I feel like our society over-pathologizes a lot of stuff and it would be a shame if we "cured" something that doesn't need a cure.
[0] https://www.psychiatrymargins.com/p/schizophrenia-is-the-pri...
I'm a non expert but I believe some people are starting to see it that way. See: https://www.google.com/search?q=schizophrenia+spectrum+disor...
Also there's huge overlap in symptoms between bipolar I with psychosis, schizoaffective disorder, and schizophrenia. People sometimes move around between these diagnoses throughout treatment, different doctors have different opinions, patient behavior changes, etc.
I personally think these symptoms come about through many different causes and the labels are somewhat inadequate. They capture a symptom profile rather than a full understanding.
I also know of numerous people who have spoken publicly about receiving a schizophrenia diagnosis and having it later be revised to schizoaffective disorder.
I also came to the impression that it is common to receive a bipolar I diagnosis during a psychotic episode and have it later the diagnosed as schizophrenia or schizoaffective disorder.
Sometimes if your doctor sucks you may stay in the less accurate diagnosis, sometimes for years.
Among those who have had first episode psychosis, the first break, there is precisely zero point on the spectrum where it's not worth treating it.
A tragic illness that wreaks havoc on the lives of the individual, and often those around them. Employment rate in the single digits, for competitive jobs.
A part of the spectrum where research shows there is nothing to cure is schizotypy/apophenia and magical thinking, but only when paired with conscientiousness and high intelligence. The combination of these traits may be linked to creative genius. But those people don't have schizophrenia.
The other Serious Mental Illness, bipolar, is far less debilitating when medicated. Esp. Type II. And linked to creative success, esp. in the arts and when paired with high verbal intelligence.
Kanye, Churchill, Cobain, Woolf, Hemingway, Van Gogh.
John Gartner, psychologist @ Hopkins, wrote a book about 20 years ago called The Hypomanic Edge.
The thesis somewhat comical yet believable, America has tons of folks on the bipolar spectrum, experiencing low level hypomania. The idea is you have to be slightly mad to leave home and travel to a distant land with nothing. Risk taking, competitiveness, etc.
As far as curing something that doesn't need a cure. There's a conversation to be had with mild forms of bipolar, especially if it never tips into full mania. Schizophrenia, after the first psychotic break, there isn't.
And the lives of those even when medicated is often really, really hard.
https://news.stanford.edu/stories/2014/07/voices-culture-luh...
> In the United States, the voices are harsher, and in Africa and India, more benign, said Tanya Luhrmann, a Stanford professor of anthropology and first author of the article in the British Journal of Psychiatry.
I also have a hard time believing that schizophrenia manifests as something like benign quirkiness in some other country.
Well, publish that null result in a journal!
> This idea relocates the problem from the individual to “culture” or “society”...
No, one could incorporate this information just fine on an individual level by treating it as less of a scary symptom and more of something to understand.
I'm generally skeptical of too-good-to-be-true factoids. My skepticism is not publication-worthy, it's pretty common, and taken too far it becomes cynicism. Every once in while my skepticism is misplaced.
I am curious though - do you have individual examples, or personal experience, of how some other culture handles schizophrenia in an understanding way? I saw the journal reference...i'm more interested in specific examples.
But if a respected peer-reviewed journal published a study demonstrating evidence of it, you'd want to at least take a peek.
> I am curious though - do you have individual examples, or personal experience, of how some other culture handles schizophrenia in an understanding way? I saw the journal reference...i'm more interested in specific examples.
These are in the article and the study itself.
"Among the Indians in Chennai, more than half (11) heard voices of kin or family members commanding them to do tasks. “They talk as if elder people advising younger people,” one subject said. That contrasts to the Americans, only two of whom heard family members. Also, the Indians heard fewer threatening voices than the Americans – several heard the voices as playful, as manifesting spirits or magic, and even as entertaining. Finally, not as many of them described the voices in terms of a medical or psychiatric problem, as all of the Americans did."
That should not be your conclusion from the article.
"the voices" are hardly the only symptom that people with schizophrenia suffer from. A lot of those affected don't have auditory hallucinations at all and are still suffering from one of the (if not the) most debilitating mental disorders out there.
Calling it "friendly" risks trivialising of the very real symptoms.
> In Accra, Ghana, where the culture accepts that disembodied spirits can talk, few subjects described voices in brain disease terms. When people talked about their voices, 10 of them called the experience predominantly positive; 16 of them reported hearing God audibly. “‘Mostly, the voices are good,’” one participant remarked.
This seems clinically useful. The existence of other symptoms doesn't really change that fact.
I am merely commenting on your takeaway that this somehow means that some cultures see schizophrenia as "friendly", which does absolutely does not follow from the fact that the "mostly, the voices are good".
I would also think that this is likely due to cultural differences and in many cases probably adds to the problem.
https://doi.org/10.3109/09540261.2012.711746
From the full Article:
"People suffering from psychotic illness continue to hold multi-explanatory models. The cultural, religious and social explanatory models are predominant in non-western cultures."
"Limited evidence suggests that traditional belief models affect [duration of untreated psychosis], and explanatory models based on spiritual and social causes of illness may result in delayed presentations for professional help."
I've noticed something similar with people on say heavy doses if hallucinogens. Some people just ride it out knowing it's the mind playing tricks on them, others hopelessly panic or make irreversible decisions.
But this is a narrow path to walk, because if you see something and someone tries to convince you it's not there, who is right?
This is why some mental health conditions are pretty terrifying, because doubting your own mind is terrifying.
Sometimes, that line is whether or not the state is somehow involved through social services or the criminal justice system.
Other delusions, hallucinations, hearing malicious voices, hearing voices which you feel you must obey, end up with individuals who have the same relative level of schizophrenic dysfunction, in terms of the way the brain operates, but the nature of the delusion can make them dangerous - "god told me to direct traffic on the freeway" or "god told me to slay demons disguised as humans".
The particulars of the case make a huge difference in how much medicine and treatment can help them live independent, normal lives. This potential treatment would be wonderful if it restores normal brain function. It also hints at why antipsychotic and other drugs which increase inhibitory signaling were partially effective.
Heck, it even has explanatory power for the different triggers of psychotic breaks - once a threshold of activity gets passed, the brain loses its ability to discriminate between legitimate, reality grounded signals and feedback that should have been inhibited, and once those neural connections are made and "configured" to operate as part of the default mode network, that person will have permanent cognitive problems.
Very cool research, and I hope it bears fruit.
That is there are many different things that can cause the behaviour.
Anyway on your main point, the definition of all psychiatric disorders has requirements of subjective suffering. So if you don't have subjective suffering you don't have the disorder.