Health news
Health news top Health news

   Login  |  Register    
Health News Make AMN Your Home PageDiscussion BoardsAdvanced Search ToolMedical RSS/XML News FeedHealth news

Early schizophrenia concepts

Griesinger
There has been no time since attempts at classification began when controversy about the nature of ‘schizophrenia’  was absent.  However,  there have been periods when a sort of orthodoxy   was   accepted.  One   of   these   was   based   on Griesinger’s teaching that only what we would now call affective and schizoaffective disorders constituted a ‘primary’  disease process (Griesinger 1861). What we now call chronic schizophrenic impairments could develop secondarily, but only after earlier affective episodes. Griesinger eventually came to agree that there could be a primary psychosis, even in the absence of these preliminaries, and thus ‘abandoned the classification system of mental disorders hitherto traditional for him and his time’ (Janzarik 1987). Thirty years of confusion about the relationships between a multiplicity of syndromes followed.

Kraepelin
It was not until the publication of the fifth edition of Kraepelin’s textbook (1896/1987)  that a firm line of demarcation was drawn between dementia praecox and affective psychosis and a sort of consensus again achieved.  Both Griesinger’s and Kraepelin’s concepts were couched in terms of ‘disease entities’, following the lines of successful developments in medicine at that time. The discovery of the anatomical and physiological concomitants of clinically identified syndromes, often with a ‘natural’ history and a pathology, and sometimes with what appeared to be a single causal agent such as the tubercle bacillus or the cholera vibrio, proved irresistible to the neuropsychiatrists who were also carving more specific syndromes out of the global concepts of dementia, delirium and insanity that preceded them.

Kraepelin introduced a simple distinction between conditions characterized by mental deterioration such as the catatonia and hebephrenia of his contemporary Kahlbaum (1874/1973), which with paranoid deterioration became subdivisions of the disease, and more periodic forms of mania and melancholia, such as the folie circulaire of Falret (1854). His follow-up data suggested a mental state profile recognizable at the time of presentation and a ‘generally regular and progressive’ course.

Emil KraepelinEmil Kraepelin, a German psychiatrist, provided the first characterization of schizophrenia, in the late nineteenth century. He believed that the disorder was caused by irreversible physical damage to the brain. National Library of Medicine Because cause was unknown, although variously postulated, classification depended largely on the course and outcome of groups of symptoms.

The chief symptoms were auditory and tactile hallucinations, delusions, thought disorder, incoherence, blunted affect, negativism, stereotypies and lack of insight. The phenomena were expressed as psychological rather than physical abnormalities, with catatonic symptoms, for example, being described in terms of disorders of the will. Paranoia was regarded as a separate disorder, characterized by incorrigible delusions often circumscribed in topic,  a general absence of hallucinations,  and a chronic but non-deteriorating course. Kraepelin also adopted Kahlbaum’s model – general paralysis of the insane – as his prototype for a disease based on unity of cause, course and outcome.  The nature of the disease was obscure although probably related to ‘a tangible morbid process in the brain’.

A sympathetic and illuminating account of the development of Kraepelin’s ideas up to 1913 has been provided by Berrios and Hauser (1988). They point out that his concept was neither as simple nor as rigid as is generally assumed and that it continued to develop.  Indeed,  Kraepelin (1920)  eventually came to agree that dementia praecox and manic-depressive psychosis could coexist and,  thus,  that a unitary psychosis could not be ruled out.

Bleuler
The term ‘schizophrenia’  stems from Eugen Bleuler (1911/1950), who acknowledged in his preface his indebtedness to Kraepelin for ‘grouping and description of the separate symptoms’ and to Freud, whose ideas Bleuler used to ‘advance and enlarge the concepts of psychopathology’. He retained the separation from manic-depressive psychosis while pointing out that affective symptoms could coexist. His concept was based on an assumption that the manifold external clinical manifestations masked an inner clinical unity that ‘clearly marked [them] off from other types of disease’. Moreover, he argued that ‘each case nevertheless reveals some significant residual symptoms common to all’. The end results were identical, ‘not quantitatively but qualitatively’.

