This is an archive of past discussions about Schizophrenia. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.
not sure what this means or how to integrate it: "Nowadays medical treatment is the mainstay of antipsychotic treament. Although drugs that are in use are better tolarated sometimes patients show signs of extrapyramidal side-effects." --KQ
Well I found a description of various EPSE but wasn't sure whether to paraphrase the material or link to it, so I linked to it.
Another article or a subpage with info for more scientifically minded ?
--Kpjas
I don't understand your question. Sorry. Is that a request for one or the other? Do you think the article is too general? Personally I have to admit I like it how it is, so that the average reader can understand it, but I see nothing at all wrong with adding more information. If you'd like to add more, by all means go ahead; I've just reached the limit of what I can do without having to research. I don't think it should be replaced entirely though. --KQ
Very nice entry. Thanks!
Added Julian Jaynes because I think people reading The Origin of Consciousness will be looking for more info on schizophrenia.
I think your qualification is quite mild. Indeed, historians of early periods do more than not support it - they scoff at his use of sources. His psychology may or may not be useful, but his understanding of early civilization is not, particularly. I think there's room for him in the entry, but only with a stronger sentence of qualification. --MichaelTinkler
I was shooting for very NPOV there. If you think Jaynes info should be different, please edit at will! Thanks.
Added mention of types of schizophrenia in West and sluggishly progressing schizophrenia in the Soviet Union.
Daniel C. Boyer
Added some clarfication on antipsychiatry.
Daniel C. Boyer
Removed duplicated material from Emil Kraepelin article, which seems to be about Kraepelin, not schizophrenia:
According to the eminent psychologist H. J. Eysenck, Kraepelin not only deserves credit for the discovery of schizophrenia and manic-depression--he is also the founder of modern scientific psychiatry, psychopharmacology and psychiatric genetics. Kraepelin postulated that psychiatric diseases are principally caused by biological and genetic disorders and in this respect are no different from Alzheimers disease or the then very common general paresis of the insane, or cerebral syphilis. Kraepelin's psychiatric and diagnostic methods completely dominated the field of psychiatry worldwide at the begining of the twentieth century. He vigorously opposed the approach of Freud who regarded and treated psychiatric disorders as caused by mysterious psychological forces. Though Kraepelin's contribution was largely ignored through most of the twentieth century due to an uncritical adoption of Freudian speculations, Kraepelin's basic approach now once again dominates psychiatric research on the psychoses and academic psychiatry, and today the published literature in the field of psychiatry is overwhelmingly biological and genetic in its orientation. Largely for political reasons, Kraepelin's great contribution in discovering schizophrenia and manic-depression remains relatively unknown to the general public and his work is little read, despite the recent widespread adoption of his fundamental theories on the etiology and diagnosis of psychiatric disorders which form the basis of all major diagnostic systems in use today, especially the American Psychiatric Association's DSM-IV and the World Health Organization's ICD system.
For detailed information on Emil Kraepelin who first discovered schizophrenia, manic depression and co-discovered Alzheimers disease including biographical, bibliographical and historical information, as well as contact information for answers to specific questions about the disease and its history, visit the International Kraepelin Society at: http://www.kraepelin.org/
Added mention of Lawrence Stevens and link to his article.
Daniel C. Boyer
If a religious believer sees a vision or hears voices, are they by definition psychotic? Or does psychiatry make provision for genuine revelation? Think Joan of Arc. --Ed Poor
No. According to DSM-IV, in order for there to be a diagnosis of psychosis, the visions must not be
cultural sanctioned. I.e. if seeing visions is within a person's cultural background, seeing them is
not considered psychosis.
If this does not make everyone see that DSM-IV is a book about social control rather than medicine, I can't help you. Tell me about another disease that would be defined this way -- this severely undermines currently fashionable claims that schizophrenia is a biological disease like any other! Would one not diagnose diabetes because it was within one's cultural background to have a blood sugar of 170?
Daniel C. Boyer
Damned if you do. Damned if you don't. If DSM-IV listed objective characteristics of delusions, people would
also claim that it was a tool of social control. Note that there is nothing that says the culture has to be
mainstream.
This is interesting. Is your point that if the "cultural background" is a subculture this would pass muster? I am concerned how this justification of delusions would work vis a vis involuntary commitment.
Daniel C. Boyer
The way psychiatrists use "cultural background" is that anything which makes sense from the point of view of the patients cultural background is not considered delusional (even if it is a subculture). This is an important point in that most people who see devils and angels are as alarmed by it I would be if Satan popped out of the computer screen right now. If it were part of a patients belief system that is it "normal" to see Satan pop out of a computer screen, then it's not considered a delusion.
As far involuntary commitment. Bizarre beliefs are ***NOT*** grounds for commitment. The criteria used for commitment is danger to self or others.
Thomas Szasz has repeatedly explained in his writings that this magic phrase, "danger to self or others," really has no clearly-defined meaning, though we know in fact it is only used against certain people (he gives the example of trapeze artists, astronauts and race-car drivers, clearly dangers to themselves, who receive public admiration, and on the other hand the would-be suicide and the polysurgical addict). As someone who has had legal training the least I would like to see is the standard "danger to self or others," presently basically completely open-ended, more precisely defined. We may think we know what is meant by "danger to self or others" but this and similar phrases used in involuntary commitment laws have no clear definition, and this creates the risk of those who are not insane being subjected to involuntary commitment. Furthermore, the claim "the criteria [sic] is danger to self or others" is patently false. Someone planning murder, who nobody claims is insane, is obviously a severe danger to another or others, yet that person will not be involuntarily committed. "Bizarre beliefs" would have to be the first step in a two-tier process.
Daniel C. Boyer
"danger to self or others" is no more vague than other legal terms such as "due process", "reasonable person", "criminal intent" In order the avoid abuse, the standard procedure in involuntary commitment, as in the rest of the legal world, is to have legal counsel argue over these things. There are lots of gray areas, but that shouldn't prevent one from pointing out that there are lots of areas where there isn't grounds for much dispute.
You can argue this about some of these other legal standards as well, but the problem with "danger to self or others" is that the entire thing is a "gray area." Where do we draw the line with respect to danger to self? Snowboarding? Reckless driving? Eating foods that contain too much "bad cholesterol"? Being overweight? Working for the bomb squad? There is no indication that it is limited to what we tend to assume it is, and in fact, many psychiatrists might argue that the behaviour of some "at risk" teenagers is caused by a "mental illness." The range of "diseases" in the DSM is so broad as to cover nearly the entire range of human behaviour.
Daniel C. Boyer
A person standing harmlessly in a street corner who is minding his own business talking to angels would *not* be subject to commitment under the laws of most states. Involuntary commitment is used only when the angels start telling that person to kill people. In practice, involuntary commitment is used only when there is violence or the threat of violence or suicide.
And the definition isn't unreasonable. How do you know what
a normal blood sugar is? Answer: You test a whole bunch of people and then look at the norm.
in the former Soviet Union, was added a fifth, "[sluggishly progressing schizophrenia]?". Particularly in the RSFSR (Russian Soviet Federated Socialist Republic), political dissidents were diagnosed with "sluggishly progressing schizophrenia" and confined to psychiatric hospitals for the purpose of silencing them or getting them to recant their ideas. The first four, widely varying, forms of schizophrenia have led some to pose the controversial question, "Is schizophrenia one illness, or different illnesses that have been mistakenly classified under one heading?" Others (including Lawrence Stevens in his article on the World Wide Web "Schizophrenia: a nonexistent disease"; see link at end of article) have maintained that schizophrenia does not exist
This is an extraordinarily confusing paragraph. Does "sluggishly progressing schizophrenia" exist at all, or was it, as the article seems to imply, only a political invention used to repress dissidents? Could this be made clear in the article? Going on to question whether schizophrenia is one disease or a number of miscategorized conditions is interesting, but conflating that issue with political repression and Lawrence Stephens' mildly-tinfoil-hat assertions seems like a poor idea. There's already a section on anti-psychiatry lower down in the article. Perhaps this would be a better place for Mr. Stephens' doubts? I'm loath to mess with the article myself because I don't know enough about the subject. -D
Perhaps it could be better edited -- the point is that "sluggishly progressing schizophrenia" (of very doubtful existence, to say the least) was one of the varieties of schizophrenia recognized in the RSFSR, and this, combined with the four other extremely divergent types of schizophrenia, might lead some people to question: is schizophrenia one disease? several diseases? another type of phenomenon/a miscategorized as an illness? even anything at all? and is it entirely impossible that at least some individuals diagonsed with schizophrenia in the West are misdiagnosed as a form of political repression?
You call Stephens' article "mildly-tinfoil-hat" but have not undermined any of his points or proven in any way anything he said is untrue. I would argue that many of the generally accepted beliefs about schizophrenia are more "tinfoil-hat," have far less to support them, than what Mr. Stephens says.
Really, that's not my intent here. I'm not trying to "disprove" what Stephens is saying. In fact, I don't think you can "disprove" what he's saying because he he's not exactly offering affirmative evidence that one can disprove. All he does is cast doubt on existing evidence, and point out that we don't understand the causes of the disease. That's all true, and worth pointing out. But his conclusion, that schizophrenia isn't a brain disease at all, is just wild conjecture.
As is, I would maintain, the existence of schizophrenia as a brain disease, given that we don't know what it is.
Daniel C. Boyer
And given the lack of affirmative psychological evidence provided, and the existence of various (non-conclusive) physiological evidence (such as PET scans and drug results)
How can you maintain that schizophrenia is a brain disease because certain drugs can, perhaps most of the time, lessen the speech or behaviour identified as a disease? Would it not be possible to identify (with more or less justification) any set of behaviours as a disease, and then create a drug which will when ingested will make people exhibit that set of behaviours less? Have you heard of LSD therapy? This really doesn't prove anything.
Daniel C. Boyer
It's a disease because people who see devils flying around, don't want to see devils flying around,
But for those who are subjected to involuntary commitment it obviously isn't a question of "not wanting to see the devils flying around." Your argument would seem to suggest that if you want to see the devils flying around, it's not an illness.
Yes it is. One thing that you are ignoring is here is that it many perhaps most cases where involuntary commitment is used, the patient in question does not have an opinion about where they want to be. If you have a patient who is seeing devils and doesn't care about anything else, you need a legal mechanism to get them into a hospital if they don't have the ability to check themselves in.
But if this is the case it is practically a non-issue -- if they do not object to the commitment or initiate or support procedures to contest the commitment the commitment is involuntary only in a very technical sense; indeed it becomes voluntary when the patient waives his right (even if simply by failing to exercise it) to contest the commitment. The argument only becomes important if the patient contests the commitment; only here would there be "legal counsel [to] argue over these things."
Daniel C. Boyer
Also, yes, I would argue that someone who is functional in society,
Here again the issue of social control raises its ugly head. Society demands that people behave in certain ways or they are considered "non-funcitonal."
Daniel C. Boyer
who sees devils, and who wants to see them should indeed not be regarded as ill.
This fundamentally undermines your claim about the biochemical basis of schizophrenia. Either schizophrenia is biochemically based, and any time a certain biochemical factor or combination of factors act in a particular way on a given individual, that individual has schizophrenia, or schizophrenia can be "opted-out-of" if the individual is willing to accept the symptoms of these biochemical causes! Yet you cannot simply opt out of influenza, diabetes melitus, or a cold.
Daniel C. Boyer
In practice, this situation doesn't come up often in schizophrenia, but it does come up more often in other mental illnesses. I know people who could be diagnosed with depression who I wouldn't consider ill because the moods are part of who they are and they manage their mood swings.
Daniel C. Boyer
and antipsychotic drugs stop the devils. It's not only a matter of behavior, it's a matter of perception. It's a great misconception that people with schizophrenia are inarticulate. Many if not point people with schizophrenia can tell you exactly what they are seeing and what the world looks like when they are on or off medication.
Person sees devils and believes that people are reading their mind. 300 mg of clozapine makes the devils go away and the world looks normal and people stop reading their mind. Stop taking the medication and the devils and mind readers reappear. In addition, if you give a high enough dose of methamphetamine to you or I, we will go into psychosis and have pretty much exactly the same symptoms as someone with schizophrenia. The logical conclusion here is that there is some biochemical basis for what is going on.
from schizophrenia patients, Stephens' conclusions are even less supportable than the prevailing wisdom he's so eager to attack (not that Mr. Stephens really demonstrates a detailed knowledge of psychiatry or physiology in this article-- he seems more inclined to jump on terminology and spotlight some conflicting quotes from medical professionals.)
Another problem with Mr. Stephens is that his not-very-well-spelled-out conclusions can be interpreted as anything from "schizophrenia is a psychiatric condition" to "people with schizophrenia aren't really sick at all, doctors just don't like they way they're acting" to "they're all faking it." Some of those conclusions are deeply offensive and disturbing to people who have first-hand experience with the conditions classified as schizophrenia. -D
I don't think the point is the feelings of those who self-identify as schizophrenics. The main purpose of Mr. Stephens writings here and elsewhere is to challenge the practice of coercive psychiatry. I don't think anywhere in his article it denies that people can suffer mentally or emotionally; it just questions, what is the origin of that suffering, and maintains that is something other than a disease, "schizophrenia." That some may take offence at any conclusion is not evidence that the conclusion is untrue.
But the fact that Mr. Stephens shows no evidence that he has first hand experience with people who have schizophrenia suggests to those of us who do that he doesn't know what he is talking about. Bashing psychiatrists is not the issue here. Most everyone who has dealt with schizophrenia has dealt with incompetent psychiatrists.
I don't object to challenging coercive psychiatry.
If you don't object to challenging coerceive psychiatry, do you support the practice of involuntary commitment? Because involuntary commitment is coercive psychiatry per se; to deny this is to engage in doublespeak.
Daniel C. Boyer
When someone lunges at me with a knife with intent to kill me (i.e. while they are screaming that I must die), yes I think they need to be locked up for a while. Part of the reason I don't object to involuntary commitment laws so much is that in the cases I've had to face the involuntary commitment laws are *FAR* less harsh or coercive than the alternative. If you lunge at me with a knife with intent to kill me, that's several years in prision. If my friend does it when she is off her medication that's several weeks in a mental hospital as they get her back on her meds. If the knife actually hits and someone dies, we would be looking at the death penalty or life in prision without possibility of parole rather than several years in a mental institution with some hope at least of getting out at some point in her life. I respect your experiences, but you need to respect mine. My experience is that the laws as designed seem to work well and do a good job preventing abuse.
There are some know-it-all psychiatrists who think they are God and know best and aren't willing to listen. But getting rid of incompetent psychiatrists is something which is altogether different from denying the existence of schizophrenia.
Daniel C. Boyer
Daniel C. Boyer
Frankly, having gone what I've been through. I find Mr. Stephen's article which denies the existence
of schizophrenia as offensive and morally repulsive and downright ***disgusting*** as a Holocaust
extermination camp survivor would find an article which denies the Holocaust.
Well, I find your drawing parallels between positions I hold and Holocaust denial offensive and morally repulsive and downright ***disgusting***. But neither of our feelings proves or disproves anything.
Daniel C. Boyer
We are not talking personal feeling. We are talking personal experience. The most important piece of evidence that a Holocaust survivor can give to refute a Holocaust denier is simply to say "I was there." I personally have had face to face daily contact with a schizophrenia patient, enough to say that Mr. Stephen is talking total garbage. His facts are just plain wrong.
Please identify the specific facts Stevens cites that are "just plain wrong."
Daniel C. Boyer
Among other things. He seems to imply that the notion that dopamine is related to schizophrenia has been rejected, when in fact it is widely accepted. I will check his quotes, but I'm pretty sure that they are
either obsolete or wildly out of context. He states that schizophrenia is simply a catch-all for behavior that the psychiatrist such doesn't like (which isn't true) (see the above discussion on cultural factors).
But isn't this just another way of putting it? Isn't this just saying that rather than "the psychiatrist... doesn't like" a certain set of behaviours the culture "doesn't like" a certain set of behaviours? Therefore not just the psychiatrist enforcing his personal preference but the societal norm. This is pretty obvious in the Stevens article. I think it's a pretty legitimate question, moreover, how many advancements for the future, in technology, in social-political understanding, in medicine, etc., etc. have been shut off because they were too far a leap from what came before, and if the innovator has not been quiet enough about them, has been psychiatrically repressed. Antonin Artaud with his "theatre of cruelty" and "theatre of the plague" is a good example of this. The culture may not be ready to accept something but it may be the wave of the future, even the distant future. In his time it was "Fulton's Folly" but a steam-boat is a completely banal object today.
I'm sitting in a room. Someone hits me because they see a devil next to me that tells them to kill me. I'm not in the mood to engage in an abstract discussion about cultural norms.
So would you admit that I have won this point?
Daniel C. Boyer
Daniel C. Boyer
The other thing is that he seems to be
under the impression that schizophrenia is only defined in terms of behavior when it is also defined in
terms of perception. Stevens also makes some glaring omissions. For example, no where does he mention
that to be defined as schizophrenia, the symptoms have to last for six months.
He says that my friend doesn't exist when she does. If schizophrenia doesn't exist them why is **** dead?
I haven't
touched the link because quite frankly I do not have the emotional energy to get into an
argument about it, just as a survivor of Auschwitz would probably rather not be in a
situation where he has to defend the existence of the Holocaust, and in any event I do not
have the energy to maintain anything like NPOV regarding his claims.
I would question your right to critique an article you have not read.
Daniel C. Boyer
I read the article. Emotionally I want to delete the link, but the feeling is so strong that I think it is better for someone with more emotional detachment to decide what to do.
But suffice to say, that the Andrea Yates situation is not that uncommon. These situations
are usually quietly handled, but situations in which a person with schizophrenia does not
take medication and kills family members, themselves or both are not that infrequent.
Whilst I have neither the time or expertise to do a detailed refutation of the article you quote, I would merely add that I have personally met a few schizophrenics, and know people who work with them regularly. *They*, along with virtually the entire medical profession, have absolutely no doubt that schizophrenia is a real disease.
Surely it cannot have escaped you that in the past there were things that "virtually the entire medical profession" accepted, yet were totally wrong. "Virtually the entire medical profession" initially rejected germ theory, yet most would now accept that Pasteur was right. Many conceptions of the nature of physical illness, and many more harebrained conceptions of why people think and act differently from others, or differently from how the others would like them to, have risen and fallen over the course of history. People would like to forget that before "mental illness" the same phenomena were ascribed to witchcraft, tertiary stage syphillis, hysteria, moonbathing, &c. This does not mean that mental illness and its "star witness" (schizophrenia) do not exist, but neither does it mean that they do. It is extremely possible that in the future schizophrenia will be exposed to be as completely ridiculous as the previous paradigms. Maybe it will not be, but we cannot exclude that it will. The present is not some priviledged time with a unique angle on the truth.
Daniel C. Boyer
I would like to add an example of this from Thomas Szasz' article CREATIVITY AND CRIMINALITY: The Two Faces of Responsibility: "While he was alive, the Hungarian obstetrician, Ignaz Semmelweis -- who discovered the microbial causation of puerperal fever before the discovery of microbes as pathogens -- was considered to be wedded to an erroneous belief, which he defended irrationally."
Daniel C. Boyer
It is found around the world in every culture in roughly the same proportion,
This assertion is to some extent false. Schizophrenia is more commonly diagnosed in the United States than in Western Europe, and in the late '80s was more commonly diagnosed in the U.S. and U.S.S.R. than the rest of the world. This might be a big fat coincidence, but it does make you wonder.
Quoting DSM IV-TR: "for instance, a far higher incidence for second-generation African Caribbeans living in the United Kingdom." What are the reasons for this? Unknown. They could be genetic, they could be the result of psychiatrists seeing how these people act or talk or write through a racist prism, or they could be the result of characteristic difficulties they have reacting to their environment. But it is another example of how false the claim is and it by no means supports the existence of schizophrenia. --Daniel C. Boyer 17:52 Apr 9, 2003 (UTC)
Daniel C. Boyer
and the symptoms are pretty much the same, and there are measurable physical effects in the brain. I have to say that this guy sounds right up there with the crackpots who claim AIDS isn't the result of HIV.
As it stands now, the article gives far too much prominence to a very small minority of people who think schizophrenia is not a real disease. --
I don't know what to do about this problem, if it is a problem. I think not, however, as I have tried in the writing I have done on this article to maintain NPOV and I also think it is important to give those who look it up the broadest possible range of information, even about challenges that are very controversial. The controversial nature of these challenges is repeatedly spelled out in the article.
There is no denying that many people have symptoms in the list of "symptoms associated with schizophrenia". These symptoms are often so distressing as to be a real problem for them.
What is at issue is what causes these symptoms. It may, as theorized, be due to a physical cause. It may, as also theorized, be due to faulty thinking. Another possibility, much less often considerd in these materialistic days, is spiritual influences.
Regardless of what really causes the problem, the problem still exists. Calling a diseases psychosomatic doesn't make the disease unreal.
The way you guys are going on is enough to drive me crazy (grin). -- Ed Poor
Mr. Boyer,
Question: What is the basis of your beliefs? The reason I've come to the conclusions on schizophrenia that I have is from first hand experience with someone who has the disease. I've seen first hand the symptoms and how she reacts or doesn't react to treatment, and what I've seen clearly points to a biochemical basis for schizophrenia. There also appear to be a lot of other people here with similar first hand experience. It's not like seeing the Loch Ness monster. Schizophrenia is (unfortunately) rather common. I also (unfortunately) have lots of first hand experience dealing with the psychiatric and legal professions.
What I'm trying to figure out here is whether it is a waste of my time or not to argue with you. Is there any possibility that anything I say will convince you that Mr. Stevens is talking total non-sense?
Possibly, but I haven't heard anything close to it yet.
