The
Construction of Schizophrenia as a “Mental Illness”
by
Information Pages on the Internet
Murdoch University
Perth, Western Australia
June 6, 1999
“Schizophrenia” is a term which has been adopted by the mainstream mental health profession to describe a condition in which individuals display a vast array of symptoms, all of which can be seen as a departure from what society regards as “normal” behavour. There are a number of different theories regarding the origins of “abnormal behaviour” and the best method of treatment. Those within the profession of psychiatry who have a focus in “biological psychiatry” present schizophrenia as a biologically-based “disease” of the brain, and offer medication as the most effective form of treatment for it (Torrey, 1995). There does exist, however, a body of opinion which contests a biological account of the causes of “abnormal” behaviour. In contrast to the biological, or “disease” model of schizophrenia, the antipsychiatry movement (as it is sometimes regarded) argues that such “abnormal” behaviours emerge when individuals encounter problems in living (Szasz, 1960) or experience a psychospiritual crisis and psychological overwhelm (Breggin, 1991).
Whilst there is a great deal of disagreement within the profession of mental health and the academic world regarding the nature of, or indeed the existence of, “mental illness,” there also exists a number of non-professional organizations which advocate particular points of view. Organisations such as the National Alliance for the Mentally Ill (NAMI) in the United States and SANE in Great Britain and Australia are firm advocates of a strictly biological basis for schizophrenia. On the other hand, organizations such as the Citizens Commission of Human Rights, The Antipsychiatry Coalition, and those aligned with the Thomas S. Szasz, M.D. Cybercenter for Liberty and Responsibility, argue strongly against the biological position and support a more psychosocial orientation.
The purpose of the present investigation is not to argue for or against either of these two orientations. Rather, it intends to investigate, using a discursive method (Burr, 1995), the way in which the biological model of “mental illness” which is advocated by biological psychiatry is reproduced in publications by organizations such as NAMI, in such a way as to construct schizophrenia as being concretely describable as a “mental illness.” The study also intends to examine the possible influence that such publications may have on the ideas and opinions of family and friends of those diagnosed with schizophrenia who turn to such sources for information regarding the nature of schizophrenia. The medium of communication chosen for investigation was the Internet, as it was thought to represent an easily accessible source from which families and friends of those diagnosed with schizophrenia could glean information.
A search of the Internet was performed by entering “NAMI (National Alliance for the Mentally Ill) into the Alta Vista search engine. Upon opening the NAMI homepage, the researcher followed the suggested links to subsequent “Schizophrenia Fellowship” homepages and, in turn, also followed the links provided by these pages. The final result was a collection of eight schizophrenia information pages for use in the analysis (see Appendix for a full listing of the pages used). The pages were selected based on the fact that they stated their intention as being to provide information to “patients” and their families about schizophrenia. Another feature of the pages selected was that they all made reference to schizophrenia as either an “illness” or a “disease.”
The pages were thoroughly read and analysed by the researcher, with careful attention being paid to identifying common devices of language that the pages utilised to present “schizophrenia” as being unambiguously definable as a “mental illness.”
On way in which almost all of the pages promoted schizophrenia as being an illness or disease was by categorically and unproblematically stating that its cause lay in the biologically-abnormal functioning of the brain. The key assertion inherent in such arguments was that the brain of the “schizophrenic” operates in some form of defective way, and that it can be seen as responsible for the observable “abnormal” behaviour of people so diagnosed. It should be noted that this idea is presented to the reader without any hard “medical” evidence to lend it support. The “diseased brain” concept is given as a hard fact, but without the accompanying hard evidence. Let us examine some examples of the use of this device of language.
Extract 1. (from schizophrenia.com)
“Symptoms of Schizophrenia
In healthy people, the brain functions in such a way that incoming stimuli are sorted
and interpreted, followed by a logical response (e.g. saying “thank you” after a gift is
given, realizing the potential outcome of arriving late to work, etc. Conversely, the
inability of patients with schizophrenia to sort and interpret stimuli and select
appropriate responses is one of the hallmarks of the disease.”
