In Pursuit of Schizophrenia: Reflections on "Imprecision" in Scientific and Professional Thought and Practice

By Anthony Marsella

This volume is a collection of scholarly, editorial, and personal commentaries (Chapters) on "schizophrenia" with special attention directed toward the consequences of "imprecision" in professional and scientific thought and practice because of our failure to accept "schizophrenia" is a construct. A construct is a term, word, concept subject to

• Language: English
• Publisher: ReadersMagnet LLC
• Release date: Feb 16, 2023
• ISBN: 9781959761792

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In Pursuit of

Schizophrenia

In Pursuit of Schizophrenia

Copyright © 2023 by Anthony Marsella

Published in the United States of America

ISBN Paperback: 978-1-959761-78-5

ISBN eBook: 978-1-959761-79-2

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any way by any means, electronic, mechanical, photocopy, recording or otherwise without the prior permission of the author except as provided by USA copyright law.

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Table of Contents

Dedication

Preface

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Back Cover Material

IN PURSUIT OF SCHIZOPHRENIA:

REFLECTIONS ON PROFESSIONAL AND SCIENTIFIC IMPRECISION IN THOUGHT AND PRACTICE

"Fifty-Five Years of Inquiry,

Thought, Bewilderment, and...Longing"

Anthony J. Marsella, Ph.D.

AURELIUS PRESS

ALPHARETTA, GEORGIA 30022

April 1, 2016 10:12 AM

Waste no more time arguing

about what a good man should be.

Be one!

Marcus Aurelius

(121 CE – 180 CE)

DEDICATION

Thomas Ward Leland, M.D.

Psychiatrist and Schizophrenologist

Friend, Colleague, Mentor, Model

People enter our lives each day, some for just a moment, others for a lifetime. All are to be respected; but those who remain for a lifetime, are to be treasured, for they are the substance of our lives, anchors of personal and professional identity and purpose.

Thomas M. Leland entered my life in the early 1980s, when I was in urgent need of a collaborating psychiatrist for the World Health Organization Division of Mental Health Project, "Course and Outcome of Severe Mental Disorders." The project required a psychiatrist willing to devote time and energy to an extraordinary international research effort: the identification and assessment of psychotic patients for long-term follow-up.

There were local psychiatrists who contributed to the project, but none had an enduring interest in research. The project required a psychiatrist with a deep and abiding commitment to the study of severe mental disorders, especially "schizophrenia." Enter Tom! Tom called himself a schizophrenologist! He had a lifetime commitment to the study and treatment of schizophrenia.

The project also required a colleague willing to respect my contrarian views: tolerating them, tendering them, and mentoring me, based on their own hard-won clinical experiences. I was a clinical psychologist, the only psychologist appointed to lead a WHO Research Center for Severe Mental Disorders. Tensions among the professions in the late 1970s required a collegial psychiatrist for whom professional degrees meant less than a substantive respect for scholarly credibility. Enter Tom!

Fortuitously, Tom’s wife, Jean, was a Ph.D. clinical psychologist. Tom was accustomed to clinical psychology’s professional and scientific views of psychopathology and therapy. Ah, destiny! An ally! As our work progressed, Tom fondly called me a schizophrenologist. It was a compliment of the highest order.

Amidst Tom’s vast clinical knowledge, warm presence, critical thought, cryptic comments, and witty humor, my outside of the box views, thrived. Tom never wanted more than to learn about "schizophrenia." It was his calling for more than 60 years! The two of us went on to become good friends, and remain so to this day. For this, and for so much more, I dedicate this volume to Tom. Like Tom, some of the chapters in this volume have aged, but they remain fertile sources of insights and wisdom!

Photo 1: Tom enjoying the Pacific Ocean from the veranda of Halekulani Hotel, Honolulu, Hawaii. Photo 2: Tom and Jean Leland. Jean is a clinical psychologist practicing in Honolulu, Hawaii. They have been married for 34 years.

PREFACE

This is an unusual volume! It is unusual because in an effort to understand the topic of my concern, schizophrenia, I turned to personal narrative, observation, scholarly chapters, editorial opinions, and, in some instances, passionate political commentaries. I have not hesitated to address the harsh consequences of asymmetric distributions in power controlling current professional and scientific views of schizophrenia.

