Schizophrenia is one of the most famous syndromes in the field of mental health. Its striking characteristics and the strangeness of the hallucinations and behavioural disorders it produces have made this concept known to many people who are not involved in psychiatry or clinical psychology. Of course, among patients and health professionals, schizophrenia is important not so much because of the above but because of the serious consequences it has for the health of those who have been diagnosed with it.
However, it is one thing for the symptoms associated with schizophrenia to be unbelievably severe, and another for this clinical entity to exist as such, as a natural phenomenon well separated from the rest. In fact, the concept of what we’ve been calling schizophrenia for years may have its days numbered .
What if schizophrenia didn’t exist?
Until a few years ago, Asperger’s syndrome was one of the best known diagnostic labels, due among other things to the striking characteristics shown by some of the patients of this type: intelligent, with difficulties in empathizing, and obsessed with very specific areas of knowledge.
However, today this denomination is no longer used. The phenomenon referred to Asperger’s syndrome has become part of a spectrum ; specifically, Autism Spectrum Disorders.
Something very similar could soon happen with the label of schizophrenia, harshly criticized by psychology for decades. Now, doubts about its existence are gaining strength even within psychiatry. There are two main reasons for this.
Several causes for different disorders?
As with virtually all so-called “mental illnesses,” there is no known specific biological disorder that causes schizophrenia.
This is understandable, considering that the nervous system in general and the brain in particular are tremendously complex biological systems , with no clear path of entry and exit, and involving millions of microscopic elements in real time, from neurons and glial cells to hormones and neurotransmitters.
However, another possible explanation for the failure to isolate a neurological basis for schizophrenia is that it does not exist. That is to say, that there are several and very diverse causes that end up generating different chain reactions but at the end of which a set of symptoms appear that are very similar to each other: hallucinations, delusions, stupor, etc.
On the other hand, attempts to link schizophrenia to a few altered genes, which would provide a quick and easy way to explain a disease by pointing to a very specific element as its cause, have been unsuccessful. Only 1% of the cases in which this syndrome appears have been associated with the elimination of a small section of chromosome 22. What happens in the remaining 99% of cases?
Different treatments for various types of schizophrenia
Another evidence that reinforces the idea that schizophrenia does not exist as a homogeneous entity is that not only are parallel pathways intuited by which the symptoms of this syndrome may appear; there also seem to be parallel pathways in its treatment .
The fact that certain types of treatments seem to work specifically in cases where this syndrome seems to be caused by certain triggers, and not others, points to the fact that there are different foci of nerve activity linked to schizophrenia, and these do not all appear at once in all patients.
The opposite may also be true, that in certain patients with schizophrenia who share significant characteristics in common (which differentiate them from other patients with schizophrenia), some drug treatments work particularly poorly , or not at all. For example, in children where the onset of psychotic symptoms associated with schizophrenia coincides with exposure to traumatic events, antipsychotic drugs are not very effective.
One of the problems of psychiatry is that, sometimes, it is inferred that the problems shown by patients are found in the depths of their nervous system , isolated from the context in which the person has developed and learned to behave.
Of course, this belief has reason to be in certain pathologies in which certain nerve cells have been seen to be destroyed, for example.
However, attributing the focus of syndromes such as schizophrenia to something that spontaneously “comes into existence” in patients’ brains can be fallacious. That there is a set of symptoms suggesting disruption with reality does not mean that all these cases are rooted in a particular disease and separated from all others. Holding that idea, to a certain extent, may be simply to give use to a word that has been used for a long time. But we must bear in mind that in science language adapts to reality, and not the other way around.
For this reason, researchers such as Jim van Os, Professor of Psychiatry at the University of Maaschrist, have proposed that the term “schizophrenia” be replaced by the term “Spectrum Disorders of Psychosis”, an idea in which there is room for different causes and poor mechanisms that take shape this break with reality. This less essentialist approach to schizophrenia can make us really understand what happens in the lives of patients, beyond trying to fit their behaviours into a single homogenising category.