Does Schizophrenia Exist?

A Deflationary Perspective




Psychiatry, Nosology, Existence, Reality, Disorder, Metaontological Deflationism


This paper develops and defends a deflationary analysis of existence claims involving psychiatric disorders. According to this analysis, a given psychiatric disorder exists if, and only if, there are people who have the disorder. The implications of this analysis are spelled out for our views of nosological decision making, and for the relationship between claims about the existence of psychiatric disorders and claims about their reality. A pragmatic view of psychiatric nosology is defended and it is argued that worries about the “reality” of any given disorder have to be distinguished clearly from questions about its existence.


Abou-Saleh, Mohammed T. and Helen L. Millar. 2016. “Schizophrenia Does Exist: It Is Kraepelin’s Disease.” British Medical Journal 352 (Responses, 23 February).

Andreasen, N.C. 1995. “The Validation of Psychiatric Diagnosis: New Models and Approaches.” American Journal of Psychiatry 152, no. 2: 161–162.

APA (American Psychiatric Association). 2013a. Diagnostic and Statistical Manual of Mental Disorders. 5th edition. Washington, DC: American Psychiatric Publishing.

———. 2013b. “Highlights of Changes from DSM-IV-TR to DSM-5.”

Berezin, Robert. 2015. “No, There Is No Such Thing as ADHD.” Mad in America, 17 March.

Bird, Graham H. 1995. “Carnap and Quine: Internal and External Questions.” Erkenntnis 42: 41–64.

Boyle, Mary. 2006. “Developing Real Alternatives to Medical Models. Ethical Human Psychology and Psychiatry 8, no. 3: 191–200.

Boysen, Guy A. and Alexandra VanBergen. 2013. “A Review of Published Research on Adult Dissociative Identity Disorder 2000–2010.” Journal of Nervous and Mental Disease 201, no. 1: 5–11.

Bradley, Darren. 2018. “Carnap’s Epistemological Critique of Metaphysics.” Synthese 195: 2247–2265.

Cambrosio, Alberto, Peter Keating, Thomas Schlich, and George Weisz. 2006. “Regulatory Objectivity and the Generation and Management of Evidence in Medicine.” Social Science & Medicine 63, no. 1: 189–199.

Canfield, John Vincent. 1974. “Criteria and Rules of Language.” Philosophical Review 83, no. 1: 70–87.

Carey, Robert M. and Paul K. Whelton. 2018. “Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline.” Annals of Internal Medicine 168, no. 5: 351–358.

Carnap, Rudolf. 1950. “Empiricism, Semantics and Ontology.” Revue Internationale de Philosophie 4, no. 11: 20–40.

Champlin, T.S. 1981. “The Reality of Mental Illness.” Philosophy 56, no. 218: 467–487.

Cuthbert, Bruce N. 2014. “The RDoC Framework: Facilitating Transition from ICD/DSM to Dimensional Approaches that Integrate Neuroscience and Psychopathology.” World Psychiatry 13, no. 1: 28–35.

Decker, Hannah S. 2013. The Making of DSM-III: A Diagnostic Manual’s Conquest of American Psychiatry. New York: Oxford University Press.

Doust, Jenny, Per O. Vandvik, Amir Qaseem, Reem A. Mustafa, Andrea R. Horvath, Allen Frances, Lubna Al-Ansary, et al. 2017. “Guidance for Modifying the Definition of Diseases: A Checklist.” JAMA Internal Medicine 177, no. 7: 1020–1025.

Drescher, Jack. 2015. “Out of DSM: Depathologizing Homosexuality.” Behavioral Sciences 5, no. 4: 565–575.

First, Michael B., Tahilia J. Rebello, Jared W. Keeley, Rachna Bhargava, Yunfei Dai, Maya Kulygina, Chihiro Matsumoto, Rebeca Robles, Anne-Claire Stona, and Geoffrey M. Reed. 2018. “Do Mental Health Professionals Use Diagnostic Classifications the Way We Think They Do? A Global Survey.” World Psychiatry 17, no. 2: 187–195.

