"Another element which further muddles the scene is the way in which the term 'schizo­phrenia' has come to be used, especially in the United States and Soviet Union.  Some professionals will label as 'schizophrenic' virtually anyone who looks cross-eyed or wears different color socks.  Labels like 'borderline schizophrenic,' 'latent schizo­phrenic, 'pseudo­neurotic schizophrenic' are used.  As such the term has become almost meaning­less and its demise, along with that of psychiatry itself, will be a welcome addition to the clarity of thought.  ...  The term 'schizophrenia' will wither away to the shelves of museums, looked back upon as an historical curiosity along with the crank telephone." — Psychiatrist E. Fuller Torrey, M.D., in his book The Death of Psychiatry (Penguin Books 1974, p. 160), before he began promoting the concept of schizo­phrenia

The word "schizophrenia" has a scien­tific sound that seems to give it inherent credibility and a charisma that seems to dazzle peo­ple. In his book Molecules of the Mind—The Brave New Science of Molecular Psychology, University of Maryland journalism profes­sor Jon Franklin calls schizo­phrenia and depres­sion "the two classic forms of mental illness" (Dell Publishing Co. 1987, p. 119).  According to the cover article in the July 6, 1992 Time maga­zine, schiz­ophrenia is the "most devilish of mental illness­es" (p. 53).  This Time magazine article says "fully a quarter of the na­tion's hospital beds are occupied by schizo­phrenia patients" (p. 55).  Books and articles like these and the facts to which they refer (such as a quarter of hospital beds being occupied by so-called schizo­phrenics) delude most people into believ­ing there really is a disease called schizo­phrenia.  Schizo­phrenia is one of the great myths of our time.
      In his book SchizophreniaThe Sacred Symbol of Psychiatry, psychiatry professor Thomas S. Szasz, M.D., says "There is, in short, no such thing as schizo­phrenia" (Syracuse University Press 1988, p. 191).  In the Epilogue of their book Schizophrenia—Medical Diagnosis or Moral Ver­dict?, Theodore R. Sarbin, Ph.D., a psy­cholo­gy pro­fessor at the University of Cali­fornia at Santa Cruz who spent three years working in mental hospitals, and James C. Mancuso, Ph.D., a psy­chology professor at the State University of New York at Albany, say: "We have come to the end of our journey.  Among other things, we have tried to establish that the schizo­phrenia model of unwant­ed con­duct lacks credi­bility.  The analy­sis directs us ineluctably to the conclu­sion that schizophre­nia is a myth" (Per­ga­mon Press 1980, p. 221).  In his book Against Thera­py, pub­lished in 1988, Jeffrey Masson, Ph.D., a psychoana­lyst, says "There is a height­ened awareness of the dangers inherent in label­ing somebody with a disease category like schiz­ophrenia, and many people are beginning to realize that there is no such entity" (Atheneum, p. 2).  In 2011, Richard P. Bentall, Professor of Clinical Psychology at the University of Bangor in Wales (UK), said "Nobody in the academic, I mean hardly anybody, in academic psy­chia­try believes in the concept of schizophrenia now.  It's pretty much on its way out.  ...  It is virtually useless.  It is like star signs." ("Is there value in a psychiatric diagnosis?", YouTube.com at 1:26).  In 2012 in his book Rethinking Madness (Sky's Edge, p. 17) psychologist Paris Williams, Ph.D., says "the diagnosis of schizophrenia is highly controversial.  Despite over a century of intensive research, no biolog­ical markers or physiological tests that can be used to diagnose schizophrenia have been found, its etiology continues to be uncertain, and we don't even have clear evidence that the concept of schizophrenia is a valid construct." Jim van Os, full professor and chair of the Department of Psychiatry and Psychology at Maastricht University Medical Centre in the Netherlands, states his conclusion in the title of his February 2, 2016 article in the British Medical Journal: "'Schizo­phrenia' does not exist" (see also ScienceDaily). He says "Japan and South Korea have already abandoned this term."
