A framework for the analysis of theoretical and therapeutic approaches to schizophrenia

IN previous work we have begun to articulate a conception of psychiatry as a profession and to show how this conception may be useful in examining specific controversial issues such as national health insurance and the concept of prevention in psychiatry (Astrachan, Levinson, and Adler 1976; Adler, Levinson, and Astrachan 1978). We define a profession not in terms of its varied theories or forms of practice, but in terms of the major tasks it must perform and the perspectives it takes regarding these tasks. Historically, psychiatry has been committed to four major tasks. These interconnected tasks have been sanctioned by society, and all must be addressed if psychiatry is to retain its credibility and legitimacy. In practice, the tasks frequently are intertwined, yet they are conceptually distinct. In the present paper, we use this conception of psychiatry as a framework for the analysis of the many approaches that have been taken to the understanding and treatment of schizophrenia. Each task is defined in terms of a problematic condition to be controlled or eliminated: illness, defect, deviance, impeded growth. The rationale for work on each task is given by a corresponding theoretical perspective. There is marked disagreement, and often bitter controversy, about the validity of different theories, the value of different treatments, and even the legitimacy of various approaches. Let it be clear, then, that our goal is not to evaluate specific concepts and techniques, nor to argue that one task or perspective is more legitimate than any other. Our goal, rather, is to clarify the nature of the disagreement and to present a comprehensive framework within which different approaches to schizophrenia can be understood and compared and then reconnected in practice.