Tuesday, June 17, 2008

Idling With Ivor 5

Ivor on Schizophrenia:

Knowing quite a few people with this dreadfully disabling mental disease, I find Ivor's insights illuminating and helpful.  In post three of this sequence I have already mentioned his insight into why schizophrenics shut out others because "they are unable to maintain the normal boundedness between themselves and others, as they are far too open and vulnerable to being invaded by others in their vicinity" (Op. cit.,  59).  I have also learned the interesting insight that they are less well able to separate from the family of origin than we are and also that any psychiatric illness is rooted in the family as well as in the person who may be a channel for the illness.  While in the US studying he had the luck also to go for some time on a further fellowship to visit Gregory Bateson's Schizophrenia Research Unit in Palo Alto. 

The experience of hearing their views on schizophrenia was a further step for me in realising that the orthodox view of it as a largely genetic, biochemical disorder simply didn't add up. (Ibid., 96)

I hasten to add, here, for the sake of balance that Ivor Browne, along with the likes of the wonderful R.D. Laing fit into what in common parlance is called The Anti-Psychiatric Movement which would question the over-reliance on drugs or pharmacology.  I have no partisan views myself, but occupy a middle ground position of "both and" rather than "either or."  For me, as a sufferer from endogenous depression of the unipolar type who has to take medication, I deeply appreciate the relevance and importance of all psychotherapeutic methods.   Both approaches are needed in my opinion.

Anyway, back to what Ivor learned from Gregory Bateson's studies and those of Jay Haley.  He feels that these two scholars offered a valuable insight into disturbed family relationships generally.  Such disturbance in internal family relationships "can be found in virtually any form of psychiatric disorder where the family is 'enmeshed' and has failed to free the offspring to leave and lead a separate life." (Ibid., 96)

Ivor repeats yet again his insight into the schizophrenic's lack of boundedness further into his book with a certain impatience and exasperation:

One of the greatest pieces of nonsense in psychiatric literature, which is repeated ad nauseam in textbooks over the years, is the notion that schizophrenics are emotionally blunted and have lost the capacity to feel...schizophrenics have no recourse but to retreat into themselves, erecting a rigid wall around themselves for their own protection. (Ibid., 203)

Then later again in the book, when discussing therapeutic practice and personality types as a function of defence and coping skills, the latter which is mapped out diagrammatically as a  graph with four quadrants like a Cartesian Plane diagram, the four quadrants of which are named by the letters A,B,C and D, Ivor tells us insightfully:

In this final quadrant are to be found those who not only have weak coping skills but also have poorly organised defences.  this is because during the course of development they have failed to reach maturity, or to form an adult personality.  At the deepest level they have failed to create a personal identity; nor are they able to manage their personal boundary.  Within this segment will be those who fit the schizophrenic spectrum, and the more recently identified Asperger's Syndrome.  There will also be found some of those with eating disorders and those suffering with chronic social phobia, panic disorder and chronic anxiety. (Ibid., 265)

The Inadequacy of Drug Treatment

Ivor questions strongly the biological or genetic origin of schizophrenia.  He talks in general about all those patients who have failed to separate from their family of origin and who, although biologically adult, "are still functioning like children in the family setting and are incapable of managing their own lives.  These are the people who, when they break down, are said by psychiatrists to be suffering from a 'biological' mental illness and hence are not amenable to psychotherapy." (Ibid., 320).  Ivor has huge reservations with this orthodox contention.  In fact he sees it as downright erroneous:

If we ask what is the causal relationship of genetics to schizophrenia, we are already biasing the results of our research.  the genetic influence may merely relate to the personality type, for example, a more sensitive or introverted type of person.  There may be no direct relationship to schizophrenia as such.  (ibid., 320-321)

Needless to say, in such a context, drug treatment will be wholly inadequate.

All in the Psychiatrist's Mind

This heading may be a little biased admittedly, but I feel it is a fair criticism of Ivor's anti-pharmacological views of both psychiatry and the treatment of schizophrenia.  Towards the end of this fine, interesting and deeply humane memoir, which it is my privilege to have read, our man contends that schizophrenia is an invention of psychiatry.  I suppose every science and every technology and every branch of knowledge invents its own terms for the way they look at the problems or issues before them.  I'm sure there are many ways of seeing things rather than a specific way outlined and made almost axiomatic by a particular branch of knowledge, so this is no wonderful insight indeed.  I suppose it becomes problematic when we actually begin to believe that everything exists metaphysically as each particular science imagines.  In fact, it is my belief that most human organisations and societies begin to believe their own propaganda.  Anyway, be that as it may, Ivor claims that:

...the full picture of schizophrenia is, to a considerable degree, iatrogenic, that is, partially created by the psychiatric intervention itself, establishing a pathway of illness behaviour extending over weeks and months, with heavy medication and institutionalisation.  Thus the young person loses connection with ordinary living at a critical time and finds it difficult to reintegrate back into society.  It is only then that the full picture of the illness we call schizophrenia supervenes.  (Ibid., 327)

Walking the horses on Donabate Beach, June 2008

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