Time to abandon the bio-bio-bio model of psychosis: Exploring the epigenetic and psychological mechanisms by which adverse life events lead to psychotic symptoms
John Read, Richard P. Bentall, Roar Fosse
British children raised in economic deprivation were found to be four times more likely to develop ‘non-schizophrenic’ disorders but eight times more likely to grow-up to be ‘schizophrenic’.
Patients abused as children have earlier first admissions and longer and more frequent hospitalisations, spend longer in seclusion, receive more medication, self-mutilate more, have higher global symptom severity and try to kill themselves more often.
Even within samples diagnosed psychotic or ‘schizophrenic’, child abuse is related to longer duration of untreated psychosis, poorer premorbid functioning, substance abuse, other diagnoses (especially depression and PTSD), unemployment, poor engagement with services, low medication compliance, low satisfaction with diagnosis and treatment, and, most importantly, suicidality.
Most genetic and brain researchers, however, have either ignored the psychosocial causes of psychosis or relegated them to the role of triggers or exacerbators of a vulnerability which they assumed to be genetic.
The President of the American Psychiatric Association recently warned: “If we are seen as mere pill pushers and employees of the pharmaceutical industry, our credibility as a profession is compromised. As we address these Big Pharma issues, we must examine the fact that as a profession, we have allowed the bio-psycho-social model to become the bio-bio-bio model”.