behaviour, and everybody
in society may have some such experiences in their life. This is known as the 'continuum model of psychosis' or the 'dimensional
approach' and is most notably argued for by psychologist Richard
Bentall and psychiatrist Jim van
Os.
Although no definite causes of schizophrenia have been identified, most researchers and clinicians currently believe that
schizophrenia is primarily a disorder of the brain. It is thought that schizophrenia may
result from a mixture of genetic disposition (genetic studies using various techniques have shown relatives of people with
schizophrenia are more likely to show signs of schizophrenia themselves) and environmental stress (research suggests that
stressful life events may precede a schizophrenic episode).
It is also thought that processes in early neurodevelopment are
important, particularly those that occur during pregnancy. In adult life, particular importance has been placed upon the function
(or malfunction) of dopamine in the mesolimbic pathway in the brain. This theory, known as the dopamine hypothesis of
schizophrenia largely resulted from the accidental finding that a drug group which blocks dopamine function, known as the
phenothiazines, reduced psychotic symptoms. These drugs have now been
developed further and antipsychotic medication is commonly used as a
first line treatment. However, this theory is now thought to be overly simplistic as a complete explanation.
Differences in brain structure have been found between people with schizophrenia and those without. However, these tend only
to be reliable on the group level and, due to the significant variability between individuals, may not be reliably present in any
particular individual.
History
Accounts that may relate to symptoms of schizophrenia date back as far as 2000 BC
in the Book of Hearts, part of the ancient Ebers papyrus. However,
a recent study1 into the ancient Greek and Roman literature
showed that whilst the general population probably had an awareness of psychotic disorders, there was no recorded condition that
would meet the modern diagnostic criteria for schizophrenia in these societies.
This nonspecific concept of madness has been around for many thousands of years and schizophrenia was only classified as a
distinct mental disorder by Kraepelin in 1887. He was the first to make a distinction in
the psychotic disorders between what he called dementia praecox (a term first used by psychiatrist Benedict A. Morel) and manic depression. Kraepelin believed that dementia praecox was primarily a disease of the
brain2, and particularly a form of dementia. Kraepelin named the disorder 'dementia praecox' (early dementia) to distinguish
it from other forms of dementia (such as Alzheimer's disease) which typically occur late in life. He used this term because his studies
focused on young adults with dementia.22
The term schizophrenia is derived from the Greek words 'schizo' (split) and 'phrene' (mind) and was coined by Eugene
Bleuler to refer to the lack of interaction between thought processes and perception. He was also the first to describe the
symptoms as "positive" or "negative."22 Bleuler
changed the name to schizophrenia as it was obvious that Krapelin's name was misleading. The word "praecox" implied precocious or
early onset, hence premature dementia, as opposed to senile dementia from old age. Bleuler realized the illness was not a
dementia (it did not always lead to mental deterioration) and could sometimes occur late as well as early in life and was
therefore misnamed.
With the name 'schizophrenia' Bleuler intended the name to capture the separation of function between personality, thinking,
memory, and perception, however it is commonly misunderstood to mean that affected persons have a 'split personality' (something
akin to the character in Robert Louis Stevenson's
The Strange Case
of Dr. Jekyll and Mr. Hyde). Schizophrenia is commonly, although incorrectly, confused with multiple personality disorder (now called
'dissociative identity disorder'). Although people diagnosed with schizophrenia may 'hear voices' and may experience the voices
as distinct personalities, schizophrenia does not involve a person changing between distinct multiple personalities. The
confusion perhaps arises in part due to the meaning of Bleuler's term 'schizophrenia' (literally 'split mind'). Interestingly,
the first known misuse of this word schizophrenia to mean 'split personality' (in the Jekyll and Hyde sense) was in an article by
the poet T. S. Eliot in 19333.
In the first half of the twentieth century, schizophrenia was considered by many as a "hereditary defect", and people with
schizophrenia became the target of the eugenics programs of many countries.
Hundreds of thousands were forcibly sterilized, the
majority in Germany, the United States, and various Scandinavian countries.
Diagnosis and presentation (signs and symptoms)
Like many mental illnesses, the diagnosis of schizophrenia is based upon the behaviour of the person being assessed. There is
a list of diagnostic criteria which must be met for a person to be so diagnosed. These depend on both the presence and duration
of certain signs and symptoms.
