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    45 views141 pages

    The Clinical Roots of Schizophrenia Concept

    Uploaded by

    Cazan Stelian

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 141
    The clinical roots of the schizophrenia concept CONTRIBUTIONS ON SCHIZOPHRENIA sited by JOHN CUTTING M.SHEPHERD. Pajero pei Pyinry CAMBRIDGE UNIVERSITY PRESS Cambridge London New York New Rochelle ‘Melbourne Syiney iiouemeummetemerc me SEE ae ‘itor ence hur 1 aig Sed el a 8 Semen a RL Sen SERRE Ree eee eee eee eee eee Contents ‘Germanngusgecontibutions and pile demetipac linemen praecox ‘OttoDiem These dementng rm dementia OtoGreeeDemetiseanctna Wilhelm WeygendCiaommenson he psyeholgyo Joseph Bere Primary nln mentality ‘naiesttonottheschizphvenk:ryholgl eit Senaurandachiepheenia oe Pulbatuse Suds dtesonal perception GeharSehmid een fhe ern erature Thecus WererJansarit Tce inpechopstology French language contributions Philippe Chasis scone insanity s Seeaeeeer er Meeeecrae eee meres eee epee terete tere Pau Séeunondloneph Capgras Miter dels (Gatan Gatan de CiérmbestPsychosesf pasion IncquesLcan Tecan ims osl pute Preface The purpose of this collection oftranslatonsis to acquaint contempor: ary sucensof schizophrenia with some ofthe verninal works onthe subject. While the literature on the subject of schizophrenia continaes to growatanenormousrat, the quality of some recent work sullen some measure because the pressure fo publish dscourages workers from placing thei own ndngsin store content. The eons hope {hat by consltng papers inthis collection, contemporary student all beable to emsich and broaden ther own contributions This book would not have been possible without expert translators land we should like to thank both Miss Helen Marsal, exlibaran of the institte of Paychiary, and Dr Ralph Emery, formerly consultant psychi at Brookwood Hospital Surrey, fr their abours, Some ofthe papers are not tansated nfl. This indiated inthe text by the usual envention = J. Cutting M. Shepherd Introduction ‘The concept of dementia praccox or schizophrenia has undergone marked changes since its oigisal formulations by Krsepein and Bleleratthe turn ofthe contury. Atthat mest wasregarded aa brain lseasedifering from other neurologial conditions only in the fan tlising absence of any definite observable pathology at postmortem Between the two World Wars 8 marked divergence of opinion developed conceming tsmatere. Ditferent counties diferent schools of thought and vanous eminent psychi all had thei own view Points, most of them at variance with Kraepels orginal concept There was shit aay fom an organi towards 3 sok formulation, attributable in some mesure tthe absence of detectable bra puthology and the undoubled sol deternation which wes out of ewping with ny inlet deine Tithe 18ts and194 despite the appearance of new paychotopic rugs, the psychological and soc formulations were so influent ‘that some authorities even suggested that schizophreni was an atefact, construct designed to label mists as mad and that the cory ‘liicans had been duped into thinking that their patients were il By the 1970s it became clear that this wa ooextreme view, and vorios ‘workers and international bodies began to develop reable butempi cal ays of defining the condition. Nonetheless, there was stil no ‘enable cerebral disorder to validate these definitions Inthe Last few yeas, however, i has become apparent thatthe sence of ross rain pathology does notin self eliminte among bass for schizophrenia. More sublle disorders, exemplified by neuro teanamitter abnormalities oF a physiological imbalance between the activity of the eo hemisphereshave comet theforeandaeattracting the attention of many neuroscientist working inthe 2 A Cutting cmd Mi. Shepherd In retrospect, it is now apparent that Kraepetin, his contemporaries ‘nd immediate successors, who were so often vilified by the ant Paychintrsts and ther sympathises, deserve to be e-readin height ofthe advances in biological psjchistry and the gromth in neutep- sychological knowledge ofthe last decade, The purpose ofthis cle ti i to acquaint contemporary stadents of schizophrenia with the views of thei European predecessors inthe eae part of the century rnotmerely ass historia exerisen praise of famous men, but to show how thedesenptions and psychological speculations these ciniclens have antkipated contemporary formiations. Each of the exacts ranslated here