ABSTRACT
Paranoia, delusions, auditory hallucinations and visual hallucinations, occurring with normal, elevated or depressed mood, can emerge from dynamic defenses against anxiety and are considered reactions of the 1st domain. The implications of the etiologic heterogeneity of schizophrenia that Eugen Bleuler and Adolf Meyer recognized long ago have not been fully embraced by modern psychiatry. Patients with character pathology are often misdiagnosed with schizophrenia spectrum illnesses. In the mid-1950s, a psychogenic mechanism for understanding the kind of situations that set an ontologically insecure person on a course to schizophrenia was proposed by Gregory Bateson, an anthropologist who was not a clinician, and his colleagues, some of whom were clinicians. Starting in the 1950s, as the new paradigm of biological psychiatry took hold, the psychiatrist's role of facilitator in the psychodynamic reorganization of a person who had undergone a psychotic reaction inevitably took a back seat to pharmacological intervention.
