Schizophrenia

Abstract

When in 1908 Eugen Bleuler introduced the term schizophrenia, he did not intend to create a new concept. He just wanted to suggest a new term for the concept of dementia praecox, which had been developed by Emil Kraepelin during the preceding 15 years and had received widespread acceptance. Kraepelin’s demonstration that dementia praecox and manic-depressive illness constituted two groups of disorders that were basically different from all other psychoses and from each other helped to clarify a clinical field that until then had been more or less chaotic. As late as the middle of the 19th century many psychiatrists believed that there was only one mental disorder, and that the different clinical forms merely represented different stages of the same disease. Gradually, however, it became clear that those psychoses that could be demonstrated to be caused by a physical morbid process had characteristic psychiatric syndromes the presence of which would always indicate that the disorder was somatically determined: in acute stages, disorders of consciousness and delirium; in chronic stages, dementia, deterioration of memory and other intellectual functions. In the majority of psychoses, however, no such “organic” symptoms were present, and there were no signs of physical effects on the brain. These psychoses were called, in distinction to the “organic” group, “functional” or “endogenous.” Kraepelin’s longitudinal studies on functional psychoses showed a tight correlation between symptomatology and course: when the symptoms were mainly affective, in the form of mania or depression, the prognosis was in principle good. On the other hand, if the symptomatology was dominated by delusions, hallucinations, withdrawal, emotional blunting, odd and incomprehensible behavior and speech, the prognosis in most cases was bad. These observations led to the distinction between manic-depressive disorder and dementia praecox. In the latter disorder the symptomatology varied from case to case, and in the same patient over time. Kraepelin distinguished four clinical types: hebephrenia, characterized mainly by withdrawal and emotional blunting; paranoid form, dominated by delusions; catatonia, characterized by disturbances in attitudes and movements; and dementia simplex, characterized by arrest of most mental functions. The distinction between hebephrenia and dementia simplex was, however, not very clear.