      Rather than being a bona‑fide disease, schizo­phrenia is a nonspecific term that designates almost anything and every­thing a human being can do, think, or feel that is greatly disliked by other people or by the so-called schizophrenics them­selves.  There are few so‑called mental illness­es that have not at one time or another been called schizo­phre­nia.  Because schizo­phre­nia is a term that covers just about every­thing a person can think or do which people greatly dislike, it is hard to define objec­tively.  Typically, defini­tions of schizo­phre­nia are vague or inconsis­tent with each other.  For exam­ple, when I asked a physician who was the Assistant Super­intendent of a state mental hospi­tal to define the term schiz­o­phrenia for me, he with all serious­ness replied "split per­son­ality—that's the most popu­lar definition."  In contrast, a pam­phlet pub­lished by the Nation­al Alliance for the Men­tally Ill titled "What Is Schizophrenia?" says "Schizo­phrenia is not a split personality".  In her book Schiz-o-phre-nia: Straight Talk for Family and Friends, published in 1985, Maryellen Walsh says "Schizophrenia is one of the most misun­derstood diseases on the planet.  Most people think that it means having a split person­ality.  Most people are wrong.  Schizo­phrenia is not a splitting of the personality into multiple parts" (Warner Books p. 41).  The American Psychiat­ric Asso­cia­tion's (APA's) Diagnostic and Statisti­cal Manual of Mental Disorders (Second Edi­tion), also known as DSM-II, pub­lished in 1968, defined schizo­phrenia as "charac­teristic distur­bances of think­ing, mood, or behav­ior" (p. 33).  A diffi­culty with such a defini­tion is it is so broad just about anything people dislike or consider abnor­mal, i.e., any so‑called mental illness, can fit within it.  In the Foreword to DSM-II, Ernest M. Gruenberg, M.D., D.P.H., Chairman of the American Psychiatric Associa­tion's Committee on Nomen­clature and Statistics, says "Con­sider, for example, the mental disorder labeled in the Manual as 'schizophre­nia,'  ... Even if it had tried, the Committee could not establish agree­ment about what this disorder is" (p. ix).  The third edition of the APA's Diagnostic and Statis­tical Manual of Mental Disorders, pub­lished in 1980, commonly called­ DSM‑III, is also quite candid about the vagueness of the term.  It says "The limits of the concept of Schizo­phrenia are un­clear" (p. 181).  The revi­sion pub­lished in 1987, DSM‑III‑R, con­tains a similar statement: "It should be noted that no single feature is invari­ably present or seen only in Schizo­phrenia" (p. 188).  DSM-III-R also says this about a related (so-called) diagnosis, Schizo­affective Disorder: "The term Schizoaffec­tive Disorder has been used in many different ways since it was first introduced as a subtype of Schizo­phrenia, and represents one of the most confusing and controversial concepts in psychiat­ric nosology" (p. 208).
      In the November 10, 1988 issue of Nature, genetic researcher Eric S. Lander of Harvard University and M.I.T. summarized the situation this way: "The late US Supreme Court Justice Potter Stewart declared in a celebrated obscenity case that, although he could not rigor­ously define pornogra­phy, 'I know it when I see it.'  Psychi­atrists are in much the same position concerning the diagnosis of schizophrenia.  Some 80 years after the term was coined to describe a devastat­ing condition involv­ing a mental split among the functions of thought, emotion and behaviour, there remains no univer­sally accepted definition of schizophre­nia" (p. 105).
      In his book Surviving Schizophrenia, published in 1988, psychiatrist E. Fuller Torrey, M.D., says so-called schizophre­nia includes several widely diver­gent person­ality types.  Included among them are paranoid schizophren­ics, who have "delu­sions and/or hallucinations" that are either "persecutory" or "grandi­ose"; hebe­phre­nic schizophrenics, in whom "well-devel­oped delu­sions are usually absent"; cataton­ic schizophren­ics who tend to be character­ized by "posturing, rigidity, stupor, and often mut­ism" or, in other words, sitting around in a motionless, nonreactive state (in contrast to paranoid schizophrenics who tend to be suspi­cious and jumpy); and simple schizophrenics, who exhibit a "loss of interest and initiative" like the catatonic schizophrenics (though not as severe) and unlike the paranoid schizo­phrenics have an "absence of delusions or hallucinations" (p. 77).  The 1968 edition of the American Psychi­atric Association's Diagnostic and Statisti­cal Manual of Mental Disorders, DSM-II, indi­cates a person who is very happy (experiences "pro­nounced elation") may be defined as schizo­phrenic for this reason ("Schiz­ophrenia, schizo-affective type, excited") or very unhappy ("Schizophrenia, schizo-affec­tive type, depressed")(p. 35), and the 1987 edition, DSM-III-R, indi­cates a person can be "diagnosed" as schizophrenic because he displays neither happi­ness nor sadness ("no signs of affective expres­sion", p. 189), which Dr. Torrey in his book calls simple schizophrenia ("blunting of emo­tions", p. 77).  