Recovery From Schizophrenia: Psychiatry And Political Economy

WHAT IS SCHIZOPHRENIA? 3WHAT IS SCHIZOPHRENIA?Schizophrenia is an illness (or, equally, a group of illnesses). Psychiatrist ThomasSzasz would disagree, arguing that the whole concept of mental illness is afabrication—scientifically worthless and socially harmful. 3 Indeed there are manyconditions treated as illnesses by psychiatrists that might more logically beconsidered as non-medical forms of deviance—for instance, nicotine dependence,transvestism and conduct disorder of childhood (to name just a few), all mentaldisorders listed in the fourth edition of the American Psychiatric AssociationDiagnostic and Statistical Manual (DSM-IV). 4 Schizophrenia, nevertheless, fulfillsany criteria we might wish to establish to define an illness. It is a non-volitionaland generally maladaptive condition that decreases the person’s functional capacityand that may be identified by a reasonably circumscribed set of characteristicfeatures. Within rather broad limits, the age of onset and the expected course ofthe condition may be specified. Researchers have identified anatomical,physiological and biochemical abnormalities in the brains of people exhibitingfeatures of schizophrenia. The predisposition to develop the condition appears tobe inherited, and in essentially similar forms the disorder is universally identifiablein all societies around the globe with (as we shall see, in Chapter 9) a surprisinglysimilar incidence rate. We may regard schizophrenia as an illness, but it will beapparent that it is an illness that is strongly affected by the sufferer’s environment.Schizophrenia is a psychosis. That is to say, it is a severe mental disorder inwhich the person’s ability to recognize reality and his or her emotional responses,thinking processes, judgment and ability to communicate are so affected that his orher functioning is seriously impaired. Hallucinations and delusions are commonfeatures of psychosis.Schizophrenia is one of the functional psychoses. These are the disorders inwhich the changes in functioning cannot definitely be attributed to any specificorganic abnormality in the brain. As more is learned of brain pathology in mentalillness this distinction has become less relevant. It allows us, however, todistinguish certain mental illnesses from such organic mental disorders as the preseniledementias (like Huntington’s chorea), drug-induced psychoses (such asthose that amphetamine may cause) or delirium tremens (secondary to alcoholwithdrawal).The two most common functional psychoses are schizophrenia and bipolaraffective disorder (also known as manic-depressive illness). The distinctionbetween the two is often not easy to make and, as we shall see, psychiatrists indifferent parts of the world at different times have not drawn the boundaries inthe same way. In essence, however, bipolar disorder is an episodic and recurrentdisorder in which the psychotic symptoms are associated with severe alterations inmood—at times elated, agitated episodes of mania, at other times depression, withphysical and mental slowing, despair, guilt feelings and low self-esteem.Schizophrenia, on the other hand, while it may be episodic, will tend to relapseat irregular intervals, unlike the more regular, cyclical pattern of bipolar disorder;