First, Michael B., Geoffrey M. Reed, Steven E. Hyman, and Shekhar Saxena. 2015. “The Development of the ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders.” World Psychiatry 14, no. 1: 82–90.

First, Michael B., Venkat Bhat, David Adler, Lisa Dixon, Beth Goldman, Steve Koh, Bruce Levine, David Oslin, and Sam Siris. 2014. “How Do Clinicians Actually Use the Diagnostic and Statistical Manual of Mental Disorders in Clinical Practice and Why We Need to Know More.” Journal of Nervous and Mental Disease 202, no. 12: 841–844.

Garb, Howard N. 2005. “Clinical Judgment and Decision Making.” Annual Review of Clinical Psychology 1, no. 1: 67–89.

Global Initiative for Chronic Obstructive Lung Disease. 2019. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease.

Glock, Hans-Johann. 2002. “Does Ontology Exist?” Philosophy 77, no. 2: 235–260.

———. 2003. Quine and Davidson on Language, Thought, and Reality. Cambridge: Cambridge University Press.

———. 2015. “Meaning and Rule Following.” In International Encyclopedia of the Social and Behavioral Sciences, edited by Neil J. Smelser and Paul B. Baltes, 841–849. 2nd edition. Oxford: Elsevier.

Glüer, Kathrin, Åsa Wikforss, and Marianna B. Ganapini. 2022. “The Normativity of Meaning and Content.” In Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta.

Guloksuz, S. and J. van Os. 2018. “The Slow Death of the Concept of Schizophrenia and the Painful Birth of the Psychosis Spectrum.” Psychological Medicine 48, no. 2: 229–244.

———. 2019. “Renaming Schizophrenia: 5 × 5.” Epidemiology and Psychiatric Sciences 28, no. 3: 254–257.

Hacking, Ian. 2007. “Natural Kinds: Rosy Dawn, Scholastic Twilight.” Royal Institute of Philosophy Supplement 61: 203–239.

Halpin, Michael. 2016. “The DSM and Professional Practice: Research, Clinical, and Institutional Perspectives.” Journal of Health and Social Behavior 57, no. 2: 153–167.

Hyman, Steven E. 2010. “The Diagnosis of Mental Disorders: The Problem of Reification.” Annual Review of Clinical Psychology 6, 155–179.

Jablensky, Assen John McGrath, Helen Herrman, David Castle, Oye Gureje, Mandy Evans, Vaughan Carr, Vera Morgan, Ailsa Korten, and Carol Harvey. 2000. “Psychotic Disorders in Urban Areas: An Overview of the Study on Low Prevalence Disorders.” Australian and New Zealand Journal of Psychiatry 34, no. 2: 221–236.

Kendell Robert E. 1991. “Schizophrenia: A Medical View of a Medical Concept.” In What Is Schizophrenia?, edited by William F. Flack, Morton Wiener, and Daniel R. Miller, 59–72. New York: Springer.

Kendler, Kenneth S. 2016. “The Nature of Psychiatric Disorders.” World Psychiatry 15, no. 1: 5–12.

Kendler K.S., D. Kupfer, W. Narrow, K. Phillips and J. Fawcett. 2009. “Guidelines for Making Changes to DSM-V.” Unpublished manuscript. Washington, DC: American Psychiatric Association.

Keshavan, Matcheri S., Henry A. Nasrallah, and Rajiv Tandon. 2011. “Moving Ahead with the Schizophrenia Concept: From the Elephant to the Mouse.” Schizophrenia Research 127, nos. 1–3: 3–13.

Kinderman, Peter, John Read, Joanna Moncrieff, and Richard P Bentall. 2013. “Drop the Language of Disorder.” Evidence-Based Mental Health 16, no. 1: 2–3.