hasbeen chosen elther forts contemporary importance or forts relevance to current nations schizophrenia, he firs action contains translations of work by Kraepelin, Diem, Gros, Stansky, Weygandt and Berze. Kraepelin’s arte isthe fist account inthe literature of dementia praccon, the eonditon which Blevler renamed the schizophrenias, Kraepelin’s descnption of dementia praeoxin the 1913 edition ofhistextbook wastranslote! into English 1918, but this very fist account, succinct in form and Bod i conception, deserves tobe more widely known, Simple schizophrenia, ax described in Diem’s article, has been Something of « diagnostic enigma ever since Bleler included it alongside the more obvious varieties hs rarely dlagosed these day in Europe or America and many psychiatrists hove rcommende that the concept be abandoned (Stone e a. 19K8) However, there are ‘several pointers inthe rcentiteraturettsiagnostic usefulness nd {case canbe made for its resuereton, Far example sehizaphnen ‘often regarded asa spectrum of disorders which incl eta type ‘of abnormal personality as well xa core group with fank psychos (Rosenthal, 1968). The lnk between psychotic individuals and _etsin non-psychotcecentrics has been established by showing that both may emanate from the same genetic tock (Parnas 1983). ‘What these two types of individual share, according to Sever Gu fans ane fas o ape with Hoche when he ad inthe wo of esi ai enn ant to ‘ac the psyehologieasideof out work ax specie in nervous a rental sioner sa seayshaben math more seu seen ‘nanderstanding examination of the pen ange at idea ona om helping and accompanying hi inh elton, han on sume tion and bypronin, may beaded that unplessant subconscious memory gents dha th unples doplayspartinhystencal mod disturbance and n amines can most okhly te overcme BY coping and lng iy a rare naire ‘method sapped the ment processes of dementia proccon Freud tried todo this meaty os Ie ascrng fa dementia paranoides (schizophrenia) wat tence eure paychoss which tke hysteria and absessonl stats, sose rom repression opal "memories, and that the form of the patient! symptoms was deter mine by the contentol tei tepreted eos "he word determines is course open touilferent interpretations. ‘ean be equated with ‘conditioned or used directly tomers exceed 1 should be emphasised here that Freud's successors, who in they analysis of hysteria admit that there is just possibly an element af predisposition present, also distinguish between ‘determined and “uses and concede that another, perhaps ton, factr may pony playa part Freud, of course, thought of a deeper relationship, as we can see from one case that he described. A thity-yearld woman became ‘mentally land thought that she was beng observed epecally whe undressing. She experienced sensations in her slomon which she ‘eae as being caused by indecent thoughts on the port ofthe Barloaeinaid. She had visual hallucinations of maleand female gets ond thought that her own genitals were being observed Though Froud stresses that the hallucinations egan when the patent sw other female patents naked in the commarallatiewars /eadmits that she was then alreadyillShenow reported thats hla sf ss she had taken all her clothes off in font of her lite broths without feeling ashamed, but that between the ages of eight nd seventeen she had been ashamed at hernakediess in the bath infront, cofher muther. her sister and the doctor The onset of her nero od {isturbonce is now sai to have comcided with quate! with het husband and her brother. The idea that people wished her il came fo her because of something said by avining seteristooe se nothing fo dispute inthis a female patent witha developing mood disorder and sensory delusions formed a connection betes, Sewual sentations and the disturbing experince of necng several naked women in the bathroom, thereupon she had visual Felsen tions of genitals I can accept that in response to questioning she {ought he remembered childhood experiences of taking at her Glathes off What in my views cannot be reiably asserted, however, {hatthess images woul have returned intoher consciousness aun the doctor probing questions, of tha hey played any pacer pot ininluencing her mei dese Among. Eres followers it was Jung in particular who tok up this EaDLePt of dementia praccon, which he has ted to develop ether in jis interesting book. He too, however, concedes thatthe rece say have an underlying physical cause that