Academic journal article Ethical Human Psychology and Psychiatry

Rethinking Schizophrenia: Its Original Nature, Its Drug-Altered Character, and Thoughts about Its Treatment

Academic journal article Ethical Human Psychology and Psychiatry

Rethinking Schizophrenia: Its Original Nature, Its Drug-Altered Character, and Thoughts about Its Treatment

Article excerpt

The nature of schizophrenia has changed markedly over the past half-century because the drugs used to treat it aggravate the disability it causes. This aggravation results from (1) the brain damage caused by the drugs themselves and (2) the replacement of the doctorpatient relationship, psychiatry's most important therapeutic tool-within which patients' problems and behaviors should be addressed-by a narrow psychiatric focus on drug effects upon symptoms. Psychiatry today thus resembles 19th century obstretrics, in which, as Ignaz Semmelweis pointed out then, physicians' activities harm the patients they care for.

Keywords: schizophrenia; aggravation by drugs; drug interference with doctor-patient relationship; brain damage from drugs

Schizophrenia has long been the loosely defined term for the most severe type of mental disability without clear, anatomically demonstrable brain pathology. Although a huge research industry has engaged for almost a century in a still-fruitless search for specific biological causes, this Gordian knot was cut by Richard Jenkins (1952), director of research for the Veterans Administration, when he proposed that schizophrenia was really a psychosocially produced neuropsychological disorganization (the acute phase) followed by faulty reorganization, the chronic phase.

At that time, when psychopharmacology was just beginning in American psychiatry, 3.38 per thousand Americans were functionally mentally disabled, with most of them diagnosed with what might be called predrug chronic schizophrenia. In 2004, 50 years later, with medication having eclipsed counseling within the doctor-patient relationship as the heart of psychiatric treatment, the number of functionally mentally disabled Americans has increased six times, to 19.69 per thousand, again with most diagnosed as chronic schizophrenia-but this is the drug-era kind. This startling development, in association with other data, suggests the existence of a new cause of chronic schizophrenia: medication (Whitaker, 2005).

In support of that hypothesis, Whitaker points out that "MRI studies have shown the . . . link between [psychotropic] drug usage and chronic illness. In the mid-1990s, several research teams reported that the drugs cause atrophy of the cerebral cortex and enlargement of the basal ganglia. Then, in 1998, researchers at the University of Pennsylvania reported that the drug-induced enlargement of the basal ganglia was 'associated with greater severity of both negative and positive symptoms.' In other words, they found that over the long term, the drugs cause changes in the brain associated with a worsening of the very symptoms the drugs are supposed to alleviate. The MRI research, in fact, had painted a very convincing picture of a disease process: an outside agent causes an observable change in the size of brain structures, and as this occurs, the patient deteriorates." These patients represent the new iatrogenic chronic schizophrenics.


Predrug schizophrenia has two meanings: schizophrenia before the current drug era, and a first episode schizophrenia patient today who has not yet been given medication. Jenkins' notion of schizophrenia as disorganization followed by reorganization (applicable to both meanings) is close to Whitehorn's concept (as cited in Liddell, 1956, pp. 75-78.) of the acute emotional experience. This he defines as "an unpleasant, confusing, disorienting, biological condition, characterized subjectively as an excited, tense feeling with considerable tendency to act, but with some uncertainty as to what to do, and characterized objectively by motor restlessness or activity, not smoothly patterned, with indications of excess effort, as shown in the facial and respiratory musculature, tremor of voice and of skeleto-muscular action, together with sudden changes in visceral activity. It is disruptive of the smooth, habitual, integrative modes of behavior. …

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