It has recently been suggested that upbringing, and in particular, any abuse that may have occurred when the patient was young, rather than heredity, is crucial in the development of psychotic disease. This suggestion, made by contributors to the journal Acta Psychiatrica Scandinavica, contradicts the experience of many patients, their families and doctors. It ignores the strongly hereditary nature of the psychoses, and the anatomical and physiological knowledge about the workings of the schizophrenic brain that has been accumulated over the past 60 years.

Few, if any, would assume that the nature and severity of schizophrenic symptoms are entirely the result of genetic inheritance, or of early environment. But too often two facts are overlooked: sometimes both parents, at other times only one, and other members of the family, carry the same genes. As a result, it is most unlikely that any new member of the family will have a standard upbringing.

The other factor often overlooked is that in any family with these genes, those affected will display a range of symptoms. These may vary in intensity from the frankly psychotic to the amusingly eccentric.

To denigrate the value of the drugs, even with their limitations, is to threaten to return the treatment of schizophrenia and bipolar disorder to the Dark Ages, when these patients, if poor, were locked up and physically or chemically restrained. When the patients were rich, they were sometimes wrapped in cotton wool to guard against their troubles. Where an analytical psychological approach was used, it often seemed to be serving the therapist more than the patient. Even Sigmund Freud used to avoid treating psychotic patients with the psychological approach, useful as it was for those with personality disorders.

I started in clinical medicine at the time when antipsychotic drugs were being introduced. Previously, it had been common to encounter patients whose lives appeared to have been for ever marred because they had fallen into the hands of analytical psychologists.

By the very nature of their condition, patients with schizophrenia, even if they are not frankly paranoid and deluded, are liable to be for ever seeking to blame others.To suggest that they should spend days each month delving into their past is asking for trouble. Inevitably, their delusions will be reinforced. When, as a young doctor, I took too long a history from a schizophrenic patient, my mentor told me that it was sometimes better not to stir up the water at the bottom of a potentially dirty well.

Only those who have seen the terrible mess that clumsy analysis can make of patients can understand the joy of having medication available that alleviates some of the fears and anxieties that schizophrenic delusions and hallucinations induce. Now the newer, atypical antipsychotics even remove some of the actual delusions, although these later drugs have undesirable side-effects.

As the psychotic diseases have a strong hereditary basis, the abberant characteristics carried by the genes in the mother or father are bound to bear some similarity to those that are causing the psychosis in their child. However hard they try to be good parents, they may have fragile personalities and find it difficult or impossible to ease the path for a child with a vulnerable personality.

If, later in life, the child develops a psychosis and is plagued by fears, hallucinations and grotesque delusions, he or she is rarely to blame. Evidence suggests that psychotic diseases are not inherited as the result of a single gene. The severity of the symptoms depends on many factors, including the nature of the genetic package inherited. Early background also plays a part. This encompasses peer group, siblings, education and scholastic and family expectation. Other risk factors include health, the time of year that the patient was born, race, whether the patient had a rural or urban life, and whether families were migrant or static.

The nature of a patient’s history is unlikely to be detached unadorned when he or she is suffering from fearful, grotesque delusions and hallucinations, however, it is unfair to suspect the adults of the patient’s childhood of abuse.

www.timesonline.co.uk/talkingpoint