A cause related A cause related alternative for the alternative for the harmful concept of harmful concept of

schizophrenia.schizophrenia.

Prof. Dr. M.A.J. RommeProf. Dr. M.A.J. Romme

Why harmfull?Why harmfull?

The concept it selves makes it The concept it selves makes it impossible impossible

to solve the patient’s problems that lay to solve the patient’s problems that lay at at

the roots of becoming ill.the roots of becoming ill.

the essential problemsthe essential problems The scientific validity of the concept is Zero and it neither The scientific validity of the concept is Zero and it neither

refers to a brain disease.refers to a brain disease.

The diagnostic process neglects the reasons for the The diagnostic process neglects the reasons for the existing symptoms.existing symptoms.

The relationships between the core symptoms and The relationships between the core symptoms and experiences in life are neglected.experiences in life are neglected.

The inter relationships between the core symptoms are The inter relationships between the core symptoms are neglected.neglected.

The core symptoms do not represent expressions of The core symptoms do not represent expressions of psychopathology.psychopathology.

Learning to cope with the symptoms and with the problems Learning to cope with the symptoms and with the problems at hart are neglected.at hart are neglected.

People who recover from the illness do that outside of People who recover from the illness do that outside of psychiatry.psychiatry.

The missing validity:The missing validity: Bentall 1998 Bentall 1998

““It would seem that schizophrenia is an It would seem that schizophrenia is an illness that consists of illness that consists of

no particular symptoms, no particular symptoms, no particular outcome,no particular outcome, responds to no particular treatment. responds to no particular treatment.

No wonder research revealed that it has No wonder research revealed that it has no particular cause.”no particular cause.”

It has never been validatedIt has never been validatedMary Boyle (1990)Mary Boyle (1990)

Kraepelin and Bleuler merely postulated Kraepelin and Bleuler merely postulated the existence of a peculiar pattern of signs the existence of a peculiar pattern of signs and symptom, which they then attempted and symptom, which they then attempted – unsuccessfully – to validate.– unsuccessfully – to validate.

““None of them (including Schneider as None of them (including Schneider as well) presented evidence of having well) presented evidence of having observed a set of regularities, which would observed a set of regularities, which would justify a new hypothetical construct. justify a new hypothetical construct. Certainly, none of them identified a Certainly, none of them identified a syndrome.” syndrome.” ( ( Boyle Second edition 2002 p.80Boyle Second edition 2002 p.80).).

Heinrichs (2001)Heinrichs (2001) Constitutes a review of the results from Constitutes a review of the results from

neuroscience research for publications appearing neuroscience research for publications appearing

between 1980 - 1999between 1980 - 1999 (p. 84) :(p. 84) :

“ “In summary this extensive appraisal across many In summary this extensive appraisal across many areas of neuroscience reveals no common areas of neuroscience reveals no common abnormality in all cases of schizophrenic illness. abnormality in all cases of schizophrenic illness.

The strongest, most consistent evidence suggests that The strongest, most consistent evidence suggests that 50 – 70 % of schizophrenia are deficient in cognitive 50 – 70 % of schizophrenia are deficient in cognitive brain function. brain function.

In comparison most of the neurobiological In comparison most of the neurobiological abnormalities in the illness, probably occur in a abnormalities in the illness, probably occur in a minority of patients. minority of patients.

Moreover close to 40% of the biological findings are so Moreover close to 40% of the biological findings are so weak and variable that they may represent minor, weak and variable that they may represent minor, unimportant, or chance abnormalities with no unimportant, or chance abnormalities with no intrinsic link to schizophrenia”.intrinsic link to schizophrenia”.

Blom (2003)Blom (2003)

““From the work of Heinrichs we may From the work of Heinrichs we may cautiously conclude that cautiously conclude that contemporary neuroscience contemporary neuroscience research, likewise fails to provide research, likewise fails to provide persuasive means of validation for persuasive means of validation for the schizophrenia concept”. the schizophrenia concept”.

The conclusion might well be The conclusion might well be that: that:

The people with the symptoms exist The people with the symptoms exist but the illness does not existbut the illness does not exist..

Between them there is a great variaty, Between them there is a great variaty, which is mostly overlookedwhich is mostly overlooked

Some more arguments:Some more arguments:

The Diagnostic procesThe Diagnostic proces

The background of the core symptomsThe background of the core symptoms

Interrelationship between core Interrelationship between core symptomssymptoms

Some more argumentsSome more arguments

The Diagnostic procesThe Diagnostic proces

The background of the core symptomsThe background of the core symptoms

Interrelationship between core Interrelationship between core symptomssymptoms

Diagnostic procedureDiagnostic procedure In clinical psychiatry.In clinical psychiatry.

