Transcultural psychiatry studies whatever pertains to the field of psychiatry in relation to cultural differences. The variable in these studies is the culture. We can study whether a given culture confers a special type of symptomatology to schizophrenia. We can attempt to determine whether a given culture enhances the occurrence of some syndromes, related to schizophrenia, but not generally included in the schizophrenic category.

We shall now study schizophrenia from the point of view of its progression, meaning progression toward regression.

This chapter discusses primary prevention aimed at lowering the incidence (or making less probable the onset) of psychiatric disorders.

1. Basic prevention, which aims at the elimination of those items that increase potentiality or increase the vulnerability for the disorder.

2. Longitudinal prevention, which aims at assisting the individual throughout his life to avoid those developments that will enhance actualization of schizophrenia.

3. Critical prevention, which aims at avoiding those factors or specific events that will precipitate an attack or onset of schizophrenia.

The second, or advanced, stage of schizophrenia is reached when the symptoms seem crystallized, to have assumed a fixed and definite form.

I gave the name “preterminal” to a stage of schizophrenia that is rather difficult to delimit or to differentiate. This stage occurs generally from five to fifteen years after the beginning of the illness but may occur sooner or later. Particular attention will be given in this chapter to two habits that are the most common—the hoarding and the self-decorating habits.

We have now come to the fourth, or last, stage of schizophrenia during which a new set of phenomena occurs. Some of the symptoms appear no longer as predominantly psychological but neurological. It seems as if the disorder has reached a level where psychology and neurology coalesce.

A summary of the progression of of schizophrenia from the first through fourth stages.

In the studies on the origins of schizophrenia, the constitutional, cardiovascular, endocrinological, and neuropathological researches have lost ground. On the other hand, the genetic, biochemical, and neurophysiological approaches have gained support.

A large number of researchers have carried out biochemical investigations of schizophrenia, pursuing the hypothesis that a biochemical or metabolic error is at the basis of the disorder.

We shall study separately gesture, action, and volition. By gesture we mean a motion of the body (or of parts of it) that expresses a special psychological state of the individual. By action we mean a purposeful or meaningful behavior, even if the purpose or meaning is not known to the subject. Volition is the process of choosing and of initiating, continuing, actualizing, interrupting, or terminating the chosen action. When we study volition, we refer to the process of choosing and putting into effect the action.