I'm pretty sure it has something to do with dopamine neurotransmission (and so do most psychiatrists). Also, I would take issue with
a definition that doesn't regarding seeing demons next to you as not a disease. One should also point out
that an overdose of PCP or methamphetamine will cause most normal people to display symptoms of paranoid
schizophrenia. It's not a huge jump to think that what is happening in the brains of people with schizphrenia
is analogous to what happens in someone who has overdosed on PCP.
Mr. Boyer, have you had any first hand experience with anyone with schizophrenia?
You should say, "diagnosed with schizophrenia," but yes. They said he was unable to carry on a conversation but I carried on conversations with him, and so forth. Basically because they had already decided he was a schizoprenic his entire speech and behaviour -- that would have been accepted as normal in a person without the diagnosis -- had to be interpreted in light of the schizoprehnia.
But that's not necessarily unreasonable. The person I know appears perfectly normal when she is on her medication.
Maybe so, but the person I am talking about was supposed to be totally unresponsive to medication. I am talking about what he was like when he was supposed to be floridly schizophrenic.
Daniel C. Boyer
She's nice, intelligent, charming, articulate, and very few people knew she had schizophrenia. I would argue in fact that when she is on her medication, she *is* normal because the medication corrects the underlying biochemical defect. When the medication is removed, however, she starts seeing demons and the world literally turns into hell. Part of the reason *I* think schizophrenia is biochemical is because the people I know with the disease appear normal or only slightly odd when they are medicated, because when properly medicated they *are* normal or only slightly odd. It's when you take the medication away or when she gets stressed, that things literally fall apart.
Daniel C. Boyer
There's a difference between "I don't know what causes schizophrenia because the various hypotheses aren't consistent with first hand experiences" and "I don't know what causes schizophrenia because I haven't met anyone with schizophrenia." There's also a big difference between "I've known people diagnosed with schizophrenia and I don't think it's real" and "I believe what I do because I've read a lot of books." If the former is the case, I'm really interested in why your experiences are inconsistent with mine. If the latter is the case, I'll limit the amount of energy I'm spending on this. I've gone through hell because of schizophrenia, and engaging in a discussion with someone who thinks that I've imagined the last decade of my life is just not worth it.
Incidentally, if one wants to take a look at a disease for which there IS real debate over its existence. Look at multiple personality disorder.
Daniel C. Boyer
I did it.
I moved Mr. Stevens article to anti-psychiatry. There is a good NPOV reason for doing so in that it puts his article in context with the work of Thomas Szasz and R.D. Liang, and that even judged from its own term
Steven's article is not a good exposition of the anti-psychiatry position.
But Stevens' article is not intended as an exposition of the anti-psychiatry position and should more properly be put under schizophrenia which it directly addresses.
I was referring to the anti-psychiatry position on schizophrenia. Stevens' doesn't offer any original ideas or insights and is simply quoting others. It's better to bypass him and link directly to his sources. The notion of schizophrenia not being a disease was invented by Thomas Szasz and R.D. Liang, who quite frankly do a better job of defending it than Stevens' does.
And the notion of schizophrenia being a disease was invented by Bleuler (see his admission that we cannot speak of the brain as becoming diseased)! This doesn't prove anything! --Daniel C. Boyer
Daniel C. Boyer
I've added links to Thomas Szasz and R.D. Liang. Since they are the people who originated the claim that mental illness does not exist and are much better expositors for this position. Also check out this article by Ted Stevens [[1]] in which he takes the position that suicide is a civil
right.
The sentence
Mental illness exists.
should be broken down into two sentences:
People really do experience distressing mental symptoms.
These symptoms have a biological cause.
It is possible to agree with the first and say that some people are really mentally "ill" while disputing the second. I myself am unsure of what causes schizophrenia.
I am in firm agreement with 1. and with the statement "I myself am unsure of what causes schizophrenia." I would add that this shades into the possibility that there is no such thing as schizophrenia in the sense that, if certain reasons were the cause for the symptomatology it would not make sense to refer to the set of symptoms as a "disease." I don't agree that number 1. proves that people are mentally ill, because as Stevens would point out there could be many causes of distressing mental symptoms which were clearly not a disease, i.e. job loss, conflict with one's spouse.
Daniel C. Boyer
Do you not know because you haven't looked? Again, I ask you how much first hand experience with people with schizophrenia. Not having contact with the disease and then not knowing what causes it isn't proof of much of anything. Also, I disagree about your statement about the causes of the disease. The fact that someone thinks that everyone in the world is reading their thoughts and that they see a demon standing next to me that is telling them to kill me (and that this mental state lasts for over a week) is serious enough that I'd regard it as a disease, no matter what the cause.
But clearly, the mere seriousness of the mental problems, difficulties, symptoms, however one wants to put it, and it may be that at least parts of these descriptions could be arguable, does not establish that it is a disease. For instance, in 2000 I was in a very serious sledding accident and got a concussion. My memory and thinking ability were extremely impaired, and then improved, over a period of 48 hours. But the injury could have been of a different severity or quality and never improved, or continued for a week; this would still leave it as an injury, not a disease. --Daniel C. Boyer
Fortunately, dopamine blockers stop this. Unfortunately, not taking dopamine blockers forces this to start up again.
I suspect that most of the people who think schizophrenia is not a disease have simply not talked to someone who is in this mental state. I very strongly suspect that this is the situation in your case and would be very interested if this were not the case.
Please do not define schizophrenia as "this set of symptoms, which are caused by a physical disease" and then complain when skeptics say that it does not exist. It's better to define schizophrenia as "this set of symptoms" and to show additionally (yet separately) the evidence for a physical cause.
If you don't understand the NPOV guidelines, please be aware that your contributions are apt to be mercilessly edited. Ed Poor, educated layman and all-around sympathetic guy.
Much of the point of view of Thomas Szasz and R.D. Liang is that "illness" is the the not best way of describing the pheonmenon associated with schizopherenia. One analogy is that until rather recently what people call Alzheimer's disease was not considered an illness but rather a normal process of aging. There are those who argue that people who are deaf are not handicapped, but form their own culture. A lot of these came out of the 1960s and some of this sort of thinking did help correct some of the abuses of psychology.
However, one thing that has changed things is advances in neuroscience. For example, we think we know what neural pathways cause schizophrenia, and nowadays when people design new anti-psychotics, they create molecules which are designed specifically to block those neural receptors. The biochemical viewpoint explains a lot of things. Patient sees demons. Patient takes drug. Two weeks pass. Patient stops seeing demons and appears normal. Patient stops taking drug.
Two weeks pass. Patient starts seeing
demons. (This isn't second hand. I watched this happen to someone I know, and it's very painful.) The drug that is used
has a known biological effect. It blocks dopamine receptors. Where it gets interesting is that you can cause someone who is "normal" to start seeing demons by giving him an overdose of amphetamine, which curiously enough has the biological effect of increasing dopamine transmission. It's lots of pieces of evidence like this that makes people believe that schizophrenia is largely the result of malfuction in neurotransmission. It also leads to some promissing avenues of research. It turns out that traditional anti-psychotics attach themselves to only one of the dopamine receptors, and most of the new drugs are working by attaching themselves to different receptors.
The supposed conflict between schizophrenia and individual choice is for that most part specious. If someone sees demons
and angels, is happy with that, and can lead an independent life without bothering me. Fine. More power to them. However,
it's not like that. Most untreated people with positive schizophrenia react to what they see and feel with the same reaction that you or I would if we suddenly started to see demons if we suddenly started to believe that there was a microtransmitter buried in our brain. Most untreated people with negative schizophrenia don't have the skills needed to function independently (i.e. it's difficult for them to have a conversation, much less drive a car or fill out a job application). If someone is happy
with the way they are and can function independently. Fine. No problem. They can believe whatever they want as long as they don't bother me with it. However, most people with schizophrenia are miserable to the point that they want to commit suicide or are so convinced by the reality of what they are experiencing that they are compelled to commit homicide.
One other thing to note is that Szasz and Liang were products of the 1960s and there have been major changes in the
treatment and legal situation of mental patients since then.
The article looks pretty good as of March 14, 2002. I hope the conflict has subsided. I have kept my belief that some "schizophrenia" might be caused by actual spirits communicating with people on the earth, to myself for now. In my religion, we don't advocate giving the mentally ill spiritual treatment such as exorcism; it's not generally effective. We have some rituals akin to exorcism, but I should probably write a separate article on them, before I even think of linking here. Ed Poor
Shouldn't there be a mention of Bleuler in the article?
Daniel C. Boyer
It is believed by most researchers and clinicians that the basis of the disease is primarily biological and results from the malfunctioning of dopamine pathways in the brain (though the reasons why such malfunctioning causes schizophrenia symptoms is not clear).
For the most part I do not dispute the inclusion of this sentence in the article. But it might bear quoting what Kraepelin (the inventor of this disease) himself said: "It is true that, in the strictest terms, we cannot speak of the mind as becoming diseased."
Daniel C. Boyer
Psychiatry and anarchy are obviously going to take opposite positions on this.
Psychiatry emerged as a way to justify mercy, of making persons "exceptional" and not deserving of the harsh punishment we would as a society wish to dole out to people who had extremely selfish or widely shared rationales for their actions. By definition extreme selfishness ("self-absorption") or broadly shared resentments (e.g. envy of the rich, hatred of another ethnic group) are infectious behaviors...
So, it's more that schizophrenia and other "mental illness" became defined into existence to protect those whose behaviors were *not* so infectious...
That's more or less according to Thomas Szasz... compiled down a lot...
There is new material under the heading "New material: for review" that needs to be reviewed and edited for NPOV: I'm not aware if these views are generally accepted, controversial, or just idiosyncratic.
I'd like to point out that many of the studies on the differences between "schizophrenic" brains and the brains of "normal" individuals fail to take into account that the differences may be caused by the drugs used to "treat" schizophrenia, and lacking proper control groups. --Daniel C. Boyer
Moved contentious material out, as it does not seem to have been reviewed or edited after several months tacked on to the article:
Loss of dendritic spines on interneurones and pyramidal cells in deep layer 3 of cerebral cortex. (see neuropil)
Emilio Costa has found about a 30% reduction in reelin and related metabolites in studies of psychotic brains compared to normal brains.
Conversely we know:
That the apparent differences between a normal brain and a schizophrenic brain, while real, are relatively subtle.
My explanation for this is:
I believe the fundamental neural defect is reduced inter-neurone connectivity. This is caused by reduced "neuropil" or the stuff composed of axons, spines and synapses that lies between neurones. This in turn caues the thinning of grey matter and the compensatory expansion of the ventricular sinuses. Conjecture on how reduced inter-neuronal connectivity causes the symptoms of schizophrenia.
I believe that the various neurotransmitter abnormalities are consequence (probably compensatory) of the disturbed neuroanatomy.
Neuropil is an active living substance within the brain probably largely controlled by the reelin system. It seems that this reelin-integerin system is the fundamental biological fault in many (possibly all cases of schizophrenia).
Should "insulin shock treatment" be included as one of the therapies now considered ineffective? --Daniel C. Boyer
When it says that schizophrenia was "identified" this begs a question. Should be rewritten for NPOV. --Daniel C. Boyer
Quote: "Positive" symptoms include hallucinations, delusions, disordered speech, disordered thought and "negative symptoms" (lack of affect, apathy, etc.).
Positive symptoms include negative symptoms? Huh? -- Timwi 17:11 15 Jun 2003 (UTC)
Edited to make it clearer. -- Anon.
R.D. Laing
The brief discussion on R.D. Laing portrays him inaccurately (regardless of what you think of him or his ideas).
Are you saying that he doesn't believe that Schizophrenia doesn't exist? -- RM
WikiProject Psychopathology started, please feel free to join. This entry seems to need a bit of work, perhaps this WikiProject might be useful for interested Wikipedians to get their heads together and consider some changes - Vaughan.
rewrite
Hello everyone,
I'm going to try and steadily rewrite parts of this entry, as I think it contains a few factual errors and red herrings. However, I'm keen not to step on anyone's toes, as there's much excellent information here. I'll try and reference the changes I make as I go, and if anyone has any objections, I'll keep an eye on the Talk page so we should be able to thrash them out.
I think I might have to deviate a little from the Wikipedia:WikiProject_Medical_Conditions format. As with all psychiatric diagnosis, the definition is based upon the presentation of signs and symptoms so it is necessary to list them to define the disorder, rather than further down the entry.
I've tried to give a brief summary of the important issues without going into too much detail at this point. The sections below do that quite well, and can be expanded upon where needed later.
The initial description is taken from the Diagnostic and Statistical Manual of Mental Disorders, as it is the most accepted definition of schizophrenia. I've been careful to define it as a label for a diagnosis rather than present it as a cut and dry illness and have mentioned the objections of the antipsychiatry movement and the dimensional approaches below.
People interested in the history of the psychiatric view of schizophrenia may wish to check out Chapters 1 and 2 of Bentall's Madness Explained (ISBN0713992492) and Turner, T. (1999) Schizophrenia. In G.E. Berrios and R. Porter (eds) A History of Clinical Psychiatry (ISBN0485242117) (from where the note about T.S. Eliot is from).
Information about the causes, neurodevelopment and medication of schizophrenia are taken from Michael Foster Green's Schizophrenia Revealed (ISBN0393703347) and David Healey's The Creation of Psychopharmacology (ISBN0674006194).
I've added Madness Explained and Schizophrenia Revealed to a section at the bottom called 'Recommended Reading' as these are both excellent and accesible books for the non-specialist as well as researchers and clinicians.
Please add any other books which take a balanced approach and which you feel readers could benefit from.
I've changed the title of the section 'Famous Schizophrenics' to 'Famous people affected by schizophrenia' to try and not define people by their diagnosis. Have added Vaslav Nijinksy (ballet dancer), Syd Barret (past member of [[Pink Floyd) and Peter Green (from rock group Fleetwood Mac) and James Tilly Matthews.
Let me know if anyone wants references to specific academic papers for any the the points.
Very good article, many thanks to all who have contributed to it! -- poco poco 21:07 19 Jul 2003 (UTC)
References
Hello everyone,
I'm going to try and add references to the main body of the text. I'll try doing this by using superscripted numbers (like so1) and adding the reference to the reference list.
I'll try and keep the introduction reference free, and leave that to the sections that go into more detail.
Changes to diagnosis and presentation (signs and symptoms)
I've merged the Diagnosis and Presentation (signs and symptoms) sections, as the issues are heavily interlinked as with most mental illness.
I've cut some discussion on the types of hallucinations and delusions that might be present as this is general for all psychotic disorders, not just schizophrenia and I think it's adequately covered in the delusion and psychosis entries.
Maybe it's worth moving the 'Categories' section up here as well as it discusses lots of the same issues (the bit on 'sluggish schizophrenia' is great and also highlights the subjectivity in diagnosing mental illness).
In the Cause section there should be mentions to research showing the effects that the social environment can have in children`s brain development, with profound consequences for the entire adult life. For example, see the following works:
John Read et al.`s "The Contribution of Early Traumatic Events to Schizophrenia in Some Patients: A Traumagenic Neurodevelopmental Model";
Repetti et al.`s "Risky families: family social environments and the mental and physical health of offspring";
Bruce Perry`s "What childhood neglect can tells us about nature and nurture";
DeVries et al.`s "Social modulation of stress responses";
And i know there is a lot more about these issues, for example, studies about the neurobiology of child abuse, showing that adults that suffered abuse in childhood have an anatomically different brain, because of this. Since there are also animals models for this phenomena (i mean the social environment influencing brain development), like Devries`et al.`s research, and many others, there are good reasons to believe in this studies.
Why would children`s brain be insensitive or invulnerable to our social environment, especially considering that cientists like Dunbar say that the main reason for humans to have evolved big brains is just for dealing with conspecifics, and not for controlling the physical (or nonsocial) environment ? (This is the "Machiavellian Hypothesis"...)
Alberto
Hi Alberto,
I think John Read's work (for example) is excellent and highlights an important area in schizophrenia research that has been neglected in the past. However, I think it's important that the article does not over-emphasise certain areas of research that are not widely cited.
Personally, I would like to see such research more widely known and cited, but I'm not sure Wikipedia is the correct place to promote this aim.
I'm a bit concerned that individual studies should not be given more prominence in the article than they are given in the academic and scientific literature. For example, the article already cites reviews (see ref 7) that include the recently added NAS-NRC veterans study.
I thought the atypicals only reduced the incidence of EPSE and not the NMS. NMS is already rare to begin with ... and still occurs with the newer drugs. Alex.tan 18:38 26 Jul 2003 (UTC)
Will check up on this and I'll post results here. Thanks Alex. - Vaughan 09:37 27 Jul 2003 (UTC)
After a brief lit search it seems the relatives risks of typical (older) and atypical (newer) antipsychotic medication is still a bit unclear. e.g.: "Although the newer, atypical antipsychotics have also been associated with NMS in published case reports, the relative risk of NMS with these new drugs compared to the typical antipsychotics remains uncertain" from here.
...pending further information. Thanks Alex, well spotted ! Vaughan 15:40 28 Jul 2003 (UTC)
Ive speculatively added a chunk on the User-based approaches that have been emerging in recent years with a link to the 'hearing voices movement'. The balance isnt right, and it could probably go under other sections -either alternative approaches or controversies.
Also the Treatment sect looks a little thin. There is a mass of evidence now about the value of psychological treatments -particularily CBT. The B.P.S. (2000), conclude that there is convincing evidence, now,’.... that psychological interventions are effective for many people in reducing psychotic experiences and the distress and disability they cause’.
The recent developments in Cognitive Behavioural Psychotherapy (CBT) have been well documented in the literature demonstrating a broad range of clinical benefits across a range of client groups (such as the young, newly diagnosed; people with long-term, drug-resistant problems, through hospital and community settings). Indeed the most recent findings are extremely promising as acknowledged by a recent Cochrane review of the literature. “....a variety of CBT methods are associated with substantially reduced risk of relapse”
CBT provides a range of interventions that can enable people who hear voices to empower themselves.
Can anyone update?
Hi there,
The material you added is valuable and should certainly have a place in wikipedia, although I think it perhaps deserves an article of its own (perhaps Hearing Voices Network, which can include new philosophies and approaches to voice hearing outlined in Accepting Voices - ISBN1874690138). It might be worth summarising the material you added in a sentence or two, and then linking to a fuller article on the HVN with much of the new material. I'll aim to do this in the next couple of weeks if it hasn't been done already. I also agree CBT should be highlighted. Comments, suggestions on this welcome as always - Vaughan 12:20, 14 Oct 2004 (UTC)
Great, thats perfect. The bit I included has got pulled for copyvio despite being a selection from an original article (and me as the author!). Not too sure why I keep attracting these. But thanks for your responseJinko 13:24, 14 Oct 2004 (UTC)
Jinko, I almost pulled the section as a copyvio except I couldn't find it on the internet so I accepted on good faith that it was not. (It was too good and came in one insert so take it as a compliment.) If I had found it on the internet then I would have pulled it. Firstly, great stuff but I tend to agree with Vaughan that it deserves it's own area. The schizophrenia article is too big already. What about putting it in Hallucinations and then leaving a one sentence reference to this in the schizophrenia article. Alternatively, it's own article with references in the relevant articles such as schizophrenia and hallucination. Secondly, it is really worth putting a brief paragraph in the talk page with a new heading to say you have added your own info that you have written when you put in a big chunk like this. That way any copy editor can check the talk page and see that it is NOT a copyvio. Thirdly, if you put an article in with references, please also put in the references in the same format as the rest of the article. "Baker (2000) in OpenMind ..." does not really allow the reader to access what Baker said in full. All picky points but the bottom line is, thanks for the great contribution. --CloudSurfer 18:58, 14 Oct 2004 (UTC)
Yes Understood -all the points you make -make sense. Lots to learn aboutfor me here. The work is from articles I have published so a bit sad you didnt find on the internet! I will try and follow these directions when I have a little time. If any one else wants to help or have a go, please do! Jinko 23:27, 14 Oct 2004 (UTC)
I have seen the claim in this section that antipsychotics are a treatment for schizophrenia. How do they treat schizophrenia? --Mihai cartoaje01:28, 7 January 2006 (UTC)
I edited "first line treatment" to "first line pharmacological therapy" as I believe this is more objective. We can not rule out the application of early social interventions in primary prevention as a treatment measure. This still permits the view that antipsychotics have their place especially in acute care. Perhaps we need some more discussion of this in this section? Referenced UK NICE guidance which I believe backs up this argument. Any opinion on adding more refs? --Ben Taylor15:46, 30 March 2006 (UTC)
Referenced 'thirds' recovery figure and added information about suicide risk .
-- Vaughan
I thought the prognosis was more on the order of 1/5 have full recovery, a bit less than 1/5 have very poor prognosis and most people are somewhere in between ... Alex.tan 18:35 26 Jul 2003 (UTC)
Misc Changes
I brought back an incorrectly deleted reference which was not cited inline using superscripts but was nonetheless (in the style of an encyclopedia) correctly referencing a source. In addition some of the information that was pruned from that source was deleted. I merged it back into the article. I am not sure why it was removed.
I've moved the new information on genetic linkage out of the summary to keep it lay-person friendly. It's now in the 'Causes' section.
I'd like to tone down the sentence "overwhelming evidence (including causative gene findings) argue for a genetic cause modified by enviromental stressors in the etiopathogenesis of schizophrenia" as its impossible to seperate genetic and environmental influences in a cause of a disorder.
My version would be:
While the reliability of the schizophrenia diagnosis introduces difficulties in measuring the relative effect of genes and environment (for example, symptoms overlap to some extent with severe bipolar disorder or major depression), there is evidence to suggest that genetic vulnerability modified by enviromental stressors can act in combination to cause schizophrenia.
