Forty-five years of schizophrenia: personal reflections

Abstract

International audienceViews about schizophrenia can change dramatically, even within one lifetime. In order to illustrate such changes over the last forty-five years, this article uses the example of ‘Mandy', a composite woman patient with a diagnosis of schizophrenia. It shows that, although there have been many advances over this period, understanding of schizophrenia continues to be elusive, and treatments remain imperfect. Therefore, as perspectives shift and the ground moves beneath us, the psychiatric profession needs to anchor itself firmly in the stories our patients tell us

Historical Perspectives on Mental Health and Psychiatry

“…Initially, there were no rating scales, and results were reported in a narrative fashion. 37 This all was swept away. As Ann Donald in an article in Culture, Medicine, and Psychiatry argues, one result was the introduction of 'algorithms of care' or 'Wal-Marting'.…”

Critical psychiatry is becoming Luddite

“…If we look at the history of psychiatry it is only when, and only very recently, the discipline has followed the path of medical scientific enquiry, that we have gained knowledge. Neurofibrillary tangles in Alzheimer's disease, lithium for bipolar disorder, cognitive–behavioural therapy for traumatic stress disorders, methylphenidate for attention-deficit hyperactivity disorder, therapeutic communities for personality disorder; the advances here have all been made by following systematic independent evaluation, including personal stories (Seeman 2006), qualitative and observational studies. All NICE guidelines follow the same approach and there is no difference in the form of this evaluation between medical and psychiatric disorders.…”