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I am rather astonished to find myself, a Continental psychiatrist, opening this discussion on the therapy of schizophrenia, because it seems to me that what one might call a European tradition in clinical psychiatry is responsible for a certain lack of optimism about the subject we are discussing to-day.
Bleuler's fundamental work, published in German in 1911, became in Europe a starting-point for innumerable investigations into the aetiology, symptomatology, heredity, histopathology, and therapy of schizophrenia. The differentiation between 'process psychosis' and psychogenic development became a diagnostic task of the greatest importance. The findings of all these laborious investigations form the basis from which the European psychiatrist works when making a diagnosis of schizophrenia and assessing the prognosis in the individual case.
Thus I came to consider real schizophrenia as an incurable disease, organic in origin, and mainly determined by hereditary factors. Clinical experience seemed to teach us that eventual cure by psychotherapeutic means was possible, but that this disease was particularly apt to give the appearance of successes attributable to psychotherapy ('sham successes'). The discovery of a discordance of 30 per cent. in an investigation carried out on monozygotic twins seems to be of importance in relation to the cure of schizophrenia by psychotherapy. There is some evidence that a healthy sexual life can, where a predisposition to schizophrenia exists, prevent the manifestation of the illness.
The possibility of 'sham success' is present above all in acute cases which progress in attacks (episodes). Especially in the intermission following the first attack it is often hardly possible to prove the existence of a schizophrenic deterioration, and if one takes into consideration that intermissions lasting for forty years have been known, then it becomes evident that therapeutic optimists are afforded the opportunity to boast of great successes.