Richard Bentall, Madness Explained 
Chapter 4: Fool’s Gold 
It’s not possible to give an incontrovertible link from heredi...
the use of medication since Kraepelin’s time, and he used narcotics, 
soporifics, chloroform, ether, and other concoctions...
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Ch 4 Richard Bentall 'Madness Explained'

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Genetic predisposition to develop psychosis, early antipsychotic medication, and more, are discussed in this chapter.

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Ch 4 Richard Bentall 'Madness Explained'

  1. 1. 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
  2. 2. 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.

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