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頁面建立日期
2018.10.09

頁面更新日期
2019.11.20

思覺失調 Psychosis


簡介 Introduction

Psychosis is a broad term for a range of ways in which we might experience a different reality from most other people. It is a more formal name for what we mean by madness or craziness. The most commonly discussed examples are hearing voices that others cannot hear (‘hallucinations’) and holding unusual, idiosyncratic beliefs that seem strange or frightening to others (‘delusions’). These beliefs are often about fearing that others are out to harm us (‘paranoid delusions’) and sometimes about unusual powers or responsibilities we feel we have (’grandiose delusions’).

Understandings of these experiences has varied throughout history, with religious explanations dominating until the last two centuries. Today, understandings greatly between cultures. Many ‘developing’/’third world countries’ continue to make sense of hearing voices and so on from a social and spiritual context which provides a shared meaning to the experiences.

In ‘developed’/’first world’ countries, meanwhile, the official view of madness is dominated by a biological/medical framework. This ideology dictates that hearing voices is a symptom of an illness, invented at the end of the 19th century in Germany. This supposed brain disease, called ‘schizophrenia’, is said to have a biological and genetic basis. In fact the construct itself is meaningless. There are five types of symptoms of this invented illness: (hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms’ (e.g. having no feelings). We only need two of these five to get the diagnosis. So I can have the first two and nothing else, and you might have the last two and nothing else. We have no symptoms in common, but we get the same diagnosis. In scientific circles this is called a ‘dysjunctive’ category and is immediately discarded.

Both the label ‘schizophrenia’ and belief in bio-genetic causal beliefs have been shown in study after study to increase stigma, fear and prejudice. Many people given the diagnosis report that the reaction of other people when told of the diagnosis is worse than the problems that earned them the diagnosis in the first place. And yet ‘destigmatisation’ programmes, often funded by drug companies, promote the false notions that ‘mental illness is an illness like any other’ and that ‘schizophrenia’ is a debilitating, permanent condition involving inferior genes and a dysfunctional brain. Unsurprisingly this attitude leads to pessimism about recovery, among the public, professionals and ‘patients’.

However, in all but one (the U.S.A.) of the 23 countries (‘developed’ and ‘developing’) where surveys have been conducted the public believes that mental health problems, including madness/psychosis/’schizophrenia’, are cause primarily by life events (stress, unemployment, violence, child abuse/neglect., war trauma, rape, etc) rather than by biological or genetic factors.

It seems the public may be right. The evidence linking adversities, in childhood and thereafter, to psychosis is overwhelming. The evidence put forward in support of bio-genetic causal notions is flawed and unconvincing. Nevertheless the ‘medical model’ has a powerful ally. The pharmaceutical industry exerts its enormous financial might to influence research funding and journals, professional training, prescribing practices, the media and social, professional organisations, and drug regulation bodies (such as the FDA in the USA).

Anti-psychotic medication is currently the first line of treatment (often forcibly) despite their being only marginally more effective than placebo and having a range of severe adverse effects which shorten life span by 5 to 10 years. Evidence based non-medical approaches, including CBT for psychosis (CBTp) and Open Dialogue remain inaccessible for most people who would benefit. Meanwhile the Hearing Voices Network has established self-help groups in over 20 countries, where people can support and learn from one another without being labelled, stigmatised or drugged.

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