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SCHIZOPHRENIA
A Nonexistent Disease
by Lawrence Stevens,
J.D.
The word "schizophrenia" has a scientific sound that
seems to give
it inherent credibility and a charisma that seems to dazzle people.
In his book Molecules of the Mind - The Brave New Science of
Molecular Psychology, University of Maryland journalism professor
Jon Franklin calls schizophrenia and depression "the two
classic
forms of mental illness" (Dell Publishing Co., 1987, p. 119).
According to the cover article in the July 6, 1992 Time magazine,
schizophrenia is the "most devilish of mental illnesses"
(p. 53).
This Time magazine article says "fully a quarter of
the nation's
hospital beds are occupied by schizophrenia patients" (p.
55).
Books and articles like these and the facts to which they refer
(such as a quarter of hospital beds being occupied by so-called
schizophrenics) delude most people into believing there really
is
a disease called schizophrenia. Schizophrenia is one of
the great
myths of our time.
In his book Schizophrenia
- The Sacred Symbol of
Psychiatry, psychiatry professor Thomas S. Szasz, M.D., says
"There
is, in short, no such thing as schizophrenia" (Syracuse University
Press, 1988, p. 191). In the Epilogue of their book Schizophrenia
- Medical Diagnosis or Moral Verdict?, Theodore R. Sarbin,
Ph.D.,
a psychology professor at the University of California at Santa
Cruz who spent three years working in mental hospitals, and James
C. Mancuso, Ph.D., a psychology professor at the State University
of New York at Albany, say: "We have come to the end of our
journey. Among other things, we have tried to establish
that the
schizophrenia model of unwanted conduct lacks credibility. The
analysis directs us ineluctably to the conclusion that schizophre-
nia is a myth" (Pergamon Press, 1980, p. 221). In his
book Against
Therapy, published in 1988, Jeffrey Masson, Ph.D., a psychoanalyst,
says "There is a heightened awareness of the dangers inherent
in
labeling somebody with a disease category like schizophrenia,
and
many people are beginning to realize that there is no such entity"
(Atheneum, p. 2). Rather than being a bona-fide disease,
so-called
schizophrenia is a nonspecific category which includes almost
everything a human being can do, think, or feel
that is greatly
disliked by other people or by the so-called schizophrenics them-
selves. There are few so-called mental illnesses that have
not at
one time or another been called schizophrenia. Because schizophre-
nia is a term that covers just about everything a person can think
or do which people greatly dislike, it is hard to define objec-
tively. Typically, definitions of schizophrenia are vague
or
inconsistent with each other. For example, when I asked
a
physician who was the Assistant Superintendent of a state mental
hospital to define the term schizophrenia for me, he with all
seriousness replied "split personality - that's the most
popular
definition." In contrast, a pamphlet published by the
National
Alliance for the Mentally Ill titled "What Is Schizophrenia?"
says
"Schizophrenia is not a split personality". In
her book Schiz-o-
phre-nia: Straight Talk for Family and Friends, published
in 1985,
Maryellen Walsh says "Schizophrenia is one of the most misun-
derstood diseases on the planet. Most people think that
it means
having a split personality. Most people are wrong. Schizophrenia
is not a splitting of the personality into multiple parts"
(Warner
Books, p. 41). The American Psychiatric Association's (APA's)
Diagnostic and Statistical Manual of Mental Disorders (Second
Edi-
tion), also known as DSM-II, published in 1968, defined
schizo-
phrenia as "characteristic disturbances of thinking, mood,
or
behavior" (p. 33). A difficulty with such a definition
is it is so
broad just about anything people dislike or consider abnormal,
i.e., any so-called mental illness, can fit within it. In
the
Foreword to DSM-II, Ernest M. Gruenberg, M.D., D.P.H.,
Chairman of
the American Psychiatric Association's Committee on Nomenclature,
said: "Consider, for example, the mental disorder labeled
in the
Manual as 'schizophrenia,' ... Even if it had tried, the Committee
could not establish agreement about what this disorder is"
(p. ix).
The third edition of the APA's Diagnostic and Statistical Manual
of
Mental Disorders, published in 1980, commonly called DSM-III,
was
also quite candid about the vagueness of the term. It said:
"The
limits of the concept of Schizophrenia are unclear" (p. 181).
