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Let’s forget the diagnosis of schizophrenia
Schizophrenia does not exist. And so we should stop to make that diagnosis. Psychosis exists. And fortunately we can do something about it, writing
Jim van Os and five others.
March 7, 2015
Jim van Os is the professor in psychiatry from Maastricht, member of the DSM-5 schizophrenia sub-committee and co-founder of schizofreniebestaatniet.nl. Wilma Boevink is a Senior Researcher at the Trimbos Institute and co-founder of the site. Rutger Jan van der Gaag is chairman of the Royal Dutch Medical Association Doctors Federation. Aartjan Beekman is chairman of the Dutch Association for Psychiatry. Robert Vermeiren is Chairman Department of Child and Adolescent Psychiatry, Dutch Psychiatric Association. Rutger Engels is CEO Trimbos Institute.
Schizophrenia does not exist. Yes, you read that right. Schizophrenia, wrongly known as the disease of the “split mind” does not exist. Psychosis exists. About three percent of people suffer from it, as an adolescent or young adult. Someone who is psychotic, taking under the influence of personal emotions reality so distorted that other people no longer understand him or her.
Misunderstanding that we often see in other mental disorders, depression or anxiety disorders for example. Only, there are therapists ready to help. People with psychosis are considered hopeless cases. And that’s baloney. Because research has shown just that people with psychosis usually get back on top – with the right help. That they do not get, for three reasons.
Firstly, we have so much pessimism about the future of people with psychosis palmed that hope and recovery is not automatic central to the treatment. Secondly treatments that demonstrably works, such intensive counseling to training or work, not sufficient. And third, there is the current “diagnosis-prescription-symptom list” system of market forces in healthcare no room for the psychological process of recovery.
Because people with psychosis have too little help, they remain needlessly hanging in an empty existence, deprived of education and work until they die a premature death. Early yes, because life takes a fifth less than that of the average American. A crude form of social injustice.
To stop that, and people with psychosis, their environment and society to give a realistic picture, the website schizofreniebestaatniet.nl was created. We want to create the term schizophrenia in five years and eliminate room for the following principles for treatment and support of people with psychosis:
1 There is scientifically make a clear distinction between psychosis and other experiences. Psychosis is simply to treat.
2 More than 15 percent of adolescents and young adults have psychotic symptoms during normal development. They hear voices or paranoid. In 80 percent of them disappear these symptoms naturally.
3 About 3.5 percent of people have so much experience psychotic symptoms they should seek help. Their diagnosis is psychosis sensitivity: their symptoms are part of a psychotic syndrome that looks different in each of them.
4 The course of psychosis sensitivity is variable and unpredictable. Only 20 percent of people who suffer from it have a poor prognosis; Most recover or learn to live with it.
With the right help, people with psychosis usually bounce back
5 A psychotic experience is often a reaction to trauma, adversity, disappointment, humiliation or discrimination – the burden is too heavy for the individual.
The dominant view that psychosis is a manifestation of an underlying biomedical brain disease (schizophrenia) is scientifically incorrect. That view, however, contributes to negative expectations about the recovery and should not be central in psychoeducation.
6 Psychiatry shares psychosis sensitivity in all ‘schizo-diagnoses (schizophrenia, schizoaffective, schizophreniform, etc). But everyone has a different mix of symptoms, and does not fit well in a diagnostic box.
7 People with psychotic syndrome should receive from the first moment of hope and perspective. Recovery is a psychological process. People must learn to adapt to their psychosis sensitivity, with support of skilled experts and, where necessary, of doctors and therapists to support that recovery.
8 Anyone with a psychosis must from the outset have access to an expert by experience, like no other can help in providing hope and perspective.
9 Return to the home environment, training and work at the forefront of the treatment plan. Even if there are residual symptoms, people can pick up the thread. The current practice to wait for complete “cure” is counterproductive.
10 Everyone who comes with psychosis in mental health care, should be encouraged to talk about it. The contents of psychosis should be taken seriously and be considered significant, for it is often the key underlying problems.
11 Anyone who has suffered from psychosis should be offered psychotherapy by a therapist with experience in psychosis.
12 Antipsychotic drugs may be necessary to dampen violent experiences, but they can not correct underlying biological abnormality. An antipsychotic does not heal.
Schizophrenia does not exist. That’s a good thing. Because of psychosis, we fortunately do very much.
A version of this article appeared on Saturday, March 7th, 2015 in NRC Handelsblad.
This article is copyright of NRC Media BV, respectively, of the original author.