Great information on the COMT linkage (good ref here) but perhaps a little selective ? A recent review paper (I've uploaded the full version here for those that are interested) identified 7 gene candidates. Certainly COMT seems the only gene with a obvious functional linkage in terms of dopamine function, but perhaps it is either worth discussing this or briefly mentioning the other candidates. Also, I would argue over-emotional mothers do seem to be an environmental influence on schizophrenia (see ref 8) but perhaps it is worth mentioning that it is not mothers in particular but any people with high levels of 'expressed emotion'. Would you mind if I rejigged it a little in light of this ?
Please reply if you think otherwise or would rather do your own rejigging !
FWIW, I think your rewording sounds better. -- Ram-Man 22:56 24 Jul 2003 (UTC)
Changes to 'Alternative Approaches' section
Rewrote part of it because of distortion of message (i.e.. 'anti-psychiatry says schizophrenia doesn't exist'). Added Tim Crow theory. Moved info about higher rates of schizophrenia minority communities to causes section.
Reworded new info on genetics for flow and to take the academic edge off it. Added ref to COMT study. Took out sentence which mention family stress and drugs / alcohol as it's handled by existing sections.
Recent edits related to genetic causation in schizophrenia are weak and might stem from a failure to keep current with the literature. There is NO debate regarding the heritability of
schizophrenia and the hesitancy to clearly state this reminds one of past unwillingness of the
- Wow, and you're a SCIENTIST? Since when did humans get anywhere by refusing to countenance alternative hypotheses? I think Mandark should get out of his lab and into a library. Can I suggest some Karl Popper?
psychiatric community to view mental illnesses as biological in origin. What purpose does it serve the lay reader to suggest that this issue is under debate? As for specifics of COMT, there have been no other papers to demonstrate a functional link between any gene and this illness. This is not a selective discussion, but simply a paucity (at the time of this writing) of findings. There will be published reports on at least two other genes in the upcoming year (dysbindin and disc-1) to add to the list.
Hi Mandark, From looking at the text as it is, I don't think it leaves any doubt that inheritance plays an important role in the development of schizophrenia. It is the amount of hereditory influence in general, and role of specific genes in particular, which seem to be the subject of debate among researchers.
I'm not sure what you mean about 'no debate' but recent exchanges in The Lancet after Harrison and Owen's recent review of 'Genes for Schizophrenia' seemed to show quite a strident debate, with Tim Crow going as far as to say that there is "little firm evidence of genetic linkage to psychosis" (I've put the whole exchange here and here for those without access to The Lancet). Whilst you may not agree with him (and few people do) I think it's important to communicate that there is an ongoing debate to be make the article fully NPOV.
On a related note I was interested to read a recent paper again suggesting that epigenetic factors may be important, but I'm not a geneticist (although I try and keep up with the literature as best I can). Could you (or anyone else) comment on how important this is and whether it's worth a mention in the article ?
Also, I notice we got listed on the Wikipedia:Brilliant_prose_candidates page. Excellent work all round I think, although I'm sure as Mandark mentions, there's probably still work to be done !
Pretty weak retort. Tim Crow is a famous for biased and selective reviews the literature and never provides data of this own or of others to back up his point (as in the Lancet exchange you cite). Funny, I'm not surprised you see his response as support for your points. Please see American Journal of Human Genetics Sept. 2003 for a series of meta-analyses that answer Dr. Crow's suggestion that heritability is not high. As for epigenetics, in our lab we too feel this is important and are investigating alternate splicing, methylation, etc. But, until more is known about the transmission of these modifications, much will remain conjectural. I have re-read the schizophrenia section and notice a number of "controversies" that are no longer seriously considered valid, yet are of historic importance and appear to be cited (as you have done with Tim Crow) with little critical evaluation, but rather in deference to the notoriety of the author(s). I guess this does liven things up and interested readers are provided with numerous links to outside reading.
I don't cite Crow's suggestion as support for any point except that there is a debate about the role of genetic factors in schizophrenia (and mental illness in general). As it happens both you and I are of the same opinion that genetic factors are important in schizophrenia, but this is not a universally held view. For example, the recent book The Gene Illusion by Jay Joseph (ISBN1898059470) is extremely critical of genetic research in psychiatry and this is not an isolated example. Hence I think both sides of the debate should be reflected in the article to be fully NPOV, rather than purely our (or anyone else's) opinions on the matter, no matter how well supported we feel them to be.
I'd be interested to hear which controversies you no longer feel are valid, as I'm keen to keep the article up-to-date. However, I have tried to draw most points from ongoing debates I encounter from current books, articles and conference so a few pointers would be handy. Thanks - Vaughan 17:24, 26 Sep 2003 (UTC)
Hello Everyone,
Nobody can say the debate about the genetics of mental ilnesses and schizophrenia is over. For example, Jay Joseph`s works show clearly it is not over. Also of importance is the article "Psychiatric hospitalization in twins", which analysed more than 16 thousand pairs of twins, from the finnish cohort, showed that monozygotic twins have only 11.0 % concordance in schizophrenia diagnoses; if schizophrenia were of genetic origin, how could it be explained that monozygotics are discordant in 89% of the cases ? Or Horwitz et al.`s article "Rethinking twins and environments: possible social sources for assumed genetic influences in twin research", in which it is shown that monozygotic twins have higher concordance rates than dizygotics because they share the same environment to a greater extent. Or, altenatively, Jay Joseph`s article "Potential confounds in psychiatric genetic research: the case of pellagra" showing that a twin study about pellagra (or even lepra perhaps), had it been performed, would show monozygotic twins having higher concordance rates than dizygotics, for the same reasons. And what about the articles trying to confirm the genetic patterns of mental illnesses, supposedly found in different loci, in previous researchs, which do not replicate the expected results, or even give the opposite results ?
For me it seems that Wikipedia`s articles about psychiatric issues are being dominated by biopsychiatry`s advocates, and because of this "The Free Encyclopedia" is spreading false informations for lay people. It makes me feel sad: systematic lies about schizophrenia are being spread in Wikipedia.
I agree that the current article does not seem to represent the debate adequately, so have edited it a little to hopefully better represent the ongoing controversy.
Alberto, "monozygotic twins have only 11.0 % concordance in schizophrenia diagnoses; if schizophrenia were of genetic origin, how could it be explained that monozygotics are discordant in 89% of the cases ?" Because schizophrenia is a complex diease. Like most complex diseases, you can have a genetic predisposition but if there aren't the necessary environmental factors then the condition won't develop. This is not specific to mental illness, it occurs in all diseases, and it explains the results of the monozygotic twins in both your cited studies.
As for your second question, this is because statistical tests tend to overstate the impact of genetic loci, sample issues and publication bias.
In my eyes there is no debate. This would be like including the 'ongoing debate' about the earth being flat in the earth article.Matt Peacock21:36, 13 May 2006 (UTC)
I am not aware of any evidence for a genetic cause for schizophrenia. In the twin study, mz twins hospitalized for sp were more likely to have lived together their whole life (47%) than dz twins hospitalized for sp (18%). One explanation I can think of is that psychiatrists were more biased toward recommending hospitalization for the second mz twin if they lived together. --Mihai cartoaje09:26, 14 May 2006 (UTC)
There is an extensive literature on genetic aspects of schizophrenia, which have moved on from simple twin and family studies. A good start would be Harrison & Weinberger's paper which details a number of genes that have been implicated. The point that simple models of heritability tend to underestimate environmental factors by assigning all gene-environment interactions to genetics is well taken, but the role of genetics in schizophrenia is pretty much incontrovertable, how great that role is is open to debate. If you're interested in genome scans then Levinson et al did a good meta-analysis, a non-Tim Crow skeptical note on linkage studies was provided by DeLisi et al --Coroebus12:16, 14 May 2006 (UTC)
Saying "Famous people afflicted with schizophrenia" is POV. --Daniel C. Boyer 21:38, 18 Dec 2003 (UTC)
Actually says "Famous people affected by schizophrenia" - Vaughan 12:12, 21 Dec 2003 (UTC)
Symptom prevalence
Removed the following. Useful information, but I think 1973 is a little out of date for a survery of symptoms. Any chance of finding a more up-to-date report on this ?
I couldn't find anything analogous to the list above but the 2001 WHO report on mental illness might provide some starting points. This seemed the most useful chapter. Mazzy 17:38, 14 Jul 2004 (UTC)
I can't see any reason to delete this useful list just because it is 30 years old. With the same justification you could ignore Schneider. Until there is a more up to date reference why not keep it in? Are you really suggesting that schizophrenia has changed so much in the last 30 years that this is no longer valid? I doubt it.
Hi there
I would argue that an out-of-date list is not worth including as symptom prevalence may be affected by factors such as, population demographics, social environment and diagnostic standards, all of which have changed to varying degrees since 1973. For example, delusions have been found to vary with country, gender and social class, culture and exposure to urban environment and in the same vein, diagnostic standards are being increasingly challenged (e.g. recent Appelbaum study).
Schneiderian first rank symptoms are still relevant because they are still used as diagnostic criteria (see Sims, 2004 - ISBN0702026271), although the article mentions problems as to their reliability, so they are not presented without criticism. - Vaughan 09:31, 8 Sep 2004 (UTC)
I agree with your reasons but perhaps a compromise until better data were available would be to reinsert the list with these caveats. As a psychiatrist I very much appreciate your reasons but I do feel that the many non psychiatrists who read this article would better understand schizophrenia with this list reinstated. By the way, apologies as a newbie for not signing my initial comment. CloudSurfer 09:39, 9 Sep 2004 (UTC)
Hi CloudSurfer
Fair point, but perhaps we can look for some more up-to-date information. This article supposedly has WHO symptom prevalence data from 1986. I have not read the article in full yet, but I shall do so and keep looking for more recent information. If you come up a pointer to anything more recent please post it here. If none of our leads look useful after a brief investigation (perhaps we can give it a week or two), I think we have a good case for including the 1973 data. - Vaughan 10:10, 9 Sep 2004 (UTC)
This is my first time posting to a Wikipedia section, so bear with me with any mistakes I may have made while adding this post. :) Okay what I have to say is: Why isn't there any mention of "Memoirs of My Nervous Illness" by Daniel Paul Schreber? I would think this would be recommended reading! Thanks for reading this feedback note.
Sincerely,
The Puzzle Fish Who Is A Real Fish! But At The Same Time A Snack Good For Parties.
I think that Schreber needs an article of his own really, as he's a pivotal psychiatric case, especially since James Tilly Matthews is already written up. Definitely one for the 'to do' list. I'll see if I can make a start shortly, then perhaps we can link it in with the schizophrenia page. - Vaughan 21:20, 16 Feb 2004 (UTC)
Schizophrenia vs. D.I.D
Shouldn't there be a paragraph explaining the common misconception that Schizophrenia is Multiple Personality Disorder (aka Dissociative Identity Disorder)? I can't count the number of times I've heard people confuse the 2.
See the second to last paragraph in the History section. - Vaughan 17:03, 14 Jul 2004 (UTC)
Although a quick review of this paragraph suggests that it needs a bit of work for clarity. To be completed shortly. - Vaughan 17:15, 14 Jul 2004 (UTC)
I thought that the schitzophrenia DID congruity stemed from research that suggests people with schitzophrenia hear their own the own thouhts but ar unable to recognize them causeing them the believe and claim multiple personalities.207.99.90.25315:03, 26 January 2006 (UTC)
Removed image
Hi there,
I've removed the image 'SchizophreniaBrain.jpg' from the schizophrenia page, as it's from a copyrighted source, as far as I know. Unfortunately, it comes from the following article:
Paul M. Thompson, Christine Vidal, Jay N. Giedd, Peter Gochman, Jonathan Blumenthal, Robert Nicolson, Arthur W. Toga, and Judith L. Rapoport. (2001) From the Cover: Mapping adolescent brain change reveals dynamic wave of accelerated gray matter loss in very early-onset schizophrenia. Proceedings of the National Academy of Sciences, 98, 11650-11655.
Barring good (meaningful) images of schizophrenic brains, what other images could this article utilize? A common example in psychology books is the degeneration of Louis Wain's artwork in the 1930s (link) as he apparently suffered from schizophrenia and some think it was responsible for his shift away from realism (some don't think it had much to do with it, though). It's from the 1930s at the very latest which, I think, makes it copyright a-ok, but I don't know. Other ideas? This topic is lacking in visual stimulation, so to speak... --Fastfission 17:13, 16 Jul 2004 (UTC)
Gene Ray
With reference to Gene Ray been listed in the 'Famous people affected by...' section, he mentions he has been diagnosed with schizophrenia on his webpage timecube.com. Someone kindly pointed this out to me on my talk page, so I thought I better reiterate it here. - Vaughan 12:41, 11 Oct 2004 (UTC)
Recommended reading
I've removed a couple of books from the recommended reading list. They're both excellent books but very academic, and perphaps not suitable for the general reader as the others are.
Anyway, they're listed here so as to not remove them entirely as they're certainly worth tackling if you're interested in the neuropsychology of schizophrenia and psychosis:
Green, K. J. (1998). Schizophrenia from a Neurocognitive Perspective. Boston, Ally and Bacon
David, A. S., et. al. Eds. (1997). The Neuropsychology of Schizophrenia. Brain Damage, behaviour, and cognition Series. East Sussex, UK, Psychology Press.
Not the second. From the reviews on Amazon, it appears to be forced-drugging advocacy, and not to be up-to-date on the omega-3 research. --Mihai cartoaje02:11, 9 March 2006 (UTC)
The omega three point is irrelevant, and if forced drug advocacy is a significant point of view it should be covered.--Coroebus21:32, 10 March 2006 (UTC)
Congratulations
Congratulations are in order for anyone who has worked on this article - it's fantastic! zaius 15:19, 14 Feb 2005 (UTC)
I agree. This really sets a standard. Congratulations on Featured Article status and Main Page article 10/24/05.—Gaffταλκ16:10, 24 October 2005 (UTC)
Recommended reading
The books below were added to the recommended reading section of the article. They have all been influential books, but are very much in the anti-psychiatry / critical psychiatry camp, certainly, Breggin's work has received a great deal of criticism from mainstream psychiatry, so I'm concerned that they do not provide a NPOV in this section.
The books which were originally chosen for the recommended reading section were for their reasonably balanced approach to schizophrenia (although Green would be more inclined towards the mainstream view, and Bentall towards a critical approach) and have been well received by the research and clinical community.
Perhaps books for this section are best suggested here and voted on or something similar ? Otherwise, endless lists of books arguing for a certain political angle on schizophrenia (or as with the books below, psychiatry in general - which should really be in the psychaitry article) can be added.
Books recently added:
Louis Sass (1994) "Madness and Modernism", ISBN0674541375, argues that schizophrenia has some 'super-normal' aspects and is not necessarily always degenerative.
Jay Joseph (2004) "The Gene Illusion: Genetic Research In Psychiatry And Psychology Under The Microscope", ISBN0875863434. The most cited genetic studies about schizophrenia have gross methodological flaws.
Robert Whitaker (2002) "Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill", ISBN0738203858. The World Health Organization showed that people labeled schizophrenic fare much better in poor countries (like India, Columbia and Nigeria) than in developed countries (like USA and 8 others); Whitaker argues that it occurs because neuroleptic drugs, being toxic and without healing power, worsen long-term outcomes in rich countries`patients. This book also reports of unethical experiments being conducted nowadays in the USA, with schizophrenic patients.
Peter Breggin (1994) "Toxic Psychiatry : Why Therapy, Empathy and Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the "New Psychiatry"", ISBN0312113668, criticizes mainstream psychiatry and shows psychiatric drugs do not have healing power and may even cause irreversible neurological diseases.
Hey You Wikipedia "Sheriff",
Jay Joseph`s book is a science-based and statistic-based critic; it should be included, in order to allow lay people to exert their right to know some facts, and think by themselves; he criticizes genetic psychiatric studies not with ideology or political views, but with strong facts and arguments.
Robert Whitaker`s book is not above criticism, because his way of interpreting the results is debatable, but he has done an excelent synthesis of World Health Organization`s long-term follow-up cross-cultural studies about schizophrenia in different countries; he deserves a place among the critics of (bio)psychiatry.
Peter Breggin`s book warns against psychiatric drugs, because they do not have healing power, they only block symptoms, and they will create irreversible neurological diseases like tardive akathisia and tardive dyskinesia, in a high percentage of patients, if taken for prolonged time. His theory of chronic powerlessness as a cause of psychosis is also interesting, and deserves consideration.
Please Wikipedia "Sheriff", give lay people a chance of knowing about these books.
Alberto, from Brazil
Hi Alberto,
I am not a "sheriff" but someone who has a good (professional) working knowledge of the area, so often move recently added section to the talk page for discussion, particularly when they are known as controversial. Certainly, Joseph's book has been influential, but it is not without its critics.
However, it's worth noting that none of the books listed above (including Joseph's) are specifically on schizophrenia, so I think they might be better placed in psychiatry, as they address more general issues to do with mental illness and mental health.
OK, now i understood it is Wikipedia`s practice to debate new stuff before add it to the articles.
I agree with you these books address more general issues, so they should be placed in a section about broader issues. But i think this stuff has to be mentioned somewhere in Wikipedia.
Another issue: I would like to know your opinion about the phenomena of children`s neurodevelopment being influenced by the social environment (and also by the physical environment; i mean, for example, by pollutants); and i would like to see that stuff be discussed and added somewhere in Wikipedia, in a more general section. Please read my comment in "Changes to Cause section" about this.
Thank you,
Alberto
Hi Vaughan,
I added Jay Joseph`s book again, because it is hard to find any defense of biological psychiatry that does not mention genetic studies, like twin studies about schizophrenia, and his book contains one of the most devastating criticism of these. As far as i know, the other kinds of genetic studies, like linkage studies, that have supposedly found proofs of the genetic patterns of mental illnesses were never replicated, so they are only speculative, not scientific, therefore they shouldn`t be mentioned in the article.
Alberto
Hi Alberto,
I won't remove the book, but I am concerned about its place in the recommended reading list, as it is not specific to schizophrenia (rather to psychiatry in general), and when it does address schizophrenia, it specifically addresses genetic studies rather than the condition as a whole.
The recommended reading section is intended for books that give a general and comprehensive introduction to schizophrenia.
While Joseph's book undoubtedly contains some important criticisms for the genetic work in this field, I'm not sure we should be directing people to such specific issues, when they would be better as references in appropriate places in the text (which Joseph's book already is).
A further quick thought... Maybe a compromise might be to list Read et al's book Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia (ISBN1583919066) in the recommended reading list, rather than Joseph's The Gene Illusion.
Models of Madness is a critical book (and could be noted as such) and covers a whole range of areas in schizophrenia (not just genetics) but also contains a chapter by Joseph summarising his work and his main arguments from The Gene Illusion.
Other chapters include work by Read on the impact of social factors and trauma on schizophrenia, and critiques of strictly neurobiological theories of the condition.
I've replaced the reference to Jay Joseph's book with a reference to Methods of Madness in the recommended reading section. The chapter by Joseph in this book is called 'Schizophrenia and heredity: Why the emperor has no genes', so gives a good review of this important area of critical analysis, whilst the book also has many other chapters on all aspects of schizophrenia.
OK, no objections, i did not know about the book "Models of Madness". It`s better not to give excessive amounts of information to the readers. Sometimes more information means less learning, and vice-versa.
Alberto
Shamanism updates
It has also been suggested that the widespread cross-cultural presence of shamanic traditions in ancient cultures may reflect an evolutionary advantage of such altered states in guiding the shaman's tribe via some form of ESP. To the degree that schizophrenia is correlated with shamanism, then schizophrenia may have been selected out for its supra-normal aspects.
Seems a little speculative to me, although I'd be happy to see some research cited to back up the points.
Sounds like twaddle to me, unfortunately, written by someone who has never met a schizophrenic. -- The Anome 23:29, Mar 12, 2005 (UTC)
Introduction needs expansion
Now that it has a satisfactory picture, I'd like to put this article on the main page. However, the introduction is totally insuffecient and needs expansion. →Raul654 02:02, Mar 31, 2005 (UTC)
Criminality issue was not addressed
Added paragraph on ciminality. It is a very acute problem. I cannot understand how people (like ladies riding alone) can still trust mad-looking aliens and give then a hitchike, then end up murdered.
This typicial madman faced scum of the earth gutted seven women at least, shall he get gassed for good:
http://www.cnn.com/2005/LAW/03/31/interstate.slaying/index.html
Medication skipping schizos murder people everywhere
Why the fuck these assholes are still not radio tagged with blood sensor, so police will known when they abandon medication and then they are immediately arrested to prison hospital for forced treatment? How many more innocent healthy humans will have to fall because these genetic junk want to indulge in their sick minds? How the fuck can a schizo own a firearm? Now this piece of junk will claim insanity in court and get away with murder. He is responsible for abandoning medication and he should pay for that!
"Harris, 23, the mother who threw her three young children into the cold waters of San Francisco Bay, has a history of mental health problems, including schizophrenia, her relatives said Thursday. A cousin said Harris was supposed to be taking prescription drugs for her treatment, but "she had quit taking her medication." She is eligible for the death penalty."
There is no way around, they must be embedded with dosing pump and removal or sabotage of it is a felony offense. There must be a federal law to that extent. I hope more and more US states get to ban the insanity defence, in line with the supreme court's decision which says it can be eliminated.
There is no reason to take medicine to any mental illness. "Schizophrenics" are oppressed people and they have a right to use violence. The real question is why the capitalist society has a right to use violence against the "mentally ill".
-- Tommi Höynälänmaa
SILENCE, children. This is a serious topic. Knock it off.
If the conservative forces start seriously to use crime as an excuse for a war against civil liberties of the "mentally ill" we could refuse to cooperate with the authorities for crime investigation, as an extreme means.
Insanity defence should indeed be removed. There is no reason for it. All the people shall be equal in front of the law.
Psychiatry itself has rather little to do with crime prevention. Psychiatric concept of "dangerousness" is a joke and to be "dangerous" for a psychiatrist you don't have to be violent. Part of these "dangerous" people may also be dangerous to the psychiatric personnel, in which case nothing wrong is done.
