Schizophrenia and bipolar disorder are diseases of the brain
by Dr. E. Fuller Torrey
It has been suspected for over a century that schizophrenia and bipolar disorder (manic-depressive illness) are diseases of the brain. In 1837, Dr. W.A.F. Browne, the best-known English psychiatrist of his generation, wrote: “Insanity, then, is inordinate or irregular, or impaired action of the mind, of the instincts, sentiments, intellectual, or perceptive powers, depending upon and produced by an organic change in the brain.”
In that same year, Dr. Amariah Brigham, one of the founders of American psychiatry, also wrote that insanity “is now considered a physical disorder, a disease of the brain.”
It would be 150 years, however, before these statements could be proven. Since the early 1980s, with the availability of brain imaging techniques and other developments in neuroscience, the evidence has become overwhelming that schizophrenia and bipolar disorder are diseases of the brain, just like multiple sclerosis, Parkinson’s disease, and Alzheimer’s disease. The brains of individuals with these diseases are measurably different from individuals who do not have these diseases, both structurally and functionally.
Approximately 50 percent of individuals with schizophrenia and bipolar disorder, including those who have never been treated, have impaired awareness of their own illness. This is a clinical symptom called anosognosia that has been shown in at least 50 different studies. Such individuals do not realize that they are sick, and they will, therefore, usually not accept treatment voluntarily. Studies suggest that this impaired awareness is probably related to the decreased function of the prefrontal area. These individuals are thus similar to some patients who have had a stroke and, because of brain damage, are unaware of their disability and deny it. The lack of awareness of illness in individuals with schizophrenia and manic-depressive disorder is the most common reason that they do not take their medication. 15, 16, 17
1 Van Horn, J.D., and McManus, I.C. (1992). Ventricular enlargement in schizophrenia. A meta-analysis of studies of the ventricle:brain ratio (VBR). British Journal of Psychiatry, 160, 687–97.
11 Hoff, A.L., Shukla, S., Aronson, T. et. al. (1990). Failure to differentiate bipolar disorder from schizophrenia on measures of neuropsychological function. Schizophrenia Research,3, 253–60.
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