Schizophrenia - Definition problem

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Increasingly, in acknowledgement of the methodological weaknesses, poor prognostic power, symptomatic variability and general weaknesses inherent in the diagnostic validity of the term 'Schizophrenia', the psychological literature has increasingly tended to focus on specific or discrete symptoms or aspects associated with it (Bentall, 1990). The problems may be categorized as:

Loss of differential meaning

By the 1970's the term schizophrenia had lost much of its differential meaning and had become employed as a "catch all" for insanity (Cooper et al, 1972). So, for example, in the US, Kuriansky et al (1974) reported that in some hospitals 80% of the patients carried the diagnosis.

Inconsistent application in practice

Cooper et al (1972) identified substantial disagreement between psychiatrists in their use of the diagnosis and in particular they drew attention to the very different diagnostic practices used in Europe when compared to the US.

When they recorded video-taped patient interviews, and asked psychiatrists from the other side of the Atlantic to rate them, they found the British practioners were using a more restricted definition that their American collegues.

In response to this finding researchers had to develop a new standardised rating scales to try and define clear criteria for the application of the diagnosis.

The most successful of these is Wing's Present State Examination. This facilitated a higher level of agreement between raters (Wing et al, 1974) which largely solved the problem of unreliability for researchers if not in actual practice for workaday clinicans. Although there has been a tightening of US diagnostic practice and this is now more similar to European guidelines.

Problems with reliablity

Related to this there were a number of studies looking at the inter-rater reliability of the diagnosis.

Spitzer and Fleiss (1974) evaluated the reliability of diagnosis using data from a number of studies and found that the coefficient of agreement between assessors ('kappa') averaged only 0.6. This confirmed Beck et at. (1962) earlier finding that 32% of the disagreement arose as a result of poor and inconsistent measurement of symptomatology and 63 per cent due to unclear and differing criteria.

Mary Boyle

Thomas Szasz

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See also

• Antipsychiatry

Key texts

Books

Cooper J.E., Kendell R.E., Gurland B.J. 1972, Fsychiatnc Diagnosis in New York and London New York: Oxford University Press

Papers

Beck A T, Ward C H, Mendelson M, Mock J E and Erbaugh J K 1962,y Reliability of psychiatric diagnosis: II A study of clinical judgements and ratings, American Journal of Psychiatry 119: 351-7 Kuriansky J B, Deming W F. and Ciurland B J 1974, On trends in the diagnosis of schizophrenia. American Journal of Psychiatry 131: 402-8

Additional material

Papers

• Google Scholar

External links

Schizophrenia as ‘Spiritual Emergency’

    Much needless suffering results from ignorance of the multidemensional nature of the human personality, human psyche or ‘human nature’. Insights on the nature of human nature are revealed by combining Western scientific research with new concepts provided by Eastern psychologies such as Buddhism. These insights can be applied to the study of the healthy healing process involving psychic overload of uncontrollable spiritual growth i.e. spiritual emergency or so-called 'schizophrenia'. Schizophrenia is not a 'mental illness' but an intense transpersonal or ‘spiritual’ experience involving spiritual awakening or ‘spiritual emergence’. It is a chaotic and uncontrollable self-organizing process which has been designated as a psychospiritual crisis or 'spiritual emergency'. The apparent 'craziness' of spiritual emergency reveals the passage into a higher consciousness state required for effective adaptability. The result is so-called 'individuation', 'self-realisation', 'self-actualisation', 'spiritual renewal' or 'rebirth' and represents the affirmation of a life of total well-being or 'high level wellness'. Spiritual emergency is a part of the human condition and involves the 'beyond ego' or 'transpersonal' dimension of human nature. It is therefore a concern of so-called 'depth psychology', also known as 'spiritual psychology' or 'transpersonal psychology'.   
    Schizophrenia has been described as a nonspecific disease by the psychiatric profession. This supposedly devastating condition was originally named by the German psychiatrist Emil Kraepelin (1856-1926). Kraepelin believed that the condition involved an irreversible mental deterioration and coined the term named 'dementia praecox' - Latin for 'prematurely out of one's mind'. It later became clear that the term was a misnomer and a new term was coined in 1910 by Swiss psychiatrist noted for his kindness and humanity Eugen Bleuler (1857-1939). Bleuler was the teacher of Carl Jung and professor of psychiatry at the University of Zürich where he headed the famous Burghölzli Clinic. Since the condition seemed to involve a mental split between thought and emotion Bleuler coined the term 'schizophrenia' for 'splitting of the mind' The term is derived from German 'schizophrenie' from Greek 'skhizein' meaning 'to split' and 'phren' of unknown origin meaning 'heart or mind'. According to Greek etymology,  ‘schizophrenia’actually means 'broken soul' or 'broken heart’. There is still no universally accepted definition of the term. It has been applied to many so-called 'mental illnesses'  including a set of socially and culturally unacceptable thinking and behaviour patterns which other people greatly dislike thus making it a model of unwanted conduct. The condition is largely misunderstood as a result of people’s fear of the unknown.    
    It turns out that schizophrenia is not a disease or ‘mental illness’. It is not a hopeless condition but a brilliant one. In fact schizophrenia is a personal 'story' which involves a natural and temporary self-organising transformative process or crisis of transformation, a ‘psychospiritual crisis’now known as 'spiritual emergency'  - the term coined by psychiatrist Stanislav Grof. Spiritual emergency is a self-healing process involving the dissolution and removal of illusions and false beliefs originating in the programming of social conditioning which gives rise to aberrant thought complexes  and prevent the person from making accurate evaluations for appropriate decision-making for effective social adaptation. In a period spiritual emergency, the person instinctively surrenders to a spontaneous organismic process involving the temporary separation of thought and emotion (‘ego-loss’) which is necessary for the reassessment of  their thoughts without having to deal with the emotional implications. The person undergoes a series of varying stages or ‘episodes’ and eventually learns to grow beyond fear based ego-consciousness, beyond cultural conditioning and the expectations of others to a higher consciousness state and a new level of awareness. The state of so-called  ‘ego-transcendance’is characterised by an inner sense of emotional liberation which allows for increased creativity and the discovery of ideas and behaviours which  increase the effectiveness of social adaptability. Ego-transcendance purifies and sharpens consciousness and therefore results in clarity and a true perception of reality. Accurate perception is a function of moral consciousness or 'intuition' of rational conscience and depends on complete moral or 'spiritual development’ – the defining characteristic of the human psyche or human personality i.e. ‘human nature’.
   And what is human nature?  Human nature can be defined in terms of the universal moral values of humanness, the social values required for survival of the species as a social species i.e. ‘human values’. Human values are universal values of moral justice, understanding or 'knowledge', social responsibilityor ‘peace’, wisdom of compassion or 'lovingkindness' and so on. Awareness of human values results in heightened intuition and social intelligence which is necessary for effective adaptation to the complexities of changing social conditions i.e. 'adaptability'. Human adaptability is a function of the social nature of the human organism as a social organism with instincts for social cooperation and social harmony i.e. ‘social instincts’. These must be cultivated in a process of development of moral consciousness or ‘conscience’. Rational conscience is a product of moral or ‘spiritual’ growth based on the preservation of the integrated functioning of the personality and involves transformation of the self or 'enlightenment' of so-called 'spiritual emergence'.   

