Models of Madness

Psychological, Social and Biological Approaches to Psychosis

Dr John Read, Professor Richard Bentall, Loren Mosher, John Read, Jacqui Dillon, Dr John Read, Professor Richard Bentall, Loren Mosher, John Read, Jacqui Dillon

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134055029
• Edition: 2
• Topic: Psychologie
• Subtopic: Psychopathologie

Are hallucinations and delusions really symptoms of an illness called 'schizophrenia'? Are mental health problems really caused by chemical imbalances and genetic predispositions? Are psychiatric drugs as effective and safe as the drug companies claim? Is madness preventable?

This second edition of Models of Madness challenges those who hold to simplistic, pessimistic and often damaging theories and treatments of madness. In particular it challenges beliefs that madness can be explained without reference to social causes and challenges the excessive preoccupation with chemical imbalances and genetic predispositions as causes of human misery, including the conditions that are given the name 'schizophrenia'. This edition updates the now extensive body of research showing that hallucinations, delusions etc. are best understood as reactions to adverse life events and that psychological and social approaches to helping are more effective and far safer than psychiatric drugs and electroshock treatment. A new final chapter discusses why such a damaging ideology has come to dominate mental health and, most importantly, how to change that.

Models of Madness is divided into three sections:

• Section One provides a history of madness, including examples of violence against the 'mentally ill', before critiquing the theories and treatments of contemporary biological psychiatry and documenting the corrupting influence of drug companies.
• Section Two summarises the research showing that hallucinations, delusions etc. are primarily caused by adverse life events (eg. parental loss, bullying, abuse and neglect in childhood, poverty, etc) and can be understood using psychological models ranging from cognitive to psychodynamic.
• Section Three presents the evidence for a range of effective psychological and social approaches to treatment, from cognitive and family therapy to primary prevention.

This book brings together thirty-seven contributors from ten countries and a wide range of scientific disciplines. It provides an evidence-based, optimistic antidote to the pessimism of biological psychiatry. Models of Madness will be essential reading for all involved in mental health, including service users, family members, service managers, policy makers, nurses, clinical psychologists, psychiatrists, psychotherapists, counsellors, psychoanalysts, social workers, occupational therapists, art therapists.

Part I The Illness Model of Psychosis

DOI: 10.4324/9780203527160-1

1 'Schizophrenia' is not an Illness

John Read, Loren Mosher and Richard Bentall

DOI: 10.4324/9780203527160-2

‘Schizophrenia is a chronic, severe, and disabling brain disease.’ In June 2003, this was the opening statement of the US government agency, the National Institute for Mental Health, on its public information website (www.nimh.hih.gov/publicat/schizoph.pdf) about the topic of our book. Such an opinion can still be found, in 2013, in most ‘educational’ material, from psychiatric textbooks to drug- company-sponsored pamphlets.

We disagree.

The heightened sensitivity, unusual experiences, distress, despair, confusion and disorganization that are currently labelled ‘schizophrenic’ are not symptoms of a medical illness. The notion that ‘mental illness is an illness like any other’, promulgated by biological psychiatry and the pharmaceutical industry, is not supported by research and is extremely damaging to those with this most stigmatizing of psychiatric labels. The ‘medical model’ of schizophrenia has dominated efforts to understand and assist distressed and distressing people for far too long. It is responsible for unwarranted and destructive pessimism about the chances of ‘recovery’ and has ignored – or even actively discouraged discussion of – what is actually going on in these people’s lives, in their families and in the societies in which they live. Simplistic and reductionist genetic and biological theories have led, despite the high risks involved and the paucity of sound research proving effectiveness, to the lobotomizing, electroshocking or drugging of millions of people.

The research we have gathered together in this book supports our belief that our efforts to understand and assist people experiencing the ‘symptoms of schizophrenia’ will benefit greatly from a fundamental shift away from unsubstantiated bio- genetic ideologies and technologies to a more down- to-earth focus on asking people what has happened and what they need.

We have not attempted an even- handed, ‘objective’ approach. What is required, after a hundred years or more of the dominance of an approach that is unsupported scientifically and unhelpful in practice, is a balancing stance rather than a balanced one. The traditional viewpoint is omnipresent in textbooks, research journals and the media. Other views have had difficulty being heard. As responsible critics, we have included discussion of bio- genetic theories and the treatments they have spawned to show the methodological flaws involved in the research that purports to support those theories and treatments. Our main purpose, however, is to show that there are sound research- based psychosocial alternatives to both understanding the origins of and intervening with what is currently called ‘schizophrenia’.