Even if the schizophrenics did commit more murders or crimes than other people this would be only a statistical fact, since very little number of people are murderers and relatively little part of people are other kind of criminals.
The capitalist system currently oppresses the "mentally ill" and a "mentally ill" person can be locked to an psychiatric hospital. If "dangerousness" is used as an excuse for this there would be many more reasons to lock all chauvinist pigs or people who systematically dominate and humiliate other people into some institutions.
It is also possible that schizophrenics are being humiliated by other people because of their alleged illness and it is possible that persecution of the schizophrenics is presented as schizophrenic delusions.
I also suspect that the high number of schizophrenics among murderers is partly because murderers are more thoroughly checked for "mental illness". Are there lots of cases in which the psychiatric investigation is done because of some crime and schizophrenia is diagnosed there? In other words, are there people for which schizophrenia is diagnosed because they commit some serious crime but for whom it would not have been diagnosed if they had not committed the crime?
-- Tommi Höynälänmaa
Listen Tommi NOBODY ABSOLUTELY NOBODY has the right to ever use violence to make a point. As for this sections starter what the HELL IS FUCKING WRONG WITH YOU! Schitzophrenics are not directly and knowingly responsible for their own actions and cannot legitimatly be tried for murder if they do not understand they they commited it. Symmetric Chaos13:32, 30 January 2006 (UTC)
"NOBODY ABSOLUTELY NOBODY has the right to ever use violence to make a point"
If violence is used in the struggle against psychiatry it is not a question about "making a point" but defending civil liberties. Psychiatry deprives many fundamental human rights (personal liberty, right to decide about one's own body) from the persons diagnosed as "mentally ill", it uses torture (in the West and right now), and it is used against dissidents in bourgeois-democratic countries. The dissent thought need not always have an explicit political form. You can protest against the system, for example, by your way of living.
"Schitzophrenics are not directly and knowingly responsible for their own actions and cannot legitimatly be tried for murder if they do not understand they they commited it."
You are wrong. The insanity defence should be removed. Roughly any person who can think is knowingly responsible for his/her actions. You confuse here two things:
1. Can a person understand what he did?
2. What does a person think about what he did?
I argue that schizophrenia or any other "mental illness" very rarely leads to a situation where a person actually did not understand what he is doing. Of course, if a person has some hallucinations he then has partly distorted view of the reality.
The present insanity defence is a violation against human rights itself because it means practically that some people are treated like children as "they are not responsible for their own actions". Insanity defence also supports the existence of involuntary commitment.
Do you really think that a schizophrenic would not realize that he had committed murder after doing it? I disagree. I have been diagnosed schizophrenia myself and I have also seen other patients in the psychiatric hospitals. Your claim that schizophrenics are so ill that they are not responsible for their own actions is not true. I have also been personally tortured by the Finnish mental health system (binding and strong medication).
-- Tommi Höynälänmaa
I hereby call to action all people on this site who consider themselves to be rational thinking human beings who have visited this discussion section to STOP POSTING IN THIS SECTION FROM NOW ON! Perhaps if we leave these people alone they will stop distorting the issue and find another article to screw with.
Symmetric Chaos13:47, 31 January 2006 (UTC)
I add below material on schizo and crime. If this is removed or edited destructively, I will contract wiki top admins and tell cnn and generally make a scandal. The previous article was totally partisan without any mention of crime issue. Note, I don't mention lesser crimes, because they are irrevelant. Homicide is the only category of crime that cannot be undone by any means. I find it offensive that liberal-enacted censorship tries to muzzle those who say schizos are in fact dangerous and they must be forced to take medication, because untreated they are a danger to society. Of course the deceased, whom the schizos stabbed or choked cannot come here to complain. Responsible people have to stand up and tell the public about the dangers.
Regards, Tamas Feher <etomcat@freemail.hu>
Hi Tamas,
I have reverted the recent inclusion of the text below. Please cite reliable sources for these figures, as the article is based on peer reviewed research. I have not been able to find any that back up the points you make, so if you have references for it, please provide them.
The most recent reviews of the research on schizophrenia and homocide suggests that a sub-group of people diagnosed with schizophrenia have a two fold risk of homocide (Schanda et al., 2004) (a very minor absolute increase in risk) and are more likely to be victims of violence than perpetrators (Barkataki et al., 2005). In other words, society is more a threat to them, than they are to society.
Furthermore, threatening to "contract (sic) wiki top admins and tell cnn and generally make a scandal" really doesn't help your case. I agree the issue of risk and schizophrenia should be discussed in the article, but threating to cause trouble if your (currently unsupported) points are not included is hardly the way to go about it.
I noticed the 'crime' section (now renamed to 'Schizophrenia and violence') had been re-inserted. I've rewritten it to reflect the research findings in this area, rather than the wild speculations and anecdotal evidence that keeps getting included.
Some schizophrenic people do commit serious violent acts, including murder and suicide. According to criminal records, 80% of all serial killers apprehanded had a mental condition and half of those were diagnosed with schizophrenia. The risk of violent crime is increased when schizophrenic people abandon their prescribed medication. Contrary to great advances made by the psychotropic pharmaceutical research since the 1950s, relatively few countries have enacted legislation to this day to require that schizophrenic patients adhere their prescribed medication protocol, even though the benefits greatly outweight the few side effects caused by modern pills.
Homicide committed by any schizophrenic patient usually attracts widespread media attention, in no small part because in many legal systems murderers can evade death penalty or inprisonment, provided they are found insane. It is generally perceived that many violent schizophrenic criminals are released from custody after relatively brief treatment at mental facility, receive little supervision thereafter and the authorities fail to take responsibility if he/she perpetrates another violent crime. Mass media, including the film industry often presents the diagnosis of schizophrenia as a state-issued licence to kill. There is an abundance of "psychopatic serial killer" themed thriller movies.
I disagree with the statement Homicide committed by any schizophrenic patient usually attracts widespread media attention, in no small part because in many legal systems murderers can evade death penalty or inprisonment, provided they are found insane. It is generally perceived that many violent schizophrenic criminals are released from custody after relatively brief treatment at mental facility, receive little supervision thereafter and the authorities fail to take responsibility if he/she perpetrates another violent crime.. The reason why is because ppl who are found insane usually end up as ferensic cases, and end up in a state hospital for a long time, according to my case manager, at least in the USA. Admiral Roo (Talk to me)(My Contributions)(See lyrics I created)11:14, August 8, 2005 (UTC)
A bald linking of schizophrenia with slightly higher murder rates, as in the article, is misleading, as a causative relationship is likely to be inferred, if it isn't actually invited, whereas there are clearly additional correlates to these factors, e.g., poverty and unemployment. Etaonsh09:33, 29 April 2006 (UTC)
Schizo and violence: split minds are 9x likely to kill
You said: 8.7-8.9% percent of murderers are schizos in Sweden and ANZAC => you show schizos are 9x more likely to kill because only 1 out of 100 people are schizos on average.
Also Sweden and NZ are countries with low crime rate in world comparison, they are bad examples. They also don't have those notorious serial killers fond elsewhere.
So I added info and statements with links to back them up.
On a related note, two days ago a 24-year old twice-convicted rapist and hostage taker schizo beat to death a 14 year old schoolgirl and threw her into a lavatory pit to die, in Hungary. There is huge public uproar.
Hello there
Please read the actual research rather than just making figures up off the top of your head.
You said: 8.7-8.9% percent of murderers are schizos in Sweden and ANZAC => you show schizos are 9x more likely to kill because only 1 out of 100 people are schizos on average.
This does not even make mathematical sense let alone having any relevance to the actual findings.
BTW, the 1 in 100 figure is not accurate (as is mentioned and referenced in the article). The 1 in 10 suicide rate is accurate however, and has been mentioned elsewhere in the article.
Please read the article and the relevant research properly.
This section seems unfair to me: if the article is to debate schizophrenia & harm & self-harm, i demand a consideration of the issues:
- Iatrogenic factors: neuroleptic drug-induced akathisia (neurological disease, often permanent, characterized by extreme unpleasant feelings, caused by the drugs, not by the mental condition), and withdrawal-induced psychosis (overcompensation mechanisms of the brain leading to an increase in psychiatric symptoms during drug withdrawal after prolonged drug use).
- Biographical factors: psychiatric patients in general, and schizophrenics included, were shown to have suffered child abuse and chronic humiliation much more often than non-patients.
Unfortunately, it is true that people labeled schizophrenic perform harm (for example homicides) and self-harm (for example suicide) more often than non-psychiatric patients, but if this is to be shown in Wikipedia, it is necessary to also show some possible explanations, like these 2 i mentioned.
Otherwise, this public encyclopedia will be sensationalist and misinform the readers. Mainstream media already does this disservice, so this article has to be careful.
Alberto
While it is found that ppl with schizophrenia are more often the target of abuse, it is also found that we are not often the perpitratiors of abuse. Do some research. Admiral Roo (Talk to me)(My Contributions)(See lyrics I created)11:02, August 8, 2005 (UTC)
If you knew anything on the subject, you wouldn't be so crude as to refer to them as "schizos". You especially would not say "split minds" are more likely to kill - schizophrenia is NOT a split personality. 60.231.221.8112:41, 30 December 2005 (UTC)
Although it is unfair and extremely crude to rfer to people with schizophrenia as "schizos" schizophrenia does in fact literaly mean "shattered mind"207.99.90.25315:10, 26 January 2006 (UTC)
There arguably needs to be a separate 'Schizophrenia and the Press' section to debunk the 'murderous schizophrenic' image from the tabloids. Etaonsh09:10, 29 April 2006 (UTC)
About Neurosciences and Schizophrenia and Mental Disorders in General
Dear Sirs of Wikipedia,
I protest against the section about Neurobiological Influences of the article about Schizophrenia, because it grossly underestimates how much social environment can influence children`s neurodevelopmental processes, in some cases leading to consequences throughout the whole lifespan. I have some articles about this in my computer, but most of them are not specific about schizophrenia, they are about broader psychiatric issues, like stress reactivity, social dominance, anxiety, and depression, and even functional gastrointestinal disorders. Some of the best of them are animal models showing the early social environment (events and features) clearly influencing neural circuits, sometimes for the entire lifetime. Therefore, showing that people labeled schizophrenic or psychotic have differences in brain functioning&anatomy do not prove this is the ultimate cause of the very inadequate (sometimes criminal) behavior.
I demand the section Neurobiological Influences in the Schizophrenia article to be rewritten.
I can provide the papers with complete references and even links. But most of them are not specifically about schizophrenia or psychosis.
How could children`s brain neurodevelopment be insensitive to the social environment ? It is absurd to think it could be insensitive. If even the bowels are sensitive to the social environment, why wouldn`t the human children`s brain be a "socially sensitive" organ ?
I also have some papers showing psychotherapy can influence the brain, and the social environment can influence even genetic expression, through messenger RiboNucleicAcid (mRNA).
Thank you,
Alberto
Hi Alberto,
Everything we experience changes the brain in some way, but the neurobiology section is intended to discuss neurobiological mechanisms of influence and studies using the neurobiological paradigm. Environmental influences are discussed in the previous section at some length, so I don't think there is a need to muddy the waters by putting evidence for their effect in the neurobiology section as well.
I really think the issues of environment and neurobiology are connected; for example, social events (like negative social events in childhood, or psychotherapy in adulthood) can change brain activation patterns, which, by its turn, if sustained for long enough (especially during childhood, when neuroplasticity is very high), could change even brain anatomy. This way environment can be linked to a different neurobiological paradigm, in which brain phenomena are proximate causes, but not ultimate causes, in a "causal chain" which generates schizophrenic behaviours.
Thank you for your attention,
Alberto
Hi Alberto,
I entirely agree. Your addition to this section is excellent, and I have just edited it to make it a little more clear. I think it's important to separate the research evidence into sections that make the article easier to read and point out the different approaches to understanding schizophrenia, but your addition definitely added a 'missing link' in the neurobiology section.
I added 3 new articles with links, about schizophrenia and child abuse, and removed 1 previous article, because it was not very specific about the issue. But these 3 are now cited only in the section "Schizophrenia and Violence", and i think they should be cited also in other sections like that about cause of scz. Correlation does not necessarily imply causation, but in this case it does.
Thank you for your attention,
Alberto
>I added 3 new articles with links, about schizophrenia and child abuse
It's on CNN web, schizo US mother drowns her 3 children in the sea. That's more than child abuse. That was blood libel.
Hi Alberto,
Thanks for the additions. I've replaced the reference you took out, as this was relevant to the issue of both violence and schizophrenia. The role of abuse in the development in schizophrenia is mentioned in the 'Neurobiological influences' section, but I agree it should be highlighted elsewhere, so I've added a bit to the 'Genetic and environmental influences' section as well.
Also, I've just reformatted the references a little. As a future note, if you can link to the PubMed entries in preference to the online journal it would be useful. The PubMed entries remain static, and often have links to the articles when they become publicly available.
I added 1 more reference about child abuse and schizophrenia, authored by READ and ARGYLE, please don`t delete because it shows correlations among different kinds of child abuse, and "positive" symptoms, including command hallucinations and paranoid ideation, which are also involved in cases of violence and suicide. It has a link for PubMed with free full text.
In my opinion you should change the link of reference about the "Traumagenic Neurodevelopmental Model", because PubMed does not give access to full text, but CHILD TRAUMA ORGANIZATION web site does: www.childtrauma.org/CTAMATERIALS/Psychiatry_02.pdf
Alberto
Hi Alberto,
Thanks for the full text link. I've kept the PubMed link there, as that will always remain the same, whereas a full text link might change. However, like with some other psychopathology articles on Wikipedia, I've added a 'full text' link after the reference.
I think perhaps we might need to cut down the amount of child abuse references we have, as there are now five about the same thing. Perhaps we can select two or three at most that give a good review of the area and provide the best evidence for the link, as has been done with the rest of the article. It's always possible to add more references to back up any point, but for the sake of brevity I think it's best to choose the ones that give the reader 'best value' for their reading time.
Certainly the Janssen study is considered one of the best (see John Read's recent letter to the British Journal of Psychiatry - also see this letter for a debate on whether the link is between a diagnosis of schizophrenia or non-specific psychotic symptoms) - and Read's most recent view of this area is this:
Read, J., Goodman, L., Morrison, A., et al (2004) Childhood trauma, loss and stress. In Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia (eds J. Read, L. Mosher & R. Bentall), pp. 223 -252. Hove: Brunner-Routledge.
Perhaps the Janssen study and the most recent review article might provide good evidence and a good general overview of the area ? Also, both of these review the other studies currently referenced.
Sorry, i took so long to answer your question. I think Schenkel et al.`s article has to be included, because it has very good very recent literature review, and full-text available. Read et al.`s article about the "Traumagenic Neurodevelopmental Model" also should remain included, because it is about how social environment can cause biological changes relevant to the issue of Scz. Harrier L Macmillan et al.`s NOTE 46 could be removed, because it is not specific to Scz. I would like to keep reference to Read & Argyle`s article, because i think it is very good and has full text available.
The following was recently added. I've moved it here for discussion and comments, before re-integrating it. Text in italics is quoted from the recent addition.
Historically, the most difficult problem in understanding, and therefore treating, schizophrenia has been in determining its etiology. In the West, demon possession or the consequence of a sinful life were the earliest explanations. In the 19th century, this was modified to a quasi-physical weakness of character or constitution. With the advent of psychoanalysis, childhood trauma of a severe sort became a prevalent explanation. By the 1950s, with the discovery of Thorazine as a chemical counteractant to its more severe symptoms, the probability of an underlying physical cause came to be recognized, although reactive positions among non-medical psychotherapist groups arising in the 1960s varied between blaming major parental abuse (perhaps repressed in memory) on the one hand, to denying the existence of an "illness" at all on the other.
It's important to make the distinction between the non-specific concept of madness and schizophrenia. i.e. Demon possession and sinful life have never been given as an explanation for schizophrenia, because the concept of schizophrenia, by its very nature, entails a medical explanation. Also, physical explanations for madness have been around for many thousands of years (the four humours theory of medicine is one example) and preceded the introduction of chlorpromazine. Even for schizophrenia / dementia praecox specifically, Kraepelin argued for a physical basis for the disease when he classified it. The introduction of chlorpromazine promoted the dopamine hypothesis of schizophrenia as a particular physical explanation. Good historical sources for this are Roy Porter's work on the history of madness, and David Healy's The Creation of Psychopharmacology.
Since the late 1980s, research has indicated, however, that measurable and visible, frequently genetic, biochemical differences in the brains of schizophrenics (vs. non-schizophrenics), are the root cause, often complicated by social and environmental factors acting as "triggers" for the more psychotic phase of the condition. This has triggered development of a number of psychotropic medications which can rapidly ameliorate and, in maintenance dosages, stabilize the symptoms so that the individual may return to his community, home and even work.
The problem here is an assumption of causality, as much research has shown associations and correlates but no clear causes, largely because of the differences in individual variation. In other words, the identified factors are not necessarily present in a person with schizophrenia. It's also the case that the things you mention as "triggers" may result in the neurobiological changes you mention as "root causes". As these sorts of studies are usually done in retrospect, there's little strong evidence for any reliable "root causes", even in the genetic work. e.g. See Harrison and Owen's 2003 review on 'Genes for schizophrenia' in the Lancet, and the subsequent firestorm over their conclusions.
Among laymen, schizophrenia is often incorrectly assumed to be the same as 'Multiple personality disorder' or "split personality", a confusion regularly perpetrated by Film and Television script writers. It is also often incorrectly assumed to equate with a greater risk of resort to physical violence, due to the undue attention of the news media to the relatively bizarre crimes which can occur on the rare occasion that someone with a Sociopathic personality disorder also is schizophrenic.
These seem like good points, although largely covered by existing parts of the article. However, I think they're well worth integrating, as especially the comments on the media are pertinent.
Your insistence on designating schizophrenia as currently "controversial" is grossly misleading, in fact untrue. There is more agreement now about the disorder, its nature and causes, since the 1950s, when Thorazine was discovered and the presence of a biochemical component first became evident. Citing 60s cultural-revolution thinkers like Laing, Szasz, Berne, Schiff, et al. is appropriate in historical context, but few practitioners or educators buy their theories now. I've been a psychotherapist for 30 years and I know of not one provider since the late 80s who questions the primacy of the biochemical component of schizophrenia. Your persistence in insisting otherwise suggests an extreme lack of awareness of contemporary thought and practise, or else a personal agenda. If you're intent upon reverting text corrections on that and stylistic points (vague descriptives, e.g.), I can't fight it, but you are being much too controlling and territorial on this article for the good of Wikipedia, especially considering that you are giving out blatant misinformation in the process. JVC - 1 July 2005
Hi there,
Berne and Schiff are not mentioned in the article and Laing and Szasz are only listed under alternative approaches.
However, there are many current providers who question the primacy of the biochemical component of schizophrenia, or its diagnostic specificity, as can clearly be seen from the recent literature, much of which is cited in the article. Similarly, the alternative viewpoint is also represented in the article.
Rather than simply accusing the article of spreading 'misinformation' it would be helpful if you provide references to back up your points, rather than relying on rhetoric.
Although you accuse the article of being based on a personal agenda, all the points are fully referenced and taken from the relevant literature, so please provide alternative sources (preferably ones published in peer-reviewed journals) if you want to represent another side of the argument.
Your response avoids the main issue, namely, that you insist on defining, in your initial paragraph no less, that schizophrenia is "controversial", and to make the point hit home, you even highlight the word. The impression you thus give the reader is that there is major disagreement and discord among mental health practitioners, researchers and scholars, and that just is not so. The fact that you stuff General Reading with books written from minority positions on the matter does not alter the fact that they are minority positions not evidence of major controversy.
You are being dishonest - whether because you want to be or because you don't know your subject matter except from a minority viewpoint, that doesn't really matter. What matters is, you are passing that dishonesty, that misrepresentation of rampant "controversy", on to novice, lay readers, some of whom may "be" schizophrenic or be family members, as if it were a behind-the-scenes reality of which they should be wary, instead of a tempest in a teapot eminating from the orifices of Scientology and a few still-dissident, aging, 60s "Psychology Today" radicals.
I have 30 years practice experience as a psychologist, working with and learning from hundreds of other actively-practising mental health professionals (not just ivory-tower speculators), and the vast bulk of the evidence and practise frame of reference are now in the biological-basis school. I did not start out practising from that frame of reference, but since the middle 1980s, the evidence has become overwhelming and I have had to tailor my approach to accommodate the significant biochemical aspect of schizophrenia.
I can list major contemporary works on the subject, and you can list more fringe works, and that will not solve the problem of, in wikipedia terms, this article lacking an NPOV as you insist on it being skewed from the very introduction. Your bias shows, as does your intent to control the content of this article to maintain that bias, and that is what I am confronting.
What, BTW, are your credentials in the mental health field in general, and in diagnosis and treating schizophrenia in particular, that you should be given such control over this article's content, tone and direction by wikipedia?
--JVC, June 2, 2005.
Hi there,
I do not claim any authority to 'control' the article, and if you look at the edits, I am one of a number of people involved. In fact the recent edits you mention are largely not mine. However, I am aware of the literature and ongoing debates in the area, largely because I am a psychologist working between a university and a hospital researching the neuropsychology of psychosis. I am also a lecturer on graduate and postgraduate psychiatry courses teaching medical students and working psychiatrists. However, comparing 'rank' is largely pointless. It is more important to argue the points based on the published academic work, as is required on wikipedia.
