Posted by Squiggles on October 8, 2006, at 8:13:57
In reply to Re: Encephalitis lethargica » Squiggles, posted by SLS on October 8, 2006, at 7:23:19
....
> So now, I do understand that Kraeplin could have done anything he wanted to with this term. However, you are saying that he demoted it from being a separate disorder to being a part of a spectrum of some sort?
>
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> - ScottIf i understand him correctly (i have not
read all he has to say on it), in Chapter VII
of "Manic Depressive Insanity and Paranoia",
he does make a distinction between schizophrenia (a kind of paranoia) and other kinds of paranoia.Here is the distinction, from p.273 [reprint
ed. Ayer Co. Pub., 1990]:"*Schizophrenia*:--....many cases of apparent paranoia might really be imperfectly developed schizophrenias. In the individual case it is not always easy to decide the question. The delusional system of the paranoiac is internally more closed, more rounded off, more thought out; it takes account up to a certain degree of objections, tries to explain difficulties, in contrast to the abrupt delusional ideas of the paranoid schizophrenics, which are often contradictory to each other and also change frequently. In the latter, moreover, the signs of emotional devastation will not be missed, the slight internal interest not only in the surroundings, but also in the delusion, which at most leads to occasional outbursts, but provides no permanent motives for activity. In the paranoiac, also we meet now and then a reserved, repellent manner, and peculiarities of many kinds in the conduct of life. But his conduct is invariably far more grounded on deliberation or emotional processes than the impulsive peculiarities of the schizophrenic."
Despite this distinction based on observation of the inner and outer emotional state of the patient, Kraepelin believes that the paranoias *are* a spectrum, and says that he has seen transitions between an underdeveloped and a full-blown state of paranoia, which we now call schizophrenia.
His archaic language (phrenia means skull, and maybe biological?) makes for difficult reading, but it is the meticulous, and empirical observation of his patients "inner life" that makes him a devoted doctor of mental illness.
As for medical certainty... he is very careful not to overdiagnose and researches the correlation with causes, according to the symptoms which observes. He offers many possibilites, based on statistics and his colleagues records and studies. One very interesting statistic about the paranoias (in which schizophrenia would fall) is found in Chapter V, "Frequency and Causes": p. 253
"The frequency of paranoia in my experience does not nearly amount to one per cent. of the admisssions, the reason of this probably being tha the majority of patients do not require institutional treatment or only require it temporarily.....
....half of the patients lived undisturbed for more than nine years in freedom, before they came into the hands of the alienist;" [heh!]
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btw, thank you for the info. on Morel.
Squiggles
poster:Squiggles
thread:691873
URL: http://www.dr-bob.org/babble/20061003/msgs/692939.html