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Conquering schizophrenia: Switzerland has made many contributions to the growing awareness of schizophrenia. The company Sandoz in Basel discovered the first psychotropic drug, while Zurich's Burgholzli clinic opened new avenues of psychotherapy.

During the whole 19th century, most insane asylums looked like visions from hell. Since the inmates, during their psychotic fits, might howl, smash furniture and assault the wardens, they were treated like wild beasts or worse.

In 1920, the German book 'Life Unworthy of Life' caused the deaths of thousands of mentally deranged Germans, many of whom suffered from what we now call schizophrenia. Under Nazi rule, they were classified as 'useless parasites' and sent to gas chambers.

Even as late as the 1950s, the treatment of 'incurable' schizophrenic patients in certain U.S. psychiatric units consisted mainly of separating them from society instead of therapy and rehabilitation.

Courageous Pioneers

A contributing factor to their sad fate consisted undoubtedly in the classification of 'dementia praecox' (later called schizophrenia) as an absolutely incurable degenerative illness, by the 'Godfather' of descriptive biological psychiatry, Emil Kraepelin (1856-1926), who worked in Munich. Kraepelin ridiculed Freud's attempts to understand schizophrenia in psychoanalytical terms. He simply considered it a hopeless brain disease.

Far from rejecting Freud's theories, Eugen Bleuler, the predecessor of Carl Gustav Jung at Zurich's Burgholzli Psychiatric Clinic, belonged to his first supporters. He gave dementia praecox its present name schizophrenia, composed of the Greek terms 'schizein' (to split) and 'phren' (mind). But Bleuler was also very pessimistic about the healing prospects of schizophrenic persons.

Even C.G. Jung, who pioneered schizophrenia research as Bleuler's young assistant and believed in its potential, confessed in his old age why he tried to avoid schizophrenic patients: "Sometimes, their treatment may be successful, but at great risk for the therapist's own mental health. The attempt of merging the patient's split partial souls into one whole requires superhuman efforts."

Psychedelic Delusions

in 1938 Dr. Albert Hoffmann, a senior researcher at Switzerland's Sandoz headquarters, first synthesised lysergic acid diethylamide (LSD) from a fungus, and used it as a painkiller.

Five years later, after having accidentally absorbed a little LSD through his skin, Hoffmann fell into a kind of trance producing fantastic images in intense kaleidoscopic colours. The mind-exploding properties of the first psychotropic drug raised nigh hopes of its possible use to cure schizophrenia; it was a hope that reality dispelled soon after violent crimes were committed under the influence of LSD.

While discontinuing production of LSD, Sandoz continued its search for effective antipsychotic drugs despite unfriendly press campaigns in the 1980s, which described pills in psychiatry as 'gentle murder'.

Miracle Drugs

The next 'miracle drug' was found by accident as well. in 1967 Sandoz acquired the Bern-based company Dr. Wander Ltd. Unexpectedly, Sandoz researchers hit on the almost forgotten drug clozapine, discovered by Wander in 1854.

Despite its psychotropic properties, experts deemed the drug unsuitable for treating schizophrenia because it did not produce the customary side effects of antipsychotic drugs. But after clozapine had performed miracles on some schizophrenic persons, Sandoz was inundated with frantic demands for the drug, which was not yet approved by the U.S. Food and Drug Administration (FDA).

In 1975, side effects ultimately did occur: nine schizophrenic patients under dozapine treatment in Finland suddenly died from agranulocytosis, a rare blood disease. For pharmacologists, dozapine was now out of the question.

Interestingly, the issue did not go away. Since certain patients in other countries apparently could not survive without clozapine medication, the FDA approved the drug in 1989. As a precautionary measure, doctors had to subject patients to continuous blood tests in order to avoid a new 'Finnish catastrophe'. Ultimately, the nine deaths, all occurring in one small district of Finland, were never fully explained.

Other wonder drugs followed, whose effectiveness in individual schizophrenia cases often had to be determined by trial and error, adjusting the dosage in relation to the concerned patient's tolerance. Medication is indispensable in stabilising the patient's psychotic behaviour sufficiently to undergo therapy and psychosocial training.

Swiss Initiatives

Apart from breakthrough drugs produced by Switzerland's pharmaceutical industry, this country also played a leading role in the psychiatric treatment of schizophrenia. The abolition of straitjackets in 1896 marked the beginning of more humane treatment of the inmates in Zurich's then new psychiatric clinic on the Burgholzli hill.

The inmates included famous names such as Jung's patient Sabina Spielrein (the protagonist of the 2002 movie 'Prendimi l'anima') and the schizophrenic son of Albert Einstein.

Schizophrenia Today

The fearful stigma of the once incurable disease is no longer justified, since today about one-third of patients regain their health, while another third may be restored to a quasi-normal life outside mental clinics, in the end, only a small percentage of schizophrenics are permanently hospitalised.

The direct medical cost for schizophrenia treatment amounts to between 1.5-3.0 per cent of the total health care spending in Western countries, i.e. one billion CHF in Switzerland alone. Nowadays, the worldwide number of schizophrenics is estimated at 90 million.

Finally, there are often preliminary signs whose early detection can oftentimes prevent schizophrenic teenagers from committing suicide, getting into traffic accidents or from conflict with the police. In view of the impressive therapeutic progress made in recent years, schizophrenic patients can hope for an even brighter future.

For more information on schizophrenia please refer to the book 'Understanding and Helping the Schizophrenic' by Professor Silvano Arieti.
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Author:Bucher, Marcel
Publication:Swiss News
Geographic Code:4EXSI
Date:Mar 1, 2005
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