The Concept Of ‘schizophrenia’ Could Disappear Soon

Critics of this diagnostic label are gaining strength in the field of psychiatry.

Schizophrenia is one of the most famous syndromes in the field of mental health. Its shocking characteristics and the strangeness of the  hallucinations and behavioral alterations that it produces have made this concept known to many people who are not dedicated to psychiatry or clinical psychology. Of course, among patients and health professionals, schizophrenia is important not so much because of the above, but because of the serious consequences it has for the health of those who have been diagnosed with it.

However, it is one thing that the symptoms associated with schizophrenia are incredible and very severe, and another is that this clinical entity exists as such, as a natural phenomenon well separated from the rest. In fact, the concept of what we have been calling schizophrenia for years could have its days numbered.

What if schizophrenia didn’t exist?

Until a few years ago, Asperger’s syndrome was one of the best known diagnostic labels, due to, among other things, the striking characteristics that some of the patients of this type showed: intelligent, with difficulties to empathize, and obsessed with areas of knowledge very specific.

However, today this denomination is no longer used. Since the phenomenon referred to by Asperger’s syndrome has become part of a spectrum ; specifically,  Autism Spectrum Disorders.

Something very similar could happen soon with the label of schizophrenia, harshly criticized from psychology for decades. Now, doubts about its existence are gaining traction even within psychiatry. The reasons for this are, fundamentally, two.

Multiple causes for different disorders?

As with practically all so-called “mental illnesses”, no specific biological disorder is known to be the cause of schizophrenia.

This is somewhat understandable, taking into account that the nervous system in general and  the brain in particular are extremely complex biological systems, without a clear entry and exit route, and in them, millions of microscopic elements participate in real time, from neurons and  glial cells to hormones and  neurotransmitters.

However, another possible explanation for the fact that a neurological basis for schizophrenia has not been isolated is that it does not exist. That is, there are several and very diverse causes that end up generating different chain reactions but at the end of which a set of symptoms very similar to each other appear: hallucinations, delusions, stupor, etc.

On the other hand, attempts to link schizophrenia to a few altered genes, which would provide a quick and easy way to explain a disease by pointing to a very specific element as its cause, have been unsuccessful. Only 1% of the cases in which this syndrome appears has been associated with the elimination of a small stretch of chromosome 22. What happens in the remaining 99% of cases?

Different treatments for various types of schizophrenia

Another piece of evidence that reinforces the idea that schizophrenia does not exist as a homogeneous entity is that not only are parallel pathways through which the symptoms of this syndrome may appear; There also appear to be parallel pathways in its treatment.

The fact that certain types of treatments seem to work specifically in cases in which this syndrome seems to be caused by certain triggers, and not in others, indicates that there are different sources of nervous activity linked to schizophrenia, and these do not all manifest themselves at once. once in all patients.

The opposite can also occur, that in certain schizophrenia patients who have significant characteristics in common (which differentiate them from other schizophrenia patients), some drug treatments work especially poorly, or do not work. For example, in children in whom the onset of psychotic symptoms associated with schizophrenia coincide with exposure to traumatic events,  antipsychotic drugs are not very effective.

conclusion

One of the problems in psychiatry is that it is sometimes inferred that the problems that patients display lie deep within their nervous systems, isolated from the context in which the person has developed and learned to behave.

Of course, this belief has reason to be in certain pathologies in which it has been seen that certain nerve cells are being destroyed, for example.

However, attributing the focus of syndromes like schizophrenia to something that is spontaneously “born” in the brain of patients can be misleading. The fact that there is a set of symptoms that suggest disruption with reality does not mean that all these cases are rooted in a specific disease and separated from all the others. Sustaining that idea, to some extent, may simply be giving use to a word that has been used for a long time. But it must be borne in mind that in science language adapts to reality, and not the other way around.

For this reason, researchers such as Jim van Os, professor of Psychiatry at Maaschrist University, have proposed that the term “schizophrenia” be replaced by that of Psychosis Spectrum Disorders, an idea in which different causes and mechanisms fit under the that this break with reality takes shape. This less essentialist approach to schizophrenia can make us really understand what happens in patients’ lives, beyond trying to fit their behaviors into a single homogenizing category.

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