The dominant neo-Kraeplinian biomedical paradigm of schizophrenia and its failures: Time to tell the Emperor to get dressed?

Andrew Moskowitz1; 1Aarhus University, Denmark

Emil Kraepelin (1856-1926) was convinced that brain pathology would ultimately be found for mental disorders. This certainty derived from his obsession with General Paresis (GP) – convincingly linked to tertiary syphilitic infections early in his professional career. GP served as Kraepelin’s model disease entity, or paradigm, for his concepts of Manic-Depressive Insanity and Dementia Praecox. Evidence for this assertion, along with the true history behind Kraepelin’s famous diagnostic cards, will be presented. Next, the fundamental links between Kraepelin’s assumptions and those driving the current diagnostic system will be elucidated – particularly, the emphasis on categorical entities and biological determinism. The lack of evidence for the basic assumptions of the biomedical paradigm, despite decades of research, will be presented. Similarities between structural brain abnormalities associated with schizophrenia and those found after early childhood adversity will be used to argue for the need for paradigm change. Then, the importance of dissociation for understanding schizophrenia will be presented. Beginning with Eugen Bleuler’s (1857-1939) original dissociation-driven concept of schizophrenia, links between dissociation and schizophrenia will be presented, including evidence that auditory hallucinations are dissociative in nature. It will be argued that any new paradigmatic way of understanding schizophrenia should take dissociation into account, as well as childhood adversity. The talk will end with a discussion of the possible barriers to paradigm change, and speculation as to when a ‘tipping point’ will be reached, and a genuine scientific revolution in psychiatry ensue. Until then, we will have to continue to admire the Emperor’s existing wardrobe.

Topic Area: Diagnosis and Phenomenology

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