Schizophrenia: Think again!

New research on schizophrenia suggests that the drugs won't always work

The psychiatric establishment is about to experience an earthquake that will shake its intellectual foundations. When it has absorbed the juddering contents of the latest edition of one of its leading journals, Acta Psychiatrica Scandinavica, it will have to rethink many of its most cherished assumptions.

Not since the publication of RD Laing's book Sanity, Madness and the Family, in 1964, has there been such a significant challenge to their contention that genes are the main cause of schizophrenia and that drugs should be the automatic treatment of choice.

With his colleagues, guest editor John Read (whose name I shall use as a generic term for this body of evidence), a leading New Zealand psychologist, slays these sacred biological cows. The fact that some two-thirds of people diagnosed as schizophrenic have suffered physical or sexual abuse is shown to be a major, if not the major, cause of the illness. Proving the connection between the symptoms of post-traumatic stress disorder and schizophrenia, Read shows that many schizophrenic symptoms are directly caused by trauma.

Before proceeding any further with Read's evidence, two important caveats must be entered. Firstly, many parents of offspring with the illness may find what follows deeply upsetting or infuriating. But this is not about blame, and it is not being suggested that all cases are caused by parental care. It is also important to realise that the new evidence is far more optimistic in its implications than the psychiatric establishment's view, for patients, parents and carers alike. Secondly, it is important to stress that plenty of psychiatrists do not subscribe to all the tenets of the establishment view. I recognise that many are working in good faith with an incredibly testing patient population, and do a tremendous amount to help them.

The cornerstone of Read's tectonic plate-shifting evidence is the 40 studies that reveal childhood or adulthood sexual or physical abuse in the history of the majority of psychiatric patients (see, also, Read's book, Models of Madness).

A review of 13 studies of schizophrenics found rates varying from 51% at the lowest to 97% at the highest. Crucially, psychiatric patients or schizophrenics who report abuse are much more likely to experience hallucinations. The content of these often relate directly to the trauma suffered. At their simplest, they involve flashbacks to abusive events which have become generalised to the whole of their experience.

For example, an incest survivor believed that her body was covered with ejaculate. The visual hallucinations or voices often tyrannise and belittle the patients, just as their tormentors did in reality, creating a paranoid universe in which intimates cannot be trusted.

More research is needed to establish if abuse also heralds the other key symptoms of the illness, for example, incoherent, confusing or downright weird language. Studies already show that this is much more likely if the subject of conversation is emotionally charged. When asked to talk about sad rather than happy memories, speech becomes measurably more disordered, increasingly so the more personal the subject matter. We need research to investigate if verbal incoherence is abuse-related.

Another symptom is dissociation (feeling disconnected from oneself and surroundings). This has been shown many times over to be more common in the abused. It remains to be seen if catatonia (complete withdrawal from the world) is so related, although it seems extremely likely that it will be because elements of this are often found in victims of trauma. The same may be true of depressive thoughts, which many schizophrenics suffer and which are rife in the abused. About 15% of schizophrenics die by suicide, and depression is the norm in the suicidal. Suicide attempts are more common among people who have been abused as children, suggesting an abuse-schizophrenia connection, via depression and suicide.

Among the sexually abused there is a greater risk of developing schizophrenia the earlier the abuse happened, the closer the relation to the abuser and the more invasive the acts. Of course, not all schizophrenics suffered trauma and not all abused people develop the illness. What makes the difference?

Apart from the possible role of genes, less overtly cruel early childhood maltreatment, other than actual abuse, may be important. In a review of the 33,648 studies conducted into the causes of schizophrenia between 1961 and 2000, Read found that less than 1% was spent on examining the impact of parental care. What is more, the amounts have decreased steadily, from 1.6% during the 1960s, to four times less than that during the 1990s. Despite this, enough studies have been done to suggest negative or confusing early care may be an important addition to abuse as a cause.

Since mothers spend far more time caring for children than fathers (who account for much of the abuse), their role may be critical in this regard. There is now a vast body of evidence that early infantile deprivation and erratic or unresponsive care as a toddler make adults more vulnerable to depression and personality disorder (a close diagnostic relative to schizophrenia. See my book They F*** You Up - How to Survive Family Life).

