Reviewing Schizophrenia 2: Professor Ivor Browne

Today, most experts advocate a holistic approach to the treatment of mental illness or mental disorders.  As I have emphasised in my last post, psychopharmacology or treatment by medication alone is one avenue to the assuagement of mental suffering, and, thankfully, psychotherapy in its many manifestations is generally used in conjunction with administering prescription drugs.  Medical intervention may, more often than not, be necessary, but very seldom is it used alone and to the exclusion of more holistic, therapeutic and creative approaches.  The key concern today is BALANCE, and the approach is always open-ended and positive, never closed and negative.  An understanding of the history of psychiatry that led to such a balanced approach is interesting to study, as it shows that such is the outcome of no little suffering on the part of patients and many intellectual challenges to the authoritarian, and often patriarchal, approaches of traditional medicine and society.  One interesting movement against such authoritarian approaches was that of the Anti-Psychiatric Movement, which, in general, sought to put the rights and humanity of the patients at the centre of the psychiatric enterprise.  Patients, for these advocates, were thinking, feeling and volitional human beings, not merely collocations of symptoms or sites of diseases.  However, these experts or scholars went too far overboard in their radical views.  I will review a book and a published interview here by an Irish professor of psychiatry, Dr Ivor Browne, who would proclaim such a radical view.  It is not a mainline or accepted view, but for balance, I wish to discuss his thinking here.  It is important to point out that the views of these radical scholars and clinicians are motivated primarily by humanitarian concerns and deep respect and empathy for their suffering patients.  However, as is obvious from my previous post, I hold the mainline views expressed by Professor Anthony Clare.   

The Anti-Psychiatry Movement emerged in the 1960s and was a loose, international intellectual movement that questioned the validity, the ethics, and the practices of traditional psychiatry. It was led by figures like Dr Thomas Szasz (1920 – 2012) in the USA and R.D. Laing (1927 – 1989), in the UK.  Basically, this movement challenged the involuntary commitment of patients to asylums, the medical model of mental illness, and the use of involuntary treatments like ECT, and indeed the utilisation even of drugs.  Its proponents argued that these treatments were socially controlling, coercive, and more harmful than helpful.  In Ireland, Professor Ivor Browne (1929 – 2024) of University College Dublin was a follower of the insights of Dr Ronnie Laing.  While Professor Browne agrees with Laing that the central problem for schizophrenics is the failure to separate (properly) from the family, he faults his old friend Ronnie Laing for demonising parents and making something quasi-sacred of the psychotic (The Irish Soul in Dialogue, The Liffey Press, Dublin, 2001, 22-23). 

 In that same book, in an interview with Dr Stephen J. Costello, Professor Browne underscored his independence of mind and stated that he had learned to think for himself at Oxford: “Most people who enter psychiatry do so because they have questions about themselves.  They have trouble understanding themselves, and I certainly had plenty of that.  The sad thing about much psychiatry, about people who take the medical, organic view, is that they end up not studying themselves and so learn nothing and go off into a tunnel.  But I certainly didn't follow that direction” (ibid., p. 11). Moreover, Professor Browne is unusual because he was both a psychiatrist and a psychotherapist.  He had sessions of psychoanalysis along Adlerian lines as a young psychiatrist with an English Doctor and psychoanalyst called Joshua Bierer in Marlborough, England.   

Furthermore, Browne’s heralding of these radical insights and his opposition to the overuse of psychotropics and antipsychotics or heavy-duty psychiatric medication can easily be understood from his informative, eccentric, imaginative and compelling memoir, Music and Madness, (Atrium, 2008) that distils his experiences as a psychiatrist in the Irish medical system from the late nineteen fifties through to the early 2000s.  In that book, he recounts his early introduction to St Brendan’s Psychiatric Hospital (Grangegorman) as a consultant psychiatrist. He found that patients back then in 1962 were strongly medicated and confined to bed for most of the day, while the director practised his putting skills for golf in his office.  Dr Browne was enraged by this and, when his turn came to be the hospital's director, he instituted a very humane regime that incorporated psychotherapy as well as medication.  In this memoir, he states that he believes that schizophrenics shut out others because "they are unable to maintain the normal boundedness between themselves and others, as they are far too open and vulnerable to being invaded by others in their vicinity" (p. 59). Unlike those who saw medicine as a ticket to status and wealth, Professor Browne was filled from the beginning of his career with a spirit of public service, a burning intellectual curiosity about new ways of treating the mentally ill and a determination to change the inhuman mental hospital set-up which locked people up and then forgot about them.