The
revision published in 1987, DSM-III-R, contains a similar
statement: "It should be noted that no single feature is
invariably
present or seen only in Schizophrenia" (p. 188). DSM-III-R
also
says this about a related diagnosis, Schizoaffective Disorder:
"The
term Schizoaffective Disorder has been used in many different
ways
since it was first introduced as a subtype of Schizophrenia, and
represents one of the most confusing and controversial concepts
in
psychiatric nosology" (p. 208).
Particularly noteworthy
in today's prevailing
intellectual climate in which mental illness is considered to
have
biological or chemical causes is what DSM-III-R, says about
such
physical causes of this catch-all concept of schizophrenia: It
says a diagnosis of schizophrenia "is made only when it cannot
be
established that an organic factor initiated and maintained the
disturbance" (p. 187). Underscoring this definition
of
"schizophrenia" as non-biological is the 1987 edition
of
The Merck Manual of Diagnosis and Therapy, which says a
(so-called)
diagnosis of schizophrenia is made only when the behavior in
question is "not due to organic mental disorder" (p.
1532).
Contrast this
with a statement by psychiatrist E. Fuller
Torrey, M.D., in his book Surviving Schizophrenia: A Family
Manual,
published in 1988. He says "Schizophrenia is a
brain disease, now
definitely known to be such" (Harper & Row, p. 5). Of
course, if
schizophrenia is a brain disease, then it is organic. However,
the
official definition of schizophrenia maintained and published
by
the American Psychiatric Association in its Diagnostic and
Statistical Manual of Mental Disorders for many years specifically
excluded organically caused conditions from the definition of
schizophrenia. Not until the publication of DSM-IV
in 1994 was
the exclusion for biologically caused conditions removed
from the definition of schizophrenia. In Surviving Schizophrenia,
Dr. Torrey acknowledges "the prevailing psychoanalytic
and family
interaction theories of schizophrenia which were prevalent in
American psychiatry" (p. 149) which would seem to account
for this.
In the November
10, 1988 issue of Nature, genetic
researcher Eric S. Lander of Harvard University and M.I.T.
summarized the situation this way: "The late US Supreme Court
Justice Potter Stewart declared in a celebrated obscenity case
that, although he could not rigorously define pornography, `I
know
it when I see it'. Psychiatrists are in much the same position
concerning the diagnosis of schizophrenia. Some 80 years
after the
term was coined to describe a devastating condition involving
a
mental split among the functions of thought, emotion and behaviour,
there remains no universally accepted definition of schizophrenia"
(p. 105).
According to Dr.
Torrey in his book Surviving
Schizophrenia, so-called schizophrenia includes several widely
divergent personality types. Included among them are paranoid
schizophrenics, who have "delusions and/or hallucinations"
that are
either "persecutory" or "grandiose"; hebephrenic
schizophrenics, in
whom "well-developed delusions are usually absent";
catatonic
schizophrenics who tend to be characterized by "posturing,
rigidity, stupor, and often mutism" or, in other words, sitting
around in a motionless, nonreactive state (in contrast to paranoid
schizophrenics who tend to be suspicious and jumpy); and simple
schizophrenics, who exhibit a "loss of interest and initiative"
like the catatonic schizophrenics (though not as severe) and unlike
the paranoid schizophrenics have an "absence of delusions
or
hallucinations" (p. 77). The 1968 edition of the American
Psychi-
atric Association's Diagnostic and Statistical Manual of Mental
Disorders, DSM-II, indicates a person who is very happy (experienc-
es "pronounced elation") may be defined as schizophrenic
for this
reason ("Schizophrenia, schizo-affective type, excited")
or very
unhappy ("Schizophrenia, schizo-affective type, depressed")(p.
35),
and the 1987 edition, DSM-III-R, indicates a person can
be
"diagnosed" as schizophrenic because he displays neither
happiness
nor sadness ("no signs of affective expression")(p.
189), which Dr.
