The Psychogenesis of Schizophrenia

Abstract

The Editor of theBritish Journal of Psychiatryhas been kind enough to ask me to write a summary and a critical survey of the objective data bearing on the causation of schizophrenia by environmental factors, especially those of a psychogenic nature. I was also asked to combine with this a general assessment of our knowledge in this field. At first sight the task as defined seems a simple and easy one, namely to collect together all those facts which point to the probability of schizophrenia being caused by the psychogenic influences of the patient's environment. But almost at once, a number of serious doubts arise. What are we to understand by the concept of “Schizophrenia“—should we take it in its widest sense as including all the “schizophrenic reaction types”, as do many American authors, or in the far narrower sense favoured by Scandinavian psychiatrists, who recognize only a central or “nuclear group” as true schizophrenia, and describe all related conditions as “schizophreniform psychoses“? Further, what do we mean here by “causation”, and what do we call “objective data”? We shall see later that if we were to collect as data only such as a “non participant observer” (H. Stierlin) thinks he can perceive in the schizophrenic's environment, we should miss the significance of those very factors which are most relevant to the development of the psychosis. It is indeed a complex question—and one which has been the subject of much philosophical reflection— whether it is at all legitimate to assume the existence of “causes” for psychological processes, and whether a search for “causes” is a meaningful undertaking. This, however, lies outside the scope of the present survey; all we need to do is to bear in mind that the use of a one-sided conception of causality might from the very start greatly restrict our field of enquiry, so that essential processes by which schizophrenia arises might not even come to our notice.