Cervantes' puzzle — A commentary on Alex Cohen's “Prognosis for Schizophrenia in the third world: A reevaluation of cross-cultural research”
✍ Scribed by Kim Hopper
- Publisher
- Springer US
- Year
- 1992
- Tongue
- English
- Weight
- 666 KB
- Volume
- 16
- Category
- Article
- ISSN
- 0165-005X
No coin nor oath required. For personal study only.
✦ Synopsis
When chiding others for discrepancies between reach and grasp, it is well to pay special heed to the measures of claim and evidence in one's own argument. Alex Cohen's challenge to over a quarter-century of received orthodoxy is a serious and consequential one. If, upon close scrutiny, it too can be faulted on the same grounds as those he criticizes, he has nonetheless worked some valuable mischief with this inquiry. In what follows, I first concentrate on what I take to be errors of interpretation or inconsistencies in the argument Cohen presents, and then go on to open up a few of the topics he touches upon. If, as I continue to believe, 2 the emperor is not entirely naked, neither would it be safe to assume that his raiment is as seamless as we once supposed.
LIMITATIONS OF COHEN'S CRITIQUE
Research on long-term recovery in schizophrenia remains an epidemiological minefield, despite some heroic attempts to make sense of the mountains of data that have accumulated over the years. Owing in large measure to the formidable logistics, the technical difficulties of standardizing instruments across cultures and times, the delicate political and professional sensibilities at stake in large collaborative studies, and the sheer costs and time involved, well-designed prospective studies that are also mindful and resourceful enough to take into close account the cross-cultural settings in which they occur, are rare. Typically, the numbers followed are small, treatment and social contexts are ill-defined, instrumentation reflects investigators' biases, and criteria of recovery -which should be able to distinguish patterns of relapse, symptoms and functioning ("course"), as well as such gross indicators as time spent in hospital, time spent employed, quality of relations with others, current symptom breadth and intensity ("outcome") -are, not uncommonly, vague. Even within the same culture, for roughly comparable time periods, inconsistency reigns. 3 Researchers and critics alike are hard-pressed to say whether the differences are real, artifactual, or some measure of both.