About 25 years ago I was diagnosed with borderline schizophrenia. This happened when I told my therapist that I sometimes hear voices in my head. I sought counseling because of anxiety and panic attacks. I was shaken by this diagnoses because I didn't know what that meant for me. The therapist didn't reccomened medication or specialized treatment. I was also alarmed because I have two cousins with this disorder ( the therapist knew this ).
In all my therapy sessions weren't helping and I found someone else who was able to help with my issues.
During the pandemic, increased incidences of distress can be portrayed as proliferations of mental illnesses such as ‘Depressive Disorder’ and ‘Anxiety Disorder.' Alternatively, we can talk about our fears, worries, grief, pessimism, and despondency as understandable reactions to the general crisis and to our personal losses, actual and anticipated.
I prefer the latter framework. It locates the origin of our problems in the reality of our social contexts, rather than implying that there is some defect in us as individuals, in our genes or brains. Research shows that increased anxiety and depression during the pandemic is predicted by obvious social factors like loss of income and having children at home.1 Yet our mental health services, and research, remain dominated by the medical-model approach, which calls the labels it uses ‘diagnoses.'
Perhaps we should revisit the creation of the archetypal psychiatric diagnosis—schizophrenia—to understand how we went from understanding that depression, for example, is caused, for all of us, by depressing things happening, to the notion that depression is caused by some of us having something biologically dysfunctional inside of us called ‘depressive disorder.'
Two ‘grandfathers’ of psychiatry, Emil Kraepelin and Eugen Bleuler, were responsible for the invention (or, from their perspective, discovery) of ‘schizophrenia’.2 In 1893 Kraepelin presented his new mental disease, in which deterioration begins in adolescence and ends inevitably in dementia. Hence the name ‘dementia praecox’ (‘praecox’ means early). His immediate problem was that some people insisted on getting better. He made no claim to have cured them. So, he just changed the diagnosis if people recovered.2 The American psychiatrist Harry Stack Sullivan argued in 1927 that: ‘The Kraepelinian diagnosis by outcome has been a great handicap, leading to much retrospective distortion of data.'3
In 1911, Bleuler, working in Switzerland, published his famous Dementia Praecox or the Group of Schizophrenias.4 He rejected Kraepelin’s notion of incurability and demonstrated that Kraepelin had grouped together numerous, quite different, types of problems. This was soon ignored, however. It is ignored today every time the term schizophrenia is used as if it were a meaningful, unitary, explanatory concept.
Kraepelin eventually described no less than 36 groups of ‘psychic’ symptoms and 19 types of ‘bodily symptoms.'5 One patient could have symptoms entirely different from another's, but both supposedly had the same illness. Such constructs are known as ‘dysjunctive’ and are scientifically meaningless.2
The symptoms listed by Kraepelin and Bleuler read rather like a list of broken social norms. For example:
- "They conduct themselves in a free and easy way, laugh on serious occasions, are rude and impertinent towards their superiors, challenge them to duels, lose their deportment and personal dignity; they go about in untidy and dirty clothes, unwashed, unkempted, go with a lighted cigar into church".5
- "More in girls, there is reported irritability, sensitiveness, excitability, nervousness, and self-will . . . [and] those patients, belonging rather more to the male sex, who were conspicuous by docility, good nature, anxious conscientiousness and diligence, and as patterns of goodness".5
- "Patients are in love with a ward-mate with complete disregard of sex, ugliness, or even repulsiveness".4
- "Patients sit about idle, trouble themselves about nothing, do not go to their work".5
- "A hebephrenic [a subtype of schizophrenia] whose very speech was confusion, held the cigar-holder to the mouth of another patient suffering from muscular atrophy. . . with a patience and indefatigability of which no normal person would ever be capable".4
- "Many schizophrenics display lively affect. Among them are the active writers, the world improvers, the health fanatics, the founders of new religions".4
- "Perversions like homosexuality and similar anomalies are often indicated in the whole behaviour and in the dress of the patient".6
‘Flat affect’ and ‘inappropriate affect’ were ‘primary symptoms.' Feeling two opposite emotions was also abnormal, such ‘ambivalence’ being another defining characteristic of schizophrenia. Remembering too intensely was another symptom: "Even decades later . . . nuances of sexual pleasure, embarrassment, pain or jealously, may emerge in all their vividness which we never find in the healthy".5
There was no evidence to support their claim that they had discovered an illness with a biological cause. Bleuler wrote of a ‘schizophrenic cerebral disease’ but admitted that ‘Direct investigation for specific cause or factors has left us stranded’.4 Autopsies revealed no abnormalities.7 By 1913 Kraepelin conceded that the causes ‘are at the present time still wrapped in impenetrable darkness’.5 The words ‘at the present time’ are still used today by researchers permanently on the verge of finding a biochemical, neurological or genetic cause of schizophrenia.7, 8
Today’s definition of schizophrenia requires just two of five types of symptoms.9 So if I have just hallucinations and delusions, and you have just thought disorder and catatonia, we have nothing in common. Yet we get the same diagnosis. So schizophrenia remains, after 100 years of redefinitions, as scientifically meaningless as it always was. It explains or predicts nothing (except that you will definitely receive antipsychotic medication and probably be on the receiving end of some nasty prejudice and discrimination).
