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Do you think the trigger of schizophrenia may, perhaps for many sufferers, be psychological trauma and social stress, hard to tackle for very young people, exacerbated when social support is scarce or lacking? Then it may develop into biological illness?

Yours sincerely,
Berit Bryn-Jensen
Arendal, Norway

Answered by Irving I. Gottesman, Ph.D.:
The most widely accepted broad idea (the big picture) about schizophrenia is that it is the result of a predisposition (or diathesis) combining with some kind of stressor (prenatal, perinatal [at the time of delivery], or postnatal). A great deal of effort and money has been expended worldwide for the past 50 years to put meat on these bones, with moderate success in my opinion. However the complexities involved (see the issue of Science magazine for April 26, 2002 for an in-depth treatment of the "puzzle" of complex diseases) require even more effort and funding to make progress toward understanding that will result in the practical results for treatment and prevention of this dreaded disease.

Common sense answers as to what constitutes relevant stress are often disproved when put to empirical testing; for example the incidence rates of severe mental illness did not rise in the United Kingdom when the population was subjected to the blitz of German bombs and rockets during World War II. And, what is a stressor for me may not be a stressor for you, depending on our life experiences and our individual resistances to different stressors. The reoccurrence of a psychotic episode in persons currently in good remission can be delayed or prevented by proper psychological support, in consumers taking their medications, as demonstrated by the programs of research from the University of Pittsburgh by Dr. G. E. Hogarty and colleagues, and from UCLA by Dr. R. P. Liberman and colleagues.

Irving I. Gottesman

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