Abstract
No abstract available.
Highlights
An adequate understanding of the phenomena of the psychoses remains elusive
These systems served to bring a degree of order into the confusion of psychiatric nosology, and strove to meet, at least to some extent, the criteria of reliability and objectivity in order for psychiatry to achieve its scientific aspirations
One is that certain diagnostic categories have become reified, whereby a tentative, hypothetical construct, having perhaps a degree of validity in the light of current knowledge, is endowed with an inappropriate and confining independent status, and possibly a more doubtful validity in the light of subsequent knowledge. Another related consequence is the relative neglect of phenomenology.[1]
Summary
An adequate understanding of the phenomena of the psychoses remains elusive. This might seem a rather perplexing observation given strenuous research endeavours and a wealth of scientific information, in recent years in the domains of molecular biology and neuro-imaging. Understanding psychotic phenomena must necessarily include the first-person account: neglecting this merely because it does not meet the criteria of scientific objectivity limits understanding and undermines scientific rigour.[3] In current practice there appears to be a gulf between diagnostic explanations and a sufficient understanding of the predicament of the individual in a specific personal and social context.[4] An adequate understanding of the phenomena of schizophrenia, for example, is lacking, and will require an integration of three levels: the neurobiological derangement, the aberrant cognitive processes at the psychological level, and the personal idiosyncratic experience of these processes.[5] Diagnostic explanations and meaningful understanding should not be considered dichotomous, but standard clinical practice and research programmes seem to disregard the need to integrate the two perspectives, both to foster an improved therapeutic alliance and to clarify the neurobiological basis for more disease-specific symptoms.
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