A Stressful Social Situation as a Precipitant of Schizophrenic Symptoms: An Epidemiological Study

Abstract

Modern hypotheses as to the aetiology of schizophrenia are likely to be multifactorial and to include psychosocial factors. A typical aetiological hypothesis might propose that an “identity” crisis precipitated psychotic symptoms in an individual who was predisposed to schizophrenia; the predisposition could be due both to inherited biological factors and to abnormal personality traits caused by a faulty family environment or other social factors. Hypotheses such as these lead to the expectation that schizophrenia would be precipitated by psychological stress. However, statistical studies which have attempted to relate the onset of schizophrenia to psychological stress have not produced evidence consistent with such an expectation. For example, hospital admissions for psychosis were not increased in England during the blitz (10, 12, 13). Nor was a grossly increased rate of psychosis found in populations of concentration camp survivors (9, 16). Also, it has been claimed that the rate of psychosis was not increased by combat exposure among U.S. soldiers in World War II, whereas the rate of neurosis was clearly affected by combat exposure (6). Consistent with this last point it has been stated that the rate of hospitalization for psychosis in U.S. military personnel has remained relatively constant over the last 40 years apparently independent of war or peace (7, 1), whereas the rate of hospitalization for nonspsychotic disorders has fluctuated widely (7).