Robert Graves Lecture 1991_Professor John Lionel Waddington

18/09/1991 in Royal College of Surgeons in Ireland, Dublin 2

The Pathobiology of Lost Human Potential: Schizophrenia as a Neurodevelopmental Disorder

Professor John Lionel Waddington, Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St. Stephen’s Green, Dublin 2


The honour of the award of the 1991 Graves Lecture by the Royal Academy of Medicine in Ireland and the Health Research Board carries with it the responsibility of compiling this review. Its topic is one that is to many of the public at large ~, and indeed to some members of the medical profession and associated health professionals, shrouded in a considerable degree of mystery and misunderstanding; yet schizophrenia occupies more hospital beds than any other single medical disorder. The characteristic psychotic symptoms of the disorder commonly emerge in the late teens or twenties and, in the absence of any known pathognomonic biomedical sign, diagnosis proceeds inferentially, often in conjunction with internationally recognised operational criteria(2). However, reference to the typical ‘positive’ diagnostic symptoms of delusions, hallucinations and thought disorder fails to convey the consequences of the totality of schizophrenia, which can additionally reflect the so-called ‘negative’ and potentially more pernicious symptoms of affective flattening, poverty of speech, social withdrawal and anhedonia; as espoused in a recent report of the U.S. National Advisory Mental Health Council:

“The disease assaults in its victims virtually everything that is distinctly human. In schizophrenia… [the] entire human personality is laid waste, and the psychological and social building blocks of everyday life are crushed, often beyond recognition. The devastations wrought by schizophrenia … make this disease the most calamitous of all mental disorders. Indeed of the major health problems of the 20th century, none combines the frequency of occurrence, degree of disability, and squandered human potential that characterizes schizophrenia.

Furthermore, few illnesses, if any, can so destroy the stability and well-being of the family and, with a lifetime prevalence rate approaching 1% of the general population, so burden a nations’ economic resources for health and social services.

Irish Journal of Medical Science, , 160:402

This being the thirty-first Graves Lecture since its beginnings in 1961.