The Dialectics of Schizophrenia

Philip Thomas

reviewed by Mira de Vries

Published in 1997, this is apparently Thomas’s first book, although he has publications in professional journals to his name. Perhaps because of his being a less prolific writer than some of his colleagues, his name is not yet known to us. He definitely deserves a place among the heroes of our movement.

A major theme in Thomas’s book is the culture gap. In the introduction he describes an inner-city environment that many of us will recognize, though the accents may differ (Thomas works in Great Britain): poverty, homelessness, discrimination, disaffection. He poignantly portrays the contrast with the environment from which the doctor comes: wealth, comfort, privilege, and arrogance. Early in his career it became clear to Thomas that the job he was expected to do was not to treat people but to dispose of them.

Contrary to other writers in the field, Thomas does not advocate discarding the term “schizophrenia” altogether. He sees the “positive symptoms” as occurring in non-psychiatrized people as well and not necessarily a deviation from the normal. The term “schizophrenia” to him should be reserved for those people who present negative symptoms such as paucity of speech and shallow emotions (I assume he means before being drugged as he recognizes these characteristics as also being caused by the drugs) and for which according to him a plausible neurological explanation exists (what is it?). I could not discern what the difference is between Thomas’s “narrow definition of schizophrenia” and autism, and wonder why we would need two separate terms. Indeed, at one time in history the two were the same. Yet throughout his book Thomas uses the term schizophrenia apparently in the meaning of “labeled schizophrenic.”

Epidemiological studies of schizophrenia prove only one thing: that it is endemic to the disadvantaged classes, says Thomas. He correlates biopsychiatric theories – locating the cause of disease in the individual’s brain chemistry or genes rather than in society – with political focus on individual responsibility as opposed to community responsibility. I do not agree with the political conclusions he draws but they will surely please the socialists among us.

Thomas relates an anecdote which illustrates what a special person he is in attempting to bridge the gap between himself and his patients. As part of an experiment conducted by him and his colleague David Healy (writer of “The Creation of Psychopharmacology”), he ingested 5 mg haloperidol. That’s not the same as being injected with high doses for many years, but apparently it was enough for Thomas to get the point. By the end of that chapter he and Healy characterize the relationship between psychiatrist and patient as that which exists between abuser and victim.

Hearing voices fascinates Thomas. He has not experienced them himself, but goes to quite some length exploring their possible meaning in terms of “inner language.” Here his thoughts remind me of Oliver Sacks’s book “Seeing Voices” about language development in deaf people. As I have also not experienced hearing voices, I’m not in a position to evaluate Thomas’s theories. However, I whole-heartedly agree with his endorsement of peer support rather than professional paternalism. In fact, Thomas feels that “patients” have more to teach psychiatrists than medicine. True, but then what is the point of the profession of psychiatry?

I’ll end with a final anecdote. One of Thomas’s patients, a woman who self-mutilated, invited him to act with her in a play. Thomas accepted (for which he terminated his professional relationship with her). You will surely agree with me that Thomas is a rare doctor who is capable of shrugging off arrogance and sees his patients as human beings like himself.

In spite of a few flaws, “The Dialectics of Schizophrenia” is a book that cries out to be recognized by our movement.

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