Dave's Progress. Chapter 124: Does Schizophrenia Really Exist?

" Is it that an organic brain condition known as schizophrenia exists? Personally, I doubt it."

Paul Hammersley.

On Thursday, we at the Pathways Group were visited by CBT counsellor and leading light of the CASL (Campaign for the Abolition of the Schizophrenia Label) campaign, Paul Hammersley. Throughout his talk, Paul shared his views on the causes of psychosis, particularly how it is linked to the experiences of trauma and dissociation.

Paul explained that, in his view, one cannot speak of psychosis without understanding "dissociation". So, what exactly is "dissociation"? Well, as far as I understood it, dissociation occurs when one is trapped in some sort of traumatic situation. When we are caught in a dangerous or stressful predicament from which we cannot escape, the body's in-built defense mechanism is to literally just shut down. The brain will stop working as normal when there is no possibility of the body's usual response of fight or flight. So, imagine, for example, that you are stuck in a car wreck. You are unable to move and death seems imminent. In this situation you may begin to dissociate, i.e. the brain will shut down and you will, for want of a better phrase, sort of "zone out". Or, imagine you are a child on the receiving end of physical abuse. You cannot escape your attacker nor can you fight back, the result being that you begin to dissociate to avoid the imminent pain (emotional as well as physical).

Paul stressed that dissociation is not an illness, but rather a normal response to such situations. Indeed, he showed us a "spectrum" of dissociation, ranging from the normal to the experience of dissociative disorders, such as dissociative identity disorder (DID), previously known as multiple personality disorder. Indeed, Paul suggested that dissociation is such a normal response, it even occurs amongst animals. We all are familiar with the image of a rabbit seemingly "trapped" by car headlights. Paul pointed out that the rabbit, when in this situation, is probably dissociating. So, dissociation is a normal, animal, defensive response to extremely dangerous or stressful situations.

Paul then went on to explain how such dissociation is linked to later experiences of psychosis, suggesting that it is some form of trauma which causes a person to have psychotic experiences in their life. Unfortunately, I do not recall all of what Paul said here, but the main thrust of it was that when trauma happens we become dissociative, and that this dissociative response mirrors many of the "symptoms" of psychosis. For example, if I remember correctly, Paul stated that when we begin to dissociate our consciousness becomes fractured. So, things like memory, our sense of self, our senses and such begin to operate in a non-integrated way. Paul cleverly tied this in to the experience of psychosis, suggesting that the same things can happen with that disorder. For example, a non-integrated sensory experience might emerge as a hallucination of some kind.

A lot of what Paul was saying to us, then, was quite controversial. Viewing trauma as perhaps the major cause of psychotic experiences and, therefore, the diagnosis of schizophrenia, is not the current orthodoxy. Many still see schizophrenia as an organic condition caused by certain chemical imbalances in the brain, a theory which is endorsed by the pharmacological industry, because their drugs are designed to combat such chemical imbalances. Paul's views would obviously, then, upset this current way of thinking and, indeed, it seems that some who share his views are unpopular within the psychiatric field, even to the point of having difficulty publishing their work. But this didn't stop Paul from saying, as I quoted above, that the existence of schizophrenia as an organic brain condition is, to his mind, doubtful.

Paul gave one devastating statistic to back up his claim that trauma is the major (although it must be said not exclusive) cause of psychotic illness. Apparently, in the Amish community, which has very low levels of stress, rates of schizophrenic illness run at 0.3% of the population. In war-torn Somalia, where levels of stress and danger are obviously very high, schizophrenia affects 33% of the population. The much bandied about statistic of rates of schizophrenia running at 1% of the population across the board (and which I have often quoted in this blog) then seems to be entirely false, and the notion that trauma has everything to do with the inducement of psychosis rather than any chemical imbalance is made more solid by such statistics. 

So, it was controversy at Thursday's Pathways Group. I must point out finally, though, that Paul stressed that he is not "anti-psychiatry", and although he questions the validity of the diagnosis of schizophrenia, he would not have us all throw down our medication and simply follow him. All Paul seems to want is for people to remain open-minded, to accept that there is more than one way of looking at things. I think that he, and the CASL campaign, deserve that at the very least.