Introduction
Notably, schizophrenia is a severe and typically chronic mental condition that results in long-term impairment, posing a significant personal and social impact. According to Dollfus and Lyne (2017), schizophrenia is marked by “positive (hallucinations, delusions), negative (alogia, avolition, and anhedonia), and disorganized symptoms (speech and behavior),” as well as cognitive decline (p. 1). It is genetically determined, and scientific understanding of its genetic architecture has improved dramatically in the last decade (Legge et al., 2021). Consequently, this advancement has been chiefly made possible by advances in molecular genetics technology, making large-scale genotyping and decoding viable and accessible. Notably, the study explores the term ‘schizophrenia’; it provides a recent analysis that explains the term’s interpretations, whether they are valid and valuable, and how other notions of mental disorder might impact therapeutic interventions. The primary research question is ‘Is the current concept of schizophrenia valid and useful?’ Hence, it is crucial to evaluate the empirical basis to answer the question and discuss the alternative system.
The Current Concept of Schizophrenia and Its Interpretations
Despite its low incidence, schizophrenia contributes significantly to the worldwide disease burden. Charlson et al. (2018) claim that mental conditions account for around thirteen million years of disabled life. Premature death, long-term hospitalization, medication resistance, and poor quality of life are prevalent consequences (Legge et al., 2021; Rund, 2018; Jeganathan & Breakspear, 2021). Moncrieff and Middleton (2015) emphasize that schizophrenia is a classification that suggests the presence of a biological condition because no particular body ailment has been shown, and the vocabulary of ‘sickness’ and ‘disease’ is inadequate to describe the intricacies of mental health issues. Moreover, neither does the term ‘schizophrenia’ refer to people who share similar behavioral responses and characteristics. Some patients struggle with disordered speech and behavior; nonetheless, “more generic terms, such as ‘psychosis’ or just ‘madness,’ would be preferable” because they are less strongly associated with the disease model and allow for the recognition of the uniqueness of each patient’s condition (Moncrieff and Middleton, 2015, p. 264). Thus, this claim needs to be evaluated by demonstrating research evidence.
Essentially, psychiatry has put an excessive and incorrect focus on the therapeutic value of diagnosis. For instance, schizophrenia diagnosis could not provide verifiable hypotheses about pathoetiology, care plans, or control, but instead merely shifts the goalposts with the assertion of forecasting the course, which in reality is based on the deeply embedded chronicity and decay in the interpretation of schizophrenia (Maj, 2018; Guloksuz & Van Os, 2021). Although schizophrenia diagnosis has been primarily regarded as relatively consistent and conclusive, mental health care providers say that inaccuracies and controversies in schizophrenia diagnosis occur regularly in the clinical settings (Bitan et al., 2018). In the event of a schizophrenia diagnosis, mental health doctors’ beliefs regarding the correctness of psychiatric classification are much more significant. According to Bitan et al. (2018), the diagnosis of schizophrenia influences the expectations of mental health and primary care providers, such as patient adherence and capacity to manage their condition and their medical decision-making. Thus, the classification system of schizophrenia has its flows, and there is a need for an alternative method.
The term ‘schizophrenia’ is outdated and decaying; the debates on reliability continue among various scholars and researchers. For instance, Moncrieff and Middleton (2015) demonstrate their key findings to support the claim based on scientific research. First, the illness paradigm of schizophrenia is unsupported by data, and it misrepresents psychiatric care’s true purpose. Essentially, a century of research has failed to uncover evidence of a particular abnormality in the structure or function of the brain, or any other part of the body, that causes schizophrenia. Studies indicating lower brain size and greater brain cavities compared to ‘normal controls’ are the most consistent data offered as differentiating those diagnosed with schizophrenia (Moncrieff & Middleton, 2015). Lastly, the term ‘schizophrenia’ is not linked to any particular pattern of aberrant behavior or results. Additionally, patients with mental and behavioral issues have traditionally been cared for and contained without reference to the illness paradigm. Thus, to establish more inclusive and participatory mental health care, it is vital to abandon the disease model.