The most commonly-used criteria for diagnosing schizophrenia are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the
World Health Organisation's International Statistical Classification of
Diseases and Related Health Problems (ICD). The most recent versions are ICD-10 (http://www.who.int/whosis/icd10/) and DSM-IV-TR (http://www.psych.org/research/dor/dsm/index.cfm).
Below is an abbreviated version of the diagnostic criteria from the DSM-IV-TR, the full version is available here (http://www.behavenet.com/capsules/disorders/schiz.htm). (DSM cautionary statement)
To be diagnosed as having schizophrenia, a person must display:
- A) Characteristic symptoms: Two or more of the following, each present for a significant portion of time during a one-month
period (or less, if successfully treated)
- delusions
- hallucinations
- disorganized speech (e.g., frequent derailment or incoherence). See thought disorder.
- grossly disorganized or catatonic behavior
- negative symptoms, i.e., affective flattening (lack or decline in emotional response), alogia (lack or decline in speech), or avolition (lack or decline in
motivation).
- Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of hearing voices.
- B) Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more
major areas of functioning such as work, interpersonal relations, or self-care, are markedly below the level achieved prior to
the onset.
- C) Duration: Continuous signs of the disturbance persist for at least six months. This six-month period must include at least
one month of symptoms (or less, if successfully treated) that meet Criterion A.
Historically, schizophrenia in the West was classified into simple, catatonic,
hebephrenic, and paranoid. The
DSM now contains five sub-classifications of schizophrenia. These are
- catatonic type (where marked absences or peculiarities of movement are present),
- disorganized type (where thought disorder and flat or inappropriate affect are present together),
- paranoid type (where delusions and hallucinations are present but thought disorder, disorganized behaviour, and
affective flattening is absent),
- residual type (where positive symptoms are present at a low intensity only) and
- undifferentiated type (psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic types
has not been met).
Symptoms may also be described as 'positive symptoms' (those additional to normal experience and behaviour) and negative
symptoms (the lack or decline in normal experience or behaviour). 'Positive symptoms' describe psychosis and typically include delusions, hallucinations and thought disorder. 'Negative symptoms' describe inappropriate or nonpresent emotion, poverty of speech, and lack of motivation. In three-factor models of
schizophrenia, a third symptom grouping, the so called 'disorganisation syndrome' is also given. This considers thought disorder
and related disorganized behaviour to be in a separate symptom cluster from delusions and hallucinations.
It is worth noting that many of the positive or psychotic symptoms may occur in a variety of disorders and not only in
schizophrenia. The psychiatrist Kurt Schneider tried to list the
particular forms of psychotic symptoms which he thought were particularly useful in distinguishing between schizophrenia and
other disorders which could produce psychosis. These are called first rank symptoms or Schneiderian first rank
symptoms and include delusions of being controlled by an external force, the belief that thoughts are being inserted or
withdrawn from your conscious mind, the belief that your thoughts are being broadcast to other people and hearing hallucinated
voices which comment on your thoughts or actions, or may have a conversation with other hallucinated voices. As with other
diagnostic methods, the reliability of 'first rank symptoms' has been questioned4, although they remain in use as diagnostic criteria in many countries.
Diagnostic issues and controversies
It has been argued that the diagnostic approach to schizophrenia is flawed, as it relies on an assumption of a clear dividing
line between what is considered to be mental illness (fulfilling the diagnostic criteria) and mental health (not fulfilling the
criteria). Recently it has been argued, notably by psychiatrist Jim van Os and psychologist Richard
Bentall, that this makes little sense, as studies have shown that psychotic symptoms are present in many people who never
become 'ill' in the sense of feeling distressed, becoming disabled in some way or needing medical assistance6.
Of particular concern is that the decision as to whether a symptom is present is a subjective decision by the person making
the diagnosis or relies on an incoherent definition (for example, see the entries on delusions and thought disorder for a discussion of
this issue). More recently, it has been argued that psychotic symptoms are not a good basis for making a diagnosis of
schizophrenia as "psychosis is the 'fever' of mental illness — a serious but nonspecific indicator".5
Perhaps because of these factors, studies examining the diagnosis of schizophrenia have typically shown relatively low, or
inconsistent levels of diagnostic reliability. Most famously, David Rosenhan's 1972 study,
published as On being sane in insane
places, demonstrated that the diagnosis of schizophrenia was (at least at the time) often subjective and unreliable. More
recent studies have found agreement between any two psychiatrists when diagnosing schizophrenia tends to reach about 65% at
best33. This, and the results of earlier studies of
diagnostic reliability (which typically reported even lower levels of agreement) have led some critics to argue that the
diagnosis of schizophrenia should be abandoned34.
