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Most clinicians agree that schizophrenia is a useful diagnosis, but few agree on what it is. We have embraced schizophrenia to classify some peculiar mental states and to manage some unusual, bizarre, and, at times, frightening behaviors. But there is little agreement on the mechanism of disease. In this issue of JAMA Psychiatry, Kahn and Keefe1 claim that we have gotten it all wrong: “schizophrenia is not primarily a psychotic disorder, it is a cognitive illness.” They forcefully state that the focus on psychosis has held us back from finding better treatments for schizophrenia. Ironically, they list Emil Kraepelin and Eugen Bleuler as their witnesses to allege that dementia praecox and schizophrenia were defined as cognitive disorders and that psychosis is a “secondary or associated part of the illness.”
Heckers S. What Is the Core of Schizophrenia?. JAMA Psychiatry. 2013;70(10):1009-1010. doi:10.1001/jamapsychiatry.2013.2276