The Unfalsifiable Thesis of Organogenesis
The biomedical disease concept causes a dilemma regarding illness-like conditions for which no physical aberrations can be found. The root of the dilemma is that it is in practice very difficult, and theoretically even impossible, to prove the absence of any bodily aberration. This has very important consequences which occur in particular in psychiatry. Anyone who wishes to can insist that “schizophrenia” is basically a brain disease for which the nature of the organic disorder has not yet been definitely demonstrated, and that all psychoses are organic disorders as will become apparent at some future time. As the absence of physical aberrations is in principle not provable, a core theoretical and scientific stalemate is reached in which each is free to believe in either the biological cause or psychogenesis and/or sociogenesis, as well as a combination of these two, or yet a different cause.
There is only one way out of this predicament, namely, by demonstrating a physical aberration. The organogenicists are in the comfortable, though nonetheless in the scientifically not unequivocally enviable circumstance, that there is always a chance that they will be proved right, and no chance that they will be proved wrong. Research into possible organic aberrations in schizophrenia has been extraordinarily expansive and expensive. The argument that it turned up no convincing evidence and that a different kind of research would probably turn up more relevant information contradicts the established order and is therefore powerless. We have long been caught in the trap into which the biomedical disease concept has lured us.
As disease is the object of medicine, and so that with which physicians (should) concern themselves, proof that certain complaints or symptoms indeed are caused by bodily aberrations attains strong, but overrated, appreciation in the biomedical disease concept. Whoever “discovers” a new disease or can demonstrate a new organic aberration is admitted to medicine’s Hall of Fame. Whoever can demonstrate the biomedical cause of schizophrenia makes his mark as a real doctor. That is why the search for, and as long as next to nothing has been found, the claim for an organic cause of schizophrenia has status from a medical perspective. If what Szasz posits is true, namely that psychiatry and psychoanalysis “…have acquired their social power and prestige largely through a deceptive association with the principles and practice of medicine” (Ideology and Insanity, pp 166-67) then this would be a strong motivation for physicians and psychiatrists to continue looking for organic causes of schizophrenia into the distant future.
Finally, the definition of disease as an organic aberration poses a problem for psychiatrists who feel that they are physicians: at some time the presumed organic aberrations will have to be proved in order to justify the status of psychiatry as a branch of medicine, and the status of the psychiatric patient as a real patient. So researchers are unduly motivated to find an organic aberration in schizophrenia rather than a different kind of cause which falls outside of the scope of the biomedical disease concept. Szasz was right in emphasizing this dilemma which may be why criticism of his work is often so acrimonious.
The insolubility of the dilemma can also be clarified as follows. The difference in the physical sciences and humanities, as Szasz experiences and describes them, renders both realms in which the mind and body of man are studied separate fields. As these two groups of sciences employ different languages their pronouncements are presumed irreconcilable. On that ground Szasz defends his biomedical disease concept. At the same time this means that no matter how convincing the theories on psychogenesis and sociogenesis of certain psychiatric disorders, these theories can never be valid as a counter-argument to those who view disease as necessarily linked to organic aberration. The physician who embraces this disease concept can do nothing but continue following the same track without ever finding what he is looking for. Sociopsychological theories are left behind because they no longer have anything to do with illness and being ill.
This serious situation has the character of a dilemma, a dilemma which can only be solved when one is prepared to revise the definition of disease which led to it.
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