An interesting review of one of my favorite manuals on Schizophrenia

Review - Surviving Schizophrenia
A Manual for Families Consumers and Providers, Third Edition
by E. Fuller Torrey
Harperperennial, 1995
Review by Matt Lee
Dec 19th 2001 (Volume 5, Issue 51)
The manual Torrey has written is a toolbox of information and contacts, written for the everyday lay reader with an interest in the practical side of schizophrenia. It presents as part of that genre of writing that we might call 'medical empowerment', where users or providers outline the background to their concerns, in this case schizophrenia, as well as describing practical methods for negotiating the varieties of treatments and social implications. It focuses on North America alone and so the details Torrey gives of practical issues and possible solutions is limited in scope and means the book is of little use outside of North America. It is also inevitably going to have a relatively short shelf life. The edition I reviewed was from 1995 and is already 6 years out of date and I would suspect that in order for such a manual to fulfill its function adequately it would need updating and reviewing every two to three years. The book then is limited in its remit, useful mainly for North Americans and then only after noting that some of the details will be redundant. One questions remains then. Is it a good manual; can it do what it intends to, which is enable people to 'survive' schizophrenia.

The first thing to note when reading Torrey's manual is his apocalyptic tone with regard to schizophrenia, a tone which is part of an overall polemical attitude that is quite aggressive and often questionable. The first chapter of the work is entitled 'dimensions of the disaster' and traces a history of schizophrenia in the last century in North America. This 'disaster' is not, however, simply schizophrenia itself, although Torrey is clear that being 'afflicted' by schizophrenia is itself a disaster for both the schizophrenic and everyone around them. The real 'disaster' with which Torrey opens his work, however, is the closure of the asylums in North America. Hospitalisation has been reduced too much, according to Torrey, and there is now a crisis in the treatment of schizophrenics for which the main solution seems to be a radical increase in hospitalization. This advocacy of the hospital is a central point in his polemic but that is not the focus of Torreys polemic. The main focus is any suggestion that schizophrenia is anything other than a massively debilitating brain disease treatable with drugs. Torrey is a primary advocate of this medical model and does so in such a way that any discussion or challenge to such a model is seen as not only ludicrous but often as dangerous to the schizophrenic. This is particularly the case with 'insight-oriented psychotherapy'. Such treatment is "not only negligent, it is malpractice" (p.169).

The polemical tone of Torrey's work comes throughout the work and the text is littered with side swipes at psychoanalysis, Thomas Szasz, R.D.Laing, anti-psychiatry and the National Institute for Mental Health (NIMH). It is also littered with the phrase 'schizophrenia is a brain disease' and at no point tolerates any deviation from this basic model, even though the manual itself deals in large part with the medical social situation of the schizophrenic. Despite schizophrenia being a 'brain disease' the chapter on neurology (Chapter 6) is a cursory overview of the competing theories. Torrey presents 4 main theories, 5 minor theories and 6 'obsolete theories', none of which inspires much confidence in the rather blunt and absolutist way in which he reduces schizophrenia to brain disease. Moreover the history of psychiatric theories of schizophrenia is not one of increasing clarity of theory but, as anyone who begins to examine the area will find, rather one of ongoing waves of 'fashionable' theories, each of which seems to last a generation or two before being moved onto the shelf of minor or obsolete theories.

Torrey clearly revels in the argument but his polemic is too strident to be convincing. He attempts to offer a route through the maze of treatments and practices on offer in North America and through so doing highlights the crisis in social and medical policy that exists in that country. He does not inspire any confidence, however, in his own approach. The crucial issue of the social implications of schizophrenia is reduced, in essence, to a practice of finding the 'right' doctor or the 'right' treatment. Torrey's own role within the debate appears to blind him to the fact that schizophrenia is a major site of social struggle, possibly the most urgent site of such struggle in our attempt to grapple with 'biotechnologies' and our ability to affect ourselves through medicine.

Torrey himself has taken charge of one of the largest 'brain banks' in the world, as a result of private funding, and now controls a large part of the budget for research into schizophrenia in North America. His preferred organisation, the National Alliance for Mentally Ill, is a particular group within the debate, largely family orientated and inevitably partisan in its approach. The final chapter in his book, 'How to be an advocate' reads as a form of recruitment manifesto for NAMI but does so not through putting the policy differences clearly but rather through writing a history in which, in some sort of inevitable evolution, the only real advocacy organization is now the NAMI. At this point Torrey's clearly political - with a small 'p' - agenda comes to the fore and yet at no point does he step back from the controversy and attempt a more objective account of the issues. In the end the manual is marred fundamentally by this partisanship. A manual should aim to be an objective tool. It should not be a way to garner support for a particular policy with regard to schizophrenia. Torrey uses his position within the medical profession - even down to the 'M.D.' after his name on the cover - to give a veneer of authority and objectivity to his manual but this is an objectivity that he singularly fails to deliver.
©

2001 Matt Lee