Abstract
Reviewed by: Sara Bender, Department of Psychology, Central Washington University, USA
Kevin Silber’s Schizophrenia is one of the newest books from the Insights series available from Palgrave Macmillan. This series presents readers with a comprehensive introduction to psychological concepts in a manner that is both compact and captivating. The information provided within Schizophrenia is detailed and well-researched yet is presented in a tone suitable for readers of any audience, whether it be for general reading or an academic setting.
The text begins by acknowledging the high level of misunderstanding surrounding the diagnosis of schizophrenia. Silber identifies several myths concerning the illness and provides evidence to disprove each. He then introduces the reader to an accurate portrayal of schizophrenia by providing a concise overview of the positive and negative symptoms associated with this psychotic disorder. The chapter concludes with a brief exploration of the potential contributing factors to the disease.
Chapter 2 explores genetic explanations of the disease in detail. First, the author addresses the potential heritability of schizophrenia by reviewing a number of twin and adoption studies. Environmental factors, including the impact of maternal stress, socioeconomic status, cannabis use, and other correlates, are also considered. Silber explains that, while research suggests there is likely to be a genetic component of schizophrenia, the disease appears to be more complicated. Specifically, he suggests that people suffering from schizophrenia are likely to have a genetic predisposition to the disease, which is later exacerbated by some type of external force.
Potential biological explanations for schizophrenia are presented in Chapter 3. First, the author presents the reader with a basic explanation of how neurotransmission works. Once this fundamental process is explained, the dopamine hypothesis, glutamate hypothesis, and the serotonin hypothesis are each presented as potential causes for schizophrenia. The author does an excellent job explaining how each of these neurotransmitters may contribute to schizophrenic symptoms, and also provides the reader with an ample overview of the studies completed to investigate each hypothesis. As a biological psychologist himself, Silber ultimately acknowledges the complexity of schizophrenia and suggests that the most accurate explanation for the disorder is likely to be a combination of neuronal systems in conjunction with a number of other biological and environmental factors.
Chapters 4 and 5 are dedicated to exploring alternative biological explanations for the development of schizophrenia. Specifically, brain damage, the presence of enlarged ventricles, cortical asymmetry, and damage to various areas of the brain are considered. Additionally, potential reasons including obstetric complications, maternal infection during pregnancy, birth order, and even basic evolutionary processes are reviewed as potential explanations for the genetic and biological hypotheses presented in the first three chapters of the text.
After exploring the potential biological aetiology of schizophrenia, Silber clarifies for the reader that the presentation of the disorder is highly variable. This variability is especially noticeable via the neurocognition exhibited by those with the disorder, including a number of perceptual, attentional, language, and reasoning deficits. A lack of a theory of mind is also introduced as a potential explanation for the social impairment often demonstrated by those with schizophrenia. Via a synthesis of the available literature on the topic, Silber concludes that an inability to understand others’ perspectives impacts the perception of social situations amongst those with schizophrenia, which, consequently, has an impact on the manner in which they interact with the world and quality of life secondary to those interactions.
Once the reader is provided with potential genetic and biological explanations for schizophrenia, a psychoanalytic perspective is offered. While often dismissed as too simplistic an explanation for the disease, the psychoanalytic theory highlights the impact an individual’s family dynamics may have on the presentation of the illness. While Silber rejects many of Freud’s assertions regarding the development of psychosis, he does agree with many psychoanalysts by acknowledging that the communication patterns of a family are likely to contribute to the symptomology of a person with schizophrenia. Further, he also agrees with past researchers’ conclusions that family therapy is one effective intervention to combat schizophrenic symptoms.
Given the often-devastating effects of schizophrenia, finding an effective treatment for the disease’s symptoms is a top priority for many researchers. Silber does an excellent job within the final two chapters of his text presenting the reader with a comprehensive overview of the treatments available. Both first-generation and second-generation anti-psychotics are explained in detail. The discussion regarding these medications is simplistic enough, however, that it may be understood by readers of almost any level, especially given the explanation of neurotransmission provided earlier in the book. The discussion regarding the use of medications is accompanied by an honest account of potential side effects, which often contribute to a lack of adherence to medication orders, providing the reader with additional insight into the perpetuation of symptoms. Non-medication biological treatments are also reviewed, including: electroconvulsive therapy, transcranial magnetic stimulation, psychosurgery, and alternative herbal supplements. Further, psychosocial approaches to treatment are described, including: psychodynamic therapy, psychoeducational groups, art therapy, music therapy, dance therapy, and combination therapies. Each therapy is described and evaluated for its likely efficacy in combatting the symptoms of schizophrenia. It is notable that Silber emphasizes both western and non-western approaches to treatment, encouraging a comprehensive approach to improving the quality of life of those afflicted with the disease.
Overall, this is a high-calibre text. It provides great insight into a typically misunderstood and emotive subject. The information provided throughout is well-researched and detailed, yet accessible. The format of the book is set up in a way that actively aids the audience in processing the information provided with clear chapter objectives, detailed drawings, chapter summaries, and suggestions for further reading. While originally written for an academic audience, Schizophrenia is formatted in a manner that makes a complex subject palatable to almost any reader.