Typically, there are different publication forums for empirical research papers, theory papers, personal narratives, or opinion editorials on schizophrenia. This is done to maintain the aura of scientific objectivity. Scientific objectivity, however, is itself a controversial concept, term, word. Increasingly scholars are coming to recognize the limitations in objectivity’s alleged purposes and misguided assumptions in scientific research. One scholar, Sigmund Koch, coined the term epistemopathologistics to explain our inclination to accept cognitive errors in our "scientific and professional thought, as indisputable truths.

I agree! In this volume, I combine scholarly, personal, editorial, and opinion alternatives, often times sliding from one approach to another, with no hesitancy or apology.

For me, transcending accepted publication conventions enriched my message. I wanted to capture the panorama of my experiences as a student, professional, scientist, and scholar of schizophrenia. Thus, the volume includes an array of published and unpublished papers, lectures, public addresses, and personal observations and experiences. They complement one another, offering the reader an opportunity to join me in exploring imprecision in professional and scientific thought regarding schizophrenia.

As is widely known, there is considerable controversy regarding scientific, professional, medical, political, and moral dimensions of schizophrenia, even as certain sectors dominate thought and practice. Controversies exist among and within scientists, scholars, social commentators, families, patients, and society. There is no single accepted view of "schizophrenia; no consensual agreement on schizophrenia’s nature, causes, treatments, or prevention." There are, however, official and authoritative views held by medical, professional, and legal sources and forces; these views, in my opinion, should not elude discussion and debate.

Chapters in this volume speak to the abuses associated with the dominance of psychiatric and related mental health professions, because of their assumptions and practices. Medical, professional, and legal positions of these groups are institutionalized across society and the world, empowering a vast mental health services’ complex. This complex maintains a powerful canon of accepted thought and practice, resisting criticism and change. The canon tolerates and encourages imprecision.

As I began to write, several purposes in my writing emerged: First I could explore and question aspects of the existing canon of "schizophrenia;" second, I could provide historical, clinical, and cultural insights regarding the imprecision of schizophrenia; third, I could explore and question sources of resistance among professions and sciences claiming authority and legitimacy.

What was clear to me is the mental health services complex sustains and preserves a corporate entanglement of hospitals, professional practice organizations, pharmaceutical companies, and educational institutions. There is a cultural web of relationships serving to protect interests of each player.

The history of "schizophrenia reveals a powerful cultural web tied to the medicalizing psychiatry and associated professions. The cultural web resists criticism and change. The subsequent monopoly of thought and practice fosters imprecision." This became for me the theme of writing this volume.

I wanted this volume, to provoke discussion, and to inspire a rethinking of conventional thoughts and practices. I do so, not out of malevolence, but from a deep and sincere concern for all I have witnessed and experienced in the course of my career as clinical psychologist The inspirational words of Antoine de Saint Exupery (1900-1944) (www brainyquotes.com), apply:

If you want to build a ship, don’t drum up people to collect wood, and don’t assign tasks and work, but rather teach them to long for the immensity of the sea.

I long for a revisionist vision of "schizophrenia’s" history, nature, and implications. I seek recognition and awareness of errors tolerated for centuries because of the accepted contributions of schizophrenia’s revered pioneers. These contributions have assumed gospel-like status, rendering them resistant to revision.

In spite of the virtues of respecting historical contributions, however, I came to recognize they are products of human endeavor and experience, subject to specific eras of thought, and personal character, temperament, inclinations, and circumstances. The contributions are templates, not truths! Different templates yield different insights and different conclusions! Their value resides in their explanatory power justifying thought and practice. I question whether the accepted and dominating templates offer explanatory power, or whether they have become a self-sustaining system perpetuating century-old notions rooted in medicine’s specialty: psychiatry.

CHAPTER 1:

INTRODUCTION: ARE WE MAKING PROGRESS?

The Conundrums of "Change

It can be argued we have made great progress in our understanding of schizophrenia across the centuries, steady advances yielding improvements in thought and practice. My answer to this view is yes and no.

Certainly, recent brain, neurological, cognitive, and medical research findings have brought stunning findings on the brain and CNS determinants of human behavior. However, without a continued appraisal of findings regarding concepts, terms, and words, we risk anchoring our path. The pleasurable hiatus of contentment and satisfaction following a finding fosters basking in glory amid the finding. Accommodating the finding within the context of prior knowledge and future implications is often dismissed or ignored.

It is natural, perhaps, for this to be the case, like savoring a victory after a long battle, and unwilling to question it! A win is a win! But this is a risky response. Many of findings emerging in recent years are a function of reductionism approaches, aided by technical changes, revealing brain and CNS structures and processes determinants of behavior. This has important scientific consequences! It also has important philosophical consequences.

