The Divided Mind by Edward Bullmore review – do we now know what causes schizophrenia?
In 1973, an American psychologist named David Rosenhan conducted a groundbreaking experiment that challenged the very foundations of psychiatric diagnosis. He sent eight "pseudo-patients" to psychiatric institutions, feigning symptoms of schizophrenia and hearing voices with negative connotations. Despite their lack of symptoms, they were all admitted and diagnosed. This experiment revealed a startling truth: psychiatrists struggled to differentiate between sane individuals and those with genuine mental illness. Rosenhan's findings sparked a public debate, raising questions about the nature of mental illness and the effectiveness of the psychiatric establishment.
The implications of Rosenhan's study resonated deeply, leading to the film "One Flew Over the Cuckoo's Nest," which further exposed the flaws in the system. As a response, the psychiatric community tightened diagnostic criteria, attempting to categorize symptoms more precisely. However, this reaction inadvertently triggered a counter-reformation, solidifying the medicalization of psychiatry.
Surprisingly, it was later discovered that Rosenhan's paper was largely fabricated, with most of the pseudo-patients invented. This revelation adds a layer of complexity to the narrative, questioning the reliability of the initial findings. Despite the controversy, Rosenhan's work exposed a fundamental divide within the field of psychiatry, stemming from the ancient schism between the mind and the body, popularized by Descartes and Saint Paul.
Bullmore, a professor of psychiatry, argues that this divide has led to a separation between the "mindless" tribe, which prioritizes biology, and the "brainless" tribe, which focuses on a person's upbringing. This dichotomy has influenced the field's understanding of mental illness, with the brainless tribe prevailing in the intellectual arena. However, the mindless tribe's victory in the literal war has led to a more comprehensive approach to mental health.
Advancements in neuroscience, scanning, mathematics, genomics, and immunology have provided valuable insights into schizophrenia. Bullmore highlights the emerging understanding that schizophrenia is caused by the abnormal development of brain networks during childhood and adolescence, influenced by immune dysfunction and genetic variations. This new perspective integrates biology and experience, offering potential avenues for prevention.
While Bullmore acknowledges the contributions of anti-psychiatrists like RD Laing, he does not fully engage with their ideas. He also avoids discussing the adverse effects of long-term psychiatric medication and its impact on the interpretation of biological differences in schizophrenia. Despite this, Bullmore emphasizes the importance of addressing psychiatry's dark past, particularly the Nazi program's targeting of psychiatric patients, which resulted in the murder of approximately 260,000 individuals.
Bullmore's writing is both intellectually stimulating and accessible, making complex ideas understandable. He is a far cry from the stereotypical stern megalomaniac, driven by a genuine desire to improve patient care and understand the underlying causes of mental illness. This book is a testament to his dedication and a valuable contribution to the field of psychiatry.
