SCHIZOPHRENIA by Ronald Chase

I’ve been reading books on mental illness for the last thirty years because my son has been diagnosed with a number of them, including schizophrenia.

Dr. Chase’s book is one of the better ones I’ve come across. His is a double story: A story of personal grief as he witnesses the course of his older brother’s mental illness, and the story of his findings in a lifetime of professional work in brain research.

Dr. Chase’s argument that “mental illness” happens as a result of brain malfunction for a number of possible reasons (genetic predisposition, physical brain trauma, faulty development in teen years) is clear and accessible to non-specialists. His reflections on the causes of stigma suffered by people with mental illness are equally persuasive. He relates this to the philosophical assumptions which traditionally divided brain and mind into two separate entities. It’s as if a brain afflicted with illness could produce a mental process independent of it, and therefore open to ethical judgment.     

Dr. Chase, a professor of biology, offers a good outline on how various   chemicals interact in our brain circuitry and may cause disruptions. Our understanding of these processes, however, is far from complete.  As the author points out, the various DSMs (The Diagnostic and Statistical Manual of Mental Disorders) have been repeatedly revised because they attempt to formalize symptoms that are “heterogeneous.” 

This leads me to the major critical observation I have of Dr. Chase’s book. Although he admits that antipsychotic medications have a debatable track record, he does not really question their use – even though he suspects that they may have been a factor in his brother’s untimely decline and death. He cites all kinds of studies on the subject, and I do realize that my own observations, in comparison, are only “anecdotal.” Nevertheless, I would like to make a case for these observations the way Dr. Chase uses his brother’s story to personalize his argument.  

My son was given a number of prescribed drugs from Thorazine to some of the “atypicals.” They did not alleviate his major symptoms of auditory hallucinations and paranoia. The side effects, however, were severe – from acute lethargy to compulsive movement.  In time, he stopped taking them altogether, and manages reasonably well. He cannot always tell whether “the voices” are real or imaginary, but he understands that he has this condition, and lives with it as best he can.

Compared to that, a friend’s son with very similar symptoms has gone the rounds of mental hospitals and half-way houses described in Dr. Chase’s book, with intervals of homlessness and street drugs. My son too has resorted to street drugs and alcohol early on, which we now understand as self-medication. The difference between my friend and our situation is financial. We had the means to see our son through his ups and downs, and to support him independently of the official mental health culture.

For it is a “culture,” and much of it severely dysfunctional. Being scientifically inclined, Dr. Chase focuses on genetics, brain research, and chemistry. Fine, but as he himself concludes, significant results still belong in the future. Yet despite inconclusive application results, psychotropic drugs are big business. My husband and I have attended “seminars” and “workshops” whose claims were so questionable that one came to wonder whether they were prepared by the pharmaceutical PR staff. In that magical narrative each specific drug was a silver bullet targeting a specific disorder.

The health professionals who conducted these encounters and the family members who attended them were remarkably compliant: the general concern was about how to “control” the patient. True, the mentally ill can be disruptive, bewildering and a challenge to deal with for health professionals and families both. So here come the “meds” – they are professionally endorsed and scientifically respectable – and they are cheap, relatively speaking.

Psycho-social therapies, on the other hand, are expensive and the insurance industry does not like them.  It’s not as if I too did not have to deal with high-handed psychiatrists on the model of Dr. Held in Dr. Chase’s book. The author’s argument against the very notion of “mental illness” is well taken, because the real focus of investigation should be the brain.

But chemical experiments and the use of MRI techniques are not the only access to our brain. As Dr. Chase points out as well, psycho-social therapies do work – and this must mean that they do impact the brain. Cognitive research supports this view: the linguist George Lakoff demonstrates how neural networks become organized and “set” around certain belief systems in childhood as the result of family environment.

Dr. Chase also dismisses the recourse to AA type programs. They cannot “cure” schizophrenia, but something in their acceptance and support system did help my son to stay away from drugs and alcohol, which do disrupt brain function. I feel that a discussion of all promising options should be on the table. Surely childhood trauma caused by sexual abuse, or the PTSD of war veterans deserve any and all research efforts? In documenting the life of his brother, as well as the results of his scientific research, Dr. Chase’s book is most valuable. However, our family has chosen to resist the use of psychotropic drugs. Prevailing resort to them seems to be this generation’s addiction to quick fixes as respect for guru-like psychiatrists used to be the previous generation’s misplaced trust.  Unfortunately, the mentally ill, however you label their various conditions, are not a powerful constituency in the face of the financial interests in the field of mental health – and politics. Our hope is scientific research as well as innovative therapy approaches. And it must also be in better politics, where money does not always have the last word.