New Scientist - April 18 2009 (Malestrom)

INTRODUCTION
AN ENCOUNTER with untreated schizophrenia
can be a deeply unsettling experience that
leaves no doubt about the debilitating nature
of the condition. Who hasn’t averted their
gaze from a person engaged in an agitated
conversation with someone who isn’t there?
Psychiatric medicine has lessened the
frequency of such encounters. Where people
with schizophrenia have access to medical
care, their hallucinations can now be well
controlled with antipsychotic drugs.
That’s progress, but it helps those afflicted
with the condition less than it may appear:
even after the voices in their heads are
silenced, their ability to function in society
remains blunted by cognitive deficits that
make it hard to process information, learn,
remember and plan. Too often, despair brought
on by a lifetime of struggle ends in suicide.
That’s why the latest, extremely promising
results from a “brain training” approach to
treating schizophrenia (see page 13) are so
welcome. If the computer-based tools can be
further refined, there is real hope of restoring
patients’ cognitive abilities to the healthy
range, and maybe even safeguarding them
against decline in the first place.
The key test will be whether the lab results
translate into significant improvements in
quality of life. Particularly important will be
a trial led by Bruce Wexler of Yale University,
who is testing whether such training improves
performance in the workplace. This will be
important in societies that marginalise those
who are unable to hold down a job, particularly
for people with genuine difficulties who are
wrongly labelled lazy or stupid.
Alongside further developments in
treatment, there needs to be a better public
understanding of the problems faced by
those with schizophrenia. Over the past
decade or so, psychiatrists who specialise in
the condition have come to realise that the
cognitive deficits are more debilitating than
the hallucinations.
Word of this revised understanding
has been slow to get out, however, in part
because the official criteria used to define
schizophrenia – laid down in a volume
published by the American Psychiatric
Association called the Diagnostic and
Statistical Manual of Mental Disorders (DSM) –
do not include the cognitive symptoms .
That should change in the next edition of
the DSM , due in 2012, but efforts to inform the
public of the full nature of schizophrenia need
not wait until then. Schizophrenia has been
misunderstood and misrepresented perhaps
more than any other disease. Rather than
averting our eyes, we should do all we can
to offer a helping hand.

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