The three of us have worked with hundreds of people unfortunate enough to be labelled ‘schizophrenic’. We have been saddened, and sometimes angered, by the readiness of some mental health professionals to believe that the complexities of human experience can be reduced to, and understood in terms of, a single, contextless, medical- sounding word. We have too often seen that instead of trying to find out how the individual – and their loved ones – understands what is going on and what might help, the only solution offered is a chemical or electrical one, usually delivered in a dehumanizing, prison- like ‘hospital’. Together with the other contributors to this book, from six countries and a range of disciplines – including users of mental health services – we want to see a less ideological approach to understanding and treating ‘madness’. We want to see a truly evidence- based range of possible explanations discussed when individuals and families come into contact with us, and a wider range of options offered in terms of what might be helpful.

Since the 1970s, the illusion of a balance, of an integration of models, has been created by the so- called ‘bio- psychosocial’ approach. An integral part of this has been the ‘vulnerability- stress’ idea that acknowledges a role for social stressors but only in those who already have a supposed genetic predisposition. Life events have been relegated to the role of ‘triggers’ of an underlying genetic time bomb. This is not an integration of models, it is a colonization of the psychological and social by the biological. The colonization has involved the ignoring, or vilification, of research showing the role of contextual factors such as stress, trauma (inside and beyond the family), poverty, racism, sexism, and so on in the aetiology of madness. The colonization even went so far as to invent the euphemism ‘psycho- education’ for programmes promulgating the illness ideology to individuals and families.

Perhaps most cruelly of all, the belief that because ‘schizophrenia’ is an illness and, therefore, life events and circumstances can play no role in its causation has led to the awful conclusion that nothing can be done to prevent it. Rather than lobby governments to fund primary prevention programmes that could improve the quality of life for children, adolescents and their families, biological psychiatry gives politicians a perfect excuse for doing nothing.

The majority of the public, many members of the mental health professions and most people labelled ‘schizophrenic’ understand that mental health difficulties originate in the life circumstances – past and present – of the individuals and families concerned. Only one very powerful branch of one profession, biological psychiatry, insists on overemphasizing biology and genetics. Its power is compounded by the support of the pharmaceutical industry. This book, then, has been written largely to bring together the body of evidence that will increase the confidence of the majority when faced with that misguided but powerful minority who proclaim with all the trappings of scientific and professional expertness: ‘it’s an illness – so you must take the drugs’, by force, if necessary.

This book is not only about the one in a hundred of us who attract the label ‘schizophrenic’. Few families have no contact with someone who has been through the mental health system. The increasing medicalizing of human distress, ably abetted by drug company propaganda, knew no bounds in the latter part of the twentieth century. To market tranquillizers and antidepressants, what used to be called worrying and feeling sad are now ‘anxiety disorders’ and ‘depressive illnesses’. Millions of our children are now on amphetamines to treat their difficulty concentrating and sitting still. Millions of older people sit tranquillized in ‘homes’. Tens of thousands are still having electric shocks applied to their brains to cause convulsions in the name of ‘psychiatric treatment’.

Beyond offering some alternatives and the evidence supporting those alternatives, this book examines the historical, economic and political contexts in which such simplistic bio- genetic ideology gained such a damaging supremacy. We do this lest we suffer illusions about the uphill struggle facing all of us determined to return mental health services to a more humane and effective pathway. Overcoming the obstacles will require that everyone – mental health professionals (including psychiatrists), people currently called ‘schizophrenic’, their loved ones, researchers, policy makers, service funders and managers and politicians – play their part. For our part, we have gathered together the research evidence that can be presented, in that struggle, to those whose minds are not forever closed to the rather simple ideas that human misery is largely inflicted by other people and that the solutions are best based on human – rather than chemical or electrical – interventions.

Our book is not the first to undertake such a task. For over 50 years, many others have documented the sterility and futility of trying to explain and treat ‘madness’ with the crude concepts and tools of biological psychiatry, and have offered alternatives. A selection of these is listed below. Our own contribution is partly an updating of the evidence, partly a resurrecting of forgotten or taboo research findings, and partly an introducing of newer approaches (such as understanding the role of childhood trauma, documenting that biological causal beliefs exacerbate stigma and explaining...