Wednesday, October 5, 2011

Musings on the Notion that Schizophrenia is Biological



Theory and Method:

My problems with the argument that schizophrenia is biological are primarily methodological and theoretical.

I make several assumptions all of which, I think, are empirically grounded:
--human biology is dynamic. As Darwin noted morphology can be changed by the environment. And as analysis is showing environmental factors like pollution can and do change human DNA.
--human social and cultural life is dynamic (historical).
--interaction is at the heart of all life on this planet (biology meets environment and in some cases society and culture).
--statistical analysis is static even when those statistics have a longitudinal dimension to them. Both the contemporary and longitudinal dimensions of statistical analysis are, at best, only snapshots in time and space. As such they do not and cannot capture the interactional and dynamic aspects of human life.
--the notion that schizophrenia is biological in etiology or origin is static because no evidence has, or probably ever can be, offered which shows that schizophrenia has existed across historical time and across geographic space. Analogies such as the one which equates the shaman of the past with the schizophrenics of today or which equates dementia praecox (being out of one's mind) are not conclusive or particularly compelling. They are simply analogies, and perhaps not quite compatible analogies.
--schizophrenia clearly has social and cultural components to it because contemporary schizophrenics from Christian cultures express their schizophrenia in language. Christian schizophrenics, for instance, maintain that the Christian god and the Christian Satan are pulling their strings. Language, of course, is an aspect of culture.
--raised serotonin levels are equally explainable as the end product of environment changing biology or as factors associated universally across time and space with schizophrenia. Is the raised heartbeat associated with fear the product of biology or the product of an environment full of dangerous predators? Which came first, the chicken or the egg? Any argument for the universality of schizophrenia has to show that schizophrenia has been around in all times and all places.
--the studies of schizophrenia by psychologists and psychiatrists are static snapshots in time and space. They are the psychological equivalent of Chomsky’s notion that one specific language speaker in a particular time and place can tell you everything you need to know about language in general. These assumptions are highly problematic from a historical point of view. As such these perspectives do not and cannot capture the interactional and dynamic dimensions of human life.
--are biology is destiny arguments the new secular version of Calvinist determinism?

In order to argue that schizophrenia is cross-cultural and trans-historical the analyst has to produce sound cross-cultural and trans-historical evidence for the existence of schizophrenia. I haven’t seen any such evidence though I could be missing something.

Practise: A Case Study:
I once worked with a "schizophrenic" when I lived in Muncie, Indiana and Bloomington, Indiana. Let’s call him “Tom”. Quite often some event, an event often associated with a failed romantic relationship (though once it was the death of Elvis) set “Tom” into a tailspin of melancholy, walking around town, and drinking. These actions, in turn, eventually resulted in “Tom” experiencing slow response times--it sometimes took “Tom” what seemed like several minutes to respond to simple "yes"/"no questions--an inability to cook something on the stove without burning posts and pens, "Tom hearing the voices of the Christian god and devil who, “Tom” later told me after he came out of one of his schizophrenic funk, that the Christian devil told him to open and close doors repeatedly. “Tom” would follow these orders when in his "schizophrenic" state.

What really struck me about “Tom’s” "illness" was the cultural forms it took. It was set off, in my estimation, by culturally driven cognitive dissonance. Tom's romantic view of the world, a cultural view of the world deeply enmeshed with the poetry of Shelley and Byron for "Tom", simply did not mesh with what happened to "Tom" in the "real" world. "Tom" desperately wanted to have a relationship with a woman that mirrored the romantic images and cultural expectations of the world he grew up in the America of the 1950s. He was deeply pained by the death of Elvis Presley, the 1950s rock and roll “god” he grew up “worshipping”. He heard the voices of the Christian god and devil. “Tom”, of course, grew up in a Christian household.

When “Tom” and I talked about his history after he came out of his schizophrenic funk he told me that he had had a difficult relationship with his father. He also told me that he had desperately wanted the relationship with his father that society said he should have (the Father Knows Best complex?). He told me that he wanted to have romantic relationships that were consistent with the ideas of romantic relationships he imbibed from the romantic culture he chose to live in. In both cases the world he was forced to live in simply wasn’t the cultural or ideological world he wanted to live in. The result: cognitive dissonance and eventually, in my opinion, mental illness.

Conclusions:
--Since schizophrenia expresses itself culturally anyone who argues that schizophrenia is biological alone has to deal systematically and analytically with the cultural dimensions of schizophrenia and explain why it doesn't manifest itself in purely biological terms.
--Schizophrenia clearly has biological aspects to it. However, since proponents of the biological explanation of schizophrenia cannot show that schizophrenia has existed in all or in most places and times they have to explain in systematic and analytical terms why schizophrenia was not diagnosed until the nineteenth century. Additionally, they have to systematically and analytically explain why, given that biology and environment are integrally interconnected and the latter can lead to changes in morphology and DNA, schizophrenia is not the product of environment rather than biology given the relatively recent "discovery" of schizophrenia.
--Given both of these proponents of the biological argument for schizophrenia have to be much more circumspect and much more limited in the scope of their argument and admit that culture plays an important role in schizophrenia as well as biological factors.

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