SCHIZOPHRENIA. — Under the term “dementia praecox,” Kraepelin (1893) grouped the forms of what Kahlbaum called “catatonia,” Hecker’s “hebephrenia,” and the “paranoid” forms, presenting as a common characteristic “a particular alteration of the intimate unity of the personality with prevailing disturbances affecting affective life and volition.”
Bleuler, on the other hand, saw at the root of the aforementioned psychopathy a loosening of the intrapsychic associations, almost a fixation of consciousness, whence the name schizophrenia (1908; σχίζω = I split, divide, and φρήν = spirit, mind), through which alien constituents might easily gain entry and become embedded in consciousness, causing its dissociation. These alien constituents, viewed by Bleuler from a psychoanalytic standpoint, are seen as psychic formations arising on the basis of intense affective experiences, especially sexual ones, or psychic traumas, eventually
becoming so deeply rooted that they dominate the entire psychic life. The patient’s personality is progressively impoverished, and the most elementary bodily functions are affected, so that the sufferer no longer cares for personal cleanliness or attire, does not eat or drink, and may even retain urine and feces or soil himself with them.
Affective blunting: at first this may be masked by the appearance of good manners, but soon acquaintances, friends, and relatives become indifferent to the patient; sometimes, due to the feeling of estrangement that overtakes him, he may even adopt a hostile attitude toward the family from which he feels isolated. Such a state of inaffectivity may culminate in “autism,” inasmuch as these patients find social life difficult to bear, appearing not only alien but hostile; they often isolate themselves for long periods in a room, leaving it only for essential needs.
Ambivalence: the tendency to experience psychological phenomena simultaneously in their positive and negative aspects. It may be considered in relation to indifference, since every thought, every action, every feeling appears devoid of value and thus is equivalent indifferently to its opposite.
Painful feeling of estrangement: due to the weakening of instinctive-affective tendencies, there is a deficit in the intuition of the self, in the sense of one’s own personality, so that the patient is often driven to continual self-examination, spending long hours before a mirror observing himself; for the same reason, the sick have a painful feeling of unreality, not only toward everything around them but also toward their own activity and especially their own thought, which they experience as illusory, cold, and alien.
2. Accessory symptoms
For the most part, these are consequences of the symptoms described above and are chiefly attributable to indifference and the loss of affective value in every mental representation. Thus disturbances of “self-conduct” (Toulouse and Mignard) appear. The external world is perceived correctly, orientation in time and space is often normal; but all this occurs without any personal interest, so that every activity is easily interrupted or diverted by parasitic ideas or abnormal sensations.Thus, with regard to memory, events unfold before the subject without his taking any interest in them; consequently, their fixation and retention as mnemonic facts appear weak, and on the other hand, their recall, unsupported by any interest or affective moment, is difficult, above all disordered and with the most bizarre associations of memories themselves. For the same reasons, the course of ideation proceeds in a bizarre manner, reflecting the more or less clear randomness of associations, so that verbalism and incoherence appear in speech.
Other anomalies in the course of thought are represented by the presence in speech of sudden arrests (barrage of French authors) or by a “stagnation” of thought that results in verbal diffidence, so that discourse meanders around the same idea with phrases that add nothing. At other times, the fragility of ideation, unsupported by interest, causes the discourse to deviate onto topics entirely different from the original purpose; or there may even be a mixing of two different ideas whose expression occurs simultaneously and thus incongruously and incomprehensibly. Naturally, it is easy to understand how, along this path, the patient easily becomes prey during speech to automatic verbalisms, such as the enumeration of verbal series (e.g., names of animals, plants, etc.), verbal associations by contiguity or assonance, verbal distortions and neologisms through perseverations or syllabic assonances, verbigeration, verbal stereotypes, word salad, and echolalia.
From the feeling of estrangement and the dissolution of physical and mental personality arise the delusions of the schizophrenic, characterized by a common theme of mysterious aggression against one’s own physical and psychic personality: ideas of negation, of organ destruction, of the introduction of strangers or animals into the organism, of thought influence, magnetism, and thought transference.
As regards motor activity, in the catatonic form (v. CATATONIA) of schizophrenia, disturbances may be observed, characterized above all by immobility or delay in carrying out actions commanded or willed by the subject himself; once begun, these actions may even be abruptly interrupted, sometimes as if by a counter-impulse (ambivalence), sometimes by a fading of the energy to execute the act (the patient’s indifference to the act itself). For the same reason, the so-called catalepsy (v.) may occur, in which the patient long maintains passively imposed postures, even if entirely incongruous and uncomfortable. Within this syndrome of motor arrest or torpor, sudden impulses (v. IMPULSIVITY) may appear, in which the subject, suddenly emerging from inertia without apparent motive—sometimes under the stimulus of an acoustic hallucination—strikes a nearby person with his fist, hurls an object, or tears his clothes, only to return perhaps to the immobility of a few moments before.
