Prognosis in schizophrenia and the role of subjectivity.

It is a little like the “Have you stopped beating your wife?” problem. Language contains assumptions and sets the context, a context from which it is almost impossible for the person to escape. The group that sets the context rarely notices that it is a context, rather taking it for granted as reality. Until around the 1970s, in most parts of the United States, the context for understanding mental illness was psychoanalytic theory and anyone who did not accept that was either “resistant” or did not know enough. Now, the context is often represented by words like “progression of the illness,” suggesting as it does a fixed evolution and implying a mainly biological substrate. But I would like to shift the focus to a related question. That question is whether a field that systematically ignores a considerable amount of data can be considered an adequate science. There has been a major failure to consider adequately patients’ subjective experiences in research, theory, and practice. We have also failed to be guided sufficiently by those experiences to develop new research questions and areas of investigation.