Today is World Mental Health Day, and what could be a better way to celebrate a day of mental calm and tranquility than to ignite a blazing row at the core of psychiatry?
Actually, the idea that schizophrenia is a single separate disorder is in a pretty shoddy state, but the argument is a textbook example of mixed agendas as the people who want to reject the label also reject the use of biological explanations in theories of mental illness, and those who argue most forcefully for the diagnosis of schizophrenia are usually heavily committed to biological psychiatry.
What gets lost, is that the validity of schizophrenia as a concept, and whether biological theories are useful, are separate issues.
This is probably because both sides seem to spend so much time trying to make us think that they’re not.
To get a good idea of what the diagnosis of schizophrenia describes in terms of our scientific understanding, the entry for schizophrenia on the OMIM database of medical conditions with genetic influences really says it all:
Schizophrenia is a psychosis, a disorder of thought and sense of self. Although it affects emotions, it is distinguished from mood disorders in which such disturbances are primary. Similarly, there may be mild impairment of cognitive function, and it is distinguished from the dementias in which disturbed cognitive function is considered primary. There is no characteristic pathology, such as neurofibrillary tangles in Alzheimer disease. Schizophrenia is a common disorder with a lifetime prevalence of approximately 1%. It is highly heritable but the genetics are complex. This may not be a single entity.
In other words, very little can be said with certainty. Any definition that finishes with the ominous “This may not be a single entity” suggests we really don’t understand much about the associated experiences.
So why does the argument over schizophrenia persist?
Mainly because the medical and legal systems are far more comfortable with cut-and-dry “you have it or you don’t” conditions than ones in which you might have a bit of this and a bit of that.
This is often due to the fact that the medical and legal systems have to make cut and dry decisions. To treat or not to treat, to detain or not to detain, and so on. These decisions become a lot easier when the supporting information is as simple as possible.
It also becomes a lot easier to market treatments for specific disorders. In fact, in many countries, drugs can only be licensed for specific disorders.
So, no diagnosis means that there’s no way of getting drugs licensed. This is why pharmaceutical companies have a vested interest in supporting the concept of schizophrenia.
In other words, the usefulness of the diagnosis of schizophrenia rests not only upon the supporting medical research, but also on its social function.
In fact, one of the ironies of the debate, is that the most recent research in molecular genetics (exactly the sort of biological approach that those against the diagnosis of schizophrenia are also opposed to) shows some of the best evidence that schizophrenia is not a discrete condition.
You can imagine that neither the drug companies nor the anti-schizophrenia-diagnosis mental health activists plaster these findings across their leaflets.