From classical psychodynamics to evidence synthesis: the motif of repression and a contemporary understanding of a key mediatory mechanism in psychosis.

The stress vulnerability model has proven to be a politically important model for two reasons. It has provided the framework that defines a temporal and dynamic process whereby a person's uniquely determined biopsychosocial vulnerability to schizophrenia symptoms interacts with his or her capacity to manage stress and the amount and type of stress experienced in such a way that the person experiences schizophrenia symptoms. Second, the development of this framework promoted the notion of inherited and acquired vulnerability. Implicit was that vulnerability was individually determined and that there was a role for psychosocial factors in the development/maintenance of schizophrenia symptoms. This proved to be a catalyst for the development of studies implicating psychosocial factors in the etiology of schizophrenia symptoms. Studies derived from cognitive-behavioral theories have proven the most successful in identifying thinking patterns, emotional disturbances, and neurocognitive and defensive vulnerability factors inherent in the development of schizophrenia symptoms. Historically, within the psychoanalytic school there has been debate regarding the role of repressive coping mechanisms in schizophrenia development. Psychoanalytic theories have always appeared incapable of providing etiologic explanations of schizophrenia symptoms, with the possible exception of Melanie Klein, than other more salient psychosocial schools. Mechanisms within the process of repressive coping are consistent with evidence and mechanisms supporting the stress vulnerability models and existing cognitive-behavioral theories regarding development of paranoid delusions. These mechanisms are less consistent with social cognitive explanations of schizophrenia symptoms.