Proponents have argued for a new approach that would use the presence of specific neurocognitive deficits to make a diagnosis. These often accompany schizophrenia and take the
form of a reduction or impairment in basic psychological functions such as memory,
attention, executive function and problem solving. It
is these sorts of difficulties, rather than the psychotic symptoms (which can in many cases be controlled by antipsychotic medication), which seem to be the cause of most disability in schizophrenia. However, this argument is relatively new and it is
unlikely that the method of diagnosing schizophrenia will change radically in the near future.
The diagnostic approach to schizophrenia has also been opposed by the anti-psychiatry movement, who argue that classifying specific thoughts and behaviours as an illness allows
social control of people that society finds undesirable but who have committed no crime. They argue that this is a way of
unjustly classifying a social problem as a medical one to allow the forcible detention and treatment of people displaying these
behaviours, which is something which can be done under mental health legislation in most western countries.
An example of this can be seen in the former Soviet Union, where an
additional sub-classification of sluggishly progressing schizophrenia was created. Particularly in the RSFSR (Russian
Soviet Federated Socialist Republic) this diagnosis was used for the purpose of silencing political dissidents or forcing them to
recant their ideas by the use of forcible confinement and treatment. In 2000 similar
concerns about the abuse of psychiatry to unjustly silence and detain members of the Falun Gong movement by the Chinese government led the American Psychiatric Association's Committee on the Abuse of Psychiatry and
Psychiatrists to pass a resolution to urge the World Psychiatric Association to investigate the situation in China.
Western psychiatric medicine tends to favour a definition of symptoms that depends on form rather than content (an innovation
first argued for by psychiatrists Karl Jaspers and Kurt Schneider). Therefore, you should be able to believe anything, however
unusual or socially unacceptable, without being diagnosed delusional, unless your belief is judged to be held in a particular
way. In principle, this would stop people being forcibly detained or treated simply for what they believe. However, the
distinction between form and content is not easy, or always possible, to make in practice (see delusion). This had led to accusations by anti-psychiatry, surrealist and mental health system
survivor groups that psychiatric abuses exist to some extent in the West as well.
Cause
Genetic and environmental influences
While the reliability of the schizophrenia diagnosis introduces difficulties in measuring the relative effect of genes and
environment (for example, symptoms overlap to some extent with severe bipolar disorder or major depression), there is evidence to
suggest that a combination of genetic vulnerability and environmental stressors can act in combination to cause
schizophrenia.
The extent to which these factors influence the likelihood of being diagnosed with schizophrenia is debated widely, and
currently, controversial. Schizophrenia is likely to be a disorder of complex inheritance (analogous to diabetes or high blood
pressure). Thus, it is likely that several genes interact to generate risk for schizophrenia. This, combined with disagreements
over which research methods are best, or how data from genetic research should be interpreted, has led to differing estimates
over genetic contribution.
Some researchers estimate schizophrenia to be highly heritable (some estimates are as high as 70%). However, genetic evidence
for the role of the environment comes from the observation that identical twins do not universally develop schizophrenia. A
recent review of the genetic evidence has suggested a 28% chance of one identical twin developing schizophrenia if the other
already has it7 (see twin study).
A study conducted about schizophrenia in twins however, carried out for persons in the Finnish Twin Cohort, involving 16,649
like-sexed twin pairs, found a much lower concordance rate for schizophrenia of only 11.0% among monozygotic twins, and only 1.8%
among dizygotic twins 37.
A recent review of linkage studies, listed seven genes as likely to be involved in
the inheritance of schizophrenia or the risk of developing schizophrenia26. Evidence comes from research suggesting multiple chromosomal regions are transmitted to people who are later diagnosed as having schizophrenia. Some family
association studies have demonstrated a relationship to a gene known as COMT that is involved in encoding the dopamine catabolic
enzyme catechol-O-methyl
transferase27. This is particularly interesting
because of the known link between dopamine function, psychosis, and
schizophrenia.
There is also considerable evidence indicating that stress may trigger episodes of schizophrenia. For example, emotionally
turbulent families8 and stressful life
events9 have been shown to be risk factors for
relapses or triggers for episodes of schizophrenia. Other factors such as poverty and discrimination may also be involved. This
may explain why minority communities have much higher rates of schizophrenia than when members of the same ethnic groups are
resident in their home country.
