Schizophenia Is Not What It Used to Be

Does schizophrenia have genetic roots?

Posted Nov 13, 2014

Does the word “schizophrenia” refer to one thing or many? This is the question that Edward Shorter asks in his excellent article “Breaking up Schizophrenia: Unless there is no Such Thing as Schizophrenia."

Contemporary geneticists, as Shorter tells us, tackle schizophrenia as if it is one specific mental health condition which has a biological cause. The cause or causes purportedly reside in our genes. However, according to a study in Nature and recently reported in Scientific American, the best that geneticists have done is to identify 128 gene alleles (variants) that are “associated” with schizophrenia. This means that these gene variants might be “risk factors” for schizophrenia at most, but they scarcely can be thought of as causes.

Shorter looks at the history of schizophrenia to untangle some of the confusion and figure out if geneticists are barking up the wrong tree.

The word “schizophrenia” was coined by the Swiss professor of psychiatry Eugen Bleuler in 1908. Previously, the names for chronic insanity ranged from “démence précoce,” the term coined by French psychiatrist Bénédict Morel in 1860, and “dementia praecox,” the word used by German psychiatrist Emil Kraepelin in 1893. In Kraepelin's and Bleuler’s views, chronic insanity like dementia praecox or what we today call “schizophrenia” was a homogeneous disease entity with a presumed biological cause.

And at the time Kraepelin and Bleuler were writing, this was apparently true--at least in some of their patients.

A number of Kraepelin’s and Bleuler's patients apparently had a condition that had a true biological cause--namely, encephalitis lethargica, a viral disease that produces inflammation of the brain. Encephalitis lethargica was unknown in the nineteenth century; thus psychiatrists like Kraepelin might well have confused its symptoms with other mental illnesses that had no such biological cause.

British psychologist Mary Boyle argues this in her paper “Is Schizophrenia what it was? A re-analysis of Kraepelin and Bleuler’s population of patients.” Boyle argues that Kraepelin's population of psychotic patients undoubtedly included patients with encephalitis lethargica which he mistakenly diagnosed with dementia praecox.

When encephalitis lethargica was identified and named in 1916 by Constantin von Economo, an Austrian neurologist, the symptoms were quite similar to Kraepelin's descriptions of his patients with dementia praecox. As Robert Whitaker observes in his book, Mad in America ,"Kraepelin's description of chronic schizophrenics deteriorating over time and sliding into dementia is also a description of people stricken by the encephalitis lethargica virus."

Today, viral encephalitis lethargica has virtually disappeared from the medical landscape. But it has left a legacy of conceptual confusion in the field of mental health. Scientists continue to search for biological causes of emotional problems, even though these supposed causes have remained elusive.

Decades of research (and billions of research dollars) have disclosed no substantial causal links between genes or other biological factors (like "chemical imbalances") with the mental and emotional confusion that we call schizophrenia or, for that matter, other mental disorders in the various DSM's (apart from well-known organic disorders like epilepsy and Alzheimer's Disease).

All of this leads me to conclude, along with Shorter, that scientists have been looking in the wrong place. Perhaps, as Shorter suggests, schizophrenia is not a single biological disease at all, and that the DSM's way of categorizing schizophrenia leads more to confusion than to clarity and usefulness.

It may be likely, as Shorter suggests, "there is no such thing as schizophrenia." Perhaps schizophrenia is, as Mary Boyle argues in her book, "a scientific delusion" or, to put it more politely, a "social construction."

Shorter does think that adolescent withdrawal from the world is a specific disease, though I’m not sure that I agree with him on this. No biological causes have been found for this condition either. It might well be more fruitful to investigate the social and emotional roots of the affliction that we call schizophrenia in adolescents and young adults. Freud, as a practicing clinician, thought of schizophrenia primarily in operational terms. He thought of schizophrenia as a person’s emotional withdrawal from the world, due to psychological conflicts. Freud found that some patients were so withdrawn that he as a psychiatrist could not connect with them.

Perhaps we will find the roots of this disturbance in an emotional rather than a biological factor--for example, in the emotional trauma of adolescents and young adults who may be ill-prepared to face the loneliness of the world outside the nest. Family therapist Jay Haley didn’t like the word “schizophrenia” to describe these troubled young people. He preferred to think of them as “mad” not “ill.”

This madness comes about, Haley believed, as the result of a specific life crisis in the individual and in the family. He called this the crisis of “leaving home.” For the family, it is a crisis of separating from their beloved child. For the young adult, it is a crisis of facing the world outside the nest. The anxiety in the family as well as in the child can trigger madness in some adolescents. They become “disturbed” with the result that they must stay at home.

There are, of course, other life crises and trauma that lead to similar disturbed states of mind; but we will never find them if we cling to the dogma of biological causes and clinical labels for every human social, emotional, and family problem.

 Copyright © Marilyn Wedge, Ph.D.

Marilyn Wedge is the author of A Disease called Childhood forthcoming in March, 2015 from Penguin/Avery.

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Image: Wikimedia commons in the public domain (author Jens Maus).