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.