Critics' attack beats the book

By MARTIN JOHNSTON health reporter

A book which suggests schizophrenia is the result of trauma rather than a genetically linked biological illness has come under attack even before it is published.

Models of Madness, containing contributions from six New Zealand authors, will not be published until next month.

But Dr Ian Goodwin, of the Australian and New Zealand College of Psychiatrists, says ideas in it fly in the face of all scientific evidence.

One of the book's editors, Dr John Read, director of clinical psychology at Auckland University, said it argued that little, if any, evidence existed that schizophrenia was a biological disease arising from a genetic predisposition - the "medical model".

He and colleagues say in the book that this model, promoted by "biological psychiatry" and the drug industry, has produced a destructive pessimism about the chances of recovery.

Anti-psychotic drugs worked for only a third of patients, he said, and their potential side-effects - including tremors from the old ones and diabetes from the new - had often been glossed over.

"About half of patients throw away these drugs because of the side-effects. That's why we have to offer a range of things like people to talk to and psychotherapy.

"There are studies showing people who don't get anti-psychotic medication from the outset do at least as well as those who do. People who are offered basic human support do just as well in terms of symptoms as people on medication.

"They do better on quality of life measures like number of friends, likelihood of having a job and so on. These studies get buried."

Dr Read's research suggests that childhood abuse is often a factor in causing schizophrenia.

He cites a Dutch study of more than 4000 people that found the risk of serious psychosis was nine times greater in those abused as children.


Dr Goodwin, a psychiatrist at Auckland's Mason Clinic for offenders with mental illness, said Dr Read's ideas were naive because he was not working at the "sharp end" of mental health.

"It's potentially dangerous to start putting out the message that people with serious mental illnesses can get by without medication.

"This stuff just flies in the face of all the scientific evidence. It's time we stopped being nice about it.

"There is incontrovertible evidence that anti-psychotics work for vastly more than 30 per cent of people. It's 70 to 80 per cent now, particularly with modern drugs."

Side-effects did not occur in all patients, and could "generally be worked through".

While drugs were important, his patients also received psychotherapy and other therapies. This mix was standard practice for psychiatrists.

A Mental Health Commissioner, Mary O'Hagan, said the new book would be a welcome addition to analysis and evidence on alternatives to the medical model.

Many mental health service "consumers" were concerned at the medical model's dominance, but it should not be rejected, said Ms O'Hagan.