Descriptive Psychopathology: The Signs and Symptoms of ...

38 Section 1: Present, past, and futureimpossibly wide, the other set refutes this and would rather emphasizes the course of illness(recovery with insight or not) and narrows down the dementia praecox group considerably ...the border between manic-depressive insanity and dementia praecox has vacillated considerablyin a kind of pendulum movement without anything new emerging. Moreover both groupsare so impossibly extended that we have to consider them victims of the same fate that in thelast century overtook all disease-entities of psychological origin. 94Jaspers illustrated Kraepelin’s flawed logic that the same outcome amongsyndromes is proof that the syndromes represent the same disease process.He criticized the lack of scientific support for Kraepelin’s classification and theuse of illness course as the fundamental criterion for forcing patients into the twoputative diagnostic categories. Jaspers would have considered the present-dayeffort to find “the genes” and “the characteristic endophenotype” of schizophreniato be misguided, akin to searching for “the gene and pathophysiology” ofmental retardation.Kraepelin’s reliance on catatonia as the foundation of dementia praecox wasanother weak link in his formulation as the relationship of catatonia to maniaand melancholia was well-known. 95 George Kirby, the director of clinical psychiatryat Manhattan State Hospital on Wards Island in New York City, wrote:I wish to offer a brief discussion of the catatonic symptom-complex and especially of itsoccurrence in individuals who have also manic-depressive attacks ... Kahlbaum ... did notview the prognosis in these cases as particularly bad, in fact he rather believed that the tendencywas toward recovery ...Kraepelin admitted that the catatonic forms ran a somewhat differentcourse from other forms of dementia praecox ... It cannot be doubted that very markedcatatonic symptoms occur in conditions other than dementia praecox, even in clearly organicpsychoses ...Upon investigating recently the outcome of a large series of manic-depressive anddementia praecox cases, we found that a good many cases had been wrongly judged to bedeteriorating types because of the presence of catatonic symptoms ...We have also shown thatmarked catatonic syndromes may appear in otherwise typical manic-depressive cases. In somecases a catatonic attack apparently replaces the depression in a circular psychosis. In casesshowing both manic and depressive phases the manic-depressive features have the greaterprognostic significance. There is little doubt that Kraepelin over-valued catatonic manifestationsas evidence of a deteriorating psychosis, and that many of these cases have served tounduly swell the dementia praecox group. 96The empirical evidence gathered throughout the twentieth century overwhelminglysupports Kirby’s comments linking catatonia to mood disorder ratherthan to schizophrenia. 97 Nevertheless, psychiatric interests in the USA weredistracted by psychoanalytic notions and influential writers paid little attentionto the catatonia–mood disorder association. Rather than presenting catatonia as aseparate diagnostic category, they followed Kraepelin and Bleuler and linked it toschizophrenia in the DSM. The error profoundly affected subsequent thinking