From: f1221-AT-cc.nagasaki-u.ac.jp
Date: Tue, 5 Jan 1999 21:27:57 +0900
Subject: Re:  destratify; cancer, schizophrenia


At 5:00 AM 99.1.4, Jeanraiso-AT-aol.com wrote:

> [...] It's not an explanation and it has nothing to do with fault or
>punishment;
> it's pointing a polarity between too much , too rigid psychic structure, and
> not enough structure and considering cancer and schizophrenia in respect to
> this  polarity. [...]

To begin with, cancer is not a single entity. There are hundreds of different
carcinomas with many subtypes, various leukemias, many types of
sarcomas and what can be said of one type of cancer, does not necessarily
hold for an other. Therefore considering >cancer< in respect to this
polarity, or any polarity, is a gross simplfication that, at least to my
mind, leads nowhere.

As an example: it has been postulated that >stress< was a predisposing factor
especially for breast cancer. The link between stress and this particular
sort of cancer being steroid hormones, either through direct action or via
immune suppression. Now, this seems not implausible at all, yet there is
no convincing epidemiological evidence for it [see e.g.: Breast Cancer Res
Treat
1994 Feb; 29(2):141-60 or Br J Cancer 1985 Apr;51(4):493-8 or
Br Med J 1995 Dec 9;311(7019):1527-30 or Br Med J 1996 Mar 30;312(7034):845
but there are many, many more].
Some of these studies claim to have found a correlation between >stress<
[or >adverse life events<] and breast cancers, but in all cases the correlation
is rather weak and statistically not or barely significant, other studies
do not
find any correlation at all. Sometimes the authors conclude their study with a
statement like: >further investigation is needed<; read: >we are not sure,
either<.

Now, incidence of breast cancer is definitely rising. Why ?
Genetic factors may be involved, maybe the diet plays a role [esp.fat]
maybe smoking, maybe stress or worries, maybe enviromental toxins that
mimick the action of estrogens, maybe alcohol, it may be that women
who have many children are somewhat >protected<, maybe oral
contraceptives are a risk factor, maybe it is a mixture of the
abovementioned and it may very well be, that something important
is missing from my list.

But the bottom line is: we do not know the single most important reason,
we do not even know, if there is a single most important reason. And as
soon as you start looking more closely into any of the points I mentioned,
you find a plethora of facts: not two people are identical. As they differ
in genetic background, nutrition and.. and.. and.. each medical record is an
individual story. Not even the cells within one and the same tumor are
completely identical.

But if you looked at every detail, you will find it impossible to device any
medical therapy [at least in time]. So one takes more distance, pragmatically
groups and classifies similar >cases< into diagnostic categories and doing
this,
necessarily simplifies. It is probably impossible to practise medicine
without doing this, but it is nevertheless simplification.

If you take even more distance from the individual cases, you find yourself
with phrases like:
> [...] it is pointing a polarity between too much , too rigid psychic
>structure, and
> not enough structure and considering cancer and schizophrenia in respect to
> this  polarity.

This, however, is carrying simplification too far. And it is of no diagnostic or
therapeutic value. Biology just is not that easy.

sY
-Yamazaki

p.s.
You have asked me for references on cancer and schizophrenia:

You will find figures on age-of-onset and incidence of many sorts of cancer
in any medical textbook [eg Harrison`s or Cecil`s]. Both contain some pages
on schizophrenia, too, but they are primarily internal medicine books.

If you are interested in references from medical journals, please consider
the following and the references therein. Those papers address the question
whether there is a correlation between cancer and schizophrenia directly:

Jeste DV, Schizophr Bull 1996;22(3):413-30
Holden RJ, Med Hypotheses 1995 Aug;45(2):169-89
Saku M,Int J Psychiatry Med 1986-87;16(3):189-97
Black DW, Int J Epidemiol 1995 Apr;24(2):366-72

The last reports results from the Iowa Record-linkage Study and it also contains
a good review of the literature. The second is a theoretical paper with
interesting
thoughts.