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The Devonport Flagstaff
July 13, 2000
Changing views on schizophrenia
by Rob Drent
A
Devonport psychologist is at the forefront of new theories on the causes of
schizophrenia. John Read spoke to Rob Drent.
The traditional view has schizophrenia as a biological illness. This theory
is now being challenged by Auckland psychologist John
Read, who with others, cites a growing body of research that indicates
childhood abuse can lead to schizophrenia in adults.
The research findings of Read and his colleagues supporting the childhood link
have proved controversial, not only because they are new and pose a different
regime to treat schizophrenia, but as they have challenged the medical
establishment view that schizophrenia is a disease.
"For most of the twentieth century, schizophrenia has been seen as a biological
illness with a strong genetic component, and we believe that is inaccurate."
Read says the traditional view has set back the treatment of people with psychosis
"quite badly."
"Usually they get offered only medication, rather than anyone to talk to
about what has driven them mad in the first place."
"It's controversial because it challenges the basic idea that we should
be treating these people as sick people with illnesses, rather than supporting
them to talk about what has driven them mad in the first place, and getting some
help with that."
Read's recent research has sparked international interest. He was invited as
a keynote speaker to 800 delegates in Norway at the International
Symposium for the Psychological Treatments of Schizophrenia and Other
Psychoses.
Read, in research with Dr Nick Argyle, found that 77% of psychiatric in-patients
who had been abused as children experienced schizophrenic symptoms such as
hallucinations and delusions. Records of 100 consecutive admissions to the
acute psychiatric in-patient unit in a New Zealand general hospital were
analysed.
Another recent review by Read of 15 international studies also shows a very powerful
relationship between child abuse and schizophrenia.
"I was very excited about how well it was received at the conference at Norway." And now Read is
pushing for change in New Zealand. He has lined up a
meeting with Health Minister Annette King to discuss the need to look at new
directions in schizophrenia treatment. "There is quite a strong case to
lobby the government for more money for the training of psychologists, who
have a different approach to psychiatrists and other professions trained in
psychotherapy and counselling.
"If you were to try to design a situation to drive somebody mad you could
not design a better situation than a young child being betrayed by a carer -
someone they love and trust at an early age."
Raising links between schizophrenia and child abuse however steps into the difficult
ground of families who are caring for a schizophrenic member.
"I am not saying that all the carers of schizophrenics are abusers - because
obviously they can take offence at this. A lot of people are caring for adult
schizophrenics and see this in the media and get very distressed."
"Only about 50% of child abuse takes place within the family - not saying
all carers are abusers, nevertheless, upbringing can have a strong effect on
our mental health later in life."
"A significant proportion of people who are diagnosed schizophrenic have
been badly abused or neglected as children, but not all. And nor am I saying
that all schizophrenia is caused by abuse or that all abused people will grow
up to be schizophrenic. All I am saying is that there is a very strong
correlation which needs investigating."
"Some of the most recent research shows the content of the voices is actually
the voice of the perpetrator of the abuse. One of the most common
hallucinations amongst people who have been abused is a command hallucination,
with the voices actually telling you to harm yourself or kill yourself."
"In not all cases but a significant number of cases the voice is the perpetrator
of the abuse - and I think that justifies further investigation."
General trauma or loss as a child can also have a profound effect on an adult's
mental health. Research also shows poverty and being a member
of an ethnic minority for instance are strongly correlated with schizophrenia.
It is unknown how many schizophrenics live in New Zealand. However, it is around
1% of the population in countries where is has been studied, says Read, a
senior lecturer in psychology at Auckland University for six years, who has
worked in the field for more than 20 years here and overseas, most recently
at the Connolly Psychiatric Unit at Auckland Hospital.
"But the rate is much higher in lower socio-economic groups and ethnic minorities - poverty and being a member of an oppressed
ethnic group increases your chances of poor mental health.
"For example Afro-Carribeans in England are three times more
likely to be diagnosed schizophrenic than white people, and the Irish are two
times more likely to be diagnosed than English people - it's difficult to
explain biologically.
A recent study showed 10% of New Zealand psychiatrists think
Maori are over-represented in our psych hospitals because they are
biologically more pre-disposed to madness.
Read says this "is just another example of how the biological model can reach
quite bizarre conclusions."
