Ist die chronische Schizophrenie ein Artefakt? - Argumente und Gegenargumente*

Abstract

The working hypothesis is investigated that chronic schizophrenia could differ from acute schizophrenia not only phenomenologically, but also in its causes. The following arguments in favour of the hypothesis that chronic schizophrenia could mainly be a psychosocial "artefact", caused by the psycho-social consequences of acute attacks of illness, are presented 1. institutionalisme and understimulation; 2. non-specifity of many phenomenons attributed to "chronic schizophrenia"; 3. great variability of long-term courses; 4. lack of influence of genetic factors on long-term course; 5. importance of social factors for long-term course; proposition of a "general principle of psychosocial inertia"; 6. family influences; 7. lack of sufficient proofs for a clearcut illness-concept. --On the other hand the following arguments against the artefact-hypothesis are discussed: 1. the question of "irreversible residual states"; 2. organic and biochemical arguments; 3. genetic arguments; 4. the problematic distinction between acute and chronic schizophrenia; 5. the ubiquity of chronic schizophrenia. --On the whole, the arguments in favour of the artefact-hypothesis seem more pertinent, but more research is needed for a definite decision.