According to psychiatry profes­sor Jonas Robitscher, J.D., M.D., in his book The Powers of Psychiatry, people who cycle back and forth be­tween happi­ness and sadness, the so-called manic-depressives or suffers of "bipolar mood disorder", may also be called schizo­phren­ic: "Many cases that are diagnosed as schizo­phrenia in the United States would be diagnosed as manic-depressive illness in England or West­ern Europe" (Houghton Mif­flin 1980, p. 165.)  So the supposed "symptoms" or defining charac­teristics of "schiz­o­phrenia", at least in the last half of the 20th Century, were broad indeed, defining people as having some kind of schizo­phrenia because they have delu­sions or do not, halluci­nate or do not, are jumpy or catatonic, are happy, sad, or neither happy nor sad, or cycling back and forth between happiness and sadness.  Since no physi­cal causes of "schiz­o­phre­nia" have been found, as I explain later in this essay, this "disease" can be defined only in terms of its "symp­toms", which as I have shown are what might be called ubiqui­tous.  As attorney Bruce Ennis said in 1972 in his book Prisoners of Psychiatry: "schizo­phrenia is such an all-inclusive term and covers such a large range of behavior that there are few people who could not, at one time or another, be con­sidered schizo­phrenic" (Harcourt Brace Jovan­ovich, Inc., p. 22).  People who are obsessed with certain thoughts or who feel compelled to per­form certain behav­iors, such as washing their hands repeatedly, are usually considered to be suffering from a psy­chiatric problem distinct from schizophrenia called "ob­ses­sive-compulsive disorder".  Howev­er, people with obses­sive thoughts or compulsive behaviors have also been called schizophrenic (e.g., by Dr. Torrey in his book Surviving Schizo­phrenia, pp. 115-116).
      Because mental illness, particularly serious mental illness, is thought by most people to have biological or chemical causes, and because schizophrenia is considered the worst of all supposed mental illnesses, what the various editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders say about physical, biological, or organic causes of schizophre­nia is ironic and revealing: The first page of the chapter titled "Schizo­phrenic Disorders" in the third edition, DSM-III (1980), says a diagnosis of schizo­phrenia is appropriate only if "The disturbance is not due to Affective Disorder or Organic Mental Dis­order" (p. 181).  DSM-III defines "Organic Mental Disorders" as follows: "The essential feature of all these [organic mental] disorders is a psychological or behavioral abnormality associated with transient or permanent dysfunction of the brain" (p. 101).  So by saying a diagnosis of schizophrenia is appropriate only if "The disturbance is not due to Affective Disorder or Organic Mental Disorder", DSM-III is defining schizophrenia as non-organic and as not caused by transient or permanent dysfunction of the brain. The next edition of this book, called the Third Edition-Revised (DSM-III-R), published in 1987, says a diag­nosis of schizophre­nia "is made only when it cannot be established that an organ­ic factor initiated and main­tained the distur­bance" (DSM-III-R, p. 187). Under­scoring this defini­tion of "schizo­phrenia" as non-organic, or non-biological, and hence non-medical, is the 1987 edition of The Merck Manual of Diagno­sis and Therapy, which says a (so-called) diag­no­sis of schizophre­nia is made only when the behavior in question is "not due to organic mental disorder" (p. 1532).
      Defining schizophrenia as being diagnosable "only when it cannot be established that an organ­ic factor initiated and main­tained the distur­bance" (DSM-III-R­­­) or as "not due to organic mental disorder" (Merck Manual of Diagnosis and Therapy, 1987) is inconsistent with the idea of schizophrenia as a disease, which creates difficulty justifying using drugs as a treatment for it, which is standard practice in psychiatry, including when the so-called schizophrenic refuses and must be forced to take supposedly antipsychotic drugs, either by threat of imprisonment in a mental hospital if he refuses, or with brute force by psychiatric personnel, typically by injection, if he refuses while "hospitalized", and sometimes with brute force by "Assisted" (Assaultive?) Community Treatment (ACT) teams who come to people's homes to administer injec­tions against the patient's will in his or her own home.  It may be for this reason DSM-IV, published in 1994, and DSM-IV-TR, published in 2000, do not include as short and easily quoted an exclusion for biologically caused conditions from the definition of schizophrenia as are found in DSM-III and DSM-III-R.  However, DSM-IV (1994) and DSM-IV-TR (2000) do in­clude the following ex­clu­­sion in the "Diagnostic criteria for Schizophrenia" (p. 286 in DSM-IV, p. 312 in DSM-IV-TR):

