Now this is hard. Bleuler's answer was the splitting of the faculties of the mind as he saw it. Kraeplin saw it as dominant psychosis. Modern doctors see it is a syndrome of positive and negative symptoms which at its core is a high level of psychosocial impairment from delusions and hallucinations caused by a brain disease. Or at least I think so. There is a lot of different views held by different types of clinicians even with the biomedical and psychosocial dogmas.
I have my own view. I think the disability and distress is very real and relates to the psychopathology as well as, and perhaps more significantly, the social and cultural factors. I think the core of a lot of the distress is the hallucinations though some people get pleasure from them or can handle them. I think there are many factors behind the disability component but this and the distress are strong causal factors in the suicide rate as well as inadvertant deaths caused by the hallucinations.
I think the positive symptoms are an example of psychopathology, I.e. in themselves they're just things which psychiatrists think are bad things. Just like homosexuality was. The negative symptoms are usually coping mechanisms or natural human responses to extreme suffering caused by internal and external factors. This is my opinion of the current mainstream and consensus definition of schizophrenia. Much of the cause is the positive symptoms and many of the negative symptoms are effects though it isn't quite as simple as that.
I think a new model of schizophrenia simply considered individual factors instead of the clustering approach. This goes beyond historical subtypes and expands the remit of psychosis healthcare to include all people based on single symptoms. What I mean is people can experience mild psychosis which would be considered sub-clinical, I.e. wouldn't be diagnosed as schizophrenia but might cause distress.
The two areas of import are distress and disability. The former is multifaceted as is any individuals suffering. The disability in my opinion is something which requires a new direction: as well as changing the individual there needs to be changes in society.
The potential of this alternative is a label-less system which could cover all mental illnesses and end the domination of psychiatry. Access to mental healthcare is open to everyone and primarily works to better distress and disability. The only label need be miserable human or, at worst, person experiencing psychosis they need help with.
This is of course a really idealistic idea which would never happen in practice but perhaps one day it might. Single symptoms are dealt with, not syndromes. The onus is on the individual and this is where things are difficult and different to the current system. This is achieved by ensuring people are educated in mental health to a high level. This is about empowering everyone to be masters of themselves and the human condition. Psychiatrists and other doctors have been flawed in their ability to truly understand their patients because they never know what's going on inside a persons head nor have the time to know everything which is going on in a persons life. They're like modern neurologists without brain scanners.
There are problems with leaving everything up to individuals of course but what I'm talking about is a new direction of empowerment of individuals as well as offering expertise and assistance from healthcare services which also change society to reduce disability and distress as well as normalising individuals on request or...I suppose...when it is absolutely necessary for the good of society or some bullshit like that.
Wouldn't this be a better future for everyone including those diagnosed with schizophrenia? The disability aspect would be reduced by valuing, understanding and accepting all people no matter how different they are. The commonality is our shared humanity and yet we can be treated as individuals too.
It is a shame I live in the present where mental health is still too often about power structures and socio-political needs as much as anything else.
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