Saturday, August 19, 2006
Emil Kraepelin and forebears described a very high degree of phenotypic diversity in schizophrenia patients, with reproductive capacity varying inversely with phenotypic severity.
Is the schizophrenia typically seen by clinicians today milder than the disease described by Emil Kraepelin in the 19th century or even that commonly seen by clinicians in the middle of the 20th?
And might natural selection be at work, progressively thinning the population of the most sorely affected patients while allowing a less-severe form of disease to survive into our day?
That's the intriguing idea floated by Thomas McGlashan, M.D., in an editorial in the July Schizophrenia Bulletin titled "At Issue: Is Natural Selection Rendering Schizophrenia Less Severe?" (Extract).
In an interview with Psychiatric News, McGlashan acknowledged that the notion hardly occurs to clinicians busy treating a disease no one would describe as mild. And credible research comparing the disease as it presented 100 years ago with today's malady is nonexistent.
But McGlashan suggests it may be reasonable for contemporary researchers and clinicians to look up, so to speak, from their work and ponder why it is that "recovery" is advanced as an expectable goal for many patients today, when 60 years ago such a notion would never have been considered. [Evolution]