Kraemer, Helena Chmura. 2015. “Research Domain Criteria (RDoC) and the DSM: Two Methodological Approaches to Mental Health Diagnosis.” JAMA Psychiatry 72, no. 12: 1163–1164.

Kriegel, Uriah. 2013. “The Epistemological Challenge of Revisionary Metaphysics.” Philosophers’ Imprint 13, no. 12: 1–30.

Lasalvia, Antonio, Elena Penta, Norman Sartorius, and Scott Henderson. 2015. “Should the Label ‘Schizophrenia’ Be Abandoned?” Schizophrenia Research 162, nos. 1–3: 276–284.

Lawrie, Stephen M. 2016. “‘Schizophrenia’ Is a Useful Concept.” British Medical Journal 352.

Moncrieff, Joanna and Hugh Middleton. 2015. “Schizophrenia: A Critical Psychiatry Perspective.” Current Opinion Psychiatry 28, no. 3: 264–268.

Murphy, Dominic. 2015. “Validity, Realism, and Normativity.” In Alternative Perspectives on Psychiatric Classification: DSM, ICD, RDoC, and Beyond, edited by Peter Zachar, Drozdstoj Stoyanov, Massimiliano Aragona, and Assen Jablensky, 60–75. Oxford: Oxford University Press.

National Geographic. 2016. “The Plague.”

Plunkett, David. 2015. “Which Concepts Should We Use? Metalinguistic Negotiations and the Methodology of Philosophy.” Inquiry 58, no. 7: 1–47.

Plunkett, David and Timothy Sundell. 2013. “Disagreement and the Semantics of Normative and Evaluative Terms.” Philosophers’ Imprint 13, no. 23: 1–37.

Price, Huw. 2009. “Metaphysics after Carnap: The Ghost Who Walks?” In Metametaphysics: New Essays on the Foundations of Ontology, edited by David Chalmers, David Manley, and Ryan Wasserman, 320–346. Oxford: Oxford University Press.

Radden, Jennifer. 2019. “Mental Disorder (Illness).” In Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta.

Reznek, Lawrie. 1987. The Nature of Disease. London: Routledge & Kegan Paul.

Saatsi, Juha. 2017. “Explanation and Explanationism in Science and Metaphysics.” In Metaphysics and the Philosophy of Science: New Essays, edited by Matthew H. Slater and Zanja Yudell, 163–192. Oxford: Oxford University Press.

Sadler, John Z. 2013. “Values in Psychiatric Diagnosis and Classification.” In The Oxford Handbook of Philosophy and Psychiatry, edited by K.W.M. Fulford, Martin Davies, Richard Gipps, George Graham, John Sadler, Giovanni Stanghellini, and Tim Thornton, 753–778. Oxford: Oxford University Press.

Sadler, John, Joseph F. Hulgus, and George John Agich. 2001. “Hindsight, Foresight, and Having It Both Ways: A Rejoinder to R.L. Spitzer.” Journal of Nervous and Mental Disease 189, no. 8: 493–497.

Shorter, Edward. 2015. What Psychiatry Left out of the DSM-5: Historical Mental Disorders Today. New York: Routledge.

Spitzer, Robert L. 2001. “Values and Assumptions in the Development of DSM-III and DSM-III-R: An Insider’s Perspective and a Belated Response to Sadler, Hulgus, and Agich’s ‘On Values in Recent American Psychiatric Classification.” Journal of Nervous and Mental Disease 189, no. 6: 351–359.

Spitzer, Robert L. and Joseph L. Fleiss. 1974. “A Re-analysis of the Reliability of Psychiatric Diagnosis.” British Journal of Psychiatry 125, no. 587: 341–347.

Stanford, P. Kyle. 2017. “So Long, and Thanks for All the Fish: Metaphysics and the Philosophy of Science.” In Metaphysics and the Philosophy of Science: New Essays, edited by Matthew H. Slater and Zanja Yudell, 127–140. Oxford: Oxford University Press.