One particularly stable and replicable finding has been the association between living in an urban environment and risk of developing schizophrenia, even after factors such as drug use, ethnic group and size of
social group have been controlled for29. A recent
study of 4.4 million men and women in Sweden found a 68–77% increased risk of psychosis for people living in the most
urbanized environments, a significant proportion of which is likely to be accounted for by schizophrenia30.
One curious finding is that people diagnosed with schizophrenia are more likely to have been born in winter or spring32 (at least in the northern hemisphere). However, the effect is
not large and it is still not clear why this may occur.
Neurobiological influences
It is also thought that processes in early neurodevelopment are
important, particularly during pregnancy. For example, women who were pregnant during the Dutch famine of 1944, where many people were close to starvation, had a higher chance of having
a child who would later develop schizophrenia10.
Similarly, studies of Finnish mothers who were pregnant when they found out that
their husbands had been killed during the Winter War of 1939–1940 have shown that their children were much more likely to
develop schizophrenia when compared with mothers who were found out about their husbands' death before or after
pregnancy11, suggesting that even psychological
trauma in the mother may have an effect.
In adult life, particular importance has been placed upon the function (or malfunction) of dopamine in the mesolimbic pathway in the brain. This theory, known as the dopamine hypothesis of
schizophrenia largely resulted from the accidental finding that a drug group which blocks dopamine function, known as the
phenothiazines, reduced psychotic symptoms. These drugs have now been
developed further and antipsychotic medication is commonly used as a first line treatment.
However, this theory is now thought to be overly simplistic as a complete explanation. Partly as newer antipsychotic
medication (called atypical antipsychotic medication)
is equally effective as older medication, but also affects serotonin function and
may have slightly less of a dopamine blocking effect. Psychiatrist David Healy has also argued that pharmaceutical companies have promoted certain
oversimplified biological theories of mental illness to promote their own sales of biological treatments12.
Much recent research has focused on differences in structure or function in certain brain areas in people diagnosed with
schizophrenia.
Early evidence for differences in the neural structure came from the discovery of ventricular enlargement in people diagnosed as schizophrenic, for whom negative symptoms were most
prominent35. However, this finding has not proved
particularly reliable on the level of the individual person, with considerable variation between patients.
More recent studies have shown a large number of differences in brain structure between people with and without diagnoses of
schizophrenia36. However, as with earlier studies,
many of these differences are only reliably detected when comparing groups of people, and are unlikely to predict any differences
in brain structure of an individual person with schizophrenia.
Studies using neuropsychological tests and brain
scanning technologies such as fMRI and PET to examine functional differences in brain activity have shown that differences seem to
most commonly occur in the frontal lobes, hippocampus, and temporal lobes13. These differences are heavily linked to the neurocognitive deficits which often occur with schizophrenia,
particularly in areas of memory, attention, problem solving, executive function and social cognition.
Incidence and prevalence
Schizophrenia is typically diagnosed in late adolescence or early adulthood. It is found approximately equally in men and
women, though the onset tends to be later in women, who also tend to have a better course and outcome.
The lifetime prevalence of schizophrenia is commonly given at 1%; however, a
recent review of studies from around the world estimated it to be 0.55%14. The same study also found that prevalence may vary greatly from country to country, despite the
received wisdom that schizophrenia occurs at the same rate throughout the world. It is worth noting however, that this may be in
part due to differences in the way schizophrenia is diagnosed. The incidence of schizophrenia was given as a range of between 7.5 and 16.3 cases per 100,000 of the
population.
Schizophrenia is also a major cause of disability. In a recent 14-country
study15, active psychosis was ranked the third most
disabling condition after quadriplegia and dementia and before paraplegia and blindness.
Treatment
The first line treatment for schizophrenia is usually the use of antipsychotic medication. The newer atypical antipsychotic medications (such as clozapine, risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole) are preferred over older
typical antipsychotic medications (such as chlorpromazine and haloperidol) due to their favorable side-effect profile. Compared to the typical antipsychotics, the atypicals
are associated with a lower incident rate of extrapyramidal side-effects (EPS) and tardive dyskinesia (TD). It is still unclear whether newer drugs reduce the chances of developing the
rare but potentially life-threatening neuroleptic malignant syndrome (NMS). While the atypical antipsychotics are associated with
less EPS and TD than the conventional antipsychotics, some of the agents in this class (especially olanzapine and clozapine)
appear to be associated with metabolic side effects such as weight gain, hyperglycemia and hypertriglyceridemia that must be
considered when choosing appropriate pharmacotherapy.
