Unraveling the Enigma of Schizophrenia

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In “Malady of the Mind,” Jeffrey A. Lieberman argues that we are finally making progress in understanding schizophrenia.


SCHIZOPHRENIA HAS LONG BEEN understood to be among the most serious and intractable of all mental disorders. The condition typically begins in early adulthood and lasts a lifetime. Its hallmark features include hallucinations, withdrawal from social situations, and serious problems in cognition, such as a highly irrational belief system and a limited attention span.

In “Malady of the Mind: Schizophrenia and the Path to Prevention,” a comprehensive history of this perplexing mental disorder from the Ancient World to the present, Jeffrey A. Lieberman argues that psychiatry has finally turned a corner in determining both what causes schizophrenia and how to treat it. “Due to the progress and success of science,” he concludes, schizophrenia is “a malady of the mind no more.”

BOOK REVIEW — “Malady of the Mind: Schizophrenia and the Path to Prevention,” by Jeffrey A. Lieberman (Simon & Schuster, 528 pages).

It’s a bold pronouncement to make, given that Lieberman himself admits that the history of psychiatry is filled with declarations of victory over a disorder that nonetheless continues to defy efforts to pin it down. Several once-heralded treatments — say, insulin coma therapy and ice-pick lobotomies, which were both popular in the 1940s — are now dismissed as barbaric. Likewise, while antipsychotic medications, which were introduced with great fanfare in the mid-1950s and remain today’s treatment of choice, can reduce the intensity of the most troubling symptoms for some patients, they are far from a cure. The chapters on past approaches are elegantly written and are helpful in giving context to current debates about how best to address this devastating illness.

Lieberman’s current optimism, however, is rooted in the findings of biological psychiatrists over the last 40 years. A longtime professor of psychiatry at Columbia — he was department chair until a year ago when he was suspended after posting a tweet that was widely considered racist and misogynistic — Lieberman himself has been a central figure in this research, having co-authored hundreds of studies in the nation’s most prestigious medical and psychiatric journals and written or edited 10 books on mental illness. Lieberman, who served as president of the American Psychiatric Association a decade ago, has also won several prestigious awards for his scholarly oeuvre, including the Lieber Prize for Schizophrenia Research from the National Association for Research in Schizophrenia and Affective Disorders and the Neuroscience Award from the International College of Neuropsychopharmacology.

As he sees it, biological psychiatry has made major advances that have put our understanding of schizophrenia on firmer scientific footing than ever before. He argues, for example, that modern research supports the notion that genetic factors play a dominant role in the onset of schizophrenia. We now know, he writes, “the numerous means by which genes conspire to preserve and confer schizophrenia.” He also suggests that numerous studies of drugs such as antipsychotics, antidepressants, and stimulants show that the dysregulation of certain neurotransmitters — say, dopamine — are primarily responsible for causing the disorder. For Lieberman, schizophrenia is a brain disease that typically responds well to current medical treatments.

The problem is that Lieberman’s framing of schizophrenia as a disorder that science is finally on the precipice of conquering runs counter to the views of many leading experts in his own field — including two former directors of the National Institute of Mental Health, Steven Hyman and Thomas Insel — who maintain that the so-called biological revolution in psychiatry has failed to deliver on its promise to unravel the mystery of complicated disorders like schizophrenia. As Lieberman himself notes, Insel, the author of “Healing: Our Path from Mental Illness to Mental Health,” has stated publicly that recent neuroscience research has produced no scientific breakthroughs, nor has it done much to improve patient outcomes. (In his book, Lieberman describes Insel’s comments as “unsettling.”)

Similarly, Lieberman’s repeated assertion that schizophrenia is largely a genetic or inherited disease is shaky at best. As sociologist Andrew Scull stresses in “Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness,” psychiatrists have been making this claim for over a century, and it has often relied on little more than fuzzy correlations such as the observation that the illness tends to run in families.

Schizophrenia affects less than 1 percent of the population — around 1.5 million Americans — many of whom are in prison or live on the streets.

Lieberman does concede that the search for a single gene responsible for the disorder, which lasted several decades and gobbled up billions of research dollars, ended up going nowhere and has recently been jettisoned. As he argues, psychiatrists couldn’t find a single gene because “many genes, possibly one hundred to two hundred, combine to confer disease vulnerability.” But as Scull notes, these genome-wide association studies are also not proving particularly helpful in pinning down the underlying biology of mental disorders…



F. Kaskais Web Guru

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