Szasz, Thomas S. 1960. “The Myth of Mental Illness.” American Psychologist 15, no. 2: 113–118.

———. 1988. Schizophrenia: The Sacred Symbol of Psychiatry. 2nd, revised edition. New York: Syracuse University Press.

———. 2011 [1961]. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Revised edition. New York: HarperCollins.

Tamminga, Carol A., Godfrey D. Pearlson, Ana D. Stan, Robert D. Gibbons, Jaya Padmanabhan, Matcheri Keshavan, and Brett A. Clementz. 2017. “Strategies for Advancing Disease Definition Using Biomarkers and Genetics: The Bipolar and Schizophrenia Network for Intermediate Phenotypes.” Biological Psychiatry: Cognitive Neuroscience and Neuroimaging 2, no. 1: 20–27.

Thomasson, Amie L. 2008. “Existence Questions.” Philosophical Studies 141, no. 1: 63–78.

———. 2009. “The Easy Approach to Ontology.” Axiomathes 19, no. 1: 1–15.

———. 2014. Ontology Made Easy. Oxford: Oxford University Press.

———. 2016. “Carnap and the Prospects for Easy Ontology.” In Ontology after Carnap, edited by Stephan Blatti and Sandra Lapointe, 122–142. Oxford: Oxford University Press.

———. 2017a. “Metaphysical Disputes and Metalinguistic Negotiation.” Analytic Philosophy 58, no. 1: 1–28.

———. 2017b. “Metaphysics and Conceptual Negotiation.” Philosophical Issues 27, no. 1: 364–382.

Van Os, Jim. 2016. “‘Schizophrenia’ Does Not Exist.” British Medical Journal, 352.

Wedge, Marilyn. 2018. “Is ADHD Real?” Psychology Today, 24 March.

Whiting, Daniel. 2016. “What Is the Normativity of Meaning?” Inquiry 59, no. 3: 219–238.

Whooley, Owen. 2010. “Diagnostic Ambivalence: Psychiatric Workarounds and the Diagnostic and Statistical Manual of Mental Disorders.” Sociology of Health & Illness 32, no. 3: 452–469.

Woodward, James. 2014. “Methodology, Ontology, and Interventionism.” Synthese 192: 3577–3599.

———. 2017. “Interventionism and the Missing Metaphysics. In Metaphysics and the Philosophy of Science: New Essays, edited by Matthew H. Slater and Zanja Yudell, 193–225. Oxford: Oxford University Press.

WHO (World Health Organization) 1993. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: WHO.

———. 2017. “Lassa Fever.”

Zachar, Peter and Assen Jablensky. 2015. “Introduction: The Concept of Validation in Psychiatry and Psychology.” In Alternative Perspectives on Psychiatric Classification: DSM, ICD, RDoC, and Beyond, edited by Peter Zachar, Drozdstoj Stoyanov, Massimiliano Aragona, and Assen Jablensky, 3–24. Oxford: Oxford University Press.

Zachar, Peter and Kenneth S. Kendler. 2014. “A Diagnostic and Statistical Manual of Mental Disorders History of Premenstrual Dysphoric Disorder.” Journal of Nervous and Mental Disease 202, no. 4: 346–352.

Zimmerman, Mark. 2016. “A Review of 20 Years of Research on Overdiagnosis and Underdiagnosis in the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project.” Canadian Journal of Psychiatry 61, no. 2: 71–79.

Zipursky, Robert B., Thomas J. Reilly, and Robin M. Murray. 2013. “The Myth of Schizophrenia as a Progressive Brain Disease.” Schizophrenia Bulletin 39, no. 6: 1363–1372.




How to Cite

Repnikov, G. (2023). Does Schizophrenia Exist? A Deflationary Perspective. Philosophy of Medicine, 4(1).



Original Research Articles (philosophy of psychiatry)