Behaviour and experiences lead to Behaviour and experiences lead to postulation of postulation of

symptom categorie (Reduction no 1)symptom categorie (Reduction no 1)

Symptom categories lead to construction of Symptom categories lead to construction of an an

ilness categorie according to DSMilness categorie according to DSM(Reduction no 2)(Reduction no 2)

No interest in other areas like No interest in other areas like – the reasons for the development of the the reasons for the development of the

behaviour and experiencesbehaviour and experiences

Differences in diagnostic Differences in diagnostic procedureprocedure

In Clinical psychiatry:In Clinical psychiatry:

behaviour and experiences are seen as a behaviour and experiences are seen as a result of an illness.result of an illness.

In Social psychiatry:In Social psychiatry:

behaviour and experiences are seen as the behaviour and experiences are seen as the result of sociaal- emotional problems in liferesult of sociaal- emotional problems in life

HarmfullnessHarmfullness

Clinical psychiatric diagnosis are harmfullClinical psychiatric diagnosis are harmfull

because:because:

They do not lead to analysis of patient They do not lead to analysis of patient problems.problems.

ThereforeTherefore The patients will not be helped with their The patients will not be helped with their

problemsproblems

Background of Core Background of Core SymptomsSymptoms

Research did not reveal particular cause for Research did not reveal particular cause for illness of schizophrenia (Bentall 1990;1998)illness of schizophrenia (Bentall 1990;1998)

Research did reveal particular cause for the Research did reveal particular cause for the separate core symptoms in individuals separate core symptoms in individuals (Romme & Escher 1989; Smith 1996; (Romme & Escher 1989; Smith 1996; Johnston 2000)Johnston 2000)

The diagnosis of schizophrenia mystifies the The diagnosis of schizophrenia mystifies the cause of the mental health problems in the cause of the mental health problems in the individual caseindividual case

Interrelationships between the Interrelationships between the

core symptomscore symptoms Each core symptom can be a reaction on Each core symptom can be a reaction on

traumatic experiencestraumatic experiences

They then become the primary symptom They then become the primary symptom (first symptom)(first symptom)

The other symptoms then develop as The other symptoms then develop as secondary reactions, because the person is secondary reactions, because the person is not able to cope with the primary symptom not able to cope with the primary symptom

One more argument:One more argument:

The core symptoms in themselves The core symptoms in themselves are not signs of psychopathologyare not signs of psychopathology

Focus of care with psychosisFocus of care with psychosis The focus of mental health care with psychosis The focus of mental health care with psychosis

should be on.should be on.

Learning to cope with the separate core Learning to cope with the separate core symptoms, mostly by Cognitive psychological symptoms, mostly by Cognitive psychological interventions.interventions.

Analysing and learning to cope with the social Analysing and learning to cope with the social emotional problems in which the psychosis is emotional problems in which the psychosis is rooted.rooted.

Recovery that is focussing on the Development of Recovery that is focussing on the Development of the person the person

Recovering from Schizophrenia is Recovering from Schizophrenia is not seldomnot seldom

AuteurAuteur Jaar Jaar No Patients No Patients %% %% recoveryrecovery total total socialsocial Bleuler 1972Bleuler 1972 208208 2323 4343 Harding 1986Harding 1986 269269 3434 3434 Huber 1975Huber 1975 502502 2626 3131 Tsuang 1972Tsuang 1972 186186 2020 2626 Ciompi 1976Ciompi 1976 289289 2929 2424

Those who recover do that outside psychiatryThose who recover do that outside psychiatry

Psychiatric care makes angry Psychiatric care makes angry becausebecause

The distress of complaints is not the focus of care The distress of complaints is not the focus of care but is used to confirm symptom categoriesbut is used to confirm symptom categories

The diagnosis does not contribute to solve the The diagnosis does not contribute to solve the person’s problems.person’s problems.

Nobody aks what has happened in relation to the Nobody aks what has happened in relation to the distresfull behaviour and experiencedistresfull behaviour and experience

Demoralising statements are made about the Demoralising statements are made about the given diagnosis.given diagnosis.

Medication often does not help with the Medication often does not help with the complaints and reduces emotional alertness.complaints and reduces emotional alertness.

ConclusionConclusion

The Schizophrenia Concept is harmfull because:The Schizophrenia Concept is harmfull because:– It mystifies the patients social emotional problemsIt mystifies the patients social emotional problems– It makes it impossible to solve the patients problems It makes it impossible to solve the patients problems

A diagnosis of “Trauma Induced Psychosis” should A diagnosis of “Trauma Induced Psychosis” should be recognised. be recognised.

Mental Health care should be oriented towardsMental Health care should be oriented towards– Learning to cope instead of supression of experiencesLearning to cope instead of supression of experiences– Analysing the causes and learn to cope with emotionsAnalysing the causes and learn to cope with emotions– Recovery and the development of the personRecovery and the development of the person