To offer hypotheses based simply on clinical experience is pathetically out of date. Perhaps it may be allowed, for a moment, in deference to my advancing years.
Fifty years ago, with some other purpose in mind, I surveyed some 370 cases of schizophrenia in young men. It struck me that, with mild but undue frequency, there was a tendency for their parents’ ages to be unusual in one of two ways – either by there being a > 10-year age difference in the couple, or by the mother being older than the father. In decades of practice since, my impression has remained that this association with schizophrenia occurs a little too often to be accidental. Of course, to prove that would have required time, money, thousands of cases, and the inclination to undertake a major statistical enterprise, and none of those was in my reach.
It is therefore gratifying now to find that, at long last, my hypothesis has been solidly supported, albeit inadvertently, by Zammit et al (Reference Zammit, Allebeck and Dalman2003). They demonstrate, in a 26-year follow-up of some 50 000 teenagers, that advancing paternal age is a risk factor for schizophrenia, while maternal age is not – the latter being a significant negative finding to which, however, they pay no further attention. Since this means that, compared with the normal population, people with schizophrenia tend to have fathers who are older but mothers who are not, it follows necessarily that the age difference between the parents also tends to be greater than in the general population.
This does away with Zammit et al's hypothesis that advancing paternal age is pathogenic for schizophrenia by virtue of increasing germ cell mutations. There is no need to invoke genetic mutation with age, given the linkage they have uncovered, in passing, between parental age difference and schizophrenia. A more economical hypothesis is that to be born to a statistically off-centre parental couple is a risk factor for schizophrenia – or, in more ordinary language, there is some psychological risk in being the child of an odd couple.
Are there other social oddities waiting to be identified statistically in schizophrenogenic couples?
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