E.  Substance/general medical condition exclusion: The distur­bance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

One might wonder: What is a "general" medical condition? Suppose a person has a bacterial or viral infection of the brain causing en­ceph­alitis (swelling of the brain) or brain cancer or a stroke?  Would that be a "general" medical condition?  No, that would be a specific medical condition (or to be seman­tically more precise, a specific health or biological condition or dis­ease).  DSM-IV (p. 165) and DSM-IV-TR (p. 181) both say "The term general medical condition refers to conditions that are coded on Axis III and that are listed outside the 'Mental Disorders' chapter of ICD.  (See Appendix G for a condensed list of these conditions.)" ICD stands for International Classification of Diseases published by the World Health Organ­ization.  Appendix G of DSM-IV and DSM-IV-TR lists probably every physical disease or biological problem known to occur in humans: Diseases of the Nervous System (e.g., Epilepsy, brain hemorrhage), Diseases of the Circulatory System, Diseases of the Respiratory System, Neoplasms (cancer, including of the brain), Endocrine Diseases, Nutritional Diseases, Metabolic Diseases, Diseases of the Digestive System, Genitourinary System Diseases, Histological Diseases, Diseases of the Eye, Diseases of the Ear, Nose, and Throat, Musculoskeletal System Diseases and Connective Tissue Diseases, Diseases of the Skin, Congenital Malformation, Deformations, and Chromosomal Abnormalities, Diseases of Pregnancy, Childbirth, and the Puerperium, Infectious Diseases, and Overdose (naming various types of drugs including Hormones and Synthetic Substitutes).  In other words, a careful reading of DSM-IV and DSM-IV-TR shows these editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders do acknowledge that if it is biologically caused, it is not schizophreniaDSM-IV-TR (p. 305) also says "No laboratory findings have been identified that are diagnostic of schizophrenia."
      This "diagnostic" (actually descriptive) criterion for schizophrenia in DSM-5 might or might not be read as indicating schizophrenia is a medical or biological condition. So for clarification I sent the following e-mail to the American Psychiatric Association and its DSM-5 Task Force (apa@psych.org and dsm5@psych.org):

July 18, 2014

To the American Psychiatric Association or the DSM-5 Task Force:

Diagnostic Criteria "E" for schizophrenia in DSM-5 (p. 99) is this:

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medi­cation) or another medical condition.

This can be understood as meaning either—

The disturbance is not attributable to a medical (bio­logical) condition, examples being the physiological effects of a drug of abuse or a medication


The disturbance is not attributable to a medical condition other than schizophrenia, e.g., a substance such as a drug of abuse or a medication.

The former interpretation indicates schizophrenia is not caused by a medical (biological) condition. The latter indicates schizophrenia is a medical (biological) condition. Which is correct?

If the latter is correct, what is the biological (medical) criteria for determining a person has schizophrenia? Page 102 of DSM-5 discusses differences in the brains of people with schizophrenia such as "Reduced overall brain volume", but on the preceding page (page 101) says "Currently, there are no radiological, laboratory, or psychometric tests for the disorder [schizophrenia]." All of the Diagnostic Criteria (on page 99) are behavioral rather than biological.