It is very possible that maternal deprivation creates a vulnerability to schizophrenia if there is subsequent abuse. Children with schizophrenic mothers are twice as likely to develop the illness as those with an afflicted father. This could be because disturbing mothers are a major factor. Equally, it could be due to gender-linked genetic inheritance, but there are strong reasons to doubt it.

For instance, the mothers of 11,000 Finns were asked if they had considered an abortion for their child during pregnancy, a clear sign that the child was unwanted, increasing the likelihood of subsequent maternal deprivation. Followed up 28 years later, the offspring of mothers who had sought abortions were four times more likely to be schizophrenic - not likely to be anything to do with genes.

Parents' negativity and tendency to be mystifying - paradoxical, contradictory injunctions - may also be important. These were measured in families with problem boys who had not yet developed signs of schizophrenia. After 15 years, the more negative and mystifying the parents had been in a son's childhood, the greater his likelihood of being schizophrenic or of having symptoms.

Of course, that does not rule out the possibility that genes may play a significant role in plenty of schizophrenia, but, even in these cases, the only recent study of the role of early environment shows how important it is. Fifty-six children born to schizophrenic mothers who had subsequently been adopted at a young age and who were therefore, in theory, put at higher genetic risk of developing the illness, were compared with 96 adoptees who were at low risk because none of their biological parents had it. The families were observed extensively when the children were small and all the adoptees were assessed for psychiatric illness in adulthood.

On its own, simply having a greater genetic risk (because of schizophrenia in the biological mother) did not increase the likelihood that the child would develop schizophrenic symptoms. Genes alone did not cause the illness. However, if there was a high genetic risk and it was combined with mystifying care during upbringing, the likelihood was greater. This suggests that genes can be implicated, but only if the family environment is of the kind that fulfills schizophrenic genetic potential.

What, then, is the main case for genes playing a role? A recent review by Robert Plomin, the world authority on genetic causes of human behaviour, revealed that, apart from for Alzheimer's, not a single gene has been shown to play a critical role in any mental illness. There is no evidence that the genetic material of schizophrenics differs in any way from people without the illness.

For the time being, this places the burden of genetic proof on studies of identical twins and adoptees. Putting to one side the fact that there are serious doubts over the validity of twin studies as a method (see Jay Joseph's The Gene Illusion), suppose 100 schizophrenics all had genetically identical siblings. Studies show that half of the identikits will also have the illness. What explains its absence in the other half? Because both have exactly the same genes, the one thing of which we can be certain is that differences in genes are not the reason. It proves beyond peradventure that environment plays an important role in causing some schizophrenia.

More general evidence of the crucial role of environment comes from sociological studies. Schizophrenia is around 12 times more common in children of West Indian immigrants to Britain. Increased rates have been found for immigrants to other countries. Poor people are several times more likely than the rich to suffer schizophrenia, and urban life increases the risk.

Rates of schizophrenia vary as much as 16-fold around the world, as does its course. It is less common in developing nations and tends to last much longer and be more severe in rich, industrialised nations compared with poor, developing ones (even so, about 20% of schizophrenics in developed nations recover completely without taking anti-psychotic drugs). In fact, if you become ill in a developing nation where hardly anyone is treated with drugs, you are 10 times less likely to have any recurrence of the illness - a huge difference, also nothing to do with genes.

What it may have a lot to do with is the administration of drugs (see British psychologist Richard Bentall's book, Madness Explained). They have been shown to impede traumatised people from understanding their voices or visions and recovering from them. There is a close relationship between the drug companies and the psychiatric establishment. While it may not be the intention, the establishment explanation of the causes of and solutions to schizophrenia are crucial components in the process of selling drugs. If patients can be persuaded their illness is an unchangeable genetic destiny and that it is a physical problem requiring a physical solution, drug companies' profits will grow. Read shows those who buy this genetic fairytale are less likely to recover, and that parents who do so are less supportive of their offspring.

