Schizophrenic Symptoms and Cerebral Pathology

The illness which was first described by Kraepelin and which he called dementia praecox was more correctly designated as a Zerfallskrankheit (disintegrative illness) by Eugen Bleuler, who called the illness schizophrenia. In this disease, or rather group of diseases, not only does one find characteristic symptoms and symptoms which occur in other functional psychoses, but, if suitable methods of examination are employed, symptoms which are found in gross brain diseases, especially those associated with focal lesions, are also elicited. Apart from this, many other symptoms acquire a new aspect when viewed from the standpoint of neuropathology. This may justify our attempt to consider all schizophrenic symptomatology from the point of view of neuropathology. I attempted to do this in my “Report on Cerebral Pathology and its Importance for Neurology and Psychiatry” which I delivered 21 years ago at the annual meeting of the Association of German Neurologists and Psychiatrists at Frankfort-on-Main. Not much space was devoted to the problem of schizophrenia in this report. However, since that time more neuropathological knowledge has been acquired as a result of the Second World War, and this has added to the not inconsiderable knowledge of neuropathology which we already had in 1936 as a result of the First World War. The increasing number of brain injuries due to road accidents has also increased our knowledge of neuropathology. New approaches to the schizophrenic syndromes have been made possible by this growth of our knowledge of the effects of brain injury. Apart from this, I was able, in collaboration with Professor Leonhard and others, to finish a few years ago the clinical follow-up studies on schizophrenia which I began in 1936. In this work we encountered a large number of schizophrenic symptoms which had neurological characteristics.