Why the medical label “schizophrenia” does more harm than good –
it’s as out-of-date as “blood-letting”.
RESILIENCE – that’s what’s missing from today’s mental healthcare. It’s as if we’re back in the Middle Ages, and people have a type of ‘mental leprosy’ – “Oh, there’s nothing you can do – they’re schizophrenic, or personality disordered, or any one of a growing number of other nasty labels – just forget about ever making them better”. This is psychiatric pessimism of the worst sort. It’s a medical and social catastrophe, one which orthodox psychiatry today embeds in its very heart.
Well, it’s time for a change. Time for a bit of realistic optimism. “You’ve nothing to fear but fear itself” said Roosevelt – and we need much more of that in present day psychiatry. If we can build supercomputers, we can explore vaccines for malaria, we can fly round and round the world – surely human ingenuity, courage, and inventive genius can do better than label people “mentally ill” for life?
Now let’s be clear – people do go off the rails. Hitler invaded Poland, and Putin did the same to Ukraine – yes, this is insane. But look closer, and there’s a pattern, there’s a thread which if you pull very carefully, unravels the whole grim picture.
People suffer mental “breakdowns”. Yes, they do. They do stupid, irrational and non-sensical things – some worse than others, but this doesn’t mean they are scarred for life. It means that things became too much for them at that time, and they need help to get back on an even keel. We are none of us super(wo)man – we have limits, we have thresholds, and we can break. Some manage a lot of stress or trauma, some not very much at all – but that doesn’t mean we are doomed. Oh no, we need to re-group, we need to re-evaluate – and when we do, the prospect looks a great deal healthier.
It's all a question of what you can cope with. And reality does take some handling. Life is a constant battle against chaos – but most of the time we can win, or at least keep the on-gong disorganisations at bay for long enough. And the most painful mental problem is psychosis, psychotic symptoms – this is when reality becomes overwhelming, and we lose touch with it.
Emotions and getting them right can be most confusing – indeed some of the theories about mental health are too complex for words – so try something much simpler, something everyone can understand – such as in a-smile-a-day-keeps-the-doctor-away, from which it follows that you can then learn to say “if I meet someone without a smile, I give them one of mine”. And, when you're really good at this –“a smile shared is a smile doubled”. All much less complicated than it might seem at first.
But when the term ‘schizophrenia’ was first invented, people went around claiming they were Napoleon, or some other heroic figure, which they weren’t. So the idea that they had a “split mind” seemed a good enough description.
But that’s all it was – a description. Now a medical diagnosis should be much more than that. Human beings can be very complicated, especially when they’re ill. So when their minds go off, clarity is at a premium. And this label is entirely counter-productive – it tells you nothing about what has gone wrong, and offers not the least suggestion as to what to do about it.
This is reason enough for me to eschew the very term ‘schizophrenia’, 100%. I never use it. I deplore its use – it simply has zero clinical utility. Indeed it festers, since it gives space to a life-long and perfectly unjustifiable stigmatisation. One of the first surprises I learnt in general practice was that psychotic symptoms are essentially episodic in nature – they come, on with stress, and go when it goes – exactly like all other psychiatric morbidity.
And just to raise a few medical hackles, I have found definitive evidence that earlier trauma, with its consequent Speechless-Terror, impacts directly on psychotic thought. Indeed, the clinical paradigm for psychosis is ‘thought disorder’ or broken cognition – starting off with one sentence and finishing with another. It’s those blighted frontals again. Cognitive paralysis. Which give rise to a series of unrelated, incoherent, sequalae – “shoes and ships and sealing wax, cabbages and kings” – as Lewis Carrol has his oyster-eating walrus expound.
I append here a snippet of dialogue from a group therapy that I recorded in 2015, with two sufferers from psychotic symptoms – they show how blocked thinking can be reversed by trustworthy emotional support – or at least, that’s what they show me, which zombifying drugs, of course, cripple.
5 MINUTE EXCERPT, ** *** 2015. [B: is Bob, me; F: is Freda; S: is Sam; ~ is ‘blocking’.]
[Note – Freda’s mum had died some 30 years before.]
B: [to Freda] So how does your experience agree with Sam’s?
F: um ~~ very much ~ the same
B: Go on – in what way?
F: I’m finding it SO difficult to think. . . and not just thn~. . I find it ~ to think about what’s being said, so difficult
B: [softly] Wow. That’s interesting, isn’t it. Why is it so difficult to think?
F: In this context . . .
B: yes
F: . . we’re talking about thinking about what we’re thinking about . .
B: yes
F: [10] how to ~ stop our parents stop us thinking. What I’m doing ~. It happens ~ that I can’t think about it. But I can’t think ~ about the supermarket shopping when my mum’s in my head either. It goes on everywhere. But here, I can’t ~ I tried to get on the point of what Sam’s saying, ‘cos it’s relevant. . .
B: It is relevant, yes.
F: . . . and I can’t think [sighs exasperatedly]. I can’t think [sighs again] properly.
B: [gently] It’s training, right? You’ve trained yourself not to think
F: mmm
B: say that
F: ~~ I’ve trained ~. I have ~ trained, I’ve trained myself not to think.
B: yes, ‘and now I have to train myself TO think.’
F: [smoothly] and now I have to train myself to think.
B: what do you have to think?
F: [20] I have to ~ think ~ what I want to think, individually
B: yes? And what with respect to your mum?
F: ummm. I want ~ if I want. I want her to go. I want to think her gone. I really have to believe that, that I want to think her gone, so that I can think. I get myself little rhythms, and tongue tied things that I . . . [continues.]
[Note – Freda’s mum had died some 30 years before.]
I play audio versions of this clip in my workshops so that clinicians, and others, can note the ‘blocking’ for themselves. You don’t actually hear or see what happens in psychotherapy sessions very often – and I’m grateful to these two for allowing me to record what they said. They were keen to communicate what they found most difficult to do. And, if you study the progress they made, you can see how adding psychiatric drugs to the mix can only hinder. I’m not against tranquilisers for use when things get too much – but I’m adamantly opposed to suggestions that these mind-altering drugs can assist thinking. For that you need trustworthy, reliable, honest, friendly support – we all do, and labelling each other ‘schizophrenic’ does just the opposite. Here’s hoping for a more humane psychiatry in the not too distant future.
Rock on
Bob
Dr Bob Johnson I started publishing an article today please if you can spread if you consider is worth it thank you https://humanitylives.substack.com/p/549e4c58-d929-4a07-8806-49c9ae1cdfac
Thank you Dr Bob Johnson 👏👏