Schizophrenia cannot be justified as brain pathology
Lieberman & First justify the concept of schizophrenia as brain pathology.1 However, they admit that the cause of the disorder and the precise pathophysiology are unknown.
Operational diagnostic criteria were introduced in an attempt to improve the reliability of psychiatric categories, such as schizophrenia.2 Despite what Lieberman & First say, the genetic basis of schizophrenia can be challenged.3 It is not clear why they dismiss disturbed psychological development and parenting as factors in aetiology. Nor what abnormalities in brain structure and function they think have been demonstrated on neuroimaging and electrophysiological tests.
The question is whether schizophrenia is an improvement over the mere description of psychotic symptoms. Eugene Bleuler introduced the term in 1911 as an advance over Emil Kraepelin's notion of dementia praecox, as not all schizophrenic patients are "victims of deterioration early in life".4 Bleuler regarded schizophrenia as a functional disorder, although he could not exclude the possibility of "certain mild organic disturbances". He believed it was a disease, which did "not permit a full restitutio ad integrum", and that it was demarcated by the presence of fundamental symptoms which occur only and always in schizophrenia representing "a more or less clear-cut splitting of the psychic functions".
Few would now accept this Bleulerian understanding of schizophrenia. And yet the term survives. This is more in the Kraepelinian rather than Bleulerian sense. What is needed is a biopsychological understanding of schizophrenia.5 The danger of focusing on schizophrenia as a biomedical diagnosis is that it may avoid understanding of the person by reducing mental health problems to brain pathology. The justification for retaining the concept of schizophrenia is that it seems to provide some organisation to the classification of psychosis, not because it points to an underlying brain abnormality.
Lieberman JA, First MB. Renaming schizophrenia. BMJ 2007; 334:108. (20 January 2007) [Full text]
Bleuler E. Dementia praecox: or the group of schizophrenias. (trans. by J. Zinkin). New York: International Universities Press, 1950
Double DB. The biopsychological approach in psychiatry: The Meyerian legacy. In DB Double (ed) Critical psychiatry: The limits of madness, pp 165-87. Basingstoke: Palgrave Macmillan, 2006.
Competing interests:
None declared
Competing interests:
No competing interests
29 January 2007
D B Double
Consultant Psychiatrist
Norfolk & Waveney Mental Health Partnership NHS Trust, Peddars Centre, Norwich NR6 5BE
Rapid Response:
Schizophrenia cannot be justified as brain pathology
Lieberman & First justify the concept of schizophrenia as brain pathology.1 However, they admit that the cause of the disorder and the precise pathophysiology are unknown.
Operational diagnostic criteria were introduced in an attempt to improve the reliability of psychiatric categories, such as schizophrenia.2 Despite what Lieberman & First say, the genetic basis of schizophrenia can be challenged.3 It is not clear why they dismiss disturbed psychological development and parenting as factors in aetiology. Nor what abnormalities in brain structure and function they think have been demonstrated on neuroimaging and electrophysiological tests.
The question is whether schizophrenia is an improvement over the mere description of psychotic symptoms. Eugene Bleuler introduced the term in 1911 as an advance over Emil Kraepelin's notion of dementia praecox, as not all schizophrenic patients are "victims of deterioration early in life".4 Bleuler regarded schizophrenia as a functional disorder, although he could not exclude the possibility of "certain mild organic disturbances". He believed it was a disease, which did "not permit a full restitutio ad integrum", and that it was demarcated by the presence of fundamental symptoms which occur only and always in schizophrenia representing "a more or less clear-cut splitting of the psychic functions".
Few would now accept this Bleulerian understanding of schizophrenia. And yet the term survives. This is more in the Kraepelinian rather than Bleulerian sense. What is needed is a biopsychological understanding of schizophrenia.5 The danger of focusing on schizophrenia as a biomedical diagnosis is that it may avoid understanding of the person by reducing mental health problems to brain pathology. The justification for retaining the concept of schizophrenia is that it seems to provide some organisation to the classification of psychosis, not because it points to an underlying brain abnormality.
Competing interests:
None declared
Competing interests: No competing interests