Psychiatry has lost its way with Schizophrenia

confused-by-creditThe only thing I partially agree with in “Limited Progress Made in Schizophrenia Understanding and Treatment”, by Heidi Anne Duerr, MPH, “Psychiatric Times”, October 3, 2013, is that “we have only made a series of baby steps in understanding the etiology, pathology, and treatment of the disease.” In my view we may have made a few baby steps backwards. Throughout the last hundred years there have been many theories about schizophrenia. Most have been wrong. But by the nature of schizophrenia itself, it’s all too easy to project a dehumanizing theory onto these human beings and then professionals operate as if this unproven theory is true. The only contribution in pharmacological psychiatry is that Thorazine and some of the later atypicals help with symptoms. That’s it.

Kraepelin is more accurate about schizophrenia than all the experts who have followed. Antipsychotics play a role in diminishing certain symptoms. And as psychoactive agents, they also can alter, and not diminish delusions. Antipsychotics do not create catatonia. It just hadn’t been properly diagnosed. Catatonia and hebephrenia are no longer correctly diagnosed because we are looking through today’s narrow brain prism. But they are still out there. As opposed to the rest of psychiatry, the only two diagnoses that have an actual causative element in the brain are schizophrenia and manic-depression. Patients with schizophrenia are no different from the rest of us. We all develop our characters from the collision  between our genetic temperament and nurture – responsiveness, abuse, and deprivation. Due to either early trauma or something epigenetic, or genetic, they develop psychotic characters. Real treatment, like for the rest of us, is psychotherapy of character, with the useful addition of antipsychotics to help with schizophrenic terror, reflecting the dissolution of the intactness of their sense of self, and a horrific ‘play’ of consciousness. This is spelled out in more detail, in my book, “Psychotherapy of Character, the Play of Consciousness in the Theater of the Brain”, by Robert A Berezin, MD., specifically chapter 17.

Even though there is a brain element in schizophrenia it is a human problem. And the real treatment is in human scale with psychotherapy.

3 replies
  1. Dan Feldman
    Dan Feldman says:

    As a dad pf a 25 yr old who has suffered through this problem, I am gratified to express my heartfelt thanks to you and your perceptions about mental illness. please keep your wise analysis coming and know that they are deeply appreciated.

    Daniel Feldman

    Reply
  2. leslie
    leslie says:

    So what do we do with a 26 yr old with psychosis, diagnosed with bipolar who does not recognize that he is affected? He is in terrible shape but the laws will not allow us to demand treatment. As a parent this is the most terrifying event in my life.

    Reply
  3. Pamela Wagner
    Pamela Wagner says:

    Precisely what symptoms of so-called schizophrenia does Thorazine, a drug once also known as a chemical lobotomy “help” with? Do you have any notion of what a PWSc ( person with schizophrenia) feels like on drugs like Thorazine or Risperdal?! I do. For many years, i took each of these, at different times, and the former at massive “anti-schizophrenic” doses, thanks to American psychiatry. Plus any number of other typical and atypical “anti-psychotic” drugs at other times…Not once did i feel better, not once did i feel that my symptons were actually helped by such drugs. I felt drugged up, yes, and i felt drugged into a mute stupor in which i could not object even to forcible ECT…

    But i never felt HELPED. It is known now that these drugs do NOT help improve psychotic symptoms like the ones you describe, delusions and hallucinations. All they have ever done, right from the start, if you recall your basic neuroleptic history, is act like a chemical restraint, or lobotomy. Now you might argue about the desirability of inducing such brain damage in your patients diagnosed with schizophrenia, but at least in the 1950s when Thorazine was introduced, no one pretended it was anti-psychotic in action or anything but a chemical agent that produces a response equivalent to a lobotomy, the psych-surgical procedure we now call abuse.

    By the way, although in my younger years i suffered several episodes of rather serious catatonia, Risperdal inevitably and invariably induced catatonia in me every time i took 1mg or more for longer than a week.

    Much appreciation for your thoughtful blog nonetheless,

    Pam Wagner

    Reply

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