Eugen Bleuler Eugen Bleuler, a contemporary of Emil Kraepelin, believed that schizophrenia was caused by psychological trauma sustained early in life. National Library of Medicine. Bleuler’s primary symptom was cognitive: a form of ‘thought disorder’,  loosening of the associations.  It provided links to Kraepelin’s ‘dementia’  and to the biological origins of the disease, but also, through ‘psychic complexes’, to disorders of affectivity, ambivalence, autism, attention and will. These essential symptoms could be observed in every case.  Catatonia, delusions,  hallucinations and behavioural problems he regarded as accessory psychological reactions,  not caused by the biological process or processes.

A substantial subgroup was designated ‘simple schizophrenia’, in which no accessory symptoms (the most easy to recognize) need be present. Diem (1903/1987), who worked with Bleuler, gave a description of two cases that he thought were caused by simple dementing forms of dementia praecox.

Both were apparently normal as children, but as young men they began inexplicably to lose volition and purpose,  ending as vagrants. Delusions and hallucinations were absent. Although no early developmental history was provided, these two people certainly became severely impaired in psychological and personal functioning and fitted Bleuler’s severe version of simple schizophrenia. Bleuler’s own examples are less easy to recognize.  Among the lower classes,  they ‘vegetate as day labourers, peddlars, even as servants’. At higher levels, ‘the most common type is the wife . . . , who is unbearable, constantly scolding, nagging, always making demands but never recognizing duties’. Beyond this ‘simple’ form of the disease, the largest subgroup was labelled ‘latent schizophrenia’:  ‘irritable,  odd, moody, withdrawn or exaggeratedly punctual people’. Bleuler thought it ‘not necessary to give a detailed description’ of the manifestations in this group but there is a clear merger with subsequent concepts of schizoid and schizotypal personality (e.g. Kendler 1985).

This is in contrast to Kraepelin, whose account even of the ‘mild’ form of the course sounds severe. Thus, although Bleuler separated those with the disease from those without, the concept was in effect dimensional.  Although accepting much of Kraepelin’s formulation,  Bleuler substantially widened the concept, while continuing to describe his concept as a disease entity.

The simple and latent forms,  whose vaguely defined primary symptoms could be elaborated through ‘psychic complexes’, were thus able to carry the weight, power and putative severity of a widely recognized diagnosis. Under the influence of contrasting types of theory – one psychoanalytical, the other biological – Bleuler’s least differentiated subgroups came to exert an undue influence on the way that the diagnosis of schizophrenia was made and used in the USA and USSR during the 1970s (Wing 1978).

J.K. Wing and N. Agrawal

Edited by
Steven R. Hirsch
MD FRCP FRCPsych
Professor of Psychiatry Emeritus, Division of Neuroscience and Psychological Medicine Imperial College Faculty of Medicine and Director of Teaching Governance, West London Mental Health NHS Trust London, UK


Daniel R. Weinberger MD
Chief, Clinical Brain Disorders Branch Intramural Research Program National Institute of Mental Health Bethesda MD 20982, USA