When I first read the schizophrenia segment on Wikipedia, I was very disturbed! The whole controversial wording just felt like I was sitting in a lecture somewhere in the 1960's. I have a son with a more severe form of this illness and his father has bipolar which was not diagnosed until after his son was diagnosed. I can somewhat sort through the garbage that is in the literature where many family members find that difficult to do. Having any material related to Szasz and other antipsychitry folks is nothing more than heart breaking for me because it is this kind of thinking which influences the politics and laws still today in 2005. it is a terrible thing to say but i wish that anyone who writes publicly about schiziophrenia should have a child with the illness and then they would "get the picture". You would never see an article written about Alzheimers or autism EVER mentioning that it could be child abuse, parenting or that it may not even be the brain that's affected. Although this article is improving, myself and thousands of other family members along with the general public will turn to this kind of public information to help us understand and learn. Those who control the content are responsible for that learning.
It is plainly clear from this work that the status of schizophrenia is controversial and this can be easily demonstrated with a working knowledge of the recent literature. For example, recent articles by Kendler in the American Journal of Psychiatry and Harland et al editorial in the British Journal of Psychiatry deal with exactly these issues. If they are not controversial, why are they being discussed in the leading psychiatric journals ?
Similarly, the works listed in the general reading section are certainly not minority works. Madness explained recently won the 2004 British Psychological Society's Book Award, and Richard Bentall ([au&cmd=search PubMed link]) is a leading researcher and clinician in the field. Similarly, Michael Foster Green is one of the leading researchers into the neuropsychology of schizophrenia ([au&cmd=search PubMed link]). Each book actually argues for quite different positions on schizophrenia, although both mention critiques of the diagnostic approach.
As to your edits, there are no objective diagnostic criteria for the diagnosis of schizophrenia. This is made clear in the DSM and the ICD. Diagnosis is made from a third person perspective based on an interpretation of behaviours and experiences determed from a mental state examination. The subjective criteria can clearly be seen from the criteria listed in the article and in the DSM itself. Again these points are clearly stated in current psychiatric textbooks (e.g. ISBN0702026271, ISBN0198528108).
If you can find any sources which mention that there are objective criteria for diagnosing schizophrenia, please cite them.
Ouch. I am sorry for what you went through. My experience in the professional world of psychiatry/psychology was not that bad, thogh ppl who are not pros gave me and still give me a hard time about my diagnosis. I was thinking of going to Canada because I don't like what is happeining here in the USA. But after reading your post, I am starting to rethink that move. My main country I would like to be in is Sweden, but I know it would be extreamly difficult to get in because they have one of the best political systems in the world as well as one of the best health care systems in the world, and they know it. Admiral Roo (Talk to me)(My Contributions)(See lyrics I created)12:42, August 11, 2005 (UTC)
Thank you for the response. I did give my full diagnosis (both now and in the past) as well as a detailed statement of my life with Schizoaffective disorder. See my user page, or go directly to the section about me and my disorders. The three primary reasons why I want out of the USA are as follows:
The care for the disabled (not just the mental health part) is slowly being destoyed. For example, in my county, their is only one group home for the mentally ill, and RSS (Residentail Supplimental Services, an Ohio state program) are frozen right now. All group homes in the area vanished because of lack of funding, most required $800 or more for a person to live in. Without the help of RSS, most ppl, like myself, can't afford that kind of care. Another example is that with the Medicaid program, only some of your medications are covered. I have two that are not coverd totaling in about $80 per bottle. $76 for Allegra (I have sevear allergies during the late spring to early fall months) and about $9 for Sarna (A skin medication, for some odd reason, for the last few months, my skin has been itching and peeling).
The country, imo, is falling apart and becomeing a police state, not unlike what happend to Germany during the rise of the Nazies.
The cost of education is vary high here, and keeps getting higher, just like our medical costs.
Admiral Roo (Talk to me)(My Contributions)(See lyrics I created)14:11, August 11, 2005 (UTC)
BTW, I linked your site (that you gave in your paragraph above mine) so others can just click on it without having to copy and past it in thier browsers.
Dear ISBN0702026271, ISBN0198528108 be careful about using absolutes as you stated that autism has NEVER been refered to as child abuse which is not true. Although I do sympathize with you it must be remembered that society is naturally resistant to change. Before you write angry letters you may wish to consider that Wikipedia records both facts and view points but when possible makes it clear if a statment is fact or view point.207.99.90.25315:18, 26 January 2006 (UTC)
I think that this article should mention that schizophrenia seems to cover a wider range of disorders in the USA than in some other parts of the English speaking world. --MacRusgail02:44, 11 July 2005 (UTC)
I am concerned about the authors rigid statement of "In spite of its name, schizophrenia does not involve a 'split personality'", as my understanding is that one origin is dissociative defence menchanisms of escaping into a make-believe world of characters by a child being traumatied and the real world too frigtening to bear, becomes ingrained into the childs psyche as they age with the different personalities that they make up to 'shield' them from harm in the daily life that becomes a workable solution for them to survive with their childhood maladapted pshyche, schizophrenia is when they start loosing their social awarness to keep these different personalities hidden causing expression, which to the observer is the person 'talking to themselveshearing voicesseeing things' all symptoms of the mind decompensating and unable to differentiate between thought and realty due to heavy mental processing occuring from the different individually indentifiable personalities now less cooperating with each other to effect a common decision and action. I think this article continues to struggle to explain schizophrenia as in the past, without taking into account the new information of the pathology spectrum of this form of illness of the psyche. Sam.
Recent changes and the necessity of reading the research
Hi there,
I notice recent changes of mine have been rv'ed so I thought I'd tackle some of the issues here.
1) Firstly formal thought disorder is not the primary sign of schizophrenia. It is a symptom (which is plainly clear from reading the diagnostic criteria) and any of the references in the formal thought disorder wikipedia article. To quote Sims (ISBN0702026271) it is "abnormality in the mechanism of thinking described by the patient introspecting into his own processes of thought: that is the patient describes in his own words a process of thinking which is clearly abnormal to the outside observer". This is also described in other psychiatric textbooks, such as Fish and even Jaspers.
The "primary sign of schizophrenia is considered to be fragmentation of basic thought structure and cognition" is often given as cognitive dysmetria (see Fristons recent article in Brain) although this is only one theoretical approach.
2) "Mainstream research in the past two decades has established the causative influences of biochemical and genetic factors on the neurobiology of the brain"
Almost no definitive causitive processes have been established, largely due to the heterogeneity of any of the identified factors meaning they are not present in all people diagnosed with schizophrenia. For example, see the recent review article on the neurobiology of early psychosis in the British Journal of Psychiatry, or this review article on the neurobiology of schizophrenia from Molecular Interventions, or this review article on the neurobiology of psychosis from the Canadian Journal of Psychiatry, or this review article on the genetics of schizophrenia in Trends in Genetics.
I could go on, or you could just read the relevant research. The most that can be said with any confidence is that "both biological and sociocultural influences are important contributing factors" as was stated in the original edit.
3) It is the status of schizophrenia which is considered controversial, as well as the diagnosis. Much recent work has considered whether it is a discrete disorder at all, rather than a spectrum of experiences and behaviours. This is being questioned by mainstream psychiatrists (see Craddock and Owen's recent article) by a large array of empirical studies (reviewed in this article) and a number of authors critical of the whole concept (there are many, I'm sure you're aware of them). Again, there are many others.
4) "There is also no association of schizophrenia with a predisposition toward aggressive behavior"
There is, but it is very small. Read the research referenced in the Schizophrenia#Schizophrenia_and_violence section of the article. It is clearly stated there.
5) Following empirical findings, reported in peer-review scientific journals with "On the other hand" and then giving your interpretation of the data with no supporting reference to published research is POV.
For example, to quote the article:
A recent study of 4.4 million men and women in Sweden found a 68%–77% increased risk of psychosis for people living in the most urbanized environments, a significant proportion of which is likely to be accounted for by schizophrenia30. On the other hand, it may be that the relatively high-stimulus and high-stress nature of urban life is eliciting psychotic responses in individuals who could avoid them in a more "laid back" or isolated rural environment.
The findings are given from an empirical study and the "On the other hand" point adds nothing except subjective interpretation. Why not let the reader decide for themselves, or read the original research which is referenced ?
6) Don't be surprised if subjective points are removed when they run counter to published research. The article is extensively referenced so you can read it for yourself.
Dear anonymous user who keeps reverting article and accusing me of POV...
Hi there anonymous user who keeps reverting the article and accusing me of 'ongoing, obsessive personal POV control',
Please discuss your differences of opinion here, and equally as importantly, please provide evidence that supports the claims you make in the modifications to the article.
From the evidence I am aware of, they are largely unsubstantiated, which is why I've removed your changes once more. However, if there is research that supports the points you make, please cite it here, as I'm always interested to read research on the topic that I've not yet encountered and I'm sure the article would benefit.
This article looks very well done to me, Vaughan I appreciate your contributions. I wondered over here from the stub on logorrhoea which was previously about its use in rhetoric. If you've got the time I'd appreciate you casting a critical eye over that and some other articles I've worked on, motor neurone disease and labile affect.
--PaulWicks19:45, 10 September 2005 (UTC)
Kraepelin quotes source request
These quotes were added to the article but I've been completely unable to source them. I've removed them for the time being, and hope someone can provide a source and verify their accuracy.
The quotes were:
[Kraepelin] described schizophrenia as being what he called "a hell of the mind; inescapable and terrifying". Kraepelin wrote "schizophrenia stands alone amongst mental conditions; the madmen fall under the spell of the moon as it were. They are lunatics. Lovers of the moon."
Schizophrenics do not suffer from visual hallucinations, they however do suffer from auditory hallucinations.
Visual hallucinations are usually associated with substance abuse. The "visual hallucinations" described by schizophrenics are delusions (i.e. they think the man walking towards them is Napolean). Hallucinations are by definition seeing (or hearing) things which are physically not there at all.
If this is the case, why hedge--just say "auditory hallucinations" instead of having an awkward sentence structure. It's right next to delusions. Seems like everything gets covered that way. Metaeducation21:46, 24 October 2005 (UTC)
Hi there,
Visual hallucinations are common in schizophrenia (for example, see this scientific paper), although auditory hallucinations are thought to be of particular diagnostic importance.
The last paragraph in the "Alternative approaches to schizophrenia" section about anti-psychiatric movements is completely inappropriate and should be removed. I agree with it, but it is definitely not encyclopedic and should at least be listed as one view of an issue. In its current form it is really an attack.
Yeah, it was inserted just a few hours ago. I've removed it. You could have done it yourself, though. But thanks for noticing. Shanes12:32, 24 October 2005 (UTC)
No - the requirements for a featured article say it should have a references section coupled with judicious use of inline references; however, the particular referencing style is left up to the article writer's choice. →Raul65418:19, 24 October 2005 (UTC)
Incidence: per year ?
The article says: The incidence of schizophrenia was given as a range of between 7.5 and 16.3 cases per 100,000 of the population. Yet, the article on incidence says it is measure over a defined period. What is the period here ? A year ? This should be clarified, or the incidence article should be corrected. As I'm no epidemiologist, I leave others to correct. - Anon. 24 0cober2005
I agree with your assessment. It is surprising this has not been corrected by anyone in the last six weeks. I am not an expert on this either, but a reasonable assumption would be that the missing time period would be one year. Twelve new cases (the median number given) per year in the population of 100,000, over 60 years would yield a lifetime prevalence of 0.7 % which is within the correct range. --Blainster17:57, 12 December 2005 (UTC)
Schizophrenia and violence removal
I've removed a couple of sentences from the 'Schizophrenia and violence' section as follows
Frequently, [violence suffered by people with schizophrenia] is a result of the victim’s inability to function well and maintain proper behavior and thinking in the public sphere, and violent action is taken upon the victim while the perpetrator is most often unaware that the victim has a crippling mental illness. People with schizophrenia who wind up in prison (often indirectly as a result of their illness) are also highly prone to being victims of violence, as many fellow inmates fail to make a distinction between the perceptions and behavior of a person with mental illness as with a person who expresses normal behavior.
Although plausible, this seems completely anecdotal to me. If anyone has any further evidence to support the above statement, we can drop the text back in with proper references.
comments on Vaughan's revert - proposal for revision
My dear Vaughan. There is a problem which I was seeking to correct in my language revision which is noted here. This seems to be a very grievous point of contention at wikipedia. People in western english speaking countries are convinced that Their cultural perspective is equivalent with NPOV. If anyone wants to give other cultural or historical contexts for that topic, such things are erroneously considered to be POV. I admit the rewording in that revision was a bit awkward. But the springboard I was trying to give to the article was to show that research into Schizophrenia is very inconclusive as of the year 2005. The article, as it currently stands, admits that. There are no defined borders somehow, in psychological theories, between the various definitions of different kinds of mental problems. There is no way to put pieces of the puzzle together in a way that cohesively explains the current theoretical frameworks about these maladies. To a large extent, research into schizophrenia has consisted solely categorizing whatever observations there are to be seen.
There is a wonderful quote by Aristotle in his third chapter of his book entitled "posterior analytics." To paraphrase, he says that if a scientist has a theory which is drawn together out of inference - where there is no way for him to put together the pieces of the puzzle of observations in a clear and concise fashion - then, that scientist's models are null and void.
The biological theory of schizophrenia is largely based on the foundation of the studies done by pharmaceutical companies who were seeking to make a market for various kinds of antipsychotic medications. I realize that such famous authors like Edward Fuller Torrey are impressed by the physical differences in brain form which were seen with a few dissections of corpses. But - as is mentioned in this article - even that, is inconclusive research, because the sampling in the study was too small.
I would like to propose a very dramatic revision of the article - which would include cultural context, descriptions of the inner experience from people who are daunted by the experience of this malady, etcetera. -- Rainbird19:22, 31 October 2005 (UTC)
Hi Rainbird,
I agree with many of your points above, and as you admit, the article mentions that the research is inconclusive as regards to the nature and status of schizophrenia.
However, there are a few points with which I'd disagree. The first, from your original revision, is that "Current Western psychology has defined...". Many of the concepts of what we know call schizophrenia have been around for many hundreds (and if you include psychosis, thousands) of years, and the specific diagnosis for almost a century. Although the diagnostic concept arose from German speaking psychiatrists, it is now defined by a world-wide community of researchers. For example the National Institute of Mental Health and Neuroscience in India is a respected research and treatment centre for schizophrenia. Also, psychology has not defined schizophrenia, psychiatry has. Whilst I appreciate the sentiment, that the diagnosis is specific to a cultural tradition, I'm not sure that the rewording of the first paragraph is the best place to address this.
Perhaps more appropriate would be some additional discusson of these points in the 'Diagnostic issues and controversies' section, as I think you've highlighted that cultural issues are not adequately covered by the article as it stands.
I would agree that the biological studies into schizophrenia were first largely motivated by drug companies, although it is important to note that the majority of research into biological issues is now conducted by independent researchers. Also there is a large body of evidence for biological changes associated with schizophrenia, although, as the article mentions, these tend only to be reliable at the group level.
"Descriptions of the inner experience from people who are daunted by the experience" are certainly very important to understand, but I am not sure how useful it is for the main article as encyclopedia articles tend to stick to widely accepted information, rather than 1st person experience.
Anyway, I hope the above makes sense. Please let me know your comments.
I agree with all of the above, but it's important not to throw out the baby with the bathwater. Neurobiology does not only apply to "legitimate brain diseases" but to many other things also understood on the level of experience. For example, there is now a lot of research on the neurobiology of speech, and even things such as moral decision making. Neither of these things would be defined in terms of the biology, but that doesn't mean it is useless to try and understand the biological processes that underly them. I think the difficulty comes when neurobiology is promoted as the only way to understand these things, which is unfortunately what some people are trying to do with schizophrenia, of which drug companies have been some of the main culprits, as you highlight.
Just as we could have a legitimate neuroscience of speech, we can have a legitimate neuroscience of schizophrenia, as long it is integrated with other approaches and understanding.
I agree the "chemical imbalance" theory is largely rubbish, as it is really a caricature of the actual science. I also agree there is a split between 'brain diseases' such as (such as Alzheimer's or Parkinson's) and and 'emotional or mental' conditions, but largely in terms of how they are defined. They both equally involve the neurobiology of the brain.
Actually, the more you learn about neurology the more you realise that many 'brain diseases' are actually less cut and dry than is usually thought. Epilepsy, for example, is just a variation of normal human brain activity as everyone has some seizure activity at some point, whether they realise it or not. Indeed, the only thing they may notice is having unusual thoughts and experiences. Some people can even experience 'fits' without any detectable changes in brain function (known as psychogenic non-epileptic seizures). The same goes for Alzheimer's disease. It is diagnosed on the basis of behaviour, rather than any specific neurobiological changes, although these changes are known to occur during the disorder. These changes (amyloid plaques) can also be present in some people without any significant dementia.
I think part of the problem with psychiatry is that deals with very complex problems and is a relatively new in terms of a science. Anything can be studied scientifically (after all, they use many of the same techniques as neurologists, but just study different sets of behaviour) so it no more a pseudoscience than any other scientific approach to human behaviour. For example, we study everyday thought and emotion scientifically, so psychiatry is no less scientific for the fact it studies more extreme or unusual forms of the same thing.
It is highly politicised, however, in that it has been used abusively in the past, still has some major problems in defining who it should and shouldn't be treating and still uses some fairly crude treatments in some instances. This is no different from the early days of many branches of medicine, and we would have been a whole lot worse off if neurology was abandoned 150 years ago for the same reason.
Hopefully, with a combination of science and social pressure (including from activitists like yourself) a comprehensive understanding of the psychology, neurobiology, emotion and social influences on mental distress can be developed. I think everyone would agree there's still some way to go yet though.
Hi, vaughan, I'd like to revisit a revert you did. Just because laing is linked isn't really ideal. The thing is, some material belongs in both articles, it's in Laing because its his life, and in schizophrenia because its a view on the subject. The link to Laing suggests - "here is more info on Laing if you want to look him up". What it doesn't imply that there is significant material there which is about and directly relevant to schizophrenia, that's not given in this article. In that circumstance its appropriate to include it, and the change was only a few lines and some citations of books, to more roundedly represent Laing's view on it.
My concern is that Laing's main views are already (albeit briefly) summarised in the article. I agree that much of his work is directly relevant to schizophrenia, but then so is many other people's. For example, whole sections could be pasted in from Emil Kraepelin, Eugene Bleuler, Karl Jaspers and Kurt Schneider (to name only a handful), but I think a more detailed explanation of their contributions are probably best left in their own pages, with their main contributions summarised in a concise fashion.
Just noticed your edit with regards to the above. Great solution. Many thanks - Vaughan
Shane's Recent Reversion
Could you please put in there a definition of positive (i.e. things being present that shouldn't be) versus negative (i.e. things being absent that should be there) in the description of schizophrenia's symptoms? I'm not sure how to word that but I think it's important for casual readers to understand the meanings of positive/negative here. Thanks. Francesca Allan of MindFreedomBC03:47, 14 November 2005 (UTC)
Shorter life
Studies have shown that people with schizophrenia live on average between 15–20 years less than people without mental illness, and evidence has shown that few people with schizophrenia have lived beyond their sixties.
Is it true? Are there any references? If it is true, then it needs to be moved to Prognosis section, and maybe to begining of article.
This may be a circumstance where using a mean may be more accurate than using an average. It's well known that schizophrenics have a high suicide rate but I don't know if there's any evidence that, barring suicide, their life expectancy is shortened. Francesca Allan of MindFreedomBC02:14, 19 November 2005 (UTC)
Hi there,
I looked up studies on the link between a diagnosis of schizophrenia and mortality and have added a paragraph and reference to the most recent study I could find. This is now in the prognosis section:
"In a study of over 168,000 Swedish citizens undergoing psychiatric treatment, schizophrenia was associated with an average life expectancy of approximately 80-85% of that of the general population. Women with a diagnosis of schizophrenia were found to have a slightly better life expectancy than that of men, and as a whole, a diagnosis of schizophrenia was associated with a better life expectancy than substance abuse, personality disorder, heart attack and stroke."
As research talks about the general picture for people diagnosed with schizophrenia, rather than for each individual case, it seems reasonable to quote the average. In fact, the article references does include confidence intervals for each average given, although these show remarkably little variation from the mean. I agreee an average is not necessarilly predictive for any one individual, but nothing usually is in these circumstances. Any6 alternative suggestions would be gratefully received, however.
Hi, Vaughan. There really is no "general picture" for schizophrenia. It's a broad, vague, catch-all diagnosis and even bigger if you include schizoaffective disorder. I think, given the high suicide rate of this group and the usually relatively early onset of symptoms (teens/20s), an average is really not a very helpful measure for life expectancy. Francesca Allan of MindFreedomBC02:40, 23 November 2005 (UTC)
Hi Francesca,
I would disagree and say there is a general picture for people given a diagnosis of schizophrenia when life expectancy differences are quoted as an average, which we can assume that the reader knows that this is nothing more than a summary statistic and not necessarilly predictive of any one individual. I think average is a useful life expectancy measure as it is commonly used in a wide variety of comparisons (male / female, diet, diagnosis, country, height etc etc) P.S. the cited paper includes death by suicide.
Hi, Vaughan. It would be more useful if it included a comparison to non-treated schizophrenics. Just saying life expectancy is shorter on average isn't terribly helpful. And, again, what's the threshold for being considered schizophrenic? This attempting to lend undeserved legitimacy to psychiatry by applying and misapplying statistics really frosts me. E. Fuller Torrey tries this stunt all the time. He twists a Department of Justice study which counts violent crimes committed by "those with a history of mental illness" (an absurdly broad category) and invents correlations as to how many of them were schizophrenic and how many of them were treated (despite the fact that the DoJ study mentions neither diagnosis nor treatment). Then Torrey waves his fictional figures around (such as the widely cited 1,000 murders per year being committed by the untreated severely mentally ill) and the press reports on them as if they actually meant anything and the gullible public believes what they read in the press. Francesca Allan of MindFreedomBC03:18, 24 November 2005 (UTC)
Hi Francesca,
I don't know figures for treated vs untreated people, but I'll look them up. I suspect, however, that those given a diagnosis may have a shorter life span partly because of the treatment itself, as many antipsychotics are associated with diabetes, heart attack, and Parkonsin's like symptoms.
