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Paradigm shift? Purity, progress and the origins of first-episode psychosis
    1. Correspondence to Dr Suze G Berkhout, Psychiatry (Post-Graduate Medical Education), University of Toronto, Toronto M5T 1R8, Canada; suze.berkhout{at}


    First-episode psychosis has garnered significant attention and resources within mental health services in North America, Europe and Australia/New Zealand since the 1990s. Despite this widespread embrace, little scholarship exists that examines underlying concepts, ideologies and imagery embedded within the early intervention paradigm. In this paper, I offer a sociohistorical analysis of the emergence of first-episode psychosis and early intervention as entities in psychiatry, drawing on contemporary philosophical thought to explore various concepts embedded in them. Although scattered references to ‘prodrome’ and ‘incipient cases’ exist in the historic psychiatric literature, the notion of first-episode psychosis as a distinct chronological stage emerged in the late 1980s. This occurred in response to a desire for a homogeneous, medication-naive population within schizophrenia research. Thematically, concerns regarding ‘purity’ as well as notions of ‘progress’ can be read off of the body of work surrounding the creation of the term and its development into a clinical organising concept. Furthermore, examining the sociohistorical context of the term demonstrates its entanglement with the course of atypical antipsychotic drug development, the expansion of clinical rating scales and wider neoliberal biopolitics within healthcare. Within psychiatry, the early intervention model has been termed a ‘paradigm shift,’ with the promise that earlier interventions will translate into shorter durations of untreated illness, improved utilisation of services and better prognoses for recovery. While these are laudable goals, they are tied to assumptions about biomedical progress and idealisations of clinical populations that feminist and disability critiques problematise.

    • philosophy
    • psychiatry
    • feminism
    • cultural history

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    • xi A full discussion of the course of development of antipsychotic medications is outside of the scope of this article. For a good review, see ref.56 Notably, references to the ‘new era’ abound in the literature discussing atypical antipsychotics.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SGB is supported by the university of Toronto Norris scholar award.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators Juveria Zaheer, Gary Remington.