The Alternative System
Essentially, schizophrenia has become the main prism through which everything ‘psychotic’ is evaluated. For instance, Guloksuz and van Os (2017) suggest that schizophrenia only covers thirty percent of a much greater multifaceted psychotic condition, even affective states with mild psychosis labeled ‘ultra-high risk.’ Canon et al. (2016) claim that the ultra-high risk paradigm of schizophrenia, which focuses on psychosis, is ineffective in predicting schizophrenia transition. In medical practice, there is an illusion of etiological specificity. Hollander et al. (2020) state that the research thus far indicates that the genesis of mental diseases is multicausal, interdependent, interacting, and non-specific elements that contribute to essentially common behavioral, social, and biological mechanisms; schizophrenia is one of a kind.
Dopamine and glutamate are two of the most popular explanations for the disorder’s neurobiology. Fresh data from in vivo imaging studies and experimental results on the involvement of both neurotransmitters in schizophrenia has enhanced knowledge of dopamine and glutamate dysfunction in schizophrenia (Howes et al., 2015). According to Howes et al. (2015), the evidence that has permitted considerable revisions of the dopamine hypothesis of schizophrenia has accumulated in the first decade or so of the twenty-first century. Thus, the predominant dopaminergic aberration is anticipatory, that it occurs at the outset of sickness and is linked to psychosis. Moreover, the glutamate hypothesis has continued to get empirical support in the twenty-first century, with multiple converging lines of evidence showing that a glutamatergic imbalance may be at the root of schizophrenia (Howes et al., 2015). While there have been substantial breakthroughs in understanding the nature of glutamate malfunction in schizophrenia, some discrepancies have not resulted in significant therapeutic advances.
Thus, schizophrenia is a mental condition with unknown and likely varied causes. While the condition can have various effects, a study has primarily been deficit-oriented, highlighting the difficulty that the disorder causes patients, their relatives, and the community (Moritz et al., 2018). Guloksuz and Van Os (2021) highlight the failure of psychiatry to conceptualize psychosis as a multifaceted symptomatic variation with a mostly uncertain trajectory and outcome–both within and across individuals–limits research and recovery-oriented therapy. A multimodal exploration of genetic vulnerability at multiple levels of environmental interaction utilizing an objective multidimensional evaluation of the psychosis spectrum that is not distorted by present diagnostic categories might help understand psychotic occurrences better (Guloksuz & Van Os, 2021). Additionally, the clinical practice now requires professionals to make rapid judgments under strain. As a result, the central question regarding the multidimensional psychosis spectrum approach is whether it will be beneficial or burdensome in the hectic routine of clinical practice, which includes ever-increasing organizational requirements and a persistent disparity between medical load and psychological health workforce around the globe.
The idea of reifying mental diagnostic categories as separate entities is causing increasing discomfort. Guloksuz & Van Os (2021) argue that the investigation of the causes of schizophrenia has provided no practical or concrete information. The US National Institute of Mental Health (NIMH) established Research Domain Criteria (RDoC) and Hierarchical Taxonomy of Psychopathology (HiTOP) as alternatives to categorical conceptualization, specifically for research purposes (Guloksuz & Van Os, 2021). Although the multidimensional evaluation of schizophrenia was offered as ’emerging measures’ and the terminology was somewhat changed to ‘schizophrenia spectrum disorder,’ these revisions had little influence on the therapeutic application of schizophrenia.
Scholars and medical professionals clearly need additional research to suggest radical modifications in the nosology of mental diseases, including schizophrenia. As a result, Guloksuz and Van Os (2021) offer a modest solution that emphasizes the relevance of clinical characterization above diagnostic reductionism to provide a basis for a better conceptual framework and improved clinical practice. They adopt a trans-syndromal framework of mental suffering while maintaining an umbrella syndrome categorization, namely, psychosis spectrum disorder, to meet clinical practice standards and urge clinicians and academics to go outside the bounds of schizophrenia (Guloksuz & Van Os, 2021). In fact, the following approach is proposed: psychotic spectrum and clinical characterization together (Guloksuz & Van Os, 2021; Guloksuz & Van Os, 2020). Because the term “schizophrenia” has permanent negative connotations and suggests endorsement for a separate entity, renaming is necessary (Guloksuz, S., & Van Os, J., 2018; Moncrieff & Middleton, 2015). Hence, the name change for the disorder will permit looking beyond the present schizophrenia concept’s imagined limitations.
