We appear to have gone wrong somewhere in Western society in our treatment of people diagnosed with schizophrenia, which is characterised in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by hallucinations, delusions, disorganised thinking (speech), significantly disorganised or abnormal motor behaviour (including catatonia), and negative symptoms. Despite conventional treatment in the modern age, many people diagnosed with schizophrenia have poor outcomes. U.S. data on outcomes from severe mental illness such as schizophrenia show that there is greater psychiatric disability today than in the 1940s. People diagnosed with schizophrenia also have higher suicide rates today and the utilisation of hospital beds for this population has not improved. Data also indicates that outcomes for people diagnosed with schizophrenia are at least as good, and in many cases better, in the developing world than in the West. Where have we gone wrong?
In the late nineteenth century, Emil Kraepelin concluded, on the basis of symptom and outcome data, that there are three main types of psychosis: schizophrenia (then more commonly referred to as dementia praecox); manic depression; and paranoia. The philosopher-psychiatrist Karl Jaspers then argued that psychotic symptoms can only be explained in terms of aberrant biology and never in terms of the person’s experiences. This was, and is, a very dangerous and reductionist viewpoint which, shockingly, continues to underpin much of the thinking and treatment of schizophrenia today.
The assumption that schizophrenia can be explained only in terms of haywire biology has seemingly encouraged the use of drastic biomedical interventions, discouraged attempts to address people’s emotional and psychological needs, and also denied other systemic factors such as trauma and abuse. In short, it has placed all of the blame on the person’s biology and any potential sense of responsibility and shame, therefore, within the person themselves.
As we have written about elsewhere, diagnoses need to have both reliability and validity in order to stand on any kind of legs at all. To be reliable, any system of categorisation needs to have stable and consistent outcomes. In order to diagnose someone with schizophrenia, however, the medical profession must exercise a great deal of personal judgement and opinion-based reasoning; what might be deemed as a ‘negative symptom’ in one culture may be seen as positive in another. The experience of voice-hearing, for example, is often seen as a sign of spiritual awakening in the African continent but typically seen as a symptom of psychosis in the West. In order to be valid, any scientific system needs to measure what it says it measures. Since the process of diagnosis relies heavily on opinions and subjective judgements, it is impossible to ascertain if diagnostic labels actually reflect the presence of any actual pathology.
Given the limited reliability and validity, and indeed success, of aetiological research based on biology, some researchers have begun to seek alternatives and to consider other factors such as trauma within the conglomeration of symptoms typically diagnosed as schizophrenia. Indeed the the Hearing Voices approach, and its application of Voice Dialogue, sees the experience of hearing voices not as pathological but, rather, as pointing to deeper experiences and struggles in the person’s psyche that need addressing and assimilating. Other approaches appreciate the aspect of embodiment in schizophrenia, focusing on the presentation of symptoms through the body i.e. auditory hallucinations and other somatic experiences.
A research study conducted this month (Nyboe et al, 2016) looked at physical activity and anomalous bodily experiences in people with first-episode schizophrenia (FES). The purpose of the study was to compare physical activity in patients with FES with controls; to investigate changes in physical activity over one year of follow-up; and to explore the correlations of physical activity and anomalous bodily experiences reported by patients with FES. Physical activity and aerobic fitness were found to be significantly lower in people with FES compared with healthy controls. Over one year of follow-up, people with FES had lower physical activity and aerobic fitness. Those with more severe anomalous bodily experiences had significantly lower physical activity compared with others with fewer such experiences. An obvious conclusion to draw from these findings is that people with FES may benefit from physical activity given that both anomalous bodily experiences and negative symptoms are significantly correlated with low physical activity.
One such form of physical movement, with the additional benefits of the mindfulness, embodiment and interoceptive elements, could be trauma sensitive yoga. Here at the Minded Institute we have found that yoga can have incredible potential benefits to people diagnosed with schizophrenia in a plethora of ways, which is an understanding underpinned by a growing body of compelling research in this area. To explore our trainings in yoga for schizophrenia and psychosis, please visit our CPD page at, http://www.yogaforthemind.info/events-in-the-uk-and-europe/ or contact us as firstname.lastname@example.org. Namaste.
Nyboe, L., Moeller, M., Vestergaard, C, Lund, H. &, Videbech, P. (May 2016). Physical activity and anomalous bodily experiences in patients with first-episode schizophrenia. Nord Journal Psychiatry, 5, 1-7.