paid for my work in mental health information and activism.
"
The medical model
Firstly, the Western medical model sees psychotic experiences and states
of mind as something that
needs to be treated and is 'unusual', abhorrent and outside normality.
This goes back to Emil Kraeplin
and dementia praecox (the old name for schizophrenia) but this
misunderstanding stretches further back
in history. An analogy to the psychiatric view of psychosis would be to
describe an elephant by looking
through a telescope: they mistake the trunk for a leg and conclude a
five-legged animal is abhorrent.
The medical view is rooted in symptoms not causes. The medical view is
defined by either ICD-10
(used in the UK and most of the rest of the world) or DSM-IV (used in
the US and for research). In fact
the diagnosis of schizophrenia may only be people who are severely
affected by the distress this state
of mind causes. In fact the only meaning a diagnosis has is it indicates
the treatment program that a
psychiatrist would use however in practice the label carries with it
stigma from the public which further
adds to the person's suffering. There is also stigma in the profession
because some of the books on
schizophrenia paint a negative picture of those who are diagnosed with it.1
It is noteworthy that the traditional view of psychiatry is that these
experiences are not real however in
the last couple of decades this view is changing. This is through the
work of people like Prof. Romme
and Sandra Escher, the Hearing Voices movement, Rufus May, the survivor
movement and others who
challenge the status quo. However the alternative view of the experience
of schizophrenia/psychosis can
be seen in the Iliad where (apparently) actions are initiated by the
'hallucinated' voices of the gods2.
The medical model has looked at brain chemistry using MRI scanners but
has found limited evidence for
causality between the way we know the brain to work and the experience
of psychosis. Tiny differences
have been found in the amygdale, hippocampus and other parts of the
brain between people with and
without the diagnosis of schizophrenia. There is research being done
into genetic pre-disposition as
well, though this may be a resurgence of the hereditary argument –
something that can have dangerous
consequences (Hitler used this as a justification for chemically
castrating people with schizophrenia).
An alternate view
Many people who are diagnosed with schizophrenia look for ways to
interpret where these voices come
from. A common one is telepathy, i.e. that these thoughts are projected
into the mind from someone else
– you can imagine how these ideas could be extremely distressing. Other
people, including the famous
mathematician John Nash believed them to be a government conspiracy.
There are many different ways
people attempt to understand the experience of psychosis and where the
voices come from.
Other cultures view the experience of psychosis differently.
Rastafarians see the voices as those of their
ancestors. In Nigeria people who hear voices are thought to be possessed
by spirits. Hearing voices is
something that features in profound religious experiences. The voices of
god that saints and prophets
have heard are akin to the modern concept of voice-hearing. There is a
phenomenon (observed by the
medical profession) called Jerusalem syndrome where people who visit the
city experience psychosis,
yet many people would see this an ecclesiastical epiphany ,
The artistic and creative fields have had a longstanding relationship
with an alternate and positive view
of schizophrenia. It's not something that I know a lot about but there
people who are better informed
could cite several examples. One study found that subjects who were more
likely to experience
psychosis also scored higher on a scale of self-interest and skill in
music, art, poetry and mathematics.
There have been many famous people who have experienced voice hearing4:
Abraham, Moses, Jesus, Mohammed, Socrates, Joan of arc, Bruno (the
philosopher), Jung, Churchill,
Gandhi, Anthony Hopkins and Micheal Barrymore
(there are undoubtedly others).
It is worth noting that these people would undoubtedly be treated and
possibly sectioned had they been
exposed to the modern psychiatric system.
The fringes of the fringe
There is a view that psychosis/schizophrenic disorders are caused by a
state of awareness and perhaps
a higher state.5 It says that everyone 'hears' voices and those who
report the auditory hallucinations,
paranoia and other facets of psychosis are noticing what other people do
not notice. People commonly
talk about the voice in their head and see this as their 'self' however
people who hear voices may see
the self as one part of a conversation that is happening in their head,
as though there is a committee in
their head and they are the chair.
Freud described three parts of the self or mind: the id, ego and super
ego. He understood these through
observation of his own thoughts and considered all three to make up his
'self or 'I'. In the schizophrenic
mind the 'I' is only one of Freud's id, ego or superego and the other
parts may be considered to be the
auditory hallucinations spoken about in schizophrenia. Psychiatry might
consider schizophrenia to be
a breakdown of the self but it could also be a higher state of
consciousness or awareness and this is
something very difficult to understand without having experienced it.
For a person who has first become aware of the voices in their head the
effect on their esteem is
catastrophic: what a person would have known as free will before becomes
a fallacy. Every decision
they have ever taken suddenly becomes not their own but a combination of
them (their new sense of
I) and their voices6 (that they used to think was 'I'). All their
actions from the point of reaching this state
of awareness become seen as being controlled by these voices as though
they are a puppet. This
reasoning can explain some or indeed all of the negative symptoms.
The main problem with this theory of schizophrenia is that it is
virtually impossible to prove using the
hypothesis-testing paradigm that is the fundamental philosophy of
science. (interestingly the godfather of
this philosophy of science, Socrates, also was an untreated schizophrenic).
"
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