Other research suggest mental health professionals
are not taking abuse histories from patients in as much detail as they
should.
Read is part of a team running training programmes with mental health professionals
in Auckland to help show "when and how
to ask about abuse, and how to respond appropriately."
Does the schizophrenia debate come down to the biological model versus the social
model ? "Most people accept that both have some
role," says Read.
"But the dominant view on schizophrenia is that genetics and biology have
by far the more powerful role, and these psycho-social events just trigger off
this underlying genetic predisposition."
But, "Most recent research shows the family factors are seven times more
powerful than genetic about predicting who will become schizophrenic.with
this population, and what seldom happens is people asking you "what do you
think has driven you mad ?"
On a positive note, "One of the more exciting developments in New Zealand,
across Auckland and in all the large cities, is there are now early psychosis
intervention teams who are doing some very exciting work in providing a
service really early on, designed to keep people out of hospital and meet
their needs beyond medication, and offering therapy and counselling.
"One of the key things there is if you can identify the kids early enough
who have been abused, and do relatively short-term counselling especially geared
around getting those kids not to blame themselves - that is one of the big
things.,"
Overall, child care and protection agencies and police child abuse teams need
better funding, Read says.
He is currently working with colleagues in the United States on research which
has shown what happens in the brains of traumatised children "is almost
exactly the same as the dysfunction shown in the brains of adult schizophrenics."
"It's a major breakthrough and another step away from the biological illness
model."
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The following critique from 1997 is repeated. Read has apparently not accepted
three years later that the basis of his research rests on a flawed assumption
COSA
Casualties of Sexual Allegations
Newsletter December 1997
Volume 4 No 10
A suggestion that schizophrenia is caused by sexual abuse
Recovered memory proponent John Read, Clinical Psychology Department,
Auckland University, pre-released to the media the findings of a paper he had
written suggesting that childhood abuse and schizophrenia might be causally
related. This created some media attention and Letters to the Editor. DSAC
President Selina Green wrote in praise of Dr Read’s
research which found that when asked, many schizophrenic patients reported
past sexual abuse. Drs Read and Green assumed that this means sexual abuse
causes schizophrenia, a flawed assumption.
While not denying that some schizophrenic patients will have been exposed to
sexual abuse in the past, it is wrong to infer that this is the cause of
their condition. Just because two things appear to occur together (have some
association) it cannot be concluded that there is a causal relationship. For
example: You are looking for the cause of nits in school children. You
examine a class and separate those with nits from those without. You find
that most of those with nits are wearing hair ties. You conclude that hair
ties can cause nits and that the way to get rid of nits is to stop wearing
hair ties. This is faulty logic. In fact, nits and hair ties are only
associated because both are more likely to occur in children who have long
hair. Long hair is called a confounding factor and in fact there is no causal
relationship between hair ties and nits.
Reports of past abuse are not the same as proven events. False reports may be
deliberate or the result of suggestive questioning. Furthermore, contrary to
Dr Read’s claims, people suffering from acute psychosis are more likely than
the average person to claim events that did not happen. Delusions and being
out of touch with reality are hallmarks of this condition. Workers dealing
with acutely psychotic people have long recognised that many such patients
have preoccupation with sex and may be prone to intense, often violent sexual
fantasies and make wild accusations. When they are well again, these patients
will often recognise that their allegations were about imaginary events.
Further, schizophrenic delusions are often influenced by what is considered
to be the enemy in contemporary society. During the McCarthy era in USA in the 1950s, many
people in psychiatric institutions believed they were being persecuted by
communist. Today they believe they are victims of sex offenders.
Far more women are sexually abused than men – According to Dr Read, about 30%
of women and 10% of men have been sexually abused. Yet schizophrenia affects
about 0.5% of the population, and women are not more likely to be affected
than men.
While causes of schizophrenia are unknown, evidence indicates that there may
be a number of components, including heredity, viral illness and birth
trauma. Claiming sexual abuse as a major cause unjustly blames distressed
families, who are often struggling to care for their ill family member.
References:
Sunday Star-Times (26 Oct 1997). ‘study links
mental illness to sex abuse’;
NZ Herald (22 Oct 1997). ‘Psychotic disorders linked to childhood abuses’)
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