The lifestyle of the "average" schizophrenic is not healthy; the vast majority are heavy smokers, have unhealthy diets, and have limited exercise. Suicide rate is high. They may engage in various forms of risky behaviour.
Francesca is correct that the metabolic syndrome is a common side-effect of some of the new atypical antipsychotics, but some are worse than others, and their clinical effectiveness (especially with regard to the negative symptoms and decreased risk of tardive dyskinesia) needs to be weighed carefully against their side-effect profile. This is a subject of much debate amongst psychiatrists, because they do actually care about their patients developing diabetes. JFW | T@lk08:31, 24 November 2005 (UTC)
The schizophrenic lifestyle (including diagnosis, forced treatment, revolving hospitalization, despair) is unhealthy, no question about that but I'm wondering how much is attributable to the condition as opposed to the poverty that usually accompanies a psychiatric diagnosis.
With respect to the newer atypicals, I believe at least one study found no safety improvements over the old ones. All evidence to the contrary, I don't actually believe all psychiatrists are evil and I have no doubt that side effects are a serious concern for most of them. However, I know from my own experience that physical health tends to take a back seat to mental health in weighing various trade-offs. When I was recovering from a serious liver condition, I was still prescribed neuroleptics despite the clear warnings. And, at the time, I wasn't even diagnosed with schizophrenia! Francesca Allan of MindFreedomBC15:06, 24 November 2005 (UTC)
I dispute that it is the treatment of schizophrenia that is the most important cause of shortened lifespan. I am in no position to defend whichever psychiatrist prescribed you neuroleptics despite warnings. Use of neuroleptics is not limited to schizophrenia, something which you probably know.
Listen, you are actually divulging a lot of private information in what is supposed to be a public medium. To give an example: vandalism on popular pages is often reverted within minutes by anonymous editors who cannot use a watchlist to track article changes. This means that some pages are served several 100 times an hour. Do you honestly want the whole word to know what kind of drugs you were prescribed? JFW | T@lk18:15, 24 November 2005 (UTC)
Wikipedians are welcome to divulge as much or little information as they wish. As Francesca consistently makes a useful contribution to the article and ongoing debates on the talk page, I can't see much of a problem. - Vaughan22:00, 24 November 2005 (UTC)
Jfdwolff, the fact that I underwent years of psychiatric assault is psychiatry's shame, not mine. I'm not in the least embarrassed and consider my surviving psychiatry to be a heroic accomplishment. My story's out on the internet already and is the subject of litigation, which is a matter of public record. Why should I fear the public knowing how I was mistreated? The public *should* know what goes on in the name of psychiatric "treatment." That's the only way we'll ever make positive changes to the system. If more people would stand up and speak out, it would do the world a lot of good. Francesca Allan of MindFreedomBC01:05, 25 November 2005 (UTC)
I'm not sure I understand this sentence, at the end of the top paragraph under "Overview": Some models of schizophrenia subsume "formal thought disorder" and planning difficulties in a third group, a "disorganization syndrome." What is "disorganization syndrome", is it a specific kind of schizophrenia that is characterized by these symtoms ("syndrome" to me sounds like a specific disease) or is it the name of this group of symtoms or... basically, what is meant by this sentence? Which are these models? /Skagedal14:24, 29 November 2005 (UTC)
Hi Skagedal
The disorganisation syndrome was first identified in an analysis by Liddle (see abstract here) and has been widely replicated in clinical and non-clinical studies. It is not necessarilly a specific type of schizophrenia, just a specific grouping of symptoms that tend to occur together in schizophrenia.
Hi Vaughan - thank you for the clarification and the note about the D,E,F criterias (below). I have done a Swedish translation of this whole text; "good job!" I say to the people who has worked on it. /Skagedal23:41, 30 November 2005 (UTC)
Diagnostic criteria D, E, F
Is there a specific reason why the criterias D, E and F (exclusion of schizoaffective syndrome, mood disorder, substance use/abuse, pervasive developmental disorder) are not included? Shouldn't these differential diagnoses at least be mentioned among the diagnostic criteria? /Skagedal16:27, 29 November 2005 (UTC)
Hi Skagedal
The actual stated criteria consist of another three paragraphs so make the section a little bulky. However, I agree they are important and so have added a short paragraph which summarises their content. The section links directly to the full DSM criteria if someone wants to get the verbatim text.
This article should include the glutamate hypothesis [3]. Vaughn, would it be alright if I posted this? That was a bit of a dramatic edit. Also, can we include some information about the different dopamine receptors? Atypical antipsychotics affect different dopamine receptors and are thought to avoid tardive dyskensia because of it. I cited a few sources for this. Would it be alright to put some of this information back in? Reid23:56, 29 November 2005 (UTC)
Hi Iamnotanorange,
Apologies for not re-integrating your informatin sooner. Your additions on dopamine mechanisms are excellent, but I think the full details are better placed in either antipsychotic or dopamine hypothesis of schizophrenia where the exact mechanisms of antipsychotic drugs and the finer details of the neuropharmacology are perhaps a little more appropriate than on a general article on schizophrenia.
I agree the article needs a little more on the glutamate hypothesis (and perhaps a new article on the glutamate hypothesis of schizophrenia as well?). Again, I think this needs to be a concise paragraph summary with a link to another article with the full details. I think this is definitely something we would work on though, so I look forward to your contributions.
I've removed the glutamate section again as I'm afraid it's a bit of a mixture of speculation and inaccurately strung-together information. In other words, it's not a great review of the literature in this area. I think you've identified a really important area, however, and I'd recommened Kandel et al's The Principles of Neural Science (ISBN0838577016) or Bear et al's Neuroscience: Exploring the Brain (ISBN0781739446) as a good starting points for a concise overview of this area before hitting PubMed. It would be great to have your contribution, either by starting off something, or editing a version I'll put up when I get a moment.
The dopamine hypothesis has recently taken a back seat to the PCP hypothesis, or the glutamate hypothesis. Schizophrenics have characteristically depleated function in the prefrontal cortex, an area rich in glutamate. When schizophrenics are asked to preform the Wisconsin Card Sorting Task, they do not use their prefrontal cortex like normal patients do. It has also been realized that normal subjects given PCP exhibit all of the symptoms of schizophrenia, including the negative symptoms [4].
With that being said, the dopamine hypothesis has not been contradicted, rather the glutamate hypothesis is an addition to its predecessor. The prefrontal cortex projects directly to the basal ganglia and mesolimbic dopamine systems. It would make sense that if, perhaps the prefrontal cortex was unable to inhibit the dopaminergic nuclei properly, there would be an excess of dopamine in the synapses of the basal ganglia. It would be in this way that the lack of glutamatergic activity directly creates the negative symptoms of schizophrenia, and it is as a consequence the [hypofrontality] that the positive symptoms emerge [5].
---
Vaughan,
Decoding Schizophrenia, January 2004 This is where I am getting the majority of my information. I happen to own both Bear and Kandel, I have reviewed it in the past, but I will give it another look. I do not believe I have assembled any radical speculations or innacurate information. Could you point to an innacuracy so I do not have to deal in generalities? One of the weakest statements is the one about the frontal lobe inhibiting the dopaminergic system. I feel as though this is presented as a hypothesis based on anatomy. The frontal lobe certainly has projections, but the inhibition quality is an educated hypothesis based upon the data. I would not mind labeling it as such. Is there anything else you do not like? Reid21:30, 6 December 2005 (UTC)
Hi Iamnotanorange,
The text you added had some good elements but included a large chunk of speculation and didn't connect the significance of the effect of NMDA antagonists, cognition and schizophrenia.
I've added a paragraph on the 'glutamate / NMDA hypothesis' with some references and it would be fantastic if you could read through, check it makes sense and is accurate. Your input would be much appreciated as neuroscientists contributing to the article are always welcome.
I've also incuded a link to an as-yet-unstarted page on the glutamate hypothesis of schizophrenia which I'm also sure would benefit from some work (I found the review papers referenced in the article here are as good a place to start as any!).
I'd prefer text was not deleted from the talk page, however prejudiced and objectionable. I think countering the arguments with rationale argument and correct information, as was done in this case, is a better approach than censorship, as I'm sure many people would benefit from reading the debate.
I understand, Vaughan. I note, however, that this was an anonymous poster and that the right to free speech isn't absolute. But I get your drift and won't delete such contributions anymore. Francesca Allan of MindFreedomBC01:26, 1 December 2005 (UTC)
Crime
I don't like this sentence: "Furthermore, research has shown that a person diagnosed with schizophrenia is more likely to be a victim of violence than the perpetrator." "more likely" is impossible to interpret out of context. It should mean: the risk multiple for increased victimhood exceeds the risk multiple for increased perpetration. Maybe one time in ten a journalist succeeds in thinking this clearly, so even when you encounter a well written article, the doubt factor remains high.
I came back. It's worse than that. The ambiguous "more likely" reduces this sentence to socio-political claptrap garbed in analytic wool.
Consider one of the main contentions about S, that S is a cluster of genetic factors, or that it was originally termed "the schizophrenias". This numeric claim references a diagnostic blend which one might well suspect blends one species who are tame and another species who are wild, whom our present understanding fails to differentiate. There's a long history of diagnostic refinement to support this.
This claim devolves upon the prevailing diagnostic standard, which is hardly fixed or even reproducible. It boils down to "a population diagnosed with S under the guidelines of DSM X as of YYYY showed a greater risk multiple for increased victimhood than for increased violence". Does this effect hold up under narrower diagnostic criteria?
The point here is that this claim is not about people with S, but about diagnostic standards and presumptions about populations bearing certain labels. In the same way that "The Philadelpia Story" is less about homosexuality than homophobia. It's easy to conflate conditions with labels with responses to labels and then lose track of which one is being addressed. Throw in some ambiguous unspecified quantification, your cake is baked. -- (unsigned comment by 24.68.134.249, Nov 30 2005)
question about the 4.3% violence figure
I assume this is from E. Fuller Torrey's unusual style of mathematics. The figure is from a 1994 Department of Justice study and actually represents the percentage of people who commit violent acts who have a "history of mental illness." There is no division within that study as to either diagnosis or treatment. This is just Torrey-math at its hateful worst. Unless this figure is being quoted from a completely different survey, it should either come out or be properly explained. Francesca Allan of MindFreedomBC01:23, 1 December 2005 (UTC)
I'm the person who added the 4.3%. Here's the reference: [6]. I got it by following the citation that was at the end of that sentence. I think you might be misreading the sentence -- it's discussing the levels of violence against people with schizophrenia, not the levels of violence by people with schizophrenia. My motivation for putting it in was in response to the comment from the anon above -- I don't agree with everything he/she said, but it is true that the "Schizophrenia and violence" section he references was very poorly organized and unreferenced. So I made two changes: I split out the section into two sections, "Violence by schizophrenics" and "Violence against schizophrenics", and I added that 4.3% rate to start to document the existing sentence "Research has shown that a person diagnosed with schizophrenia is more likely to be a victim of violence (4.3% in a one month period) than the perpetrator". But in my opinion, that sentence needs two numbers to demonstrate its truth, and we only have one, and so I wouldn't object to its removal. --Arcadian01:48, 1 December 2005 (UTC)
My mistake, Arcadian. Very sorry. The 4.3% figure just jumped out at me because Torrey and TAC used that exact figure from a DoJ study to justify forced drugging of anyone labelled "severely mentally ill." Haven't read your cite yet but thanks for clarifying. Francesca Allan of MindFreedomBC01:54, 1 December 2005 (UTC)
Hmmmmm. I'm no expert on this topic, but I just did some searching on PubMed to get the ball rolling. I can't find numbers to tie directly to the assertions in the current version of the article, but I did find some other information that might be useful. For each of these, you can click on "Related links" and find more relevant content.
This states: "RESULTS: The rate of nonviolent criminal victimization (22.4 percent) was similar to that in the general population (21.1 percent). The rate of violent criminal victimization was two and a half times greater than in the general population--8.2 percent versus 3.1 percent.". (note that this article is about victimization of the mentally ill, not victimization by the mentally ill.)
This states "CONCLUSIONS. Alcoholism and drug abuse contribute significantly to criminal behaviour, independent of sociodemographic factors; however, with a few exceptions, mental disorders such as schizophrenia and affective disorders do not contribute to criminal behaviour."
This states "RESULTS: Individuals meeting diagnostic criteria for alcohol dependence, marijuana dependence, and schizophrenia-spectrum disorder were 1.9 (95% confidence interval [CI], 1.0-3.5), 3.8 (95% CI, 2.2-6.8), and 2.5 (95% CI, 1.1-5.7) times, respectively, more likely than control subjects to be violent. Persons with at least 1 of these 3 disorders constituted one fifth of the sample, but they accounted for half of the sample's violent crimes (10% of violence risk was uniquely attributable to schizophrenia-spectrum disorder)"
This states "Looking at the risk of acquiring a first conviction, there is an independent but modest effect of schizophrenia (hazard ratio = 1.4), but the effects of gender, substance abuse, ethnicity and age at onset were more substantial.".
This states "The crime rate among male schizophrenics was almost the same as that in the general male population, whereas among females it was twice that of the general female population. The rate of violent offences was, however, four times higher among the schizophrenics. The violence recorded was almost exclusively of minor severity."
In the short term, I'd recommend whittling the "violence" section of this article down to assertions we can document, using numbers whereever possible, even if that means making the section much shorter for now. Would you be willing to take a look at that section and try to smooth it out? Obviously a topic like this has public policy implications, so it's important that it be as accurate as possible.--Arcadian05:36, 1 December 2005 (UTC)
To be honest with you, Arcadian, most of my edits are dismissed out of hand due to the fact that I am very much against forced drugging. You make great points above and I'll leave it to another editor to shape up the article accordingly. -- Francesca Allan of MindFreedomBC
I understand. In that case, I think the most useful PubMed article would be the one that mentions a hazard ratio for people with schizophrenia of 1.4 -- a moderate but measurable predictor of violent behavior. But I won't rewrite the violence section yet; instead I'll wait a bit and see if anyone else has an opinion here, since this is a contentious issue. --Arcadian18:33, 1 December 2005 (UTC)
Hi Arcadian,
I think the Wessley et al article is certainly a valuable addition to the section on violence. All the assertions in the section, however, are from peer-revied scientific papers (see references in main text). Please let me know if you are uncertain of any of the one's quoted, and I'd be happy to provide the relevant information or full text of the paper.
Perhaps this article would be better titled "Schizophrenia and Alternative Views". Why not add the schizophrenogenic mother theory? That theory was more widely held and used for "treatment" in the days of Mosher, Szasz and Laing. You might as well title it what it is because there is a significant portion of the content referenced to alternative views from main stream psychiatry.
I'm a mother with a son with treatment resistent schizophrenia and a member of the Schizophrenia Society of Canada. Personally, I don't think that Wipkipedia will work for topics such as schizophrenia. It's no different than a personal web page. Oh well.
No need for quotation marks around the word treatment if you're referring to Mosher as he accomplished a lot more than Torrey and his ilk ever have. I'm not familiar with Laing's work but I consider Szasz to be one of the world's great intellectuals. The startling difference of Mosher's approach is that he loved his patients. Mainstream psychiatry, on the other hand, appears to despise them as evidenced by Torrey's various diatribes against the mentally ill. Attempting to group the wide variety of symptoms and causes under one heading "schizophrenia" is really problematic. The debate and chaos in this wiki article and discussion reflect that. Francesca Allan of MindFreedomBC01:14, 3 January 2006 (UTC)
I also happen to think that wikipedia is an ideal place to discuss schizophrenia so as to incorporate a wide range of views (including sometimes from those who have been diagnosed with it) as opposed to the Schizophrenia Society of Canada which just promotes the tired old biochemical model and can't tolerate dissent. Francesca Allan of MindFreedomBC01:16, 3 January 2006 (UTC)
Wikipedia has a low expert density. We're still looking for a psychiatrist who is willing to take on the monumental task of brushing up the professional information on this subject. I highly respect Vaughan (talk·contribs) for his dedication to this page.
Schizophrenia is highly prevalent, enormously debilitating and notoriously hard to treat. That alone, plus its poorly understood causality, makes for lots of alternative theories. Not everything is as clear-cut as hemophilia, in which one broken gene causes everything and has clear and straightforward interventions.
The title should not be changed. There is no reason why the article should be dedicated to spreading the lies of mainstream psychiatry. What is this "treatment resistent schizophrenia"? Apparently resisting "treatment" is held as a symptom of an illness. This is a totally absurd point of view. BTW, suppose that there would be a case where a person would have been diagnosed with schizophrenia and a significant part of the symptoms would be about resisting "treatment". This would practically mean that the diagnosis would be mostly crap. If "resisting treatment" is held as a symptom of schizophrenia or any other mental illness it is a clear sign that psychiatric diagnoses are pseudoscientific and part of the violence apparatus of the bourgeois state. BTW, I once tied a bicycle chain to the door of mental health office in Oulu, Finland (this was in 1999). Many people, including the director of the Oulu mental health centre, saw this. I was locked into a psychiatric hospital again on the same day. I was then having a holiday from the psychiatric hospital and I was supposed to be acquitted. The (Finnish) mental health system also uses family values as a weapon when they terrorize and humiliate the people diagnosed "mentally ill". Some Mitläufer people actively cooperate with psychiatry when it terrorizes their relatives. --Tommi Höynälänmaa
There may indeed be a low expert density on Wikipedia. That, however, is not necessarily the case with regard to disorders of mood and mind. I have been approached by several of the admins regarding contributions to this, and other, topic areas in which I am considered to hold some expertise, possibly even some authority.
I will endeavor to lend myself to the clean up and clarification of this article, and also make an effort to void it of the rampant POV and positionality, and, in some cases, frank nonesense that issues from comments like those being posited by various individuals in this and other conversations on this page.
Great to hear you're keen to contribute to the article. All that is asked is that changes are referenced with peer-reviewed articles from reputable journals where appropriate. This means that everyone can check the veracity of contributions, regardless of their expertise.
An interesting study came out yesterday. [8]. There are pretty good summaries here, here, and here and the whole report (warning: PDF) is at [9]. Not sure where/if it might fit in, though.--Arcadian20:36, 8 December 2005 (UTC)
This 'research' seems a coy, obtuse, verbose and euphemistic rediscovery of the fact that privelege brings freedoms to act in certain ways - and, to a greater extent, to get away with it. One of the links is already no longer functioning, so if you want to preserve this information you might want to think about recording it. Etaonsh06:53, 7 May 2006 (UTC)
Footnote reordering
I reordered all the footnotes on the page using a script I wrote. I hope I didn't mess up anything, I don't think I did. In the process, I discovered a few {{Fnb|..}}s in the references that did not have a matching {{Fn|..}}, so I took them out. The following references were removed:
^23 Psychiatrie. 8. Aufl., Bd. 1: Allgemeine Psychiatrie; Bd. 11: Klinische Psychiatrie, 1. Teil. Barth, Leipzig 1909. Bd. 111, 1913; Bd. IV, 1915. (Translation of section on the disease from the German) ^52Read, J. & Argyle, N. (1999) Hallucinations, delusions, and thought disorder among adult psychiatric inpatients with a history of child abuse. Psychiatric Services, 50, 1467-72. ^60Lahti AC, Weiler MA, Tamara Michaelidis BA, Parwani A, Tamminga CA. (2001) Effects of ketamine in normal and schizophrenic volunteers. Neuropsychopharmacology, 25(4), 455-67.
Thankyou so much for doing this. The article really needed some sensible reference ordering and has greatly benefitted from it.
I've just replaced one of the removed references which was obviously not there correctly (my fault, as it was one I included in the recently added section on glutamate / NMDA).
Perhaps you'd be so kind as to run the script every few months or so to help keep the article in order?
It makes me happy that you liked it, Vaughan! I will happily run the script when needed. Please feel free to remind me on my talk page, also tell me if you know any other pages that would benefit from this. Also, the script is available here. /Skagedal22:08, 14 December 2005 (UTC)
...on the other hand (I just discovered), the ref template does the numbering automatically, as in autism and many other articles. Using this would probably be much better! I can do this change if people think it's a good idea. /Skagedal00:43, 15 December 2005 (UTC)
Tobacco
Furthermore, many people with schizophrenia have smoked tobacco products long before they are diagnosed with the illness, and some groups advocate that the chemicals in tobacco have actually contributed to the onset of the illness and have no benefit of any kind.
I'm afraid this one slipped through my net. I'm not sure where it came from, but perhaps needs a little checking out to see if it warrants remaining in the article, as it sounds a little suspicious to me.
The references presently use a full URL to link to PubMed abstracts. A quicker way is simply inserting PMID [number] after the reference, which is automatically turned into a link, such as PMID12345678. JFW | T@lk20:53, 18 January 2006 (UTC)
Are there countries where the legislation does not allow involuntary commitment?
A quote from the article:
"Mental health legislation may also allow people to be treated against their will. However, in many countries such legislation does not exist, or does not have the power to enforce involuntary hospitalization or treatment."
Are there countries where involuntary commitment is not legally possible? What are these countries?
-- Tommi Höynälänmaa
Avoiding stigmatization
Read through this article and found it good and striving for objectivity in most senses..
However, the list of "Notable people affected by schizophrenia" seemed a bit judgmental. In my opinion, judgment and stigmatization is exactly was has to be avoided in the public discussion on any psychiatric diagnosis.
Furthermore, after looking through the list, I noted that some of the examples were largely speculative..
I changed to Notable people commonly believed to have been affected by schizophrenia, instead. Anybody opposing this?
