CRITICAL SURVEY OF THEORETICAL VIEWS ON THE PSYCHOLOGY OF DEMENTIA PRAECOX

1 The literature which treats of the psychological disturbances in dementia praecox is very fragmentary, and although parts of it are quite extensive it nowhere shows any clear co-ordination. The statements of the older authors have only a limited value, because they refer now to this, now to that form of illness, which can be classified only very indefinitely as dementia praecox. Hence one cannot attribute any general validity to them. The first and somewhat more general view concerning the nature of the psychological disturbance in catatonia, so far as I know, was that of Tschisch (1886), who thought that the essential thing was an incapacity for attention. A similar view, somewhat differently formulated, was expressed by Freusberg, who stated that the automatic actions of the catatonic are associated with a weakening of consciousness, which has lost its control over the psychic processes. The motor disturbance is only a symptomatic expression of the degree of psychic tension.

2 For Freusberg, therefore, the motor catatonic symptoms are dependent on corresponding psychological symptoms. The "weakening of consciousness" resembles the quite modern view of Pierre Janet. That there is a disturbance of attention is also confirmed by Kraepelin, Aschaffenburg, Ziehen, and others. In 1894 we encounter for the first time an experimental psychological work on the subject of catatonia: Sommer's "On the Theory of 'Inhibition' of Mental Processes." The author makes the following statements which are of general significance:

1. The process of ideation is slowed down.

2. The patient is so fascinated by pictures shown to him that he can tear himself away from them only with difficulty.

3 The frequent blockings (prolongations of reaction time) are explained by Sommer as visual fixation. The state of distractibility in normal persons occasionally shows similar phenomena; e.g., "amazement" and "staring into space." With this comparison of the catatonic state to normal distractibility Sommer affirms much the same thing as Tschisch and Freusberg, namely that there is a reduction of attention. Another phenomenon closely related to visual fixation, according to Sommer, is catalepsy; he considers it "in all cases a phenomenon of entirely psychic origin." This view of Sommer's conflicts sharply with that of Roller, with whom Clemens Neisser is in entire agreement.

4 Says Roller: "The ideas and sensations that reach perception in the insane person and force themselves into the field of consciousness arise from the morbid state of the subordinate centres, and when active apperception, or attention, comes into play it is fixated by these pathological perceptions."

5 In this connection Neisser remarks: "Wherever we look in insanity we find something different, something strange; processes that cannot be explained on the analogy of normal psychic life. The logical mechanism in insanity is set in motion not by apperceptive or associative conscious activity but by pathological stimuli lying below the threshold of consciousness." Neisser thus agrees with Roller's view, but it seems to me that this view is not quite free from objections. First, it is based on an anatomical conception of psychic processes—a conception that cannot be cautioned against too strongly. What significance "subordinate centres" have in the formation of psychic elements (ideas, sensations, etc.) we do not know at all. An explanation of this kind is merely a matter of words.

6 Second, the RolIer-Neisser view seems to presuppose that outside consciousness the psyche ceases to exist. From the psychology of the French school and from our experiences with hypnotism it is evident that this is not so.

7 Third, if I have understood him correctly, by "pathological stimuli lying below the threshold of consciousness" Neisser must mean cell-processes in the cortex. This hypothesis goes too far. All psychic processes are correlates of cell-processes, according to both the materialistic view and that of psychophysical parallelism. So it is nothing out of the ordinary if the psychic processes in catatonia are correlates of a physical series. We know that the normal psychic series develops under the constant influence of countless psychological constellations of which we are as a rule unconscious. Why should this fundamental psychological law suddenly cease to apply in catatonia? Is it because the ideational content of the catatonic is foreign to his consciousness? But is it not the same in our dreams? Yet no one will assert that dreams originate so to speak directly from the cells without psychological constellations. Anyone who has analysed dreams according to Freud's method knows what an enormous influence these constellations have. The appearance of strange ideas in consciousness which have no demonstrable connection with previous conscious contents is not unheard of either in normal psychology or in hysteria. The "pathological ideas" of catatonics have plenty of analogies in normal as well as in hysterical persons. What we lack is not so much comparative factual material as the key to the psychology of catatonic automatism. For the rest, it always seems to me rather risky to assume something absolutely new and strange in science.

8 In dementia praecox, where as a matter of fact countless normal associations still exist, we must expect that until we get to know the very delicate processes which are really specific of the disease the laws of the normal psyche will long continue to play their part. To the great detriment of psychopathology, where the only thing we are beginning to agree about is the ambiguity of our applied concepts, our knowledge of the normal psyche is unfortunately still on a very primitive level.

9 We are indebted to Sommer for further stimulating studies on the associations of catatonics. In certain cases the associations proceed in a normal way but are suddenly interrupted by an apparently quite disconnected, strangely "mannered" combination of ideas, as the following example will show:

dark green
white brown
black "good day, William"
red brown

10 These "erratic" associations were also observed by Diem, who conceived of them as sudden "whims." Sommer justly considers them an important criterion for catatonia. The "pathological inspirations" described by Breukink, following Ziehen, were observed by these authors in insane patients and were found exclusively in dementia praecox, especially in its paranoid forms, where "inspirations" of every kind play a well-known role. Bonhoeffer's "pathological...