[iroh2727]

Schizophrenia is usually a kind of coping mechanism to handle an unhandleable environment (e.g. family in the case of a young schizophrenic person). It’s also, as some psychologists (e.g. RD Laing) have argued, a kind of “journey”. If people are allowed to go through the journey, they often come out the other end healed.

ECT has always served to remove symptoms or “normalize” people by just frying them until they’re a hollow drone.

Drugs can be useful. I know many schizophrenic people are happy for their drugs. But we shouldn’t forget that “real schizophrenia” is impossible to model in mice (how do you model a terrible parental situation for example?). And more generally, we shouldn’t forget that schizophrenia is mostly social and psychological in origin, rather than purely biological. A drug can target some chemical that is present in this process, but the cause is not some exogenous chemical, so it does not treat the “real cause” (see e.g. The Myth of the Chemical Cure). Another way of saying this is that the biological system that needs to be modeled is really the holistic biological system of society, family, etc (can also be useful to think about this in a cybernetics kind of way—see e.g. Bateson who developed the “double bind” theory of schizophrenia).

Moral of the story, at least in my view: we should care and treat schizophrenic people with empathy and simultaneously aim to improve the social situations that induce schizophrenia. And how do we improve the social situations? Well, first, if needed, we just work on ourselves, our own self-respect, competence, moral agency, etc., and spread goodness to the people in our vicinity, whilst having faith that others who are quite equal to us and who we have no control over can do the same.

[Llamamoe]

Do you have any sources for that? Because last I've read neuropsychiatry literature on the topic, schizophrenia is a brain-wide neuronal dysfunction, with psychosis being a downstream consequence of erroneous information processing - as in "2+2=5" type of erroneous.

I get that some people really want to believe that everything affecting the mind must be psychogenic, but with schizophrenia you're seriously stretching it. Schizophrenia isn't just a psychiatric disorder, it's a heavy duty brain dysfunction.

[reb]

I'm pretty confident there's good evidence supporting a connection between "early childhood adversity" and the development of schizophrenia, but I'm inclined to agree: once the system has gone off the rails, it's probably too late for environmental intervention to rein things back in. And that's assuming there's any reliable way to initiate and maintain those environmental changes.

Realigning the internal systems involved in schizophrenia seems at least as important as improving external systems that might provoke it.

[Llamamoe]

Childhood adversity well might be product of parents and the environment not knowing how to deal with early manifestations of psychiatric disturbances, honestly.

[iroh2727]

Preventative is always more important than fixing after the fact where like you said it may be very difficult to do so.

Basically what I was indicating though, and which I get from for example, RD Laing and Gregory Bateson, is that the best “cure”, societally-willing, is to provide a safe community environment where the schizophrenia is allowed to “run its course”. I know capitalist societies always want a commoditized solution like a pill, and certainly those can be useful, but we shouldn’t forget that a more personal, human solution is always better.

Western medicine can also learn a lot from eastern medicine in this regard. Luckily there’s a lot of research being done on what the pros and cons of each system are. Definitely recommend the book The Web that Has No Weaver for example.

[_a_a_a_]

Lang's ideas were Self-indulgent hippy stuff back then. His idea of schizophrenia being a journey, well psychiatric nurses I know have no patience for that.

> And more generally, we shouldn’t forget that schizophrenia is mostly social and psychological in origin, rather than purely biological

I'd be curious if you could provide references for that.

> ECT has always served to remove symptoms or “normalize” people by just frying them until they’re a hollow drone.

ditto

[iroh2727]

Well the classic work on sociology of mental illness is not about schizophrenia but about suicide (Emile Durkheim’s Suicide). The same types of social causes can be observed with schizophrenia, though, in the facts of geographic disparities in diagnosis as well as changes (usually increases in recent history) over time. See for example, how urban environments are more likely to give rise to schizophrenia [1].

Also recommend like I said Gregory Bateson’s work, or more recently books like The Myth of the Chemical Cure by Dr. Joanna Moncrieff.

The general point is that if we want to model causality we have to include the full system in question. If we narrow our perspective to an inner sub-system, then anything outside looks like an exogenous cause. But we may have to keep expanding wider and wider to get an accurate picture. Intervention can be done at any level of granularity, but the lower it is done, the more we’ll be missing on the root cause of damage, which is likely causing harm elsewhere too.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049530/

[creata]

> psychiatric nurses I know have no patience for that.

Psychiatric nurses have no patience full stop.

[catskul2]

> we shouldn’t forget that schizophrenia is mostly social and psychological in origin

While it's not possible to completely decouple biological and social risk factors, my understanding of schizophrenia is in direct contradiction with your claim that it's primarily social.

As I understand it schizophrenia, the extremely high heritability strongly implicates biological factors. Beyond heritability, many of the other risk factors also implicate a biological basis, from microbe infections, drug use, and pre-natal biological stress (nutrition, maternal health, etc).

None of that contradicts the need to treat people suffering from schizophrenia with empathy, or to improve the social situations they're in, but I think your central claim about "mostly social" is wrong, and undermines the rest of your argument.

[iroh2727]

Agree, but really the question is: why is it going up and why is it going up much faster in certain locations or among certain demographics? Or why are outcomes much better in certain locations/environments/demographics?

For example, it is more prevalent in urban environments, more prevalent among minorities in western countries, etc. it has better outcomes in “developing” countries.

Core human biology likely hasn’t changed much in recent history, so what had changed? Many of these factors that have changed, like drug use, are also very much related to social and economic factors. Of course these are all psychologically related and biologically related. But the point is we need to model the whole system, and focus on what has been changing if we want to get to root causes of change.

[neworbit]

The abstract would seem to suggest methamphetamine is one correlation; you might also reasonably suggest toxoplasmosis and I have heard a naturopath suggest that it can be treated nutritionally(!) I'm certain there's other valid explanations