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When I had completed my overview of diagnosis and schizophrenia, I smiled rather sheepishly. "You'll have to forgive me Rip," I requested. "Quite frequently, when one asks a professor a question, one ends up having to enroll, even if only informally, in the impromptu classes we professor types tend to launch into at the drop of even the most innocent and simple of questions."

Rip chuckled. "No apologies are necessary," he assured me.

"I was genuinely interested in what you had to say," Rip informed me, "and you provided me with the kind of information which I had been seeking."

"Was there any particular reason for your interest in schizophrenia?" I probed.

Rip looked at me. In fact, he appeared to look deep into me or right through me. I couldn't be sure which, if either, was the case.

He didn't reply to my question right away. He seemed to be lost in thought.

While waiting for what I believed would be an eventual response to my query, I began to consider various possibilities for his interest. At the top of my list, was an empirical finding that had been known for quite some time.

The highest incidence of schizophrenia is found in the inner-city areas of a metropolitan region. This finding has been confirmed in a number of cross-cultural studies carried out in Norway, the United States, England and Denmark.

In fact, studies have shown that schizophrenia showed up in the lowest socio-economic class at a rate roughly twice that of the incidence of schizophrenia in the next lowest socio-economic class. Moreover, in general, there was a very sharp discontinuity between the rate of schizophrenia in the lowest socio-economic classes and many of the higher socio-economic classes.

There have been several explanatory approaches to this statistic linking schizophrenia and socio-economic class. One approach is known as the social-drift theory, while the other major account is referred to as the sociogenic hypothesis.

According to social-drift theorists, an individual suffering from schizophrenia may start out in a middling or upper socio-economic class. Nevertheless, the traumatic, pervasive and debilitating impact of the condition is such that during the course of the person's lifetime, they gradually, or rapidly, will drift down through the various levels of socio-economic class until they hit rock bottom as homeless, street people in the poorest part of the inner-city.

Those people, on the other hand, who are advocates of the sociogenic hypothesis contend that the numerous impoverished dimensions of life among the lower socio-economic classes are the primary causes of schizophrenia. In other words, various combinations of poor education, dysfunctional families, poverty, lack of social support services, negative self-image, inadequate nutrition, constant exposure to environmental stressors and pollutants, as well as a relative absence of different kinds of economic, social and educational opportunity, will either cause people to have schizophrenic breaks with so-called normal reality or will grease the skids for such a break in those people who may be genetically predisposed to succumb to such an onslaught of forces.

The available evidence seemed to suggest that both the social-drift theory and the sociogenic hypothesis had a certain degree of validity. Several studies indicated that while the fathers of schizophrenics were more likely to be from the lower socio-economic classes, nonetheless, the schizophrenic children of these fathers tended to end up further down the socio-economic class line.

Thus, on the one hand, empirical data gathered in relation to the socio-economic class of the fathers of schizophrenic children lent support to the sociogenic hypothesis. In other words, this data implicated the impoverished life of lower socio-economic classes as being a major precipitating factor in the emergence of schizophrenic children.

On the other hand, data from these same studies also showed that the schizophrenic children of lower socio-economic class fathers tended to end up worse off than their fathers as far as socio-economic class status was concerned. This finding lent a certain amount of support to the social-drift theories which held that the debilitating nature of this condition of mental disturbance would prevent one from holding jobs or getting an education and, consequently, would result in a drift downward in socio-economic class.

Perhaps, the reason Rip was asking questions about schizophrenia is because the inner-city work of his center, in accordance with both the sociogenic hypothesis as well as the social-drift theory, necessarily involved contact with a number of schizophrenic individuals. In fact, since many municipal and regional governments, in order to cut costs, merely were removing schizophrenics from therapeutic environments and placing them back into the communities with little more than prescriptions for different kinds of symptom-masking neuroleptic medications, Rip and the center were likely encountering quite a few more schizophrenics than may have been the case previously.

I became aware that Rip was looking at me. He seemed to be waiting for me to return from my flight of thought.

"I have been reflecting," he began, "on what you were telling me about the various issues surrounding the diagnosis of schizophrenia. I have been intrigued by the parallels between what you have been saying and what is occurring in a quite different context.

"Psychologists, psychiatrists, doctors and other mental health clinicians are very busy these days applying their diagnostic instruments to various individuals who may be suffering from conditions such as schizophrenia. What these professionals may not understand is that they, along with the rest of us, are being examined and observed in accordance with another set of diagnostic instruments by, among others, some of the spiritually intoxicated people about whom I was talking previously."

I started to feel a tightness or tension in my stomach. I had an uneasy feeling I was at the mental/emotional equivalent of the first summit of a roller coaster ride that is poised to plummet down to the bottom of a very steep incline.

Quickly, I adjusted some of the emotional and conceptual safety-cushions which buffered my sense of psychological equilibrium. I wished I had something to grab hold of with my hands. I would have felt a bit more stability, if not comfort, if, in the best tradition of these kinds of experiences, I had been able to latch onto 'whatever' in white-knuckle fashion.

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