Precursors to the concept of schizophrenia (late 19th century concepts)

Bleuler reconceptualized Kraepelin’s original idea by adding to its scope of clinical illnesses which did not evolve into the kind of ‘terminal state’ of deterioration, considered by Kraepelin to be a defining feature of the disease.¹ Bleuler introduced a fundamental distinction between basic (obligatory) and accessory (supplementary) symptoms of the schizophrenia. While the accessory symptoms comprised the delusions and hallucinations that today are commonly classified as ‘positive’ symptoms, the basic symptoms, which would be considered ‘negative’ symptoms today, included thought and speech derailment (‘loosening of associations’), volitional indeterminacy (‘ambivalence’), affective incongruence, and withdrawal from reality (‘autism’).¹ It was the presence of the basic symptoms that defined schizophrenia diagnostically.¹ He considered these four symptoms to be unique to schizophrenia and believed that many mild cases existed and considerably broadened the scope of the disease entity of schizophrenia, adding a substantial disease subgroup.²

References:

1.Jablensky A. The diagnostic concept of schizophrenia: its history, evolution, and future prospects. Dialogues Clin Neurosci 2010; 12: 271–287.

2.Tandon R, Nasrallah HA, Keshavan KS. Schizophrenia, “just the facts” 4: clinical features and conceptualization. Schizophr Res 2009; 110: 1–23.

3.Kendler KS. Kahlbaum, Hecker, and Kraepelin and the transition from psychiatric symptom complexes to empirical disease forms. Am J Psychiatry 2017; 174: 102–109.

4.Berrios GE. Schizophrenia: a conceptual history. Hist Psychiatry 2003; 14: 111–140.

5.Raskin A. Bleuler and schizophrenia. Br J Psychiatry 1975; 127: 231–234.