Moreover, Browne maintained that schizophrenics are less well able to separate from their family of origin than we neurotypicals are.   He emphasises that any psychiatric illness is rooted in the family as well as in the person who may be a channel for the illness.  While in the USA studying, he spent some time on a further fellowship to visit Gregory Bateson's Schizophrenia Research Unit in Palo Alto: “The experience of hearing their views on schizophrenia was a further step for me in realising that the orthodox view of it as a largely genetic, biochemical disorder simply didn't add up (p. 96). Furthermore, he learned from Gregory Bateson's studies and those of Jay Haley that disturbance in internal family relationships "can be found in virtually any form of psychiatric disorder where the family is 'enmeshed' and has failed to free the offspring to leave and lead a separate life." (p. 96)

Browne repeats yet again his insight into the schizophrenic's lack of boundedness further into his book with a certain impatience and exasperation:

One of the greatest pieces of nonsense in psychiatric literature, which is repeated ad nauseam in textbooks over the years, is the notion that schizophrenics are emotionally blunted and have lost the capacity to feel... schizophrenics have no recourse but to retreat into themselves, erecting a rigid wall around themselves for their own protection (p. 203).

Dr Browne further questions strongly the biological or genetic origin of schizophrenia.  He talks in general about all those patients who have failed to separate from their family of origin and who, although biologically adult, "are still functioning like children in the family setting and are incapable of managing their own lives.  These are the people who, when they break down, are said by psychiatrists to be suffering from a 'biological' mental illness and hence are not amenable to psychotherapy" (p. 320).   He has huge reservations with this orthodox contention.  In fact, he sees it as downright erroneous:

If we ask what is the causal relationship of genetics to schizophrenia, we are already biasing the results of our research.  The genetic influence may merely relate to the personality type, for example, a more sensitive or introverted type of person.  There may be no direct relationship to schizophrenia as such (p. 320-321).

Needless to say, in such a context, drug treatment will be wholly inadequate. Towards the end of this interesting and deeply humane memoir, Professor Browne maintains that schizophrenia is an invention of psychiatry:

...the full picture of schizophrenia is, to a considerable degree, iatrogenic, that is, partially created by the psychiatric intervention itself, establishing a pathway of illness behaviour extending over weeks and months, with heavy medication and institutionalisation.  Thus, the young person loses connection with ordinary living at a critical time and finds it difficult to reintegrate into society.  It is only then that the full picture of the illness we call schizophrenia supervenes (p. 327).

Post-Script: Use of Drugs to Treat Mental Disorders

• ·    As I was discussing the appropriateness of prescribing antipsychotic drugs above, recently here in Ireland, we have had an independent report published on the North Kerry Child and Adolescent Mental Health Services (CAMHS) that found there was a risk for potential harm in 209 cases of 374 reviewed.  The relevant aspect here that coincides with my interests in mental disorders is that among the issues identified was a high rate of prescribing anti-psychotic or neuroleptic medicines to adolescents on the ASD spectrum. Frequently used to manage behavioural symptoms rather than schizophrenia, these medications carry risks of severe adverse outcomes. The report also found a non-compliance with recommended physical health assessments and monitoring, and a low rate of individual or family psychotherapeutic intervention. More care, obviously, must be taken by the health services everywhere, in the HSE here in Ireland in particular, to see that there is proper governance and oversight of medical staff in the diagnosis of mental disorders in adolescents and especially in the prescription of antipsychotic drugs for those adolescents.

 

• ·       Psychotropic drugs are a broad, umbrella category of medications that affect the mind, mood, behaviour, and perception, including antidepressants, sedatives, and stimulants. Antipsychotics are a specific type of psychotropic medication primarily used to manage psychosis, such as hallucinations or delusions, in conditions like schizophrenia and bipolar disorder.