Clinically, in addition to De Sanctis’s form of precocious dementia, which strikes children, the following forms have been distinguished: the simple form (characterized above all by indifference and inertia, without delusions or motor disturbances), the catatonic form (with pronounced motor signs), the delirious or paranoid form (with predominance of delusional phenomena), and the hebephrenic form (which would represent a forme fruste, in which inertia and apathy affect only the desire to provide for one’s own needs through regular and productive employment and family and social affectivity; thus such patients live by expedients, terrorizing their families to obtain money or committing thefts or acts of violence).
For the treatment of schizophrenia, V. PSYCHOSURGERY; SHOCK THERAPY.
II. MORAL ASSESSMENT
From a moral standpoint, schizophrenia, even more than any other mental illness (v.), because of the severe alterations it produces in the individual’s mind—depriving him of the faculty to understand correctly and to will according to reasonable motives—fully deprives the sufferer of responsibility for his actions and of the validity of his consent. In the early stages of the illness, the partial disturbance of mental faculties, which is sometimes not easily determinable by a non-specialized examination, may give the appearance of full normality of thought and action; even in such cases, however, complete responsibility cannot be admitted. This must be assessed particularly in the light of subsequent episodes, in the historical judgment of the individual’s acts, already more or less impaired in proportion to the degree to which the faculties were impaired and to the rapidity and severity with which complete imbalance was reached.
In relation to the therapy applied, the process may be arrested and even regress, up to the appearance of full normality; in a high percentage of cases, however, the illness resumes its course, progressing through successive stages to the most complete disintegration of personality. During periods of remission and improvement of the condition, the question whether these represent true returns to normality with full recovery of mental faculties (“lucid intervals”) or merely periods of latent calm, and correspondingly the determination of the degree of moral responsibility and validity of consent of the sufferer, often present very difficult and controversial issues, entrusted to the work of experts. See, on this point, some decisions of the Sacred Roman Rota:
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Lezioni anche di dogmatica e etica: vi svolse un'immensa attività letteraria, che in punto importante, l'esegesi della Lettera ai Romani, fu in aperto contrasto con Lutero.
Nella dottrina sulla Rivelazione si scostò dal «cristo-monismo» neokantiano e ritschliano, parlando del divino nella natura capace di attestarci Jiddio. Ma in ciò in contrasto con K. Barth, S. volle seguire il sentiero stretto tra quel cristomonismo e la teologia naturale, gettando via il grecismo dalla teologia. Perciò approfondì lo studio delle cose giudaiche e rivendicò l'autonomia dei concetti biblici rispetto a quelli greci. Di tali idee è colorato anche il suo concetto del cristiano, che esclude che nella Chiesa, oltre l'unità della fede, si esiga una conformità di dottrina come ammette il sistema della Chiesa «greco-romana». Già nel titolo dell'importante collana Beiträge zur Förderung christlicher Theologie, che fondò nel 1897, da lui spiegato più volte, il «christliche» ha il significato già esposto: la collana è aperta a tutti gli orientamenti di teologia esclusi solo quelli che con l'intellettualismo soffocherebbero la fede in Gesù; lo Spirito Santo spira in tutte le altre correnti, che devono progredire sempre più. Con questa presa di posizione S. ha causato, almeno indirettamente e in parte, l'ecumenismo (v.) oggi molto diffuso tra i protestanti.
Oltre le numerose monografie edite nei Beiträge, pubblicò tra l'altro: Der Glaube im Neuen Test. (Leida 1885; Stoccarda 1896; 1905; 1927); una collana Das N. Test. ausgelegt für Bibelleser (Stoccarda 1887-1910) riassunta in Erläuterungen zum N. T. (3 voll., ivi 1908-10); Einleitung in die Bibel (ivi 1889, 5a ed. 1933); Gesch. Israels von Alexander bis Hadrian (ivi 1901, 1906, 1923); Theologie des N. T. (2 voll., ivi 1909); rimaneggiamento in: I. Die Gesch. des Christus (ivi 1920, 1923) e II. Die Theologie der Apostel (ivi 1922); Die philosoph. Arbeit seit Carstens (Gütersloh 1906, 1910); Das christliche Dogma (Stoccarda 1911, 1923); Die christliche Ethik (ivi 1914, 1924, 1929), Hilfe in Bibelnot (2 voll., Essen 1926-27, 2a ed. 1 voll. 1928); notevoli commenti ai 4 Vangeli (Stoccarda 1929; 1935), a Giacomo (ivi 1932), epistole ai Corinti (ivi 1934), ai Romani (ivi 1935), a Timoteo e Tito (ivi 1936), 1a di Pietro (ivi 1937). Oltre queste grandi opere, c. le altre in R. Brezger, Das Schrifttum A. Schlaters (Gütersloh 1938; Beiträge, 40, 2).