Abstract
Brett A. Clcmentz and John A. SweeneyNew York Hospital-CornellMedical CenterIn their article, Is Paranoid Schizophre-nia Really Camouflaged Depression?(April, 1988), ZigJer and Glick proposedan unorthodox view of schizophrenia.They suggested schizo-phrenia is not a true but is. .. one of several possible responses to anunderlying depressive mode (p. 289). Be-cause and manicpsychosis have overlapping symptoms, andbecause manic psychosis and substanceabuse both can be conceptualized from apsychodynamic standpoint as defensesagainst depression, Zigler and Glick in-ferred that is adefense against depression. To further jus-tify their conclusion, Zigler and Glickmentioned three parallels that exist be-tween paranoia and depression: (a) Bothinvolve a preoccupation with the self, (b)both appear to be very common, and (c)both can be ordered along a continuumof severity (see p. 287).Zigler and Gtick, in attempting to re-move paranoid schizophrenia fromschizophrenia, ignored, misinterpreted,and failed to recognize a substantial re-search base bearing on the definition ofschizophrenia. Their argument hinged on(a) an arbitrary and inaccurate conceptionof the disorder, (b) an idiosyncratic deter-mination that the traditional schizophre-nia subtypes meaningful clinical dis-tinctions, and (c) the false equation ofschizophrenia, type, with para-noid (delusional) disorder and goodprognosis schizophrenia. These difficul-ties will be discussed in turn.Zigler and Glick (1986), in a morecomplete statement of their theory, de-scribed the difficulties that arise whenschizophrenia is diagnosed using onlycross-sectional, Schneiderian first-ranksymptoms, which they asserted are ...prominent in ... DSM-III diagnoses ofschizophrenia (p. 101). This argumentled Zigler and Glick to doubt the bound-aries of schizophrenia, the first step in theirattempted reformulation of the disorder.Actually, the Diagnostic and StatisticalManual of Mental Disorders (DSM-III;Americar Psychiatric Association, 1980)and the latest revision (DSM-III-R;American Psychiatric Association, 1987)emphasize neo-Kraepelinian criteria(course of illness, flat and/or grossly in-appropriate affect, and peculiarities ofthinking) rather than Schneider's relativelynonspecific psychotic symptoms (Pope L Freedman et
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