Paranoid Psychosis

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PARANOID PSYCHOSIS

In the sixth edition (1899) of his Lehrbuch der Psychiatrie, Emil Kraepelin, spoke of dementia praecox as an autonomous illness, describing three major forms: hebephrenia, catatonia, and paranoid dementia.

In its conception, the paranoid forms of dementia praecox are opposed to the systematized delusions of paranoia. The paranoid grouping of dementia praecox is characterized by its disintegration, apparent incoherence, a progressive cutoff from the world and growing insanity, all notions that Eugen Bleuler will reduce to the fundamental process of dissociation ("Spaltung ") in schizophrenia, substituting this term (1911) for that of "dementia praecox." On the other hand the polarity represented by the paranoid's delusion distinguishes itself by the systematization of the delusions in the form of unshakeable convictions, developed in an orderly manner and clearly, and in the absence of any tendency of deterioration. A third group with chronic delusions corresponds to the observations of Kraepelin, and designated by him with the term "paraphrenia," had two characteristics: they had constructions that were more or less chaotic, based on fantastic themes and hallucinatory mechanisms, but maintained their intellectual integrity, and their adaptation to the exigencies of reality.

Under the term "paraphrenia" Freud proposed uniting the different clinical categories of dementia praecox, and then of schizophrenia. While maintaining the Kraepelinian distinction between paranoia and schizophrenia which includes paranoid dementia, he nevertheless stressed certain kinds of relation between the two conditions and the possibility of combinations of symptoms of the two types. He used, in some of his writings, the term "paraphrenia" to designate the paranoia-schizophrenia grouping. He emphasized more the underlying fixations and mechanisms than the criteria for systematization of the form of delusions. It was therefore the defense against homosexuality in the "Schreber case" (1911c [1910]) that led Freud to situate this clinical picture on the side of paranoia, in spite of a number of paranoid dementia aspects. He didn't exclude forms of passage from one condition to another, situating fixation in schizophrenia at a theoretical level anterior to the closer development of autoerotism. For him, hallucinatory mechanisms prevalent in schizophrenia linked it rather to hysteria, while projection in paranoia evoked certain traits of obsessive neurosis.

Finally, the paranoid-schizoid position of Melanie Klein refers to fears of persecution, linked to primal sadistic-oral ambivalence, able to manifest itself subsequently in schizophrenia and paranoia.

Bernard Touati

See also: "On the Origin of the 'Influencing Machine' in Schizophrenia"; "On Narcissism: An Introduction"; Paraphrenia; "Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia (Dementia Paranoides)"; Psychology of Dementia præcox ; Psychoses, chronic and delusional; Schizophrenia.