And then there are those who want to make schizophrenia go away, along with psychiatrists and their medications. Some are claiming that it is a misdiagnosis. Most of these folks, they say, are suffering from disorders of entirely psychological cause and explanation, such as DID (Dissociative Identity Disorder, which is the child of Multiple Personality Disorder) or a form of PTSD from childhood trauma, or, on the other hand, simply experiencing just one of the unusual states of mind and perception within the vast normal array of human potential.
Well, I must admit, we psychiatrists continue to struggle with, argue about, investigate, study, re-conceptualize, re-define schizophrenia, while searching for causation and better treatment. In the manner a fever and a rash are not the illness itself, but rather the body’s reaction to a pathogen, many of the symptoms of schizophrenia are the person’s, the brain’s reaction to underlying dysfunction(s). And we are only beginning to understand, at a cellular/pathway/messenger/neuron by neuron level this most complex of organs, the human brain.
There may be as many as six different pathways to this most devastating and misunderstood of illnesses, each with a different genetic vulnerability and epigenetic influence. But we know it happens quite consistently in all cultures and historical times. How we have thought about these people who become so cognitively dysfunctional, so specifically irrational, has varied from culture to culture and age to age. But they have been there and they are there now: In African villages where they might be tied to trees outside the village for families to feed until the mania passes or the patient dies. Suffering in the streets and jails in Dorothea Dix’s time. Burned as witches. Punished in stockades. Banished from villages in Europe and left to wander the country side. Poets (who undoubtedly never had to live with an insane person) speculating that insanity may be simply a form of creativity, and being someone more in tune with the rhythms of the invisible world than the rest of us. Yes, we’ve been there before.
And then in our part of the world between 1880 and 1980 mostly residing in Asylums and Mental Hospitals. And now, of course, as described in previous essays by Marvin Ross and myself, we find that vast numbers of people so afflicted are being housed in, have been returned to our jails and prisons, and kept away from public view .
(In considering historical and cross-cultural data it is always well to remember that life expectancy for the general population was about 40 years in 1850’s North America, 60 today in India, less than 50 today in Africa, and in all times and places, considerably less for the mentally ill, the poor, and the indigent.)
As Marvin Ross pointed out recently, the doctors who observed and described schizophrenia as a progressive disease with inevitable poor outcome, were doing so at a time when we had no effective treatment. They were not wrong in their observations. Untreated schizophrenia invariably leads to a progressive deterioration of function, early death, and sometimes violence. Although there are always, as with everything in this world, a few exceptions. A few.
Only 65 years have passed since we discovered the effectiveness of anti-psychotic medication, starting with the famous Chlorpromazine (Largactil, Thorazine) in France. And only 60 years have passed (1954) since this drug was first introduced to North America. And because we were so tentative with these drugs at first, often weaning our patients off them after three months of recovery without relapse (1965), and when that didn’t work, waiting six months, then a year (1970) , then making that two years, then five, then ten, (1975) and with our patients sometimes lost to follow-up, and stopping the medications themselves, some because of side-effects, and relapsing and being readmitted, and then starting over – it really has been only about 20 to 30 years now that we have concluded that most (if not all) people who suffer from schizophrenia will need to take these medications for life in order to remain stable and well. And this has finally allowed us to have, as I have had, the opportunity to see some people take these medications regularly for 30 years, and observe that with very consistent treatment (anti-psychotic medication), a good support system (usually family and some counseling), schizophrenia need not be a progressive illness with a bad outcome.