Torrey in his book calls simple schizophrenia ("blunting
of emo-
tions")(p. 77). According to psychiatry professor Jonas
Robitscher, J.D., M.D., in his book The Powers of Psychiatry,
people who cycle back and forth between happiness and sadness,
the
so-called manic-depressives or suffers of "bipolar mood disorder",
may also be called schizophrenic: "Many cases that are diagnosed
as
schizophrenia in the United States would be diagnosed as manic-
depressive illness in England or Western Europe" (Houghton
Mifflin,
1980, p. 165.) So the supposed "symptoms" or
defining charac-
teristics of "schizophrenia" are broad indeed, defining
people as
having some kind of schizophrenia because they have delusions
or do
not, hallucinate or do not, are jumpy or catatonic, are happy,
sad,
or neither happy nor sad, or cycling back and forth between
happiness and sadness. Since no physical causes of "schizophrenia"
have been found, as we'll soon see, this "disease" can
be defined
only in terms of its "symptoms", which as you can see
are what
might be called ubiquitous. As attorney Bruce Ennis says
in his
book Prisoners of Psychiatry: "schizophrenia is such
an all-
inclusive term and covers such a large range of behavior that
there
are few people who could not, at one time or another, be considered
schizophrenic" (Harcourt Brace Jovanovich, Inc., 1972, p.
22).
People who are obsessed with certain thoughts or who feel compelled
to perform certain behaviors, such as washing their hands
repeatedly, are usually considered to be suffering from a separate
psychiatric disease called "obsessive-compulsive disorder".
Howev-
er, people with obsessive thoughts or compulsive behaviors have
also been called schizophrenic (e.g., by Dr. Torrey in his book
Surviving Schizophrenia, pp. 115-116).
In Surviving
Schizophrenia, Dr. Torrey quite candidly
concedes the impossibility of defining what "schizophrenia"
is. He
says: "The definitions of most diseases of mankind has been
accom-
plished. ... In almost all diseases there is something which can
be
seen or measured, and this can be used to define the disease and
separate it from nondisease states. Not so with schizophrenia!
To
date we have no single thing which can be measured and from which
we can then say: Yes, that is schizophrenia. Because of
this, the
definition of the disease is a source of great confusion and
debate" (p. 73). What puzzles me is how to reconcile
this
statement of Dr. Torrey's with another he makes in the same book,
which I quoted above and which appears more fully as follows:
"Schizophrenia is a brain disease, now definitely known to
be such.
It is a real scientific and biological entity, as clearly as
diabetes, multiple sclerosis, and cancer are scientific and
biological entities" (p. 5). How can it be known schizophrenia
is
a brain disease when we do not know what schizophrenia is?
The truth is
that the label schizophrenia, like the
labels pornography or mental illness, indicates disapproval of
that
to which the label is applied and nothing more. Like "mental
illness" or pornography, "schizophrenia" does not
exist in the
sense that cancer and heart disease exist but exists only in the
sense that good and bad exist. As with all other so-called
mental
illnesses, a diagnosis of "schizophrenia" is a reflection
of the
speaker's or "diagnostician's" values or ideas about
how a person
"should" be, often coupled with the false (or at least
unproven)
assumption that the disapproved thinking, emotions, or behavior
results from a biological abnormality. Considering the many
ways
it has been used, it's clear "schizophrenia" has no
particular
meaning other than "I dislike it." Because of
this, I lose some
of my respect for mental health professionals when I hear them
use
the word schizophrenia in a way that indicates they think
it is a
real disease. I do this for the same reason I would lose
respect
for someone's perceptiveness or intellectual integrity after
hearing him or her admire the emperor's new clothes. While
the
layman definition of schizophrenia, internally inconsistent,
may
make some sense, using the term "schizophrenia" in a
way that
indicates the speaker thinks it is a real disease is tantamount
to
admitting he doesn't know what he is talking about.
Many mental health
"professionals" and other "scientific"
researchers do however persist in believing "schizophrenia"
is a
real disease. They are like the crowds of people observing
the em-
peror's new clothes, unable or unwilling to see the truth because
so many others before them have said it is real. A glance
through
the articles listed under "Schizophrenia" in Index
Medicus, an
index of medical periodicals, reveals how widespread the
schizophrenia myth has become. And because these "scientists"
believe "schizophrenia" is a real disease, they try
to find physi-
cal causes for it. As psychiatrist William Glasser, M.D.,
says in
his book Positive Addiction, published in 1976: "Schizophrenia
sounds so much like a disease that prominent scientists delude
themselves into searching for its cure" (Harper & Row,
p. 18).
This is a silly endeavor, because these supposedly prominent
scientists can't define "schizophrenia" and accordingly
don't know
what they are looking for.
