Why is there such a strong anti-medical model attitude towards serious mental illness when the evidence keeps growing that these are diseases of the brain? The question was posed by my colleague, David Laing Dawson, who is a psychiatrist as well as a writer, artist and filmmaker. He asked this as we were preparing to film an interview for our forthcoming documentary Schizophrenia In Focus.
It is a baffling question. Before the current advances in neuroscience, schizophrenia was looked upon with rather unscientific views and, often, mothers were blamed. According to Freud, schizophrenia is not a brain disorder, but rather a disturbance in the unconscious caused by unresolved feelings of homosexuality. In his book Schizophrenia -- The Sacred Symbol of Psychiatry, (1988) psychiatry professor Thomas S. Szasz, M.D., says "There is, in short, no such thing as schizophrenia". Then, there is the Scottish psychiatrist, RD Laing (1927 - 1989), who said that schizophrenia was a sane response to an insane situation.
That was then, before all the advances in our knowledge of the brain. Today, there is overwhelming evidence to show that schizophrenia and bipolar disorder are brain diseases just as MS, Parkinson's and Alzheimers are diseases. Dr. E Fuller Torrey summarized our present scientific knowledge:
Individuals with schizophrenia and bipolar disorder, including those who have never been treated, have:
- Enlarged ventricles in the brain, as demonstrated in over 100 studies to date
- A reduced volume of gray matter in the brain, especially in the temporal and frontal lobes
- More neurological abnormalities, as shown in more than 25 studies
- More neuropsychological abnormalities that impair their cognitive functions, including information processing and verbal memory
- Decreased functioning of the prefrontal area, an area of the brain that we use for planning and thinking about ourselves
In addition, neuroimaging using MRI and PET scans show significant differences in the brains between those with schizophrenia and those without.
People suffering from schizophrenia can have many of their worst symptoms relieved with anti-psychotic medication -- the cornerstone of treatment. The first such drug, chlorpromazine tested in 1953, has had an impact on schizophrenia much like the impact that penicillin had in infection. It allowed delusional and psychotic people to be released from their asylums for the first time ever.
One of the Canadian pioneers in the use of chlorpromazine, Dr. Ruth Kajander, 84 of Thunder Bay, has just been named recipient of the Order of Canada. In 1953, Dr Kajander was the first Canadian psychiatrist to use chlorpromazine at the Psychiatric Hospital in London, Ont. The book written about her experiences by Dr. Sam Sussman stated:
"She was astonished that treatments that were medieval were still being used. Patients drugged with morphine and opium were left so sedated they couldn't eat or drink and in many cases they died. At the time, psychiatry no longer used restraining devices like the patient crib, which resembled a small wooden cage complete with lock. But hydrotherapy was still being used in Kajander's early career."
Because of those conditions, she was spurred on to find a medicine that would help and found it in chlorpromazine. This agent, the first of many developed since that time, enabled patients to function outside institutions for the first time.
Today, the Canadian Pyschiatric Association estmates that 90 per cent of people will relapse within the first year if they don't take medication as prescribed.
Despite all this new knowledge, there are many who cling to the old and disproven concepts. Neree St-Amand is a professor of social work at the University of Ottawa and a member of the Mental Health Commission of Canada. He believes untreated schizophrenia can be a gift, and that in other cultures, hearing voices is revered as a bridge to the spirit world.
Michael T Walker is a psychologist in California at the the Los Angeles County Department of Mental Health. He recently appeared on radio in British Columbia to talk about the mental health recovery model and what he calls his post-modern consultation for those in recovery. His theories are based on what he calls the social construction of mental illness and the need to let go of the invisible chains (words) that enslave.
He states on page four of this paper:
"The vocabularies of the medical and psychological models, indeed the idea of 'mental illness' itself, are social constructions -- THEY'RE MADE UP. (his capitalization). Furthermore, they are vocabularies that describe disease and deficit. they view a human being as something that can be 'assessed,' 'diagnosed' and 'treated' much like a machine -- hence comes the obsession with 'compliance.'"
He then goes on to say that "these models make distinctions between normal and pathological. They position practitioner as expert and client as more or less passive recipient of 'treatment.' The focus of 'treatment' is on the elimination of 'symptoms.'"
I don't think that the scientific evidence suggests these are made up constructs and if treatment can help alleviate symptoms, fine. I do agree that the patient should not be a passive recipient but should be (along with his or her family) actively involved.
I believe that serious mental illnesses like schizophrenia are diseases of the brain and need to be treated like the diseases they are in order to help relieve the suffering they cause to their victims, their families who love them and to society. Nothing is to be gained from the outdated sociological concepts that science and history has disproven.