A Disappearing Heritage

The Clinical Core of Schizophrenia

Josef Parnas


Schizophr Bull. 2011;37(6):1121-1130. 

In This Article

What is Schizophrenia?

This trivial question hides certain important epistemological issues, intimately linked to the question of a "clinical core". The DSM-IV-TR[11] defines schizophrenia in the following way:

The essential features of schizophrenia are a mixture of characteristic (…) positive and negative [symptoms] that have been present for a significant portion of time (…), associated with marked social and occupational dysfunction. The disturbance is not better accounted for by …

Maj[12] criticized this definition for not offering any general account of what schizophrenia is but rather of what it is not (nonorganic, nonaffective, etc.). The definition does not consider negative or positive symptoms (or their combinations) as specific to schizophrenia. Moreover, Maj claimed that operational criteria are only useful to a clinician who is already familiar with what schizophrenia is. The issue addressed by Maj is that of "whatness" (quiddity). It refers to the properties that a particular category (eg, a patient) shares with others of its kind. 'What (quid) is it?' simply asks for a general description through some essential or prototypical commonality.

Asking such question does not presuppose a commitment to realism about natural kinds. It is a question prompted by clinical experience and based on the assumption that schizophrenia displays a characteristic core Gestalt, conferring a certain typicality or prototypicality on its concrete clinical manifestations. It is not the question of a pathognomonic symptom but rather of a characteristic Gestalt.

The question of the core dominated the psychiatric debate since the beginning of the 20th century.