Today, when we experience severe levels of distress and grief, whether or not it is related to the pandemic, we deserve better than scientifically meaningless, medical-sounding labels that wrongly imply there is something biologically defective about us as individuals, which in itself is depressing, and that run the risk of unnecessary medical interventions.
Further Information:
International Society for Psychological and Social Approaches to Psychosis www.isps.org
International Hearing Voices Network www.intervoiceonline.org
References
1. SHEVLIN, M., et al. (2020). Anxiety, Depression, Traumatic Stress, and COVID-19 Related Anxiety in the UK General Population During the COVID-19 Pandemic. British Journal of Psychiatry Open, 6, 1-9. doi.org/10.1192/bjo.2020.109
2. READ, J. (2013). The invention of schizophrenia. In J. Read, J. Dillon (eds.). Models of Madness: Psychological, social and biological approaches to psychosis, pp. 20-33. . London: Routledge.
3. SULLIVAN, H. (1927). Tentative criteria of malignancy in schizophrenia. American Journal of Psychiatry, 84, 759-782.
4. BLEULER, E. ([1911] 1950). Dementia Praecox or the Group of Schizophrenias (translated by J. Zinkin). New York: International Universities Press.
5. KRAEPELIN, E. ([1913] 1919). Dementia praecox. In E. Kraepelin, Psychiatrica (8th edition) (translated by R. Barclay). Melbourne, FL: Krieger.
6. BLEULER, E. (1924). Textbook of Psychiatry (translated by A. Brill). New York: Macmillan.
7. BENTALL, R. (2009). Doctoring the mind: Why psychiatric treatments fail. New York: Allen Lane.
8. READ, J. (2013). Biological psychiatry’s lost cause. In J. Read, J. Dillon (eds.). Models of Madness: Psychological, social and biological approaches to psychosis, pp. 62-71. London: Routledge
9. AMERICAN PSYCHIATRIC ASSOCIATION. (2013). Diagnostic and Statistical Manual (5th edition). Washington DC: APA.
Schizophrenia
Thank you
Thank you so much for this article! This is exactly what happened to me. I was experiencing a crisis due to a huge trauma. I was labeled, physically and chemically restrained in the ER ( very traumatic). Involuntary committed for 14 days (more trauma) I now have brain damage due to The copious amounts of antipsychotic s that they shot into me against my will.
Thought disorders are not “understandable reactions”
I must take issue with your assertion that serious mental illnesses are mere “understandable reactions to stress” that should not need medication. While your assertion that some mood disorders are not disorders at all but merely a reaction to situations that could cause depression or anxiety has merit, for something to rise to the level of being a disorder it has to severely negatively impact your daily life. Having some anxiety because the world is anxiety producing is not the same as having generalized anxiety disorder. Using a thought disorder such as schizophrenia to illustrate your point is groundless. Believing the CIA has implanted a computer in your brain and spending all your energy and time trying to get that computer out is not an understandable reaction to daily stressors and not compatible with a normal life. Your article does those with such a tragic disorder a huge disservice, encouraging them to not seek medical treatment and condemning them to years of misery. I cannot believe that you as a trained psychologist (I am presuming as much) would actually take such a position.
Schizophrenia article
Well said, Ms. Donch. The author's premise is simplistic and absurd and is the kind of thing that could dissuade someone who is ill from getting the help (including antipsychotics which he seems to disparage) that they desperately need. Publishing this article is irresponsible on the part of the author and Psychology Today.
Dear Mr. Rimmer
Who the bloody hell are you to make any kind of bollocks statements about what people suffering from psychosis may or may not be dissuaded from and why. As a psychosis survivor I can tell you ONE THING, sir. What dissuades a psychosis suffering individual from seeking help is the constant abuse (physical restraint and forced drug treatments) that you experience in psychiatry today... THAT and the constant coercive bullshit that is followed by an offer to take the pills... The medicine is not helpfull and by now we have a lot of well documented scientific research that fully sheds the light on the zero effect - all money game of antipsychotics, their use and the drug industry. Now do have the decency to piss off with comments like the above.
Warm regards
from an psychosis survivor (sans medicine) and occupational therapist.
Exactly. I know a case, when
Exactly. I know a case, when a teenage girl told her mother that she was unhappy and was thinking about death; the mother called helpline and was advised to take the daughter to ER immediately. She did, and then they both were shocked when the daughter was taken from the mother, over the daughter's and mother's objections, locked-up, and not allowed to be visited or even to make a call to talk to her parents. She was released after a couple of days, but this episode was traumatic. How can she share her feelings with her parents if they then take her to a place where she gets imprisoned? The mother had no idea that this would happen, of course - she expected help, not her daughter being dragged away from her. This is what dissuades people from seeking psychiatric help
Why is it psychiatry only, of all medical fields?
I always wonder why is it considered perfectly routine to discuss publicly pros and cons of all established medical procedures in all areas of medicine, except psychiatry? Not specialized publications like PT, but the general media publish that, say, widely used steroid injections for arthritis can be unsafe ( James Hamblin, in The Atlantic, October 17, 2019) or surgical implants may be harmful (Jerome Groopman, in The New Yorker, April 13, 2020 ) ... really, every mainstream media in every other issue publishes something about this or that medical controversy. Why does not anyone accuse them of being irresponsible, discouraging patients from seeking help etc.?
