
The concept of schizophrenia is dying - LiweiZ
http://theweek.com/articles/731238/concept-schizophrenia-dying
======
thanatropism
There's something important the article seems to be getting wrong: psychosis
is a symptom, not a disease.

There are such things as psychotic depression and post-partum depression;
psychosis is a symptom of severe bipolar mania, etc.

By the way, the concept of schizophrenia first comes up in Emil Kraepelin's
realization that bipolar disorder (manic-depression) and schizophrenia
("precocious dementia") are distinct pathologies -- even though they may have
similar presentations at times. With this, Kraepelin also inaugurates the idea
of differential diagnosis.

Similar in spirit (but less compatible with our contemporary understanding) is
Freud's distinction between neurosis and "psychosis", the former being
amenable to analysis. I.e. schizophrenia has always been a diagnosis of
exclusion.

If people are actually being able to open up schizophrenia into further detail
-- well, that's good. But there will always be a diagnosis of exclusion, we'll
just euphemize it as "psychotic disorder NOS" or some such.

~~~
Pica_soO
Freud is dead. Dead and gone. We moved on. Really, i know he founded the field
and made for a nice soap opera gossip generator when discussing other peoples
problems sources (generating alot of unnecessary drama, to people who already
had drama, like having the genes for schizophrenia in the family)- so please
could we stop mentioning him, when discussing modern neurology.

Its like a tribe on a pacific island had discovered boolean algebra first, and
every time somebody tried to discuss comp science ever after - out of nowhere
someone yells "This calls for a ritual, sacrifice the chicken, you cant
discuss booleans, without being ridden by baron samedi."

~~~
ivkustov
We actually shouldn't. The psychoanalysis is contempted and forgotten however
psychoanalysis is something like a computer language, the language of human
inner world.

Some kind of lisp with probably terrible interpreter.

The modern neuroscience is of course something like an assembler. So lisp or
assembler? If you want to write modern OS, then you know the answer.

The Freud, Jung, Lacan theory is related to psychotherapeutic work is like
automata theory relationships to writing modern enterprise applications.

I don't believe there is something 'true' or 'objective' in psychoanalysis -
deep inside is some ocean, some chaos of different introjections, emotions and
feelings. But the psychoanalysis helps to create structure there, to look and
make sense out of the ocean.

There is no substitude for psychoanalysis except really good prose probably or
poetry.

And of course Freud was a genius.

~~~
nradov
If a man who was wrong about almost everything can be considered a genius then
the word "genius" has lost all meaning.

~~~
dredmorbius
There are dimensions to genius.

Seeing a common subject, a set of boundaries, a _possible_ (even if incorrect)
set of guiding principles, can be genius. If it inspires further exploration
or refinement or even _rejection_ of ideas, it's a productive step.

Einstein railed against QM, Newton believed in alchemy, Kelvin though the
Earth was 30 million years old, the list of people opposed to continental
drift / plate techtonics is vast (see Naomi Oreskes several papers and books
on the history of the development of that subject), Samuel Morse had what
would now be dispicable views on race and religion, Ford was an anti-semite,
Crick and/or Watson have their own failings, etc., etc., etc.

Much of genius is being able to _jump out of and beyond_ the present dominant
paradigm and mental models. It's not about being _right_ but of being _less
wrong_. Than that which came before, not after.

~~~
nradov
The scientists you listed at least attempted to follow the scientific method
as best they could in most of their professional work (although they certainly
made their share of methodological errors and allowed personal biases to
affect their work). Whereas most of Freud's writing was the moral equivalent
of astrology: based mostly on random anecdotes and not falsifiable. Hardly
equivalent.

~~~
dredmorbius
That is not the original criticism you raised, nor is it the one I addressed.

------
bane
I grew up with a close uncle who suffered for decades from this disease. The
tales of his brilliant youth, on track as a naval nuclear engineer, are only
more tragic to the shattered shell of a man I knew. Most of his treatment
involved a cocktail mix of a dozen or so "medicines" who's primary purpose
appeared to be to keep him sedated for long stretches of the day.

