A critique of the primary/secondary construct of psychosis. A commentary by DueJusticeProject.net
DJP has been sharply critical of the primary/secondary construct of psychosis. DJP believes that it is foolish and possibly arrogant for the medical community to categorize in this way - given how little researchers understand about the hardware/software dynamics of the brain.
This 2013 article titled "Secondary psychosis: an update" discusses how the Organic vs Functional distinction gave way to the current distinction of Primary vs Secondary.
It is remarkable that anyone would have ever believed that the cognitive and behavioral manifestations of psychosis were functional in nature. Beliefs in a psychogenic cause were rooted in ancient, primitive notions of good and evil, in supernatural forces. This paper says nothing explicit about the psychoanalytical contribution to the functional idea, or the persistent beliefs in functional root causes, casting the functional characterization as an anachronism, having been replaced by the primary/secondary construct.
Today those misguided theories continue to inform the writings and clinical approaches of the psychology and psychiatry communities in the form of the traumagenesis model. People in that cohort have even tried to appropriate (or perhaps confabulate) the biogenesis model in the form of epigenetics and trangenerational trauma theories. These are not the beliefs of mentally healthy people (A study the life of Freud and the spread of the psychoanalytic movement might provide insight into the nature of people who believe such things). Their ideas have caused a great deal of damage (as mentally disordered beliefs tend to do). The damage caused by these ideas is calamitous:
Excerpting from the article:
In this paper, the primary versus secondary approach has been taken to understand psychotic disorders, since the term primary has the advantage of not ruling out a neurobiological basis.
...Not ruling out a neurobiological basis? What else can such a statement mean other than to say that the door is still wide open to the idea of functional psychosis? There can be no hinterland in this matter. Yet, a sort of operative hinterland is persistently suggested in many medical and research papers. Read just about any content on the subject of the neurobiological construct of schizophrenia, for example, and inevitably, there is the obligatory commentary to the effect that these illnesses are likely due to some combination of heredity, biology, and environmental causes (which most readers interested in the topic are likely to construe as trauma/stress/childhood adversity rather than some sort of environmental toxicity). Many mainstream psychiatrists believe in the biopsychosocial model. Some people in the research and medical communities do not seem to be cognizant that their conceptualizations of "schizophrenia" are still being influenced by beliefs borne of primitive ignorance, mysticism, and freudianism. They need to snap out of this and purify the ethos of modern medicine of these fallacious, spectrum-disordered beliefs.
Beyond the utility of clinical differential diagnosis, there is absolutely no justifiable reason to classify psychosis in "schizophrenia" as primary just because researchers do not understand the etiology of these symptom complexes. There are a host of illnesses for which the etiology is not understood, that does not cause the medical profession to tag these diseases with a qualifier that makes their biogenic cause suspect. The only reason why the primary/functional conceptualization of "serious mental illnesses" exists is because of historical misconceptualizations. The writers of the article and the medical community seem to be cautiously waiting for convincing evidence of encephalopathy (to be distinguished from encephalitis...which is one of the hypothesized root causes, and which itself is one of many types of encephalopathy) before they will finally discard the "primary" tag that is attached to schizophrenia and other neurobiological illnesses.