Monday, 24.02.2020

Thomas A. Ban
Neuropsychopharmacology in Historical Perspective
Education in the Field in the Post-Neuropsychopharmacology Era

Ernst Feuchtersleben’s separation of psychosis from neurosis
Bulletin 28
 

            The term “psychosis” was introduced in 1841 by Karl Friedrich Canstatt (1807–1852) in his Handbuch der Medizinische Klinik (Bürgy 2008).

            In 1845 the term was adopted by Ernst Feuchtersleben (1806-1849) for the separation of mental illness from William Cullen’s (1712-1790) “neurosis” that referred to a “disease which is assumed to have its seat in the nervous system and which constituted a functional disorder with no palpable lesion in the structure of the parts” (Cullen 1777; Littre 1877).  In Feuchtersleben’s formulation, “Every mental disorder implies the existence of a disease in the nervous system, but every defect of the nervous system, is not necessarily accompanied by mental disorder” (Pichot 1983).

            In its original definition, the term “psychosis” was vaguely defined with changing criteria and fluid boundaries (Ban and Ucha Udabe1995).  However, with the publication of Karl Jaspers’ (1983-1969) classic paper, Eifersuchtswahn: Entwicklung einer Persoenlichkeit oder Prozess,and the conceptual separation of developmental anomalies from the effects of disease process, the scope of psychosis was unambiguously restricted to mental illness (Jaspers 1910).

            For Jaspers (1913), “psychosis” was “the result of a disease process which seizes upon the individual as a whole, regardless whether it is a hereditary disease beginning at a certain time of life, or a non-hereditary disorder whichcalled into being by an exogenous lesion.” To qualify for “psychosis” the pathologic process has to be sufficiently strong to override normal development and the behavior displayed sufficiently different that it could not be understood as an extension of the normal and/or an exaggerated response to ordinary experience.

            Jaspers (1913) concept and criteria of “psychosis” was adopted by Kurt Schneider (1887-1967) who, in his Klinische Psychopathologie (Schneider 1950), separated “anomalies of development” or “abnormal variations of psychic life, from “psychosis,” i.e., “effects of illness.”   

            During the second part of the 20th century Frank Fish, in his 1967“Clinical Psychopathology,” defined psychosis as a distortion of the whole personality with lack of insight, construction of false environment out of subjective experiences, gross disorder of basic drives, including self-preservation, and inability to make a reasonable social adjustment” (Hamilton 1985). In contrast, in the “Encyclopedia of Psychiatry for General Practitioners,” edited by Leigh, Pare and Marks (1972), “psychosis” refers to “mental illness which is severe, produces conspicuously disordered behavior that cannot be understood as an extension or exaggeration of ordinary experience and whose subject is without insight.” Somewhat similar to Leigh, Pare and Marks’ definition is the thatof the World Health Organization in the 9th edition of its “International Classification of Diseases (ICD),” presented in 1977, in which “psychoses” are defined as “mental disorders in which impairment of mental functions has developed to the degree that it interferes grossly with insight, ability to meet some ordinary demands of life or to maintain adequate contact with ordinary demands of life or  maintain adequate contact with reality.”

            In both the DSM-III and DSM-III-R of the American Psychiatric Association (1980, 1987), “direct evidence of psychotic behavior is the presence of either delusions or hallucinations without insight into their pathological nature.” However, it is noted that “the term psychotic is sometimes appropriate also when a person’s behavior is so grossly disorganized that a reasonable inference can be made that reality testing is markedly disturbed.”

In the ICD-10 of the World Health Organisation (1990), the term “psychosis” is retained, but it is left deliberatively without any attempt of definition.

References:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Third Edition. (DSM-III). Washington American Psychiatric Association; 1980.  

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Third Edition- Revised. (DSM-III - R). Washington American Psychiatric Association; 1987. 

Ban TA, Ucha Udabe R. Clasificacion de Los Psicosis. Buenos Aires: Editorial Salerno; 1995.

Bürgy M. The Concept of Psychosis: Historical and Phenomenological Aspects, Schizophr Bull 2008; 34: 1200-10.

Cullen W. First Lines of the Practice of Physics. Edinburgh: Kincaid & Creech; 1777.

Fish F. Clinical Psychopathology. Bristol: Wright; 1967.

Hamilton M, ed. Fish’s Clinical Psychopathology. Bristol: Wright; 1985.

Jaspers K. Eifersuchtswahn: Entwicklung einer Persoenlichkeit oder Prozess. Zeitschrift fure die Gesamte Neurologie und Psychiatrie 1910; 1: 567 -637. 

Jaspers K. Allgemeine Psychopathologie. 1 Aufl. Berlin/Heidelbeeg: Springer; 1913.

Leigh D, Pare CMB, Marks B, editors. Encyclopedia of Psychiatry. Vaureauil: Hoffman La Roche; 1972.  

Littre E. Dictionnaire de la Langue Francaise. Paris: Hachette & Cie; 1877.

Pichot P.A Century of Psychiatry. Paris: Editions Roger; 1933.

Schneider K. Klinische Psychopathologie. Stuttgart: Thieme: 1950.

World Health Organization. International Classification of Diseases. 1975 Revision. Geneva: World Health Organization; 1977. 

World Health Organization. International Classification of Diseases. 1989 Revision. (February 1990 Draft for Field Trials). Geneva: World Health Organization; 1990. 

 

July 26, 2018