http://msnbc.msn.com/id/10313177/site/newsweek/Talking to The Demons
Schizophrenia is no longer seen as a genetically
predetermined disease.
By Tara Pepper
Newsweek International
Dec. 12, 2005 issue - Mike Harris left Cambridge,
England, for university in Scotland filled with
the natural enthusiasm for starting an
independent life. But he couldn't handle all the
partying and drugs on campus. After a year he had
moved back with his parents. A few years later he
tried again, but once again he had to leave.
Harris (not his real name) was plagued by voices
and "static in my head" and went for long periods
without sleep or food. "At one point I thought I
could save the world by not eating or washing. I
had very unrealistic beliefs," he says.
Harris was hospitalized several times and
underwent inpatient psychiatric treatment, but
what finally brought him back from the brink of
schizophrenia was an intensive combination of
group, individual and family psychotherapy, and
help with social skills. At the Young People's
Service, a psychiatric clinic in Cambridge,
patients shop, cook and eat together, and help
each other to negotiate their phobias.
Not long ago schizophrenia was considered an
incurable, lifelong disease caused by an unlucky
combination of genes. Sufferers were condemned to
a lifetime on drugs. Now scientists are beginning
to uncover evidence that schizophrenia is heavily
influenced by environmental factors. Their
research has huge implications for treatment.
Doctors now believe that therapy and social work
are the preferred method of treatment for most
schizophrenics. "Patients really must have
therapy in order to improve," says University of
Newcastle psychiatrist Dr. Douglas Turkington.
"Medication alone will not do it."
A study published last month in Acta Psychiatrica
Scandinavica, the most definitive look at
schizophrenia to date, argues that trauma or
childhood abuse is a factor in the development of
the disease. While schizophrenia is the product
of a complex interplay between a host of
environmental and genetic factors, it seems that
"genes do not cause the outcome, but identify
those who might be susceptible to the
environmental risks," says Dr. Mary Clarke, a
psychiatric researcher at Ireland's Royal College
of Surgeons. A review of 46 studies of
schizophrenics by Auckland University
psychologist John Read found that 59 percent of
male inpatients and 69 percent of females had
experienced childhood physical or sexual abuse.
In a separate study, which included physical
neglect and physical or emotional abuse, the
level rose to 85 percent of males and 100 percent
of women. Says Read: "We have around the world
millions of people with a diagnosis that masks
the true social causes, and therefore prevents
people from getting help which would be more
effective and humane."
The cumulative impact of this research has swayed
opinion in the profession's highest echelons. At
the American Psychiatric Society's annual
conference in August, the organization's
president, Steven S. Sharfstein, noted that
antipsychotic medicines now generate $6.5 billion
in sales a year and registered concern that
mental disorders are being overmedicalized: "As a
profession, we have allowed the bio-psychosocial
model to become the bio-bio-bio model. In a time
of economic constraint, 'a pill and an
appointment' has dominated treatment."
Responding to early signs of schizophrenia, the
findings suggest, could save patients from a
lifetime dependency on debilitating drugs.
Indeed, suffering a breakdown?often characterized
by disorganized thinking, delusions and
hallucinations?in your late teens or early 20s
could be seen as an opportunity to intervene with
therapy to mitigate the disease. "If worked
through properly, it could become a
breakthrough," says psychiatrist Dr.
Shankarnarayan Srinath, who initially referred
Harris to the Cambridge therapists. "If people
are helped at that stage, they will begin to make
meaning of their suffering. If they don't have
help to work it through, it's likely they will
become a chronic, lifelong psychiatric patient."
The findings don't rule out a significant genetic
contribution to schizophrenia. Scientists believe
that chains of hundreds of genes combine
incrementally to create a predisposition to the
disease. But "genes can't function without the
environment," says Dr. David Taylor, medical
director at London's Tavistock and Portman
Clinic. Harris, for instance, claims he was
already prone to depression. But the results of
the therapy confirm that environmental factors
play the bigger role. Few genes have been
identified as having any direct effect on mental
health. "Twenty years ago [schizophrenia
researchers] were saying, once we have the genome
sorted out we can all go home?it's going to turn
out to be two or three genes that contribute to
it," says psychiatrist Dr. E. Fuller Torrey,
author of "Beasts of the Earth: Animals, Humans,
Disease." "It's quite clear that's not the case."
This shift in thinking conflicts directly with
priorities in public-health services. The British
Medical Association says a third of the country's
mental-health teams plan cutbacks, including
dismantling specialist clinics in Oxfordshire and
Cumbria, as well as at the Young People's Service
in Cambridge, which is slated to close in
January. (The Department of Health says that
intervention teams, including psychiatric nurses
and social workers, will fill the gap.) A recent
survey of guidelines for treating schizophrenia
around the world published in The British Journal
of Psychiatry found that all countries give drug
recommendations, but advice on psychosocial
interventions remains scant. "I just cannot
overstate the importance of this kind of
treatment," says Harris, now 35, with a
girlfriend and a career in teaching. "It gave me
the tools to live my life." Schizophrenia usually
strikes just as a young person is on the
threshold of living on his own. A renewed focus
on psychotherapeutic and social treatments may
help more of them cross that line.
© 2005 Newsweek, Inc.
© 2005 MSNBC.com
