Talking to The Demons

Mike Harris left Cambridge, England, for university in Scotland filled with the natural enthusiasm for starting an independent life. But he couldn't handle all the partying and drugs on campus. After a year he had moved back with his parents. A few years later he tried again, but once again he had to leave. Harris (not his real name) was plagued by voices and "static in my head" and went for long periods without sleep or food. "At one point I thought I could save the world by not eating or washing. I had very unrealistic beliefs," he says.

Harris was hospitalized several times and underwent inpatient psychiatric treatment, but what finally brought him back from the brink of schizophrenia was an intensive combination of group, individual and family psychotherapy, and help with social skills. At the Young People's Service, a psychiatric clinic in Cambridge, patients shop, cook and eat together, and help each other to negotiate their phobias.

Not long ago schizophrenia was considered an incurable, lifelong disease caused by an unlucky combination of genes. Sufferers were condemned to a lifetime on drugs. Now scientists are beginning to uncover evidence that schizophrenia is heavily influenced by environmental factors. Their research has huge implications for treatment. Doctors now believe that therapy and social work are the preferred method of treatment for most schizophrenics. "Patients really must have therapy in order to improve," says University of Newcastle psychiatrist Dr. Douglas Turkington. "Medication alone will not do it."

A study published last month in Acta Psychiatrica Scandinavica, the most definitive look at schizophrenia to date, argues that trauma or childhood abuse is a factor in the development of the disease. While schizophrenia is the product of a complex interplay between a host of environmental and genetic factors, it seems that "genes do not cause the outcome, but identify those who might be susceptible to the environmental risks," says Dr. Mary Clarke, a psychiatric researcher at Ireland's Royal College of Surgeons. A review of 46 studies of schizophrenics by Auckland University psychologist John Read found that 59 percent of male inpatients and 69 percent of females had experienced childhood physical or sexual abuse. In a separate study, which included physical neglect and physical or emotional abuse, the level rose to 85 percent of males and 100 percent of women. Says Read: "We have around the world millions of people with a diagnosis that masks the true social causes, and therefore prevents people from getting help which would be more effective and humane."

The cumulative impact of this research has swayed opinion in the profession's highest echelons. At the American Psychiatric Society's annual conference in August, the organization's president, Steven S. Sharfstein, noted that antipsychotic medicines now generate $6.5 billion in sales a year and registered concern that mental disorders are being overmedicalized: "As a profession, we have allowed the bio-psychosocial model to become the bio-bio-bio model. In a time of economic constraint, 'a pill and an appointment' has dominated treatment."

Responding to early signs of schizophrenia, the findings suggest, could save patients from a lifetime dependency on debilitating drugs. Indeed, suffering a breakdown--often characterized by disorganized thinking, delusions and hallucinations--in your late teens or early 20s could be seen as an opportunity to intervene with therapy to mitigate the disease. "If worked through properly, it could become a breakthrough," says psychiatrist Dr. Shankarnarayan Srinath, who initially referred Harris to the Cambridge therapists. "If people are helped at that stage, they will begin to make meaning of their suffering. If they don't have help to work it through, it's likely they will become a chronic, lifelong psychiatric patient."

The findings don't rule out a significant genetic contribution to schizophrenia. Scientists believe that chains of hundreds of genes combine incrementally to create a predisposition to the disease. But "genes can't function without the environment," says Dr. David Taylor, medical director at London's Tavistock and Portman Clinic. Harris, for instance, claims he was already prone to depression. But the results of the therapy confirm that environmental factors play the bigger role. Few genes have been identified as having any direct effect on mental health. "Twenty years ago [schizophrenia researchers] were saying, once we have the genome sorted out we can all go home--it's going to turn out to be two or three genes that contribute to it," says psychiatrist Dr. E. Fuller Torrey, author of "Beasts of the Earth: Animals, Humans, Disease." "It's quite clear that's not the case."

This shift in thinking conflicts directly with priorities in public-health services. The British Medical Association says a third of the country's mental-health teams plan cutbacks, including dismantling specialist clinics in Oxfordshire and Cumbria, as well as at the Young People's Service in Cambridge, which is slated to close in January. (The Department of Health says that intervention teams, including psychiatric nurses and social workers, will fill the gap.) A recent survey of guidelines for treating schizophrenia around the world published in The British Journal of Psychiatry found that all countries give drug recommendations, but advice on psychosocial interventions remains scant. "I just cannot overstate the importance of this kind of treatment," says Harris, now 35, with a girlfriend and a career in teaching. "It gave me the tools to live my life." Schizophrenia usually strikes just as a young person is on the threshold of living on his own. A renewed focus on psychotherapeutic and social treatments may help more of them cross that line.

Talking to The Demons | News