When Kraepelin's dementia praecox (1896) and Bleuler's schizophrenia (1908) were introduced as discrete natural disease entities, accurate differential diagnosis became a necessity for both clinical and research purposes. Objectivity, the...
moreWhen Kraepelin's dementia praecox (1896) and Bleuler's schizophrenia (1908) were introduced as discrete natural disease entities, accurate differential diagnosis became a necessity for both clinical and research purposes. Objectivity, the containment of subjectivity, became a core value of the new scientific self of the psychiatrist. Focusing primarily on psychiatrists in the US in the early 20 th century, I will trace the evolution from a " scientific self of subjectivity " as a basis for diagnosing schizophrenia that relied on psychiatrists' " feelings " or bodily sensations provoked by a patient, to the development of " objective " symptom rating scales in the late 1920s and, in 1933, their linkage with factor analysis as a statistical tool for identifying invisible (latent) dimensions of structure behind the chaos of psychosis. Despite their hypothetical nature, researchers have tended to reify factors and occasionally invoke them as causative agents. I will argue that rating scales, which do not " count " anything at all and reside on the threshold of objectivity, and factor analysis, an exploratory but not a confirmatory statistical method, have been central to the dissolution of the schizophrenia concept. Reified factors of psychosis have replaced schizophrenia as objects in psychiatry. But a never-ending cycle of " deconstructing psychosis " into further hypothetical constructs that " exist " in a realm of Platonic pretensions outside the direct experience of the physician challenges claims of enhanced objectivity in diagnosis.
