harmful concept of Schizophrenia, The

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

One of the clearest inter-relationships, rigorously researched by Maher (1974), is the explanation for the voices. Because the voices are for the voice hearer a strange and unknown experience, the explanation they think of is also mostly strange to us, and therefore easily identified as a delusion. The conclusion here is that auditory hallucinations and delusions are actually interrelated experiences, and not separate 'symptoms'. This holds for many 'symptoms' being secondary reactions to a primary experience like hearing voices; experiences that scare the person and with which he/she is unable to cope.

When the concept of schizophrenia is examined in this way, the 'symptoms' are not the results of a disease entity, rather the illness picture is composed of primary experiences - possibly a reaction to traumatic experiences, and with secondary reactions because of the inability to cope with the primary experiences. This is not such a strange conception, because as we have already stated: the core experiences are in themselves not a sign of psychopathology.

There are now a significant number of epidemiological studies that show us that hearing voices and also 'delusions' are experienced by many individuals without any psychiatric diagnosis (Tien, 1991; Eaton 1991; Bijl et al 1998; Os et al, 2001). There are even more people hearing voices or experiencing delusions without illness than people with these experiences that become psychiatric patients.

This is mostly very difficult for mental health professionals to accept, because they do not meet these people, the reason being these people do not need any care. Many people are even content with their voices and their ideas, because they are helped by them in daily life.

The reality that there are many people in the general population who hear voices, or have peculiar personal convictions that we call delusions without being ill, forces us to realise that these experiences are, in themselves, not a sign of mental illness.

This is an important fact in understanding psychiatric patients with these experiences, because it opens our eves to the reasons why the person became ill. A person hearing voices becomes ill, not because he hears voices, but because he cannot cope with these voices or find a way that they can be understood. Those who can't cope with their voices are also unable to do so because they cannot cope with the problems that led up to the experience of hearing voices. This double inability makes it important not to focus on an unknown illness, but to teach the person to cope with his voices and or delusions and with the problems that lead to them.

In this way it becomes clear that to focus on experiences as being caused by the nonexistent disease 'schizophrenia' does not solve a persons problems that lie at the roots of becoming ill.

The essential difference between becoming ill and having a 'diagnosed illness'

We have to realise that there is an essential difference in 'psychotic' experience between becoming ill and being seen as suffering from a disease like schizophrenia. If we focus on the illness as a disease concept and try to treat the diagnostic construct, then we will never be able to help the patient to solve his problems. In order to help the patient we will first have to help him to cope with his experiences of hearing voices and personal convictions, and it is entirely possible to reduce the anxiety for these experiences with cognitive interventions alone. But after that, we also have to help the person to learn to cope with the original problems that lead to the experiences. This mostly concerns a change in attitude towards these problems and those people involved with them. Not simple, but rewarding.