He was absolutely unable to hold a job, or even a coherent conversation, and
was in and out of half-way houses and treatment programs. At times he would
get violent to himself or others as various psychotic fantasies moved him to
be. He famously assaulted my sister one day before my father sent him away to
stay with my mother's family (of which he was a sibling)...when he remembered
the event at all he insisted he was trying to save her from one of a variety
of fantastic and impossible sequences of events.

Often in tears trying to explain what he had been trying to do, the family
eventually concluded that in his mind he was trying to do a good thing and
help against some imaginary evil, but his reality was so distorted it had
turned into harm and that we simply couldn't risk his presence any further.

Drugs of various levels of legality were a constant feature of his life. It
was well known that he ended up dropping out of the Navy as a pot head that
morphed into a serious cocaine and lsd user. Much of his treatment in his
later years was trying to get him to stop self-medicating and to let the
professionals provide the legal stuff.

He made it to his 60s before a tumble in the bathroom knocked him unconscious
and sent him into a hospital bed where he never woke up. Another Uncle, the
guardian of his estate, made the decision to take him off of life support and
hope his next chance turned out better than this one. His autopsy wasn't
revealing, his system was basically a mobile pharmacy and narcotics evidence
locker combined, but it still devastated the siblings who had tried to help
him find his way back to the brilliant 20 year old they last remember.

~~~
I_am_tiberius
I know somebody who was brilliant (I mean brilliant as hell) as well until the
age of about 20. He started suffering from bipolar disorder later on (at about
23). Between that age he was registered at university but was not attending
it. Instead he was partying all the time. I noticed him acting odd first when
he came back from a trip to the other side of the world - my impression was
that the jet-lag in combination with alcohol consumption and the realization
that other people made a lot of progress during the years he was partying
helped initiating the illness. I think summarized the factors were lack of
sleep, alcohol, stress and high vulnerability due to inheritance.

Therefore I think the best way to prevent this illness is:

\- Avoid stress, especially in your 20's

\- Try to have an ordered life

\- Get enough sleep

\- Avoid too much alcohol consumption

\- Do sports (rarely a mistake I assume)

\- Take jet-lags seriously

I am not sure if drugs (from the trip to the other side of the world) were
involved. It is possible but I doubt it.

~~~
I_am_tiberius
I forgot to mention: He was smoking a lot as well.

~~~
Balgair
Most schizophrenics smoke a lot of cigarettes. Though not well understood, the
nicotine may act as a general stimulant and help with the disease. It's an
active area of research right now.

It's a very strange site, but it may be a good jumping of point for those
doing research in to the link:
[http://www.schizophrenia.com/nicotine.benefits.htm](http://www.schizophrenia.com/nicotine.benefits.htm)

------
Aloha
Schizophrenia is one of those disorders that medicine has, that is likely not
one discrete condition, its likely a multitude of different psychological
illnesses all flying under one banner, even if the underlying psychology and
physiology are quite different for different people. As we get better with
medicine, we find more illnesses - for example, its part of why I think cancer
is found so much more often now, while there is undoubtedly more cancer (we're
living longer, as it turns out, old age is a fellow traveler of cancer), we're
also much better at finding it.

~~~
bencollier49
Like Asthma.

------
RHSman2
I’d suggest that not taking a drug (weed/lsd/mushrooms) that alter ones
perceptions of our very existence is a good way of staying mentally sound.

If you take ten 16 yr olds, allow them to experiment, 1-2 will drop off the
world, 2-3 will have major, life changing changes to the way they view life
(border line changes in said spectrum) and the rest handle it fine although
with a significant change in lifestyle.

As someone who has had a close call with the boundaries of perception I
believe weed is of significant concern. It has a ‘benign’ perception but for
those it effects it can take their heads off to places which are not healthy
for fitting into normal, standard life. Aka the general ‘schizophrenic’ term

~~~
adammunich
How do you mean? Most folks I know who regularly use marijuana aren't close to
anything I'd call schizoaffective.

Those who I know whom have gone off the deep end so to say, seem to have had
other troubles in life which compounded to become too much to handle for them.

