deconstructingschizophrenia

Journal of Mental Health (1993)2, 223-238 Deconstructing the concept of ‘schizophrenia’ RICHARD P BENTALL Department o f Clinical Psychology, Whelan Building, Liverpool University P O Bo x 147, Liverpool L.69 3B X Abstract In this articleI challenge two assumptions that informmuch o f traditional research into psychosis:th e assumpt ion that psychotic disorders fall into discrete types such as schizophrenia and the assumption that psychotic experiences and behaviour have no meaning. Illustrating my argument with recent research o n hallucinat ionsand delusions carried out at Liverpool University I show how scientific progress can be mad e b y abandoning the concept o f schizophrenia and focusi ng on particular symptoms. In addition to the scientific advantages o f this approac h, it has the further advantage o f linking the experiences of mentally ill people to the experiences o f ordinary people. Introduction ‘Schizophrenia’ has been described as amongst the most serious o f illnesses afflict- ing modem soc iety. Between one half and one per cent of people in the de veloped wor ld can expect to be diagnosedas ‘schizophrenic’ at some time in their lives (Torrey, 1987). Ye t our un derstandingof ‘schizophrenia’ has no t kept pace with o ur understanding of other serious diseases like cancer or heart disease. Many different theories have been proposed to account for the disorde r, implicating vari- ables as diverse as childhood trauma, early family environment,life stresses, neuropsych- ological, neurophysiologica l and neuroana- tomical abnormalities, diet, genetic endow- ment and even exposure to viruses (Neale & Oltmans, 1980). Indee d, it is no exaggeration to say that every variable known to influence human behaviour has, at one time or another, been identifiedas a potential causeof ‘schizophrenia’. In this article, in which I summarise some arguments I have developed at greater length in a series of previous publications, I will suggest that it is time to abandon the conce pt of ‘schizophrenia’, mainly because it has outlived its usefulnes s. This suggestion is usually attributed to sociological, anti- psychiatric or even antiscientific attitudes. However, I will attempt tojustify my position on scientificgrounds, rather than on the basis of ethical or philosophical arguments. This is not because ethical or philosophical arguments a r e irrelevant to the question of how we construe mental illness but becauseI want to show that it is possible to challenge the traditional approach to psychiatric disorder using the kinds o f evidence which should b e highly valued by psychiatric researchers. Adopting this approach, I will argue that the concept of ‘schizophrenia’ has i mpeded the development o f adequate scientific accounts of psychotic behaviour, that there are ways of thinkingabout psychotic behaviour which do 22 3

deconstructingschizophrenia

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