Schizophrenia is the biggest known mental illness. It is a fairly recent diagnostic illness; it was first adequately described clinically in 1809. It was not actually given a name until 1911 by Bleuler who consequently called it schizophrenia. However, it is hard to imagine that schizophrenia, which is such a striking illness, could appear up from nowhere less than 200 years ago. Yet it does occur, for instance AIDS is a new disease that has suddenly appeared. Schizophrenia is essentially a disorder with psychotic symptoms such as delusions and hallucinations. There is evidence to suggest that schizophrenia is in fact a hereditary illness. Studies show that if you have a relative with schizophrenia you are ten times more likely to develop it yourself (Gottesman and Shields, 1972). There are even suggestions that the dopamine level is higher for those who are schizophrenic (Snyder, 1975). There has been extensive research into the genetic and neurological explanations of schizophrenia that in cannot be dismissed; there is just too much evidence. As a result schizophrenia cannot conceivable be socially constructed it really does exist beyond doubt.
Of course there have been studies looking at the possible social triggers of schizophrenia. For instance there is the belief from the behaviourist point of view that schizophrenia is due to operant conditioning. With lack of appropriate reinforcers or presence of inappropriate ones the child may not learn how to respond to social stimuli. They may therefore start to attend to stimuli such as inanimate objects. Once this behaviour is developed it will be reinforced by the attention gained from other people. Other social triggers could be from family life, for instance marital schism. A child becomes confused when their parents compete for their attention. This confusion could lead the child to withdraw into a schizophrenic world. These do not suggest that schizophrenia is a socially constructed they just try to explain what may cause it’s onset from a social point of view. Social explanations recognise it is an illness but feel that society has caused it rather than merely created it in a socially constructed sense. The diathesis-stress model assumes there is a predisposition to something like schizophrenia, which is usually assumed to be genetic, and onset of it is precipitated by environmental stress. Therefore it suggests that both nature and nurture has an input. Yet some people do believe that schizophrenia is a creation of society, a product of norms and expectations and therefore will vary from society to society. However, this claim is not supported by cross-cultural findings. Most societies have been found to have a label for something that approximates to schizophrenia in Western cultures.
Therefore, what can be established from this is that schizophrenia itself is not socially constructed but the label for it. It’s understandings of what it constitutes and what schizophrenia really is is what has been constructed by the different societies. Even the understandings of schizophrenia have changed through time that has affected treatments throughout the years. Although schizophrenia was first identified clinically less than 200 years ago there is possible evidence that schizophrenia may have in fact existed throughout many centuries. For example, in the early 20th century psychologists started to study historical figures for symptoms of psychosis. As a result there have bee suggestions that Jesus was in fact schizophrenic, having delusions of grandeur, believing to be the Son of God, (Schweitzer, 1913). Yet what is different in this case is not the possibility of the existence of this illness but the view that society held of it. Jesus was not seen as mad or delusional by the people but rather a prophet of sorts. This clearly shows how society’s attitudes to the ‘abnormal’ displays of behaviour have changed throughout time. What has become acceptable by society has been socially constructed over time.
What have also been socially constructed throughout the years are the cultural definitions of schizophrenia. Schizophrenic symptoms are described similarly between the UK and USA. There are six described forms of schizophrenia. There is the disorganised type, difficulty to think coherently often leading to inappropriate behaviour. There is the catatonic type, a psychomotor disorder. There is the paranoid type, they have organised systems of delusions and hallucinations. You also get an undifferentiated type; this is for people who do not fit into the other categories neatly. As can be expected this category has been abused by psychiatrists and can lead to misdiagnosis and over diagnosis of schizophrenia. However, the DSM IV has a completely different category that does not feature in the ICD. This is the residual type, this is for when the more extreme symptoms are under control but the person still displays some inappropriate behaviour and thought patterns. The ICD however, also have a different category with which the USA does not recognise as a form of schizophrenia. This is the Simple schizophrenic; this is a gradual withdrawal, idleness. There is a loss of motivation in the person; such people may become “drop outs”, homeless or drifters. This clearly demonstrates the social difference between countries on what constitutes schizophrenia. Be that as it may more people in the USA are treated for schizophrenic symptoms are some point in their life. Therefore, the more socially accepted behaviour differs between countries and societies supporting the idea that the definition of schizophrenia is scoailly constructed.
Other findings show that in fact there may some ethnic origins of schizophrenia. In Britain you are between three and six times more likely to be a diagnosed schizophrenic if you are from the African-Caribbean population (http://www.at-ease.nsf.org.uk/schizophrenia(1).html). Yet these diagnoses are based on a model of psychiatry that doesn’t take into account cultural differences. It is a controversial area suggesting a particular ethnic origin is more likely to have schizophrenia. It could bring on suggestions that it’s a way of trying to control the ethnic minority in Britain. It could just be that there cultural ways and behaviours, which originate from their countries are viewed as ‘abnormal’ behaviour by other Britons therefore they place a label of mental illness on them.
Even more support for this notion comes from a study. Gottesman and Shields (1972) looked at differences in diagnosis of schizophrenia. They took 120 case histories originating from a study of schizophrenia twins and gave them to six diagnosticians, who would eventually agree on a final number. Also other people looked at them using particular methods originally used by Kraepelin and Kety. In total 11 opinions were made, from countries such as Japan, USA and Scandinavia and psychiatrists such as Erik Essen Moller. All the people making opinions on the data had different ways of understanding schizophrenia and rating it. Therefore, it was found that under the narrowest interpretation of the World Health Organisation (WHO) only 17 were identified as schizophrenic with first rank symptoms. This increased to 52 with relaxation on criteria. Erik Essen Moller identified 34 cases. The six diagnosticians agreed on 69 cases. The broadest diagnostic standards, used by Paul Meehl an American Clinical Psychologist, identified 79 cases. It has to be noted that all 120 cases were originally classified as schizophrenic. This study clearly shows the huge differences in interpretation of what true schizophrenia is. Admittedly it is a study on western and economically developed countries. Even so this study shows there are actually differences to be found here. Therefore, what have been socially constructed here are the criteria used to diagnose a schizophrenic. This could bring in suggests that maybe some psychiatrists misunderstand schizophrenia which could ultimately lead to delayed or incorrect diagnosis. Consequently, there can be bad consequences due to the social construction of the understanding of schizophrenia. Having said that, Clare, 1983, points out that diagnosis does strongly depend on patients relaying symptoms. Therefore the way a patient relays their symptoms is a direct link to their experience and understanding of it.
As a result of all this evidence it can be concluded that schizophrenia is not socially constructed as a whole. I.e. that it is a non-existent illness and only a way to explain the different. There is too much genetic evidence to cancel that theory out. However, what can be stated is that people’s understandings of schizophrenia and how we view it is socially constructed. This is a phenomenon that will persist and never stop.