~~~
RHSman2
Are you replying to me? So, you are suggesting my story is lies? I guess you
should study stats to know that there are more than 60 people in this world.

~~~
RHSman2
Clearly weed has not helped me comment on HN . Wrong reply

------
kosma
A significant chunk of schizophrenia-diagnosed patients have already been
chipped away; it turned to be autism spectrum disorder instead. I wouldn't be
surprised if other such corrected diagnoses followed, gradually dismantling
the schizophrenia itself altogether.

~~~
mercer
On top of that I would be surprised if autism doesn't (again) split up into
separate (sub-)disorders as we find out more. Sooner rather than later, I
hope.

------
SolaceQuantum
I would argue that the indications of schizophrenia being associated with weed
is ascribing a causative effect to a correlation. Weed doesn’t increase your
chances of schizophrenia unless you already had something that would tilt you
in that direction in the first place, from my experience. I would say I do
agree that schizophrenia probably needs to be broken up; it was merely a
collection of symptoms to begin with that couldn’t be explained by other
means. Now we have explanations.

I am curious how this may affect schzioaffective, schizoid, and schizotypal
disorders. That they’re not mentioned st all in this article is rather
disappointing.

~~~
njarboe
The text does a decent job of not saying smoking weed causes psychosis:

"Compared with non-cannabis users, the daily use of high-potency, skunk-like
cannabis is associated with a fivefold increase in the odds of someone
developing psychosis."

But the photo caption below a picture of someone smoking weed explicitly
states (not supported by a study; how could one possible do a double blind
test on cannabis in the current regulatory environment) a causative effect:

"Smoking skunk every day increases your odds of developing a psychotic
disorder fivefold"

~~~
KyeRussell
Given how carefully written that aspect of the actual article text was, I'm
assuming that the photo + caption was added later on by someone else who was
more interested in clickbait than differentiation between cause and
correlation (or didn't understand the difference in the first place).
Journalism is dead, rabble rabble.

~~~
dx034
Or just not aware of the difference. Not everyone helping with layouts is evil
and just wants clickbait. They're just not always experts on the field.

~~~
jacobush
Indeed. Also keep in mind, that though someone might realize, on an abstract
level, that ”correlation is not causation”, they might not be used to actively
looking for that distinction in text. Everyday discussions tend to be more
fluid and inexact.

------
DanBC
The UK British Psychological Society recently released an update to their
_Understanding Psychosis and Schizophrenia_ report.

People may be interested in it. [http://www.bps.org.uk/networks-and-
communities/member-micros...](http://www.bps.org.uk/networks-and-
communities/member-microsite/division-clinical-psychology/understanding-
psychosis-and-schizophrenia)

It's had some criticism: it includes a bunch of people who probably aren't
psychotic (auditory hallucinations are common, and not always a sign of
illness, for example), and it appears to exclude a bunch of people who have
severe forms of illness.

Here are two blog posts that give a thorough, evidence based, review:

[https://www.nationalelfservice.net/publication-
types/report/...](https://www.nationalelfservice.net/publication-
types/report/understanding-psychosis-and-schizophrenia-a-critique-by-laws-
langford-and-huda/)

[https://www.nationalelfservice.net/mental-
health/psychosis/u...](https://www.nationalelfservice.net/mental-
health/psychosis/understandingpsychosis/)

------
MichailP
I love this snippet from Dr Gabor Mate [1], where he talks about "the myth of
normal". If you haven't seen this, please take a look, it is truly wonderful.

[1]
[https://www.youtube.com/watch?v=8_j5mmBa4mw](https://www.youtube.com/watch?v=8_j5mmBa4mw)

------
tcj_phx
I think a good case can be made that many of these "mental disorders" are
actually metabolic problems. There are many causes behind an individual's
metabolic problem that leads to schizophrenia/dementia/psychosis/(edit3:
depression)/etc...

