Going Beyond Classic Descriptions to Future Phenomenology of Schizophrenia

Abstract

The symptoms of schizophrenia span a wide range of psychopathology and display an extraordinary amount of interindividual and temporal variability. Over time, authors have invested different diagnostic value to symptoms, depending on their theoretical point of view. For Emil Kraepelin, dementia praecox was a nosological entity and the negative symptoms—Verblodung—were characteristic; for Eugen Bleuler, schizophrenia was a heterogeneous syndrome and thought disorders were the distinctive feature; and for Kurt Schneider, schizophrenia was a diagnostic convention and certain disturbances of the experience—the so-called first-rank symptoms—were the defining features. With the publication of the Feighner criteria in 1972, a number of operational diagnostic systems were developed on either statistical or theoretical grounds. This led to a “Babel of diagnostic formulations” and then consensus diagnostic systems, best exemplified by the DSM and International Classification of Diseases criteria. The schizophrenia construct of the DSM editions (particularly DSM-III) has been the most influential, both in clinical practice and in research. The main purpose of the DSM system is to achieve greater diagnostic reliability. This objective has been largely met, but reliability does not ensure validity. The DSM schizophrenia concept represents an oversimplified and incomplete view of the clinical picture leading to the (wrong) assumption that we are confronted with a simple, clear, and discrete disorder. Indeed, the putative atheoretical and pragmatic approach of the DSM classification has provided us with a mixture of arbitrary inclusion, exclusion, and duration criteria of clinical phenomena. 1