goes far beyond ore thing Psychological, fot cal twit nd pn Jung emphasises one ct whith tl ad Ces ha send ed ‘ray that salted ane of dees ply spor ung namo cus examples he tests that every actly ured appe ing becomes a complex an allel aura! Ruel eoms Processes which tendo arden nea sng et ‘Whilethekemetofhysicrathunconsnsinsstmplex whichis never ‘quite overcome sothat one an sume a cous selaonsip betes ompes and ews (a sutable predpostion alse tng tc, Jung esa trent iw destin rosin dronderome several compleses have bacome permanent fated. I'm mt hat whether the comple caves tg theless 8 peda Subject wheter i only determines symptoms a the men “net ofthese Incaneinvticha tage cua ear theinesonetempted atch caus aca tthe compen, Theres one prose, however ha the compl ak neat 8 factor X Gatun) which contre tothe dnurbnce ker repersation concedes the pont that X might als bof primar trigin. From the standpoint of phy ssogcalposcholo bom pas leis and the theory of reciprocal ston, there mould seam to be something wrong herein hat this problematical tox sre 9 ‘gly developed bos which tates toll oughoot to pach processes parca to thse whichate aleve cours The way snow open to develop sm explanation covering the wide ‘ants of smploms found in dementia praconsthe sce wn of thought, the Blockage and speten, the nepal and Sowonps Wh fi then hat estes and gaint stein tat han fr expound By epute ‘sof the heey whe Mat stil a vpn an Fares oe . tharcantats los arn the omer te rane Iho pe The iding ea by neuroma toes, eat survey andthe vexgaton of endogenesacrs hve fed sche the cone of stra, atl o tepid pancho laces, nop ° Caloue an illness ut not determine Hs escral nature, Dement Praccox in prac s more and more regarded a am illness toed fon some metabolic disturbance. Frequent analog me made mith rcs the nn accepting this feo Ae there {general paralysis of the insane, So any attempt to view dementia Praecon as «psychological disorder in its essential cance «deers neuro pychosis determined by the repression of pint compltccs Ia introduce the factor X. He also pointed! out, righ, tha ce ‘ans have known fora long time that psychogenic syn pone eve ‘cc in organic disturbances, He di, however, slam that conch 1 the pychoonayic view that peychologcl disturbance ean be Primary isunaceptabe is therescope foradaiting tha neces 2 exchange made up of ages rom long mrertar sae ys dona think iat hast of tears eae ee ace. The emergence of venday mall nay saree lyn all mena daorers, We eed think ony ofthe oe dtm ofthe soho. The source a dered eee serenoughininagethataretonomed tem ici ee ‘it Ronigen' st publcaton on rays magia te renee eke, ballucnttns onthe bas of such conceptn wich a emanate from his ldo In poner pogan eal ee role exetinsenledement,pateunalfy doko boeken $257 ayn raguenty tothe ft yareat schol ond oe MAPPen® in drama, I abo tac a many css of Wr ed ements praccox. We must, however, dlp he posters {hs sumption, the artical inerpretatons ges of ene oo SUmunnces, and above all the amp fo atch to ek ne ‘eteinativ or atop! signin Jnconclusion| should ke top forward a fentative explanation of ements praecox of my own whch might cover the roe ot memories, the infantile tats andthe mevked noe pene sould suggest thats ar asthe organic nde 8 oe Blnusble concept is one of auto damage alain a ‘Predisposed brains. . — : nan cue paper besedonastudy fold cases of dementia paccox hos scutesate ha cured alent ity yen coor Tenens ‘feqoted fining whch was preity cere in ean Commentson the cy of dame pra ” ‘namely that whilenteletwalassets maybe well preserved thecapacity ‘outisethemvsiost wilandatectn particular ar dulled andthe host and most personal of human atte, intstive and selene slsappea. Using Wund's terminology, | spoke then of ‘opperceptc dementia By studying patents with mental deticency and phenomene which ‘occu at certain stages of normal child development Iwas then snack boy asimilaty between the pte of moverentof such chilsten and the movement disorder that seen in dementia pracen, Ryton ‘movements and grimacng, fr exampie,oscurze inal vce prope Echo symptoms, and more rarely command sutomatsis, were las seen, Even speech disorder, partcultlyvergiberation and eologsms, could occur. Normal speech development in the child passes through tree stages which may be described bry as crying babiting and speaking orin other word the phase of unce-orinated

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