According to
three Stanford University psychiatry
professors, "two hypotheses have dominated the search for
a
biological substrate of schizophrenia." They say these
two
theories are the transmethylation hypothesis of schizophrenia
and
the dopamine hypothesis of schizophrenia. (Jack D. Barchas,
M.D.,
et al., "Biogenic Amine Hypothesis of Schizophrenia",
appearing in
Psychopharmacology: From Theory to Practice, Oxford University
Press, 1977, p. 100.) The transmethylation hypothesis was
based on
the idea that "schizophrenia" might be caused by "aberrant
formation of methylated amines" similar to the hallucinogenic
pleasure drug mescaline in the metabolism of so-called schizo-
phrenics. After reviewing various attempts to verify this
theory,
they conclude: "More than two decades after the introduction
of the
transmethylation hypothesis, no conclusions can be drawn about
its
relevance to or involvement in schizophrenia" (p. 107).
Columbia University
psychiatry professor Jerrold S.
Maxmen, M.D., succinctly describes the second major biological
theory of so-called schizophrenia, the dopamine hypothesis, in
his
book The New Psychiatry, published in 1985: "...many
psychiatrists
believe that schizophrenia involves excessive activity in the
dopamine-receptor system...the schizophrenic's symptoms result
partially from receptors being overwhelmed by dopamine" (Mentor,
pp. 142 & 154). But in the article by three Stanford
University
psychiatry professors I referred to above they say "direct
confir-
mation that dopamine is involved in schizophrenia continues to
elude investigators" (p. 112). In 1987 in his book
Molecules of
the Mind Professor Jon Franklin says "The dopamine hypothesis,
in
short, was wrong" (p. 114).
In that
same book, Professor Franklin aptly describes
efforts to find other biological causes of so-called schizophrenia:
"As always, schizophrenia was the index disease. During
the 1940s
and 1950s, hundreds of scientists occupied themselves at one time
and another with testing samples of schizophrenics' bodily
reactions and fluids. They tested skin conductivity, cultured
skin
cells, analyzed blood, saliva, and sweat, and stared reflectively
into test tubes of schizophrenic urine. The result of all
this was
a continuing series of announcements that this or that difference
had been found. One early researcher, for instance, claimed
to
have isolated a substance from the urine of schizophrenics that
made spiders weave cockeyed webs. Another group thought
that the
blood of schizophrenics contained a faulty metabolite of adrenaline
that caused hallucinations. Still another proposed that
the
disease was caused by a vitamin deficiency. Such developments
made
great newspaper stories, which generally hinted, or predicted
out-
right, that the enigma of schizophrenia had finally been solved.
Unfortunately, in light of close scrutiny none of the discoveries
held water" (p. 172).
Other efforts
to prove a biological basis for so-called
schizophrenia have involved brain-scans of pairs of identical
twins
when only one is a supposed schizophrenic. They do indeed
show the
so-called schizophrenic has brain damage his identical twin lacks.
The flaw in these studies is the so-called schizophrenic has
inevitably been given brain-damaging drugs called neuroleptics
as
a so-called treatment for his so-called schizophrenia. It
is these
brain-damaging drugs, not so-called schizophrenia, that have caused
the brain damage. Anyone "treated" with
these drugs will have such
brain damage. Damaging the brains of people eccentric, obnoxious,
imaginative, or mentally disabled enough to be called schizophrenic
with drugs (erroneously) believed to have antischizophrenic proper-
ties is one of the saddest and most indefensible consequences
of
today's widespread belief in the myth of schizophrenia.
In The
New Harvard Guide to Psychiatry, published in
1988, Seymour S. Kety, M.D., Professor Emeritus of Neuroscience
in
Psychiatry, and Steven Matthysse, Ph.D., Associate Professor of
Psychobiology, both of Harvard Medical School, say "an impartial
reading of the recent literature does not provide the hoped-for
clarification of the catecholamine hypotheses, nor does compelling
evidence emerge for other biological differences that may
characterize the brains of patients with mental disease"
(Harvard
University Press, p. 148).
Belief in biological
causes of so-called mental illness,
including schizophrenia, comes not from science but from wishful
thinking or from desire to avoid coming to terms with the experien-
tial/environmental causes of people's misbehavior or distress.
The
repeated failure of efforts to find biological causes of so-called
schizophrenia suggests "schizophrenia" belongs only
in the
category of socially/culturally unacceptable thinking or behavior
rather than in the category of biology or "disease"
where many
people place it.
THE AUTHOR, Lawrence Stevens, is a lawyer whose practice has
included representing psychiatric "patients". His
pamphlets are
not copyrighted. Feel free to make copies.