Atypical antipsychotics and typical antipsychotics are generally thought to be equivalent for the treatment of the positive
symptoms of schizophrenia. It has been suggested by some researchers that the atypicals have some beneficial effects on negative
symptoms and cognitive deficits associated with schizophrenia, however the clinical significance of these effects has yet to be
established. In addition some data suggests that typical antipsychotics, when dosed conservatively have similar effects.
The atypical antipsychotics are much more costly as they are still within patent, whereas the older drugs are available in
inexpensive generic forms. Aripiprazole a drug from a new class of
antipsychotic drugs (variously named 'dopamine system stabilizers' or 'partial dopamine agonists') has recently been developed
and early research suggests that it may be a safe and effective treatment for schizophrenia16.
Hospitalisation may occur with severe episodes. This can be voluntary or (if mental health legislation allows it) involuntary
(called civil or involuntary commitment). Mental health
legislation may also allow a person to be treated against their will. However, in many countries such legislation does not exist,
or does not have the power to enforce involuntary hospitalisation or treatment.
Psychotherapy or other forms of talk therapy may be offered, with
cognitive behavioural therapy being the
most frequently used. This may focus on the direct reduction of the symptoms, or on related aspects, such as issues of
self-esteem, social functioning, and insight. There have been some promising results with cognitive behavioural therapy, but the
balance of current evidence is inconclusive17.
Other support services may also be available such as drop-in centres, visits from members of a 'community mental health team'
and patient-led support groups. In recent years the importance of service-user led recovery based movements has grown
substantially throughout Europe and America. Groups such as the Hearing Voices Network and more recently, the Paranoia Network, have developed a
self-help approach that aims to provide support and assistance outside of the traditional medical model adopted by mainstream
psychiatry. By avoiding framing personal experience in terms of criteria for mental illness or mental health, they aim to
destigmatise the experience and encourage individual responsibility and a positive self-image.
In many non-Western societies, schizophrenia may be treated with more informal, community-led methods. A particularly sobering
thought for Western psychiatry is that the outcome for people diagnosed as schizophrenic in non-Western countries may actually be
much better18 than for people in the West. The
reasons for this recently discovered fact are still far from clear, although cross-cultural studies are being conducted to find
out why. One important factor may be that many non-Western societies (including intact Native American cultures) are collectivist
societies, in that they emphasize working together for the good of other society members. This is in contrast to many Western
societies, which can be highly individualistic. Collectivist societies tend to stress the importance of the connectedness of
extended family, providing a useful support mechanism for the stress that mental illness plays on both the ill and others around
them.
Prognosis
Prognosis for any particular individual affected by schizophrenia is particularly hard to judge as treatment and access to
treatment is continually changing as new methods become available and medical recommendations change.
However, retrospective studies have shown that about a third of people make a full recovery, about a third show improvement
but not a full recovery, and a third remain ill19.
World health Organization conducted 2 long-term follow-up studies involving more than 2 thousand people labeled schizophrenic
in different countries, and discovered these patients have much better long-term outcomes in poor countries (India, Colombia and
Nigeria) than in rich countries (USA, England, Ireland, Denmark, Czechoslovakia, Japan, and Russia)39. This result is contrary to the expectations of
biopsychiatrists, because patients in poor countries take much less or no neuroleptic drugs. However, according to Robert
Whitaker, patients in poor countries fare better mainly because they take much less or no drugs: in the long run, the brain
overcompensates for the effects of prolonged administration of neuroleptic drugs, leading to contrary than expected results.
There is an extremely high suicide rate associated with schizophrenia. A recent
study showed that 30% of patients diagnosed with this condition had attempted suicide at least once during their
lifetime20. Another study suggested that 10% of
persons with schizophrenia die by suicide21.
Schizophrenia and drug use
Schizophrenia can sometimes be triggered by heavy use of stimulant or hallucinogenic drugs, although some claim that a
predisposition towards developing schizophrenia is needed for this to occur. There is also some evidence suggesting that people
suffering schizophrenia but responding to treatment can have relapse as a result of subsequent drug use.
Drugs such as methamphetamine, ketamine, PCP and LSD
have been used to mimic schizophrenia for research purposes, although this has now fallen out of favour with the scientific
research community, as the differences between the drug induced states and the typical presentation of schizophrenia have become
clear.
