http://www.columbia.edu/cu/neuwrite/...vivHarpers.pdf

This is an article about prodromal schizophrenia it's interesting in its own right but there are a couple of things I found interesting about the narrative. Early in the piece there is evidence that delusions and hallucinations have changed significantly over time from communing with prophets and kings to ufo's radios blogs etc...certainly cameras. To me the changing nature of the delusions over time in some ways suggested that they are in fact not insight into another world or an alternate plane of reality but entirely based from our own thoughts(or at least mine were). This alone is a rather boring conclusion and I've known it for some time but what was interesting is the fact that the underlying basis of psychosis and sz is in fact plagued by the same flaw. Later in the article they point to the fact that thirty years ago people would say sz was due to interactions with their parents then later was the dopamine hypothesis replaced with nmda in the 90's now the kids are describing their conditions in even greater neurological terms but no one agrees just like we all have our own brand of hallucinations etc. Anyway it's unclear to me why the pdocs do not recognize their own beliefs in the biological or psychological underpinnings to be necessarily delusional due to their constant rapid acceptance and then dismissal of the theories over the past thirty years. It is in fact precisely the same scenario...there is a brilliant hypothesis based on the use of some drug but the follow up experiments are never really convincing so alternate theories are proposed later on...they know they don't have the answer but continue to promote the idea of a chemical imbalance as if simply saying we don't know would take all of their power away...Does this false belief provide support for those in crisis or does it ultimately create a sense of betrayal when it will be replaced with yet another theory? I think when the DSM 5 was created there was some desire for connection to biology rather than simply another classification system and yet I would argue that despite my distaste for the dsm it at least provides a foundation for patient care and does not invest in any of these delusional beliefs that a reason has been found. In that sense it is at least not misleading in and of itself, but rather neutral.