If Schizophrenia is a Disease or Illness Why Doesn't it Act Like One?
by Al Siebert, PhD (revised January, 1998)
IIntroduction: "The Embarassed Student Nurse"
During my last year as a psychologist at the Neuropsychiatric Institute at the University of Michigan hospital, a student nurse about to start her psychiatric rotation made a request that had everyone laughing at her. When she reported for work at the psychiatric unit, she asked her clinical supervisor where she could get shots to immunize her against mental illnesses.
The surpervisor asked why she was making such a request. The student nurse explained that she heard a public service announcement on the radio saying that mental illnesses were diseases like any other, so she wanted to be immunized when she was exposed to patients with mental illnesses. Everyone laughed when they heard about her naive request because everyone knows that no person working with mental patients has ever caught a mental illness, disease, or disorder from a patient.
Schizophreniadoes not act like a disease
According to psychiatrists, from 1 to 1.5% of the worlds population has a mental disease called schizophrenia. (Presidents Commission, 1979). In contrast to other mental disorders, this disease appeared in human beings about 100 years ago. Virtually unknown for thousands of years, it suddenly appeared all over the planet and is said to be increasing rapidly (Torrey, 1983, pp. 208-209).
Eugen Bleuler created the term schizophrenia in 1908. Since then it has been thoroughly researched with over 100,000 books and articles published on it (M. Bleuler, 1979a, p. 1403). The slowly emerging picture of schizophrenia is peculiar, however, because it does not have any characteristics of being a disease or illness. Research and clinical experience reveal the following:
The majority of all cases of schizophrenia occur in young adults (ages 16 to 25) who are not physically ill and who generally have a life history of being bright, healthy, capable youngsters. Schizophrenia rarely occurs after age 40. (Bleuler, 1978, p. 497; Arieti, 1979, p. 36; DSM-III, 1980, p. 184; Torrey, 1983, p. 63)
Who will get it is unpredictable. It occurs spontaneously with no identifiable cause. (Hoffer & Osmond, 1966, p. 163; Smith, 1982, p. 113)
Heredity has been found to play a weak role in some cases, but most cases of schizophrenia come from normal parents. (Hoffer & Osmond, 1966, p. 164; Smith, 1982, pp. 92-96; Torrey, 1983, p. 83)
Increased stress does not precipitate schizophrenia in healthy individuals. (Hoffer & Osmond, 1966, pp. 12-13; Smith, 1982, p. 14; Torrey, 1983, p. 96)
Experts in the field disagree on what schizophrenia is. Some physicians believe schizophrenia is a brain disease (Torrey, 1983, pp. 73-74). Others say that no organic basis for schizophrenia has been proven (Bleuler, 1979b, p. viii; Zubin, 1983, p. 333). A foremost neurobiological researcher says that there are no known biological markers for any mental illnesses except for dementias such as Alzheimer's disease (Andreason, 1997, p. 1586) and that brain anomalies are found only in about 20% of people with "first onset" schizophrenia (Andreason, 1996, pp.697-700). Each issue of The Schizophrenia Bulletin carries several essays by experts invited to answer the question "What is Schizophrenia?" Each experts' response is different from all the others.
Schizophrenia is a diagnostic enigma (See note 1). (Bemporad and Pinkster, 1974; Freeman, 1969, p. 333; Kendall and Leff, 1979, pp. 25-34; Knight, 1952, p. 11; Smith, 1982, pp. 46-47; Strauss and Gift, 1977, p. 1248)
The diagnosis of schizophrenia or non-diagnosis can be more strongly influenced by the expectations and mental set of the diagnoser than by the mental and emotional state of the person diagnosed. (Rosenhan, 1973, pp. 250-258)
No single symptom or pattern of symptoms is characteristic of schizophrenia because it appears to be a group of disorders. (DSM-III, 1980, p. 181; Kety, 1982)
Anyone diagnosed as having schizophrenia may, over a period of time, demonstrate different sets of symptoms. (Carpenter, 1983, p. 9; Ludwig, 1983, p. 334)
Ten different people diagnosed as having schizophrenia can each have a different set of symptoms. (Anderson and Olsen,1982, pp. 789-794; Brill, 1974, p. 1127; Freeman, 1969, p. 333; Kety, 1982)
No psychiatrist, clinical psychologist, psychiatric nurse, or other mental health worker has ever caught or developed schizophrenia from contact with a schizophrenic person.
