By Dr David Laing Dawson
Anti-vaxxers, anti-psychiatry, anti-science, anti-disease model, deniers of neurological differences, deniers of actual brain problems. Where are these people coming from? And why in such numbers in the enlightened year of 2020?
We need to teach history, real history, in schools and colleges. Not just great leaders, conquests, kings and countries, disasters, but the lives of real people through the ages, prevalent diseases, child and maternal death rates, life expectancy, how people actually lived and died.
When I was in second year medicine attending a lecture by the Professor of Psychiatry, with 60 other students in a small amphitheatre classroom at UBC, one of the yahoos in my class, when the professor had barely begun, asked or stated quite loudly, “This psychiatry stuff is not really scientific, is it?”
The professor paused for a second, adjusted his glasses, and then asked the student if he would mind explaining to the class what science is, what it means, the philosophy and underlying principles of a scientific way of thinking? The student fell silent. Then our professor put down his notes and proceeded to do just that. He delivered an hour lecture on the philosophy, history and meaning of science. And at the time I realized that I had studied high school and undergraduate biology, physics, philosophy, chemistry, and then physiology, anatomy, bio-chemistry, and even some preliminary medical subjects but in all that time I had never before attended a lecture on what science actually is, the philosophy and meaning of science. Many of my courses and subjects were “sciences” but what (historically revolutionary), principles and concepts underlay them?
“How do we know something to be true?”
In Victoria BC, a boy of seven or eight died of diphtheria in the early 1900’s. Had he lived he would have been one of my uncles. And I would estimate that at least 50% of the vocal anti-vaxxers would not have reached adulthood if it were not for vaccinations. And if they were not vaccinated, they are alive today because most of their school classmates were. This is one of the histories that should be taught before College.
Sometime in the late 1970’s, as I remember, a colleague teacher remarked to me that he could no longer take medical students to the psychiatric hospital to see patients suffering from florid mania, acute schizophrenic psychosis, catatonia, and vegetative or agitated depression. And he couldn’t do this because these patients were all now receiving treatment and were recovering. The place, he said, to observe someone in an acute manic state, was at the jail.
And on a visit to the jail not long after, I did indeed observe a manic man on the crowded range behind bars, rapidly pacing, talking, shouting incessantly, gesticulating in fearful agitation. I asked the jail nurse why he wasn’t being treated for his mania. He refuses treatment, was her simple answer.
Kraeplin and Bleuler were observing untreated schizophrenia among patients residing in the asylums and mental hospitals of the time (late 1800’s to early 1900’s). Kraeplin applied, to his observations, the first principles of science: objective observation, description and categorization, in a way that might prove to distinguish one thing from another. Most of his observations remain valid today. Bleuler later observed the same population and tried to find some organizing principles, core symptoms and signs differentiated from secondary signs and symptoms. He concluded that with some of these patients suffering from what he then called the schizophrenias, the core deficit, from which secondary symptoms and behaviours flowed, was that of the unusual and sometimes contradictory, loosened, or autistic way the brain/mind of his patients associated thoughts and feelings.
People with untreated “schizophrenia”, before the days of religious retreats, asylums, and the state mental hospitals, existed in each and every society, and were treated in a variety of ways: from temporary veneration, to punishment, to being put to death, tied to trees in the bush, or simply banished from the village to wander and die. More wealthy families hid their afflicted members. Only with the development of asylums and the enlightenment and the notions of science, could many people with untreated schizophrenia be found in the same place and studied.
And, we need to remember, the patients studied by Kraeplin and Bleuler had not ever received effective treatment and had been suffering from this illness for several and often many years.
Effective treatment was not discovered until the 1950’s. It was one of those rare instances in modern medicine when blind trials (in this case antipsychotic medication, chlorpromazine) were halted early because the positive results were so dramatic that it would be clearly unethical to withhold treatment from the placebo group.
I join this history in the late 1960’s. We still had large mental hospitals but these were being augmented by psychiatric wards in general hospitals for acute treatment. And we now had a couple of other agents related to chlorpromazine for the treatment of schizophrenia and of mania. But, every practitioner was still reluctant to make the diagnosis of schizophrenia and institute treatment early and keep on treatment for years (stigma and the pessimism inherited from Kraeplin), so at that time, the starting point of diagnosis and treatment of schizophrenia usually occurred upon the second or third or even fourth admission to hospital following a year or more of increasing illness, or relapse after the medication was discontinued.
Over the next, now 50 years, the mental hospitals have been reduced and in many cases have disappeared, and treatment of psychotic illness with anti-psychotic medication begins much earlier, in most cases. A great many of the people Kraeplin and Bleuler were studying, would, today, be found as functioning adults in our communities, regularly attending clinics and regularly taking their medication.
Unfortunately, the places today to see people with untreated florid schizophrenia are in our jails, prisons, in shelters, and on the street. Both Kraeplin and Bleuler would be hard pressed to find a cohort of this illness, whatever you wish to name it, untreated and available for study.