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Silvano Arieti was an outstanding leader in American psychiatry, president of the American Academy of Psychoanalysis, and the Founding Editor of this Journal. Most significantly, his name is associated with the point of view he brought to our understanding of the schizophrenic disorders. A review of the conceptualization of the disorder serves as an introduction to that point of view and its continued importance, an importance heightened in this era when the clinician's regard for the individual's interpretation of unique internal experience seems to have lost so much ground. It will be helpful to state the assumptions or, if you will, the biases of this author which will infuse this commentary.
It must be recognized that there are few topics in psychiatry that are more contentious than that of schizophrenia—virtually no feature has not been argued about passionately. There has not even been agreement as to its name. At various times it has been called dementia praecox, the group of the schizophrenias, the schizophrenic reactions, schizophrenic disorders, schizophrenia, etc. Severe mental illness arouses many emotions in the observer, none of which enhance dispassionate logical examination of the illness. It can be very frightening to observe severe and chronic mental disorders, particularly in young people. Fear disrupts logic, and the desire to help can become zealous. Recognizing these dangers, let me identify my assumptions more clearly.
Independent of how we name this condition, it is real and it exists. Our present ability to diagnose in psychiatry is not based on pathophysiology but rather on phenomenology, and hence our efforts at categorization are quite limited. Medical diagnosis requires pathophysiology in order to be truly scientific. It logically follows that diagnostic categories based on phenomenology will be heterogeneous, that is, will include more than one pathophysiologically based disorder.
Another assumption is that this group of illnesses has been