References

  1. American Psychiatric Association (1993) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. APA, Washington, DC.
  2. Andreasen, N.C. & Carpenter, W.T. (1993) Diagnosis and classification of schizophrenia. Schizophrenia Bulletin 19, 199 - 211.
  3. Asperger, H. (1944/1991) Autistic psychopathy in childhood. In: Autism and Asperger Syndrome. Cambridge University Press, Cambridge. Translated and annotated by U. Frith, from: Die 'Autistischen Psychopathen' im Kindesalter. Archiv fur Psychiatrie und Nervenkrankheiten 117, 76 - 136.
  4. Bentall, R.P., Jackson, H.F. & Pilgrim, D. (1988) Abandoning the concept of schizophrenia. British Journal of Psychology 27, 303 - 324.
  5. Berrios, G.E. & Hauser, R. (1988) The early development of Kraepelin's ideas on classification: a conceptual history. Psychological Medicine 18, 813 - 821.
  6. Berze, J. (1914/1987) Primary insufficiency of mental activity. In: The Clinical Roots of the Schizophrenia Concept (eds J. Cutting & M. Shepherd), pp. 51 - 58. Translated from Chapter 4 of Die primare Insuffizienz der psychischen Aktivitat. Deuticke, Leipzig.
  7. Bleuler, E. (1911/1950) Dementia praecox or the group of schizophrenias. New York: International Universities Press. Translated by J.Zinkin from Dementia Praecox oder der Gruppe der Schizophrenien. In: Handbuch der Geisteskrankheiten (ed. G. Aschaffenburg). Deuticke, Leipzig.
  8. Bleuler, E. (1919) Das Autistisch-Indisziplinierte Denken in der Medizin und Seine Uberwindung. Springer, Berlin.
  9. Bush, G., Fink, M., Petrides, G. et al. (1996) Catatonia. I. Rating scale and standardised examination. Acta Psychiatrica Scandinavica 93, 129 - 136.
  10. Cohen, H. (1961) The evolution of the concept of disease. In: Concepts of Medicine (ed. B. Lush), pp. 159 - 169. Pergamon, Oxford.
  11. Creer, C. & Wing, J.K. (1974) Schizophrenia at Home. National Schizophrenia Fellowship, London. [Reprinted with a new preface, 1988.]
  12. Crow, T.J. (1985) The two syndrome concept: origns and current status. Schizophrenia Bulletin 11, 471 - 486.
  13. Crow, T.J. (1998) Nuclear schizophrenic symptoms as a window on the relationship between thought and speech. Schizophrenia Research 28, 127 - 141.
  14. Diem, O. (1903/1987) The simple dementing form of dementia praecox. In: The Clinical Roots of the Schizophrenia Concept (eds J. Cutting & M. Shepherd), pp. 25 - 34. Translated from Die einfach demente Form der Dementia Praecox. Archiv fur Psychiatrie und Nervenkrankheiten 37, 81 - 87.
  15. Endicott, J. & Spitzer, R.L. (1978) A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry 35, 837 - 844.
  16. Falret, J. (1854) Lecons Cliniques de Medicine Mentale. Bailliere, Paris.
  17. Fish, F.J. (1958) Leonhard's classification of schizophrenia. Journal of Mental Science 104, 103.
  18. Fisher, C.M. (1983) Abulia minor versus agitated behavior. Clinical Neurosurgery 31, 9 - 31.
  19. Flaum, M. & Andreason, N.C. (1991) Diagnostic criteria for schizophrenia and related disorders: options for DSM-IV. Schizophrenia Bulletin 17, 143 - 156.
  20. Foucault, M. (1967) Madness and Civilisation. Tavistock, London.
  21. Foulds, G.A. (1965) Personality and Personal Illness. Tavistock, London.
  22. Frith, C.D. & Frith, U. (1991) Elective affinities in schizophrenia and childhood autism. In: Social Psychiatry. Theory, Methodology and Practice (ed. P.E. Bebbington), pp. 65 - 88. Transaction, New Brunswick.
  23. Frith, U. (1989) Autism: Explaining the Enigma. Blackwell, Oxford.
  24. Frith, U. & Happe, F. (1994) Autism: beyond theory of mind. Cognition 50, 115 - 132.
  25. Gillberg, C. (2002) A Guide to Asperger Syndrome. Cambridge University Press, Cambridge.
  26. Goffman, E. (1961) Asylums. Essays on the Social Situation of Mental Patients and Other Inmates. Penguin, Harmonsworth.
  27. Griesinger, W. (1861) Die Pathologie und Therapie der Psychischen Krankheiten. Krabbe, Stuttgart.
  28. Gruhle, H.W. (1929) Psychologie der Schizophrenie. In: Psychologie der Schizophrenie (eds J. Berze & H.W. Gruhle). Springer, Berlin.
  29. Jackson, J.H. (1869/1932) Certain points in the study and classification of diseases of the nervous system. Reprinted in: Selected Writings of
  30. John Hughlings Jackson, Vol. 2. (ed. J. Taylor). Hodder and Stoughton, London.
  31. Janzarik, W. (1984) Jaspers, Kurt Schneider und die Heidelberger Psychopathologie. Nervenarzt 55, 18 - 24.
  32. Janzarik, W. (1987) The concept of schizophrenia: history and problems. In: Search for the Causes of Schizophrenia (eds H. Hafner, W.F. Gattaz & W. Janzarik). Springer-Verlag, Heidelberg.
  33. Jaspers, K. (1946/1963) General Psychopathology. Manchester University Press, Manchester. Translated by J. Hoenig & M. Hamilton from Allgemeine Psychopathologie. Springer Verlag, Heidelberg.
  34. Joseph, A.B. (1992) Catatonia. In: Movement Disorders in Neurology and Neuropsychiatry (eds A.B. Joseph & R.R. Young), pp. 335 - 342. Blackwell Scientific, Boston.
  35. Kahlbaum, K. (1874/1973) Catatonia. Johns Hopkins University Press, Baltimore. Translated by Y. Levij & T. Priden from Die Katatonie oder das Spannungs-Irresein. Hirschwald, Berlin.
  36. Kanner, L. (1943) Autistic disturbances of affective contact. Nervous Child 2, 217 - 250.
  37. Kendell, R.E. (1987) Diagnosis and classification of functional psychoses. British Medical Bulletin 43, 499 - 513.
  38. Kendell, R.E. (1989) Clinical validity. Psychological Medicine 19, 45 - 55.
