Kurt Schneider

Schneider is listed as the third major alienist in the history of schizophrenia, for example by Hoenig. (32) Study of Schneider's writings shows that there is a discontinuity between his views on schizophrenia and those proposed by Bleuler. For Schneider, the 'first-rank symptoms' were not pathognomonic but suggested a diagnosis of schizophrenia only if there was no evidence of any other organic psychoses. The 11 first-rank symptoms only gain meaning when sought in the context of three diagnostic perspectives: course, symptomatology, and interaction.(33) Because, as Jaspers(34) proposed, the endogenous psychoses result from a process, there is little point in studying the 'course' of schizophrenia. (35> All that was needed was to find out whether there had been some prodromal symptoms of schizophrenia. 'Symptomatic comprehension' included the search for symptoms resulting from a defect in the integration of the self (hence it is not true to claim that Schneider believed that his first-rank symptoms were 'empirical' and 'atheoretical'). 'Comprehension by interaction' referred to the way in which the patient is perceived by the clinician. In this regard, and without naming it, Schneider described the 'praecox feeling' years before Rümke. (25>

Because Schneider had a cross-sectional view of diagnosis, the notion of 'course' (in Kraepelin's sense) was alien to his thinking. Likewise, his conception of schizophrenia included all the paraphrenias, paranoias, marginal psychoses of Kleist, etc. He also believed that, in addition to schizophrenia and cyclothymia (manic-depressive insanity), the 'endogenous psychosis' encompassed a large number of yet undiscovered diseases.(36)

In summary, there is no continuity between Schneider's notion of schizophrenia and earlier views; hence it is nonsense to choose some criteria from Kraepelin (i.e. course and duration), others from Bleuler (formal thought disorder), and yet others from Schneider (first-rank symptoms). It is nonsense because each of these alienists had a different (and non-additive) definition of schizophrenia, and hence the clinical features that each described only make sense in terms of their own conception and not in a decontextualized form. The DSM-IV definition happens to be a composite of the type that we have just described.

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