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Tijdschrift voor Psychiatrie 47 (2005) 12, 837 - 845

Essay

A critical look at the choice of the dsm diagnosis of schizophrenia as a basis for treatment guidelines

M.A.J. Romme

In winter 2003-2004 a first draft guideline was published at the internet. From a scientific point of view it seems unrealistic to use the dsm diagnosis of schizophrenia as a basis for treatment. Scientifically, the schizophrenia concept is worthless. One questions whether it is ethical to treat patients without paying any attention to the reasons for their behaviour or without considering their experiences. Another objection is that the diagnosis ignores the relationship between a patient's life history and the onset of symptoms and the possible link between the symptoms. Epidemiological research has shown that core symptoms such as hallucinations and delusions occur in the general population without being linked to illness. This means that it is unlikely that the presence of such phenomena should be interpreted as psychopathology. Those who choose to treat the illness as a whole do not learn to cope with symptoms separately and do not help solve the problems that have given rise to these symptoms. Finally, attention is drawn to the fact that many patients recover from the diagnosed illness without receiving any psychiatric help. All the more reason, therefore, for concluding that we do not yet know enough to draw up treatment guidelines and that from a scientific or ethical point of view the dsm cannot be regarded as the gold standard.

keywords diagnosis, Diagnostic and Statistical Manual of Mental Disorders, practice guidelines, reference standards, schizophrenia