The huge importance to drug company profits of the bio-genetic refrain becomes apparent when you learn that most people do not hum along with it. Surveys find that the majority of people mention such environmental factors as trauma, stress and economic hardship as the commonest causes of schizophrenia. It may be seen that the drug companies have an uphill struggle to persuade them otherwise, for which they badly need the help of the psychiatric establishment's towrope. In Read's analysis, letting go of that rope will prevent it strangling the many schizophrenics whose illness has been caused by abuse. Genes may still emerge as a major cause of vulnerability to schizophrenia, as may problems during pregnancy. There is already no question that illicit hallucinogenic drugs are a major reason some vulnerable people become ill. But even if this is true, following Read's important work, it will be hard to ignore its implications.

All patients will need to be asked in detail about whether they have been abused. Anti-psychotic drugs will no longer be doled out automatically, psychological therapies will be employed much more frequently. The psychiatric establishment will have to spend more research money on investigating the role of nurture in causing the illness. Above all, as advisers to government, it will have to recommend much better systems for early detection of traumatised individuals and the funds to provide the kind of support for parents that could prevent much, if not most, schizophrenia.

There are already signs of a change in perspective. In August, the president of the American Psychiatric Association bemoaned his profession's subservience to drug companies and the fact that "we have allowed the bio-psycho-social model to become the bio-bio-bio model". As Read reports in his earth-shattering edition of Acta Psychiatrica Scandinavica, for too long the role of trauma has been ignored by the establishment and "the possibility of a relationship with psychosis has been minimised, denied or ignored". Read's earthquake may trigger a landslide.

By Oliver James posted 27 October 05

* Oliver James trained and worked as a clinical psychologist. He is the author of They F*** You Up - How to Survive Family Life.

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Fear-mongering over convicts sperm bank donations

Is there a terrorist in your womb? Can your parent's genes label you? Not according to the Danish Health Ministry that said donors did not require a clean record as "there is no evidence that a tendency towards criminal behaviour can be inherited".

But the world's biggest sperm bank says that it has been forced to start screening all donors for any criminal record after it emerged that a man who killed his two baby daughters had been on its books.

[After someone decided to fear-monger the sperm bank?]

Horrified parents, who gave birth after receiving semen from the Cryos International Sperm Bank in Aarhus, Denmark, have flooded it with calls seeking reassurance that Heine Nielsen was not the father of their child. Nielsen, 32, who received $A54 a time to give samples, was sentenced to life in a secure psychiatric unit last week for the murder of his three-week-old daughter in January. A check on his criminal record would have revealed that he had been found guilty 10 years ago of murdering his first child, an eight-week-old girl. He served six years in prison for the killing.

Cryos has told anxious parents that none of the samples provided by Nielsen had been sent out, as he failed to attend the second of three compulsory psychological profiles. It has denied claims by Nielsen's relatives that he donated sperm twice a week for at least a year.

The head consultant at Cryos, Erich Ernst, said: "He provided only 12 samples, according to our records, but none of these was used because he did not complete the testing process. Only about 9 per cent of the applicants ever make it to the final stages, so this is quite normal." Nonetheless, future Cryos donors will be required to provide a police certificate confirming they do not have criminal records.

"We have contacted the Danish Health Ministry and have heard that it is within the law to ask our donors about any possible criminal convictions," Mr Ernst said. "We can insist someone has a clean record before we allow them to apply." The sperm bank has more than 200 donors on its books, distributing almost 10,000 units of sperm each year.

It supplies 35 infertility clinics across Europe, resulting in more than 1000 pregnancies every year.

The furore, [fear-mongering?] has [allegedly], prompted a fresh debate about whether laws should be introduced requiring would-be donors to face criminal checks as well as psychological tests and medical screening. But more importantly, laws for restricting the release of psychiatric patients convicted offenders or alleged terrorists.

[What! Nothing about state government terrorists? Murderers in the Military, Police, and prison guards, etc...What makes their Noble Cause Genes arses any better? Fear-mongering!!!]

Nielsen's mother, who has not been named, said he enrolled as a sperm donor to earn extra money.

"He was at the sperm bank several times every week . . . in 2000. I did not like it - he was sick, mentally sick, and it did not seem right," she said.

