by Romme, Marius,  Morris, Mervyn

Source: Mental Health Nursing, Vol 27 (2): 7 - 11 March, 2007

Marius Romme and Mervyn Morris outline their suggestions for a more helpful and cause-related alternative to the harmful concept of schizophrenia.

Abstract

This article explains why the term 'schizophrenia' is not just stigmatising, but also fundamentally flawed. We will show that it is a label without scientific validity, applied without reference to an individual's life experiences. Furthermore, its diagnosis ignores connections between these life experiences and core illness experiences. We urge mental health nurses and other professional to listen to what their patients are telling them and help them understand their experiences.

Key words

Schizophrenia, hearing voices, mental health, diagnosis, CASL

Introduction

On 11 October 2006 an initiative called CASL, the 'Campaign for the Abolition of the Schizophrenia Label' was launched by Paul Hammersley and others from the University of Manchester, The problems of labelling and stigma are already familiar to nurses, but it is the concept of schizophrenia itself as an illness entity that is rightly attacked in the campaign. This campaign is one that mental health nurses should support, because, as we will explain, the concept of schizophrenia is a problem that impacts on us all.

Schizophrenia is harmful because it conceptualises experiences in a way that makes it impossible to resolve the problems that lie at the roots of a person becoming ill. In order to explain this and establish a more helpful cause-related alternative, we will discuss the following issues:

1. The scientific validity of the concept is nil, and it does not refer to a brain disease.

2. The diagnostic process neglects the reasons for the experiences.

3. The relationships between the core illness experiences and life experiences are neglected.

4. The inter-relationships between the core experiences are neglected.

5. The core experiences do not represent expressions of psychopathology.

6. Learning to cope with the experiences and with the problems at the heart of the problem are neglected.

7. People who recover from being ill can achieve that outside of psychiatry.

Scientific validity

For many years, authors have criticised the concept of the illness we call schizophrenia, because it lacks both construct and content validity. In other words, putting together the experiences professionals call 'symptoms' to form the disease construct 'schizophrenia' is erroneous. And this being the case, any causal explanation of schizophrenia is meaningless.

The British researchers Richard Bentall and Mary Boyle, and also Walter Heinrichs, are particularly notable for their thorough literature reviews, in which they demonstrate that validity of the construct is missing. In Reconstructing Schizophrenia in 1990, Richard Bentall outlined his argument about this scientific error, and from his further examination of the literature he later concluded that:

'It would seem that schizophrenia is an illness that consists of no particular symptoms, that has no particular outcome, and that responds to no particular treatment. No wonder research revealed that it has no particular cause.' (Bentall, 1998).

Mary Boyle (1990) has examined the historical development of schizophrenia and shown that it has never been validated. Her conclusion is that Kraepelin and Bleuler (who coined the term) merely postulated the existence of a peculiar pattern of 'symptoms' that they then attempted - unsuccessfully to validate. Their studies never provided any justification whatsoever for the so-called peculiarity of the cluster of 'symptoms' they described. As Boyle states:

'None of them (including Schneider [who devised 'first rank' 'symptoms'] as well) presented evidence of having observed a set of irregularities which would justify a new hypothetical construct. Certainly, none of them identified a syndrome.' (Boyle, 2002 p.80).

Mary Boyle also studied the development of the DSM series (American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders) (APA, 1994) and concludes:

The development of DSM III, IUR and IV is based on question begging. Like Kraepelin, Bleuler and Schneider, the devisers of the DSM did not appear to doubt the validity of "schizophrenia": It might be complex, but it is a diagnosable disorder which clinicians recognise when they see (it). This cognitive starting point is crucial also in making failure seem like a temporary aberration'. (Boyle, 2002, p.151)

British-based Canadian researcher Walter Heinrichs (2001) carried out a Medline search of publications appearing between 1980 and 1999, reporting on objective disease markers in schizophrenia. His work constitutes a review of the results from neuroscience research. As we know, many claims have been made pertaining to the presence of specific disease markers in Schizophrenia. Heinrichs calculated the effect size of each of these studies. He states:

'In summary, this extensive appraisal across many areas of neuroscience reveals no common abnormality in all cases of schizophrenic illness. The strongest, most consistent evidence suggests that 50-70% of schizophrenics are deficient in cognitive brain function. In comparison, most of the neurobiological abnormalities in the illness, probably occur in a minority of patients. Moreover, close to 40% of the biological findings are so weak and variable that they may represent minor, unimportant, or chance abnormalities with no intrinsic link to schizophrenia.' (Heinrichs 2001, p.84)