Deconstructing schizophrenia

An analysis of the epistemic and nonepistemic values that govern the biomedical schizophrenia concept


Jan Dirk Blom

reviewed by Mira de Vries

I’ve lost count of how many books I’ve reviewed by authors who fail to reach the logical conclusion of their own arguments. Jan Dirk Blom, to use his idiom, takes the cake.

Blom tells us that he doesn’t want to look at the schizophrenia concept from a social, ethical, or political viewpoint, nor does he wish to discuss the interests of the pharmaceutical industry in perpetuating it. Why he doesn’t want to, you’ll find out at the end of this review.

Like Mary Boyle, to whom he frequently refers, Blom tries to expose the schizophrenia concept’s failure to meet the criteria set for disease concepts in biomedicine. However, unlike Boyle, he does not define a valid concept, nor does he provide an example. Blom’s approach is to analyze the writings of the two men who are credited with “discovering” schizophrenia as well as four well-known contemporary authors on the subject, plus the DSM. For this he uses two sets of criteria.

One was devised by the Dutch philosopher Gerrit Glas, and specifies four levels of conception: everyday experience, clinical, scientific, and philosophical.

The other Blom adapts from the book Mystery of Mysteries by Canadian philosopher and biologist Michael Ruse. Blom's version lists seven “epistemic values” which he defines as “truth-seeking” as opposed to cultural or religious values. They are:
  1. internal coherence or consistency;
  2. external consistency, so consistency with other accepted concepts during the same era;
  3. unifying power, or bringing together domains of knowledge which were previously not seen as related;
  4. predictive accuracy;
  5. fertility, by which he means engendering more ideas for research;
  6. simplicity or elegance; and
  7. validity
As Blom's book is rather heavy, literally as well as metaphorically, summarizing his analyses would go beyond the scope of this review. I’d like to lift out just a few interesting points he makes.

Kraepelin’s “dementia praecox” was almost synonymous with degeneration. This is the idea that not only does the individual become progressively worse until he dies, but also his progeny will become worse from generation to generation. Blom suggests that Kraepelin arrived at this theory by fusing Darwinism and Christianity. Degeneration is conceived as evolution in reverse, man's moral decline, triggered by his alienation from nature. It is a medicalized version of the doctrine of original sin. The Biblical Adam and Eve fall from grace, bringing a curse of moral decline on the next generations. Blom tersely mentions the role that Kraepelin’s views on schizophrenia played in fostering nazi atrocities.

It was Bleuler who renamed dementia praecox as schizophrenia, a term he considered better because he rejected the idea of degeneration. Bleuler was otherwise much influenced by Kraepelin, and seemed in no doubt that he was studying the same phenomenon as he. Unlike Kraepelin, Bleuler was a great fan of Sigmund Freud. He also cavorted with a popular medium, whose séances he attended. Though Bleuler regarded schizophrenia a biomedical disease, he used ideas from Freud and occultism to explain the content of psychoses. Blom suspects that Bleuler’s patients were in fact a different population from Kraepelin’s, but he does not explain what he thinks was different about them.

About the DSM Blom states that you can’t criticize its theory, because it doesn’t have any. The DSM states that psychosis is the prominent feature of schizophrenia, yet a few lines later it states that psychosis is not the core or fundamental feature of schizophrenia, contradicting itself. The definition of psychosis has changed so many times, that now the DSM plays it safe by omitting a definition altogether, opting instead for providing examples only, an explanatory method Blom considers suitable for children. One of the most revealing things Blom says about the DSM is buried in an endnote. He points to the lumping together of personality disorders and mental retardation in the same “axis.” This suggests to him that the writers have the concept of degeneration in the backs of their minds.

Having throughout the book demonstrated the invalidity of the schizophrenia concept very well, Blom nevertheless alleges that it is a real disorder. He suggests regrouping it into smaller “hopefully valid symptom clusters” (my italics) and thinking up new names for them as well as new theories to explain them, in the “dynamic and innovative spirit” of Kraepelin and Bleuler. So he is saying that psychiatrists should continue inventing diseases, the way Kraepelin and Bleuler did.

And now, here’s the big enigma: what does a psychiatrist who knows that the schizophrenia concept is fraudulent do for a living? You guessed it. Blom is employed at the Mental Health Service in the Hague (where, by the way, he was trained by Hoek, the epidemiologist). As a bigwig professor, Blom probably doesn’t come into actual contact with the people who are labeled schizophrenic. So what does he do? Unlock the wards and order detoxification of the inmates? We should be so lucky. Here are two quotes, yes, honestly, from the same book:
[M]ost mental health professionals may be trusted not to initiate any treatment until it is deemed necessary and/or desirable” (page 203)
[P]harmacological research resulted in the development of potent medications that are today indispensable in everyday psychiatric practice.” (page 232)
Necessary and/or desirable for whom? Indispensable for what? This is “epistemic”?

Perhaps Blom will dedicate his next book to the newly thought up mental illness categories he proposes. If he includes the viewpoints he was careful to avoid in this book, he could name the next one:

Reconstructing schizophrenia

New excuses for the continuing deprivation of liberty, poisoning, and torture of innocent people formerly called schizophrenics, at the hands of culpable people still called psychiatrists, who are empowered and handsomely paid by our pharmaceutically lobbied government to do so in the guise of biomedical epistemology

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