THE WAR ON LIBERTY: This is an extreme case of fear-mongering. Extreme cases are used to attempt to validate these models. In this case to start screening all donors for any criminal record. But if you can have people believe that the offenders and or terrorists are being produced or likely to be produced, because of a DNA test then there is a chance you won't be born. If you are born with these results and labelled an offender or terrorist you may be born into a prison hospital to prepare yourself for a prison cell. This has incredible wide ranging ramifications.

And the problem with that formula is that state sanctioned terrorists in the military, police, and prisons who murder for queen and country, an alleged noble cause, are no better than any other peasant criminals.

The Danish predators along side the Coalition of the Killing who are pre-emptively striking Afghanistan, Iraq, and Palestine, are actually the worst kind of terrorists killing millions of people in the name of occupation, genocide and imperialism.

The reason they've take an extreme case like a baby killer here, is because usually there is little or no support for people who have offended against a child i.e. the most unpopular person. So fear-mongering works best if the provocateur uses the worst case scenario.

What about the Coalition of the Killing, war criminals and war mongers who maimed and killed these kids? Should they be more suitable for the sperm bank?


A STRUGGLE ON TWO FRONTS: PRISONS & IMPERIALIST WAR

After a war waged by the U.S. military against Vietnam which took the lives of more than 3 million Vietnamese people and more than 58,000 GIs, the U.S. finally withdrew in 1975. It had suffered its first official major military defeat by a united people struggle led by the Vietnamese, along with a mass U.S. anti-war movement.

By Extremely Flawed 10 November 03

Feedback: Michael Strutt: IMHO sperm banks are commercial institutions with a primary responsibility to their clients. If the client does not want sperm from someone, who has killed their kid, has a low paid job, dislikes brussel sprouts or supports Manchester United that is their business.

Sperm banks already discriminate against donors for lots of reasons, many of them with no good basis in genetic science (or any other science for that matter).

The whole issue of sperm banks, egg donors and eugenics is a big one, but IMHO, ultimately trivial. I'm sure not going to fight for anyone's right to jerk off into a bottle and get paid for it.

The real issue here is the question of a genetic basis for criminal behaviour. Because the science involved is so bad as to be non-existent in this case. I think it will really serve to discredit such a link, but there are far more serious challenges in this area to face.

The most serious one I know of so far is the Dunedin study which has shown a statistical correlation between a polymorphism of the MAO gene and violent behaviour by men who were abused as children. Note that there is both a genetic and environmental factor in the mix.

This study is being carefully examined by many scientists in the field and I expect to see some responsible conclusions drawn which will then be hijacked by politicians and other publicity seekers with their own irresponsible agendas.

Interestingly, I expect the Dunedin study - in conjunction with what is now being revealed about the violent side effects of antidepressant medication - to force a general rethink about the relationship between anger and depression which may even help society to deal more sympathetically with those people unable to control violent impulses.

The MAO gene codes for the protein monoamine oxidase, which has long been known to be linked to depression. There are also studies, which attempt to correlate particular genetic variations with opiate addiction and alcoholism.

I think that the whole issue needs to be seen in the context of bioinformatics (the use of powerful computers and huge databases to try to draw statistical links between apparently unrelated pieces of biomedical data) and the attempts by drug companies and cowboy research entrepreneurs (like Craig Venter) to 'discover the gene responsible for' whatever.

The reductionist nature of contemporary medical science makes that approach very persuasive to allopathic practitioners, the general public, media outlets and (most importantly for its proponents) stock market investors. It creates a real danger of genetic discrimination and a new wave of eugenics as predicted in 'Brave New World' and 'Gattaca'.

I am not sanguine about such a danger by any means, but have reason to think that all the hype being currently being generated by the biotechs will ultimately lead to a backlash, which will mitigate against such an outcome.

The 'miracle gene cures' being anticipated in the media on almost a daily basis will generally not pan out - they are just about creating enough short term enthusiasm to cash in on the stock market, not the long haul needed for proper medical research and development of therapy.

After a few more years of this the public and media will become pretty sceptical I think. In the meantime however, there is real risk of discrimination in insurance; HealthCare, employment and the criminal justice system based on bogus or irrelevant links between genes and illness or antisocial behaviour.

The Australian Law Reform Commission has demonstrated itself as worse than useless in addressing the problem, as it is unable to stand up to even the mildest pressure from industry or authorities.

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