Extract 1 provides an excellent example of the “diseased brain” concept in action. The first thing to note in the extract is the way in which the author makes a clear distinction between “healthy people” and “patients with schizophrenia” on the basis of the functioning of the brain. Thus, the patient with schizophrenia is constructed as having a defective, diseased and unhealthy brain in comparison to normal, “healthy people.” Without reference to any appropriate literature, the difference in behaviour between the “normal” person and the “schizophrenic” is explained as having its origins solely in the “unhealthiness” of the brain.
Whilst the former example utilised a generalized construct of brain “health” to account for schizophrenia, other attempts to present a biologically based model of causality utilised far more specific “scientific” information.
Extract 2. (from Mentalwellness.com)
“Knowledge Base: Schizophrenia
. . Years of research have shown that schizophrenia is a biologically based brain
disease. The most recent advances in brain imaging have confirmed imbalances of
two brain chemicals—dopamine and serotonin—in those who suffer from
schizophrenia.”
On this occasion the author (listed as Janssen Pharmaceutica, Inc.) has taken refuge behind what can only really be described as a guise of clear-cut, scientific facts. After all, if “years of research have shown” schizophrenia to have a biological basis in the brain, then who can argue with that! Furthermore, this research, which has involved the “most recent advances in brain imagine,” has “confirmed” imbalances in brain chemicals. Obviously, if something as scientific as “brain chemicals” were involved, then the issue is beyond doubt. What the author conveniently fails to provide is a reference to any of these studies which have comprised this supposedly vast body of research. The impression imparted upon the reader is that the psychiatric and psychological community are in unanimous agreement in regards to the assertion that “schizophrenia is a biologically based brain disease,” when in actual fact much debate continually rages upon this very issue (Breggin, 1991; Szasz, 1960). The information is given as part of the “knowledge base” concerning schizophrenia. One would be justified in asking, however, “whose knowledge base this actually entails?” It could be suggested that the knowledge base presented may simply constitute that which is in the interests of Janssen Pharmaceutica Inc.
The presentation of information regarding the nature of “schizophrenia” in such a way as to give the appearance that the positions being adopted were unquestioned, unanimously accepted “facts,” was a technique employed by a number of the pages. It was common to find a situation in which the heading to the page defined the following information as being “fact.” This heading was often then followed by a categorical statement relating to the totally-biological nature of the “disease.”
For an example, let us return to the mentalwellness.com schizophrenia information page to which we referred in Extract 2 and examine the method used to “factualise” the biological theory of schizophrenia.
Extract 3 (from mentalwellness.com
. . *Schizophrenia is a neurological brain disorder that affects 2.2 million Americans today, or approximately one percent of the population.”
The factualisation of the biological theory of schizophrenia has been achieved in two ways. Firstly, the heading of “Schizophrenic Facts” obviously works to imply that the information included in the following text is in some way beyond argument. It is not constructed as being simply one of many views toward the subject, but rather as a list of pure and simple “FACTS.” It is also interesting to notice that in the same sentence in which it is announced that “Schizophrenia is a neurological brain disorder,” it is also stated that this disorder “affects 2.2 million Americans today, or approximately one percent of the population.” By placing a biological definition of schizophrenia in the same sentence as statistics regarding the prevalence of the disorder, the definition is given the same unquestionable validity as the statistics cited. The result of this grouping of information and the “FACTS” heading which precedes it is that the reader is given the impression that defining schizophrenia as a “neurological brain disorder” is as unproblematic as simply counting the number of Americans who are on record as being diagnosed with it.
Another example of such “factualisation” was found on the SANE Australia schizophrenia information page.
Extract 4. (from SANE Australia)
“ SANE |
-----------------------------
Factsheet | Schizophrenia
Schizophrenia is an illness, a medical condition”
In this extract, it is not only the definition of schizophrenia as an “illness” which is presented as a “fact.” It is also stated that schizophrenia is an “illness” which is to be dealt with solely by the medical profession. It could be argued that simply stating that schizophrenia is a “medical condition” does not entail a full conformity to a biologically-based medical intervention. However, if one considers the situation of an individual who is seeking information concerning one of their family members who has been given the label of “schizophrenic,” and is then presented with such uncontestable “facts” as : “Schizophrenia is . . . a medical condition,” it seems unlikely that alternative explanations and interventions would be explored.
