Unethical Psychiatrists Misrepresent
What is Known About Schizophrenia
by Al Siebert, Ph.D.
Abstract: Prominent psychiatrists are stating that
schizophrenia is a brain disease like Alzheimer's, Parkinson's,
or multiple sclerosis. These statements are disconfirmed by
scientific facts: no neurologist can independently confirm the
presence or absence of schizophrenia with laboratory tests
because the large majority of people diagnosed with schizophrenia
show no neuropathological or biochemical abnormalities and a few
people without any symptoms of schizophrenia have the same
biophysiological abnormalities. People with schizophrenia
do not
usually progressively deteriorate: most improve over time.
Psychotherapy and milieu therapy, without medications, have led
even the most severely disturbed individuals with schizophrenia
to full recovery and beyond. Many people diagnosed with
schizophrenia have recovered on their own without any treatment,
something never accomplished by a person with Parkinson's,
Alzheimer's, or multiple sclerosis.
The shooting of two United States Capitol building guards in
July 1998, by a man said to be suffering from "paranoid
schizophrenia," led to a flurry of media attention on
"schizophrenia." Unfortunately, prominent psychiatric experts
used these media opportunities to state that schizophrenia is a
brain disease like Alzheimer's disease, Parkinson's disease, or
multiple sclerosis. These statements are inconsistent with
published scientific facts and mislead the public.
For example, on the television show NewsHour (Farnsworth, 1998),
broadcast on the Public Broadcasting System (and later on
National Public Radio) in the United States on July 27, 1998,
journalist Elizabeth Farnsworth interviewed Dr. Nancy Andreasen,
director of the Mental Health Clinical Research Center at the
University of Iowa and editor-in-chief of the American Journal of
Psychiatry, and David Pickar, chief of the Experimental
Therapeutics Branch of the National Institute of Mental Health.
Andreasen stated: "[Various] things add up to produce a brain
injury that we then recognize as schizophrenia. ƒ it's just
about
universally recognized that it's a brain disease like every, like
all other brain diseases, Alzheimer's, Parkinson's Disease and so
on." Pickar stated: "There's no question. This is a brain
disorder." E. Fuller Torrey (1983, 1997; Yolken & Torrey, 1995),
another nationally prominent psychiatrist, has repeatedly stated
that schizophrenia is in the same category as other brain
disorders such as Parkinson's disease, Alzheimer's disease, and
multiple sclerosis.
These statements distort and misrepresent research findings
published in the scientific literature in eight significant
ways.
- Schizophrenia is not "a single disease."
Starting with the
original descriptions by Emil Kraeplin (1902) and Eugen Bleuler
(1950) nearly 100 years ago, informed professional references
describe "the schizophrenias" as a group of conditions.
According
to O'Donnell and Grace (1998): "a major problem in the study of
schizophrenia is the diversity of its symptoms, leading to the
suggestion that schizophrenia is actually a cluster of diseases"
(p. 267). Statements to the effect that schizophrenia is "a
brain
disease" (singular) are misleading.
- Evidence for the brain disease hypothesis is weak.
A few
individuals diagnosed with schizophrenia show certain brain
abnormalities, but the brain scans of most people diagnosed with
a schizophrenia fall within normal ranges (Weikert & Weinberger,
1998). Some psychiatrists, however, attribute undue
significance
to weak evidence (Boyle, 1990). For example, in a research
study
of childhood schizophrenia (Nopoulos, Giedd, Andreasen, &
Rapoport, 1998), the authors concluded that "patients with
extremely early onset (childhood) forms of schizophrenia may have
more severe developmental anomalies than those with adult onset"
(p. 1074 ). The data actually revealed that of the 24
patients
studied, only 3 (12.5%) showed abnormal enlargement of certain
brain structures, 21 (87.5%) did not. In the healthy
control
group, one subject had a similar brain anomaly.
Ismail, Cantor-Grace, & McNeil (1998) found that when
schizophrenic patients had certain neurological abnormalities,
their siblings without clinical signs of schizophrenia had very
similar abnormalities. Andreasen (1995) found that a few
people
without symptoms of schizophrenia have brain abnormalities
similar to those of some schizophrenic subjects. According
to
Lewine (1998), "there is no brain abnormality in schizophrenia
that characterizes more than 20-33% of any given sample.
The
brains of the majority of individuals with schizophrenia are
normal as far as researchers can tell at present" (p. 499).
In
addition, rarely do studies with positive findings control for
the effects prolonged use of neuroleptics and other drugs.