Wayne Ramsay

Perhaps not surprisingly, I received no reply.  Psychiatrists cannot admit schizophrenia is not a biological condition without admitting the invalidity of the concept of schizophrenia, which is arguably psy­chiatry's most well-known and most classic supposed mental illness, or what Dr. Szasz calls "the sacred symbol of psychiatry."  At the same time, psychiatrists cannot claim schizophrenia is a medical or biological condition without providing medical or biological criteria, which they cannot do, because nothing of a biological or medical nature can be found to define exactly what is meant by the term "schiz­o­phrenia".
      As I document in Psychiatric Drugs—Cure or Quackery? and Psychiatry's Electroconvulsive Shock Treatment—A Crime Against Humanity, the "reduced overall brain volume" and other changes found in the brains in people said to have schizophrenia (or other supposed mental illnesses) are caused by the drugs or electric shock they are given, not their supposed psychiatric disorder or disease.
      The non-biological nature of schizophrenia is indirectly admitted in DSM-5 by the fact that none of the criteria for a "diagnosis" of schizophrenia in DSM-5 are organic, biological, medical, or physical in nature.  As I said in the above e-mail to the APA and discuss later in this essay, all "Diagnostic Criteria" for schizophrenia in DSM‑5 (they appear on page 99 of DSM‑5) are what a person thinks or perceives or how he behaves, and for how long.  Nothing in the DSM‑5 definition of schizophrenia is physical or biological.  Similar to previous editions of the DSM, there are no tests of blood or cerebrospinal fluid, no imaging tests, no physical signs, nor anything else of a physical or biological nature that are "diagnostic" for schizophrenia in DSM-5.
      Since schizophrenia is by definition non-organic, at least if one accepts the American Psychiatric Association's definitions and "diagnostic" criteria in the various editions of the DSM, the treatment of schizophrenia with drugs reveals illogical thinking by people who prescribe drugs as treatment for schizophrenia.  Giving up "medicine" as a treatment for psychiatry's most famous and well-known "disease" might threaten psychiatrists' identity as doctors of medicine.  I believe this is an important reason why psychiatrists continue to prescribe "medication" for "schizophrenia" and other supposed mental illnesses despite the lack of evidence any supposed mental illness is a biological condition, as well as why many psychiatrists continue to insist schizo­phrenia and other supposed mental illnesses are caused by brain disease despite the non-organic and non-medical definition schizo­phrenia in the various editions of the DSM and the inability to find anything of a biological nature causing any so-called mental illness.
      An example is psychi­atrist E. Fuller Torrey, M.D., in his book Sur­viving Schizophre­nia: A Family Manual, pub­lished in 1988 when DSM-III-R was still current.  You will recall DSM-III-R said schizophrenia may be diagnosed "only when it cannot be established that an organ­ic factor initiated and main­tained the distur­bance" (DSM-III-R, p. 187). In Surviving Schizophrenia, Dr. Torrey says "Schizophre­nia is a brain dis­ease, now definitely known to be such" (Harper & Row, p. 5).  But if schizophre­nia is a brain dis­ease, it is organic.  In Surviving Schizo­phrenia, Dr. Torrey acknowledges "the prevailing psychoanalytic and family interac­tion theories of schizophrenia which were prevalent in American psychiatry", which would seem to explain the definition of schizophrenia as non-organic and not biologically caused in DSM-III (1980), DSM-III-R (1987), DSM-IV (1994), and DSM-IV-TR (2000) and at least implicitly in DSM‑5 (2013).
      Today, schizophrenia is usually thought of as a type of psychosis, and non-psychotic schizophrenia would be thought by most mental health professionals an oxymoron, like a "correct error".  For example, the Handbook of Clinical Psychopharmacology for Therapists, Sixth Edition, by psychology professor John D. Preston, Psy.D., psychiatrist John H. O'Neal, M.D., and pharmacist Mary C. Talaga, R.Ph., Ph.D. (New Harbinger Publications, Inc. 2010, p. 125), says "Schizophrenia refers to a disorder of longer than six months duration with prominent psychotic symptoms."  In his book The Great Psychiatry Scam—One Shrink's Per­sonal Journey (Manitou Communications 2008, p. 243), psychiatrist Colin A. Ross, M.D., says "Schizophrenia is a psychosis."  In contrast, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM-II, 1968) includes the diagnosis "295.06 Schizophrenia, simple type, not psychotic" (p. 23).  In his book Schizophrenia—Your Questions Answered, Trevor Turner, MBBS, MD, FRCPsych, Consultant Psychiatrist at Homerton Hospital and St. Martholomew's Hospital in London, says "What is 'simple' schizophrenia? This is an uncommon type of schizophrenia in which there is apparently no evidence of delusions, hallucinations or other obviously psychotic features" (Churchill Livingstone 2003, p. 15).  DSM-IV-TR, which was the most recent and current DSM prior to the publication of DSM-5 on May 22, 2013, on the first page of the chapter titled "Schizo­phrenia and Other Psychotic Disorders", says this (p. 297):
Despite the fact that these disorders are grouped together in this chapter, it should be understood that psychotic symptoms are not necessarily considered to be core or fundamental features of these disorders ...  In fact, a number of studies suggest closer etiological associations between Schizophrenia and other disorders that, by definition, do not present with psychotic symptoms (e.g., Schizotypal Personality Disorder).