The linking of schizophrenia
to conditions which are generally accepted to be “medical” and
biological in basis: the “just as”
technique
If we wish to present something as being a member of a certain category, then often we compare it to other members of the category in question. For example, consider the case of a primary school teacher who is trying to persuade a group of students that an animal such as an aquatic sponge is, in fact, an animal, despite its unusually plant-like appearance. The teacher would most probably present an argument centered around the fact that just like other animals, such as dogs or cats, sponges consume other living things in order to gain energy, and thus, can be defined as animals. Sponges are thereby constructed as being just as much an animal as cats and dogs are. This same argumentative tool was used by many of the pages to defend their definition of schizophrenia. In this case, the category was biologically-based medical conditions rather than the animal kingdom, and schizophrenia was the point of contention as opposed to sponges. Likewise, the exemplars of medical conditions such as cancer or diabetes replace exemplars of the category of animals, such as cats and dogs.
For our first examples of the use of this argumentative technique, let us examine extracts from the home page of the National Alliance for the Mentally Ill (NAMI). The first extract is taken from a section of the page which deals with “mental illness” in general. However, as schizophrenia is generally regarded amongst such schools of thought as the prototypical “mental illness,” the two constructs can be thought of, for the current purposes, as fairly much synonymous.
Extract 5. (from NAMI: The Nation’s Voice on Mental Illness)
Mental illnesses are disorders of the brain that disrupt a person’s thinking, feeling,
moods, and ability to relate to others. Just as diabetes is a disorder of the pancreas,
mental illnesses are brain disorders that often result in a diminished capacity for
coping with the ordinary demands of life . . .
. . Most importantly, these brain disorders are treatable. As a diabetic takes insulin,
most people with serious mental illness need medication to help control symptoms.”
In this example, both the cause and treatment of “mental illness” are presented as being just as biological in nature as the causes and treatments of diabetes. The biological basis of diabetes is, after all, widely accepted and undisputed. The impression imparted to the reader is that the scientific knowledge of the biological malfunctioning of the brain, in so-called “schizophrenics,” is just as precise and uncontroversial as that associated with diabetes. Furthermore, the preciseness and efficacy of medications used to treat “mental illnesses” is presented as being just as clear cut as the use of insulin to treat diabetics.
Many other examples of the use of what has been coined in this discussion as the “just as” technique were found throughout the pages that were analysed. Let us present some other examples in brief.
Extract 6. (from the NAMI homepage: An interview with novelist Danielle Steel, whose son was diagnosed with Bipolar Disorder)
“Danielle: . . . I also think people should know how serious it [mental illness] is when
it goes untreated . . . If you let a bad cold turn into bronchitis and then pneumonia,
without medication, it can kill you. I fyou do not treat serious diabetes, it can kill you.
If mental illness goes untreated it can kill you. People need to know that, so they get
the appropriate care.”
Extract 7. (from schizophrenia.com)
“Like cancer and diabetes, schizophrenia has a biological basis”
Extract 8. (from schizophrenia.com)
“Brain imaging technology has demonstrated that a schizophrenia is a as much an
organic brain disorder, as is Multiple Sclerosis, Parkinson’s or Alzheimer’s disease.”
All of the examples given share the same argumentative device to place schizophrenia in the category of biologically-based, medical conditions as our fictional primary school teacher used to persuade their students that sponges should be placed in the category of animals. That is, they argue that schizophrenia/mental illness has just as much of a biological base as other conditions which are commonly regarded as biological in basis such as cancer, diabetes or Parkinson’s disease. Whether or not this is actually true is a question to which there is no unanimous answer. Certainly, one could argue that the matter is far more beyond doubt than is suggested by the pages examined in the present investigation.
