Schizophrenia: physical condition or political construct?

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firemonkee57

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Schizophrenia: physical condition or political construct?

Posted: 14 April 2009 | Subscribe Online

To mark Mental Health Action Week, mental health nurse Stuart Sorensen questions the ‘facts’ about schizophrenia


Ideas have power, especially ideas that seem to be supported by evidence. Such ideas, backed by highly trained professionals, quickly come to be accepted as facts.

One such idea concerns schizophrenia. The notion of a biological brain disorder causing long-term hallucinations, delusions and thought disorders is so familiar that most people simply accept it. But just how strong is the evidence?


The disorder was first identified by Eugene Bleuler a century ago. At that time it was known as ‘Dementia Praecox’ (dementia of the young). Bleuler’s early description was of psychological problems rooted in emotional trauma and far from incurable.

Most people intuitively understand the idea that overwhelming trauma and stress results in psychological difficulty. In fact the defence of ‘temporary insanity’ resulting from life events has long been accepted by the courts as well as popular culture. Most people also accept that, given time and the opportunity to put past experiences into perspective, this ‘insanity’ can be overcome.

How then did the original idea of reaction to trauma become a biological brain disease with little hope of recovery? The answer is not scientific but political.

Psychiatry is based in physical medicine. Psychiatrists train first as doctors within the medical model, treating physical ailments with physical cures. As doctors began to take over the care of mentally disordered people it seemed natural to assume that their problems were also physical in nature.

Several ineffective physical treatments have been tried as a result of this assumption, ranging from surgical removal of parts of the brain to insulin-induced coma ‘therapy’ and electroconvulsive therapy or ‘ECT’.

Then in the 1950’s a new type of treatment emerged. Now described as an ‘antipsychotic’, chlorpromazine was the earliest of a range of drugs used to combat the symptoms of schizophrenia. First prescribed to combat vomiting it was noted that, in larger doses, it calmed psychotic patients because of its tranquilising effect. It was classified originally as a ‘major tranquiliser’ because of this sedative action. But is tranquilisation really the best treatment?


Over the years, different types of drugs have been developed, mainly based upon the dopamine hypothesis which holds that psychosis results from over abundance of the chemical ‘dopamine’ in the brain. Unfortunately there is still little evidence to support this after literally decades of research.

So what alternatives might there be?

Few would argue that antipsychotics have no place at all. But they are over-used. Arguably. the tranquilisation they provide prevents people from thinking through their difficulties. Talking treatments, such as cognitive behavioural therapy, are having a huge impact on the effects of psychosis – but only if people are alert enough to engage in the process in the first place.

Perhaps psychiatry itself, with it’s reliance on tranquilizing medications, is actually preventing recovery? Perhaps schizophrenia is no more than a self-fulfilling prophecy caused by medical assumptions about biological causes when the problem is really not physical at all? Perhaps the treatment really is worse than the disease.

Stuart Sorensen is a mental health nurse, trainer and director of AMJ Socialcare Training & Consultancy Ltd. www.amjcaretraining.site50.net


http://www.communitycare.co.uk/Articles/2009/04/14/111272/schizophrenia-physical-condition-or-political-construct.html
 
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Apotheosis

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Biology plays a role in these things. I look at these things as being loosely threefold, & having physical, psychological (mental), & spiritual components to them. I try to see things in a more holistic (wholistic) way.

Each individual is different. There are I would think multiple & different causes for mental distress - & a lot of complexities.

Some people are going to be best treated with meds. Orthodox psychiatry has a place. But many could be far better helped with more comprehensive methods.

I view 'schizophrenia' in a Jungian sense; as a naturally occurring psychological mechanism of the mind. Which if approached in certain comprehensive ways; does have the potential to be worked through & integrated. Much like 'psychosis' is a healing crisis; or a mechanism for deep change & growth - with it's roots in the 'pre-psychotic' personality.

Words lack the descriptive power to describe many things relating to these experiences. It is all too easy to miss-interpret meaning, or not be able to impart the 'right' meaning.

It is incredibly hard to successfully follow a med free recovery within our social environments. Ideally there should be comprehensive assistance for people to have real choice of treatment; & therapeutic, healing places of recovery for people to go; environments of trust; in which people can open up, & be allowed the opportunity to work through such psychological states. Such schemes have been tried & been very successful.

I also oppose the continued use of the label 'schizophrenia'. It is a very 'negative', miss-leading term, used as a pigeon holing & umbrella term; full of connotations of stigma & discrimination - it should be scrapped; in favour of something better.

There is also no telling what the future holds on a personal level. I hope one day to get completely off the meds.

It is about balance. Western materialistic / scientific reductionist viewpoints have a place; as do more spiritual /esoteric perspectives. I suppose it is about finding a balance between the two.

I think people should be free to choose whatever works best for them.

In the ideal or 'civilised' World - we would be treated with the full gamut of understanding & practise involved in the full field of MH understanding.

“There is no such ''condition'' as ''schizophrenia,'' but the label is a social fact and the social fact a political event.”
R.D. Laing
 
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Stuart Sorensen

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Hi,

Thanks for reposting my article. It's always nice to know that people have done that.

Incidentally I agree that there is a biological element and I also agree that there is a place for medication, especially in acute phases.

My concern is that biology is only one of around 5 elements that contribute to psychosis and that by ignoring the other 4 we pretty much guarantee that people will not recover.

Cheers,

Stuart
 
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Apotheosis

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My concern is that biology is only one of around 5 elements that contribute to psychosis and that by ignoring the other 4 we pretty much guarantee that people will not recover.
Hi Stuart - Glad that you could reply on here. Would you agree with the lifetime conclusions of Jung - that the causes are predominantly psychogenic? With biological nuances. & that cure can indeed be affected by purely psychological means?

