A virtually infinite number of things can cause symptoms which have some overlap with schizophrenia, and that's why today (I'm not an expert, but I'm assuming what I know of is representative) on intake they classify someone as "schizophreniform" - apparently a fancy way to say "looks like/might be schizophrenia" without committing to anything.
For every person that has a chronic condition, there are going to be many that have one episode and it never recurs. Maybe it was a virus. Maybe they had some weird allergic reaction. Hospitals are never going to know for sure what's wrong with everyone, so the humane thing is not to insist they determine whether the remainder is "real" or not.
Being involuntarily admitted as a psych patient has permanent consequences, and it's uncomfortable to think about someone who doesn't "deserve" the stigma being caught up in it. I think an obsession with this scenario drives the people who crusade against psychiatry. But putting more pressure on medical professionals to always get it right is only liable to make things worse. You can't get better results by applying thumbscrews to people who genuinely try their best to deal with a fundamentally intractable problem.
This did jump out at me:
"then, as now, no scans, no blood tests, no laboratory findings allowed them to distinguish the mad from the sane"
In the 21st century, I believe hospitals in the US typically screen for likely drugs first, when someone appears to have psychotic symptoms. But they also (at least where I know about) do pretty comprehensive blood tests that show clear metabolic abnormalities and then just discard the results when they don't know what it means. So in a sense, sure, there's no blood test for mental symptoms, and yet if positive tests for various things are routinely met with a shrug and typical psychotropic drugs administered, then the statement is misleading.
And they are basically defined by clustering of symptoms. This is driven by welfare/insurance reasons. You need a diagnosis to get benefits.
And while they often can't treat the underlying problem for schizophrenia and other diseases, they can definitely treat the symptoms. So if you have some of the same symptoms by some other unique variant of the disease, the treatment may still by useful.
And while they often can't treat the underlying problem
for schizophrenia and other diseases, they can
definitely treat the symptoms.
Psychiatry is far, far from perfect. It is a discipline that is still taking its tiniest of baby steps into the realm of actual usefulness.
I think any psychiatrist would be willing to openly admit this; that the mind is still largely a mystery to us and we have probably centuries of learning to do, due to the extreme difficulty of studying a living mind, much less performing repeatable experiments upon them.
And yet criticism of psychiatry so often misses the point! The medicines are sometimes hugely beneficial. Sometimes not. But I know lives that have been transformed for the better thanks to them.