--Serrano11:16, 23 January 2006 (UTC)
I also noticed that the list of "notable possibly schizophrenic individuals" is fuzzy. John Kennedy Toole, for example: there's no mention of schizophrenia on his own page. (Famous suicide, yes.) Someone want to delete him if they corroborate this? Bombyx06:20, 20 February 2006 (UTC)
Changes
Vaughan, why have you re-added the claim I have removed? That is an article about cigarettes. In the abstract which claims that schizophrenics are at an increased risk of violence, that is stated as the author's opinion, not a result of their study. --Mihai cartoaje18:43, 24 January 2006 (UTC)
Hi Mihai cartoaje,
The reference is incorrectly placed by the looks of it. It is indeed correct, but for the previous reference point (in 'Schizophrenia and drug use: Tobacco'). I'm just having a look and am trying to sort it out now.
The claims made in this paragraph are difficult to verify:
Research has suggested that schizophrenia is associated with a slight increase in risk of violence, although this risk is largely due to a small sub-group of individuals for whom violence is associated with concurrent substance abuse, active delusional beliefs of threat or persecution, and ceasing effective treatment for previous violent behavior51. For the most serious acts of violence, long-term independent studies of convicted murderers in both New Zealand52 and Sweden53 found that 8.7%�8.9% had been given a previous diagnosis of schizophrenia.
In detail,
Research has suggested that schizophrenia is associated with a slight increase in risk of violence,
For the most serious acts of violence, long-term independent studies of convicted murderers in both New Zealand52 and Sweden53 found that 8.7%�8.9% had been given a previous diagnosis of schizophrenia.
I would read the full articles if they are mailed to me. I do not have access to them. I can remove claims which I cannot verify because other wikipedia readers shall not be able to either. --Mihai cartoaje06:13, 25 January 2006 (UTC)
Hi Mihai,
Unfortunately, much scientific literature is not open access and so readable by the general public. However, the point of the references is that they do confirm the points mentioned. It is common practice for the authors of the papers to provide the full text if you contact them personally, though, so you might want to do this. Also, most universities will have access to the references articles. So the points can be verified either visiting a university library (most are open to the public, although you may have to contact the library first) or by asking someone at a university to provide them for you.
You can read the British Journal of Psychiatry journal yourself, because all BJP articles are available free online 6 months after they are published. The fact that it is available online is clearly stated in the PubMed entry.
I've also taken off the 'disputed section' notice off the violence section as so far you've not provided any scientific evidence that opposes what has been reported in the studies referenced. I will have a look and would be very grateful if you could find any studies that do contridict the reported findings so the section could be updated.
Nowhere in the article does it claim that antipsychotics cure schizophrenia. As to your second point, however, there has been a number of studies that have linked poor diet to schizophrenia, although, unfortunately, many of them are correlational, making it difficult to assess the strength and causal contribution of diet to the chance of being diagnosed with the condition. There has been some interesting work on the diet of pregnant women and the chance of their children later developing schizophrenia, and some supplementation / RCT trials, which provides some additional support though.
I think you've identified an area which the current article does not really tackle adequately. Perhaps you'd be interested in looking at some of the scientific literature on PubMed and as a bases for a contribution to the article in this area?
I am moving the Violence perpetrated by people with schizophrenia section here because this is not verifiable and I doubt its veracity and it needs verifiable sources in accordance with WP:V:
Although schizophrenia is sometimes associated with violence in the media, only a small minority of people with schizophrenia become violent, and only a minority of people who commit criminal violence have been diagnosed with schizophrenia.
Research has suggested that schizophrenia is associated with a slight increase in risk of violence, although this risk is largely due to a small sub-group of individuals for whom violence is associated with concurrent substance abuse, active delusional beliefs of threat or persecution, and ceasing effective treatment for previous violent behavior51. For the most serious acts of violence, long-term independent studies of convicted murderers in both New Zealand52 and Sweden53 found that 8.7%–8.9% had been given a previous diagnosis of schizophrenia.
and this belongs in an article on neuroleptics and/or childhood:
There is some evidence to suggest that in some people, the drugs used to treat schizophrenia may produce an increased risk for violence, largely due to agitation induced by akathisia, a side effect sometimes associated with antipsychotic medication.54 Similarly, abuse experienced in childhood may contribute both to a slight increase in risk for violence in adulthood, as well as the development of schizophrenia.16
Hi Mihai,
The information in the 'Schizophrenia and Violence' section has verifiable sources as can be plainly seen from the references. I have given you several methods for obtaining the papers, including contacting the authors which costs nothing - and reading the British Journal of Psychiatry paper on the web - which is freely available at this link.
However, I have uploaded the papers to save you the trouble of obtaining them for yourself. Click on the 'full text' link after each reference for the full paper.
Note 51. Walsh E, Gilvarry C, Samele C, Harvey K, Manley C, Tattan T, Tyrer P, Creed F, Murray R, Fahy T (2004) Predicting violence in schizophrenia: a prospective study. Schizophrenia Research, 67(2-3), 247-52. FULL TEXT
The subjects have been hospitalized twice for psychosis, so it is safe to assume that they had been exposed to neuroleptics (and possibly even electric shocks), so the measurements might have been of the effects of neuroleptics/ect, and not of schizophrenia. Also, they say that their study has failed to find a relationship between delusions and violence.--Mihai cartoaje05:24, 14 February 2006 (UTC)
Note 52. Simpson AI, McKenna B, Moskowitz A, Skipworth J, Barry-Walsh J. (2004) Homicide and mental illness in New Zealand, 1970-2000. British Journal of Psychiatry, 185, 394-8. FULL TEXT
Note 53. Fazel S, Grann M. (2004) Psychiatric morbidity among homicide offenders: a Swedish population study. American Journal of Psychiatry, 161(11), 2129-31. FULL TEXT
You will note that the text in the 'Schizophrenia and Violence Section' faithfully reports what is said in these papers and that the papers are published in peer-reviewed scientific journals (in fact, in three of the most important in the area).
To be specific, I will quote from the 'Schizophrenia and Violence' section and then the sections from the papers directly.
From the wikipedia article: "Research has suggested that schizophrenia is associated with a slight increase in risk of violence, although this risk is largely due to a small sub-group of individuals for whom violence is associated with concurrent substance abuse, active delusional beliefs of threat or persecution, and ceasing effective treatment for previous violent behavior" (note 51 - Walsh et al., 2004)
From the Walsh et al. (2004) paper (p247): "People with schizophrenia are more likely to be violent than the general population, albeit by virtue of the activity of a small subgroup (Tiihonen et al., 1997; Brennan et al., 2000; Arseneault et al., 2000). To date, three factors have been suggested to identify those with psychosis at increased risk of committing violent acts: co-morbid substance misuse (Swanson et al., 1990; Cuffel et al., 1994; Tiihonen et al., 1997; Brennan et al., 2000; Arseneault et al., 2000, Walsh et al., 2001), medication noncompliance (Swartz et al., 1998) and active psychotic symptoms (Taylor, 1985; Swanson et al., 1990, 1996)."
From the wikipedia article: "For the most serious acts of violence, long-term independent studies of convicted murderers in both New Zealand (reference 52; Simpson et al., 2004) and Sweden (reference 53; Fazel and Grann, 2004) found that 8.7%�8.9% had been given a previous diagnosis of schizophrenia."
The Simpson et al. (2004) study actually says that 8.7% of homocide offenders had a diagnosis of mental illness, so the figure quoted in the text incorrectly suggests that this figure represents schizophrenia alone. The figure for schizophrenia is 3.7% (p395: "The total number of people committing homicide in the study period was 1498". "Diagnostically, 55 had a primary schizophrenic disorder, 19 another psychotic disorder, 13 major depressive disorder (primarily from the infanticide group) and 5 a bipolar disorder". - 55 of 1498 is 3.7%). This will be corrected in the text - thanks for picking this up!
From the Fazel and Grann (2004) study, see the first row on Table 1 where 8.9% of Homocide Offenders in Sweden, 1988-2001 have been given a diagnosis of schizophrenia.
Furthermore, the information on childhood trauma and neuroleptic induced violence is directly relevant to the schizophrenia article because both studies directly address the issue.
If you have disagreements with how these studies have been carried out, then please address your concerns to the medical journal concerned. Wikipedia is not the place for original research.
If you can find studies (published in peer-reviewed scientific journals) which contradict the general message of the section, please add them as it would greatly enhance the information presented.
I hope you can see that the claims made in the (now corrected) 'Schizophrenia and Violence' section accurately represent those made in the scientific literature.
Importantly, they suggest that, in contrast to the impression given by the media, people diagnosed with schizophrenia are barely more likely to be violent than the general population and are more likely to be victimised than other members of the general population.
I think it's important as it counters many of the myths of schizophrenia. In particular, it was created in response to comments and edits on the article (see section of this page entitled 'Medication skipping shizos murder people everywhere') which erroneously suggested that people with schizophrenia are dangerous.
Please do not delete the schizophrenia and violence section. The talk page has demonstrated that this is an important issue as there is a great deal of prejudice about concerning the link. Indeed, common misperceptions about the issue are often cited as sourced of prejudice. e.g. the Mind information sheet about public attitudes to mental illness notes this as a problem. Having the correct information is, therefore, important in countering such stigma.
The NIMH site also says that antipsychotics do not cure schizophrenia [11] but it has inaccuracies. For example, it lists this as a symptom of schizophrenia:
Dissorders of Movement. People with schizophrenia can be clumsy and uncoordinated. They may also show involuntary movements and may show grimacing or unusual mannerisms. They may repeat certain motions over and over or, in extreme cases, may become catatonic. Catatonia is a state of immobility and unresponsiveness that was more common when treatment for schizophrenia was not available; fortunately, it is now rare.
And it's worth keeping the additional referenced point on weight gain, obesity and atypical antipsychotics. This is a well known clinical phenomenon that is reliably found in the scientific literature. Thanks!
Hey guys, ok, seeing as you both agreed to mediation I'll start here, first a couple of questions, Mihai, what are your specific complaints regarding the section. It seems fairly well sourced, I'll add a couple of fact tags to points I think are contentious... It also isn't treated in more weight than necessary for the size of the article. Could you outline the specific complaints below. - FrancisTyers11:15, 14 February 2006 (UTC)
Apologies for just rv'ing the article without discussion. I noticed the change before the comments, so I'll add the justification here. I don't think the fact tags are needed as the citations below justify the initial summary sentence. If you check these citations it does indeed support the assertion that "only a small minority of people with schizophrenia become violent, and only a minority of people who commit criminal violence have been diagnosed with schizophrenia". I'll be happy to add the references again though.
Having a section titled Schizophrenia and violence makes that the words "Schizophrenia and violence" appear at the top of the article. A reader who only reads the top of the article can think that people diagnosed with schizophrenia are violent, which can cause prejudice and discrimination.
Francesca, who has written on this page, has been diagnosed with schizophrenia and she is not violent. I think that Wikipedia's policy on attack pages applies. --Mihai cartoaje08:12, 15 February 2006 (UTC)
Interesting, but the section explicitly states that people with Schizophrenia aren't violent and are at a higher risk of being subject to violence.
Any discussion of violence statistics can make readers think, "There must be a reason why they are discussing violence statistics. Schizophrenia patients must be violent," especially since no other Wikipedia article on groups of people or health disorders has violence statistics.
Violent statistics are not helpful in having a biological understanding of schizophrenia. The main proponents of the issue of violence and schizophrenia are forced-drugging advocacy groups.--Mihai cartoaje07:52, 16 February 2006 (UTC)
I can see what you mean, how about having a section on media perceptions of people with Schizophrenia. The Post-traumatic stress disorder article has a section on Law which touches some similar subjects, although it isn't worded in the same way - I've heard reports in the media of people with PTSD going postal. Wikipedia is definately not here to leave out information just because the viewing public might get the wrong idea. It is not censored. Thinking more about it, I can appreciate your concern with including a section on public perceptions in this article as none of the other articles I've read regarding mental illness have such a section. Perhaps a separate article could be created to cover these issues and a see also could be added?
I withdraw my argument about public perception. Remains that it is advocacy spam from force-drugging advocacy groups such as TAC. It also tells us nothing about schizophrenia and adds no value to the article.--Mihai cartoaje14:10, 16 February 2006 (UTC)
Hi there,
It seems a little bizarre to claim that providing information showing that people with schizophrenia aren't likely to be violent leads to the impression that people with schizophrenia are violent.
Giving people accurate information is the key to fighting stereotypes and prejudice. Simply avoiding the issue and staying quiet seems to do nothing except let innaccurate judgments go unchallenged.
Perhaps the title could be renamed, however. Perhaps something like "Forensic issues and schizophrenia"?
I'm a bit confused, surely if it was spam from this group, the section would be saying that schizophrenia sufferers are more likely to be violent? Unless I'm reading it incorrectly it says that they aren't more violent and in fact are more at risk from violence? I can see your point that it doesn't relate to the biological causes or effects of schizophrenia, but we do have a section on Notable people thought to be effected by Schizophrenia, which kind of has a popular culture edge to it, how does that add any more value to the article than the section on violence or popular perception (which could be renamed)?
Vaughan, I'm not sure if that would be an appropriate title as the section does not particularly deal with Forensic issues, at least as I see it. Any other suggestions from any parties or any other objections? - FrancisTyers22:25, 16 February 2006 (UTC)
Hi there,
In terms of psychiatry, anything related to crime is a forensic issue (see Forensic psychiatry), so the title would be appropriate, although, I think you've just pointed out that the majority of general readers would not understand this reference. Probably suggesting that it's not a good title. I'm also a little confused about the point about biological explanation. Also it assumes that the article should only be about the biology of schizophrenia which is a very narrow approach to the topic and ignores a great wealth of information on the subject.
Ah ok, I see your point, but yes, this could easily be misunderstood. Well, I'm not sure that this article should be solely about the biology, it should be an introduction to the field of Schizophrenia, if parts are too big they should be separated out into their own articles as is common WP practice. Mihai was concerned that this didn't apply to the biology, although there are other sections in the article which don't either, for example the Notable people and Alternative approaches to schizophrenia sections. I think he has a valid point that there are groups that advocate drugging schizophrenia sufferers by force and that this might have room to be explained in any section covering public perception, the heading Schizophrenia and violence isn't really wide enough to cover this.
Mihai, do you have any other objections besides the fact that this section doesn't relate to the biology of schizophrenia? Would you be more happy if the section included some information on the existence of forced drugging advocacy groups? - FrancisTyers09:46, 17 February 2006 (UTC)
Yes and no. I don't like Schizophrenia and forensics better. Francis, I thank you for your time, but I feel like taking a break from discussing this as it is not obvious to me that Vaughan and me are progressing fast toward a concensus. --Mihai cartoaje12:08, 19 February 2006 (UTC)
No problem, as you wish. I thought we were getting somewhere, but maybe not. :) I'll close the case and I hope you'll refrain from edit warring about this. If you need further assistance in the future, please feel free to either reopen the existing case or file a new case with the MEDCAB, and of course feel free to request a different mediator if you think that might help. Thanks for staying polite guys, its refreshing not to have to warn people about personal attacks and civility :) - FrancisTyers21:26, 19 February 2006 (UTC)
Rewording to cover caveats but avoid labyrinthine wording
Hi Vaughan
I agree with your re-edit to avoid labyrinthine wording, but as a result I have some issues with it again - I wonder if there is a solution.
1) I would say Schizophrenia is now a wider clinical psychology and mental health term/diagnosis, not just psychiatric.
2) The intro still talks about describing a disorder, rather a describing a mental pattern which some say represents or indicates a disorder. (For similar reason the phrase 'A person experiencing untreated schizophrenia' doesn't sit easy - can you have someone experiencing treated Schizophrenia? Highly arguable that there is a treatment in this sense anyway)
3) The pattern of thoughts, emotions and behaviours of those seen as having Schizophrenia should not be described only as 'impairments'. Some can be seen as simply different to the norm, often in a positive way (e.g. can lead to novel insights, creativity).
Hi Franzio, thanks for your insightful comments.
1) I would say Schizophrenia is now a wider clinical psychology and mental :health term/diagnosis, not just psychiatric.
I would agree that diagnosis is not just the domain of psychiatrists, but the terms related to 'psychiatry' can also refer to the general healthcare of mental illness (e.g. psychiatric nurse), so defining something as a psychiatric diagnosis does not restrict it any particular profession. Furthermore, the DSM is a product of the American Psychiatric Association, so even in this narrower sense, the diagnosis is 'psychiatric'.
2) The intro still talks about describing a disorder, rather a describing a mental pattern which some say represents or indicates a disorder. (For similar reason the phrase 'A person experiencing untreated schizophrenia' doesn't sit easy - can you have someone experiencing treated Schizophrenia? Highly arguable that there is a treatment in this sense anyway)
3) The pattern of thoughts, emotions and behaviours of those seen as having Schizophrenia should not be described only as 'impairments'. Some can be seen as simply different to the norm, often in a positive way (e.g. can lead to novel insights, creativity)
I can see exactly your point here. My reasoning is partly to do with attempting to describe what the diagnosis aims to represent and partly to do with the structure of the article.
The diagnosis itself (see the DSM definition) does describe 'disorganisation', 'lack' and 'dysfunction', and so by these criteria, the diagnosis represents a disorder. Note, however, that none of these criteria explicity apply to the experience of (for example) delusions and hallucinations, which could be experienced without significant impairment, and I presume this is the debate you are trying to capture. In other words, is the diagnosis valid?
I think this is an important issue, and is highlighted further down the introduction and covered in some detail in the 'Diagnostic issues and controversies' section. My structural reason for describing what the diagnosis aims to represent in the very first paragraph would be that I think it should contain the mainstream description and debates about how accurate or useful this might be can be tackled further down. For example, the article on evolution describes the mainstream description in the introduction before discussing the debate over its validity later on.
In terms of potential benefits of unusual patterns of thoughts and behaviour I entirely agree that some of the experiences that could lead to a diagnosis of schizophrenia can be associated with certain benefits (e.g. creativity). Actually, this point is included in the schizotypy article, which I have just noted is linked from the 'See Also' section but not from the main text. I've now included this link in the overview section.
Hi Vaughan, thank you for the helpful and interesting points. I would only differ in some ways:
1) I feel that defining something only as a psychiatric diagnosis would restrict it to the psychiatric (medical) professions. I agree that this is the reality and origin of the term in a sense, but it is also in common and varied usage in psychology and other fields, and it is defined not just by the DSM but by the ICD, a product of a public health rather than psychiatric orgnaisation. So I feel it would be more accurate if the introductions could refer somehow to both a psychiatric diagnosis and a term in common and different usage in other fields.
2) I agree this is partly about questioning the validity of the diagnosis and that this is covered further down. But it is also about making sure that this diagnostic practice is put in its proper context in the introduction. The context being, it seems to me, that certain approaches propose that this kind of mental/behavioral pattern represents a distinct disorder which some approaches categorically separate out from 'normal' experience via a label and criteria they have constructed (i.e. they do not follow only from scientific findings). I think your phrase above 'attempts to represent a disorder' may capture this to some extent.
3) I didn't see the schizotypy link before, it's an interesting article and does address the points I was getting at. But I think the point about difference as well as impairment does also apply to schizophrenia, and in relation to thinking as well as hallucinations etc. Mathematics and several other fields wouldn't be where they are today if not for John Nash's impairment and disordered thinking...clearly he is an exceptional case but there are many others in scientific and artistic fields, famous or not.
p.s. I've noticed that Expressed Emotion only appears to be mentioned as one small aside about 'emotionally turbulent families'. Get the impression there was more on this but its been taken out? I know it's a sensitive issue that needs to be phrased in a non-blaming way, but it is a large and important area of research, and relates to staff as well as family.
Franzio
Hi Franzio
I would disagree that defining something as a psychiatric diagnosis restricts something to the medical professions, but I would also note that the diagnostic concept has always been driven by psychiatry. For example, it was first identified by Kraepelin and refined by Bleuler and Schneider, all psychiatrists, and although the ICD has public health origins, the section on mental disorder was added by a committee of psychiatrists chaired by psychiatrist Erwin Stengel. The reality is, that it is a 'psychiatric diagnosis' in this sense (and is typically representated as such in the literature) and it is not restricted to medical professions, as any clinical psychologist, social worker, or mental health lawyer would testify.
I think you've got a good point about putting the disorder in context in the first paragraph. I've attempted to do this a little better in the recent edit. I'm still a little concerned that the first paragraph should primarily communicate the mainstream definition, but I'm hoping that the current or subsequent versions can do this, as well as note the central debate within schizophrenia research.
I think your point about Nash is interesting, but many critics would note that Nash's contributions (like many other famous people with the diagnosis) were largely created when he wasn't experiencing schizophrenia (contrary to how the film portrays him). It's always difficult to use such individual cases to illustrate this point, as maybe these people would have been even more creative had they not had their experiences. I'm not saying this is the case, but it's a difficulty when using them as examples. Indeed, this is why the diagnostic criteria includes the 'six months of occupational and social dysfunction' criterion. For this reason, I think the schizotypy research provides better evidence in this regard and the idea might be more fully and appropraitely discussed in articles on schizotypy or psychosis which are concepts that do not necessarilly involve any measure of 'dysfunction'.
I entirely agree with you on the point about expressed emotion. I think the article could do with some additional description of the early Camberwell studies and the particular findings of (for example) Elizabeth Kuipers work that notes which specific aspects of EE are know to particularly impact on relapse (e.g. criticism).
Bit of an extended answer, but your thoughts are welcome.
Thanks for your feedback Vaughan. I can see your point about origins and who has done the official defining to date, although I would still personally want to include that it is a diagnosis and wider concept being used and developed by non-psychiatric professionals and researchers.
Your point about Nash is challenging. I once read that someone asked Nash how, as a man of logic, he could possibly have believed some of the wackier things that he had, and Nash replied that they had come to him in the same way/from the same part of his mind as did any of his other ideas. This would seem to be the case generally from the schizotypy research. Why he stuggled more at some points in his life than others seems a very complex question; but no one would guess from these categorical diagnostic descriptions of Schizophrenia that there is this continuum and that the same underlying processes can lead to achievement and value.
