Looking beyond behaviour

Mental Health Nursing,  Jan 2006  

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Professor Marius Romme led the Mental Health Nurses Association annual professional conference with his keynote speech 'A cause related alternative for the harmful concept of Schizophrenia'

The main reason why the concept of schizophrenia is harmful, is because the concept itself makes it impossible to solve the patient's problems that lay at the root of becoming ill,' Professor Romme told delegates.

'We are mostly too much impressed by the behaviour and experiences, and we mostly don't look at the background. The concept of schizophrenia is based only on behaviour and experience, so you never get to where the problems are.'

He explained that schizophrenia had no scientific validity and that studies have proved that it is not an illness in itself. However, the troubling symptoms associated with the condition detract from this.

While it appears there are core symptoms of the condition, including hallucinations, delusions and negative symptoms, these vary with each individual patient and will have a separate cause.

Likewise, there is no particular outcome, it responds to no particular treatment, and has no particular cause. The people with the symptoms exist', said Professor Romme, 'but the illness does not exist.'

Therefore the aim was not to cure, but to help people with psychosis develop again.

They are inhibited by their psychosis because it is a very awful experience. You can learn from each psychotic episode not to fall back immediately. But that means that you have to have a counterweight and that is in fact your development.'

Professor Romme added that most people who recover from schizophrenia do so without psychiatric treatment which makes people angry, as the diagnosis doesn not contribute to solving the schizophrenic patient's problems. Similarly, they are demoralised by long-term, yet ultimately ineffective, medicine use, and by being told that they have to adapt their lives to the level of functioning permitted by the illness.

The schizophrenia concept is harmful even though the illness doesn't exist. If it doesn't exist in itself it isn't a problem but it naturally becomes a problem because it mystifies the patient's emotional and social problems. It makes it impossible to solve the patient's problems because you don't focus on them. A diagnosis of trauma induced psychosis should therefore be recognised because the separate symptoms are about 70 per cent connected with trauma experience in the life history.

'Mental health care should be oriented to learning to cope instead of suppression of the experience, analysing the causes, and learning to cope with the emotions, recovery and development of the person.'

Professor Romme concluded by saying it was not possible to change the mental health system, but added, 'what you can do is listen to your patients and look at what's happened in their lives. You have to convince the patient that psychosis doesn't drop from heaven, that the problem is rooted in their life experiences, although those life experiences are often very awful and they are often ashamed of these things.

'You have to build up a relationship in which you earn the trust to be told what has happened and then you can find out how to go about solving it. So you are not powerless, but you can't always stick to the system.'

Copyright Community Psychiatric Nurses Association Jan 2006
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