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Diagnosis of schizophrenia: does it even exist?
Jim van Os, professor of psychiatry in Utrecht, questions whether schizophrenia, such as that found in psychiatric textbooks, actually exists.
No split personality
According to van Os, the idea of schizophrenia emerged as a split personality in the sense of the story of Dr. Jekyll and Mr. Hyde. Today the disease would still have this meaning in the general language, but not in science.
Scientific psychiatry regards schizophrenia as a chronic brain disease. Symptoms are hallucinations and delusions, also disorganized thinking and loss of motivation.
Van Os says: "Schizophrenia is a devastating diagnosis that can lead to a" burned-out schizophrenic, "a patient who has no hope and gives up on himself."
Susceptibility to psychosis
Van Os, on the other hand, calls these symptoms susceptibility to psychosis. He says: “Genetic and epidemiological research has identified hundreds, indeed thousands, of risk genes. The more someone has, the greater the risk of the disorder. However, the decisive factors are often traumatic experiences or setbacks in life. But something like immigration to another country can also play a role. ”
Need for help
The crucial question with a psychosis is: “Does someone have a need for help? Does he or she no longer find out about the psychological problems? Can the person still work and maintain relationships with others? ”
Everyone is vulnerable
Around 15% of all adolescents and young adults would hear voices at least once or suffer from paranoia. In 80% of them, these symptoms would go away.
Few can't do it alone
We assume that around 3.5% of people experience problems at least once in a lifetime to such an extent that a need for help arises.
Van Os says: “Someone has to find new goals, reinvent himself, write a new story of himself. Your own strength is of central importance, how can he or she experience life as meaningful despite the possibly remaining vulnerability and limitations? We call that “meaning”. ”
Pastoral care instead of annihilation
For van Os, the essential elements of healing psychological problems are “connectedness, hope, optimism, identity as a person - and not as a category of diagnosis - control over one's own life, empowerment and meaningfulness.”
Chronic means forever
If someone were diagnosed with a chronic brain disease, suggest that it would never get better.
Only the very end
Van Os sees schizophrenia merely as an extreme susceptibility to psychosis.
No scientific basis
According to van Os, there is no scientific basis for diagnosing one's own illness “schizophrenia”.
Do not break
Van Os says: “You mustn't destroy patients with such a bad diagnosis! Your point of view contradicts all evidence. ”
Hope is justified
Hope is essential for healing, says Van Os: “Hope and optimism are justified. The way out of a psychosis can be very different, but even with a very difficult form you can learn to live. ”
Psychiatrist in Germany against the diagnosis of schizophrenia
I have already asked psychiatrists at congresses whether we need to get rid of the diagnosis. Interestingly, the result in Europe, also in the Netherlands and Germany, is 50:50. In contrast, in the United States, 95% adhere to it.
A banal derivation is not possible
According to van Os, brain research does not have the power to define psychological problems: “Of course, the brain is necessary for our thinking, feeling and acting. But such a causal derivation for something like fear, sadness or a delusion, like the one that works with paralysis in neurology, just doesn't work. ”
Do not press the label too quickly
The psychiatrist advises: “Do not let a psychiatrist put a label on you hastily, but seek contact with someone who has already had such problems and has survived. There are also online networks for this. ”
Tap into networks
Second and third is important: “Second, seek help from a mental health network in your area that focuses on personal recovery and mental resilience. Third, involve your parents, family, and friends. You don't have to be ashamed or to hide. ”
If you turn on medical help, you should organize it yourself as best you can, says van Os.
Psychotherapy could also help, especially in the third of patients where trauma is the cause of the problems.
Embrace the problem
Van Os advises: “Get to know your problem, do not ignore it, embrace it, accept it, ask yourself what you can do with it. Be careful not to become depressed, not to lose your personal and social network. ”
One in four suffers from mental disorders
Mental health care can treat around four to five percent of the population in most countries. However, around a quarter of the population suffers from a mental disorder each year. The problem at the moment is above all that the service providers in the medical field want to generate profits and everything has to be measurable.
Slight disorders treated
Van Os says: “In practice, this means that these service providers pick out people with a slight disorder because their symptoms can be treated well. We have overtreatment in such patients. ”
Severe disorders undertreated
However, the severe cases remained undertreated. But they need help most.
Public mental health care
The psychiatrist calls for public mental health care for mild mental health problems.
Van Os wants to better educate people about mental health in order to enable prevention at an early stage and to have more freedom for the difficult cases.
Hard biology makes money
Van Os says: “The prestigious scientific journals reward biological research. These magazines have an impact and influence brings money. You get influence mainly through hard biology. ”
Industry wants to make money
According to Van Os, the industry wants biological treatments because it can be used to make money.
Patients want to die from wrong treatment
Van Os says: "What we have to take very seriously is the number of suicides, which is increasing especially in the Netherlands, especially among young people and young adults."
We need new health care
Van Os says: “A large part of science and the clinical world ignore the needs of patients and their families. We need new mental health care (…) We currently have a number of pilot studies in some neighborhoods with 20,000 people. ”
Two different systems in the USA
Two systems existed in the United States - firstly, biologically oriented academic psychiatry, and secondly, a system of donations and volunteers that help people with problems.
Van Os names the ten main groups of mental illness syndromes. These always include a personal diagnosis of the condition of the individual. (Dr. Utz Anhalt)