Examining timely debates around contentious topics in schizophrenia, Controversies in Schizophrenia demonstrates that while some criticisms of psychiatry are pertinent, many are flawed.
Drawing on diverse sources including personal accounts of people with schizophrenia, reports, and psychiatric guidance, this book conceptualises schizophrenia in the context of other psychotic disorders, in order that the condition may be understood better. Key topics covered include antipsychotic medication, a biopsychosocial view, stigma, implications of schizophrenia as an illness, brain anomalies, and neurochemical factors.
This book is essential for mental health professionals working regularly with people with psychosis, including psychiatrists, psychiatric residents, psychologists, nurses, and social workers.
Author(s): Michael Farrell
Publisher: Routledge
Year: 2023
Language: English
Pages: 190
City: New York
Cover
Half Title
Title Page
Copyright Page
Contents
1. Introduction
Introduction to the chapter
Voices of schizophrenia
David Boyles
Elyn Saks
Schizophrenia: definitions and diagnostic criteria, and early stages of the disorder
Definition and diagnostic criteria
Early stages of schizophrenia
Distinguishing schizophrenia within 'schizophrenia spectrum disorders and other psychotic disorders'
Disorders with 'integral' and 'associated' psychosis
Challenges in delineating schizophrenia, psychosis, and bipolar disorder
ICD-11 and its relationship to DSM-5
Orthodox and dissenting views
Orthodox position
Dissenting position
Aims and distinctive features of the book and its readers
Contents of the book
Chapter structure
Outline of chapters
References
2. Categories, Continua and Relativism
Introduction
Orthodox and dissenting positions
Schizophrenia as a category of disorder: a preamble
Challenges: schizophrenia's weak validity and reliability; and the permeability of psychosis
Validity and reliability; and the permeability of psychosis
Implications and responses
Criticism that schizophrenia was invented - euphemism and emotive language
Criticism that schizophrenia is unscientific paralleling astrology - overstatement
Continua as an alternative to categorisation and its weakness- misleading euphemistic parallels
Using syndromes and symptoms not categories in identification and assessment and its weaknesses - conflicting evidence
Groups of symptoms
Symptoms as the focus of intervention
Revisiting the orthodox categories view; benefits and evidence-based responses to challenges
Orthodox position on categories
Benefits of classification
Evidence-based responses to challenges of categorisation
Conclusion
Suggested further reading
References
3. A Biopsychosocial Perspective of Schizophrenia
Introduction
Orthodox and dissenting positions
A biopsychosocial approach to schizophrenia
Criticisms that physical causes demand physical treatments - illogical, and unsupported by evidence
Criticisms that physical causes demand physical treatment for schizophrenia
Physical causes are only part of the picture
Nonphysical treatments form part of the repertoire of an orthodox approach
Criticism that the 'medical model' is pessimistic - overlooking contrary evidence
Proposing subjectivism over medical evidence - self-refuting and lacking significance
Subjectivism
Schizophrenia and psychosis and subjectivism
Proposing that seeing schizophrenia as an illness is just another theory - underplaying evidence
Emphasising the simplistic, outdated, reductionist, unsubstantiated, contextless, and crude - criticising the weakest scenario
Criticism using exaggerated and emotive language
Conclusion
Suggested further reading
References
4. Stigma and Schizophrenia
Introduction
Orthodox and dissenting positions
Stigma, labelling and perception
Stigma and labelling
Stigma and perceptions of mental phenomena
Violence perpetrated by people with schizophrenia
Rarity of violence perpetrated by people with schizophrenia and concerns it is exaggerated
Higher than average (but still low) risk of people with schizophrenia perpetrating violence
Schizophrenia and violence towards family members
Stigma towards schizophrenia relating to violence and the perceived risk of violence
Violence and schizophrenia
The impact of violent acts relating to schizophrenia
Criticism of attributing stigma in schizophrenia to 'biological psychiatry' - misrepresenting biopsychosocial psychiatry as exclusively biological
'Biological' psychiatry
Critics' mistrust of drug companies
Criticism that biogenetic causal beliefs engender negative attitudes, and psychosocial beliefs promote positive attitudes - weak evidence and polarised research
