Considering conventional wisdom and the critical reconstruction of psychiatry he following comes to mind: The discussion about the concept of schizophrenia has always been at the heart of psychiatry.

Although this discussion is mainly limited to conversations between psychiatrists, we have to acknowledge that this is in fact a much wider debate and it is about time it was extended to a discussion between psychiatry and the rest of humanity.

The limits of the ‘Psychiatric View’

What happens when psychiatry decides to look at mental variation in a certain way?

This ‘psychiatric view’ is essential to how psychiatrists perceive the world around them, and make decisions about what is normal and what isn’t.

The question is whether this view is scientifically based

The discussion about the concept of schizophrenia is ongoing, with half of the psychiatrists in favour of changing it, and the other half against.

Beyond conventional wisdom, for example:

In certain Asian countries the way schizophrenia is defined has already been modernised, which has resulted in a positive change in concept as well as definition.

However, the rest of the world appears to be unresponsive to this change in language and concept.

The failure of the scientific basis

The current debate on schizophrenia mirrors a broader, but less obvious debate about the scientific foundation of psychiatry itself and is an example of the failure to address wider cognitive issues.

Why?

• There is a growing recognition of the necessity to review the epistemological assumptions that underlie the psychiatric view.
• It still is widely believed that psychiatric conditions can be summarised as “finding the right medication for the right illness”, especially in the US.

So this is the way in which psychiatry, and therefore the rest of the world as well, perceives the world of mental variation. However, this perception isn’t based on science. On the contrary; 60 years of extensive biological research has resulted in neither conclusive nor relevant evidence.

Schizophrenia and the new, moral era

Psychology needs to take on a different, more sceptic, and scientifically based view on schizophrenia, that acknowledges that it is more than a simple mental illness that can be cured with the right medication. It needs to drop the belief that they have all the knowledge, and admit that there is still very much uncertainty about schizophrenia and other mental conditions.

What has happened in Japan shows us that this is possible

There, the psychiatric association did decide to drop the outdated concept of schizophrenia and acknowledge the many complexities and the lack of scientifically based evidence regarding it. They also changed their way of treating patients. Rather than just prescribing them medication, they are looking for ways of treatment that really make a difference and improve patients’ lives in more ways than just reducing their symptoms. They also listen to patients’ and their families’ ideas and wishes, and consider all their needs (rather than just medication).

Conclusion: Psychosis and the rewrite of psychiatry

The debate on schizophrenia is just the tip of the iceberg; a small part of the problems within psychiatry. To make a change, psychiatry needs to challenge its beliefs, create new concepts and definitions, and adopt a more inclusive, patient-focused, and scientific perspective.

Science is also acknowledging that there is a lot of uncertainty and not-knowing. Only by acknowledging this, psychiatry can really add value to the lives of the people it is hoping to serve. Strong science challenges conventional wisdom.

Translated from Dutch bij SGM Taplin