Schizophrenia : relevance and dialectics of a psychiatric concept

The most widely accepted hypothesis of the pathogenesis of schizophrenia is the multi-factor hypothesis, where genetic predisposition, molecular alterations and individual psychological and social factors interact in the onset of the disease. The vulnerability associated with genetic alterations does not translate in this case into fatalistic determinism because it is firmly set in the theory of stresses capable of triggering an acute psychotic attack. We are often faced in scientific debate with cases that are difficult to slot into predetermined categories, while there are complex clinical pictures which suggest multiple diagnoses or comorbidity. There has been a growing increase in recent years in the concept of psychopathological dimensions consisting of the disturbance of an area of functioning which is characterised by a set of symptoms each of which contributes to a classification with a different "weight". This approach has proved particularly fertile in the case of schizophrenia. A "dimensional dichotomy" based on clinical observation began to gain ground as far back as the 1980s, distinguishing between "positive symptoms" and "negative symptoms". Each of the two dimensions was associated with different biological alterations, with different courses and clinical outcomes and with a different response to drug therapies. Jung's hypotheses on schizophrenia recognise a common substrate to mental disturbances: he observed the presence of an affectivity dissociated from the integrating functions of the ego as a whole. Experimenting with word association, he observed that complexes (a set of representations, thoughts, emotions, perceptions and sensations linked by a common affective tone) have a life that is independent from the function of consciousness. It is precisely the affective quality of complexes which determine the split from conscious activities when the experience of conflict exceeds the tolerance of the ego.