Mental health literacy and biological perspective
Attitude studies
Conclusion
Suggested further reading
References
5. Genetics and Schizophrenia
Introduction
Orthodox and dissenting positions
Progress in understanding genetics and schizophrenia, and continuing challenges
Progress in understanding genetics and schizophrenia
Challenges regarding phenotypic demarcation: endophenotypes and other responses
Dissenting views
Referring loosely to a genetic basis of schizophrenia
Disputable emphases when reviewing genetic research
Negative depiction of genetic research - overstatement
Criticising 'the discipline' - nebulous targets of criticism
Imputed (sometimes malign) motivations in genetic research
Conclusion
Suggested further reading
References
6. Brain Anomalies in Schizophrenia
Introduction
Orthodox and dissenting positions
Evidence for differences in brain structure and functioning in schizophrenia
Dissenting views of brain anomalies in schizophrenia
Some weaknesses of dissenting views of schizophrenia and brain anomalies
Overstating evidence that antipsychotics cause brain anomalies
Overstating the possible role of childhood trauma
Mistrustful presentation of evidence concerning drug companies
Laudatory presentation of supportive evidence
Conclusion
Suggested further reading
References
7. Neurochemical Factors in Schizophrenia
Introduction
Orthodox and dissenting positions
Dopamine
Dopamine and its pathways: mesolimbic, mesocortical, nigrostriatal, tuberoinfundibular
Dopamine receptors
Other neurotransmitters implicated in refinements of dopamine hypotheses
The development of dopamine hypotheses
Version 1
Version 2
Version 3
Towards version 4?
Continuing research
Dissenting criticisms
The original dopamine hypothesis is still current and 'popular'
The original dopamine theory is simplistic and unsubstantiated
Researchers have continually failed to confirm the dopamine ('lead') hypothesis
After the failed dopamine hypothesis, researchers turned to other neurochemicals
Orthodox researchers envisage a purely chemical 'solution' to schizophrenia
'Failed' neurochemical explanations undermine justifications for using antipsychotics
Conclusion
Suggested further reading
References
8. Antipsychotics
Introduction
Orthodox and dissenting positions
Antipsychotics: discovery, types and effectiveness, and action
The fortuitous development of chlorpromazine the first antipsychotic drug
Types of antipsychotics and their efficacy
The action of antipsychotics
The action of first-generation antipsychotics
The action of second-generation antipsychotics
Side effects of antipsychotics
Weight gain
Sedation
Movement disorders
Sexual side effects
Some research and claims associated with pharmaceutical companies invite caution
Dissenting views of antipsychotics and some weaknesses
Emphasising adverse effects of antipsychotics rather how to reduce or avoid them
Claims that those with schizophrenia in developing countries do better with less access to antipsychotics - overlooking contrary evidence
Citing inflated claims for antibiotics that are not held tilting at windmills
Faustian descriptions of sedation - overstated language
Conclusion
Suggested further reading
References
9. The Continuing Role of Electroconvulsive Therapy (ECT)
Introduction
Orthodox and dissenting positions
Patient perspectives of ECT
ECT and its application
Modern ECT procedures and their brief duration
The action of ECT
Conditions treated with ECT
Contemporary positive findings for the efficacy of ECT
Criticisms of the efficacy of ECT
Negative and emotive colouring of the earliest work on ECT
Critics citing of earlier negative studies of ECT efficacy - not recognising its limitations
Potentially misleading citation of research
Risk and ECT
Memory impairment
ECT-related deaths: critics use of older research
ECT and 'brain damage': critics use of selected research findings and emotive language
Conclusion
Suggested further reading
References
10. Involuntary Hospitalisation and Treatment
Introduction
Orthodox and dissenting positions
Reasons for hospitalisation
Provision which may reduce hospitalisation
Alternative provision
Involuntary hospitalisation and treatment
United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (adopted 1987)
UN Convention on the Rights of Persons with Disabilities 2012
Article 12
Article 15
Criticism that coercive treatment may constitute torture - a slippery redefinition of 'torture'
Key paragraphs of the Méndez' Report 2013 and rebuttals
