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Suicide is a neglected but frequent outcome of the spontaneous course of affective disorders. Lifetime suicide rates for depression were reported in 1970 by Guze and Robins to be between 12% and 19%. Fifty to sixty percent of all suicides in the normal population are due to affective disorders. Barraclough et al. (1974) found a depression in 64% of the suicides they studied, Hagnell et al. (1982) in more than 50% of subjects in the Lundby Study. Robins et al. (1959) found an affective disorder in 45% of cases. Rich et al. (1986) investigated 286 cases in the San Diego Suicide Study: in the younger age-group, less than 30 years old, 38% were depressives, in the older group 56%. Hagnell et al. (1982) found that especially men commit suicide very early after onset Of the first depressive episode and after a relatively short ambulatory treatment. The high. suicide rate for affective disorders is frequently not noticed; particularly short-term observations and treatments usually neglect the problem totally. In a small group treated over a short period, suicide is a rare event. Therefore, most reports on such treatments as psychotherapy or drugs do not mention suicide at all, and one might believe that the majority of depressives feel just fine after a treatment. In fact, as far as we know, modern psychiatric interventions have not yet been proven capable of reducing the suicide rate of depressives. On the contrary, in many Western countries the suicide rates of hospitalized psychiatric patients have increased more than the population growth and also more than the suicide rates for the total population (Ernst et al. 1980).

Siblings growing up in the same family differ considerably in physical appearance, personality, intelligence, school achievement, and other characteristics. It is a basic human need to explain these differences. If the general assumption is true that mainly environmental conditions influence human development, birth order should be of paramount importance. Being one of the few clearly defined environmental factors, it is open to scientific investigation.

Since Sir Francis Galton’s study on English men of science (1874), it has frequently been upheld that firstborns are more often eminent or more often take part in higher education than laterborns generally and middle children particularly (for a survey see Altus 1965 a, b, 1966 a, b). As the use of intelligence tests increased, the hypothesis was examined that oldest children have higher IQs than their sibs because of their closer contact with parents. Zajonc’s famous “confluence hypothesis” (see p. 39f.) then extended this theory of a firstborn advantage to a model of a largely environmental determination of a child’s IQ by his position in the sibship.

In most studies, school achievement is measured by one or another of the following variables: 1. School grades 2. Standardized achievement tests 3. Educational attainment

Research on twins and only children is of particular interest. Possible differences between children of different birth order have usually been ascribed to their differing relations with parents. Firstborn children have, until a second child is born, a monopoly on relationships and resources. Only children can be considered as extreme cases of firstborns in that they have the parents to themselves during their entire childhood. Laterborns, on the other hand, enjoy only divided parental attention and live in the company of their sibs. Twins can be considered as extreme cases of laterborns; since the spacing between them is zero, relations between twins are usually close and they are often treated as a unity. Differences between twins and singletons that are not reducible to biological differences may throw some light on the psychological importance of spacing.

Research on birth order and sibship size is carried out with a view to verifying two kinds of hypotheses: psychodynamic theories on the relationship between personality and position in the sibship (Spiegel 1959; Wohlwill 1970) and theories on the role of heredity and environment in psychiatric and somatic diseases (MacMahon et al. 1960). Very often, however, general theories are missing and hypotheses are produced ad hoc, based on vague theoretical reflections (Peuckert 1974). Besides this tendency towards a luxuriant growth of hypotheses, birth order research has another drawback in that, though seemingly simple, it is beset with methodological pitfalls. These must be discussed to some extent in order to justify criticism of many influential investigations.

A large amount of literature published before 1946 claimed that firstborns reach higher social status than laterborns (Galton 1874, 1887; Clarke 1916; Ellis 1926; Cattell 1917; Cattell et al. 1921; Apperly 1939). Most of these studies were based on the birth order of scientists and other eminent men whose names were found in biographic dictionaries or encyclopedias. The result was invariably that firstborns were overrepresented among the outstanding (for surveys, see Chen et al. 1960; Stroup et al. 1965; Sutton-Smith et al. 1970). Fallacies, e.g., different family sizes in different social classes, different occupational expectations for sibs of different sex, and (until some time ago) different rights of succession for first- and laterborn sons (and therefore different financial opportunities) were disregarded. As will be shown, this type of study was still being pursued in the 1970s, though it has always drawn criticism.

Because of the relative scarcity of diagnosed psychiatric illness in the general population, the large majority of authors study birth order or birth rank of patients within a given diagnosis, using birth order as the dependent variable. The question (often not explicitly formulated) behind this type of research is the following: Are there factors related to the psychological situation of the first- (or second- or later-) born, which are apt to lead to schizophrenia or some other disorder more frequently than in other positions?

The hypothesis was presented (see p. 53f.) that sibship size might be an indicator of background factors inhibiting school achievement rather than an inhibitor in its own right. The present investigation refutes this hypothesis. Sibship size has a very slight independent negative influence on school achievement.

