Gordon Parker and the Swedish study: unitary psychosis redividus?

After Goldney ’ s rebuttal of Parker ’ s de haut en bas apothegms, only one question remains to be added: why ignore the elephant in the room: the unitary psychosis? Far from the Swedish study being an incautious feint against papal infallibility, doubts about binary theory go back as far as Kraepelin who, at the end of his life, pointed out that a signifi cant percentage of his dementia praecox cases did recover [1]. “We cannot satisfactorily distinguish between the two diseases. The suspicion remains that we are asking the wrong questions.” No less a fi gure than Berrios criticized the ‘ continuity myth ’ of schizophrenia as almost beyond the reach of empirical correction or falsifi cation [2]. The Cradock and Owen editorial is only the latest fusillade from writers including Kendell, Van Praag and Crow asserting that the time of the binary classifi cation has passed [3,4,5,6]. Manic depressive patients respond just as well to antipsychotic medication as do schizophrenics; there are schizophrenic patients who lead a stable course without deteriorating. Neither condition breeds true; bipolar families always have a higher incidence of schizophrenic relatives. Schizo-affective disorder, occupying an uneasy place between the two classical categories [7], does not breed true, and no one has yet found a biological basis for it [8]. If this does not leave a unitary psychosis as the only option, then any other models make no sense at all and would take us back at least 125 years in nosological terms. The Swedish fi ndings have, as it were, fl ushed the classicists out of their bunkers; their predictable reaction is to man the ramparts with all the weapons at their disposal. Thomas Kuhn pointed out how reluctant members of the scientifi c establishment are to surrender a model on which they have staked their careers, whether for reasons of opportunism, personality or lack of intellectual ability [9]. As Parker ’ s cri de coeur indicates, those attempting to maintain the model of the binary psychoses are forced into increasingly desperate attempts to maintain the sanctity of the dogma – but the emperor, to anyone prepared to look, does not wear any clothes. The twenty-fi rst century requires more fl exible and nuanced responses to understand these fi ndings, lest these followers get left behind with the old paradigm.