Hallucinogenic drugs were also briefly tested as possible treatments for schizophrenia by psychiatrists such as Humphry Osmond and Abram Hoffer in the 1950s. Ironically, it was mainly for this experimental treatment of
schizophrenia that LSD administration was legal, briefly before its use as a recreational drug led to its criminalization.
There is now increasing evidence that cannabis use can be a contributing trigger
to developing schizophrenia. The most recent studies suggest that cannabis is neither a sufficient nor necessary factor in
developing schizophrenia, but that cannabis may significantly increase the risk of developing schizophrenia and may be, among
others, a significant causal factor31.
It has been noted that the majority of people with schizophrenia (estimated between between 75% and 90%) smoke tobacco. However, people diagnosed with schizophrenia have a much lower than average chance
of getting and dying from lung cancer. While the reason for this is unknown,
it may be because of a genetic resistance to the cancer, a side-effect of drugs being taken, or a statistical effect of increased
likelihood of dying from causes other than lung cancer22. It is argued that the increased level of smoking in schizophrenia may be due to a desire to
self-medicate with nicotine. A recent study of over 50,000 Swedish conscripts found
that there was a small but significant protective
effect of smoking cigarettes on the risk of developing schizophrenia later in life.28 Whilst the authors of the study stressed that the risks of smoking far outweigh these minor
benefits, this study provides further evidence for the 'self-medication' theory of smoking in schizophrenia and may gives clues
as to how schizophrenia might develop at the molecular level.
Alternative approaches to schizophrenia
An approach broadly known as the anti-psychiatry movement, notably
most active in the 1960s has opposed the orthodox medical view of schizophrenia as an
illness.
Psychiatrist Thomas Szasz has argued that psychiatric patients are not
ill but are just individuals with unconventional thoughts and behaviour that make society uncomfortable. He argues that society
seeks to unjustly control such individuals by classifying their behaviour as an illness and forcibly treating them as a method of
social control. An important but subtle point is that Szasz has never denied the existence of the phenomena that mainstream
psychiatry classifies as an illness (such as delusions, hallucinations or mood changes) but simply does not believe that they are
a form of illness.
Similarly, psychiatrist R. D. Laing has argued that the symptoms of what
we call mental illness are just reasonable (although perhaps not always obviously comprehensible) reactions to impossible demands
that society and particularly family life puts on some individuals. Laing was revolutionary in valuing the content of
psychotic experience as worthy of interpretation, rather than considering it
simply as a secondary but essentially meaningless marker of underlying psychological or neurological distress.
It is worth noting that neither Szasz nor Laing ever considered themselves to be 'anti-psychiatry' in the sense of being
against psychiatric treatment, but simply believed that it should be conducted between consenting adults, rather than imposed
upon anyone against their will.
In the 1976 book The Origin of Consciousness in the Breakdown of the
Bicameral Mind, psychologist Julian Jaynes proposed that until
the beginning of historic times, schizophrenia or a similar condition was the normal state of human consciousness. This would
take the form of a "bicameral mind" where a normal state of low affect, suitable for routine activities, would be interrupted in
moments of crisis by "mysterious voices" giving instructions, which early people characterized as interventions from the gods.
This theory was briefly controversial. Continuing research has failed to either further confirm or refute the thesis.
Psychiatrist Tim Crow has argued that schizophrenia may be the evolutionary
price we pay for a left brain hemisphere specialisation for language25. Since psychosis is associated with greater levels of right
brain hemisphere activation and a reduction in the usual left brain hemisphere dominance, our language abilities may have evolved
at the cost of causing schizophrenia when this system breaks down.
Researchers into shamanism have speculated that in some cultures schizophrenia or
related conditions may predispose an individual to becoming a shaman24. Certainly the experience of having access to multiple realities is not uncommon in schizophrenia,
and is a core experience in many shamanic traditions. Equally, the shaman may have the skill to bring on and direct some of the
altered states of consciousness
psychiatrists label as illness. (See anti-psychiatry.)
Alternative medicine tends to hold the view that
schizophrenia is primarily caused by imbalances in the body's reserves and absorption of dietary minerals, vitamins, fats, and/or the presence of
excessive levels of toxic heavy metals. The body's adverse reactions to
gluten are also strongly implicated in some alternative theories (see gluten-free, casein-free diet).
Famous people affected by schizophrenia
Recommended reading
External links
References
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