Schizophrenia term use ‘invalid’

This – at first – strikes one as a relatively well balanced article.
Unless you know anything about medicine.

Most of those quoted in this article are psychologists – not psychiatrists.

Oh, and to help some of you along, click here for the generalised definition of schizophrenia.

Example – good lord, I’ve lost count – of an unbalanced (biased?..)  report.

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5 Comments

Filed under BBC, Psychiatry, Psychology, Schizophrenia

5 responses to “Schizophrenia term use ‘invalid’

  1. Phantom:

    I found this post while looking at the “tag surfer”–and then read the BBC article. It is, shall we say, a very misinformed group that charges overuse of the term schizophrenia. I am out on a limb on this one, I’m afraid, because I’m not in the UK.

    Here in the US, it is the rule that the label of schizophrenia is very, very carefully considered before it is applied to someone. When it is applied, most often it is so that the patient can get services he/she desperately needs for subsistence-level lifestyle.

    What really takes the cake, as far as I’m concerned, is this:
    _____________________________
    “But the concept of schizophrenia is scientifically meaningless. It groups together a whole range of different problems under one label – the assumption is that all of these people with all of these different problems have the same brain disease.”

    He said this can misinform treatment, and has encouraged the widespread use of “drastic biomedical interventions” as the first-line of treatment, rather than psychological help.

    Although drugs were useful for some patients, too often they were given at extremely high doses and had some dangerous side-effects.
    ____________________________

    What’s wrong with this is that people assume psychotherapy is harmless. That’s only a stone’s throw from saying that psychotherapy is useless. Neither is true. Psychotherapy that is any more insightful in nature than supportive therapy is CONTRAINDICATED in patients with schizophrenia.

    Says who? The Practice Guidelines for Schizophrenia published by the American Psychiatric Association, that’s who. This issue has been researched over and over.

    Guess the whole thing kinda hit a nerve…

  2. Hi!
    Right, I perhaps should qualify at this point that English is my 2nd language – so would you please extend me the most enormous patience if I ask of you for clarity / re-wording perhaps of a point, as I so want to understand…
    I understand that psychotherapy has a place and is therefore neither harmless nor useless but I do not understand: –
    “Psychotherapy that is any more insightful in nature than supportive therapy is CONTRAINDICATED in patients with schizophrenia.”
    Contraindicated – not recommended?

    This kind of article is what I generally call a ‘runaway train’.
    We can look at almost any medical term that involves a range of symptoms and therein some flucuation and say immediately “It’s too broadly labelled”
    Eg. Migraines.
    Some people present with an ‘aura’, light sensitivity, palpitations, tremors etc – but if not all the people present with all the same symptoms then whoa, let’s not call it migraines.

    I hope you will pop back and help my understanding – I would be most genuinely grateful.

    🙂

  3. Phantom:

    Contraindicated is a stronger statement than simply “not recommended.” The reason? If you engage a patient with schizophrenia in psychotherapy using insight-oriented techniques, you are asking for trouble. I don’t know what your occupation is, or where you stand, exactly, on the whole drugs vs. nurture issue, but my position is very clear. Psychotherapy is just as much “mucking around with someone’s mind/brain” as is pharmacotherapy.

    Back to insight-oriented therapy and schizophrenia. In this type of therapy, you challenge the patient’s delusions and/or hallucinations, because the whole point of the exercise is to dig down deep for the
    root(s) of the problem. This cannot work for these patients because we are dealing with perceptions that are very real to the patient, and not psychologically-derived symptoms.

    The most psychotherapy that should be done with a patient with schizophrenia is supportive therapy, which focuses on solving the patient’s real and current problems.

    Dr. W

  4. Psychologists for the most part do not work with the seriously unwell psychotic patients. However, although I found that position statement rather extreme (insofar as some of their hyperbolic conclusions), the underlying basis of their position statement is sound and probably supported by many psychiatrists.

    There is probably no such thing as a single disease “schizophrenia”, but as some psychiatrists argue, it is the “schizophrenias”. That is, several psychiatric diseases that present in a similar fashion and falling within the diagnostic criteria or DSM IV or ICD-10.

    That being said, the concept of schizophrenia is still useful at this time though it is a “blunt” tool.

    An analogy; imagine if the world of medicine developed such that we have very little surgical or radiolographic knowledge. In such a word, there may be a disease/syndrome known as “acute surgical abdominitis”, with symptoms that include severe abdominal pain, fevers, nausea, vomiting. If an operation is not performed, a good proportion of patients will proceed to septicaemia, shock and death. As such, all of these patients will receive a laparotomy.

    Now, a group may then argue that “there is no such thing as acute abdominitis”, rather, it is a collection of severe different diseases, some which don’t need “drastic” interventions like surgery. This is technically true. In this case, “acute abdominitis” would include diseases such as acute appendicities, small bowel obstruction, acute cholecystitis, peptic ulcer disease, inflammatory bowel disease and gynaecological pain.

    However, unless that is a method of differentiating these milder conditions that can be treated with other forms of therapy from the severe lifethreating therapies, in this fictional world, obviously the concept of “acute abdomintis” in fact does have value and surgery is indicated.

    In schizophrenia, it is clear that the antipsychotics work and work well. It is also clear that in some patients suffering from schizophrenia, early intervention with these medications seem to prevent the cognitive and functional decline seen in schizophrenics from a generation ago. There may well be a subset of patients who fit the diagnostic criteria of schizophrenia who do not need antipsychotics or where other medications may be more appropriate. There is, however, no way of identifying these patients yet, and until there is, the suggestion of abandoning current practice is premature.

    What is needed is urgent and thorough research, and there is.

    Regards,
    Michael Tam

  5. Michael:

    I like the way you think! Your line of thought is very rational. Right now, we do have a “wastebasket diagnosis” that we apply to individuals who are psychotic before we know what caused it. This diagnosis is Psychosis NOS (not otherwise specified), and it is just like your acute abdomenitis that you mentioned above.

    The term schizophrenia was/is meant to mean something very specific. I still think one can differentiate between different types of psychoses if one pays very close attention to the patient. There are five subtypes of schizophrenia: catatonic, paranoid, disorganized, undifferentiated, and residual. Differentiating between the five subtypes is not as easy as it may seem.

    As research continues, there is reason for hope. The most recent research that is ongoing has to do with differentiating different types of psychoses objectively, which has proven very difficult. It has to do with inflammation (of all things), and is somewhat predictable depending on the rate of response to antipsychotic medications.

    Dr. W

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