- The "brain disease" hypothesis cannot accommodate solid evidence
that many people completely recover from schizophrenia.
Unlike
Parkinson's, Alzheimer's, and multiple sclerosis, schizophrenia
does not necessarily progress toward life-long debilitation, and
the outcome for any one person is unpredictable (Marengo, 1994;
Mendel, 1989; Mûller & von Zerssen, 1988; Ponyat, 1992).
Manfred
Bleuler (1979a), author of the authoritative textbook on
schizophrenia, wrote:
"the belief that schizophrenic psychoses are
essentially a progression toward dementia and death... is ... a
tragic error.... Nearly a third of schizophrenics recover for
good. In general the psychosis does not progress more after
five
years from its outbreak but, rather, improves...These and other
facts concerning the course and outcome of schizophrenic
psychoses are certainly not characteristic of organic cerebral
and metabolic disease" (p. 1407).
Indeed, longitudinal studies of thousands of ex-patients in many
countries show that one-half to two-thirds of the individuals
diagnosed as schizophrenic have achieved full recovery or
significant improvement many years later. The percentages
are:
a) Bleuler (1968), Zurich study: 23% fully recovered, 43%
significantly improved, 66% total.
b) Huber, Gross, Schuttler,
and Linz. (1980), Bonn study: 26% fully recovered, 31%
significantly improved, 57% total.
c) World Health
Organization (1979), world-wide two-year follow-up: 26% very
favourable, 25% favourable, 51% total.
d) Ciompi (1980),
Lausanne study: 29% fully recovered, 24% significantly improved,
53% total.
e) Harding et al. (1987), Vermont study: 34% fully
recovered, 34% significantly improved, 68% total.
f) Tsuang et
al. (1979), Iowa study: 20% fully recovered, 26% significantly
improved, 46% total.
g) Hegarty et al. (1994), meta-analysis
of 320 outcome studies covering all countries, all decades, with
51,800 subjects 5-6 years after being diagnosed schizophrenic
with broad criteria: 46.5% improved.
h) Warner (1994), review
of 85 outcome studies during 1956-1985: 20-25% complete recovery,
40-45% social recovery, 60-70% total.
i) Wiersma et al.
(1998), 15 year follow-up of a Dutch cohort: 27% complete
remission, 50% partial remission.
Many of the ex-patients in the studies listed above were
evaluated 20 to 35 years after discharge. Those who
recovered
include ex-patients once viewed as the most profoundly disturbed.
Courtenay Harding and her colleagues (Harding, 1987) tracked down
and evaluated 82 individuals who, 20 to 25 years before, had been
the most hopeless, chronically disturbed, back-ward patients when
discharged from a state hospital into a rehabilitation program.
Harding emphasizes that "for one-half to two-thirds the long-term
outcome was neither downward or marginal, but an evolution to
various degrees of productivity, social involvement, wellness,
and competent functioning" (p. 730). Many of them were
found to
be completely symptom free.
- No brain disease has ever been cured with psychotherapy or the
passage of time.
Many therapists have reported observing
full
recovery from schizophrenia with psychotherapy and/or milieu
therapy (Artiss, 1962; Colbert, 1996; Fromm-Reichman, 1950;
Harding, 1995; Jung, 1961; Karon, 1998; Laing, 1967; Mosher,
1999; Perry, 1974; Sechehaye, 1951; Siebert, in press; Sullivan,
1962). In the Soteria studies, young adults diagnosed as
acutely
schizophrenic were stabilized with no medication and
non-professional helpers just as well and quickly as a similar
group sent to a psychiatric hospital (Mosher & Menn, 1978).
Many
individuals diagnosed with schizophrenia have recovered on their
own without medications or psychotherapy (Brody, 1952; French &
Kasonin, 1941; Hoffman, 1985; Rubins, 1969).
In recent times the best known case of spontaneous recovery from
schizophrenia is that of John Forbes Nash. In 1949, at the
age of
21 Nash wrote a Ph.D. thesis that established him as a
mathematical genius. Nine years later, Nash suffered a
mental
breakdown and was diagnosed with paranoid schizophrenia.
His life
and career were devastated. During the next 20 years he
functioned marginally in the United States and Europe and was
hospitalized many times for brief periods. Old friends,
former
colleagues, and admirers stayed in touch with him and continued
to be kind to him. Then, for unknown reasons, Nash had a
sudden
remission. According to his ex-wife and sister, the two
people
who knew him best, his recovery was not due to any medications or
psychological treatments (Nasar, 1998).
- Some people diagnosed with schizophrenia progress beyond
recovery.
