The Epidemiology of Schizophrenia

This is an impressive book. It brings together a remarkable array of evidence. The evidence comes from papers published in English, underlining the sad fact that there is little exchange of information between the realms of different languages. English has become the medium of science, replacing the Latin of the European scholars of the Middle Ages. Although studies are done in other parts of the world and are published in French, German, Russian, Spanish, Chinese, and other languages, it is hard to find references to them in the articles written in English in this or most other books published in English. The situation is probably a little less bad in articles published in other languages that refer to work published in English, but the barriers seem to be just as high for scientists writing those articles as they are for those publishing in English. Admittedly, most of the important research nowadays appears in English, but it is probable that important work is published elsewhere that does not cross the language borders. This is not a criticism of this excellent volume but a lament over the world of science today.

This volume touches on all the points of current interest in research on schizophrenia. It is somewhat artificially divided into five parts—The Social Epidemiology of Schizophrenia, The Developmental Epidemiology of Schizophrenia, The Genetic Epidemiology of Schizophrenia, Special Issues in the Epidemiology of Schizophrenia, and Future Directions and Emerging Issues. With some exceptions, most of the chapters could be placed in any of these five groups. The grouping of the chapters into five clusters was a valiant effort to organize the vast amount of evidence about the epidemiology of schizophrenia that has become available in recent years. The effort did not quite succeed, but that is of little consequence for the value of the book, which relies solidly on the many excellent contributions of the nearly 40 authors whom the editors have assembled.

As is often the case in similar books, the quality, comprehensiveness, and scope of the chapters included in the book vary. There are, however, numerous chapters of fine quality bringing together well-assembled evidence that is not easy to find elsewhere and others that open new vistas on mental illness. I particularly liked the chapters dealing with the gene-environment interaction, the thought-provoking chapter by Jim van Os and Hélène Verdoux on the diagnosis and classification of schizophrenia, and the chapter dealing with questions of prodrome and early course of schizophrenia by Häfner.

The book regrettably does not have an author index, and the subject index has some surprising omissions—the words “culture,” “transcultural,” “cross-cultural,” “catatonia” “hebephrenic,” “paranoid,” “schizoaffective,” “mood disorders,” or “affective disorders,” for example, do not appear in the index. The absence of the some of these words is a reflection of the near absence of attention to differences of findings concerning the classical diagnostic subgroups counted under the general heading of schizophrenia. This decision can be defended in a variety of ways. I regret, however, that little attention was given to the contribution that epidemiology could make to the validation or invalidation of the nosological entities that have dominated clinical and therapeutic thinking of psychiatrists for at least a century.

In all, however, I think that this book is a very useful compendium of epidemiologic findings concerning schizophrenia and that it should be of interest and helpful not only to psychiatrists interested in schizophrenia but also to geneticists, physicians of disciplines other than psychiatry, and public health decision makers.