As for antipsychotics, they are widely "disparaged" in medical literature for causing problems ranging from diabetes ("Hyperglycemia and antipsychotic medications," J Clin Psychiatry. 2001;62 Suppl 27:15-26) to sudden cardiovascular death in healthy young people ("Association of Antipsychotic Treatment With Risk of Unexpected Death Among Children and Youths." JAMA Psychiatry. 2019;76(2):162–171). This is not to say that their benefits cannot outweigh risks in some cases, but what's wrong about discussing pros and cons and helping people make informed decision? Why is it OK to publish something in JAMA, but not OK to discuss the same thing in PT?
Why?
I think it's because other medical specialties are treating discernible pathological or disease states of the body, whereas the "diagnoses" of psychiatry are so subjective and lacking in scientific validity that practitioners become instantly defensive as soon as their belief system is attacked, even in the most rational way possible. Psychiatric diagnoses are more akin to a religion than a science, and there are True Believers and Heretics, and no room for reasoned discourse.
Additionally, there are a lot of people making lots and lots of money off of psychiatry's diversions from reason, and those people take a dim view of those who want to cut into their profit margin.
Reply to Steve
Exactly! I really like how you put it, but the problem is that the mainstream media and politicians follow the line of the "true believers," and no amount of rational argumentation will help to change the system.
Media/politicians
The media and politicians are unfortunately in the realm of those who are profiting and don't want to bite the hand that feeds them. Banning direct-to-consumer advertising and banning corporate contributions to political candidates would both really help make it more viable to get the truth out there.
Consider doing something about it?
Dear Steve,
This is so true. But is not this is something that can be changed by citizen activism? Really, nobody outside of a very narrow and closed circle knows about problems with psychiatry. Would you be interested in discussing plans for what may be done to raise awareness in this area? If yes, I would like to get connected, but the PT does not allow email addresses in comments.
If you feel like contacting me and get connected with a small (as yet, I hope) group of aspiring activists, would you consider finding me, Yulia Mikhailova, either on Facebook or through the New Mexico Institute of Mining and Technology (where I teach) - the New Mexico Tech site has my publicly available email address.
For that matter, trying and writing to the mainstream media may be worth a try - they will ignore one, or two, or three letters, but a letter campaign may have an impact. In any case, it is necessarily to reach out to the general public. I myself became aware of all these problems only recently, through a terrible personal experience (it's all fine now for me personally).
MIA
Are you a commenter on Mad in America? I think I recognize your name. I moderate the comments there, and my email is available in the staff section.
What do you know?
Actually what caused my falling into psychosis was childhood sexual abuse. John Read is on to exactly what it is about.
Psychosis is a tragic state(s) (not a disorder) of human psychological disintegration but it can be healed without medication. I am a living example that it can be healed even after 30 years.
Medicine does no good in the healing equation. Medicine makes you numb and apathetic to the world, your life and imprisons your mind in fog. In order to heal from psychosis you need to be able to think clear and you need someone to talk to who is genuinely interested and vested in helping you, truly... Not some fake person who wants to give you medicine and park you in the allocated garbage dump estimated for those that fall out of the production society.
The minute you people start listening to those of us with lived experience is the same moment we will start to consider taking you seriously. I suspect this will fall close to the time when you stop calling things disorders and drop constructs like 'schizophrenia'.
Sorry Terese - you are tearing down arguments John did not make
No where did John minimise the importance of the problems currently associated with the schizophrenia label! There is no "mere" in his writing. He is however pointing out that this term is not scientifically valid, so we should be looking for ways of responding to psychosis that are meaningful - by looking at the life experiences that precede these problems and understanding that there better ways of responding than removing people form their support networks and stresses, sedating them, then re-inserting them into the same environment, with added complications of self- and other-stigma. Thanks
Schizophrenia
What is at issue here is the question of whether unusual and distressing experiences often labelled as 'schizophrenia' might be comprehensible in terms of the patient's background. This question was first posed by R. D. Laing (1960) in The Divided Self. This question remains of the utmost scientific significance. With the passage of time and thanks to the meticulous research work of Professor Read and many others, this question is now being answered more and more in the affirmative time. Professor Read is merely pointing out that, in the light of the accumulating evidence, labels such as 'schizophrenia' obscure more than they explain by reifying a 'diagnostic entity' that so very often results in the dismissal of complex human phenomena by reference to pseudoscience i.e. as explicable simply by virtue of membership of the entirely arbitrary category, 'schizophrenia'. At what cost? A deeply human understanding that the potential for such phenomena occurring is implicated in all of us. In this light, the 'symptoms' can be understood in terms of the life history and an effective psychological conceptualization and intervention can be formulated. Other treatment modalities may of course be required. If I understand him correctly, all Professor Read is asking is that we look beyond the label so that we may find the person.
/agree
While there is certainly an argument that psychiatric medications are dispensed too readily, to suggest that someone with chronic profound mental health issues are not suffering from some underlying biological mechanism we simply don’t understand yet, is incredibly invalidating to those that suffer these issues. It is also at odds with mountains of evidence that show that, even for children separated at birth, many mental health issues including -schizophrenia, have, in some cases, strong genetic risk factors. I have spent over half a century as a therapist working with clients with intractable depression, anxiety, criminality, addiction, personality disorders and telling these people to just pick themselves up by their bootstraps, shake it off and that their problems are all just “in their head” is professionally irresponsible and just cruel. Frankly, this sort of thing is something I would expect to read on Faux “news,” not this publication.