Criticism that medically indicated involuntary treatment may constitute torture - overlooks protective aspects
Criticism that the doctrine of medical necessity hinders protection - overlooks that it helps ensure appropriate use of involuntary treatment
Criticism that solitary confinement and restraint may constitute torture - justified if it is the only way to prevent harm
The view that institutionalising legislation should be abolished - it can be life saving
Criticism that severity of mental illness should not justify deprivation of liberty - it can be appropriate to avoid suffering
Méndez' response to Lieberman, Levin, and Ruiz
Misunderstanding of Méndez report
Further reducing involuntary hospitalisation and treatment
Conclusion
Suggested further reading
References
11. Challenges and Criticisms
Introduction
Challenges facing the orthodox view of schizophrenia
Challenges: schizophrenia's weak validity and reliability; and the permeability of psychosis
Challenges - research and claims associated with pharmaceutical companies invite caution
Criticisms of orthodox positions on schizophrenia
Overstatement
The criticism that schizophrenia is unscientific
Negative depiction of genetic research
Evidence that antipsychotics are implicated in brain anomalies in schizophrenia
The possible role of childhood trauma in schizophrenia
Faustian allusions to sedating side effects of antipsychotics
Emotive language
The criticism that schizophrenia was invented
Criticism of a medical view of schizophrenia
Criticisms of the efficacy of ECT
ECT and 'brain damage'
Euphemism
The criticism that schizophrenia was invented
Weaknesses of proposing continua as an alternative to categorisation
Other rhetoric
Laudatory presentation of supportive evidence
Critics misrepresenting an orthodox position about antipsychotics
Conflicting/weak evidence
Weaknesses of using symptoms for identification and assessment instead of categorisation
Criticisms that the 'medical model' is pessimistic
Proposing that understanding schizophrenia as an illness is just another theory
Biogenetic causal beliefs involve negative attitudes, and psychosocial beliefs positive attitudes
Mistrustful presentation of evidence from research involving drug companies
Claims that those with schizophrenia in developing countries do better with less access to antipsychotics
References
12. Further Criticisms
Introduction
Distorting emphases
Disputable emphases reviewing genetic research
Criticism emphasising adverse effects of antipsychotics rather how to reduce or avoid these effects
ECT-related deaths - misleading emphasis on older research
Emphasising the simplistic, outdated, reductionist, unsubstantiated, contextless, and crude
Illogical criticisms and positions
Criticisms that physical causes demand physical treatments for schizophrenia
Proposing subjectivism over medical evidence
Misrepresenting biopsychosocial psychiatry as purely biological
The criticism that stigma towards schizophrenia stems from 'biological psychiatry'
The criticism that orthodox researchers envisage a purely chemical response to schizophrenia
The criticism that 'failed' neurochemical explanations undermine justifications for using antipsychotics
Focusing on old research or old versions of a theory or explanation
The criticism that the original dopamine hypothesis is still current and 'popular'
The criticism that original dopamine theory is simplistic and unsubstantiated
The criticism that researchers have continually failed to confirm the dopamine ('lead') hypothesis
Critics' citing of earlier negative studies of ECT efficacy
Critics potentially misleading citation of old ECT research
Distorted redefinition of torture
The distortion that coercive treatment may constitute torture
The criticism that medically indicated involuntary treatment may constitute torture
The criticism that the doctrine of medical necessity hinders protection from abuses
The criticism that solitary confinement and restraint may constitute torture
The criticism that guardianship should not allow justification of forced treatment
The view that institutionalising legislation should be abolished
The criticism that severity of mental illness should not justify deprivation of liberty
Other criticisms
Criticism referring misleadingly to a genetic 'basis' of schizophrenia
Criticising nebulous targets
Imputed (sometimes malign) motivations in genetic research
The criticism that after the failed dopamine hypothesis, researchers considered other neurochemicals
ECT historical cases conflated with modern findings
References
Index