Reductionism enjoys extensive popularity and support among medical, psychiatric, and psychological circles. There is appeal in pointing to a tangible cell or process as a cause or influence of behavior. It is capable of being seen and touched. Psychiatry and allied mental health professionals have embraced reductionism.

Reductionism has become an ideology; like all ideologies, however, ‘reductionism requires constant appraisal! We must not forget reductionism is a template, a set of spectacles, for understanding a topic. As a template, it offers a paradigmatic understanding unique to its level of explanation and understanding. It carries its own terminology, replete with their strengths and limitations. We have been here before! Each technical finding, each political insight, each social or moral insight, brings with it unbridled optimism and hope!

In my opinion, we need to be careful here! There is a human hesitancy to tolerate uncertainty! But uncertainty is the basis of doubt, and doubt is a motive for exploration. Unbounded confidence in accepted thought and practice leads to stasis! While there maybe comfort, there is a risk of closing our minds to change. There are no easy answers in the arena of thought, inquiry, and concern for schizophrenia.

Major challenges for schizophrenia reside in a complex of critical factors, including: (1) a distant history, too often ignored as the source of credible thought and practice; (2) a faulty medical classification system; (3) a commitment to a medical diagnosis system of questionable relevance for schizophrenia; (4) powerful cultural webs of mental health professionals, scientists, and industries with vested interests in the existing system; (5) the reality of multiple bio-psycho-social etiologies in psychoses, resulting in a spectrum of conditions often assigned a single term: schizophrenia, and (6), a failure to grasp schizophrenia is a construct, a term we have created, reified, and accepted as a reality. The term itself is problematic. It means everything and nothing! Think of associations coming to mind when you hear or read the word, "schizophrenia." They are bewildering!

Imagine clinicians responding to my words regarding, schizophrenia:

"Well, I don’t know about you, but I have scores of schizophrenic patients. They are really nuts. I am trying my best to help them! If you come up with an answer, let me know!"

In return, I would say:

You have scores of people who have been assigned a diagnostic label which lacks validity and reliability. It is an imposed status-marker dooming them to a living hell. It may help with insurance, and with medical records, but it interferes with clinical progress. We are using historical language, conceptual assumptions, and treatments, and they are keeping us captive.

The clinician would reply:

I agree! Thanks a lot! Tell me! What exactly would you do to treat and cure these patients, because I am trying, and I fail; but I know no other terms or assumptions beyond those I was taught; and beyond those NIMH and universities tell me to use. You know the arbiters of our profession! Are you asking me to risk going against accepted practices? Do you know how many frivolous law suits I have already had filed against me.

Aye, that’s the rub! It is a Shakespearean situation! A history! A tragedy! And in cynical and ironic ways, a comedy! Shakespeare might well say:

And on what quaky foundation, pray tell me, stout friar, doeth thou continue to engage in acts of such pernicious consequence for human mind and spirit? Art thou not uncomfortable with thy tasks? Fear thee not the risks of hell for those who feign claim sanctity in acts obvious to insult and to reason?

Tell me, friar, clothed, fed well, and filled in thy generous girth, with ale; art thou self-appointed in thy rounds, or given privilege by royal might? Know paths thou tread are filled with unknown peril, springing from darkened places, products of thy own prior acts. Be alert to thy course! For in the presence of a stricken compass, choices become subject to destiny’s record.

The D Word Trap:

The reality of the matter is clinicians and researchers are caught in a dilemma. They are wedded to D-Words (e.g., dysfunctions, disorders, diseases, deviancies, disabilities) used daily in the provision of mental health services. The D-words are rooted in deficits implying a medical problem and solution. Clearly, there is visible and tangible suffering for patient and professional! But D words are limiting us to restricted responses. Figure 1 graphically displays the D word semantic traps.

Figure 1 represents the complex interactive relations among labels used to describe human bio-social conditions. The circles are descriptors of D-words, used medically, legally, and morally without grasping consequences. They are a deficit lexicon, specific to medicine.

Those seeking help come to offices, clinics, hospital, and prison doors! The numbers are overwhelming; the solutions are few! The work is challenging, the consequences often punishing. The clinician relies on a limited array of skills and talents, unable to address the pernicious societal milieu in which most mental health problems emerge and are sustained (e.g., poverty, racism, malnutrition, crime, violence, drugs, institutional corruption and collapse). All of this occurs amid imprecision in thought and practice. Our terms guide our thoughts. There is a tyranny of language!

