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Deconstructing schizophrenia
An analysis of the epistemic and nonepistemic
values that govern the biomedical schizophrenia concept
(sic)
thesis
by
Jan Dirk Blom
2003
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:
- internal coherence or consistency;
- external consistency, so consistency with other accepted
concepts during the same era;
- unifying power, or bringing together domains of knowledge
which were previously not seen as related;
- predictive accuracy;
- fertility, by which he means engendering more ideas for
research;
- simplicity or elegance; and
- 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
Copyright © MeTZelf
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