Schizophrenia is a diagnosis that is mainly understood as a brain disease, and therefore it is mostly treated with medicine. However, more and more patients are telling stories of how they felt mistreated and stigmatized during treatment, and with the events of over-medicating the patients at the Psychiatric Center in Glostrup, the question is; are we treating this disorder correctly, and if not, why? This master thesis focuses on two main areas; what is schizophrenia, and can we understand it as a meaningful disorder? This paper is a theoretical study of schizophrenia, because to understand how we treat these patients, we need to understand the disease in itself. The paper is divided in three parts; first, there is a historical part, then a clinical-diagnostic part, and at last, a part that focuses on psychodynamic theories. All of these are used to understand what schizophrenia is.
History shows that a concept is always defined from its historical context, and schizophrenia is no exception. Today it is defined from a mostly genetical and biological point of view, which is, in most part, a reflection of the technological paradigm that rules today’s society. When trying to get a more detailed understanding of schizophrenia, as it is understood in the diagnostic systems ICD-10 and DSM-IV, the picture becomes more complicated. The diagnosis has several subcategories, and the many different symptoms reflect the concept’s variability. Patients diagnosed with the disorder vary a lot in their symptoms, and it can be hard to find two patients with the same symptoms. Schizophrenia is the only diagnosis that does not have a unique symptom; a symptom that is specific for this disorder. That means there are several diagnostic problems, and these are addressed. Schizophrenia and psychosis are also very similar, and these concepts are often used as synonyms, although they aren’t. Finding a clear and concrete answer to what schizophrenia is, is difficult. We show these difficulties with examples from the problems concerning diagnosing Anders Behring Breivik, and we present the idea that schizophrenia might not exist.
To understand schizophrenia as only a genetic concept is problematic. We think that understanding schizophrenia in a meaningful way seems logical, and we think that to see it as a pathological splitting, and as a way to protect oneself from a disintegrating ego, makes sense. This argument is substantiated by the theories of Freud, Klein, Winnicott, and Steiner. The classical view of having an innate vulnerability versus the psychodynamic view of an arisen vulnerability is discussed, and from our perspective, these views need to be better integrated. We also discuss the impact and the consequences today’s view of schizophrenia has on the patients diagnosed with it, as expectations of treatment does have an impact on the outcome. In our view, there is a need for a paradigm shift. We need to start focusing on the individual, and not the specific gene.