The main problems of schizophrenia have of late been neither neglected nor solved. Professor Benedetti and his colleagues in Switzerland, who not long ago decided to review contributions to the subject that had appeared between 1956 and 1961, were confronted with nearly three thousand articles and found it necessary to assure readers that only a minute fraction of these contained anything new in the way of findings or fruitful hypotheses. This implied no denigration of the investigators: it testified to the obduracy of the problems. Not all who scan the literature, however, see so little essential advance; the editor of an American survey, convering some four thousand articles on schizophrenia published in the decade 1946-1956, declared that “the essential, complexly integrated etiological factors are clearly available…and ready to be acted on therapeutically and preventively.”
Such diversity of opinion is particularly evident when the social and familial influences on the occurrence of schizopherenia are under examination. Some inquirers are convinced that the mothers of schizophrenics have been harmfully restrictive and inconsistent in their attitude to the child, or subtly dominating and overprotective, and that the fathers were mostly ineffectual and withdrawn: in this family pattern of relationships and upbringing they discren the genesis of schizophrenia. They may qualify this, as Frieda Fromm-Reichmann did, by limiting it to a particular culture; or they may, like Erik Erikson or Lauretta Bender, deny that a rejecting, domineering mother can play so large a part in determining that her child should become schizophrenic; but the argument either way usually turns on clinical evidence drawn from a small number of cases or a biassed sample. This is true not only where parental attitudes are in question, but also for the whole social environment as a cause of schizophrenia. Systematic, well-designed studies dealing as rigorously as possible with the social data, have been few.
Professor Hollingshead is pre-eminent among sociologists who have tried to describe and understand the settings in which schizophrenics live. The New Haven study, “Social Class and Mental Illness,” which he carried out in conjunction with Fredrick Redlich, the Professor of Psychiatry at Yale, was impregnably documented, and by its sober yet convincing analysis threw fresh light on the recognition, types, and current treatment of schizophrenia prevailing in different strata of society. He was therefore appropriately invited in 1956 to carry out, again with a psychiatric collaborator, an epidemiological survey of mental illness in Puerto Rico, where the Director of the Social Science Research Centre of the University had recognized the importance of such an inquiry in a rapidly changing society. But the full plan could not be pursued, because of lack of funds; it was therefore decided to restrict it to schizophrenia and to concentrate on personal and familial influences. For three years, from 1957 to 1960, field work went on under the close supervision of Professor Rogler, who was assisted by four psychiatrists, an anthropologist, and a number of interviewers and social workers; the subsequent analysis and presentation of the material …
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