Schizophrenia: a scientific delusion?

reported in the Lancet of 1877 makes no mention of pernicious anaemia nor of koilonychia, a feature in any event not associated with pernicious anaemia. Treves was a many-sided man whose achievements were considerable and varied. In addition to his published work, manuscript sources are available and, in the future, further study of these is likely to provide more understanding of what may seem contradictory elements in his personality. Trombley has made a good beginning. This carefully researched work seeks to destroy the concept of schizophrenia. The author's approach is one of self-confessed "social constructionism". This has the "annoying feature of turning attention away from a problem and onto those who are trying to deal with the problem". From the historical viewpoint Boyle wishes to set out "in some detail the story of the introduction, development and use of 'schizophrenia"'. This is neatly done by criticizing the works of Emil Kraepelin, Eugen Bleuler, and Kurt Schneider as the main protagonists of the concept. The remaining three-quarters of the book deals with the modern "fallacious arguments" used to support the concept of schizophrenia. Genetic research gets a quarter and seminal papers are pulled apart for their poor methodology. Her evidence is marshalled impressively. On the clinical side, it is a pity that, although her references are contemporary-as well as wide-ranging-there is no mention of how, for instance, brain imaging techniques have been used in the diagnosis of schizophrenia. More surprisingly, given that the author is a clinical psychologist, there is no attempt to deal with the issue of treatment. Why do people with schizophrenia get better with medication? Although one of her four stated aims is to "discuss alternatives to the concept", her emphasis on the "functional rather than topographical properties of behaviour" is very provisional. This erudite, provocative, if not convincing, work sorely misses reader-friendly end of chapter summaries and a proper conclusion. For much of the nineteenth century American intellectual energy was channelled into developing the vast resources of the country, and the few struggling scientific societies were largely concentrated in the three major urban areas, Philadelphia, Boston, and New York. Philadelphia was the leading intellectual centre, but even here the Philadelphia Academy of Medicine experienced a burst of energy shortly after the Revolution and then barely managed to survive until its revival in the 1840s. As with most early American scientific associations, physicians played a dominant role in …