An editorial on the cognitive deficit paper, which sort of misses the point. If a child in a family is running two SD behind their siblings there is something wrong with that kid, and that may be an early sign of psychosis.

Looking for a psychological explanation in a familial reaction to what is probably a biological deficit is fatuous.

Finally, these results raise an important question of how a person’s deviation from his or her family’s cognitive ability may shape the manner in which the environment responds to that individual. To understand how this may affect the individual-family environment, it is important to understand the magnitude of some of the most powerful results in this study. The magnitude of a 2-SD difference between the individual and the family on cognitive ability is analogous to the differences in average income in the United States of someone with a doctoral or professional degree compared with someone who did not attend high school or the difference in height between an 18-year-old and 11-year-old girl: obvious differences that almost anyone can detect. If an individual has school achievement that is 2 SDs below the norm of the population, and this is consistent with the family’s general performance, this has no effect on the risk for schizophrenia. However, if the individual performs 2 SDs below the norm and the family in general has academic performance that is at the mean of the population, this increases the risk for schizophrenia 3.5-fold. If a family member performs 1 to 2 SDs below the norm of the family, how does the family respond to this individual performing at the lower end of the familial distribution? Certainly, they may be viewed and even treated as an outsider. And what is the experience of the individual who recognizes that he or she does not fit in with the academic and cognitive levels of those that are responsible for him or her? Self-esteem can decrease when one does not reach the standard set by those on which one depends, and some of the individuals in this study come nowhere close to those expectations. Is the inability to reach expectations an important environmental risk factor for those already at genetic risk? These interactive processes of liability and environment may be crucial in understanding who will develop schizophrenia, why they do, and what we can do to develop biological and behavioral treatments to prevent psychosis from ever occurring.

We simply do not know. The findings need to be replicated: there are other multigenerational studies and I’m sure they have all just assigned a keen Master’s student to do the analysis. The results need to be published. The size of the effect has to be robust and signficant, and the post screening enrichment of selecting such young people has to be estimated.

What the editorial shows is the ongoing reach of analytic speculations. Every psychiatrist has an exposure to Freud and his followers. And there is a tendency to look for psychological explanations, if they be there or not.