The quoted statement appears below and on the same page as the chapter title: "Schizophrenia and Other Psychotic Disorders".  A layman definition of "schizophrenic" found in some diction­aries is internally inconsistent or containing contradictory characteristics or qualities.  For example, the second of two definitions in the Shorter Oxford English Dictionary on Historical Principles, Fifth edition (Oxford University Press 2002, p. 2694) of "schizophrenic" is "Char­acter­­ized by mutually contradictory or inconsistent elements, attitudes, etc."  By this lay or colloquial definition of schizo­phrenia, the American Psychiatric Association's definition of schizo­phrenia in DSM-IV-TR is itself schizo­phrenic.
      So is schizophrenia a type of psychosis, or is it not?  The answer is nobody knows.
      Reading the "Diagnostic Criteria" for schizophrenia in DSM-IV, DSM-IV-TR, and DSM-5 reveals how arbitrary and convoluted those supposedly diagnostic criteria are.  The "diagnostic" (actually descrip­tive) criteria for schizophrenia in DSM-5 (p. 99) make delusions or halluci­nations unnecessary (yes, not necessary) for the "diagnosis", because a person can qualify for a diagnosis of schizophrenia by having "Disorganized speech (e.g., frequent derailment or inco­herence)" without either delusions or hallucinations.  A person can have delusions or halluci­nations (not caused by a substance such as a drug of abuse or a medication) yet still not qualify for a diagnosis of schizophrenia, because under Criteria B the following is also necessary: "For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, inter­personal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is a failure to achieve expected level of inter­personal, academic, or occupational functioning.)"  Additionally, under Criteria C the "disturbance" must "persist for at least 6 months".  So even if you are seeing huge pink elephants marching through your bedroom (and there really aren't any), you don't meet all the criteria for a "diagnosis" of schizophrenia if your hallucination about huge pink elephants is your only problem, and you are nevertheless doing great in the impor­tant aspects of life such as work and personal relation­ships and self-care, or you meet all the criteria except for the fact that you do so for only 5 months.
      In Surviving Schizophrenia, Dr. Torrey quite candidly concedes the impossibility of defin­ing what "schizophrenia" is.  He says-
The defini­tions of most diseases of mankind has been accom­plished. ... In almost all diseases there is something which can be seen or measured, and this can be used to define the disease and sepa­rate it from nondisease states.  Not so with schizo­phrenia!  To date we have no single thing which can be mea­sured and from which we can then say: Yes, that is schizophrenia.  Because of this, the definition of the disease is a source of great confusion and debate. [p. 73]

What puzzles me is how to reconcile this statement of Dr. Torrey's with another he makes in the same book, which I quoted above and which appears more fully as follows: "Schizophrenia is a brain disease, now definitely known to be such.  It is a real scientific and biolog­ical entity, as clearly as diabetes, multiple sclerosis, and cancer are scientific and biological entities" (p. 5).  How can it be known schizophrenia is a brain disease when we there are so many definitions of schizophrenia and (as I describe later in this essay) research can find nothing wrong with bodies including brains of people who supposedly have schizophrenia?
      Throughout the just over 100 years we've had the term schizophrenia, calling something schizophrenia, like calling something pornography or mental illness, has indicated disapproval of that to which the term is applied and nothing more.  Like "mental illness" or pornogra­phy, "schizophrenia" does not exist in the sense that cancer and heart disease exist but exists only in the sense that good and bad exist. As with all other so‑called mental illness­es or disorders, a "diagnosis" of "schizo­phrenia" is a reflection of the speaker's or "diag­nos­tician's" values or ideas about how a person "should" be, often coupled with the false (or at least unproved) assump­tion that the disap­proved thinking, emo­tions, or behavior is caused by a biological abnor­mality. Consider­ing the many ways it has been used, it's clear "schizo­phrenia" throughout most of the years people have used the term has had no generally agreed upon meaning other than "I dislike it."  In DSM‑5 as in previous editions of the DSM, simply disliking the way a person talks or acts or lives is a large part of the definition.  Be­cause of this, and because of the lack of anything biological or physical in the diagnostic criteria for schizophrenia in any of the various versions of the DSM, and because of the failure of research to uncover any bio­logical causes of supposed schizophrenia, I lose respect for mental health profession­als when I hear them use the word schizophrenia in a way that indicates they think it is a real disease.  I do this for the same reason I would lose respect for someone's percep­tiveness and intellectual integrity after hearing him or her admire the emperor's new clothes.  While the layman definition of schiz­o­phrenia, internally inconsis­tent, may make sense in some situations, using the term "schiz­ophre­nia" in a way that indicates the speaker thinks it is a real disease is tantamount to admit­ting he doesn't know what he is talking about.




      Many mental health "professionals" and other "scientific" researchers do however persist in believing "schizophrenia" is a real disease despite the non-organic, non-biological diagnostic criteria in the various editions of the DSM.  Influenced by those who came before them, they are like the crowds of people observing the emperor's new clothes in Hans Christian Andersen's short story, unable or unwilling to see the truth because so many others before them have said schizophrenia is real.  A glance through the articles listed under "Schizophrenia" in Index Medicus, an index of medical periodicals, or an Internet search, reveals how widespread the schizophrenia myth has become.  Because these misguided "scien­tists" believe "schizo­phrenia" is a real disease, they try to find physi­cal causes for it.  As psychiatrist William Glas­ser, M.D., says in his book Positive Addiction, published in 1976: "Schiz­ophrenia sounds so much like a disease that promi­nent scientists delude themselves into searching for its cure" (Harper & Row, p. 18).  This is a silly endeav­or, because questions about the defini­tion of schiz­o­phrenia remain unresolved, such as whether schizophrenia is biologically caused, and whether schizophrenia necessarily involves hallucinations or delusions.  Because of the absence of a clear and generally agreed upon definition of schizophrenia, these supposedly prominent scientists are searching for the cause of a problem they can't define—or put another way, they don't know what they are looking for.




