IN the course of the last decade, while spending several thousand hours in the practice of intensive psychotherapy, I have treated— sometimes unknowingly except in retrospect—a considerable number of schizoid and schizophrenic patients. Like all clinicians, I have formed some theoretical opinions as a result of these experiences. While I have not until recently begun any systematic research efforts on this baffling disorder, I felt that to share with you some of my thoughts, based though they are upon clinical impressions in the context of selected research by others, might be an acceptable use of this occasion. Let me begin by putting a question which I find is almost never answered correctly by our clinical students on PhD orals, and the answer to which they seem to dislike when it is offered. Suppose that you were required to write down a procedure for selecting an individual from the population who would be diagnosed as schizophrenic by a psychiatric staff; you have to wager $1,000 on being right; you may not include in your selection procedure any behavioral fact, such as a symptom or trait, manifested by the individual. What would you write down? So far as I have been able to ascertain, there is only one thing you could write down that would give you a better than even chance of winning such a bet—namely, "Find an individual X who has a schizophrenic identical twin." Admittedly, there are many other facts which would raise your odds somewhat above the low base rate of schizophrenia. You might, for example, identify X by first finding mothers who have certain unhealthy child-rearing attitudes; you might enter a subpopulation defined jointly by such demographic variables as age, size of community, religion, ethnic background, or social class. But these would leave you with a pretty unfair wager, as would the rule, "Find an X who has a fraternal twin, of the same sex, diagnosed as
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