Chapter

How to move beyond the concept of schizophrenia

Jeffrey Poland

in Reconceiving Schizophrenia

Published on behalf of Oxford University Press

Published in print November 2006 | ISBN: 9780198526131
Published online February 2013 | e-ISBN: 9780191754340 | DOI: http://dx.doi.org/10.1093/med/9780198526131.003.0009

Series: International Perspectives in Philosophy & Psychiatry

How to move beyond the concept of schizophrenia

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Today, despite decades of criticism of both sorts, the entrenchment of the concept of schizophrenia and associated practices appears to be as deep as ever. Schizophrenia is fully expected to reappear in DSM-V as one of the official diagnostic categories of mental disorder, journals are replete with articles reporting on research concerning schizophrenia, mental health policy and practice continue to be widely conceptualized in terms of a brain disease called ‘schizophrenia’, and the public is being aggressively ‘educated’ about the nature of this disease, partly in an attempt to offset widespread stigma associated with the label and partly to reinforce the existing practices centred around the concept. Advocacy groups like the National Alliance for the Mentally Ill (NAMI) are especially outspoken regarding the disease status of schizophrenia for reasons having to do with mental health policy, research funding practices, and access to health care. Thus, it would appear that neither the advancement of arguments designed to undermine the scientific credibility of the schizophrenia concept, nor the advancement of deep socio-political analyses and critiques of its cultural role, have been sufficient to undermine its entrenchment in contemporary mental health practice. How could this be?

There are, at least, three possible explanations to explore. The first, predictably articulated by those of a more socio-political bent, is that the powerful vested interests served by the schizophrenia concept, the inertia of well-entrenched practices, and perhaps the contemporary Zeitgeist (e.g. concerns about efficiency and technological control, tendencies toward pathologizing problems and deviance) all have combined to overpower any purely academic considerations concerning the scientific merits of the concept or the role it plays in cultural practices. With respect to making significant social changes, considerations of money, power, prestige, political interests, and the like tend to be more effective than good arguments.

A second explanation is that, even if the concept of schizophrenia and the claims and practices based upon it are in some ways flawed, the concept still plays a useful role in contemporary culture (e.g. a role in providing access to healthcare or in distributing research funds and organizing scientific research programmes) and there is no alternative ready to take its place while maintaining comparable levels of efficiency. Hence, short of the emergence of a viable alternative for serving a wide range of pragmatic functions, the status quo is maintained.

A third explanation is that the arguments just are not as strong as the critics think: there are flaws and loopholes that make it possible for the defenders of the schizophrenia concept to argue that, although the critics may make some good points, they are not nearly good enough to justify the abandonment of the concept or the practices it supports.

There is some plausibility in each of these explanations, especially the third. Although there are core truths in both the scientific and the socio-political criticisms of the schizophrenia concept, the specific arguments advanced by the critics have serious limitations that have made it easy for the concept to persist, particularly given the powerful interests it serves and the apparent absence of a viable alternative approach. At a minimum, more effective arguments are required; although even good arguments will probably not be enough to effect the serious reform that is required.

My goals in this paper are: (1) to clarify some serious limitations of the arguments of the scientific critics; (2) to outline a strategy for strengthening the scientific case against schizophrenia; and (3) to clarify some issues and strategies involved in moving beyond the concept of schizophrenia.

In doing (1)–(3), I hope to show how the arguments and insights of the socio-political and the scientific critics can fruitfully work in concert with each other.

Chapter.  10884 words. 

Subjects: Psychiatry

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