  39. Kendell, R.E. & Brockington, I.F. (1980) The identification of disease entities and the relationship between schizophrenic and affective psychoses. British Journal of Psychiatry 137, 324 - 331.
  40. Kendell, R.E., Cooper, J.E., Gourlay, A.J. et al. (1971) Diagnostic criteria of American and British psychiatrists. Archives of General Psychiatry 25 (2), 123 - 130.
  41. Kendler, K.S. (1985) Diagnostic approaches to schizotypal personality disorder: a historical perspective. Schizophrenia Bulletin 11, 538 - 553.
  42. Kleist, K. (1960) Schizophrenic symptoms and cerebral pathology.Journal of Mental Science 106, 246 - 255.
  43. Kraepelin, E. (1896/1987) Dementia praecox. In: The Clinical Roots of the Schizophrenia Syndrome (eds J. Cutting & M. Shepherd), pp. 15 - 24. Cambridge University Press, Cambridge. Translated from Lehrbuch der Psychiatrie, 5th edn, pp. 426 - 441. Barth, Leipzig.
  44. Kraepelin, E. (1920) Die Erscheinungsformen des Irreseins. Zeitschrift fur Neurologie und Psychiatrie 62, 1 - 29.
  45. Kretschmer, E. (1966/1974) The sensitive delusion of reference. In: Themes and Variations in European Psychiatry (eds S.R. Hirsch & M.Shepherd). Wright, Bristol. Translated from Der sensitiver Beziehungswahn. Springer, Heidelberg.
  46. Laing, R.D. & Esterson, A. (1964) Sanity: Madness and the Family. Tavistock, London.
  47. Leekam, S.R., Libby, S.J., Wing, L. et al. (2002) The diagnostic interview for social and communication disorders. Algorithms for ICD 10 childhood autism and autistic spectrum disorders. Journal of Child Psychology and Psychiatry 43, 325 - 327.
  48. Leonhard, K. (1957) Aufteilung der Endogenen Psychosen. Akademie Verlag, Berlin.
  49. Locke, J. (1959) Essay Concerning Human Understanding, Vol. 1, 2nd edn (ed. A.C. Fraser ). Dover, New York.
  50. Lorr, M. (1966) Explorations in Typing Psychotics. Pergamon, London.
  51. McKenna, P.J., Lund, C.E., Mortimer, A.M. & Biggins, C.A. (1991)
  52. Motor, volitional and behavioural disorders in schizophrenia. II. The 'conflict of paradigms' hypothesis. British Journal of Psychiatry 158, 328 - 336.
  53. Magnan, V. (1893) Lecons Cliniques Sur les Maladies Mentales. Battaille, Paris.
  54. Robins, L.N., Wing, J., Wittchen, H.U. et al. (1988) The Composite International Diagnostic Interview: an epidemiological instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 45, 1069 - 1077.
  55. Rogers, D. (1992) Motor Disorder in Psychiatry: Towards a Neurological Psychiatry. Wiley, New York.
  56. Scheff, T.J. (1966) Being Mentally Ill. Aldine, Chicago.
  57. Schneider, K. (1959) Clinical Psychopathology. Translated by M.W.Hamilton. Grune & Stratton, New York.
  58. Schneider, K. (1976) Klinische Psychopathologie, 11th edn. Thieme, Stuttgart.
  59. Spitzer, R.L., Endicott, J. & Robins, E. (1975) Research Diagnostic Criteria: Rationale and Reliability. Hodder and Stoughton, London.
  60. Sturt, E. (1981) Hierarchical patterns in the distribution of psychiatric symptoms. Psychological Medicine 11, 783 - 794.
  61. Szasz, T. (1971) The Manufacture of Madness. Routledge, London. Tantam, D. (1988) Asperger's syndrome. Journal of Child Psychology and Psychiatry 29, 245 - 255.
  62. Wing, J.K. (1961) A simple and reliable subclassification of chronic schizophrenia. Journal of Mental Science 107, 862 - 875.
  63. Wing, J.K., ed. (1975) Schizophrenia from Within. National Schizophrenia Fellowship, London.
  64. Wing, J.K. (1978) Reasoning About Madness. Oxford University Press, London.
  65. Wing, J.K. (1991) Social psychiatry. In: Social Psychiatry: Theory, Methodology and Practice (ed. P.E. Bebbington), pp. 3 - 22. Transaction, New Brunswick.
  66. Wing, J.K. & Brown, G.W. (1961) Social treatment of chronic schizophrenia: a comparative survey of three mental hospitals. Journal of Mental Science 107, 847 - 861.
  67. Wing, J.K. & Brown, G.W. (1970). Institutionalism and Schizophrenia.Cambridge University Press, London.
  68. Wing, J.K., Cooper, J.E. & Sartorius, N. (1974) The Description and Classification of Psychiatric Symptoms: an Instruction Manual for the PSE and CATEGO System. Cambridge University Press, London.
  69. Wing, J.K., Sartorius, N. & Ustun, T.B. (1998) Diagnosis and Clinical Measurement in Psychiatry: the SCAN System. Cambridge University Press, Cambridge.
  70. Wing, L. (1981) Asperger's syndrome. Psychological Medicine 11, 115 - 129.
  71. Wing, L. (1982) Development of concepts, classification and relationship to mental retardation. In: Psychoses of Uncertain Aetiology (eds
  72. J.K. Wing & L.G. Wing), pp. 185 - 190. Cambridge University Press, Cambridge.
  73. Wing, L. (2000) Past and future research on Asperger Syndrome. In: Asperger Syndrome (eds A. Klin, F. Volkmar & S. Sparrow). Guildford Press, New York.
  74. Wing, L. & Gould, J. (1979) Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification. Journal of Autism and Developmental Disorder 9, 11 - 29.
  75. Wing, L. & Shah, A. (2000) Catatonia in autistic spectrum disorders. British Journal of Psychiatry 176, 357 - 362.
  76. Wing, L., Leekam, S.R., Libby, S.J. et al. (2002) The diagnostic interview for social and communication disorders. Journal of Child Psychology and Psychiatry 43, 307 - 325.
  77. Wolff, S. (1995) Loners: The Life Path of Unusual Children. Routledge, London.
  78. World Health Organization (1973) The International Pilot Study of Schizophrenia. WHO, Geneva.
  79. World Health Organization (1993) The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. WHO, Geneva.
  80. World Health Organization (1999) Schedules for Clinical Assessment in Neuropsychiatry. World Health Organization, Geneva.

