Nature vs. Nurture: Two Brothers with Schizophrenia

By Keltner, Norman L.; James, Christopher A. et al. | Perspectives in Psychiatric Care, July-September 2001 | Go to article overview

Nature vs. Nurture: Two Brothers with Schizophrenia


Keltner, Norman L., James, Christopher A., Darling, Rani J., Findley, Lisa S., Oliver, Kelli, Perspectives in Psychiatric Care


TOPIC. The nature vs. nurture argument as it pertains to two brothers.

PURPOSE. To explore the synergistic effects of heritability and environment in the cases of two brothers with schizophrenia.

SOURCES. Review of the literature and the authors' clinical experience.

CONCLUSIONS. The nature vs. nurture dichotomy may not be as relevant as looking at the interaction between these two forces. Search terms: Family, nature, nurture, schizophrenia

Psychoanalysis took a while to conquer the United States, but once it did, after the Second World War, its dominance was unquestioned, and its arrogance breathtaking. Schizophrenia, autism, and numerous other disorders were blamed on the mother, with no evidence, just utter certainty.

Acocella, 2000, p. 114

One of the great debates in 20th century psychiatry centered on etiology: Is upbringing (nurturing) or biology (nature) at the root of mental illness?

In the late 19th century, Kraepelinian thinking, which postulated an organic causation, dominated psychiatric thought. As the new century dawned, however, this view quickly gave way to what Cohn (1974) called the Freudian revolution. By the time of Freud's death in 1939, psychoanalytic thought was well on its way to achieving all its goals. It was the application of these principles during World War II that firmly entrenched psychoanalysis, and by extension psychodynamic assumptions, into the heart and soul of our culture. "From the end of World War II until the mid-1970s, a broadly conceived psychosocial model, informed by psychoanalytic and sociological thinking, was the organizing model of American psychiatry" (Wilson, 1993, p. 400).

While the nurture advocates held sway for most of the century, clearly as the millennium closed the proponents of a biological view had won the day. These biologically oriented theorists, in contrast to their more dynamically inclined colleagues, dominated influential academic positions, controlled research direction and subsequent funding, and offered the public some reprieve from the family-blaming psychodynamic models.

The quintessential point in this circling back to a Kraepelinian-like viewpoint was the development of the third edition of the Diagnostic and Statistical Manual (DSM-III) (American Psychiatric Association [APA], 1980). Strauss, Yager, and Strauss (1984), summarizing psychiatrists' opinions, stated it was the most important psychiatric publication to appear during the 1970s. Wilson (1993) suggests this document led to the "remedicalization" of psychiatry: "The history of the development of DSM-III is a story about the changing power base, as well as the changing knowledge base, within American psychiatry" (p. 408).

With this background in mind, the authors present an interesting case review of two brothers with schizophrenia. Reasoning suggests a nature perspective (i.e., genetic causation), and that may well be the most fruitful model to embrace. Yet after working with these individuals, we are attracted to a more holistic framework that accounts for the significance of heredity-environment interactions. Andreasen (1999) likens this approach to the model used to understand cancer: "schizophrenia probably occurs as a consequence of multiple `hits' which include some combination of inherited genetic factors and external, nongenetic factors that affect the regulation and expression of genes governing brain function or that injure the brain directly" (p. 645).

Schizophrenia

Schizophrenia is one of the most common causes of psychosis, affecting about 1% of the adult population (Regier et al., 1993). It is a biological brain disorder typically emerging in late adolescence or early adulthood, is exacerbated by stress, and responds to dopamine receptor antagonists (Weinberger, 1987). It is a thought disorder; symptoms include hallucinations, delusions, withdrawal, poor rapport, and difficulties in communication (APA, 1994; Keltner, Folks, Palmer, & Powers, 1998).

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