Value of diagnosis of schizophrenia remains in dispute

EDITOR—Proponents of clinical effectiveness in mental health argue that the problems of psychiatry will be solved by more focused research and a better flow of information from academics to clinicians. A good example of the limitations of this approach is McGrath and Emmerson's review article on the treatment of schizophrenia.1 The authors fail to note that the diagnosis of schizophrenia remains in dispute. The concept has little explanatory power and is scientifically suspect.2 Inclusion in the Cochrane Library does not make it any less controversial.

We are not convinced by their calls for prompt diagnosis. In recent years the word schizophrenia has increasingly taken on negative connotations in the public imagination. Telling a young person that he or she has schizophrenia can have devastating results. In ourclinical work with patients we manage perfectly well without using the diagnosis at all. McGrath and Emmerson's review is devoted almost entirely to drug treatments, with only a small section on psychosocial interventions. Users complain that drugs are often all theyreceive when they are in crisis and in need of human interaction and practical support. Perhaps the affiliations noted as the authors' competing interests—substantial linkswith the pharmaceutical industry—go some way towards explaining their narrow vision.

We believe that the clinical effectiveness paradigm in mental health will do more harmthan good if it is not balanced by a discourse on what we would call ethical issues. These issues are an examination of the values underlying diagnoses and treatments; a questioning of priorities in our work with people in crisis; an examination of the burden we often inflict with our diagnoses and treatments; and a genuine attempt to listen to what service users are telling us about the nature of care.

What in fact is schizophrenia?

EDITOR—Without doubt the question “What is schizophrenia?” is a fascinating one. In their …