Short report
De betekenis van erfelijke factoren in de psychiatrie
W.K. van Dijk
The main aims of clinical psychiatry are:
A To cure people with mental and emotional disturbances, or to provide them
help to cope with their emotional and environmental problems.
B To provide data as exact as possible as a material for psychopathology to
build hypotheses and theories to broaden and to deepen our insight in the
problems of mental and emotional disturbances.
C To procure facts as a basis for designs for effectave preventive measures
together with other disciplines.
The former and latter aims are closely interrelated, and cannot be viewed
separately: Therapeutic help is based on psychopathological theories and on
empirical clinical facts and psychopathology can only be fruitfully developed in
close contact with the empirical facts from the clinical field. Therapeutic intervention on the one hand and psychopathological theories on the other have,
in fact, preventive aspects.
How do the facts and theories developed so far concerning heredity fit in this
picture of clinical psychiatry?
A—(1) Designs for therapy are always based — even when the therapist denies
it on theoretical grounds — on diagnosis in one form or another. Diagnosis in
this sense is not to be confused with categorizing or classifying the patient in
nosological categories or giving him a place in a taxonomic system.
Rather, the diagnostic procedure, resulting in an individual structural diagnosis,
comprises two actions:
(1) The assesment of the mode of experiencing and behaviour of the patient and
ordering them in symptomatic and syndromatic patterns.
(2) After the syndrome has been determined the etiological factors must be
analysed in terras of a triad of hereditary, organic and psycho(-socio-)genic
factors. Heredity can be interpreted as conditioning a particular disposition
towards, or conditioning a vulnerability for mental and emotional disorders.
Heredity may condition: a particular somatic and mental constitution; b the
integrative capacity of the individual, (including the capacity to master tensions);
c biochemical defects in the tentral nervous system. a and b may or may not be
combined with signs of an imbalance of the autonomic nervous system or an
abnormality of brain waves.
A—(2) In view of therapy it must be stressed, that 'genetically conditioned' is not
synonymous with 'incurable'. Inherited traits may give indications for the therapeutic measures to be taken.
B— From a theoretical psychopathological point of view inheritance can be interpreted as a necessary but, in most cases, not a sufficient condition for mental
and emotional disturbances. The genotype provides the preconditions upon which
the favourable or injurious environmental factors can exercise their influence.
Heredity is the first link in a chain of processes of interaction between genotype
and environment. Men tal and emotional disturbances are generally not transmitted
as such, but only the tendency towards or the susceptibility for these
disorders. This tendency shows a broad variance in penetrante and expressivity.
The gamut comprises such extremes as Chorea Huntington on the one hand and
a slight emotional lability on the other. Some facts and theories concerning
mental def iciency, chronic brain disorders, manic-depressive psychoais and
schizophrenia will be presented.
C— For the prevention of mental and emotional disturbances an exact knowledge
of the genetic make up of the new-boen or the young child, but also of the
adult will give us — in principle at least — the possibility for designing active
measures. These measures have reference to the somatic, the emotional and the
social fields.