Sometimes people are malnourished. The B-vitamins are important cofactors for
metabolic activity. An old/new treatment for "schizophrenia" is Vitamin B3
[0]. My girlfriend's treatment provider did a genetic test this past summer
and found that she's a poor methylator. This means that she doesn't convert
folic acid (synthetic Vitamin B-9) into folate very well. They've put her on
prescription folate [1], and she's doing much better than when she was just
double-tranquilized. I asked the biochemist about this issue, and he said that
when on a good diet with folate-rich foods (liver, etc), even 'mutants' get
plenty of folate.

[0] [https://www.madinamerica.com/2017/06/schizophrenia-
deconstru...](https://www.madinamerica.com/2017/06/schizophrenia-
deconstructed/)

[1]
[https://en.wikipedia.org/wiki/Levomefolic_acid](https://en.wikipedia.org/wiki/Levomefolic_acid)

The street pharmacy's stimulants (cocaine/meth) shred the mitochondria. These
are known causes of substance-induce psychotic disorders.

People who drink heavily train their nervous system to become insulin-
resistant and run on acetate (one of the breakdown products of ethanol). I
think it's well-established that excess alcohol is inflammatory, which is also
associated with psychosis.

So... Cute anecdote from today. I called two attorneys because I've hit a wall
in my efforts to convince my girlfriend's treatment provider that she's been
misdiagnosed and is not actually benefiting from the palliative maintenance
medications (anti-psychotic/etc) they're still forcing her to take.

The first attorney listened to me, confirmed that it was within my legal
rights to file pro-se petitions with the court, said that rural judges don't
want to cause problems for their community's treatment provider, and said he
couldn't help me because he'd already done some work for my girlfriend's
treatment provider. He gave me the number for the second attorney.

It later occurred to me that the treatment provider certainly consulted him
about _my_ suit against them.

(minor edits)

edit2: physical injuries and inescapable/emotional stress are drains on the
body's energy-producing capacity too. My other friend's father gradually
became "schizophrenic" after he broke his back falling out of a tree.

~~~
gscott
Doctors are only allowed to give medications that treat a certain disorder.
Experimental herbal treatments are not going to resolve a real mental
disorder... you can try some vitamins but no medical professional is going to
stake their medical license on it. Both of my parents had schizophrenia and it
was a real hell.

~~~
LyndsySimon
> Doctors are only allowed to give medications that treat a certain disorder.

Is this true, particularly in the US?

My understanding is that a doctor can prescribe basically whatever they want
as long as they believe that "in their professional opinion" the potential
benefit outweighs the potential harm.

It's certainly common for doctors to prescribe medication "off-label" to treat
conditions for which the medication is not approved by the FDA. I don't see
how prescribing a specific vitamin in an attempt to impact a mental disorder
is any different from, say, prescribing modafinil for ADHD?

~~~
gscott
It is true a Dr could in theory do what they want to but there are treatment
guidelines and if they vary off that too much then the medical board could get
after them. This happens I know a Doctor who wanted to treat lymes disease for
patients and the medical board didn't like that it seems she was experimenting
with what would work to treat it (this was about 15 years ago when it was
pretty new).

------
vacri
Way back in the 90s when I was doing my neurophysiology degree, one lecturer
who worked with schizophrenia said that it was such a difficult disease to
work with because it wasn't one disease. Traditionally, if they didn't know
what was wrong with you, they just threw you in the 'one-size-fits-all'
schizophrenia bucket. One example of this was that the _most frequent_ symptom
(hearing voices) was present in only 69% of cases, and all other symptoms
dropped off fairly quickly from there.

At the time, he thought that schizophrenia would break up into four basic
groups, based on positive/negative affect (does an episode have the person
doing extra activity or withdrawing) and, I think, whether or not the person
has hallucinations.

I haven't really kept in touch with the literature to see how his 4-way
prediction went, but I have never seen anything to counter the idea that
schizophrenia is more than a single disease. And, of course, classification of
disease is a key element of treating it, so if schizophrenia is not being
properly classified...

