CHANGE THE NAME OF SCHIZOPHRENIA

Schizophrenia is a mental illness characterized by thought disorder, perceptual disorders and abnormal social and personal behavior, in general terms. The name of this illness was coined by  the Swiss Psychiatrist Eugene Bleuler one hundred years ago. Before him this mental malady was called Dementia Praecox by the

Emil Kraepelin

German Psychiatrist Emil Kraepelin. Both these terms gave some hints to the inner nature of the ailment. Kraepelin thought that the person afflicted with the illness become demented prematurely and hence the name dementia praecox. Blueler's naming hints to the real cause of the illness. He thought that the mind is split in a person suffering from the disease.
Dr. Mohan Isac a psychiatrist and researcher from Fremantle Hospital, the University of Western Australia participating in a Continuing Medical Education program of the Kerala Branch of the Indian Psychiatric Society, presented his thinking about the changes in concepts and nomenclature of the enigmatic mental illness of schizophrenia. He suggested it is high time to change the name of schizophrenia and proposed "Kraepelin-Bleuler disorder" as a passing remark.
I am also of opinion that it is high time to change the name of schizophrenia. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition - DSM-5  

Eugene Bleuler 

schizophrenia is included in the chapter on Schizophrenia Spectrum and Other Psychotic Disorders. There are two concepts in this terminology. The first concept is that the schizophrenia is a psychotic disorder. The second idea is that schizophrenia is not a single illness, it is the name of a spectrum of illnesses. Both are agreeable concepts. The DSM-5 gives the key features of psychotic disorders. They are delusions, hallucinations, disorganised thinking and speech, disorganised behaviours and negative symptoms such as diminished emotional expressions, inactivity and keeping aloof.
The functional neuro-imaging studies of the brain conducted in schizophrenic patients show poor mentational ability and abnormal activity in Pre-Frontal Cortex of the brain. Evidently the psychotic disorders including schizophrenia are disorders of mentation and psychoses can be renamed as Mentational Disorders.        

MY SELF AND MY MIND

My Self is present only when I am awake. When I was asleep I missed the happenings around me; I was not aware of my surroundings. I was unconscious. When I woke up I regained consciousness.

Consciousness is not merely wakefulness.  When I wake up from sleep I do not look around vacantly, taking in the sights and the sounds around me as if my wake mind belonged to no one. I am the proprietor of my mind. I am aware of each and every happenings and things around me. The myriad of contents displayed in my mind are connected with me through invisible strings  and I feel or experience these connections with me.  In other words my consciousness is endowed with subjectivity. ‘I’ move forward and look back with this innumerable things displayed and connected with me. This forward-moving merriment in me is my Self.

Search for Self

Search for self had been going on from time immemorial. Brihadaranyaka Upanishad is a treatise on Self and the great saint who composed it found that Self is the infinite universe. (Aham Brahmāsmi)

Aristotle 

Buddhist tradition holds that the root cause of suffering is the Ordinary Man’s erroneous view of Self as an unchanging essence. Furthermore, the tradition holds that this error is inevitable in the natural course of life because it is based on inborn patterns, pre-theoretic and unreasoned. 

Aristotle, following Plato, defined the soul as the core essence of a living being, but argued against its having a separate existence. Aristotle also believed that there were four sections of the soul: the calculative and scientific parts on the rational side used for making decisions, and the desiderative and vegetative parts on the irrational side responsible for identifying our needs.

 Avicenna  said that the idea of the self is not logically dependent on any physical thing, and that the soul should not be seen in relative terms, but as a primary substance. This

Avicenna

argument was later refined and simplified by René Descartes in epistemic terms when he stated: "I can abstract from the supposition of all external things, but not from the supposition of my own consciousness."

An eighteenth century philosopher David Hume thought that Self is a bundle of perceptions. “For my part, when I enter most intimately into what I call myself, I always stumble on some particular perception or other

of heat or cold, light or she, love or hatred, pain or pleasure. I never can catch myself as any time without a perception, and never can perceive anything but the perception.  When my perceptions are removed for any time, as by sound sleep, so long am I insensible to myself,  and may truly be said not to exist. And were all my perceptions removed by death, and could I neither think, nor feel, nor see, nor love, nor hate after the dissolution of my body.” David Hume: A Treaties on Human Nature.

All these were brilliant imaginative speculations by the fertile brains of the past. The first psychological enquiry of Self came from William James, an American psychologist who initiated scientific psychological enquiries. He admired Hume’s dazzling speculation on Self, but criticised. “But Hume, after doing this good piece of introspective work, proceeds to pour out the child in the bath, and fly to as great an extreme as the substantialist philosophers. As they say Self is nothing but Unity, unity abstract and absolute, so Hume says it is nothing but Diversity, diversity abstract and absolute; whereas in truth it is that mixture of unity and diversity which we ourselves have already found so easy to pick apart… he denies this thread of resemblance, this core of sameness running through the ingredients of the Self, to exist even as a phenomenal thing.”

Let us leave the brilliant speculations on Self and consciousness in the past. The conscious mind and its proprietor the Self are constructs of the brain. In a series of pioneering studies conducted in North America and Italy during the middle of the twentieth century established with certainty that the brain stem is the

Brain stem

critical contributor to consciousness. More recent studies conducted in neurological patients whose consciousness was compromised by focal brain damage.

Relationship between consciousness and self

Portuguese-American neuroscientist, Antonio Damasio in his marvelous book Self Comes to Mind says: “When selves do not occur within minds, those minds are not conscious in the proper sense. This is a

Antonio Damasio

predicament faced by humans whose self process is suspended by dreamless sleep, anaesthesia, or brain disease.”

Two notions of Self

The Self is a process and not a thing, and this process is present all times when we are conscious. We can consider the Self from two vantage points. One is the vantage point of an observer appreciating a dynamic object.  This dynamic object is constituted by certain working of minds, certain traits of behaviour, and a certain history of life.

The other vantage point is that of the self as knower. This is a process that gives a focus to our experiences and eventually lets us reflect on those experiences. Combining the two vantage points produces a dual concept to Self. In everyday life each concept corresponds to a level of operation of conscious mind, the Self-as-object being simpler in scope than the Self-as-knower. There is no dichotomy between the two. The simpler Self-as-object evolved earlier in the course of evolution and the later evolved Self-as-knower is piled up on the top of the Self-as-object.

The Self as the witness of the mind

Countless creatures for millions of years have had active minds happening in their brains. But only after those brains developed a self as the protagonist capable of bearing witness did consciousness begin, in the strict sense, and only after those brains developed language did it become widely known that minds did exist. The Self, as the witness, is the protagonist is something extra that reveals the presence of implicit brain events that we call mental. Understanding how the brain produces that something extra, the protagonist we carry around  and call self, or me, or I, is an important goal of the neurobiology of consciousness.