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By Dr. Victor "Van" Wiesner III 
If you want to know more about the historical underpinnings of schizophrenia and update yourself with contemporary research, you could spend hundreds of hours reading professional journals. As an alternative, you could read an elegant mystery novel that explains these complex concepts in an efficient and understandable manner with intrigue on every page.
Michael Foster Green continuously alternates from the “little picture” to the “big picture”. He makes wise use of repetition to drive home core messages. He emphasizes that while schizophrenia is a psychotic disorder, it is not primarily a disorder of psychotic symptoms. Schizophrenia is an illness of neural connections and neurocognitive deficits. The psychosis can be thought of as the ‘fever’ of this severe mental illness and while important it is not central to the disorder.
“People are born to have the illness of craziness, how does it come about?...it is an illness started in the womb, resulting from a bad scare of the mother when she was pregnant.” This quote is more accurate than most of the speculations that came after it. When was this written? Roughly 2,000 years ago in a Chinese medical text called the
Yellow Emperor’s Classic of Internal Medicine.
Worldwide schizophrenia appears in roughly one person out of every one hundred; that corresponds to a 1% risk for the general population. Children of those with schizophrenia have about a 12% risk of developing the disorder. If your full-blood sibling has schizophrenia, your risk becomes 8%; if this sibling is a fraternal twin your rate goes up to 17%; and if he or she is an identical twin, your overall odds increase to 48%. If schizophrenia were entirely genetic, one would always expect both identical twins to have the condition if one had it, but that is not the case.
Abnormalities in development may be seen early in life. Raters were generally accurate when asked to identify pre-schizophrenic children in home movies. The pre-schizophrenic children often showed more negative emotions such as crying when coming in contact with adults, and frequently the children had unusual and awkward motor movements (atypical hand posture is one example).
Some signs found more in schizophrenic groups than control groups include: high-steeped palate, a small or large distance between tear ducts, malformed ears, webbing between the toes, a lower or higher number of ridges in fingerprints, and atypical handedness. These are signs of neurodevelopment problems but one should not diagnose or differentiate on the basis of these signs.
From the 1910s to the 1940s, the therapy of choice was hydrotherapy. Agitated patients were wrapped in cold sheets (40°) while others were wrapped in warmer sheets (100°). Another form of hydrotherapy used continuous baths of varying temperatures. In later years, malaria induction, insulin-induced coma, electroconvulsive treatment, and prefrontal lobotomy were treatment options.
Michael Green covers topics such as the features of schizophrenia, the development of the disorder, genetic studies, neurocognitive deficits, neuroimaging, interventions, and outcome studies. I found his delineation of drug interventions both clarifying and hopeful. Apparently some newer drugs are providing neurocognitive benefits. This is crucial because neurocognitive benefits seem to be more related to positive functional outcome than the mere reduction or elimination of positive symptoms (such as delusions and hallucinations) or negative symptoms.
Green’s text should find a wide audience. His coverage of schizophrenia is both broad and deep. I found myself referring to medical dictionaries at some points and there are plenty of citations for one to follow up. The layperson may be overwhelmed at times as this book has a research feel to it. A bit technical at times, I think this is unavoidable due to the depth of the discussion. I read the book twice and found the information so contagious that I’ve told many friends, colleagues, and students about the interesting findings. Green does a superb job in making the connections between neurons and social interaction understandable.
About the Author...
I practice in The Woodlands, Texas. I am a university professor. wiesner.homestead.com Last Update: 3/13/2008
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