A Review of “Schizophrenia: 100 Years On” (Part 1)

Anthony Morgan, convenor of “Schizophrenia: 100 Years On,” writes:

2011 marks the 100th anniversary of the introduction of the diagnosis of schizophrenia, the most severe, enigmatic and controversial of mental disorders. At a time when biological and neuroscientific accounts of schizophrenia dominate, there is a risk that crucial questions are closed off as we await the promised conquering of madness and distress by scientific and technological advances.

Through exploring schizophrenia from a variety of perspectives including cultural theory, psychotherapy, sociology, psychiatry and philosophy, this series of talks aims to open up key questions and reinvigorate debate on this fascinating and most important of subjects.

So went the blurb on the flyers for a series of four monthly talks held in a slightly dilapidated function room above a pub in Newcastle upon Tyne between February and May of this year. The talks were held in collaboration with the Newcastle Philosophy Society and attracted in the region of 50 people to each of the talks, many of whom had received a diagnosis of schizophrenia or were close to someone who had. The high turn-out suggests that the topic remains of considerable public interest.

Angela Woods from the department of Medical Humanities at Durham University kicked things off with her talk ‘Schizophrenia – 100 Years of Controversy’. Angela initially highlighted the huge diversity of ways in which schizophrenia can and has been explored – from the experiences of people and their narratives to psychoanalytic theories of psychosis to the politics of the anti-psychiatry movement to the literary and cinematic representations of schizophrenia to the consumer/survivor/ex-patient and mad pride movements. Given all these different understandings, an obvious question arises: how have we arrived at the dominant picture of schizophrenia as a disease of the brain?

Angela then took us on a whirlwind tour of the history of schizophrenia from the early confidence in the imminent discovery of the genetic, neurochemical and physiological lesions underlying the ‘disease’, to the scandals of Nazi psychiatry and the human rights violations of certain therapeutic regimes, to the rise of DSM and psychopharmacology to the renewed confidence and optimism characteristic of the age of neuroscience and the genome, a time when schizophrenia can finally be ‘understood and conquered’. In more sober moments, psychiatry may of course reflect that the decade of the brain has passed and they have still not offered us any definitive account of schizophrenia’s origins or any ‘cure’ for its symptoms.

A key point that emerged from Angela’s paper is that conflict is not something that has just surrounded schizophrenia in the therapeutic, clinical, scientific, personal and political spheres, but is in fact the very essence of this most enigmatic of psychiatric diagnoses. Using her idea that schizophrenia is the sublime object of psychiatry (explored in her forthcoming book The Sublime Object of Psychiatry: Schizophrenia in Clinical and Cultural Theory), Angela argued that the way that psychiatry since Kraepelin has framed schizophrenia as an object or disease entity waiting to be discovered has diverted attention from the fact that the category of schizophrenia is not neutral, nor self-evident. And further that the widespread assumption that schizophrenia is a brain disease has important implications beyond mere theoretical musings: the fixation on a brain disease model means that there is little support or incentive for people to investigate the environmental and social factors involved in psychotic experience. In addition, the aggressive promotion of a biological model of schizophrenia has had the effect both of increasing stigma and the desire for social distance as well as doing little to offset, and maybe even contribute to, the myth that schizophrenia is strongly associated with violence.

Trauma has long been a central theme in the lives of those individuals who are diagnosed as schizophrenic. One psychiatrist has even recently proposed re-naming schizophrenia as post-traumatic psychosis. Tony Wright, a clinician from the charity ‘Freedom from Torture’ gave the next talk, ‘Survivors of Torture: Broken Bodies and Broken Minds’, in which he focused on the experiences of some of his clients who displayed behaviours and patterns of thinking that may be understood as schizophrenic. He explored how it was possible to re-frame these behaviours within an understanding of normal reactions to extreme circumstances and how this offered us possibilities for fresh understanding beyond the realm of psychopathology. Since R.D. Laing, there have been consistent (albeit generally marginalised) efforts to re-frame our understanding of psychosis – to make the ‘un-understandable’ comprehensible. There is of course the risk that with an increasing focus on biology, psychiatry will move towards becoming a discipline that deals primarily with causes at a neural level rather than meanings at a person level.

Tony explored the ways in which many of his clients’ experiences such as hallucinations and delusions can be understood within the context of a torture narrative: the smell of kerosene in the room; the hands of the torturer on the back; the smell of death; the sound of a bullet whistling past the left ear; the persecutory and paranoid narratives of spies in the streets or ears in the walls. While the current psychiatric understanding of schizophrenia tends to focus on internal factors while paying lip service to external ones, torture narratives provide a chilling example of how traumatic experiences can act as the crucial agent in the aetiology of the signs and symptoms listed in the DSM and ICD.

Using a single case study of a client who displayed all the key behaviours that fall within the diagnosis of disorganized/hebephrenic schizophrenia, Tony highlighted a key tension lying at the heart of his work: that he both wanted and did not want psychiatric intervention for his client. He wanted it because his client was highly suicidal but he was also scared that psychiatric intervention would mean seeing his client specifically as a set of hebephrenic schizophrenic symptoms. If this was the case, then help would most likely be limited to that symptomology without understanding the torture narrative and the normality of his reactions given his experiences of trauma. Too often in current mainstream mental health services even therapeutic (as opposed to pharmacological) interventions have a tendency to ignore the ways in which clients make sense of their situations as the emphasis shifts to ‘fixing’ people and returning them to productivity.

Tony also highlighted a tragic paradox: that although his clients regularly report suicidal feelings, they are frequently refused mainstream medical care under the official position that their distress is a reasonable response to what they have experienced and therefore not to be dealt with by mental health services. One could also read a political decision into this: a refusal, if at all possible, to provide mental health services to asylum seekers.

[Continued in Part Two]

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