The core Gestalt of schizophrenia

Abstract

The recent debate in World Psychiatry on prototypes versus operational criteria 1 invites a prototypical reassessment of the clinical-phenomenological presentation of schizophrenia, especially in the light of recent developments in phenomenological psychopathology 2. Although schizophrenia has been intensively studied for more than a century, with a bewildering accumulation of empirical data, we have still only a very partial understanding of its diagnostic boundaries 3 and pathogenetic mechanisms 4,5. This epistemic resistance motivates a variety of responses: e.g., shortcutting the phenotype-related problems by studying more easily graspable proxy variables; attempts to convert schizophrenia into a dementia-like neurocognitive disease; proposals of further simplification of psychopathological diversity (e.g., the notion of a “unitary psychosis”); or elimination of the notion of schizophrenia altogether. It seems unlikely, however, that a strategic evasion of a defiant phenotype and silencing the epistemological problems associated with this defiance will somehow lead to an ultimate scientific enlightenment. One additional and timely response is to reexamine the clinical nature of schizophrenia, highlighting its distinctiveness and the theoretical difficulties of its current nosological representations. Perhaps, the epistemic difficulties are related to a disappearance of the phenomenological distinctiveness of schizophrenia in its reifying operational permutations.