24 Stress and Schizophrenia: Some Definitional Issues by Bonnie Spring Abstract This article discusses definitional ambiguities in research on the role of stress in the etiology of schizo- phrenia. Implications of the change to DSM-111 criteria are considered, as is the question of whether prior research samples have overincluded acute schizo- phrenics. It is suggested that the problem of defining schizo- phrenia's time of onset is one of the thorniest in this literature. Three different operational defi- nitions of stress are examined. Stress may be considered a re- sponse involving disruption in homeostasis, or as a stimulus with objectively specifiable properties. Stress is also defined interaction- ally with reference to characteris- tics of the individual and the sur- rounding life context. Relative merits of the three definitions are evaluated, and an attempt is made to clarify the differentiation be- tween formative and triggering ef- fects of stress. Further study of the impact of remote life events on vulnerability is encouraged. Is stress a precursor of schizo- phrenia? Professional opinions on the question have completed sev- eral full cycles over the course of the past century. The fact is that stressful life events have been found to account for somewhat less than 10 percent of the variance in the onset of schizophrenia and depression (Andrews and Tennant 1978). However, it has been suggested that problems of sample size (Rabkin and Struening 1976) and sample selection (Dohren- wend and Egri 1981) may have rendered this estimate overly con- servative. This article suggests that conceptual issues in defining stress and dating illness onset have never been adequately resolved. There- fore, both the magnitude and the importance of the association be- tween stress and schizophrenia may warrant reexamination. Defining Schizophrenia For more than a century, psychopathologists have at- tempted to come to grips with the major problem of the schizo- phrenia researcher: heterogeneity. Schizophrenics are a diverse group in terms of their symptoms, pre- morbid social functioning, and even precipitating circumstances. It has long been hoped that if a core group of "true" schizo- phrenics could be isolated based on homogeneity of these presen- ting features, a unitary etiology might perhaps emerge. It may be worth questioning whether such a fantasy bids fair to come true. If we carefully reduce the schizo- phrenic populace into a nuclear, core, or process group, and various other peripheral clusters (e.g., schizotypal, reactive, schizoaffec- tive), will we find a uniform causal pathway for the nuclear group? Or will we continue to rediscover the historic truth—that the schizo- phrenic clinical picture emerges as a final common pathway along many different etiological high- Portions of this article will appear in Spring, B., and Coons, H. Stress as a precursor of schizophrenia. In: Neufeld, R.W.J., ed. Psychological Stress and Psychopathology. New York: McGraw-Hill, Inc., in press. Reprint requests should be sent to Dr. Spring at Department of Psychol- ogy and Social Relations, Harvard University, 1102 William James Hall, Cambridge, MA 02138. Downloaded from https://academic.oup.com/schizophreniabulletin/article/7/1/24/1939294 by guest on 22 September 2023