Saturday, November 28, 2015

Is 'psychosis' a substitute for 'schizophrenia'?

Huw Green in his article in Social Theory & Health mentions that Mary Boyle reluctantly adopts the word 'psychosis' as a substitute for 'schizophrenia' in order to discuss the topic of psychiatric diagnosis she has chosen to address. He uses this situation to reinforce his view that talk about psychiatric diagnosis is inevitably a form of communication. I have similarly criticised Mary for attempting to abandon psychiatric diagnosis completely (see my article). Psychiatric diagnosis needs to be recognised for what it is - an attempt to describe psychological states. It is, therefore, related to unobservables and not describable in a natural scientific sense. There will inevitably be limitations in the application of psychiatric diagnosis, whatever way symptoms and signs are grouped and conceptualised. Psychiatric practice needs to acknowledge this state of uncertainty. The concepts of mental illness do not need to be abandoned for this reason alone.

It's not surprising, therefore, that Mary reintroduces a notion of psychosis, however much she may think that the concept of schizophrenia is unscientific. But, neither is psychosis an absolute concept. Even the BPS attempt to explain psychosis and schizophrenia in everyday language still uses the terms (see previous post). The usefulness or validity of terms like 'psychosis' and 'schizophrenia' may depend on the ability to identify certain patterns between different patient presentations (see another previous post).

For example, the experience of hearing voices can be a dissociative symptom. This situation may have been used as a rather superficial argument for the abandonment of the diagnosis of schizophrenia but it does create a category of 'dissociative voice hearing'. As Green says, if the new catgory provides "more clinical information than the DSM, there is a chance that [it] will be adopted and applied instead, or even incorporated into that manual". Dissociation, in fact, does feature as a category already in DSM, including dissociative identity disorder (see changes made in DSM-5). It's a weakness of the BPS report, mentioned above, that it makes no attempt to discuss the difference between psychosis/schizophrenia and dissociation. The point I'm making is that it is a meaningful discussion to have and we do need to have words to communicate about it.

As Green concludes, "no psychiatric language is able to 'do justice' to the particulars of any given case". However, it serves a function in giving rise to a general form of pragmatic knowledge. DSM-5 has failed in its attempt to move from symptom-based diagnoses to aetiologically-based diagnoses using the latest advances from neurosciences and genetics (see previous post). We need to make the most of this failure (which should have been predicted anyway) to have a better diagnostic understanding of terms like psychosis and schizophrenia, if they have any meaning at all (see another previous post).

2 comments:

cobweb said...

I am using the link in a rather tortuous way to raise awareness of articles published in the BJPsyche Bulletin December 2015..mmie I am using Google to publish a comment as googling peoples' private lives is what is proposed by some as being an acceptable probability

The Special Articles this month are deliberating the supposed ethics of psychiatrists using google/facebook/u tube/twitter etc -to pry into the lives of people they are treating in order to gain more information about them. Some high-minded debate about the rights to invade the human right to privacy sees some getting their knickers in a real twist - suggestions that users should be consulted..why were they not before this rather covert way of behaving by the authors of these papers and the college of psychiatrists published what amounts to one of the most shabby collections of articles they have published yet
Obviously considering that psychiatrists and lets not forget the admin staff and trainees involved are as human as anybody else. some will already be following individuals they have an interest in - when users or the public indulge their curiosity it is seen as unacceptable. even stalking..if this proposal by some of the authors of the special articles is given approval they will be doing nothing but the same but under cover of professionalism. - in a so called democracy this is a shameful idea.

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