I think one issue is that these clinical criteria are primarily focused on defining when someone is problematic enough (for themselves or their society) to need care etc. They are not necessarily giving a balanced representation of the full range of processes and abilities involved, which is why I think they are dubious as supposedly neutral or official sources. And why so many object to the stigma they cause, especially when so widely used to label people or refer to a supposed underlying pathology as well as to refer to particular states of mind (you seem to be using it in the latter sense which seems more acceptable to me).
Such criteria also conflate the internal mental processes of a person with the interaction between a person and their society, assuming that success in society is a test of health and appropriate mental 'order'. The social model of disability, talking of people being differently abled or as being disabled by society, now seems to be a pretty mainstream view but you wouldn't guess it from psychiatry.
I agree that such issues might be more fully dealt with in pages on schizotypy or psychosis etc, although of course many view 'schizophrenia' as just a hodgpodge diagnostic bin for those who have varying and varied combinations of these different issues in their thinking/perception (and therefore more dysfunction, despite the underlying processes being the same).
I was thinking of the EE work and aspects you mention, I could try to add something on those if I get time unless you plan to.
Clinical depression is a state of sadness or melancholia that has advanced to the point of being disruptive to an individual's social functioning and/or activities of daily living. The diagnosis may be applied when an individual meets a sufficient number of the symptomatic criteria for the depression spectrum as suggested in the DSM-IV-TR or ICD-9/10....
To follow the same pattern, we can start this article with,
Schizophrenia is a state of disorganized thoughts that has advanced to the point of being disruptive to an individual's social functioning and/or activities of daily living. The diagnosis may be applied when an individual meets a sufficient number of the symptomatic criteria for schizophrenia as suggested in the DSM-IV-TR or ICD-9/10....
I prefer that in some ways. Another possibility might be something like:
'Schizophrenia is a psychiatric and general mental health term referring to a mental state or trait characterized by unusual perceptions (e.g. hearing internal voices), cognitive processes (e.g. beliefs appearing delusional) and communication (e.g. appearing to go off-topic). Guidelines which are predominantly psychiatric (see DSM and ICD) propose cut-off criteria for diagnosing this as a disorder if it causes a particular degree of distress or problems for the person and/or their society'
I think it's important to mention that the above descriptions only really describe the positive symptoms of psychosis, and schizophrenia is generally defined as more than simply experiencing psychosis, otherwise the article would not make the distinction between diagnoses such as schizophrenia, schizophreniform disorder, brief reactive psychosis and so on.
The ICD also includes subtype of schizophrenia called 'simple schizophrenia' where psychosis can be absent, and the DSM includes the 'residual subtype' where psychotic symptoms can be hardly present.
How about just reflecting the WHO ICD statement then: "the schizophrenic disorders are characterized in general by fundamental and characteristic distortions of thinking and perception, and affects that are inappropriate or blunted". But I would personally use different words to 'distortions' and 'inappropriate' to reflect that in a more neutral sense they are just different from the typical. Or else, add something about negative or unusual affect to the above (I had included mention of mental processes including feelings and thoughts, but then just gave the example of delusions). Franzio09:31, 3 March 2006 (UTC)
Hi Franzio,
I think that's a fantastic idea. Certainly, referring to the WHO definition avoids a lot of argument about its definition, allows for context for the stated diagnostic criteria and allows room for criticisms of the diagnosis and concept.
I would say it can help achieve that good balance you describe, as long as it is not presented as the definition, or as from an NPOV source (because it is one medical care source, using a particular terminology). Franzio12:13, 3 March 2006 (UTC)
Has this come to any conclusion or are we waiting for more views? I feel like I'm going on too much so I won't keep doing so. But I think the opening statement really needs clarifying because even according to the DSM there only needs to be some 'dysfunction' for a 'significant period' after onset (which only has to be less than previously or expectations, which may have been very high). And only needs to be in one of social, occupational or self care areas, so not necessarily social. And this doesn't exclude the possibility of high functioning and achievement in some areas or completely for most of the time. And as you mentioned it needs to include the negative/flat emotions aspect too. Franzio16:01, 9 March 2006 (UTC)
Expressed Emotion
I've added a paragraph on this to the environmental influences section, and couple of other edits in that section. I have citations for everything stated, but I do not know how to insert these using the number system (so that they are in the right number order in the text and the references list at the end), despite trying to read the help article on citation. Can anyone briefly clarify? Franzio10:35, 6 March 2006 (UTC)
Hi Franzio
The expressed emotion section is fantastic, many thanks for adding that.
As for citations, just add them as references on the end and don't worry about the citation numbers being 'out of place' in the text. Skagedal kindly wrote a script which orders the references which we'll run once in a while to stop them becoming such a spaghetti.
The only advice would be that it's tempting to reference everything as there's usually a huge amount of research on schizophrenia for any particular area, so, if possible, reference review articles or select key papers.
I've removed some of the references and replaced them with a single reference to the most recent review article in this area (which references the citations you added) which should hopefully keep things a little more brief (and more current).
Also, I've removed the reference to the Gallup poll on paranormal beliefs. Although this is frequently cited in the psychosis continuum literature, it doesn't actually have anything to say about the prevalence of delusions in the general population. It just suggests that unscientific beliefs are quite prevalent and these might be on a continuum with delusional beliefs (which are defined and diagnosed in quite a different way). See the Johns and van Os (2001) paper for a good discussion of this.
I think the EE reference you added is great, but is focused on family and doesn't really address staff, and doesn't seem to cite the articles I'd referenced (although one appears similar). As EE is commonly perceived to relate only to family I felt this was important, and gave both a study providing primary data and a more recent 2003 review article. I will put the review one back in if no objections.
The Gallup poll data appears highly relevant to me. The definition of delusion is a matter of much professional difference and debate, and attempted categorical divides are widely accepted as unsatisfactory in both theory and diagnostic practice. In any case, even if not making a technical claim about continuity, Schizophrenia is widely described as involving unusual beliefs and it appears important to put this in the context that, for example, 32% of Americans believe in ghosts/spirits and 31% in telepathy/clairvoyance. If no objections I will reinstate a Gallup link but to the most recent data in 2005 (http://poll.gallup.com/content/default.aspx?ci=16915&pg=1), clarifying this context.
Franzio11:07, 10 March 2006 (UTC)
Hi Franzio,
I have to say that I strongly disagree about the Gallup poll being relevant. It's important to note that the poll shows exactly that these beliefs aren't unusual at all. There's just unscientific and prevalent. The delusions literature from Jaspers on clearly makes a distinction between unusual beliefs and those that are delusional based on non-content criteria such as fixity, incorrigibility, primary changes in semantic meaning etc etc so to cite it in reference to delusions and schizophrenia seems simply to muddy the waters.
I'll revist the EE review paper, as if the information you mention is missing, it wouldn't be the same as having the individual references in the article.
I don't understand why you feel so strongly against it Vaughan. The similarities and overlaps in content is one of the reasons why the attempts have been made to differentiate them by other features (although they also usually overlap and vary) - this is surely something which can be usefully pointed out to people. Secondly, schizophrenic beliefs/delusions are widely assumed to be completely wacky and abnormal in terms of content (and obviously in most fields and general usage these terms are assumed to mean content) so it can really help reduce stigma and increase understanding to show the wider connections (an aim Jaspers would have agreed with, as I understand it). Thirdly, I completely disagree that the literature adopts a clear accepted definition or distinction, the less so in recent years with proliferating multifactorial approaches which often make connections between the content of the beliefs associated wtih schizophrenia and those held more widely, in terms of cognitive processes, personal meaning or social context.
Hi Franzio
Despite the ambiguities in the literature on criteria for defining delusions, the majority of people are not considered delusional, nor would they be diagnosed as such by a competent clinician, simply because they believed in ghosts. Hence, my objection is to inserting the reference is that it would simply confuse matters without the great deal of context needed to understand why it's relevant.
Your text directly above is very useful in this regard, but adding this necessary explanation is not appropriate for the article on schizophrenia when this is an issue which applies to delusions in general (from whichever diagnosis they are 'attached' to) and so would be better included in the delusion article in my view.
The dealing with stigma is important, but it also applies to people with unusual beliefs who are not distressed or impaired by them (i.e. in this Peters et al. (1999) study). Without enough context in the article there is a danger that the reader might go away thinking that any unscientific or unusual belief is a sign of mental illness.
I assume the review on EE and professionals can be reinserted, if no other problems with it. It looks like there is only the review you added left now. As this isn't specific to Schizophrenia or indeed to mental health, I feel another paper on EE and Schizophrenia which goes into more specific depth can also be added. This would be no more citation than for other issues addressed in the article. Franzio13:05, 13 March 2006 (UTC)
I've just re-read the Wearden et al. (2000) paper and I agree. Another relevant EE paper would certainly add missing depth. Thanks for looking over this so carefully.
Ok I've reinserted the two EE refs. So there are now three main ones in order to address: schizophrenia and EE in families; EE and professional staff; EE and mental health in general. The 94 aggregate analysis paper, that was there before, could be replaced by a more recent one, but I would say this should be an overview focused on schizophrenia or have as large a sample size, ideally cross-cultural.
Obviously people wouldn't be diagnosed as delusional for believing in ghosts (other Gallup examples would be belief in ability to communicate with the dead; possession by the devil or other spirits). But I think you make light of the overlaps, and the possible risk factors. I take your point that the stigma issue goes both ways. But surely that is all the more reason to address the issue. Although the issue applies more generally than schizophrenia it is particularly central to and characteristic of this diagnosis and its media portrayal and public perception, and I can only disagree that it is not worth a few sentences to explain. Franzio12:08, 14 March 2006 (UTC)
Hi Franzio
I don't make light of the overlaps or risk factors, but a phone poll by a marketing company asking about common paranormal beliefs does not provide much valid evidence in this regard. As the rest of the article cites academic and peer-reviewed work, I don't see the need to make an exception for such a weak piece of research, particularly when more rigorous work is already cited.
The issue isn't specific to schizophrenia and applies to the spectrum of psychosis and psychosis-like experience. Should we put the same discussion in every article about a psychosis-related condition? It's is much better included in the article on delusions. In fact, there could really do with an article being created on the 'continuum model of psychosis' that deals with the spectrum of both these sort of beliefs and anomalous perceptual phenomena.
Particularly with an article of this length, reducing clutter is a priority and, in light of the existing citations to quality research, a poll by a marketing company certainly strikes me as clutter.
Hi Vaughan, Well I just think there's a danger of not letting people see the wood for the trees, especially with a condition with such widespread media portrayal and public awareness, usually characterised as weirdness and an 'us versus them' sort of distinction. No doubt there can be a link to a proper discussion on continuity, but there is already several parts of this article addressing this in the specific context of schizophrenia, and I didn't see the problem with adding another more general finding which many people could relate to. I take your point about the science, but at the same time Gallup is probably the most respected and widely cited polling organisation in the world, and as you mentioned these findings are cited in the continuum literature. Franzio10:31, 16 March 2006 (UTC)
Developmental or Neuro-psych findings
I wonder whether there is any way to clarify the various causes and levels of explanation in the system of headings. Tricky I know given that genetics, neuro-psych, and environment all interact. I think the term 'biological' rarely clarifies what is going on, and that 'neuro' is usually also 'psychological', (except under a dualistic philosophy now generally considered unscientific, unless making a sort of 'hardware vs software' distinction).
Hi Franzio
I think, like all behavioural explantions, these should be thought to describe different levels of explanation, rather than distinct and parallel causes. After all, everything is ultimately biological, or chemical, or physical etc etc. Dividing the causes section up in this way just reflects research traditions.
The section on neurochemical functioning, that I'm guessing started from the NIMH website, only refers to effects of drugs on these systems, whereas life events and interventions such as CBT are also known to have these kinds of effects. This could be clarified even if we currently only have specific evidence for the drugs. The information in this section also makes misleading statements regarding drug findings, e.g.
"The precurosrs D-serine, glycine, and D-cycloserine all enhance NMDA function through the glycine modulatory site. Several placebo controlled trials have shown a reduction mainly in negative symptoms with high dose therapy.60"
The abstract of this citation actually states: "In the current limited data set, a moderate amelioration of negative symptoms of schizophrenia was found, but no other statistically significant beneficial effects on symptoms of schizophrenia.". In addition, the full text states: "We found a beneficial treatment effect on negative symptoms of schizophrenia only by glycine and D-serine" and "D-Cycloserine seems to be ineffective in treating schizophrenia and may in fact be harmful". The studies and metaanalysis also failed to properly assess the harmful effects that occured: "extractable data were minimal partly because continuous data from adverse effect scales were skewed and therefore had to be excluded from our meta-analysis. Usable binary data on adverse effects were only reported in a few papers." (but included "constipation, diarrhea, insomnia, lower-extremity weakness, suicidal ideas and vague somatic discomfort" apparently all up compared to placebo).
Also in the Wiki article:
"Currently type 1 glycine transporter inhibitors are in late-state preclinical for the treatment of schizophrenia. They increase glycine concentrations in the brain thus causing increased NMDA receptor activation and a reduction in symptoms." - no links or citations given for these theoretical and efficacy claims.
Be good to make some changes to address these issues, don't know what people think.
I think the information in this section, while accurate, is too specific for an encyclopaedia article. This text is similar in that respect: "None of the drugs taken by the persons scanned had moved neural synchrony back into the gamma frequency range. Gamma band and working memory alterations may be related to alterations in interneurons that produced the neurotransmitter GABA. Alterations in a subclass of GABAergic interneurons which produce the calcium binding protein parvalbumin have been shown to exist in the DLPFC in schizophrenia". Too much detail really and it doesn't really add much to the bigger picture of the rest of the article.
I think they can be both removed or significantly reduced without losing much overall coherence.
I agree about levels but feel that the headings don't quite balance them. I think some of what is there under 'early neurodevelopment' is more broadly 'developmental factors'. The glutamate and dopamine headings could be combined into 'neurochemical'; the wider brain function and scanning stuff could be 'neurocognitive' or 'cognitive neuroscience' as now widely termed. And a section (which isn't really there currently) on the psychological processes research. Since all these are accepted as subdivisions all reflecting both mental processes and social influences and neural functions and drugs, I think this can be clarified and reflected in the overall heading where it currently says neurobiology.
Franzio11:57, 10 March 2006 (UTC)
Hi Franzio
I think your suggestions for new heading titles are excellent. Would you like to re-arrange as necessary and I'll tweak to show my preferences and we can work towards something that's hopefully a little more coherent. Perhaps we can cull some of the 'too much detail' information here as well.
Let me know if you'd rather me have a go first and I'd be happy to do so.
That sounds great. I'll try to help in this way when I can - not sure when I will have time to get my head around it enough incl. for a psych proccesses summary, but please don't wait for me if you want to go aheadFranzio12:18, 14 March 2006 (UTC)
Torrey
User Mihai cartoaje, can you please justify removal of the Torrey book. You may dislike Torrey and his message but why must you keep removing it? I disagree with many points of view expressed in this article but I don't just remove them. --Coroebus22:26, 10 March 2006 (UTC)
I fully agree with this. But how does one illustrate an article on a topic like this? One idea I had is to look for works by schizophrenic artists. From the list in the article I found:
A drawing by Louis Wain — supposedly, psychologists have argued that the abstract patterns in the background are symptomatic of Wain's schizophrenia. This page describes how Wain's artwork changed as his illness kicked in.
Maybe this drawing of James Tilly Matthews "air loom" could be used to illustrate paranoia?
"Irren-Anstalt Band-Hain" (what does this mean? babelfish gives "Lunatic asylum volume Hain"...) by Adolf Wölfli
For some inspiration, I took a look in the schizophrenia chapter my textbook, Abnormal Psychology (ISBN0-534-63356-9 Parameter error in {{ISBN}}: checksum). These are the pictures it has:
A man in a cell, with his hands around his head. Photo by Robert Daly.
Picture of man on a sofa with apathetic face expression, leaning away from photographer, to illustrate negative symptoms.
Picture of a homeless woman, with the text: "Homeless people who suffer from paranoid schizophrenia often bear the additional burden of persecutory delusions, which interfere with outside efforts to help."
Picture of Irving Gottesman, psychologist who "has contributed significantly to our understanding of schizophrenia".
Picture of woman with a strange look and a teddybear, not paying attention to therapist, illustrating: "One of the major obstacles to drug treatment for schizophrenia is compliance."
Picture of patient and mom.
Picture of acupuncture: "In China, acupuncture and herbal medicine are often used with antipsychotic medications for schizophrenia."
* Pictures of notable researchers/theorists etc. mentioned in the text. Image:Ronald D. Laing.jpg (GFDL) could illustrate the "alternative views" section.
I agree about the article despite my recent focus on issues. I love the idea of artwork, and think the cat one seems great. I would worry about these being presented as reflecting symptoms of an illness rather than ways of perceiving or thinking about the world which have been linked to the concept/diagnosis of schizophrenia. I wonder if something depicting the common negative/flat feelings and sensitivity/withdrawal might be possible.. Franzio16:15, 13 March 2006 (UTC)
Random Russian
Why is random Russian text included, possibly duplicating the "role of dopamine" section? Should it be merged into the Russian page? I don't speak it well enough to do it myself, but it doesn't appear to have a duplicate. 198.82.59.17404:29, 29 March 2006 (UTC)
Paraphrenia & Freud
I added a little blurb about how Freud was competing with Bleuler for the renaming of dementia praecox, obviously Freud's term "paraphrenia/paraphrenic" lost out to Bleuler's term. Jordangordanier00:10, 3 April 2006 (UTC)
Ted Kaczynski
Please keep the reference to Ted Kaczynski out of this article. True or not, the last thing we need is people associating schizophrenia (or any mental disorder) with terrorism. A close friend of mine has schizophrenia, she is truly a kind-hearted person who wouldn't harm a soul. It's things like the Ted Kaczynski reference that make it harder for her to talk with other people about her illness. Let's not have Wikipedia becoming a medium for perpetuating stigma.
Notable people thought to be affected by schizophrenia
I am for removing schizophrenia.com from the external links because it is an insulting website which misrepresents itself and has false statements. I think it was added to the article only to boost its rating in google. --Mihai cartoaje13:02, 4 May 2006 (UTC)
category
while some people consider this to be a personality disorder and some not, it's a fact that people search for it under [[Category:Personality disorders]] and thus should be linked there as well for navigational help, even if it's not technically a PD, but in such case it should be explictly stated on the text.
My point is that categories are for navigational help. They are not "definitions" for example "Affective spectrum" is not a personality disorder, but the concept is closely related, thus is included on the Personality disorders category. Likewise here. It's not, but it's related and people may be looking at that category for this, is THIS article job to explain why. -- ( drini's page☎ ) 04:29, 15 May 2006 (UTC)
two-hit model
Is there any reason as to why the two-hit model of schizophrenia is never mentioned in this article? I've been dealing with it in psychology class and was surprised that it wasn't in this (featured!) article. ref:two-hit model of schozphrenia -Obli (Talk)?23:44, 15 May 2006 (UTC)
Hi there,
You'll notice that the article does describe this model ("Although no common cause of schizophrenia has been identified in all individuals diagnosed with the condition, currently most researchers and clinicians believe it results from a combination of both brain vulnerabilities (either inherited or acquired) and stressful life-events.") but not using the title 'two-hit model', but rather the more common title of 'stress-vulnerability model'. It is also called the 'stress-diathesis model' if you want more search terms for a literature search.
The study you referenced does not show that no anomalies were detected. Firstly, it found anomalies in 5% of cases, and secondly it was looking for relatively gross lesions (e.g. space-occupying lesion) not structural differences per se.
I wrote anomalies clinically related to their psychiatric condition.
The study did not have a control group, and did not compare between clinical groups, so provides no evidence for anomalies related to psychiatric condition. - Vaughan13:28, 21 May 2006 (UTC)
Furthermore, the study aimed to test the utility and cost-benefit of CT scans for detecting additional organic damage, not find anomalies specifically related to the psychiatric condition, and it specifically excluded patients who had "previously documented CT brain scan abnormalities".
Structural differences between the brains of people diagnosed with schizophrenia and the brains of those without a diagnosis (on the group level), are a reliably found with MRI (see Flashman and Green ,2004).
People with schizophrenia can have a slight neural atrophy which is reversible when recovering.
I don't know of any evidence of this reversing, although I'd be pleased to see any. Any references would be gratefully received. - Vaughan13:28, 21 May 2006 (UTC)
I have included that abstract because it has a discussion of the utility of routine CAT scans. Since a CAT scan has a dose of xrays equivalent to 20 years of natural radiation (20mG), it can be useful for patients who don't want to get cancer. --Mihai cartoaje10:57, 21 May 2006 (UTC)
Except the discussion is not related to schizophrenia, it is related to its use in psychiatry as a whole. - Vaughan13:28, 21 May 2006 (UTC)
Role of Reelin glycoprotein in Schizophrenia
I have added the section on the glycoprotein reelin's role in schizophrenia in the reelin article. Reduced reelin levels in this disease have been independently confirmed. If you deem it appropriate, you may include a link to these facts in your article.--CopperKettle04:06, 1 June 2006 (UTC)
You know Wikipedia is worried about schizophrenics signing on with the encyclopedia. I am worried about the millions of post communist chinese who may sign on with Wikipedia, and edit its web pages. —The preceding unsigned comment was added by 207.19.141.251 (talk • contribs) 21:17, 25 June 2006 (UTC).
A drawing by Louis Wain — supposedly, psychologists have argued that the abstract patterns in the background are symptomatic of Wain's schizophrenia. This page describes how Wain's artwork changed as his illness kicked in.
Maybe this drawing of James Tilly Matthews "air loom" could be used to illustrate paranoia?
"Irren-Anstalt Band-Hain" (what does this mean? babelfish gives "Lunatic asylum volume Hain"...) by Adolf Wölfli