A schizophrenic experience may in some cases have
a
beneficial effect on those diagnosed, leading to favorable
changes in personality and psychological growth (Arieti, 1979;
Bernheim & Lewine, 1979; Bleuler, 1950; Bowers, 1979; Cancro,
1974; French & Kasonin, 1941; Jung, 1961; Menninger, 1963; Perry,
1974; Pickering, 1976; Rubins, 1969; Silverman, 1970; Sullivan,
1962; Warner, 1994). John Weir Perry (1999) reported that
85
percent of the clients (all met DSM criteria for schizophrenia
and were "severely psychotic") treated at Diabasis, "not only
improved, without medication, but most went on growing after
leaving" (p. 147).
For some, a schizophrenic episode appears to function as a
breakthrough to a higher level of mental and emotional
functioning (Pickering, 1976; Sannella, 1981; Siebert, 1996).
Silvano Arieti (1978) stated that "with many patients who receive
intensive and prolonged psychotherapy, we reach levels of
integration and self-fulfillment that are far superior to those
prevailing before the patient was psychotic" (p. 20).
Earlier,
Arieti (1974) wrote: "some of my patients whom I consider cured
have achieved important positions in life, in the academic world
as well as in other activities" (pp. 616-617).
No one with Parkinson's, Alzheimer's, or multiple sclerosis is
known to have fully recovered and developed a level of health and
functioning superior to their pre-illness condition.
- The cause of schizophrenia is unknown
(American Psychiatric
Association, 1994; Gottesman, 1991). Andreasen stated
during her
interview (Farnsworth, 1998) that schizophrenia results from
"multiple things„perhaps a genetic predisposition, nutritional
factors early in life, viral infections, head injuries, exposure
to toxin, exposure to drugs of various kinds, illicit
drugs. All
these things add up to produce a brain injury that we then
recognize as schizophrenia." This statement is an educated guess,
not a scientific fact. Given the encompassing list of risk
factors, why do not more people exposed to them develop
schizophrenia? Why do not more siblings of individuals diagnosed
with schizophrenia „ who have identical genetic predispositions
and are exposed to the same neurological trauma „ develop
schizophrenia (Ismail, Cantor-Grace, & McNeil, 1998)?
If Andreasen's speculations were true, many people with similar
"genetic predispositions" would eventually develop schizophrenia
from the multiple neurological trauma caused by chronic smoking
and drinking, cumulative environmental toxins, viral infections,
poor nutrition, an aging brain, decreased immune system
efficiency, and early stages of such brain diseases as
Alzheimer's and Parkinson's. Proponents of the "brain
disease"
hypothesis cannot explain why schizophrenias occur so
consistently in physically healthy young adults, aged 16 to 25,
but rarely in anyone over 40, regardless of any physiological
stressor (Arieti, 1979; M. Bleuler, 1979b; Hoffer & Osmond, 1966;
Lewine, 1998; Ponyat, 1992; Smith, 1982).
- There is no "universal" recognition that schizophrenia is a brain
disease "like all other brain diseases."
Medical textbooks and
pathology journals do not include schizophrenia as a
pathophysiological condition (Schaler, 1998). Medical
specialties
that deal with neuropathology and neurological diseases such as
Parkinson's and multiple sclerosis, have nothing to say about the
schizophrenias. None of the following neurology journals
published articles on schizophrenia between 1995 and 1998:
Neurology (official journal of the American Academy of
Neurology), Journal of Neurology (European Neurological Society),
Journal of Neurological Sciences (World Federation of Neurology),
Journal of Neuroradiology; and Archives of Neurology. One
article
on the epidemiology of schizophrenia appeared in Journal of
Neurology, Neurosurgery, and Psychiatry (Cannon & Jones, 1996),
but it had nothing to do with brain research. Most articles
attempting to support the "brain disease" hypothesis of
schizophrenia appear in psychiatry and biopsychology journals.
Andreasen's claim of almost "universal" recognition of
schizophrenia as brain disease is also belied by statements from
many psychiatrists and psychologists, clinically experienced with
the schizophrenias, who see no convincing evidence for the theory
(M. Bleuler, 1979a; Breggin, 1997; Karon, 1998; Lewine, 1998;
Menninger, 1970).
