harmful concept of Schizophrenia, The

Mental Health Nursing, Mar 2007 by Romme, Marius, Morris, Mervyn

So in the clinical psychiatric diagnostic procedure, the complaints, behaviour and experiences are interpreted into a reduced number of 'symptom' categories. It has not been necessary to explore what the voices say or thoughts are about. It has not been necessary to find connections and meaning in these experiences. With these 'symptom' categories the psychiatrist constructs a diagnosis within the rules laid down in the DSM. But of course this is in principle not even a diagnosis but a category, because it is only based on the behaviour and experiences; there are no causes for the experiences and behaviour taken into account.

This is what makes a diagnosis harmful, because there is no inherent interest in either the problems of the person that have led to the different complaints, or for the psychological suffering of them. How will it ever be possible to help a person with his problems when in the diagnostic procedure there is not the slightest interest in these questions?

There are naturally (and fortunately) psychiatrists who not only construct a diagnosis, but who are also interested in the problems of their clients. But with psychosis, it is both our and many patients' experience that mainstream clinical psychiatry is hardly interested. This is especially a problem with psychosis, because slowly over the last 30 years the idea has formed that the social and emotional background is not essential to the development of psychosis; the general view is they may play a role as triggers, but not so much as a cause.

What is also misleading about the diagnostic procedure is that it is presented as a medical model. This is simply not the way of working in general medicine, where the clinician looks for the cause for the complaint and this cause is essential for the diagnosis. For example, in diabetes the diagnosis is based on the disturbance of insulin as the cause of the complaints. In other words diabetes, unlike schizophrenia, has a clearly specified cause; this is what makes it a diagnosis.

In clinical psychiatry, a diagnosis in the area of psychosis generally is constructed on the basis of a person's behaviour and experiences only. The great problem is that as a consequence treatment is given without analysing the causes for this behaviour, and therefore only the 'symptoms' are treated, not the patient's underlying problems. From our perspective this looks like a juridical system that reacts to behaviour and is not much interested in the reasons for that behaviour. It is therefore no surprise to us that many patients in psychiatry are not very content with these procedures - and they are quite right.

The background of the core 'symptoms'

It is harmful to make a diagnosis without analysing the reasons for the behaviour and experiences. Not only do we know there are no particular causes for schizophrenia, we now know that that there are causes for the different core 'symptoms' of schizophrenia when we look at each person individually. The diagnosis of schizophrenia instead mystifies the cause of the various behaviours and experiences of the individual. It is our understanding that experience and behaviour needs to be de-mystified and this analysis can be the successful focus of therapy. And there are various studies that point us toward a cause in individuals.