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Is there really a Schizophrenia? The Long-term Course of Psychotic Phenomena∗

Published online by Cambridge University Press:  29 January 2018

Luc Ciompi
Luc Ciompi*
Affiliation:
Murtenstrasse 21, CH 3010 Berne, Switzerland
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Summary

The author fundamentally questions the traditional concept of the disease-entity (or several disease entities) of ‘schizophrenia’ and discusses an alternative concept, based on vulnerability and information-processing. According to this, schizophrenia-like psychotic phenomena develop in three phases. In the first, premorbid phase, combined biological (genetic and possibly other organic) and psycho-social influences lead to a premorbid ‘vulnerability’, characterised by a low tolerance of cognitive and emotional stress, corresponding to an insufficient capacity for the adequate processing of complex information. In the second phase, stressful life-events can lead to unique or repeated acute productive psychotic episodes. The third phase, that of long-term evolution, depends more on psycho-social influences than on biological factors. Under unfavourable conditions, it may lead to predominantly unproductive residual states of various degrees, which can largely be understood as regulatory mechanisms to restrict stressful over-stimulation. There is no clearly delimitable disease entity of schizophrenia with constant causes, psychopathological picture, or course, but rather a multi-conditioned life-process, occuring in people with a particular vulnerability, interacting with complex life-events and circumstances. This new concept has important consequences for therapy and prevention.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 145 , Issue 6 , December 1984 , pp. 636 - 640
Copyright
Copyright © 1984 The Royal College of Psychiatrists 

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References

Bateson, G. (1980) Mind and Nature. A Necessary Unit. Toronto: Bantam Books.Google Scholar
Bateson, G. Jackson, D. D., Haley, J. W. & Weakland, J. W. (1956) Towards a theory of schizophrenia. Behaviour Science, 1, 251–264.CrossRefGoogle Scholar
Bellak, L. (1979) Psychiatric Aspects of Minimal Brain Destruction in Adults. New York: Grune and S trat ton.Google Scholar
Bleuler, M. (1978) The Schizophrenic Disorders: Long-term Patient and Family Studies. New Haven: Yale University Press.Google Scholar
Bleuler, M. (1984) Schlusswort. [Conclusion]. Yverdon: 106. Annual Meeting of the Swiss Society of Psychiatry (in press).Google Scholar
Brown, G. W. & Birley, J. L. T. (1968) Crises and life changes and the onset of schizophrenia. Journal of Social Health and Social Behaviour. 9, 203–214.Google Scholar
Chapman, L. (1979) Recent advances in the study of schizophrenic cognition. Schizophrenia Bulletin. 5, 568–580.Google Scholar
Ciompi, L. (1980) The natural history of schizophrenia in the long-term. British Journal of Psychiatry. 136, 413–420.CrossRefGoogle ScholarPubMed
Ciompi, L. (1983) How to improve the treatment of schizophrenics? A multi-causal illness concept and its therapeutic consequences. In: Psychosocial Intervention in Schizophrenia (eds. Sticrlin, H. Wynne, L. C. & Wirsching, M.). Springer: Berlin.Google Scholar
Ciompi, L. & Mueller, C. (1976) Lebensweg und Alter der Schizophrenen. Eine katamnestische Langzeitstudie bis ins Senium. (The Life Course and Aging of Schizophrenics. A Long Term Follow-up Study into Old Age). Berlin: Springer.Google Scholar
Ciompi, L. Dauwalder, H. P. & Ague, C. (1979) Ein Forschungsprogramm zur Rehabilitation psychisch Kranker. III. Längsschnittuntersuchungen zum Rehabilitationserfolg und zur Prognostik [A research program on the rehabilitation of the mentally ill. III Longitudinal investigation on the success of rehabilitation and on prognostic factors]. Nervenarzt, 50, 366–378.Google Scholar
Dauwalder, H. P., Ciompi, L., Aebi, E. & Hubschmid, T. (1984) Ein Forschungsprogramm zur Rehabilitation psychisch Kranker. IV. Untersuchungen zur Rolle von Zukunftserwartungen bei chronisch Schizophrenen. [A research program of the rehabilitation of the mentally ill. IV Investigations on the role of expectations in chronic schizophrenics]. Nervenarzt, 55, 257–264.Google Scholar
Dohrenwendt, W. P. & Egri, G. (1981) Recent stressful life events and episodes of schizophrenia. Schizophrenia Bulletin, 7, 12–23.Google Scholar
Erlenmeyer-Kimling, L., Comblait, B., Friedman, D., Marcuse, Y., Rutschmann, , Simmens, S. & Dav, D. (1982) Neurological, electrophysiological and attentional deviations in children at risk for Schizophrenia. In: Schizophrenia as a Brain Disease (eds. Henn, F. A. & Nasrallah, H. A.). New York: Oxford University Press.Google Scholar
Huber, G., Gross, G. & Schuettler, R. (1979) Schizophrenie. Eine Verlaufs- und sozialpsychiatrische Studie. [Schizophrenia. A longterm course and Sociopsychiatric study]. Berlin: Springer.Google Scholar
Janzarik, W. (1978) Wandlungen des Schizophreniebegriffes. (Changements in the concept of schizophrenia]. Nervenarzt, 49, 133–139.Google Scholar
Kernberg, O. F. (1980) Internal World and External Reality. Object Relation Theory Applied. New York: Aronson.Google Scholar
Lempp, P. (1973) Psychosen im Kindes- und Jugendalter; eine Realitätsbezugsstörung. [Psychoses in Childhood and Youth—a Disturbance of the Relation to Reality]. Bern: Huber.Google Scholar
Mednick, S. A., Schulsinger, R., Teasdale, T. W., Schulsinger, H., Venables, P. H. & Rock, D. R. (1978) Schizophrenia in high-risk children. Sex differences in predisposing factors. In Cognitive Defects in the Development of Mental Illness (ed. Serban, G.). New York: Brunner & Mazel.Google Scholar
Miller, J. G. (1969) Living systems. Basic concepts. In General Systems Theory and Psychiatry (eds. Gray, W., Dual, F. J. & Rizzo, N. D.). Boston: Little and Brown.Google Scholar
Mueller, Ch. (1983) Ueber späte Besserungen von Schizophrenie. [On late improvements of schizophrenia]. Lecture for the 80th birthday of Prof. Manfred Bleuler (in press).Google Scholar
Piaget, J. (1976) Die Aequilibration der kognitiven Stukturen. [The Equilibration of Cognitive Structures]. Stuttgart: Klett.Google Scholar
Prigogine, I. & Steng ers, I. (1981) Dialog mit der Natur. Neue Wege wissenschaftlichen Denkens. [Dialogue with Nature. New Ways of Scientific Thinking]. München: Piper.Google Scholar
Suellwold, L. (1983) Schizophrenie. [Schizophrenia]. Stuttgart: Kohlhammer.Google Scholar
Vaughn, C. E. & Leff, J. P. (1976) The influence of family and social factors on the course of psychiatric illness. British Journal of Psychiatry, 129, 125–137.Google Scholar
Wing, J. K. & Brown, J. (1970) Institutional is m and Schizophrenia. London: Cambridge University Press.Google Scholar
Zubin, J. & Spring, B. (1977) Vulnerability—a new view on schizophrenia. Journal of Abnormal Psychology, 86, 103–126.Google Scholar
Zubin, J. Magaziner, J. & Steinhauer, S. R. (1983) The metamorphosis of schizophrenia: from chronicity to vulnerability. Psychological Medicine, 13, 551–571.Google Scholar
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