And yes, the stress many are feeling at the moment may not be something that should be automatically met with a prescription. But the entire rest of this article is awful and entirely unsupported by science and research.
.
What is time if even after 50 years one does not understand?
Shannon, you write you have spent over half a century working with clients with various forms of serious mental distress.
Well, I have spent more than half my life suffering from severe psychosis. Frankly I find it incredibly invalidating to have you come here and write that a client is just suffering from a biological disease (schizophrenia), that 'my problems' are all just in my genes and that the prospects of healing is very low. I find it professionally irresponsible and cruel that you lack the empathy to at least try to see this from my side... Being told that I suffer from a biological disease (a claim for which there is no merit nor evidence) is not adding anything positive or even meaningful to a condition (psychosis) in which being lied to, coerced and forced into medical treatment is part of the problem, not the solution.
Especially since I am OK now because of people like John Read. Because of people understanding that my psychotic experiences were founded in trauma (childhood sexual abuse in my case).
Being told by people like you that I am suffering from a disease or biological condition that was already present in me from birth is borderline EVIL considered that I have had psychotic experiences for more than 30 years starting from when I was sexually abused but NOT before I was sexually abused. It borders very much at blaming me (my biology) for having been through hell rather than blaming the traumatising events in my life.
You see my point? You are accusing John Read of invalidating people suffering from severe mental distress. In fact you are the one invalidating me and mine. What John Read is doing is EMPOWERING us because we need to find out what happened to us (trauma) and then get it healed.
We do not need diminishing or demeaning or patronising gobshite about being biologically responsible (by default of bad genes) for our own misery (oh and then being told that there is no way out). Shame on you.
Shannon M - who are you
Anonymous wrote:While there is certainly an argument that psychiatric medications are dispensed too readily, to suggest that someone with chronic profound mental health issues are not suffering from some underlying biological mechanism we simply don’t understand yet, is incredibly invalidating to those that suffer these issues. It is also at odds with mountains of evidence that show that, even for children separated at birth, many mental health issues including -schizophrenia, have, in some cases, strong genetic risk factors.
*Sorry - not sure you've got these facts straight - there are apparently 108 genes that can confer up to 0.5% increase risk of developing a psychosis.I have spent over half a century as a therapist working with clients with intractable depression, anxiety, criminality, addiction, personality disorders and telling these people to just pick themselves up by their bootstraps, shake it off and that their problems are all just “in their head” is professionally irresponsible and just cruel.
* Not sure where you got the idea that this got Prof Read's proposal - are we reading the same paper????Frankly, this sort of thing is something I would expect to read on Faux “news,” not this publication.
And yes, the stress many are feeling at the moment may not be something that should be automatically met with a prescription. But the entire rest of this article is awful and entirely unsupported by science and research.
.
Genetic risk factors
Hi, there,
I have to take issue with your contention that there are mountains of evidence of a genetic etiology for schizophrenia. The most optimistic correlations from large-scale genetic association studies were something like 10-15% of the variation explained by correlation to a collection of over 100 genes in various combinations. Whereas correlations with known childhood trauma exceed 80% in most estimates (much higher for "mood disorders"), with a "dose-dependent" relationship (aka the more trauma, the higher the odds of a "disorder"). Childhood sexual abuse is especially correlated with "schizophrenia," as is migration to a new culture and living in an urban environment. It is difficult to countenance these claims of genetic causation when the correlation with other events is orders of magnitude higher than even the most optimistic stretch of the genetic correlation data.
useless
Generalized anxiety disorder is as scientifically baseless as schizophrenia. It's just a collection of symptoms that don't fit with other collections of symptoms, but it's all arbitrary.
/agree
The medical model for mental health is one that is poorly supported at best. The medial model doesn’t even work that well for medicine.
In the medical model there is a symptom (or constellation of symptoms) such as an infection, that can be confirmed with tests and microscopes. The cure is traditionally antibiotics. However, the body, from the “second brain” being the stomach and GI track to other biological ecosystems such as female genitalia operate and are more comprehensively and successfully conceptualized as ecosystems. Antibiotics can throw these ecosystems into imbalance resulting in GI symptoms and secondary effects such as yeast infections. Antibiotics attack all bacteria in the body, including helpful, symbiotic bacteria. So, the medical model fails even in this assumed straightforward medical health issue.
Similar biological ecosystems exist in the brain, but are profoundly more complex and significantly less understood. The medications used in the mental health field are like using sledge hammers to sew two pieces of cloth. Psychosocial and biological brain phenomena (and the interactions of both) are poorly understood at best. This leads us to try and create models for understanding and treating psychosocial issues from chronic intractable Depression and Anxiety disorders to Schizophrenia to Addiction to Personality Disorders and a slew of other debilitating mental health issues.
However, these models can be off the mark and are * highly * arbitrary, grouping constellations of characteristic symptoms as possible criteria for a diagnosis. This is why the DSM and ICD publications for mental health disorders can radically change with each new edition which uses the best science we have available to try and provide some semblance of organization to impart understanding for the benefit of both patients and the clinicians trying to help them. These models do help understand what is going on and guide treatment(s), proven through clinical studies. However, it must always be kept in mind that humans are infinitely complex organisms, especially regarding disorders/dysfunctions of the mind, and clinicians must keep in mind that our understanding, based on the best knowledge at the time, is not an exact science.
