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Oxford Medicine Online. Publications Pages Publications Pages. Intentionality: an essay within the philosophy of brain. Cambridge, united kingdom: Cambridge college Press. Spence, S. Alien keep an eye on: from phenomenology to cognitive neurobiology. Spitzer, M.
Kant on schizophrenia. In: Philosophy and psychopathology ed. Spitzer and B. A cognitive neuroscience view of schizophrenic concept affliction.
Schizophrenia Bulletin, 29— Stanghellini, G. For an anthropology of vulnerability. Psychopathology, 1— Psychopathology of logic. This sort of analysis leads to ideas for how to effect meaningful change; but the ideas are of an essentially socio-political character: e. A second example concerns the recognition that entrenchment of the con- cept of schizophrenia is maintained by the shaping of perception, thought, and action of the public, policy makers, other scientists, and most importantly future generations.
Such shaping is accomplished by promulgating entrenched ways of thinking through public relations and advertisement campaigns e. This risk is especially severe when a crisis exists in a scientific sub-community, and it is made worse when scientists in adjacent sub- communities become co-opted e. And, how we answer these questions will directly affect how we conceive the phenomenon of interest and how we approach scientific, clinical, and social issues focused upon it.
In the light of this sort of understanding, a variety of targets and ideas for action are suggested: e. And, with respect to the training of researchers, in light of the issues of scientific expertise described above, improvements should reach not just those who are directly involved in research concerning mental illness, but also researchers in adjacent or embed- ding fields as well e.
This line of thought clearly requires more systematic development, but the thrust is clear: strategies for protecting against this sort of co-opting of the larger scientific community as well as the general public should be developed. First, the ideas of the scientific and socio-political critics concerning the concept of schizophrenia and related practices should be refined and integrated to produce more effective arguments and more effective frameworks within which to pursue change in all areas of mental health practice.
Second, when critical scrutiny of both sorts is aggressively pursued, the scientific and pragmatic arguments for change become overwhelming and the targets for effective revolutionary action come into view. This usage does not carry with it any implication regarding disease, disorder, or dysfunction in any of the technical senses advanced in the literature.
I will be assuming for present purposes that a demonstration of the lack of construct validity of SZ schizophrenia will be sufficient for establishing the lack of scientific justification for believing that schizophrenia exists.
The following description of the NDMS and the evidence advanced in its support is based upon materials found in Weinberger , Green , , Johnstone et al. The purpose of constructing such a map is to clarify and make salient the various elements and relations that become the object of an evidential assess- ment, as roughly outlined in the text and the next footnote. Space limitations prohibit more systematic presentation of the assessment strategy alluded to here. Intuitively, a given study or group of studies that support an empirical finding e.
Those factors concerning how much bearing an empirical finding has on a certain target statement is a matter of relevance, whereas those factors concerning how much evidential support a finding provides, assuming that it bears on the target, is a matter of force.
In short, the evidential strength provided depends on the extent to which a finding bears on a target statement and the degree of support the finding provides.
In such a case, the construct, is a free rider contributing nothing beyond the contribution of the included feature. These points are consistent with the fact that many clinicians and researchers use the concept in their various practices to make decisions, and, indeed, with the fact that many clinicians and researchers have a strong sense that the concept is useful. Such psychological and sociological facts do not entail that the clinical work is getting done effectively or that the research is productive.
Presumably, we would not be inclined to say either that this validates the category of demonic possession or that the label is therefore justifiably employed in clinical practice. The reason is that responsiveness of specific features in some members of a class is consistent with the class being artificial and problematic.
This way of framing the issues and the argument for revolution has been heavily influenced by the work of Hacking Information regarding the character of this process is more available than it had been in the past due to the publication of the DSM sourcebook and related development documents. The process of developing recent versions of the DSM has been subjected to critical scrutiny by Kirk and Kutchins , and Caplan , among others.
See Poland , for reviews of the first and second volumes of the sourcebook. Under such conditions i. This, at least, is the risk to which we are currently vulnerable. See Poland and Spaulding forthcoming for discussion, and see Kitcher , and Longino , for more general discussions of authority in science.
Recent work in the philosophy of science suggests that such a distinction is bogus, that attempts at demarcation are fruitless, and that deeper analysis reveals that the social the moral, the political is an essential dimension of the scientific.
