Schizophrenic Split

Psychiatry is as sharply split in its views on the causes and treatment of schizophrenia as schizophrenics are supposed to be split in their personalities. The prevailing view is still that of Freud: that schizophrenia is the full flowering of a maladjustment to other people that is seeded in childhood; to cure it, the victim must be helped to establish better relationships. At the opposite end of the psychiatric spectrum are those who hold that schizophrenia is a biochemical abnormality; if the abnormality could be identified, the victim might be cured by correcting the body's chemistry.

One of the most persistent and articulate proponents of the biochemical view is Tulane University's Dr. Robert G. Heath. In 1956, Heath announced that he had isolated a mysterious protein from the blood of schizophrenics. When injected into monkeys or prison volunteers, the protein caused schizophrenia-like symptoms. Now, in the Archives of General Psychiatry, Dr. Heath reports that he has succeeded in further purifying this substance, taraxein. It works like an antibody, he says, in effect sensitizing a person against certain parts of his own brain. If this can be confirmed, schizophrenia would be classed as one of the autoimmune diseases, in which the body makes antibody against one of its own parts.

Checkmate. On behalf of the analytic school, London's Dr. Ronald David Laing says: "Schizophrenia is not a disease at all. And in contrast with traditional thinking, schizophrenia is not in one person but is between people. It represents a broken-down relationship, and the way to mend it is to involve the schizophrenic in a relationship that means something to him." Dr. Laing, 38, does not claim to have originated this idea. It traces back to the brilliant American psychiatrist Harry Stack Sullivan (1892-1949), whose theories have been neglected partly because he wrote in obscure jargon. Sullivan blamed emotional problems on difficulties in "interpersonal relationships," then defined "a person" not as a person in the usual sense but as a social concept. Starting from that, Dr. Laing sees the schizophrenic as an individual who has had trouble fitting into the social concepts dinned into him from infancy.

After Dr. Laing and his colleagues had studied scores of patients in painstaking detail, they concluded: "The experience and behavior that are labeled schizophrenic are a special sort of strategy that a person invents in order to live in an unlivable position. He cannot make a move, or make no move, without being beset by contradictory pressures both internally, from himself, and externally, from those around him. He is in a position of checkmate." Before schizophrenia can be better understood and its treatment improved, psychiatry itself must undergo a deep change, Dr. Laing believes. He insists that a mental hospital is no place to treat a schizophrenic because there the psychiatrist has to play his role according to doctor-patient rules.

As They Please. To practice its "anti-psychiatry," the Laing group has set up centers in London that it refuses to call hospitals, but regards as simply households where people live and interact. "There are no psychiatrists and no patients," says Dr. Laing. "It just happens that some of these people would be in mental hospitals if they weren't in the center, and others would be called psychiatrists outside. Visitors can't tell which is which. No one is being 'treated' in any accepted sense." In the centers, schizophrenics get an absolute minimum of tranquilizing drugs, and no shock treatment or brain surgery. The atmosphere is infinitely more permissive than in the most liberal mental hospital. Patients get up and go to bed when they please. They may do household work and cooking--or not, as they choose. They may spend whole days at solitaire or checkers, or just watching TV. But always--24 hours a day, seven days a week--whenever they feel like communicating with someone else, by word or even by gesture, there is one of those indistinguishable staff members ready to listen. Some of the patients establish a relationship of the kind they need by helping others who are more severely withdrawn.

Biochemical Straitjacket. On the average, patients "treated" by the nontreatment technique are discharged after three months, Dr. Laing reports in the British Medical Journal. Three-fourths of them go back to work. If they are returning to the family setup, which may have helped to bring on their illness, the psychiatrists meet with other family members to smooth the way. Fewer than one-fourth of the patients have to be readmitted. Though Dr. Laing hates being drawn into the numbers game, he asserts that these results are as good as those from intensive drug treatment, if not better. Too many drug-treated schizophrenics, he says, have to stay on drugs indefinitely, "in a biochemical Straitjacket," and their readmission rate is higher.

Many of Dr. Laing's discharged patients may still seem a bit queer by society's standards, but that does not bother him as long as they can live with others and live with themselves.

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