In a new article, published in Schizophrenia Bulletin, psychiatrist Sir Robin Murray reflects on the history of ‘schizophrenia’ research and mistakes made. Murray, a professor at the Institute of Psychiatry, Psychology, and Neuroscience in London, states that he ignored social factors that contribute to ‘schizophrenia’ for too long. He also reports that he neglected the negative effects antipsychotic medication has on the brain. Murray states:
“Amazingly, such is the power of the Kraepelinian model that some psychiatrists still refuse to accept the evidence, and cling to the nihilistic view that there exists an intrinsically progressive schizophrenic process, a view greatly to the detriment of their patients.”
Murray, who began his work as a psychiatrist in 1972, describes the shift in U.S. psychiatry during the mid-1970s “from being wholly psychoanalytical to almost wholly biological.” Since this shift, there has been an increased focus on the role of dopamine and genetic factors in ‘schizophrenia.’ During the 1970s, ‘schizophrenia’ came to be understood as a neurodegenerative disorder. This theory was supported by a study that found enlarged ventricles in the brain for individuals diagnosed with ‘schizophrenia.’ Murray regrets that he and many others ignored another study published around the same time, which noted how long-term use of antipsychotic medication can result in persistent brain changes, mainly in the sensitivity of dopamine receptors, which can result in tardive dyskinesia.
It was not until 2008, when a newer study showed the effects of antipsychotic medication on ventricular volume, that Murray began paying attention to the long-term effects of antipsychotic use. He states, “So, in 2016, it is clear that high-dose antipsychotics contribute, not to the subtle brain changes present at onset of schizophrenia, but to the subsequent ‘progressive’ changes thereafter.” Murray also reviews the neurodevelopmental theory of ‘schizophrenia,’ the idea that the disorder is caused by issues during birth and early development. Now, Murray refers to this theory as an “overstatement” of the evidence.
Murray also discusses dopamine supersensitivity, that long-term antipsychotic treatment can result in an increase in dopamine receptors, which increases the sensitivity to dopamine and decreases the effectiveness of antipsychotic medication. He states, “We raise the possibility that antipsychotic medication may make some schizophrenic patients more vulnerable to future relapse than would be the case in the natural course of the illness.” Murray believes in the use of antipsychotic medication to treat schizophrenia, but has become more cautious in its long-term use, saying:
“There is no doubt that antipsychotics are necessary in acute active psychosis. But do (we) have to continue to prescribe them in some patients because we have rendered the D2 [dopamine] receptor supersensitive to the excess dopamine released? I, and indeed most investigators, have neglected this vitally important question.”
Murray states that he expects the concept of ‘schizophrenia’ as a discrete disorder to become obsolete, just like “dropsy.” He writes:
“In the decades following 1976, I spent more time and energy than I like to recall, trying to find what caused the brain changes in schizophrenia. Sadly, I did not realize that the effects of risk factors such as adverse obstetric events, on brain structure and function, which can be readily seen in nonschizophrenic samples, are obscured in people with established schizophrenia by the effects on antipsychotics and other nonspecific factors.”
It is significant to have a prominent psychiatrist admit psychiatry’s mistakes and call for more research on environmental factors and epigenetics. Perhaps it signals a shift in the field of psychiatry if others follow Murray’s lead. He concludes,
“If I had the chance to have a second career, I would try harder not to follow of the fashion of the herd. The mistakes I have made, at least those into which I have insight, have usually resulted from adhering excessively to the prevailing orthodoxy.”
Murray, R. M., (2016). Mistakes I have made in my research career. Schizophrenia Bulletin. Advance online publication. doi:10.1093/schbul/sbw165 (Full Text)