Dave's Progress. Chapter 64: Nobody Knows Anything.

The above title is taken from a quote by William Goldman, the Hollywood screenwriter whose credits include the brilliant "Butch Cassidy and The Sundance Kid", and it refers to his belief that prior to a movie's release, nobody in Hollywood has any real idea how well a film will do. No matter how well you think you know the public mind, you never really do. And, I believe, one could use Goldman's quote in a similar way to describe psychiatry. For, the more research I do on the subject, it seems that for every theory about psychiatric illness that is espoused, there is always someone else out there who thinks differently, or has done research to prove otherwise.
This seems particularly true of schizophrenia. Is it an illness, or is it, as some would argue, a "state of being", for example? Is it caused by a mere imbalance of chemicals in the brain (the medical, dopamine model) or is it more to do with some emotional trauma and is really a form of post-traumatic stress disorder (hence, one of the proposed "new names" for schizophrenia, as espoused by the likes of The Campaign for the Abolition of the Schizophrenia Label or CASL, being post-traumatic psychosis)? Is it purely genetic or inherited, or is it, as some would say, that the research done to prove a purely genetic link to schizophrenia was inherently flawed and there is no schizophrenia "gene"? Is it that those with a diagnosis of schizophrenia often go through some form of head trauma during pregnancy and birth? Once again, there is some evidence for this, but in the end, who knows? And finally, do those with a diagnosis of schizophrenia have larger than average heads and toes? OK, so I think we can discount this last one, but it does come from a real piece of research, and shows, to my mind, just how crazy some of the investigation of "craziness" can become.
As if to prove this point further, there was a recent programme on TV, BBC2's "Horizon", entitled "How Mad are You?", which investigated just how difficult it is to identify someone who has had a mental illness. The programme took the form of putting ten people together, five with previous diagnoses of mental ill health, five without, and asked three eminent psychiatrists to decide which was which. The ones with experience of mental ill health had diagnoses ranging from depression to social anxiety disorder to bipolar disorder and the psychiatrists were asked to attribute these diagnoses to the people they felt they belonged to. So, after putting the ten volunteers through a variety of tests designed to expose their illnesses, the psychiatrists sat around and debated just which diagnosis belonged to who. If I remember correctly, I think they only got two correct out of the whole bunch, and at one point, one of the psychiatrists remarked, "I just want to reiterate the point that we may be getting everything wrong".
So, when it comes to psychiatry, it would seem that much of it can be sheer guess work. It is not, after all, an exact science. And while this would appear to be good from the anti-stigma point of view, that indeed one can not really tell just by looking at some one if they have had a mental illness, it is disheartening from the treatment side of things, whereby it seems that we are all at the mercy of conflicting points of view. Indeed, in my own treatment, having gone from a diagnosis, at first, of depression, and then to bipolar, then to schizo-affective disorder and finally to schizophrenia, one does indeed wonder about the reliability of such diagnoses. Why, for example, wasn't the true nature of my illness identified sooner? Anyway, I doubt if you saw me walking down the street that you would say, "there goes another schizophrenic- shame really." No, you would probably see just another human being going about his business. After all, nobody really knows anything.
That's all for now from your normal, average paranoid and delusional man.


dcrelief said…
Hi David,
"Larger than average heads and toes"? Hmm... don't make me think too much.
Childhod is a mish-mash of measles, mumps, falls, scrapes, and other things that might actually accumulate to dimenish brain chemistry. We are after all like fine tuned machines.(right) Emotional trauma, such as a favourite pet dying can deplete the endorphins. People exercise less frequently. No one gets outdoors much for needed vitamin A & D. In short those chemicals may not get reloaded to appropriate levels.
A side effect of one medication I took, years ago, was "hearing voices". It almost cost me my life when I mentioned it to a doctor. If I hadn't sought a second opinion, I might still be taking the script today, and still hearing voices. It was unnerving!
I can only say that vigilance and diligence saved me from further disaster... and maybe, as you quote Goldman, it's because: "Nobody Knows Anything". We must take good care of ourselves.
I really enjoyed reading this blog!
Respectfully, dc
klahanie said…
Dear David,
So I wonder if somebody knows something.
I remember that show on BBC 2 that you have noted. It just goes to show that people cannot fit into convenient labels based on popular conceptions. Which, in actuality, can be popular misconceptions.
Another excellent, thought provoking article, David. You bring up an important point regarding potential misdiagnosis through guess work. It is saddening to think that someone can be subjected to a wrong and even devastating wrong evaluation.
You are just another guy walking down the street trying to get on with his life. I wish you all the best in your ongoing journey.
With respect and kindness, Gary
David said…
Dear Dixie,
Glad that you enjoyed my blog, but sorry to hear of your own tribulations regarding taking the wrong meds.
My mother still maintains that I suffer from bipolar and not schizophrenia, so who knows, I too may be taking medication which I need not, and which, as I have often said, has terrible side-effects. So, as you say, perhaps the best answer is to just "take good care of ourselves".
Thank you for your continued interest.
Yours with Respect,
David said…
Dear Gary,
Perhaps, somewhere, somebody does know something. Who knows!
And yes, I suppose, after years of illness, I am just a normal, average (paranoid and delusional) guy trying to get on with my life.
It would be nice if there weren't seemingly so many obstacles to this endeavour, but like you, I shall remain eminently positive.
Thanks for your kind remarks, Gary, and hopefully I will see you soon,
Anonymous said…
nice job! waiting for your new artical. ........................................
bazza said…
Hello David. Sometimes I think all of science is like this. The current theory is always 'the truth' until the next theory comes along and replaces it.
Newtonian physics was absolute until there was Einstein - and then came quantum mechanics and string theory. Are we there yet?
RD Laing questioned who was 'mad', the so-called patients or those making the diagnosis. There is no such thing as an expert.
David said…
Dear Bazza,
Thanks for your erudite comment. Indeed, it does seem that there is only the truth of a certain age, or era, until a new theory comes up. I believe the French philosopher Foucault wrote of this, saying that as a result there could be no such thing as "absolute" knowledge. He had a word for this phenomena, but I believe in the scientific world the things you mention are known as "paradigm shifts". Indeed, the organisation CASL, which I mention in my blog, are not only looking to change the name of schizophrenia because of the stigma which surrounds it, but also to create a whole paradigm shift in how it is treated. Lots of traditionalists would appear to disagree with them, but as I say in my blog, who really knows anything for sure?
As for Laing, I have read some of his work and know that he was an important member of the anti-psychiatry movement of the '60's and '70's, along with luminaries such as fellow Brit David Cooper and American Thomas Szasz. All of them brought about important changes to how psychiatry was viewed, and I remember Laing remarking that someone who says they have a bomb inside them is regarded as insane, and yet is harmless, whereas those who make and drop bombs, although causing destruction, are regarded as sane. Therefore, was it the individual who was "mad", or the world?
Anyways, thanks once again bazza- I always look forward to your intelligent remarks.
With Very Best Wishes,

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