In the end, this makes treatment for mental health issues as much art as science. It also means that flexibility regarding diagnosis and treatment can be critical as applying “cookie-cutter” treatments for a given mental health issue may not always be the most helpful. My experience over decades has shown that most mental health issues must be dealt with holistically, comprehensively and, in the end, individually on a case-by-case basis. This approach has always run into conflict with the medical model of mental health and the health insurance industry’s drive to force mental health treatment into a medical model. This model treats mental health issues as discrete, unconnected problems, which is not how they usually operate inside clients, nor within the complex psychosocial environments in which we all live.
.
Where exactly in this post do
Where exactly in this post do you see that the author encourages those with serious problems, such as believing that CIA implanted something in their brain, "to not seek medical treatment, condemning them to years of misery"? Do you equate any critique of any medical theory and/or practice with discouraging sick people from seeking medical help and condemning them to suffering? When scientists of the past argued that blood-letting did not work for most patients and often caused harm, did they condemn people to misery, or did they advocate for better medicine? There are many diagnoses that were used in the past, but not now - "black bile," "melancholy," "dropsy" used to be considered specific illnesses. We now know that swelling (the defining feature of "dropsy) can be a symptom of many different diseases and is caused by many different reasons. If nobody had ever criticized diagnostic criteria, there would have been no progress in medical science and we would still be diagnosed with "dropsy" and "treated" with leeches.
how was this published?
I am agreeing with Rimer and Donch. Dr. Read's dismissal of schizophrenia, just because it is not yet fully understood and, yes, may embody several overlapping or perhaps discrete disorders, is surprising at best and very damaging at worst. I knew this was an extremely questionable opinion article when I read "... depression, e.g., is caused, for all of us, by depressing things happening ... ". I have sympathy for anyone who is a patient of Dr. Read.
Please explain to me
Your vision of what it feels like to be told what you suffer from, why you suffer from it and that you will get cured by taking some pills... --> when clearly that is a fraudulent lie. Because that happens all the time in psychiatry today.
Would it be so frightfully hard to consider that actually the person suffering from psychosis is a person that owns his/her own narrative? That you are clearly intruding if you are taking coercive measures in order to bend this persons mind to your own will or outlook on things?
Have you ever considered why we have rules of law that reads that you are innocent until proven guilty and why this careful consideration should be used when we are discussing psychosis and 'schizophrenia'; yet we have the completely hopeless situation in which the general construct and understanding of 'schizophrenia' is that it must be a disorder for which there must be a medical treatment option.
I have sympathy for you. For your lack of understanding. For your lack of empathy. For your lack of will to consider dropping 'disorder' in order to help a person back on foot who has lost his/her bearings. I am glad you never have and never will be in charge of treating me...
The problem of over simplification
Anna, unfortunately you "and, yes, may embody several overlapping or perhaps discrete disorders" is the nub of the problem with this diagnosis. As a side issue, it's worth noting that this label in the ICD is a 'classification' of disorder, not a diagnosis (see F20 in the ICD - WHO International Statistical Classification of Disease).
However, the main point is that by conflating all these concerns under a demonstrably invalid construct, any real progress is hampered, if not entirely stymied. Imagine that we called 'fever' a diagnosis and agreed that paracetamol (acetaminophen in the USA) was the best way to reduce the symptoms, and accepted that approach as the only treatment. Of course it is vital to separate the various illnesses that have this common symptom (fever), and the same is true of psychosis... Thanks
reply
I am seeing now a broader interpretation of Dr. Read's article. My apologies for my sudden reaction as I realize it was coming from a certain view, one of advocating for patients with severe psychosis (or however it may be named) not necessarily caused by abuse or other trauma. I agree that a full assessment and consideration of appropriate/best available treatment should be provided by a person's psychologist and/or psychiatrist.
Psychosis and assessments
Good! Thank you.
I think that a full assessment and consideration of appropriate/best available treat should never be provided but deliberated in close concert with the 'patient' and always always always with a client centered perspective in focus. It should always be the patients choice and option to either accept or dismiss any treatment available.
I don't know how you define severe psychosis but I have suffered from a trauma based psychosis that was severe enough to have me walking in front of a train at the command of voices. If that is not severe enough then I was completely in the grasp of psychotic voices for more than 30 years after the original trauma.
I managed to come out on top of this without medication. I believe you can help people suffering even the most severe cases of psychosis in the same way as described in Soteria houses, Open Dialogue, Genuinely profound psychotherapy, art-therapies, Healing Homes and many other none-abusive, none-invasive treatment forms. Sometimes medicine can even be helpful in assisting a primary form of therapy but never if it is forced upon a 'patient'.
To Anna
Apology accepted Anna. Glad to see we are really on the same page after all.
Anna Vinson, I am confused
What do you call "dismissal of schizophrenia"? You agree that it may "embody several overlapping or perhaps discrete disorders," but you also think that PT did wrong in publishing a text that makes exactly this argument - that schizophrenia is a blanket term for diverse phenomena.
Scientific language needs precise terms and conceptual clarity. If psychiatry is a science, the same word cannot be used for what is "perhaps discreet disorders." For a progress in science, it is necessary to differentiate clearly between what is known and what is not.
You seem to say that schizophrenia is a word for something that is not fully understood and may be several different diseases, but anyone who questions that this "something" must be called schizophrenia somehow makes a terrible crime.
Or did you simply want insult the author? You are sorry for his patients? So, do you give the same treatment to all your patients diagnosed with schizophrenia? If yes, what if they have "perhaps discrete diseases," but receive the same treatment? If no, why do you insist on calling their different conditions with one and the same term?
