It is unsettling to recall that for nearly two centuries
leading figures in clinical medicine and basic science have
understood severe mental illnesses to be manifestations of
brain pathology. It is unsettling because, at the late
date of 2006, those suffering from these conditions
continue to be suspected of moral weakness and
self-indulgent rejection of societal norms.
There is, not doubt, much mischief that passes for
"illness" in the cluttered world of psychiatric
speculation, and it is because of this that even patently
disabling conditions tend to be viewed with skepticism.
What is important to recognize, however, is that careful
study of the anatomical and functional features of the
brains of those uncontroversially judged to be
schizophrenic are not only different from normal brains but
pathologically different.
This is not the place for a review of the authoritative
literature. It is sufficient to note that schizophrenia is
associated with reduction -- often significant (25%)
reduction -- of gray matter in temporal and frontal cortex.
The magnitude of the loss matches up with the severity of
symptoms, including delusional and hallucinatory states.
The Society for Neuroscience (SFN) hosts a membership
and a number of publications at the leading edge of
research and theory in the "brain sciences". Among their
more accessible publications are the "Brain Briefings"
designed to provide informative summaries of major
findings and developments. A decade ago (Summer
1995), the Brain Briefings noted,
"For years, the severe disturbances in thinking, social
behavior and emotion associated with schizophrenia,
which affects two million Americans, were attributed to
some personality flaw or demon. Many felt the disease
could not be treated. That's changed in recent decades
as scientists have begun to learn what goes wrong in
the brains of schizophrenic patients".
Clearly, in the matter of our mental, emotional and social
lives, the complexity of brain function itself -- and, one
would expect, the even greater complexity of disordered
functions -- will prove to be elusive to investigators and
practitioners. At the present time, it is chiefly
combinations of drugs, all with undesirable side-effects
and all with uncertain efficacy, that exhaust the range of
credible treatments. Psychotherapy is largely useless when
not administered as an adjunct to anti-psychotic
medication.
In ancient Greece, the greatest strides in clinical
medicine were made by Hippocrates and the school
devoted to his teaching. The general view at the time was
that some diseases, especially those associated with "fits",
were forms of "divine madness", visited upon the sufferer
by an offended god. The Hippocratic rejection of such
nonsense was wonderfully politically correct: As the gods in
some sense cause everything, there's no reason to think
one or another illness is uniquely in their province -- so let's
treat all diseases as -- diseases.
Ah, those clever Greeks!
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