The 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.