When a profession or discipline is empowered to be prosecutor, jury, judge, and enforcer of societal conventions, opportunities for abuse are many. Unfortunately, psychiatry, and associated mental health professions serve as priests, judges, and juries of societal normalcy. They assess and enforce societal conventions and values. Society has few others it can turn to other than courts and police. This state of affairs has consequences.

Convention, tradition, and law sustain and limit clinicians. There is a cultural web of public and private mental health services supported, by insidious forces, including physicians, hospitals, insurance companies, pharmaceutical companies, professional associations (e.g., both APA’s), academics, and professional and scientific leaders, unwilling to change or challenge the culture for historical, societal, moral, and financial reason.

The post-modernism revolution in thought called attention to the distribution of power in our lives. Power is present in all relations and relationships. It is present in families, schools, workplaces, and in institutionalized mental health systems. While power distribution may be part of the natural order of a society, it requires a constant evaluation of its presence, function, and consequences.

Figure 1:

Graphic Representation of

Complex Relations among Psychological

Social, Biological States and Conditions

Power in the mental health system is mal-distributed; help-seekers (patients) and providers can become victims. Those in power determine accepted clinical practices and deny others! They determine what is available, accessible, and acceptable? It is like the myth of peer review. Appeal to the peers, and your product will pass review. But if you challenge accepted dogma, you may not be published or acknowledged. It is a closed system!

The problem is professional and scientific knowledge is restricted by those in power, who are determined to hold beliefs, positions, and regulations affirming their views. In some cases, there is an intentional and willful denial of alternative views. This is a professional and scientific tragedy!

For example, recent news reveals much of the psychopharmacology research is flawed; many studies were not shared because of negative results. When the motive is profit, beware! This means data we rely on was fixed or cooked. Much of the psychological research is also a problem because it is limited by sampling, measures, statistics, and failures to meet other essential research criteria. The inadequacies deserve attention!

In brief, as noted previously, we have a mental health services’ complex of beliefs, practices, and institutions. But what do the terms mental and health mean? And what of the powerful and lucrative DSM gospel, now being challenged by its own creators? DSM categories, criteria, and disorders are ambiguous; subject to varying definitions and regulations by those in positions of authority.

Yet the system survives and thrives, gaining support each day. We hear the cry: Support mental health! The sources of power sustaining this system require recognition. This situation is graphically displayed in Figure 2.

Samuel Kris, in his recent article, entitled, Book of Lamentation (The New Inquiry October 18, 2013) (Http://thenewinquiry.com/), likens the entire DSM enterprise to a dystopian novel. This may seem an extreme view to some, yet Kris argues persuasively about the motives responsible for this massive classification system of problems, and the consequences it signals.

It is, after all, an effort to establish descriptions of normality or acceptable behaviors and experiences, with a special attempt at claiming disorders cited in the classification, through the inclusion of criteria, can lead to a medical diagnosis, with implications for an understanding of etiology, expression, treatment, and prevention. Tragically, it is a powerful myth with profound consequences.

Figure 2:

"MENTAL HEALTH

SERVICES’ COMPLEX"

In critiquing the American Psychiatric Association DSM-5 (991 pages), Kris states the following:

It’s also not exactly a conventional novel. Its full title is an unwieldy mouthful: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The author (or authors) writes under the ungainly nom de plume of The American Psychiatric Association . . . . Over two inches thick and with a thousand pages, it’s unlikely to find its way to many beaches. Not that this should deter anyone; within is a brilliantly realized satire, at turns luridly absurd, chillingly perceptive, and profoundly disturbing. . . . Here, we have an entire book, something that purports to be a kind of encyclopedia of madness, a Library of Babel for the mind, containing everything that can possibly be wrong with a human being.

The sufferers of DSM-5, meanwhile, have no voice; they’re only interrogated by a pitiless system of categorizations with no ability to speak back. As you read, you slowly grow aware that the book’s real object of fascination isn’t the various sicknesses described in its pages, but the sickness inherent in their arrangement. . . . Our narrator seems to believe that by compiling an exhaustive list of everything that might go askew in the human mind, this wrong state might somehow be overcome or averted. . . . As such, the entire story is a portrait of the narrator’s own particular madness. With this realization, DSM-5 starts to enter the realm of the properly dystopian.

Kris’ words are a sharp and painful commentary about the DSM system. To class the DSM system as a dystopian novel insert an image of the mental health professions as controlling system authorized by many of the elements