Monday, October 09, 2006

"Experts" say term schizophrenia should be abolished

Schizophrenia term use 'invalid'
BBC News

The term schizophrenia should be abolished, experts have said.

They claim the category falsely groups a wide range of symptoms and encourages over-reliance on anti-psychotic drugs rather than psychological intervention.

The academics also said the label stigmatised people as being violent, dangerous and untreatable...

Richard Bentall, professor of experimental clinical psychology, from the University of Manchester, said: "We do not doubt there are people who have distressing experiences such as hearing voices or paranoid fears.

"But the concept of schizophrenia is scientifically meaningless. It groups together a whole range of different problems under one label - the assumption is that all of these people with all of these different problems have the same brain disease."

He this can misinform treatment, and has encouraged the widespread use of "drastic biomedical interventions" as the first-line of treatment, rather than psychological help. He said although drugs were useful for some patients, too often they were given at extremely high doses and had some dangerous side-effects.

He said: "Overall, I think the concept is scientifically meaningless, clinically unhelpful and ultimately has been damaging to patients."

Paul Hammersley, also of the University of Manchester, who is involved with the Campaign to Abolish the Schizophrenia Label (Castle), wants the term dropped.

He said: "It is associated with violence, dangerousness, unpredictability, inability to recover, constant illness, constant need for medication and an inability to work. I cannot emphasise enough how stigmatising this label is."

But the academics could not give a definitive answer to what should replace the term schizophrenia if it was eliminated.

They pointed to Japan, where the category schizophrenia was replaced with "integrated disorder" in 2004, as a possible model.

And Professor Bentall suggested patients should be treated on the basis of individual symptoms, as opposed to an overarching category.

Robin Murray, professor of psychiatry at the Institute of Psychiatry, London, said most psychiatrists accepted term schizophrenia was imperfect but warned that were it discarded another method of classification must be devised.

He said: "If we don't have some way of distinguishing between patients, then those with bipolar disorder or obsessional disorder would be mixed up with those currently diagnosed as having schizophrenia and might receive treatments wholly inappropriate for them.

"Most psychiatrists would still agree that the term schizophrenia is a useful, if provisional, concept. My personal preference would be to replace the unpleasant term schizophrenia with dopamine dysregulation disorder which more accurately reflects what is happening in the brain when someone is psychotic. "

Til Wykes, professor of clinical psychology and rehabilitation at the Institute Of Psychiatry, said: "We should be careful not to throw the baby out with the bath water, as despite its limitations, a diagnosis can help people access much needed services.

"What all of us have to remember is that these are people with a diagnosis of schizophrenia, not 'the schizophrenic'."


At 10:03 PM, Blogger Nicolas Martin said...

Living in sanity
13 Oct, 2006|

'If you talk to God, you are praying', wrote Thomas Szasz, a critic of mainstream psychiatry. 'If God talks to you, you have schizophrenia'. According to him, disease must be found on the autopsy table and meet a pathological definition instead of being voted into existence by members of the American Psychiatric Association.

A lot of people have felt exactly that way about schizophrenia, the profoundly debilitating psychotic disorder usually equated with insanity. The overwhelming majority of psychiatrists, however, have stuck to their guns and not given up on their rights to the illness.

That situation now seems slated to change after several behavioural experts finally recommended that the term schizophrenia be abolished.

Speaking on the eve of World Mental Health Day on October 10, they said that it had become a catch-all label which did not define a specific illness, yet at the same time destroyed people's lives by stigmatising them as violent, dangerous and untreatable.

They also claim the category falsely groups a wide range of symptoms and encourages over-reliance on drugs rather than intervention. That's because symptoms such as delusions and hearing voices are invariably viewed as the consequence of an illness and never as reactions to traumatic or troubling events in life.

Anti-psychiatry proponents have been saying the same thing ever since the movement gained ground in the 1960s. Well-known psychiatrists like R D Laing, Theodore Lidz and Szasz himself questioned whether insanity might not often be just a sane reaction to a world perceived as gone insane.

More recently, David Smail, a psychotherapist, emphasised the fact that feelings and emotions are not, as is commonly believed, features of the individual, but rather responses of the person to particular situations in society. In any case who defines insanity?

Definitely not psychiatrists, otherwise would it be that commonplace, for example, to read about murder trials where eminent psychiatrists for the defence are contradicted by equally eminent psychiatrists for the prosecution on the matter of some defendant's sanity?

Nor is it clear if the salient characteristics that lead to diagnoses reside in the 'patients' themselves or in the environments and contexts in which observers find them. After all it was only as late as in 1974 when the American Psychiatric Association decided to remove homosexuality as an illness category.


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