Schizophrenia and Dr. Read
Dr Read has done everyone a great disservice in the posted article in psychology today when he uses the example of schizophrenia in an attempt, in a laudatory but misguided fashion, to place much of the current distress in the COVID era as arising from social causes. Citing literature from 100 years ago and ignoring advances in neuroscience he suggests that schizophrenia is a social construct ( he must have read Laing in his youth), ignoring all evidence to the contrary. This is not only potentially harmful to individuals with schizophrenia and their loved ones, it is an astounding lapse on the part of psychology today in publishing such a biased one sided view.
Neuroscience
Most psychiatric diagnoses and the whole psychiatric diagnosis system is a social construct. This has nothing to do with Laing. It has to do with the fact that we are not talking about disorders here. We are talking about mental distress. It is irresponsible to think and act like psychosis has anything to do with neuroscience. On top of that it is absolutely disgraceful to think that you are helping anyone suffering from psychosis by taking the position that they are suffering from a brain disorder.
The sexual abuse that caused my falling into psychosis had absolutely nothing to do with my brain being in any form of disorder. I was a happy developing healthy child before I was subjected to sexual abuse. The abuse did not in any magical way insert a brain disorder into me. I wish you people would stop harming the people you are supposed to help.
Sorry, what advances in neuroscience?
I have been amazed that anyone thinks that advances in neuroscience have made any difference to our understanding of the different factors concerned with the emergence of psychosis - however, I would be pleased if you can point me to any evidence I may have missed.... Thanks
Scott Theriault, any lit citation please?
" Citing literature from 100 years ago and ignoring advances in neuroscience he suggests that schizophrenia is a social construct." Read never mentions "social construct"; he argues that there is nothing "biologically defective" with somebody diagnosed with schizophrenia.
You do not agree? You think, there is a biological defect there? Would you please cite any publications about biology of schizophrenia? Any astonishing new discoveries since 2011, when the Psychiatric Times published Ronald Pies's "Pshychiatry's new brain-mind and the legend of the 'Chemical imbalance'"?
Only please do not cite anything with "may explain," "may relate," "further research is needed to confirm." In those cases, let's wait until further research does confirm biomarkers of schizophrenia.
Also, please cite the researchers who explain their methodology for differentiating between the biomarkers of the disease and the biological impact of the medications.
I assume, for example, that you are familiar with the research of monkeys receiving antipsychotics and showing the same shrinkage in brain volume as patients diagnosed with schizophrenia and taking antipshychotics.
In monkeys' case, the shrinkage could not be caused by schizophrenia. Any recent groundbreaking research showing that in patients it was not medication, but disease?
In short, share with us your knowledge of advances in neuroscience that Read ingnored
Agree with Dr. Reed
Extreme mental anguish, altered states of consciousness, and severe emotional isolation are real. But Dr. Reed is correct - psychiatry is as wrong in its formulations of "schizophrenia" today as it was wrong in its formulations of homosexuality 50 years ago. Just look honestly at the research history of schizophrenia and you'll see a completely different picture than today - past psychiatrists typically expected a significant portion of their schizophrenic patients to recover completely without medications through therapy and time, and understood schizophrenia more in its social and psychological context as a "schizophrenic reaction." Only in the profiteering Big Pharma era do we get "disease management medication for life" and the biological determinism of today. The truth is far from what we hear in the media and in the doctor's office, and it is hard to believe that science has strayed so far afield. But take a look at the film A Beautiful Mind with Russell Crowe portraying mathematician John Nash. The film says Nash recovered through medications. Now read Nash's actual biography and learn the truth - Nash attributes his recovery explicitly to /not/ taking medications. This disconnect from reality in a major Hollywood film supposedly presenting a sympathetic portrayal of schizophrenia speaks volumes about the dishonesty in medicine taking place today. You also need only discover the patient survivor movement to meet many people with a schizophrenia diagnosis who have recovered without medications and attribute their success to breaking with the narrow dogmas peddled by medical professionals. Or take a look at the successes of Open Dialogue, a family based approach to psychosis and schizophrenia in Finland. Or look at the raging controversy among leading schizophrenia researchers who are pointing to exactly what Dr. Reed is discussing here, the shaky antiquated foundations at the base of schizophrenia as a concept and the need to update to a more nuanced and complex view. Or the growing pushback among cognitive scientists who are questioning the prevalence of neuroscience reductionism today that overstates what the science of fMRIs and genetics is actually revealing about the nature of the human mind and its struggles. You may also want to look at what Tom Insel formerly of the NIMH has been saying more recently that in fact the science of chemical imbalances being chased in mental health research for the past many decades turned out to be a dead end with nothing conclusive discovered at all. It's upsetting to learn that mainstream dogma turns out to just be dogma and not based in fact, though it should be no surprise that those Pharma ads you see all the time aren't actually telling you the truth. That is the situation today with the prevailing science around so-called schizophrenia. The sooner we start to admit what we don't know and admit where the science had made mistakes, the sooner we can start to offer real meaningful solutions for people suffering extreme mind states and severe emotional isolation.
Thank you!
This is exactly what it is about. Thank you so much for pointing out the truth of the matter.
