The purpose of this volume is, rather than looking for the right answers, to attempt more modestly to find some relevant questions for further research in the puzzling field of functional psychoses. Therefore, I want to start my chapter with a provocative statement about our ignorance concerning schizophrenia. In spite of 7-8 decades of continuous effort, we still do not know with sufficient precision what schizophrenia is, nor what are its limits, causes and best treatment. Worse, in the light of modern multifactorial, probabilistic, cybernetic and process-orientated scientific thinking, it becomes less and less certain that there exists such an illness as schizophrenia - or several schizophrenias - as a well-shaped disease entity with constant given causes, psychopathological picture and course. More likely, differing combinations of - certainly in part biological and in part psychosocial- factors might, in certain circumstances, converge (as is found in systems theory) towards more or less identical acute psychotic states which will then again split off into a wide variety of long-term evolutions which depend upon a great number of concomitant factors. Before focussing directly on my specific topic concerning therapy, I therefore feel the necessity to describe briefly certain important trends in the current understanding of schizophrenia and their slow but, as I believe, steady progress toward some useful overall hypotheses. Accordingly, I will discuss the following themes:

1. some general trends in the current understanding of schizophrenia: the 3-phase-model, the vulnerability-hypothesis, the information processing hypothesis, and the distinction of the schizophrenic syndromes I and II;

2. two significant therapeutic trends: the prevention of acute relapses and the social rehabilitation of chronic schizophrenics; and

3. summary conclusions on some relevant questions for further research.

Some general trendsin the current understanding of schizophrenia

As I have already discussed in detail on several other occasions (Ciompi, 1981, 1982, 1983), I think that the current knowledge of schizophrenia can best be summarized by the following three-phase-model (Fig. 1):

In the first, premorbidphase, a variety of combinations of interacting biological and psychosocial factors (these may be genetically inborn, and/or pre or perinatally acquired, organic, e.g neurophysiological defects, unfavourable social and familial conditions, disturbed communication patterns, learning experiences, interpersonal relations, etc.) lead to a particular premorbid vulnerability. Its relative specificity is probably best described as an increased difficulty in the adequate processing of complex information.