Schizophrenia : the epigenetic puzzle / Irving I. Gottesman, James Shields, with the assistance of Daniel R. Hanson.
- Irving Gottesman
- Date:
- 1982
Licence: Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
Credit: Schizophrenia : the epigenetic puzzle / Irving I. Gottesman, James Shields, with the assistance of Daniel R. Hanson. Source: Wellcome Collection.
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![2 Schizophrenia: the epigenetic puzzle impression made by a patient or, often, by the hospital chart of a dead or unavailable patient on clinicians with varying expertise. The present-day emphasis on research diagnostic criteria, as embodied in the DSM-III {Diagnostic and Statistical Manual of Mental Disorders, third edition, 1980) or the structured interview of the Present State Examina¬ tion (PSE) (Wing, Cooper, & Sartorius, 1974), represents a codification of what most clinicians had been doing all along. The structured, criterion- based approach to diagnosis permits the training of new diagnosticians so that they achieve at least a minimal reliability. The question of validity, however, must stand on additional data. It would be easy, for example, to mandate a rigid, perfectly reliable research definition that had zero validity. It would be terribly wasteful and unfair to throw out all literature on family studies of schizophrenia produced before 1970 because the authors did not use the Chinese-menu approach to diagnosis (i.e., three symptoms from Column A, one from Column B, and [exclusion criteria] none from Column C). Still, we must choose the studies carefully for assembling the pieces in the puzzle; not all the studies are of equal merit, and legitimate concerns have been raised about such things as contaminated diagnoses, in which the author who diagnoses a relative already knows the diagnosis of the proband. Sample case history of a schizophrenic person Dealing in the abstract with symptoms, criteria, consensus judgments, and issues of validity and reliability leads too quickly to losing sight of the persons, often patients, whom we are trying to characterize. No two schizophrenics are exactly alike, not even identical twins reared together. We offer the following very abbreviated excerpt from the case history of a contemporary paranoid schizophrenic known and described by a senior clinician, John Romano (1977), with a vast experience with schizophrenics since the early 1930s. No one patient can be prototypical; other sources give other examples of their phenomenology (e.g., E. Bleuler, 1950; M. Bleuler, 1978; Schneider, 1971; Slater & Roth, 1969). With caution, some generalization to other cases of schizophrenia is defensible; in a consecutive series of 1,522 admissions to a university-based psychiatric hospital in West Berlin, Helmchen (1975) was able to classify 432 (28%) as schizophrenic. The use of a 123-item symptom checklist permitted him to categorize the schizophrenics into the 10 subtypes listed in the International Classification of Diseases (e.g., catatonic, residual, schizoaffective, etc.). The modal phenotype and the largest plurality by far was paranoid schizophrenia at 37%; the next most common phenotypes were residual (14%) and simple (10%).](https://iiif.wellcomecollection.org/image/b18029735_0021.JP2/full/800%2C/0/default.jpg)
