Schizophrenia: An Unfinished History

Summary

In Schizophrenia: An Unfinished History, Orna Ophir summarizes the history of the concept of schizophrenia, with a focus on its psychiatric definition, diagnosis, and lived experience. The book begins with descriptions of madness from biblical stories and antiquity, discusses the transition from the diagnosis of dementia praecox to schizophrenia through histories of clinical psychiatry and psychoanalysis, analyzes the shifting definition of schizophrenia in the DSM-5, discusses the Hearing Voices Movement and the stigma associated with schizophrenia as a label, and discusses the clinical ethics of the diagnosis and efforts towards its abolition.

The book has an introduction and seven chapters. The introduction sets forth the book's analytical framework. Ophir situates psychiatric and social views of schizophrenia within mutually exclusive paradigms. On the one hand, there is a "categorical" approach that defines schizophrenia as a natural, biological construct that is different in kind from normal behavior and cognition. On the other hand, she contends that others take a "dimensional" view of schizophrenia as existing on a spectrum or continuum, reflecting matters of degree in human behavior.

In the first four chapters of the book, Ophir applies the book's analytical framework to the history of schizophrenia. Chapter 1 discusses historical examples from the Bible and ancient Greek and ancient Roman medicine through the 20th century. Chapter 2 summarizes the history of the development of the diagnosis of schizophrenia, from its 19th century predecessor dementia praecox, in the early 20th centuries by Emil Kraepelin, who took a categorical approach, and Eugen Bleuler, who viewed schizophrenia as being on a spectrum. Chapter 3 analyzes a debate over Freud's competing views of schizophrenia, one of which Ophir argues was categorical and the other dimensional. Chapter 4 analyzes the text of schizophrenia's diagnostic criteria and accompanying materials in the various versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), from the first edition in 1952, DSM-I, to the 2013 DSM-5.

Chapters 5 focuses on the Hearing Voices Movement and how people who hear voices have reframed their experiences against categorical discourses. Chapter 6 discusses popular and clinical efforts to rename or abolish schizophrenia as a diagnosis. Chapter 7 concludes with a discussion of the clinical ethics of diagnosing a patient with schizophrenia.