The psychopathologic basis of psychotherapy of schizophrenia.

Abstract

Treatment must be based on a dynamic psychopathology which considers the biosocial individuality of the patient. It is therefore necessary that one establish the psychopathologic phenomena in their dynamic significance, their relationship to each other and to physical, psychologic, and social factors. It is important that one observe the changing psychopathology during the whole period of treatment and try to separate essential from accessory or even incidental symptoms. Our concepts of essential and accessory symptoms have changed greatly during the last few decades. It is necessary to look critically at the descriptions and formulations of the earlier workers, e.g., Eugen Bleuler and Adolf Meyer. In American literature, it is rarely mentioned that Bleuler spoke not of schizophrenia but of the group of schizophreniae. His original concept implied that the broad group of schizophrenic illnesses should be reconsidered with progress in our psychopathologic and clinical knowledge. Furthermore, he proposed “tentatively” 4 subgroups: the paranoid, catatonic, hebephrenic, and simple schizophrenia. These wise limitations were, however, forgotten and one became accustomed to accepting the concept of schizophrenia as a unit and the fixity of the subgroups, the certainty of the symptoms and their explanations, and treatment was formulated accordingly. Some of the fallacies involved become apparent when one considers critically the schizophrenic illnesses from the point of view of physiology, social influences, and cultural significance. There are some physiologic findings which point to the probability