Long-term followup studies: a commentary.

Recent followup studies establish that schizophrenia, however defined, is a disease of very variable outcome. Many patients recover completely and improvements can occur after many years. This is difficult to reconcile with the concept of slowly progressive brain disease, and it seems increasingly likely that the neuropathology observed in chronic schizophrenia largely precedes the onset of symptoms. The adverse effect of a hostile or overprotective emotional environment on the prognosis of schizophrenia, and recently reported differences in family environments between industrial and Third World countries, may account for the relatively good outcome of schizophrenia in the latter. Despite its many imperfections, the concept of schizophrenia is unlikely to be abandoned until we have radical new insights into the etiology of the "functional psychoses."