Neither of these points means that there is no such thing as scientific objectivity; they mean that we need a more sophisticated understanding of what such objectivity consists. See Kitcher , , Longino , , and Lacey for important, but somewhat different, approaches to these ideas.
A version of this paper was presented to the Philosophy Department at Washington University during the Fall of References American Psychiatric Association Washington: American Psychiatric Association Press.
American Psychiatric Association Washington: American Psychiatric Asso- ciation Press. Andreasen, N. Brave new brain. New York: Oxford University Press. Barr, C. Exposure to influenza epidem- ics during gestation and adult schizophrenia: a 40 year study. Archives of General Psychiatry, — Bentall, R. Reconstructing schizophrenia. New York: Routledge.
Bogen, J. Saving the phenomena. Philosophical Review, — Boyle, M. Schizophrenia: a scientific delusion? London: Routledge. Reading: Addison-Wesley.
Cromwell, R. Preemptive thinking and schizophrenia research. In: Nebraska symposium on motivation, vol. Spaulding , pp. Lincoln: University of Nebraska Press. Crow, T. Prenatal exposure to influenza as a cause of schizophrenia: There are inconsistencies and contradictions in the evidence. British Journal of Psychiatry, — Done, J.
Complications of pregnancy and delivery in relation to psychosis in adult life: data from the British Perinatal Mortality Survey Sample. British Medical Journal, — Frances, A. DSM-IV guidebook. Gottesman, I. Schizophrenia genesis: the origins of madness. New York: Freeman.
Green, M. Schizophrenia from a neurocognitive perspective. Boston: Allyn Bacon. Schizophrenia revealed. New York: Norton. Hacking, I. The social construction of what? Cambridge: Harvard University Press. Heinrichs, R. Schizophrenia and the brain: conditions for a neuropsychology of madness.
American Psychologist, — In search of madness. Johnstone, E. Schizo- phrenia. Cambridge: Cambridge University Press. Kirk, S. Hwang,Paul C.
And, once made, it was once among the most limited, offering few options in the management of care for schizophrenia patients with comorbid conditions. It was not until , with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition DSM-IV , that diagnostic guidelines first permitted additional diagnoses on Axis I, such as anxiety disorder, in the presence of schizophrenia.
Yet remnants of the old hierarchical diagnostic system remain, diverting attention from the pressing issue of managing what appear to be common -- and treatable -- disabling conditions, such as panic disorder and obsessive-compulsive disorder OCD , that often occur with schizophrenia.
Schizophrenia and Comorbid Conditions: Diagnosis and Treatment lays diagnostic oversimplification of schizophrenia to rest once and for all. All schizophrenia patients are not the same. The editors of this groundbreaking work criticize the reductionist view of schizophrenia as a single unitary disorder -- a view that has led many psychiatrists and mental health care professionals to overlook potentially important syndromes.
Asserting that these patients should be managed on the basis of their individual clinical presentations, not just their categorical diagnosis, recognized experts in their specialties offer a fascinating array of topics. Chapter 1 goes straight to the heart of this assertion, beginning with epidemiology and showing how hierarchical diagnostic concepts keep associated psychiatric syndromes APS hidden from clinical and scientific attention.
Also presented are the findings of the few treatment studies of APS in schizophrenia. Additional chapters feature the following topics: Chapter 2 takes an indepth look at the extensive literature on depression in patients with schizophrenia, including a discussion on differential diagnosis and treatment approaches. Chapters 3 and 4 detail obsessive-compulsive disorder and panic symptoms, using case vignettes to illustrate the clinical management of schizophrenia with these two conditions.
Chapters 5 and 6 discuss the recognition and management of medical and surgical illness and the management of pregnancy in patients with schizophrenia, respectively. Chapter 7 reviews cognitive impairment in older patients with schizophrenia, including etiology, assessment, and treatment approaches.
Chapter 8 presents old and new approaches to the treatment of aggressive behaviors and violence in patients with schizophrenia. Chapter 9 extensively reviews substance abuse in schizophrenia, with suggested practical approaches to assessing and treating the "dual-diagnosis" schizophrenia patient.
Intended to help practitioners enhance their recognition of and improve treatment for the large -- and often neglected and clinically challenging -- group of schizophrenia patients with comorbid conditions, this unique collection combines a wealth of clinical and research experience of enduring value to practitioners and researchers alike.
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