Even the Diagnostic and Statistical Manual (fourth edition) of
the American Psychiatric Association (1994), states plainly: "No
laboratory findings have been identified that are diagnostic of
schizophrenia" (p. 280). This statement highlights that the
"brain disease" hypothesis stands or falls on simple
criteria. A
true brain disease must be identified and confirmed by laboratory
tests. No blood chemistry, neurological, or brain scan test
(or
any other test) independently evaluated by a neurologist,
biochemist, or pathologist who knows nothing about the patient's
clinical symptoms is able to reliably discriminate between a
person experiencing a first episode of schizophrenia and someone
who is not (Andreason, 1997). However, such a test might
well
identify someone who has been taking neuroleptic medications for
many years.
- "Treatments" for schizophrenia are often worse than the
"disease."
In the Farnsworth (1998) interview, Pickar stated that
when people stop taking their medications "the consequences can
be very severe." What Pickar did not report however, is that
withdrawal symptoms can be disabling and mimic psychosis (Cohen,
1997) and that long-term drug use may be quite harmful.
Neuroleptic medications may cause profound brain dysfunction and
frequently lead to irreversible tardive dyskinesia, in up to 50%
of patients (Breggin 1997; Buckley, 1982; Cohen, 1997; Mosher,
1999; Rappaport, Hopkins, & Hall, 1978). This is a solidly
established fact in psychiatry.
Many people diagnosed as schizophrenic say they are helped by
neuroleptic drugs. It is professionally irresponsible,
however,
for Pickar and other schizophrenia psychiatrists not to inform
the public that many people are seriously harmed by neuroleptic
medications and that many people can recover and maintain a full
recovery from a schizophrenia without medications.
Discussion
As we have seen, some psychiatrists significantly distort and
misrepresent research findings published in the psychiatric
literature. They consistently downplay evidence that most
people
with a schizophrenia do not have brain or biochemical
abnormalities and that some people with similar abnormalities
have no signs of a schizophrenia. People with
neuropathological
diseases have never been cured by psychotherapy nor found decades
later to be fully recovered.
While some weak positive correlations have been found between the
presence of schizophrenic symptoms and certain brain
abnormalities, a basic scientific principle remains: correlation
does not mean causation. In some instances, an underlying
cause
may lead to both brain abnormalities and schizophrenic symptoms.
Some psychotherapists reporting cases of successful recovery from
a schizophrenia say that the symptoms often trace back to
extremely traumatic childhood incidents that created powerful,
conflicting feelings of loneliness and terror (Karon,
1998). What
if some "schizophrenic" conditions turn out to stem from some
form of chronic childhood traumatic stress disorder (Ford, 1998)
that has persistent effects on brain structure or function?
The real "tragedy of schizophrenia" may be that thousands of
people diagnosed with "schizophrenia" are led to believe that
they have a chronic, debilitating, progressive brain disease like
the incurable diseases of Alzheimer's, Parkinson's, and multiple
sclerosis. For many, this amounts to hearing themselves
sentenced
to a slow, painful, early death. Yet no one ever dies of
schizophrenia, even when it is untreated (Mendel, 1989). Is
this
erroneous and misleading information contributing to the high
suicide rates of people diagnosed as schizophrenic?
Responsible, scientifically accurate statements to the media
about schizophrenia might be expressed as follows:
"A person diagnosed as having schizophrenia is expressing
thoughts, feelings, and behaviors very disturbing to others and
usually, but not necessarily, disturbing to the person expressing
them. Research suggests that a few people diagnosed with a
schizophrenia have neurological complications, but many people
with the same neurological profile do not develop a
schizophrenia. There is no known cure for
schizophrenia. Some
people benefit from medications that control their undesirable
symptoms, some people are harmed by the medications, and other
people do better without medications. About one person in
ten
never recovers from the original disturbed or disturbing
experience and the effects of repeated hospitalizations, but five
or six out of ten can be expected to fully recover or
significantly improve. At present we cannot predict who
will
develop schizophrenia or why, who will recover or who will not.
Further, we cannot explain why some people recover within weeks
or months while others take from 5 to 20 years to recover."
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Acknowledgments:
The author wishes to express appreciation for valuable editing by
Tom Greening and David Cohen, research contributions by Bert
Karon, and inspiration from John Weir Perry.
This article first appeared in Journal of Ethical Human Sciences and
Services. New York: Springer Publishing Company, Vol. 1, No.
2, Summer 1999, pp. 179-89 as "Brain Disease Hypothesis for
Schizophrenia Disconfirmed by All Evidence."
Notice to students, editors and publishers: If you quote
or reprint any part of this research paper, please send an
electronic copy to Al Siebert at asiebert@thrivenet.com, or a
hard copy to: Al Siebert,
Ph.D., P.O. Box 505, Portland, OR 97207.
This article appears on this website with the permission of the author, Al Siebert.
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