The Use of “What Schizophrenia is NOT”:
Denial of any role of the family in causation
It was found that whilst the information pages went to lengths to inform the reader of what schizophrenia was, there was also a large emphasis placed on providing a list of what schizophrenia was not. In the same way that the “just as” technique was used to argue for the categorization of schizophrenia as a biological illness, the listing of “myths” surrounding schizophrenia as a biological illness, the listing of “myths” surrounding schizophrenia was used to discredit psychosocial positions which involve any suggestion of family influences or upbringing as a factor in its. onset. Opponents of the theory of biological causality of so-called schizophrenia, such as Breggin (1991) and Laing (1960), have put forward many arguments for the involvement of family environments and upbringing as causal factors in the development of what has come to be labeled as schizophrenia. There also exists a large body of research that suggests that highly stressful family environments can have detrimental effects on outcomes for schizophrenic patients returning to their homes following discharge from hospitalized care (Vaught and Leff, 1976, 1981; Leff, Berkowitz, Shavit, Strachan, Glass and Vaugh, 1989; Karno, Jenkins, de la Selva, Santana, Telles, Lopez and Mintz, 1987).
By embedding family influences and upbringing within a list of “myths” surrounding schizophrenia, the pages effectively discredited such theories. In fact, one could argue that this method of debunking psychosocial theories of schizophrenia’s causality achieves this goal far more efficiently than by directly challenging such positions. The pages do not cite the positions of the likes of Breggin and Laing, or the research of Vaughn and Leff, and then argue against them. Instead, they present such positions within lists of myths surrounding schizophrenia which also include such ideas as schizophrenia being a split personality. Let us examine some examples of this presentation of information.
Extract 9. (from Schizophrenia Fellowship of New South Wales Inc.)
“Schizophrenia is NOT caused by:
*Domineering mothers or passive fathers
*Poverty
*Bad parenting
*Sinful behaviour”
This extract presents the reader with an argument suggesting that the degree to which upbringing contributes to the development of schizophrenia can be compared to the influence of such factors as “Sinful Behaviour.” This provides the reader with a very simple, yet powerful, argument against the possible involvement of family and upbringing. After all, it would seem likely that the majority of readers would assume that no research exists supporting “Sinful Behaviour” as a possible causal influence in schizophrenia. After reading the neat listing of factors in Extract 9, the reader could also be given the impression that there is no research in existence regarding family influences, or that the suggestion of psychosocial causality holds as much weight within the literature as do factors such as “Sinful Behaviour” or “Poverty.”
Extract 10. (from Schizophrenia Ireland: Lucia Foundation)
“Schizophrenia . . .
*is not hereditary though there appears to be a genetic predisposition. While the cause
is unknown, personality traits, chemical imbalances and stress within the environment
probably contribute towards its development.
*is NOT caused by pressures within the family
*is NOT having a split personality”
The grouping of the concept of family pressures as a causal factor together with the concept of schizophrenia being a split personality was found across a number of pages examined in the analysis. The false representation of schizophrenia as a split personality is an image which has often been pervasive within the media, especially in cinema (Barlow and Durand, 1995). The explosion of such myths by the information pages reviewed can thereby be seen as a more than worthy exercise in terms of increasing public awareness of the nature of schizophrenia. However, by grouping together “pressures within the family” as a causal factor and the societal myth of schizophrenia as being a split personality, the result is to present family influences as also being nothing more than a societal myth. There is certainly no suggestion that the influence of family environment has been quite widely researched and that sections of the mental health community regards them as important factors.