     "In the most general terms, spiritual emergence can be defined as the movement of an individual to a more expanded way of being that involves enhanced emotional and psychosomatic health, greater freedom of personal choices, and a sense of deeper connection with other people, nature and the cosmos. An important part of this development is an increasing awareness of the spiritual dimension in one's life and in the universal scheme of things. Spiritual development is an innate evolutionary capacity of all human beings. It is a movement towards wholeness or 'holotropic state', the discovery of one's true potential."  (Stanislav Grof) 

  Spiritual emergence is a gradual dynamic, fluid, naturally ordered and integrated on-going process of personal development into greater maturity and spiritual awareness and involves personal evolution from the limited sense of self or 'ego' and its egocentric perspective to the expanded sense of self beyond ego… the ‘higher self’or 'Self'… and its transpersonal perspective. The transpersonal perspective allows for the attainment of knowledge of one's true nature… or huan nature… as the source of motivation for personal productiveness and creativity or ‘work’ i.e. 'self-knowledge'. As a result of transcendance of the 'ego or ‘ego-transcendance’, the consciousness is expanded, purified and sharpened to allow for a clearer perception of reality. The result is a sense of the wisdom of compassion an understanding of the ultimate connectedness or ‘unity’ of all things and an appreciation for the divinity of humanness. This spiritual awareness allows for more accurate evaluation of changing social conditions and more effective adaptability. Self-knowledge is the source of personal power and creativityi.e. 'self-empowerment’. 

Each person is at a different stage of spiritual emergence depending on the level of their moral or spiritual development.

   Spiritual emergence takes place over a period of years and depends on conditions of freedom in education i.e. 'free education' or 'holistic education'. Holistic education is based on the necessary fulfillment of biologically based motives or ‘human needs’ which must be met in a process of normal moral or ‘spiritual’ development. Human needs include both 'lower' psychological needs for security and self-esteem - the 'ego needs' - and 'higher' psychological needs for moral or ‘spiritual’ development - the spiritual needs for unconditional love or ‘metaneeds. Motivation by the metaneeds… metamotivation’… allows for the discovery of one’s true potential. 

  If in highly sensitive individuals the processs of spiritual emergence is blocked for any reason the person might be warned that their growth is in grave danger and that they rapidly need to make adjustments which are for essential for effective adaptation. The transformation process of spiritual emergence can be so dramatic as to become uncontrollable and reach a point of crisis or emergency. So-called ‘spiritual emergency’is known by many names such as transpersonal experience, transpersonal crisis, psycho-spiritual transformation, psycho-spiritual crisis, spiritual journey, hero's journey, dark night of the soul, spiritual opening, psychic opening, psychic awakening, spiritual awakening, enlightenment, kundalini awakening, kundalini process, kundalini crisis, shamanic initiation, shamanic crisis, psychotic-visionary episode, ego death, ego loss, alchemical process, positive disintegration, post traumatic stress disorder with psychotic features, night sea journey, psychosis, shamanism, mysticism, gnosis, inner apocalypse, and so on. 

    Spiritual emergency is a process of healing and renewal and represents positive transformation of the self. It is characterised by spontaneous alternative consciousness states or ‘realities' in which the person experiences unbearably distressing psychic overload involving chaotic and overwhelming sensory experiences which in fact offer invaluable opportunities for personal growth. The experiences can be frightening and confusing because they appear to be out of context with everyday reality. As a result they are often misunderstood and discredited as being pathological..Hence the medical model of so-called ‘schizophrenia’which in fact is a concern for psychology of the spiritual dimension of human nature i.e. ‘transpersonal psychology’.