Richard Bentall, Madness Explained
Chapter 4: Fool’s Gold
It’s not possible to give an incontrovertible link from heredity to
madness. Research is limited. In any case it seems that only 25% of
those who inherit schizophrenic genes actually develop psychosis,
and only 1 in 17 of close relatives to a schizophrenic actually get ill.
As far as psychosis goes, the more there are tendencies to
schizophrenia in a patient, the more likely it is that manifestation of
illness in relatives will be schizophrenia, and likewise for bipolar. It
has been reported that there is implication of a link from
schizophrenia to mood disorder, as two ends of a spectrum. (This
is an opposite view to Kraepelin with his discrete categories.) This
is a deficiency in the DSM.
Outcome studies are not definitive. However, researchers including
Bleuler’s son have found that schizophrenia is not just a one-dimensional
brain disease, there are other influences on outcomes.
(Bleuler senior coined the term ‘schizophrenia’.) Outcomes vary
widely for individuals with the same diagnosis. Many studies show
better lifetime outcomes for bipolar than schizophrenia. There can
be a tendency for people at either end of the spectrum to get
attention rather than those who have symptoms from both
extremes. There is no clear gap in the spectrum between
schizophrenia and mania. Also it is pure chance to predict what will
happen to patients in their futures.
There is a clear and remarkable omission in research, to identify
different drugs that will work with different diagnoses. However,
neuoleptics are most commonly prescribed for schizophrenia, and
lithium and carbamazapine for mania. Discoveries in medication seem
to be accidental. For 50 years before the use of chlorpromazine,
(which was originally an antihistamine) there had been no progress in
the use of medication since Kraepelin’s time, and he used narcotics,
soporifics, chloroform, ether, and other concoctions. Laborit
discovered the effectiveness of chlorpromazine in mental health as
a sedative in the early 1950’s in France, after being sent samples of
‘4560 RP’ by chemical company Rhone-Poulenc. This became known as
chlorpromazine and was widely used from the mid-1950’ onwards in
mental health. Since the mid-1950’s there has been diagnosis-specific
research into chlorpromazine and lithium. There is the
hypothesis that schizophrenia is associated with dopamine. (This
remains to become unchallenged.) Bentall is primarily concerned
with the assumption that the two different drugs are rightly
diagnosis specific. In one experiment which was ‘double bind’,
meaning that neither patients nor experimenters knew which was
placebo or not, it appeared that drug response was symptom
specific, not diagnosis specific. Although most clinical trials of
neuroleptics involve schizophrenics, initially trials were on mania
patients in the early 1950’s.
Bentall concludes by remarking that there are more similarities than
differences between schizophrenia and bipolar. Some have argued
that we need to give up classifying people like plants. Including some
in the user movement.
However, no new system has been taken up generally due to the
difficulty of implementing anything new in practice.