Could you explain a bit further what you consider the other 4 elements are please - To my mind they are predominantly & fore mostly psychogenic - influenced in part & contributed to by trauma & environmental influences/individual circumstances (relationships with others/social situation ect). & more 'spiritual' aspects. That the 'condition' is three fold - physical, mental & spiritual. I use the term spiritual in a loose & non-religious sense.

That the best treatment is the one which addresses the 'whole person' & all the elements of potential cause.
 
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Stuart Sorensen

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5 basic elements

Hi Apotheosis,

I tend to agree with the stress and vilnerability model of mental disorders first posited by Zubin & spring back in 1977. The model suggests that we all have differing degrees of vulnerability to psychosis (including bioological vulnerability) but that in order for us to develop psychosis there must be something else as well. The something else is broadly defined as stress.

So the way to overcome psychosis is to concentrate on either reducing stress in all 5 areas to manageable proportions whilst simoultaneously increasing coping in all 5 areas.

For this reason I do not believe that there is no place for medication in psychosis (as I made clear in the article) but I do think that it's overused.

Medication can help people by enhancing coping and in some cass reducing biological stressors in acute phases of psychosis but it also prevents people from thinking through their difficulties thus preventing any meaningful work on other areas.

Have a look at the following articles from my website - they should outline my views - at least in brief.

http://www.amjcaretraining.site50.net/1_15_Psychosis.html

http://www.amjcaretraining.site50.net/1_3_Understanding-Recovery.html

I will however copy and paste an extract of a handout I use in training that gives a very brief outline of the stress and vulnerability model:



"The ‘Stress & Vulnerability model’ postulates that a biological vulnerability is a necessary element of mental disorder. This is in agreement with the traditional medical model of mental disorder.

In addition to the biological factor, however it may arise, trauma
of one kind or another does appear to be vital.

The model seems to occupy the middle ground in the ‘nature versus nurture’ debate and acknowledges the validity of both sides. For this reason many people are happy to work with it. It states that all people are vulnerable to stress but that the amount of stress they can cope with is variable. So one person may become disordered because of problems that another would simply shrug off but ultimately all people, if given enough stress, will develop similair problems.

People with low vulnerability need to experience a great deal of stress before they experience mental health problems whereas those people with high vulnerability need only a small amount of stress to ‘tip them over the edge’ into serious mental disorder.

Types of vulnerability include:

• Biological
• Psychological
• Social/cultural
• Environmental
• Developmental"


Hope that helps.

Cheers,

Stuart
 
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Apotheosis

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Hi Apotheosis,

I tend to agree with the stress and vilnerability model of mental disorders first posited by Zubin & spring back in 1977. The model suggests that we all have differing degrees of vulnerability to psychosis (including bioological vulnerability) but that in order for us to develop psychosis there must be something else as well. The something else is broadly defined as stress.
Hello - & thanks for the reply.

I'm not familiar with Zubin; it sounds reasonable.

For this reason I do not believe that there is no place for medication in psychosis (as I made clear in the article) but I do think that it's overused.
Under the 'right' therapeutic circumstances I do think it is possible to recover 'med free', although with our present social climate & medical model; do make that option incredibly hard. I have found a lot of interest in the writing & work or John Weir Perry. There are those that will best respond with meds; & need them for the best quality of life. I just think that there should be far more in the way of more comprehensive help. Medication if used should also be given in conjunction with a plethora of other 'therapies', & I would think meds should be used minimally & as a 'last resort'.

Medication can help people by enhancing coping and in some cass reducing biological stressors in acute phases of psychosis but it also prevents people from thinking through their difficulties thus preventing any meaningful work on other areas.
This is the problem I have. & I have no clear answers. I take 175mg of Amisulpride. It is a low dose; but I don't feel that I am functioning on this drug as well as I could be. I have stopped it 3 times, & tried a number of reductions. Without a certain increased level of support; I don't think I can presently stop it; or reduce. The LMHT have been discussing a med change with me, to Abilify; but that too I am wary of. Ideally I would like to be med free. I do think the effects are withdrawal effects to a large degree; but also lack of confidence being off this drug; & it is very difficult to separate out med withdrawal reactions from underlying 'condition'.

I have just been trying to be as accepting as possible of things,to relax & let go as much as I can, & not focus on these 'problems'.

"The ‘Stress & Vulnerability model’ postulates that a biological vulnerability is a necessary element of mental disorder. This is in agreement with the traditional medical model of mental disorder.

In addition to the biological factor, however it may arise, trauma
of one kind or another does appear to be vital.

The model seems to occupy the middle ground in the ‘nature versus nurture’ debate and acknowledges the validity of both sides. For this reason many people are happy to work with it. It states that all people are vulnerable to stress but that the amount of stress they can cope with is variable. So one person may become disordered because of problems that another would simply shrug off but ultimately all people, if given enough stress, will develop similair problems.

People with low vulnerability need to experience a great deal of stress before they experience mental health problems whereas those people with high vulnerability need only a small amount of stress to ‘tip them over the edge’ into serious mental disorder.

Types of vulnerability include:

• Biological
• Psychological
• Social/cultural
• Environmental
• Developmental"


Hope that helps.

Cheers,

Stuart
Thanks; it helps a lot & makes a lot of sense. I will check out the articles you linked to.
 
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Apotheosis

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I will check out the articles you linked to.
Good articles. I still don't think anywhere near enough is known about the brain - or exactly what is going on in schizophrenia - to categorically state with proof the bio medical perspective. Give me a bio chemical physical test that proves I have this condition; & I will be proved wrong.

The open questions still remain as to whether the condition is predominantly psychogenic; as concluded by Carl Jung (among others). Everything I have read & experienced points to the same thing. That is not to deny a biological component - but personally I consider them nuances at best.
 
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