Psychiatry - July 2008 - (Page 64)

physical object like the brain?” etc.). Nonetheless, my review of numerous pathology texts belies the claim that they do not recognize schizophrenia as a bona fide form of disease. Even bipolar disorder is gradually achieving recognition as a disease in some recent texts, though this is beyond the scope of the present commentary. Let us begin with Boyd’s Introduction to the Study of Disease, Eleventh Edition, published in 1992.13 The author, Dr. Huntington Sheldon, was at the time a professor of pathology at McGill University. Dr. Sheldon classifies schizophrenia under the rubric of “functional disorders.” He goes on to argue that schizophrenia “…might be United Kingdom. All told, there are seven pages in the text that deal with schizophrenia. Schizophrenia is considered in detail in the chapter entitled, “Psychological and social aspects of disease.” [italics mine] Phillips, et al., observe that, “A variety of clinical investigations and imaging techniques…have revealed a number of interesting findings [in schizophrenia], including evidence of cerebral atrophy, left temporal lobe dysfunction, [and] evidence of neuronal loss and disorganization.”14 The text goes on to note that the significance of the “inconsistent” pathological findings in schizophrenia are “…a matter of current speculation;” however, there follows a critically important statement: “…the biology of this false claims that schizophrenia and related disorders are not recognized as diseases outside of psychiatry damage both our profession and those whom we treat. regarded as a cancer of the mind, gnawing into the very soul of the patient.”13 Now, those who believe that schizophrenia is only a “metaphorical” disease may dismiss Sheldon’s vivid description as mere poetic imagery—not the stuff of hard science. Yet Sheldon goes on to note the beneficial effects of hemodialysis in “a small group of schizophrenics…” leading him to hypothesize that there may be “…a biochemical substance…that directly affects the ordered functioning of the central nervous system” in schizophrenia.13 Almost a decade after Dr. Sheldon wrote this, we find another discussion of schizophrenia in the textbook, Biology of Disease, Second Edition, by Phillips, Murray, and Kirk.14 Although this is arguably not a standard textbook on pathology (it also aims to encompass elements of clinical medicine), Dr. Murray was then in the department of pathology at the University of Birmingham, 64 Psychiatry 2008 [ J U L Y ] disease is as yet poorly understood.”14 [italics added] Now, critics of psychiatric diagnosis may rush to seize upon the words “poorly understood”—but that would be a philosophical error of the first magnitude. The biology of many diseases, including some types of cancer, is “poorly understood.” The critical words are “this disease.” There is simply no question that the authors of the text view schizophrenia as a disease—and that this classification is not dependent on our having a full understanding of schizophrenia’s biology. The meanings of words do not drop on our heads like Platonic Forms falling from heaven. As the philosopher Ludwig Wittgenstein argued,15 meanings evolve in human contexts to serve human—and humane—needs. That is precisely why Phillips, Murray, and Kirk14 can comfortably use the term disease in reference to schizophrenia and have confidence that thousands of readers will understand why they do so. Other references to schizophrenia may be found in standard pathology texts, such as the Oxford Textbook of Pathology.16 Interestingly, in the latter, schizophrenia is briefly mentioned in the chapter entitled, “Molecular genetic analysis of coronary artery disease.” The authors are discussing a number of medical conditions and their familial patterns: “Early heart attacks…noninsulin dependent diabetes, hypertension, schizophrenia, and some types of cancers often ‘run in families;’ but all of these disorders also have a strong environmental component.”16 Critics of psychiatry sometimes make much of the distinction between disease and disorder; in fact, however, these terms are used almost interchangeably, if not promiscuously, in the historical literature of medicine.10 It is evident, in any case, that for the Oxford Textbook authors, schizophrenia is in the same basic “family” of conditions as diabetes mellitus and some types of cancer. Arguably, the coup de grace for the claim that pathology texts don’t recognize schizophrenia is delivered by the book, The Neuropathology of Dementia edited by Esiri and Morris, in which 20 pages of text (including an entire chapter by Harrison) discuss the neuropathology of schizophrenia.17 Finally, even one textbook of forensic pathology18 includes a brief discussion of schizophrenia as an example of “endogenous mental disease.” OTHER MEDICAL TEXTBOOKS Pathology texts are by no means the only non-psychiatric medical textbooks that include mention or discussion of schizophrenia. Consider, for example, Blumenfeld’s textbook, Neuroanatomy Through Clinical Cases.19 This book contains 17 pages with references to schizophrenia. In one of the case vignettes (Case 10.6, p. 403), we are presented with a 64-year-old woman “talking ragtime.” She is said to have

Table of Contents Feed for the Digital Edition of Psychiatry - July 2008

Psychiatry - July 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Reliability of Diagnoses: Do Psychiatrists Use Structured Interviews In Real Clinical Settings? Trend Watch: Use of Atypical Antipsychotics in the Elderly Review: The Struggle for Mental Healthcare in New Orleans-One Case at a Time Psychotherapy Rounds: Psychotherapeutic and Adjuntive Pharmacologic Approaches to Treating Posttraumatic Stress Disorder Original Research: Baseline Dissociation and Prospective Success in Special Forces Assessment and Selection Commentary: Performance-Enhancing Drugs: Where Should the Line Be Drawn and By Whom? Commentary: Psychiatric Diagnosis and the Pathlogist's View of Schizophrenia Journal Watch Classified Advertising Information for Authors

Psychiatry - July 2008

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