Too Long; Didn't Read

Introduction My short sketch on the Content of the Psychoses which first appeared in the series of "Schriften zur Angewandten Seelenkunde" under Freud's editorship was designed to give the non-professional but interested public some insight into the psychological point of view of recent psychiatry. I chose by way of example a case of the mental disorder known as Dementia Præcox, which Bleuler calls Schizophrenia. Statistically this extensive group contains by far the largest number of cases of psychosis. Many psychiatrists would prefer to limit it, and accordingly make use of other nomenclature and classification. From the psychological standpoint the change of name is unimportant, for it is of less value to know what a thing is called than to know what it is. The cases of mental disorder sketched in this essay belong to well-known and frequently occurring types, familiar to the alienist. The facts will not be altered if these disorders are called by some other name than dementia præcox. I have presented my view of the psychological basis in a work[195] whose scientific validity has been contested upon all sorts of grounds. For me it is sufficient justification that a psychiatrist of Bleuler's standing has fully accepted, in his great monograph on the disease, all the essential points in my work. The difference between us is as to the question whether, in relation to the anatomical basis, the psychological disorders should be regarded as primary or secondary. The resolution of this weighty question depends upon the general [313]problem as to whether the prevailing dogma in psychiatry—"disorders of the mind are disorders of the brain"—presents a final truth or not. This dogma leads to absolute sterility as soon as universal validity is ascribed to it. There are undoubted psychogenic mental diseases (the so-called hysterical) which are properly regarded as functional in contrast with organic diseases which rest upon demonstrable anatomical changes. Disorders of the brain should only be called organic when the psychic symptoms depend upon an undoubtedly primary disease of the brain. Now in dementia præcox this is by no means a settled question. Definite anatomical changes are present, but we are very far from being able to relate the psychological symptoms to these changes. We have, at least, positive information as to the functional nature of early schizophrenic conditions; moreover the organic character of paranoia and many paranoid forms is still in great uncertainty. This being so it is worth while to inquire whether manifestations of degeneration could not also be provoked by psychological disturbance of function. Such an idea is only incomprehensible to those who smuggle materialistic preconceptions into their scientific theories. This question does not even rest upon some fundamental and arbitrary spiritualism, but upon the following simple reflection. Instead of assuming that some hereditary disposition, or a toxæmia, gives rise directly to organic processes of disease, I incline to the view that upon the basis of predisposition, whose nature is at present unknown to us, there arises a non-adaptable psychological function which can proceed to develop into manifest mental disorder; this may secondarily determine organic degeneration with its own train of symptoms. In favour of this conception is the fact that we have no proof of the primary nature of the organic disorder, but overwhelming proofs exist of a primary psychological fault in function, whose history can be traced back to the patient's childhood. In perfect agreement with this conception is the fact that analytic practice has given us experience of cases where patients on the borderline of dementia præcox have been brought back to normal life.

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