Special Aticle

Korean Journal of Schizophrenia Research 2008;11(2):78-88.

“정신분열병은 존재하는가”：이와 관련된 몇 가지 질병분류학적 질문들

Seong Hoon Jeong, MD, PhD

Abstract

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been steadily expanding its influence on the psychiatric community and now accepted as a cornerstone of psychiatric knowledge. Its use is not confined to diagnostic and statistical area but extended to clinical practice, research, legal and administrative purposes. In this process, a diagnostic label “Schizophrenia” defined in DSM is being implicitly regarded as a real nosological entity not as a hypothetical construct. The relationship between a category (=a noun) produced by classification and the referent designated by that category is an age-old problem debated between Aristotelian realism and nominalism. Re-introduction of Neo-Kraepelinian doctrine into DSM gave weight to the Aristotelian realist tradition and favored the strictly scientific medical model. However, careful analysis revealed that the abuse of this realistic doctrine brought about much confusion. The misrecognition of a category (=a noun) as a natural kind pervades our way of thinking and is responsible for the majority of these confusion. Following the tradition of Wittgenstein and Rosch, a hypothesis was formed which argued that the category “Schizophrenia” is not a real existing nosological entity but a hypothetical construct forged by embedded human cognitive activity. The supporting evidence of this hypothesis was looked for in the human tendency to form a prototype and to classify things based on the similarity with the prototype. The entire analysis will outline the Wittgensteinian explanation of the human use of concepts and nouns. According to Wittgenstein, the essential meaning of a concept lies not in the referent but in both the actual use of that concept and the initial problems posed to the users of that concept. In this line, the meaning of “Schizophrenia” may lie in the diverse uses of this concept and the various problems posed by real, suffering patients. This new way of seeing would get rid of many theoretical confusions surrounding the concept “Schizophrenia” and lessen the excessive burden imposed on DSM. The answer to the question “Does schizophrenia exist?” is affirmative not in the sense of an independent nosological entity but in the sense of many unsolved human problems necessitating the use of this concept. (Korean J Schizophr Res 2008;11:78-88)

Key Words: Schizophrenia,DSM,Nosology,Realism,Aristotle,Prototype theory,Wittgenstein.