There is also a glaring contradiction inherent in Extract 10. Firstly, it is outlined that whilst the cause of schizophrenia is unknown, stress within the environment “probably” contributes towards its development. In other words, a stressful environment is put forward as a possible causal factor for the development of schizophrenia. In the very next sentence, however, the author vehemently denies the influence of “pressures within the family” as a causal factor. Surely a stressful family environment is in no way different to any other form of stressful environment. In fact, one could be excused for assuming that an individual’s family environment represents the environment in which the individual spends a very large percentage of their time whilst growing up. How the author can manage to present a stressful environment as a causal factor and vehemently deny any influence of pressures within the family in the same paragraph must be questioned. A possible answer to this question is that organizations comprised of families of those diagnosed with schizophrenia are highly motivated to deny any influence of family environments and upbringing upon its onset and course. However, determining whether or not this may be the case is not the main aim of this investigation. This study intends to investigate what is said, how it is said and what this may achieve, rather than trying to categorically answer the question of why it is said.
This study has presented a discursive analysis of the way in which the web pages of non-professional organizations advocating a predominantly biological position construct schizophrenia as being understandable solely as a “mental illness,” a “disease,” or a “neurological brain disorder.” Four main features of the method by which such an account were generally constructed have been outlined. These included the presentation of schizophrenia as being the result of a “diseased brain,” the “factualisation” of information, the linking of schizophrenia to “other medical conditions,” and the denial of psychosocial influences by categorizing them as societal myths.
Perhaps the most important point to be taken away from this analysis is that information sources which claim to present “facts” about issues such as schizophrenia (or any other issue for that matter) should never be viewed as categorically correct accounts of the way things are in the world. Any publication must be written by an author, and as such, its construction will always be influenced to some degree by the personal ideology of that particular author in regards to the issue being considered.
This study has not set out to advocate one particular view of schizophrenia. It has rather been to demonstrate the way in which a particular view can be constructed, through discourse, in such a way as to give the impression that it represents an unambiguous truth regarding the way things are, rather than simply one opinion of the way things are. To conclude, however, one is encouraged to also remember that the present investigator does not claim to be any further removed from their particular ideology than any of the authors whose publications were examined within the analyses.
Care in Action: National Schizophrenia Fellowship Scotland Homepage
http://www.nsfscot.org.uk/right.htm
Mentalwellness.com
http://www.mentalwellness.com/reference/knowledge/schzop.htm
NAMI (National Alliance for the Mentally Ill) Homepage:
SANE Australia.
http://home.vicnet.net.au/~sane
Schizophrenia.com: The Schizophrenia Home Page.
Schizophrenia Society of Canada.
Schizophrenia Fellowship of New South Wales.
http://www.sfnsw.webcentral.com
Schizophrenia Ireland: The Lucia Foundation.
http://www.iol.ie/lucia/si/index.htm
Barlow, D. and Durand, V. (1995). Abnormal psychology: An integrative approach.
New York: Brooks/Cole
Breggin, P. (1991). Toxic psychiatry. London: Fontana.
Burr, V. (1995). An introduction to social constructionism. London: Routledge
Karno, M., Jenkins, J., de la Selva, A., Santana, E., Telles, C., Lopez, S. and Mintz, J.
(1987). Expressed emtion and schizophrenic outcome among Mexican-American
families. Journal of Nervous and Mental Disease, 175 (3), 143-151
Laing, R. (1960). The diivided self. London: Tavistock
Leff, R., Berkowitz, R., Shavit, N., Strachan, A., Glass, I., and Vaughn, C. (1989). A
trial of family therapy v. a relatives group for
schizophrenia. British Journal of
Psychiatry, 154, 58-66
Szasz, T. (1960). The myth of mental illness. American Psychologist, 15, 113-118
Torrey, E. (1995). Surviving schizophrenia, 3rd ed. New York: Harper-Perennial
Vaughn, C. and Leff, J. (1976). The influence of family and social factors on the course
of psychiatric illness. British Journal of Psychiatry, 129, 125-137
Vaugh, C. and Leff, J. 1981). The role of maintenance therapy and relatives expressed
in relapse of schizophrenia: A two year follow-up. British Journal of Psychiatry,
139, 102-104
Copyright, 1999, Tim Kurz
Department of Psychology
Murdoch University
South Street
Murdoch 6150
Western Australia
Australia
Note: Tim Kurz completed his undergraduate degree at Murdoch University in December 1999. He is now at work on his doctoral degree there.