Creating A Mental Illness Called Schizophrenia

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.

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.

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.

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.

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.

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.

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.

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.

Tardive down 90%. Nightmares not as bad.

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.

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

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.

I simply echo everything that Jim van Os has said. He put it perfectly. A much-needed article by John Read.

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.

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.

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.

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.