      According to three Stanford University psychia­try professors, "two hypotheses have domi­nated the search for a biological substrate of schizo­phre­nia."  They say these two theories are the trans­methylation hypothesis of schizo­phrenia and the dopamine hypothesis of schizo­phrenia (Jack D. Barchas, M.D., et al., "Biogenic Amine Hy­poth­esis of Schizophrenia", appearing in Psycho­phar­macolo­gy: From Theory to Practice, Oxford University Press 1977, p. 100.)  The trans­methyla­tion hypoth­esis was based on the idea that "schizo­phrenia" might be caused by "aberrant formation of methyl­ated amines" similar to the hallucino­genic pleasure drug mescaline in the metabolism of so-called schizo­phrenics.  After reviewing various attempts to verify this theory, they conclude: "More than two decades after the intro­duction of the trans­methyla­tion hypothesis, no conclusions can be drawn about its relevance to or involvement in schizophrenia" (p. 107).
      Columbia University psychiatry professor Jerrold S. Maxmen, M.D., succinctly describes what is, or until recently was, the most widespread biological theory of so-called schizo­phre­nia, the dopamine hypothesis, in his book The New Psychiatry, pub­lished in 1985: "...many psychia­trists believe that schizophrenia involves excessive activity in the dopamine-receptor sys­tem...the schizo­phrenic's symptoms result partially from receptors being over­whelmed by dopamine" (Men­tor, pp. 142 & 154).  But in the article by three Stanford University psychiatry profes­sors I referred to above they say "direct confir­mation that dopa­mine is involved in schizo­phre­nia continues to elude investigators" (p. 112).  In 1987 in his book Mole­cules of the Mind Profes­sor Jon Franklin concluded "The dopamine hypothesis, in short, was wrong" (p. 114).
      The opposite theory also been proposed, namely that "schizophrenia" is caused by low levels of dopamine in the brain (Guy Chouinard, M.D. and Barry D. Jones, M.D., "Evidence of Brain Dopamine Deficiency in Schizophrenia", Canadian Journal of Psychiatry, November 1979, Vol. 24, p. 661).
      In the words of psychologist Bruce E. Levine, Ph.D., in a book published in 2007, "Not too long ago, psychiatrists were convinced that certain psychoses, especially schizophrenia, were caused by too much of the neurotransmitter dopamine.  Today, psychiatry admits that most people diagnosed with schizophrenia have no evidence of increased dopamine, and some actually have reduced levels of dopamine" (Surviving America's Depression Epidemic, Chelsea Green Publishing Co., p. 104).
      In Molecules of the Mind, Professor Franklin aptly describes efforts to find other biological causes of so-called schizo­phrenia:

As always, schizo­phrenia was the index disease.  During the 1940s and 1950s, hundreds of scientists occupied them­selves at one time and another with testing samples of schizo­phrenics' bodily reactions and fluids.  They tested skin conductivity, cultured skin cells, ana­lyzed blood, saliva, and sweat, and stared reflec­tively into test tubes of schizo­phrenic urine.  The result of all this was a continuing series of announ­cements that this or that differ­ence had been found.  One early researcher, for instance, claimed to have isolated a substance from the urine of schizophren­ics that made spiders weave cockeyed webs.  An­other group thought that the blood of schizo­phrenics con­tained a faulty metab­o­lite of adrenaline that caused hallucinations.  Still another proposed that the disease was caused by a vitamin deficiency.  Such developments made great newspaper sto­ries, which general­ly hinted, or predicted out­right, that the enigma of schizo­phrenia had finally been solved.  Unfortun­ately, in light of close scrutiny none of the discoveries held water. [p. 172]