A breath of fresh air
Dr. Reed's article is a welcome breath of fresh air and I concur with what I understand to be its core message. While diagnostic frameworks and practices can have some provisional efficacy in better understanding and therapeutically assisting people having anomalous psychic experiences, they tend to stultify such efficacy and understanding if used prescriptively. Diagnostic criteria and frameworks in clinical psychiatry and psychology are often used as scientific facts, when they are not. As stated in iterations of the DSM, they are provisional constructs (i.e. not medical facts). Indeed, the DSM-IV Task Force Chair, 'psychiatrist Allen Frances, made a strong case against over-diagnosing in his book 'Saving Normal' and he continues to assert this concern. Walking alongside people and their experiences is therapeutically better-by-far than the approach of cold clinical diagnostics based on assumptions that have been forged into 'facts'. The latter approach diminishes, rather than advances, our understanding of anomalous psychic occurrences and the lived experience of people who are having them.
Psychosis
Thank you, John Read for this well thought and well written article.
As a psychosis survivor (sans medicine) I am so happy to know that there are people in the world that will seek to understand and see things from the narrative perspective of the person suffering from psychosis. I found a home in ISPS (The International Society for Psychological and Social Approaches to Psychosis). Both as a psychosis survivor and as a health care professional occupational therapist.
In my opinion and reflecting my own experience with psychosis, psychosis has to do with trauma that disintegrates or threatens to disintegrate you as a person. Psychosis is the utmost defensive position in order to stop disintegration from fully happening. Lars Thorgaard (Danish psychiatrist) would refer to psychosis as the minds emergency stop button. I always found to be a very accurate description. It explains the whole withdrawal from the world (the trauma) as a way to survive when there is no hope left of surviving in the world. The Mind starts building it's own parallel world with its own meanings and values, complete with social and judicial systems that link to reality in somewhat obscure ways. For me it was imperative to not relive the trauma so this second hand sort of dimension kept it out of my conscious mind for many many years. I believed the voices. It was not until my first daughter was born that things really changed because the voices had convinced me that I could not have children. When I finally did the whole juggernaut came tumbling down. It took a girl, who believed in me, who wanted to be with me despite all odds, safety, empathy and meeting people like you and all the people who placed faith in me, even before you knew what I was struggling with, to overcome psychosis. I did! I am here on the other side. Now I have two children, a family, a life...
If I had ended up in a psychiatric ward (which I bloody well could have), my narrative would probably have been one of medication, dysfunction and hopelessness.
One of the keys to finding your way back from psychosis is to perform and engage in meaningful and valuable human activities with people who are able to contain your psychosis when it is present. People who will not inject you with drugs to calm you down at times when you most need their empathy and compassion.
Off The Meds Some Improvement.
Tardive down 90%. Nightmares not as bad.
Side effects
Nice to hear that you are getting better being off the medications, Greg.
Thank you. This makes so much sense to me and my family.
This article is really helpful to me and my family. It will really help my son have a clearer understanding of what has happened to him. He has been very angry for a long long time about the way he has been treated. He says that much of it feels like abuse and has not helped him at all. He has always rejected this diagnosis and found it very damaging. After 20 years he is now no longer subjected to the mental health act, including CTO, and now feels empowered to speak out about what really helps him.
We need more honest and accessible articles like this which empower us all to speak the truth and create a more compassionate way of working with those who experience extreme states of terror and despair. This needs to include families and supportive networks too where possible. So let’s create more Soteria Houses with Open Dialogue approaches. Thank you John for writing this.
The usefulness (or not) of schizophrenia as a diagnostic categor
It would be interesting to hear how those who have rushed in to attack John Read for his article respond to Professor Sir Robin Murray’s article published in 2017 in Schizophrenia Bulletin. After a career spanning 35 years at the Institute of Psychiatry, during which time he became one of the world’s pre-eminent psychiatrists researching schizophrenia he had this to say about the condition: “I expect to see the end of the concept of schizophrenia soon. Already the evidence that it is a discrete entity rather than just the severe end of psychosis has been fatally undermined.” Sir Robin speaks for a great many psychiatrists who no longer feel the concept has any value or utility. Before rushing in and attacking someone for being n iconoclast it’s important to step back, look at the literature and taking a more balance view.
Murray, R. Mistakes I Have Made in My Research Career
Schizophrenia Bulletin, Volume 43, Issue 2, 1 March 2017, Pages 253–256
Mainstream science agrees with Dr. Read - when will psychiatry?
In the last two years, many prestigious medical and psychiatric journals have been publishing critical articles that agree with Dr. Read. It is unlikely that academic psychiatry can remain deaf and blind for this much longer. Here are some recent citations:
CITATION 1
"There is enormous investment in basic neuroscience research and intensive searches for informative biomarkers of treatment response and toxicity. The yield is close to nil. Much of the mental-health–related burden of disease may be induced or prevented by decisions in areas that have nothing to do with the brain. Our societies may need to consider more seriously the potential impact on mental health outcomes when making labor, education, financial and other social/political decisions at the workplace, state, country, and global levels." (Ioannidis JPA (2019). Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders? Behavioral and Brain Sciences 42, e13.)
CITATION 2
"Ironically, although limitations of ‘biologic treatments’ are widely recognized, the prevailing message remains that the solution to psychological problems involves matching the ‘right’ diagnosis with the ‘right’ medication. Consequently, psychiatric diagnoses and medications proliferate under the banner of scientific medicine, although there is no comprehensive biologic understanding of either the causes or the treatments of psychiatric disorders."
