Reconsidering the classification of schizophrenia and manic depressive illness--a critical analysis and new conceptual model

Abstract

The idea of 'disease entity' in psychiatry and the nosologic map of insanity with the distinction between dementia praecox (schizophrenia since Bleuler 1911) and manic depressive insanity, originally developed by Emil Kraepelin (1986), is an important landmark in the history of psychiatry (Jablensky 1995). This classification, however, has been vigorously debated throughout the years, and new evidence emerging from epidemiological, clinical, genetic and biological research demonstrates that the two nosological categories have distinct features as well as share many similarities in their risk factors, genetic predisposition, brain pathology, neurophysiology, clinical phenomenology and response to treatment, thus raising questions about the validity of the categorical classification of psychoses. In this paper we examine some of the similarities and differences between schizophrenia and bipolar illness emerging from recent biological and clinical research and attempt to clarify major inherent logical contradictions in the application of the 'disease' model of psychiatric diagnosis to the categorical classification of schizophrenia and bipolar illness. Then we examine how similar predicaments have been resolved in other natural classification systems, namely the biological classification of species and the periodic table of the elements. Finally we propose a hypothetical conceptual approach to the classification of psychoses that has been greatly informed by the organizing principle underlying the periodic table of the elements, and is distinct from the 'disease' model of psychiatric classification.