Discussion of paper by Manfred Bleuer
“Conception of Schizophrenia within the last fifty years and today”
International Journal of Psychiatry, 1965, 1
Professor Bleuler's research experience has been very wide and entitles his views to close examination. During the course of a very productive life he has progressed from genetic studies to endocrinologic ones, to psychotherapy and psychodynamics, and finally into human interrelationships. But as far as the etiology of schizophrenia is concerned, the fruit of these labors is entirely negative. There is, he tells us, no specific gene, no specific endocrine disturbance, no specific trauma, no specifically phase in development, no specifically shizophrenogenic relationship. There is, indeed, no specific schizophrenia. Schizophrenic is normal and normal is schizophrenic; beneath the surface in each of us schizophrenic life is going on. There is hardly even illness. When we look at the mentally crippled asylum inmate, we are to remember that “no schizophrenic morbid process exists which would destroy healthy life for good and replace it by a new form of life." I do not understand how Bleuler can be so sure of his negatives, merely because a few decades have not brought us the answers we want. The cancer worker, after an enormously greater effort with no more conclusive result shows no such discouragement.
Bleuler's argument is founded on faulty logic, as a single example may show. He bases his conclusion that genetic factors are nonspecific on the considerations: (1) more than one genetic model can be made to fit the observations; (2) it is difficult to make sure of the clinical diagnosis of schizohrenia; (3) schizophrenics of the older generation affect the environment of the younger generation, so that the effects of heredity and environment are difficult to disentangle. These are, of course, grounds for uncertainty in drawing conclusions from our research, but they have no relevance whatever to the nature of those conclusions. To argue, as Bleuer does time and again, that because no cause has been found no cause exists, is to rush to a conclusion no less dwgerous for being negative.
Even in the consequences he draws, Bleuler repeatedly lands in self‑contradiction. Although, he says, there is no specifically vulnerable phase in development, and no such person as the schizophrenogenic mother, his first and second priorities for research are the questions: “What periods of development are more decisive than others?” and “What types of poisoned human relationship do more harm than others?” The biggest contradiction of all is to continue our researches into schizophrenia, since for Bleuler schizophrenia is an abstraction without validity. “The genesis of schizophrenia is dominated by the personal and the unique.” If so, it is beyond discovery. All we have to work with is the 'chizophrenic patient. If we cannot learn from him some nonpersonal nonunique lesson, to be applied to another schizophrenic and to the class of schizophrenics as a whole, then there is nothing to be earned, and we are wasting our time.
Bleuler seems to believe that decisive effects may arise from the interactions of factors which are in themselves without effect. For example, he offers the plausible‑sounding suggestion that, instead of a specific gene or genes, an incompatibility of different hereditary dispositions might be responsible for hereditary influences in schizophrenia. If we start on such a slippery path, we land in an infinite regress. If the interactions turn out to be uninformative subjects of study, we can then turn our attention to second-order effects and the interactions between interactions. First things first. Let us begin by finding out the amount of variance, e.g., in the differences between schizophrenics and nonschizophrenics, which within a given community can be attributed to environmental differences between individuals, and the amount of variance to be allotted to genetic differences. Only when these sources of variance have been parceled out can we estimate the amount of variance to be ascribed to their interaction.
The value of a hypothesis depends on the ease with which it can be put to the test; an irrefutable hypothesis is useless. Until we have cleared up the prohlens relating to the primary factors, generalizations about their interrelations remain so much word‑spinning. One cannot get any kind of a research plan out of the statement that “the whole life expcrience has significance”! There is no human problem of any kind whatever that cannot be "explained" by an appeal to human relationships. Just because such a hypothesis leaves nothing unexplained one finds when one has used it to the full that one has arrived at nowhere ‑ and has been left without a clue to take one further on the road.