      Other efforts to prove a biological basis for so-called schizo­phrenia have involved brain-scans comparing normal people with people considered schizophrenic.  These efforts have been a dismal failure, because there is so much variation among normal people that it is impossible to determine from a brain scan whether a person is schiz­o­phrenic.  According to psychologist Al Siebert, Ph.D., "A few individuals diagnosed with schizophrenia show certain brain abnor­malities, but the brain scans of most people diagnosed with a schizophrenia fall within normal ranges" ("Unethical Psychiatrists Misrepresent What is Known About Schizophrenia", antipsychiatry .org/siebert.htm, accessed July 19, 2013).  Sometimes differences are found when comparing brain scans of identical twins when only one is a sup­posed schizo­phrenic, but the flaw in most of these studies is the so-called schiz­ophren­ic has been given brain-damag­ing drugs called neuroleptics as a so-called treatment for his so-called schizophre­nia.  Anyone "treated" with these drugs will have the brain damage researchers falsely attribute to schizophrenia.  Damag­ing the brains of people eccen­tric, obnox­ious, imaginative, or mental­ly dis­abled enough to be called schizo­phrenic with drugs (erroneously) believed to have anti­schizo­phrenic proper­ties is one of the saddest and most indefensible conse­quences of today's widespread belief in the myth of schizo­phrenia.
      Brain-imaging studies of supposed schizophrenics who have never taken or been admin­istered neuroleptics or other neurologically damaging drugs are equally invalid.   Psychiatrist E. Fuller Torrey, M.D., in a book in 1997 in which he tries to prove schizophrenia is a brain disease, and coauthors, acknowledge brain scans are completely useless for diagnosing schizo­phrenia in people who do not have an identical twin, because variation between normal indi­viduals is great enough differences thought to indicate schizophrenia "only become evident when an identical twin control is available for purposes of comparison" (Schizophrenia and Manic-Depressive Disorder, Basic Books 1997, p. 114).  They also acknowledge brain scans cannot be used to diagnose "schizophrenia" even in people who have an identical twin, because when comparing the brain scans of identical twins, only one of whom is thought schizophrenic, some­times the normal twin's brain scan looks schizophrenic to researchers, and the supposedly schiz­ophrenic's brain scan looks normal (see, for example, Id., pp. 107 & 114).
      According to Christoff Koch, Ph.D., Professor of Cognitive & Behavioral Biology at California Institute of Technology (Caltech) and Chief Scientific Officer at the Allen Institute for Brain Science in Seattle, Washington, where he studies human brains using high-resolution magnetic resonance imaging (MRI), "We can't tell a schizophrenic brain from an autistic brain from a normal brain" (quoted in Carl Zimmer, "Secrets of the Brain", National Geographic, February 2014, p. 28 at 56).  Similarly, in 2012 psychiatrist Daniel Carlat, M.D., said "As far as the MRI question, mostly that's charlatanism.  ...  I felt that they were, basically they were, the information that you could derive from such scans, was valueless" ("Daniel Carlat—Un­hinged: The Trouble With Psychi­atry", YouTube.com, up­load­ed September 11, 2012, at 47:31).  In their book Brainwashed—The Seductive Appeal of Mindless Neuro­science (Basic Books 2013, pp. 23-24), psychiatrist and Yale University School of Medicine lecturer Sally Satel, M.D., and Emory University psychology professor Scott O. Lilienfeld, Ph.D., say there is "near-universal agree­ment among psychiatrists and psychologists that [brain] scans cannot presently be used to diagnose mental illness" and that "The failure of brain-imaging techniques to have made major inroads into the causes and treatment of mental illness" shows those who say brain-scans can be used in these ways are "pulling off little more than a brain scam."  They say "In our view, the potential for functional brain imaging to mislead currently exceeds its capacity to inform" (Id. p. 121) and "Taken together, MRIs and CT [computerized tomography] scans provide valuable information about fixed anatomy but leave us largely in the dark about the brain's functioning" (Id., p. 4).  They suggest contrary claims are "21st-century phrenology" (Id., p. 3).




      Belief in biological causes of so-called mental illness, in­clud­ing schizophrenia, comes not from science but from wishful thinking or from desire to avoid coming to terms with the exper­ien­tial or environmental causes of people's misbehavior or distress.  The American Psychi­atric Associa­tion's defini­tion of schizo­phrenia as non-organ­ic or non-medical in DSM-III, DSM-III‑R, DSM-IV, and DSM-IV-TR, and the failure to delineate a biological cause for schizophrenia or even an association between schizophrenia and anything of a biological nature in DSM-5, and the repeated and consistently unsuccessful efforts to find a biologi­cal cause of so-called schizo­phre­nia, suggest "schiz­o­phrenia" belongs only in the category of socially/culturally unacceptable thinking or behav­ior rather than in the category of biolo­gy or "dis­ease" where many people place it.

Recommended Reading

Theodore R. Sarbin, Ph.D., "Schizophrenia Is a Myth, Born of Metaphor, Meaningless", Psychology Today, June 1972, p. 18.

Thomas S. Szasz, M.D., Schizo­phrenia—The Sacred Symbol of Psychiatry (Syracuse University Press 1988)", especially Chapter 3, "Schizo­phrenia: Psychiatric Syndrome or Scientific Scandal?"

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The author is a volunteer (pro bono) attorney for the Law Project for Psychiatric Rights (psychrights.org) and may be reached at wayneramsay (at) mail (dot) com

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