Provided by ArmMed Media

Email this to a friend Bookmark this! Printable Version

RELATED STORIES:


 Comments [ + Post Your Own

Now you're in the public comment zone. What follows is not Armenian Medical Network's stuff; it comes from other people and we don't vouch for it. A reminder: By using this Web site you agree to accept our Terms of Service. Click here to read the Rules of Engagement.

There are no comments for this entry yet. [ + Comment here + ]




We are pleased to let readers post comments about an article. Please increase the credibility of your post by including your full name and email.

All comments are reviewed by our editors before they are posted on the site. Just keep it clean, kids.

Name:

Email:

Location:

URL:

Remember my personal information

Notify me of follow-up comments?

   [advanced search]   
Interactive Quiz:
I have a decreased need for sleep.
yes
no
Test you knowledge



Health Centers

Health Centers





Diabetes









Health news
  


Health Encyclopedia

Diseases & Conditions

Drugs & Medications

Health Tools

Health Tools



   Health newsletter

  





   Medical Links



   RSS/XML News Feed



   Feedback






Add to Google Reader or Homepage
Mental Health News, Headlines and Latest Stories on Health.am
Add to My AOL





UrologyToday.net
Popular Searches:
» depressed what to do?
» helping the depressed person
» depression glossary
» adolescent depression
» major depression
» types of depression
» checklist for depression
» depression overview
» symptoms of depression
» what Is depression?