Conclusion
To conclude, the current definition of schizophrenia is neither reliable nor helpful because it does not correspond to a known condition and does not depict a predictable pattern of behavior. Thus, the term ‘schizophrenia’ may be replaced by ‘psychosis.’ Additionally, to fulfill clinical practice standards and encourage clinicians and academics to go beyond schizophrenia, the alternative model was proposed – a combination of the psychotic spectrum and clinical classification. The remaining question and area for future research is the primary concern is whether the multidimensional psychosis spectrum method would be advantageous or problematic in clinical practice’s frenetic schedule.
References
Bitan, T. D., Grossman Giron, A., Alon, G., Mendlovic, S., Bloch, Y., & Segev, A. (2018). Attitudes of mental health clinicians toward perceived inaccuracy of a schizophrenia diagnosis in routine clinical practice.BMC Psychiatry, 18(1). Web.
Cannon, T. D., Yu, C., Addington, J., Bearden, C. E., Cadenhead, K. S., Cornblatt, B. A.,… & Kattan, M. W. (2016). An individualized risk calculator for research in prodromal psychosis.American Journal of Psychiatry, 173(10), 980-988. Web.
Charlson, F. J., Ferrari, A. J., Santomauro, D. F., Diminic, S., Stockings, E., Scott, J. G., McGrath, J. J., & Whiteford, H. A. (2018). Global epidemiology and burden of schizophrenia: Findings from the global burden of disease study 2016. Schizophrenia Bulletin, 44(6), 1195–1203. Web.
Dollfus, S., & Lyne, J. (2017). Negative symptoms: History of the concept and their position in diagnosis of schizophrenia.Schizophrenia Research, 186, 3–7. Web.
Guloksuz, S., & Van Os, J. (2018). Renaming schizophrenia: 5 × 5.Epidemiology and Psychiatric Sciences, 1–4. Web.
Guloksuz, S., & Van Os, J. (2020). Dr. Strangelove, or how we learned to stop worrying and love uncertainty. World Psychiatry, 19(3), 395–396.
Guloksuz, S., & Van Os, J. (2021). En attendant Godot: Waiting for the funeral of “schizophrenia” and the baby shower of the psychosis spectrum.Frontiers in Psychiatry, 12, 1-5. Web.
Hollander, J. A., Cory-Slechta, D. A., Jacka, F. N., Szabo, S. T., Guilarte, T. R., Bilbo, S. D., Mattingly, C. J., Moy, S. S., Haroon, E., Hornig, M., Levin, E. D., Pletnikov, M. V., Zehr, J. McAllister, K. A., Dzierlenga, A. L., Garton, A. E., Lawler, C. P., & Ladd-Acosta, C. (2020). Beyond the looking glass: Recent advances in understanding the impact of environmental exposures on neuropsychiatric disease.Neuropsychopharmacology, 45, 1086-1096. Web.
Howes, O., McCutcheon, R., & Stone, J. (2015). Glutamate and dopamine in schizophrenia: An update for the 21st century. Journal of Psychopharmacology, 29(2), 97–115.
Jeganathan, J., & Breakspear, M. (2021). An active inference perspective on the negative symptoms of schizophrenia.The Lancet Psychiatry. Web.
Legge, S. E., Santoro, M. L., Periyasamy, S., Okewole, A., Arsalan, A., & Kowalec, K. (2021). Genetic architecture of schizophrenia: a review of major advancements. Psychological Medicine, 1–10. Web.
Maj, M. (2018). Why the clinical utility of diagnostic categories in psychiatry is intrinsically limited and how we can use new approaches to complement them. World Psychiatry, 17(2), 121–122.
Moncrieff, J., & Middleton, H. (2015). Schizophrenia: A critical psychiatry perspective. Current Opinion in Psychiatry, 28(3), 264-268.
Moritz, S., Mahlke, C. I., Westermann, S., Ruppelt, F., Lysaker, P. H., Bock, T., & Andreou, C. (2018). Embracing psychosis: A cognitive insight intervention improves personal narratives and meaning-making in patients with schizophrenia.Schizophrenia bulletin, 44(2), 307-316. Web.
Rund, B. R. (2018). A review of factors associated with severe violence in schizophrenia. Nordic Journal of Psychiatry, 72(8), 561-571. Web.