A cause related alternative for the harmful concept of schizophrenia. Prof. Dr. M.A.J. Romme

Why harmfull? The concept it selves makes it impossible to solve the patient’s problems that lay at the roots of becoming ill.

the essential problems The scientific validity of the concept is Zero and it neither refers to a brain disease. The scientific validity of the concept is Zero and it neither refers to a brain disease. The diagnostic process neglects the reasons for the existing symptoms. The diagnostic process neglects the reasons for the existing symptoms. The relationships between the core symptoms and experiences in life are neglected. The relationships between the core symptoms and experiences in life are neglected. The inter relationships between the core symptoms are neglected. The inter relationships between the core symptoms are neglected. The core symptoms do not represent expressions of psychopathology. The core symptoms do not represent expressions of psychopathology. Learning to cope with the symptoms and with the problems at hart are neglected. Learning to cope with the symptoms and with the problems at hart are neglected. People who recover from the illness do that outside of psychiatry. People who recover from the illness do that outside of psychiatry.

The missing validity: Bentall 1998 “It would seem that schizophrenia is an illness that consists of no particular symptoms, no particular symptoms, no particular outcome, no particular outcome, responds to no particular treatment. responds to no particular treatment. No wonder research revealed that it has no particular cause.”

It has never been validated Mary Boyle (1990) It has never been validated Mary Boyle (1990) Kraepelin and Bleuler merely postulated the existence of a peculiar pattern of signs and symptom, which they then attempted – unsuccessfully – to validate. “None of them (including Schneider as well) presented evidence of having observed a set of regularities, which would justify a new hypothetical construct. Certainly, none of them identified a syndrome.” ( Boyle Second edition 2002 p.80 ).

Heinrichs (2001) Constitutes a review of the results from neuroscience research for publications appearing between (p. 84) : “In summary this extensive appraisal across many areas of neuroscience reveals no common abnormality in all cases of schizophrenic illness. “In summary this extensive appraisal across many areas of neuroscience reveals no common abnormality in all cases of schizophrenic illness. The strongest, most consistent evidence suggests that 50 – 70 % of schizophrenia are deficient in cognitive brain function. In comparison most of the neurobiological abnormalities in the illness, probably occur in a minority of patients. Moreover close to 40% of the biological findings are so weak and variable that they may represent minor, unimportant, or chance abnormalities with no intrinsic link to schizophrenia”.

Blom (2003) “From the work of Heinrichs we may cautiously conclude that contemporary neuroscience research, likewise fails to provide persuasive means of validation for the schizophrenia concept”.

The conclusion might well be that: The people with the symptoms exist but the illness does not exist. but the illness does not exist. Between them there is a great variaty, which is mostly overlooked

Some more arguments: The Diagnostic proces The Diagnostic proces The background of the core symptoms The background of the core symptoms Interrelationship between core symptoms Interrelationship between core symptoms

Some more arguments The Diagnostic proces The Diagnostic proces The background of the core symptoms The background of the core symptoms Interrelationship between core symptoms Interrelationship between core symptoms

Diagnostic procedure In clinical psychiatry. In clinical psychiatry. Behaviour and experiences lead to postulation of Behaviour and experiences lead to postulation of symptom categorie (Reduction no 1) Symptom categories lead to construction of an Symptom categories lead to construction of an ilness categorie according to DSM (Reduction no 2) No interest in other areas like No interest in other areas like –the reasons for the development of the behaviour and experiences

Differences in diagnostic procedure In Clinical psychiatry: In Clinical psychiatry: behaviour and experiences are seen as a result of an illness. In Social psychiatry: In Social psychiatry: behaviour and experiences are seen as the result of sociaal- emotional problems in life

Harmfullness Clinical psychiatric diagnosis are harmfull because: They do not lead to analysis of patient problems. They do not lead to analysis of patient problems. Therefore The patients will not be helped with their problems The patients will not be helped with their problems

Background of Core Symptoms Research did not reveal particular cause for illness of schizophrenia (Bentall 1990;1998) Research did not reveal particular cause for illness of schizophrenia (Bentall 1990;1998) Research did reveal particular cause for the separate core symptoms in individuals (Romme & Escher 1989; Smith 1996; Johnston 2000) Research did reveal particular cause for the separate core symptoms in individuals (Romme & Escher 1989; Smith 1996; Johnston 2000) The diagnosis of schizophrenia mystifies the cause of the mental health problems in the individual case The diagnosis of schizophrenia mystifies the cause of the mental health problems in the individual case

Interrelationships between the core symptoms Each core symptom can be a reaction on traumatic experiences Each core symptom can be a reaction on traumatic experiences They then become the primary symptom (first symptom) They then become the primary symptom (first symptom) The other symptoms then develop as secondary reactions, because the person is not able to cope with the primary symptom The other symptoms then develop as secondary reactions, because the person is not able to cope with the primary symptom

One more argument: The core symptoms in themselves are not signs of psychopathology The core symptoms in themselves are not signs of psychopathology

Focus of care with psychosis The focus of mental health care with psychosis should be on. The focus of mental health care with psychosis should be on. Learning to cope with the separate core symptoms, mostly by Cognitive psychological interventions. Learning to cope with the separate core symptoms, mostly by Cognitive psychological interventions. Analysing and learning to cope with the social emotional problems in which the psychosis is rooted. Analysing and learning to cope with the social emotional problems in which the psychosis is rooted. Recovery that is focussing on the Development of the person Recovery that is focussing on the Development of the person

Recovering from Schizophrenia is not seldom AuteurJaar No Patients % AuteurJaar No Patients % recoverytotal social recoverytotal social Bleuler Bleuler Harding Harding Huber Huber Tsuang Tsuang Ciompi Ciompi Those who recover do that outside psychiatry Those who recover do that outside psychiatry

Psychiatric care makes angry because The distress of complaints is not the focus of care but is used to confirm symptom categories The distress of complaints is not the focus of care but is used to confirm symptom categories The diagnosis does not contribute to solve the person’s problems. The diagnosis does not contribute to solve the person’s problems. Nobody aks what has happened in relation to the distresfull behaviour and experience Nobody aks what has happened in relation to the distresfull behaviour and experience Demoralising statements are made about the given diagnosis. Demoralising statements are made about the given diagnosis. Medication often does not help with the complaints and reduces emotional alertness. Medication often does not help with the complaints and reduces emotional alertness.

Conclusion The Schizophrenia Concept is harmfull because: –It mystifies the patients social emotional problems –It makes it impossible to solve the patients problems A diagnosis of “Trauma Induced Psychosis” should be recognised. A diagnosis of “Trauma Induced Psychosis” should be recognised. Mental Health care should be oriented towards Mental Health care should be oriented towards –Learning to cope instead of supression of experiences –Analysing the causes and learn to cope with emotions –Recovery and the development of the person