Calling Schizophrenia a Brain Disorder doesn’t Give Primacy to the Biomedical Model

In this essay, I want to argue that we should refer to psychotic disorders as brain disorders, but that doing this doesn’t mean giving primacy to the biomedical view versus the biopsychosocial view.

In keeping with some of my previous thoughts, let’s assume you get a broken leg. Furthermore, let’s assume that your broken leg is due to a social ill—someone assaulted you.

You go to the doctor. You get a cast, but, in addition, as you heal, you may need physical therapy in order to heal better in your leg.

Seeing a broken leg as a medical issue doesn’t mean you won’t need treatments other than having a cast, and using crutches until you heal.

In fact, this may be yet one more trauma in your life that you don’t need.

Now imagine that, years down the road, you become psychotic. Imagine further that this is because you have experienced hardship, childhood abuse, and trauma, including being assaulted by someone who broke your leg, years back.

You are taken to the hospital. The psychiatrists there see you as a brain patient. They try to treat your brain by giving you antipsychotics.

But, in addition, you are assigned a treatment team that includes social workers, case managers and counselors.

Seeing psychosis as a brain issue doesn’t mean you won’t need other treatments, like counseling. And, further, your society may need some treatments of its own, if it produces people who traumatize and torments people, and produces social injustice.

Calling psychosis a brain illness doesn’t negate other biopsychosocial causes or cures, just as thinking of a broken leg as a medical issue doesn’t negate the fact that you have been assaulted, and may need counseling, or physical therapy. In other words, calling schizophrenia a brain disorder doesn’t commit us to the biomedical model over the biopsychosocial model.

Broken Bones and Psychosis: Psychosocial Causes and Testability

Imagine that you get assaulted. You are kicked in the leg and it is broken. You go to the hospital. Your leg is x-rayed, and casted. You are given crutches, and asked if you want to press charges.

That’s the way it normally goes, I assume, when you are assaulted and get a broken leg.

No one says you aren’t really hurt, even though your broken leg was caused by a social ill—a bad person assaulting you.

Now imagine you have a psychotic break. Your symptoms cause your family to call the police so you can be taken to a hospital. At the hospital, your blood is taken, you are given a CAT scan, and are, after a while, diagnosed with schizophrenia.

The tests in involved—taking blood, and CAT scan—don’t reveal anything. They are done in order to rule out other things. You are given an antipsychotic, and released from the hospital after seven days, when the doctors see that your medication seems to be working.

At home, you peruse the literature, and find that some people think your illness is not real the way a broken leg is real—because your illness, they think, has psychosocial causes. Perhaps you experienced a lot of adversity, or trauma as a child. These are things correlated with experiencing psychosis.

Not everyone who gets kicked in the leg will get a broken leg. That depends on a lot of things—where you were kicked, how hard you were kicked, if you were kicked repeatedly, and if your bones were prone to breaking.

Not everyone who experiences adversity or trauma will experience psychosis, either.

Both of these things can be caused by social illness, and social ills in combination with your makeup. If you have especially brittle bones, and some bad guy kicks you, you are probably more likely to get a broken leg. Likewise, if you “are prone to” (we don’t know what that means, but let’s not assume it means you are less “hardy”) psychosis and experience trauma, you are more likely to develop schizophrenia.

But no one says you aren’t *really* hurt when you get a broken leg this way.

Unfortunately, they do say this when you become psychotic.

There is no test, they say, for schizophrenia.

True, the biomedical markers for schizophrenia are not testable in most hospitals. They can’t, for every patient, check for chemical imbalances. Instead, they rule things out, try a medication, and see if that medication (in my case, regulating dopamine) works to restore health.

Not long ago, before the x-ray, they couldn’t *see* a broken bone, either. They had to do similar things in order to diagnose and treat a broken bone. The patient would, I assume, report symptoms and people could observe symptoms. That doesn’t mean broken legs weren’t real problems before the x-ray, just like it doesn’t mean psychosis isn’t real just because not everyone has access to MRIs.

Just because something may have a psychosocial cause, or can’t currently be directly apprehended in the hospital doesn’t make it less real.

Psychosocial Causes, and ‘The Real’

The tendency has always been strong to believe that whatever has a name must be an entity or being, having an independent existence of its own. And if no entity answering to the name could be found, men did not for that reason suppose that none existed, but imagined that it was something peculiarly abstruse and mysterious. –JS Mill

I just read a psychosocial report on psychosis. While I agree with looking at psychosocial causes of psychosis, the report states that psychosis is not real the way a broken bone is real. That there are no medical tests, like an x-ray, that can help us diagnose psychosis.

I think, when thinking about the ‘mental’ or ‘psychological’, people get mystified by it. That’s one reason why I decided to refer to schizophrenia as a brain disorder. The fact is, in many people who experience psychosis, there *are* biological differences. There is, according to many studies, excessive pruning of neurons in the brain. There is, moreover, often chemical differences, which is why regulating dopamine in my brain is helpful to me.

However, that doesn’t mean psychosocial causes aren’t important. I’m a believer that they can be causes just like, if someone kicks you in the leg, you may get a broken leg. Not everyone who gets kicked in the leg will experience a broken leg, but some will. There are a lot of factors at play, such as how hard they kicked you, if you were kicked more than once, and how vulnerable your leg is to being broken. And when we look at data, we will find that people who got kicked in the leg will show up more to the hospital with a broken leg, just like we find that people who, eg, experience childhood trauma will more often later show up with psychosis.

So we think of a broken leg as a medical problem with the leg, and I (at least) think of psychosis as a disorder of the brain. This, even though abuse may be the cause of both of them.