Introduction

Abstract

Psychiatry has been endeavouring for many decades to clarify the endogenous psychoses. Overemphasis on heredity has diminished; instead psychosocial factors have been moved into the foreground without however knowing what form they should take. Theories which have been suggested have not been confirmed. Because of this the wheel is now being turned backwards: hereditary causative factors are again becoming more prominent. In consideration of the lack of true progress many authors have adopted an attitude of resignation, stating that clinical research in etiology should be abandoned until bodily causes have been found. My opinion is quite different. Lack of success in clinical etiological research in my opinion is the result of the fact that endogenous psychoses have been roughly divided into only two forms. In this way a majority or even a multitude of disorders have been lumped together and therefore no uniform etiology could of course be found. Above all so-called schizophrenia (singular!), taken as a unit, is completely unsuited for etiological research. Clinically I see here the most significant differences. How can fantastic paraphrenia be combined as a unit with foolish hebephrenia or negativistic catatonia? Kraepelin’s division into only two forms of endogenous psychoses in this respect has been a great disadvantage. It is true that Kraepelin himself beyond the division into two undertook many more fine separations, but his successors did not pay any attention to this, they saw only the gross division of endogenous psychoses into Dementia praecox or schizophrenia and manic-depressive illness. The teaching of mental illnesses in which no external cause was found was in this way shockingly oversimplified. While the sister discipline of neurology has identified perhaps hundred endogenous disorders and continues to describe others, psychiatry recognized only two, perhaps three or four. And while neurologists in the hereditary forms of endogenous diseases are seeking the heredity of each single form and even in conditions which clinically seem to be unitary find several types of heredity, psychiatrists are still disagreeing about one hereditary form of schizophrenia, as if underlying the so colorful and even extremely different clinical pictures there was only one disease with only one uniform heredity.