As I’ve written in four previous blogs devoted to examining the barriers that block persons presumed to have major mental illnesses from living longer and more effective lives, it’s time to discard the disease/biological model that’s been used for the past 30 and more years to explain the causes and course of schizophrenia and all other major mental illnesses. First and foremost, the disease model is centered on treatment that relies predominately on psychoactive medications which, prescribed too-often in too-great quantities for too-long periods of time, put a premature end to too-many lives (c.f. # III for a full discussion of this issue).
Secondly, a biological or genetic cause for major mental illnesses has never been uncovered, and biology or genetics don’t determine the course of these illnesses. Rather, the recent WHO schizophrenia prevalence studies, as well as the long-term outcome studies conducted by Bleuler and Harding and colleagues over thirty years ago underline the importance of environmental factors, particularly the presence or absence of support systems, in influencing whether a person undergoes recovery or not. The key question, then, and the focus of this blog, is what new model, if any, do we put in its place?
My own struggle to uncover a conceptual and treatment frame for schizophrenia began when I was a rookie social worker on Maimonides Medical Center’s in-patient psychiatric unit in 1976. This was at the time when the work of Stack Sullivan, Fromm Reichmann and other proponents of “intensive psychotherapy” was being discredited as costly and ineffective; when the family therapists, e.g., Ackerman and Bowen, among others, were being hailed, then assailed, for examining family systems and family interaction as causative of schizophrenia; when there appeared to be no practical, i.e., therapeutic, application of Bateson’s “double bind” theory; when neuroleptic medications were being prescribed extensively to control psychotic symptoms and the disease model began to gain acendancy.
Ironically, this was also the time, the mid-70s, when Leonard Mosher and colleagues were opening the doors to Soteria in northern California, the scaled-down and relatively short-lived American version of R.D. Laing’s Philadelphia Association, where staff was trained “to be with” rather than “treat” residents as they cycled through the various stages of their psychoses. Over time, I’ve cycled back to agree with Laing, whom I’ve begun to re-read, that schizophrenia is an existential problem, a problem in living, regardless of the putative cause.