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Rip's voice drew my attention away from the memories, associations, and reflections with which my mind had been filled. "What do you do for a livelihood, David?" he asked.

"I teach psychology," I responded. "In addition, there is a certain amount of private, clinical work I do independently of my job at the college."

"What courses do you offer at your school?" he inquired.

"The topics tend to vary from year to year," I replied. "Our Department likes its faculty members to keep current in a number of areas and believes the demands of teaching different courses will help encourage us to keep up with new developments, theories and research. In addition, none of the faculty members in our Department wants to get bored and stale with what we are teaching, so there is a tendency, within certain limits, to change the nature of our responsibilities from time to time."

"I know," Rip said, "there are a lot of different areas of psychology to be taught. Do you have much to do with abnormal psychology?" he queried.

When Rip asked this question, I had a very peculiar, though fleeting, intuition that he already knew the answer. Maybe the fact I had mentioned doing clinical work had led to the reasonable assumption that I probably would have some degree of acquaintance with various aspects of abnormal psychology.

"I've taught a number of courses on abnormal psychology," I informed him. "I've also worked in a couple of private mental hospitals on several occasions during summer holidays when I was an undergraduate."

"What do you know about schizophrenia?" he inquired.

Although I didn't believe he was pursuing this line of questioning for the sake of idle curiosity, I really wasn't sure where he wanted to go with things. I shrugged my shoulders and said: "I know enough to understand that nobody really knows what's going on."

Rip didn't respond to my statement. He seemed to be waiting to see if I would say anything else.

I hesitated briefly and, then, proceeded to expand a little on my initial reply. "There have been a number of studies involving twin offspring, both identical and fraternal, of schizophrenic mothers. These studies would suggest there is a strong genetic component to the condition but that genetics alone is not sufficient to account for schizophrenia.

"More specifically, depending on the study, the concordance rate of identical twins, or the extent to which the condition shows up in both of the children of, say, a schizophrenic mother, can vary anywhere from 0 to roughly 85%. Furthermore, studies involving fraternal twins show concordance rates that have values ranging somewhere between two and about thirty-five percent.

"Consequently, genetics does not seem to be the whole answer to the puzzle. If it were, then one might anticipate, for example a concordance rate in identical twins which approaches 100%, but this is not what has been established so far.

"A lot of theories have been advanced about what other conditions are necessary complements to genetic factors. These theories point fingers at different kinds of causal scenarios, ranging from: certain species of dysfunctional families; to various psychoanalytical accounts of ego melt-down; to double-bind or lose-lose scenarios of interaction from which one cannot withdraw; to a creative process of trying to adapt to an insane world; to nutritional deficiencies; to LSD-like metabolites roaming around in the brain; to environmental allergens; to auto-immune diseases of one sort or another.

"For the last thirty-five years, or so, there has been a lot of interest in the biochemistry of a number of neurotransmitters, such as dopamine and serotonin, that seem to be implicated, to a degree, in certain cases of schizophrenia. However, no one has been able to work out a fully satisfactory etiological account of the cause or causes underlying breakdowns in the normal process of neurotransmitter activity or how the complex symptomatology of schizophrenia can be generated by problems in the malfunctioning of just a few neurotransmitters.

"No one really knows why schizophrenia has an early onset in some individuals, or a later onset in other individuals. No one knows why the prognosis is, in general, relatively poor in the former cases, and, to a degree, more promising in the latter cases.

"Furthermore, no one understands why there should be spontaneous remission in a certain number of cases of schizophrenia. No one understands how to fit this phenomenon in with either the data on neurotransmitters or our current knowledge of genetics.

"Considered from, yet, another direction, the problem of trying to determine the cause or causes of the onset of schizophrenia has not been helped by the fact that the diagnostic profile, which supposedly helps to identify those who suffer from this condition, has gone through a number of transitional stages over the years. In addition, there have been significant differences between how, for example, Europeans and Americans have diagnosed schizophrenia.

"The Swiss clinician, Eugen Bleuler, coined the term 'schizophrenia' around 1908. From that time to the relatively recently released version-IV of the Diagnostic and Statistical Manual, the way in which this term has been used and applied has exhibited considerable variance."

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