The author summarizes a monograph study on the course of schizophrenia into old age, which he co-authored with C. Müller, and which includes mortality and cause-of-death statistics on 1,642 original cases and an average of 37 years of catamnestic observation of the 289 patients who survived until the final followup examination. The separate investigations of the development of schizophrenia, the psycho-organic symptomatology, and the social adaptability show that the long-term course was favorable in at least half of the cases. From a statistical viewpoint, outcome depended primarily on premorbid personality factors, on certain psychopathological factors, and on the influence of advanced age. These findings supported and supplemented important findings by other authors (in particular those of Bleuler and Huber), on the long-range development of schizophrenia.

No abstract

It is well known that in some small European countries there exist especially favourable conditions for certain types of research which elsewhere meet enormous difficulties. This is exemplified in Denmark and other Scandinavian countries by the famous studies on the influence of genetic and environmental factors in schizophrenia, which were made possible by the exceptional availability of well organized national registers on twins, adoptees and psychotics.

A new psychosocial/biological model of the psyche is proposed, in which the affects play a central role in organising and integrating cognition. The psyche is understood here as a complex hierarchical structure of affective/cognitive systems of reference (or 'programmes for feeling, thinking, and behaviour'), generated by repetitive concrete action. These systems store past experience in their structure, and provide the functional basis for further cognition and communication. Affects endow these programmes with a specific qualitative value (such as motivation), connect cognitive elements synchronically and diachronically, and contribute to their storage and mobilisation according to context. They also participate in differentiating cognitive systems at higher levels of abstraction. These assumptions are supported by recent findings on the role of the limbic and hypothalamic system for the regulation of emotion, on neuronal plasticity, and on the phenomenon of state-dependent learning and memory. Refutable hypotheses are formulated for further research on the interaction of emotion and cognition.

We still do not know enough about the aetiology and pathogenesis of schizophrenia, nor are the therapeutic methods generated by our definition of it satisfactory. Therefore, innovative approaches to treating schizophrenic patients, even if they only promise some partial progress, warrant consideration. The purpose of the pilot project ‘Soteria Berne’ is to assess the effectiveness of an open residential programme which has been providing mainly psychotherapy, sociotherapy, and milieu therapy instead of standard pharmacotherapy to about 60 acute schizophrenic patients for more than six years.