Fifty Years: Do Over or Move Forward

Abstract

The following text reflects remarks presented at the 2016 SIRS meeting where four of us from the durable goods department were asked to comment on what we would do if starting our careers today. For reasons best understood in the framework of ego psychology I opted to indicate how I would change what I have done before speculating on beginning a career now envisioning the next 50 years.My best contributions to knowledge and understanding regarding schizophrenia have been in the context of bright and fun colleagues who think deeply and critically. My most regrettable self-identified flaw is the failure to be bold in pressing the field to change rapidly in areas that related to our data and my understanding of collective knowledge. Several examples will illustrate before commenting on the future I would like to have.1. Stop DSM-III from moving schizophrenia to a reality distortion disorder. In the late 1960s it was clear that the diagnosis of schizophrenia needed to be harmonized internationally and a (the) critical problem was perceived as a broad definition applied in the United States that ignore the central features of true or nuclear schizophrenia. These features were not the weakening of the well-springs of volition that Kraepelin defined, together with the dissociative pathology described by Bleuler, as the two central clinical features. Rather, psychopathology proposed by Schneider as indicating the presence of schizophrenia and by Langsfeldt to distinguish true from pseudo schizophrenia was viewed as critical. DSM-III gave unique status to first rank symptoms (FRS) with the presence of a single FRS being sufficient to meet the criteria for a diagnosis of schizophrenia.In the early 1970's, together with John Strauss and John Bartko, we conducted the only empirical test of the central hypotheses related to Langfeldt and Schneider criteria. 1,2 We found them in psychotic conditions other than schizophrenia and within schizophrenia these symptoms lacked prognostic significance. Schneider and Langfeldt positive schizophrenia did not differ from schizophrenia without these reality distortion symptoms. Heterogeneity of the syndrome was not reduced. My mistake was to only make these data known to the DSM-III leaders and publish results, trusting the normal processes to be effective. The result was a unique role in DSM for FRSs that was not changed until DSM-5 in 2013. Negative symptoms were omitted from the criteria DSM-III and the concept shifted to a reality distortion syndrome (ego boundary disturbances if you prefer the concepts of 50 years ago) contributing to the greatly diminished current attention to thought disorder. We also provided data on the clinical features most discriminating in differential diagnosis of schizophrenia and published in Science without any effect on the DSM-III criteria. 3At the SIRS conference I noted the effectiveness of a forceful personality and believe that if I had been more like Fuller Torrey I would have found a way for science rather than pre-conceptions to define core path...

The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum

“…In his self-reflection, looking back at his prolific career spanning over 50 years, Carpenter states that his major regret is his failure to be bold enough in pressing the field for reconstructing schizophrenia (Carpenter, 2017). We can learn from the past and finally show some collective courage to open up the discussion of how we could replace the slowly dying schizophrenia concept.…”

A New Step Forward in “Carving Nature by its Joints” in Psychopathology/Psychosis

“…And still more, as suggested by Carpenter [1] after 50 years of an outstanding career in research on schizophrenia, we have to be bold not only in translational research but also in the deconstruction of classic clinical syndromes of schizophrenia.…”