Psychosis and psychoticism

In previous chapters we have seen that while psychopathology was clearly enmeshed with genius and creativity, the usual psychiatric concepts, e.g. psychosis, were clearly counter-indicated; psychosis (schizophrenia, manicdepressive disorder) was rarely found in geniuses, equally rarely, in creative writers, mathematicians, scientists, or architects, and in any case its diagnosis was so unrealiable, even in live patients studied intensively, that diagnosis on the basis of accounts written centuries ago would be pretty worthless. An even more serious objection would be that the orthodox psychiatric system of nosology is not in line with modern discoveries, and entails many serious defects. The major defect, which is absolutely fundamental, concerns the notion that psychiatric disorders differ qualitatively from normality, just as tuberculosis, or malaria, or mad cow's disease is differentiated qualitatively from healthy normality. Such a categorical differentiation was already criticized by Kretschmer (1936, 1948) and many others, and does not accord with reality (Claridge, 1985). This point will be discussed in more detail presently.

A very relevant weakness, often noted in psychiatric nosology, is the reliability of diagnoses; different psychiatrists very frequently apply different diagnostic labels to a given patient. It is frequently claimed that the arrival of DSM-III, the Diagnostic and Statistical Manual of Mental Diseases, published by the American Psychiatric Association, has overcome this difficulty, and that now all is plain sailing. A recent book by Kirk and Kutchins (1992) has shown clearly that these claims, often made by official sources, are quite unjustified; parturient montes nascetur ridiculus mus! (The mountains will be in labour, to produce a ridiculous little mouse! Horace.)