Far from the Tree: Parents, Children, and the Search for Identity

by Andrew Solomon

The usual course for the condition, however, is that it unfolds through five predictable stages. It is asymptomatic until puberty in the premorbid phase, though recent research points to delays in walking and talking, more isolated play, poor school performance, social anxiety, and poor verbal short-term memory. This is followed by a prodromal phase, which lasts for four years on average, in which positive symptoms begin gradually to appear. The adolescent or young adult in this phase experiences changes in cognition, perception, volition, and motor function; has strange thoughts flash across his mind; struggles to understand whether illogical beliefs are true; and becomes suspicious and wary. Some people who will develop schizophrenia seem curiously detached from the real world even in childhood and gradually slip into psychosis. Most appear to have a dramatic break, sometimes in reaction to trauma and sometimes with no obvious trigger, in which they are suddenly transformed beyond recognition. This marks entry into the psychotic phase, with the onset of hallucinations or bizarre delusions, including delusions of control, thought insertion, thought broadcasting, and thought withdrawal. This usually occurs between ages fifteen and thirty and lasts for about two years. No one has yet been able to discover what maturational event triggers psychosis. There are three primary possibilities. One is that the teenage rush of hormones changes gene expression in the brain. The secon...