(Gardner C & Kleinman A (2019). Medicine and the Mind - The Consequences of Psychiatry's Identity Crisis. New England Journal of Medicine 381, 1697-1699.)
CITATION 3
"We suggest that clinical psychiatry’s taken-for-granted, everyday beliefs, and practices about psychiatric disease and treatment have narrowed clinical vision, leaving clinicians unable to apprehend fundamental aspects of patients’ experiences."
(Braslow JT, Brekke JS & Levenson J (2020). Psychiatry's Myopia-Reclaiming the Social, Cultural, and Psychological in the Psychiatric Gaze. JAMA Psychiatry (Epub ahead of print))
CITATION 4
"The main message delivered to lay people, however, is that mental disorders are brain diseases cured by scientifically designed medications. Here we describe how this misleading message is generated. Biomedical observations are often misrepresented in the scientific literature through various forms of data embellishment, publication biases favoring initial and positive studies, improper interpretations, and exaggerated conclusions. These misrepresentations are spread through mass media documents. Exacerbated competition, hyperspecialization, and the need to obtain funding for research projects might drive scientists to misrepresent their findings. These misrepresentations affect the care of patients."
(Dumas-Mallet E and Gonon F. Messaging in Biological Psychiatry: Misrepresentations, Their Causes, and Potential Consequences. Harv Rev Psychiatry 2020; 28: 395-403. 2020/11/07.)
I rest my case.
Thank you!
Thank you, Jim van Os, for this succinct and helpful little lit review. When will we see similar citations in the general media that still feeds people with stories of "chemical imbalance"? Did anyone try contacting, say, Times?
Excellent article that should be welcomed by everyone.
I simply echo everything that Jim van Os has said. He put it perfectly. A much-needed article by John Read.
Dismissing labels vs. dismissing people
Thank you very much Dr. John Read for reminding us yet again the importance of life contexts in human distress. Many thanks also to those who supported this blog, sharing diverse experiences and perspectives. As mental health educators we want to highlight that the dismissal of narrow diagnostic labels is not the same as the dismissal of the experience of distress. On the contrary, people feel validated when their experiences are located in the context of their lives. As previous responders pointed out, not seeking medical treatment is primarily due to people's experiences of being dismissed and invalidated by psychiatric systems.
Dr. Read blog
Thank you, Psychology Today, for publishing this long overdue blog by Dr. Read. Psychotherapy does help an individual who has the diagnosis of schizophrenia, this has been repeatedly proven. I don't know of any expressed genetic disorder where that can happen, such as hemophilia.
Full agreement with John Read
As a psychiatrist who has been in practice for over 35 years, I welcome John Read's take on the concept of 'schizophrenia'. In my experience, this diagnosis is not helpful for people who come to services, or for their families. In fact, it only creates confusion. It does not explain what is happening for the person who is struggling and serves to create fear and negative expectations in the minds of family, friends and others.
Reply
I have read all the responses to this article, some of them quite impassioned, and I realize that Dr. Read’s article has been read and interpreted in a very different light from my own reading. My condemnation of his argument was very judgmental and detracts from the discussion of this important issue and for that I offer apologies. My point was to not discount patients’ experiences. However, clearly many have suffered at the hands of those in the medical profession when being treated for their troubles. (I hesitate to use the term “illness” because it seems to be loaded on this website). We all do patients a disservice if we close our minds to all avenues of therapy including psychotherapy and medications. For those writers who have suffered in spite of or due to their medical care, know that the focus of most medical professionals is to help you, not dismiss you or label you.
Help and doctors
Dear Terese,
Thank you for acknowledging and for apologising. Us, the people with lived experiences that is, are often in an opening process of vulnerability at the point when we seek help. Even aggressive behaviour must be seen in this light. It is at this point that you need the most compassionate and none-coercive and none-forceful care.
I can really recommend that you watch Daniel Mackler's brilliant film Healing Homes. I cannot link to it but it is on Youtube and free to watch.
Clearly it comes as a big surprise (shock) to many doctors that people with lived experience have a fundamentally different perception of forced medication and coercive power exertions than what they learn at the universities. I understand this if it is due to the fact that you are taught differently through most of your career. I really do hope that the comments of people like myself and others can open a path to enlightenment for people like you.
We do not harvest any ill prejudice about doctors as a starting point. Then we would have never looked for help in the first place. Unfortunately many patients get stuck in the system of psychiatry and social services due to the fact that they are forced and coerced into staying on prescription drugs and bound to a diagnostic system that is not helpful. This is also a fact due to economic issues as in many countries you cannot get social service help if you do not comply with treatment options (such as drug therapy).
It all adds up to the feeling of being abused by the system and the people that have wowed to help you but themselves are 'slaves' of the system. This needs to change.
If patients were given freedom of choice I am certain that some would actually pursue a path of medical treatment including medication out of their own virtue even if I do not myself believe in it. But set us free, please. Present us with options in an unbiased matter. Let the decision on which treatment to follow fall upon us, for whom it matters the most and for whom it is a matter of life, death, being comfortably numb or drugged down without ever getting the chance to heal properly.
If you create a safe space of comfort, compassion and empathy (and you can do that just by being and living that) then you give us the trust to seek your help, your advice and help us come to terms with the psychotic experiences and even understanding them and learning to live in harmony with them. Potentially even to let go of them.
Thank you!
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