Tuesday, December 20, 2011

"We don't see things as they are, we see things as we are"

--- The Talmud (also attributed to Anais Nin), quoted by Allen Frances in his review (pay wall) of Richard Noll's American Madness: The rise and fall of dementia praecox in New Scientist, 10 December 2011

Quote in context:
"We don't see things as they are, we see things as we are." This simple Talmudic saying summarises the essence of epistemology. Psychiatric disorders provide a striking example: they are not real things in nature, but labels we create to describe troubling aspects of human experience.

Sometimes labels take on a life of their own. People mistakenly think that naming a psychiatric problem shapes it into a simple disease with a reductionist, biological explanation. Labelling mental disorders is useful in providing a common language and guide to treatment. But psychiatric disorders are remarkably heterogeneous and overlapping in their presentations and complex in their causation. The human brain rarely reveals its secrets in simple answers.

All of which brings us to the wonderful book, American Madness, an artful analysis of the rise and fall of the label "dementia praecox" from its promising birth in 1896 to its unlamented death in 1927. Introduced by the German psychiatrist Emil Kraepelin, the term was used to describe an early onset of psychotic symptoms that presaged a tragic downhill course and poor outcome - as distinct from manic depressive illness, which has a more variable age of onset, cyclical course, and greater chance for a good outcome. 

Later in the piece, Frances notes:
In retrospect, there was nothing inherently superior about either term. Schizophrenia won [over dementia praecox because it was less discouraging, implied therapy might help, was not of German origin when the US was at war with Germany and was of Swiss origin at a time when the two major figures in American psychiatry were Swiss immigrants. If it sounds arbitrary, it was. Human nature doesn't sort into neat and obvious categories.