Sex ratio by birth order may vary for biological or psychological reasons. Teitelbaum (1970), analyzing all USA births in 1955, found that beginning with birth order 6 there was a small but consistent underrepresentation of male births in comparison with firstborns. There is some evidence that the reduced frequency of male births is correlated with lower social class. Male pregnancies may be more affected by adverse circumstances than female pregnancies and/or there may be antibody formation against the male fetus.

Die vorliegende statistische Untersuchung befast sich mit der pramorbiden Personlichkeit, dem Krankheitsverlauf und der Atiologie endogen depressiver Psychosen unter Ausschlus der Schizophrenie. Das Schwergewicht liegt auf genetischen Fragestellungen.

Die Diagnosen der unter Eltern und Gesdiwistern im einzelnen beobaditeten affektiven Erkrankungen und Sdiizophrenien sind nosologisdi gruppiert nadi Ver-wandtsdiaftsgrad und Gesdiledit getrennt auf Tabelle 59 zusammengefast. Es soll im folgenden gepruft werden, ob die Diagnosen der Sekundarfalle sidi denjenigen der Probanden gleidien.

Tschudin (1958) und Delay u. Mitarb. (1959) vermuteten, Kranke mit affektiven Psydiosen in der Verwandtsdiaft wurden oft besser auf Imipramin anspredien als Verwandte mit stummer Familienanamnese. Wir sind dieser Frage wiederholt nachgegangen, haben sie an Hand der Wirkung von Imipramin (Angst, 1961) Amitriptylin, Opipramol und Noveril (Angst, 1964) gepruft und nie signifikante Unterschiede in den Erfolgsquoten mit den genannten Substanzen bei der Gegenuberstellung von Probanden mit oder ohne affektiven Psydiosen unter den Verwandten ersten Grades (Eltern, Gesdiwister, Kinder) gefunden. Tabelle 63. Imipraminwirkung und Morbiditatsrisiko fur MDP unter der Verwandtschaft von 108 manisch-depressiven Probanden Imipramin Verwandte Bezugsziffer (Weinberg 20–60) Falle Morbiditatsrisiko fur MDP in % erfolreich 60 Probanden erfolglos 48 Probanden Eltern Geschwister Eltern Geschwister 102,5 138,25 85,5 96,75 12 17 9 10 11,7±3,17 12,3 ±2,79 10,5±3,31 10,3±3,24

Es gibt zwisdien Sdiizophrenien und manisdi-depressiven Psychosen (Cyclothymien) eine Gruppe von Psydiosen, deren diagnostisdie Zuordnung zu einem der genannten Formenkreise grose Schwierigkeiten bereitet und bei welchen eine Entscheidung oft eine Frage des Ermessens ist. Diese atypischen Psychosen werden in der vorliegenden Arbeit mit Mayer-Gross (1932) und vielen anderen als Mischpsychosen bezeichnet. Es werden darunter, in Anlehnung an E. und M. Bleuler, Psychosen verstanden, welche phasenhaft gut remittierend verlaufen und bei welchen sich entweder innerhalb einer Phase manisch-depressive und schizophrene Symptome mischen oder bei denen im Langsschnitt von Phase zu Phase ein Wechsel zwischen manischdepressiven und schizophrenen Symptomen zu beobachten ist. Schon Kraepelin hat betont, das gerade in solchen Fallen nicht so sehr nur die einzelnen Symptome, sondern das psychische Gesamtbild und der Verlauf fur die Diagnose von groser Bedeutung sind. Die Problematik ist ausfuhrlich durch Pauleikhoff (1957) dargestellt worden.

Eigentlich systematische und genetisdie Untersudiungen uber das manisch-depressive Kranksein gibt es erst, seitdem manische und depressive Psychosen unter einem einheitlichen Krankheitsbegriff zusammengefast worden sind und geeignete statistische Methoden zur Verfugung stehen.

Die nosologische Sonderstellung der Involutionsmelancholien ist nach ihrer Unterscheidung von den manisch-depressiven Psychosen schon durch E. Kraepelin selbst angezweifelt worden und hat nach der Arbeit von Dreyfus zu vielen Erorterungen gefuhrt. Heute wird von Kallmann (1954) noch immer angenommen, die Involutionsmelancholien seien scharf von den manisch-depressiven Psychosen zu trennen und besasen gewisse Beziehungen zur Schizophrenie. Auch nach Luxenburger (1942) und Brockhausen (1937 und 1939) nehmen die Involutionsdepressionen eine Sonderstellung ein.

Das manisch-depressive Kranksein begegnet dem Beobachter viel haufiger unter Frauen als unter Mannern. Schon Jung (1864) fiel das Uberwiegen der Frauen auf, was spater von zahlreichen Autoren bestatigt wurde. Die Feststellungen bezogen sich aber meistens auf die Proportion der Geschlechter unter den Klinikaufnahmen. [Soukhanoff und Ganouschkin (1903), Kraepelin (1903), Schott (1903), Lipschitz (1905), Jolly (1913), E. Bleuler (1916), Slater (1938), Lange (1939, 1942), Arieti (1959), Weitbrecht (1960), Rosanoff (1935), Sjogren (1948), Petrilowitsch und Heinrich (1961).]