“Early Psychosis” as a mirror of biologist controversies in post-war German, Anglo-Saxon, and Soviet Psychiatry†

Abstract

The English term “early psychosis” was coined in the 1930s to refer to feelings of irritability, loss of concentration, hypochondriac ideas, moodiness, and lassitude that were seen to precede the onset of clear-cut hallucinations and delusions. The history of thinking about “early psychosis” under names such as “latent,” “masked,” “mild,” “simple” or “sluggish” schizophrenia before World War II and afterwards on the different sides of the Wall and the Iron Curtain reveals “early psychosis” as a mirror of quite aged international biologist controversies that are still alive today and to the same extent as they are misunderstood, are influential in their implications in today's psychiatry.

A historical account of schizophrenia proneness categories from DSM-I to DSM-5 (1952-2013)

“…Interpreted with psychodynamic and psychoanalytic lenses, as Meyer's notion of reactions to life events and Freud's defense mechanisms, the schizophrenia concept broadened even more in the US than its original author would intend. Schizophrenia became just a more severe psychological maladjustment than other personality or neurotic manifestations (Rzesnitzek, 2013).…”

“…It was considered by Bleuler a very widespread and underdiagnosed kind of schizophrenia with blurred boundaries especially to schizophrenia simplex, a form that presented only basic symptoms in their full intensity, but not accessory ones as hallucinations, delusions, and dementia. Although both latent and simplex schizophrenias could cast doubt about where was the beginning of schizophrenia course, for Bleuler both forms were already considered psychotic clinical pictures on their own, and not prodromes (Rzesnitzek, 2013). Regarding the latter, he acknowledged:…”

“…(Sullivan, 1926(Sullivan, /1994 Other psychiatrists in the US took a similar approach, devoting time to study the early manifestations of schizophrenia. The introduction of terms like "ambulatory schizophrenia", "pseudoneurotic schizophrenia", and "borderline states" reflected the psychodynamic view on early psychosis (Rzesnitzek, 2013).…”

The Philosophy of Psychiatry and Biologism

“…Last not least, the target article by Lara Rzesnitzek shows that some issues debated in today's psychiatry have already an astonishing long history (Rzesnitzek, 2013). An example of this is the "psychosis risk syndrome"-one of the contentious points in the preparation of the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).…”

Comment on Lara Rzesnitzek (2013) “Early Psychosis” as a mirror of biologist controversies in post-war German, Anglo-Saxon, and Soviet Psychiatry

“…Lara Rzesnitzek (2013) in her informative and readable review recalls the early discussion on the nosological status of “early psychosis”: are its seemingly unspecific but in its entirety rather specific psychopathological phenomena before the manifestation of unequivocally psychotic symptoms dispositional and stable risk factors or initial symptoms of a gradually developing schizophrenia? Today's psychiatrists may wonder about the categorical black-or-white thinking of former conceptualists due to the currently dominating, more multiconditional concept, i.e., a specified bio-psycho-social model: developmental interactions between genetically conveyed sensitivity toward a distinct social context (and perhaps perinatal brain lesions as well) may form a disposition of vulnerability for critical life events, e.g., hormonal changes or social stress during adolescence (Zubin and Spring, 1977; Häfner, 2002; Haddad and Meyer-Lindenberg, 2012).…”