Abstract
In her editorial, Professor Yung repeats the arguments for risk detection for schizophrenia: ‘It is now largely recognized that risk for schizophrenia occurs on a spectrum’ (Yung, 2011). By her reading of our arguments (Rosenman and Anderson, 2011), Professor Yung believes that our apparent opposition to this recognition has ‘unfortunately confused’ arguments about the diagnostic status of ultra-high risk (UHR) with arguments about treatment. Not so. We do not oppose treatment. We think the problems will not be solved by sorting out the diagnostic details or the validity of the UHR concept. We dispute its very foundation.
The UHR concept reprises the ancient, venerable concept of schizophrenia that has outlived its usefulness. Repetition embeds the old concept deeper into the profession’s conceptual foundations and language so that it becomes the only way we can talk about a whole domain of problems. This generalizing language obscures important discriminations. More serious is the implicit belief that schizophrenia is a particular mental process. That belief takes psychiatrists and researchers deeper into the mud of misleading concepts.
How does the philosophical problem about mental processes and states . . . arise?—The first step is the one that altogether escapes notice. We talk of processes and states and leave their nature undecided. Sometime perhaps we shall know more about them—we think. But that is just what commits us to a particular way of looking at the matter. For we have a definite concept of what it means to learn to know a process better. (The decisive movement in the conjuring trick has been made, and it was the one we thought quite innocent.) (Wittgenstein, 2001)
See Editorial by Yung, 2011, 45(11): 915–919