In 1895 there was not a single case of dementia praecox reported in the United States. By 1912 there were tens of thousands of people with this diagnosis locked up in asylums, hospitals, and jails. By 1927 it was fading away . How could such a terrible disease be discovered, affect so many lives, and then turn out to be something else? In vivid detail, Richard Noll describes how the discovery of this mysterious disorder gave hope to the overworked asylum doctors that they could at last explain—though they could not cure—the miserable patients surrounding them. The story of dementia praecox, and its eventual replacement by the new concept of schizophrenia, also reveals how asylum physicians fought for their own respectability. If what they were observing was a disease, then this biological reality was amenable to scientific research. In the early twentieth century, dementia praecox was psychiatry’s key into an increasingly science-focused medical profession. But for the moment, nothing could be done to help the sufferers. When the concept of schizophrenia offered a fresh understanding of this disorder, and hope for a cure, psychiatry abandoned the old disease for the new. In this dramatic story of a vanished diagnosis, Noll shows the co-dependency between a disease and the scientific status of the profession that treats it. The ghost of dementia praecox haunts today’s debates about the latest generation of psychiatric disorders.

The revisions of both DSM-IV and ICD-10 have again focused the interest of the field of psychiatry and clinical psychology on the issue of nosology. This interest has been further heightened by a series of controversies associated with the development of DSM-5 including the fate of proposed revisions of the personality disorders, bereavement, and the autism spectrum. Major debate arose within the DSM process about the criteria for changing criteria, leading to the creation of first the Scientific Review Committee and then a series of other oversight committees which weighed in on the final debates on the most controversial proposed additions to DSM-5, providing important influences on the final decisions. Contained within these debates were a range of conceptual and philosophical issues. Some of these - such as the definition of mental disorder or the problems of psychiatric “epidemics” - have been with the field for a long time. Others - the concept of epistemic iteration as a framework for the introduction of nosologic change - are quite new. This book reviews issues within psychiatric nosology from clinical, historical and particularly philosophical perspectives. The book brings together a range of distinguished authors - including major psychiatric researchers, clinicians, historians and especially nosologists - including several leaders of the DSM-5 effort and the DSM Steering Committee. It also includes contributions from psychologists with a special interest in psychiatric nosology and philosophers with a wide range of orientations. The book is organized into four major sections: The first explores the nature of psychiatric illness and the way in which it is defined, including clinical and psychometric perspectives. The second section examines problems in the reification of psychiatric diagnostic criteria, the problem of psychiatric epidemics, and the nature and definition of individual symptoms. The third section explores the concept of epistemic iteration as a possible governing conceptual framework for the revision efforts for official psychiatric nosologies such as DSM and ICD and the problems of validation of psychiatric diagnoses. The book ends by exploring how we might move from the descriptive to the etiologic in psychiatric diagnoses, the nature of progress in psychiatric research, and the possible benefits of moving to a living document (or continuous improvement) model for psychiatric nosologic systems. The result is a book that captures the dynamic cross-disciplinary interactions that characterize the best work in the philosophy of psychiatry.

Schizophrenia was 20th century psychiatry's arch concept of madness. Yet for most of that century it was both problematic and contentious. This history explores schizophrenia's historic instability via themes such as symptoms, definition, classification and anti-psychiatry. In doing so, it opens up new ways of understanding 20th century madness.