Approaches to knowledge and understanding of schizophrenia

The author describes the breadth of theories, concepts, and inquiry in psychiatry, and notes areas of major impact on medicine, the brain sciences, and severe mental disorders. Conflicts that sometimes divide the field are often based on a misunderstanding of competing methods. The major explanatory methods are based on the disease construct and questions of mechanism on the one hand, and the life story approach and questions of meaning on the other. Instead of being mutually exclusive alternatives, these methods are complementary and each can enhance the other. The author briefly defines schizophrenia, and notes the major advantages and assumptions associated with choice of a medical model. He argues that a broad medical (the biopsychosocial) model has advantages over more reductionistic models, particularly in accounting for alterations at one level (e.g., biological) associated with perturbation of the system at another level (e.g., psychological). In concluding, the author finds new directions emerging from several disciplines and a mature scientific psychiatry prepared to capitalize on converging opportunities.