There is considerable debate about the nature of schizophrenia and other psychotic disorders, with the differing conceptions leading to dramatically different ideas about how best to treat people struggling with psychosis.

The Conventional Belief

In the American Psychiatric Association’s Diagnostic and Statistical Manual,  schizophrenia is defined by what the field terms “positive” and “negative” symptoms. “Positive” symptoms are experiences that psychiatry considers as additional to “normal” functioning (i.e., hallucinations and delusions). “Negative” symptoms are experiences that psychiatry considers as reducing “normal” functioning (e.g., apathy, isolation, emotional flatness). There are also cognitive symptoms, such as confusion and illogical or circular thinking.

Hallucinations include hearing sounds (often including voices) that others do not hear, and seeing things that others do not see. Delusions are defined as beliefs that are not “normal” or supported by objective evidence. Psychiatrists consider themselves able to define when a person’s beliefs are delusional or whether the person has reason for those beliefs. Some specific delusions include paranoia (delusional fear) and grandiosity (delusions of superiority).

It is the “negative” and cognitive symptoms that most impede functioning. It’s difficult to work when you feel apathetic; it’s difficult to connect with others if you feel emotionally blank. It’s difficult to do either when you feel confused, or if others are confused by what you perceive as your normal conversation.

According to the medical model of the psychiatric field, schizophrenia is the result of a still-unidentified neural pathology (brain illness) that necessitates treatment with neuroleptic medication (major tranquilizers). The illness is said to be “chronic,” necessitating life-long use of the drugs.

In addition to the schizophrenia diagnosis, the Diagnostic and Statistical Manual lists a number of other psychotic disorders, which are seen as less severe. However, in general, the thought is that such disorders are the result of a chronic brain illness, which requires long-term use of antipsychotics.

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