Schizophrenia as such has no adverse effect on physical health; no one dies from it and it does not shorten life although life expectancy is shortened by institutionalization, medications, and other factors. (Bleuler, 1989a, p. 1403; DSM-III, 1980, p. 185; Laing and Esteron, 1964, pp. 16-17)
People diagnosed as having schizophrenia frequently disagree that they are mentally ill and must be forced to submit involuntarily to treatment efforts. (Smith, 1982, p. 155; Torrey, 1983, pp. 106, 185, 191)
There is no known cure for schizophrenia. (Presidents Commission, 1979; Torrey, 1983, p. 99)
The symptoms of schizophrenia can sometimes be reduced with antipsychotic medications in a supportive environment (Torrey, 1983, p. 126), but antipsychotic medications make some people with schizophrenia worse. (Buckley, 1983; Rappaport, Hopkins and Hall, 1978, pp. 110-111)
Psychotherapy has no measurable positive effects on schizophrenia. (Torrey, 1983, pp. 124-125)
Psychotherapy makes some people with schizophrenia worse. (Rogers, Gendlin, Keisler and Truax, 1967; Matarazzo, 1967, pp. 156-157; Torrey, 1983, p. 125)
A person with schizophrenia left at home instead of being hospitalized usually does better than persons hospitalized and discharged. (Pasamanick, Scarpitti, and Dinitz, 1967, p. ix)
Regaining effective functioning is negatively related to number of days of hospitalization. (Mendell, 1966a, p 232; Mendell, 1966b, p. 312)
Chronicity of symptoms and deterioration of mental functions of persons hospitalized with schizophrenia are not a consequence of psychopathology but, rather, are attributable to the effects of institutionalization and other psychosocial factors. (Zubin, 1983, p. 333)
Any alternative to hospitalization is usually more effective. (Kiesler, 1982, p. 349)
One-third of all persons developing schizophrenia get well spontaneously no matter what is done. (Torrey, 1983, p. 126)
Schizophrenia does not generally progress for more than five years from onset but, rather, improves. (Bleuler, 1979a, p. 1403)
When left alone, people with schizophrenia can recover on their own. (Brody and Redlich, 1952, pp. 43-44; French and Kasonin, 1941, pp. 1-22; Rubins, 1969, p. 2)
Persons with schizophrenia may be unusually perceptive, insightful, and have rich inner lives. (Arieti, 1979, p. 227; Bleuler, 1979a, p. 1403; Grant, 1975; Rokeach, 1974; Smith, 1982, p. 105)
Schizophrenia can have a beneficial effect, leading to favorable changes in personality and improvements in psychological strengths. (Arieti, 1979, pp. 168-169; French and Kasonin, 1941, pp. 1-22; Laing, 1965, pp. 7-15; Rubins, 1969, p. 2; Silverman, 1970, pp. 63-65; Sulivan, 1962, p. 14)
No known disease matches the facts listed above. In addition, correspondence with the National Center for Disease Control verifies that the Center officers do not consider schizophrenia a disease and do not monitor its occurence.
Questions About the Minds of the Beholders
If schizophrenia does not act like a disease or illness, then why do so many experts believe it is? To help bring understanding to the situation, it is useful to ask some questions about the people who diagnose and try to remove schizophrenia from others. One such question is: Why is it that when a person acts, thinks, feels or speaks in certain ways the thought "That's schizophrenic" is triggered in the minds of mental health experts?
Other questions include: Why does a person viewed as schizophrenic become a target for curing? Why is it supposed to be sick, for example, to feel like Christ or Napoleon? Why are well-intentioned therapists unable to resist attempting to eliminate undesirable thoughts and feelings from the person, often in spite of a person's protests, while telling the person that such actions are entirely for his or her own good?
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- Note 1. See the latest issues of the Schizophrenia Bulletin. Editors Strauss, Bowers, and Keith are publishing an ongoing series of invited articles all attempting to answer the question, "What is Schizophrenia?"
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