Dementia Praecox

A Historical Precursor to Schizophrenia

BY: T. Franklin Murphy | June 25, 2022

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Dementia praecox was diagnosed when individuals displayed schizophrenia like symptoms in the the late nineteenth century and early parts of the twentieth century.

Dementia praecox was a term previously used to describe the disease now known as schizophrenia. The term dementia praecox is no longer commonly used in diagnosis. The word schizophrenia was coined by the Swiss psychiatrist Eugen Bleuler in 1908, describing the separation of function between personality, thinking, memory, and function. By the 1970's when the first Diagnostic Statistical Manuel was compiled, the dementia praecox was formally listed as schizophrenia.

The disease now known as schizophrenia existed long before the name, even before this grouping of symptoms was coined dementia praecox by German psychiatrist Emil Kraepelin in the late 1800's. The disease has gone through "a series of labels, from different variations of the French word ‘demence’ or loss of mind in the 1800s, to dementia praecox, and its current description, the mental disorder schizophrenia (Plumptre, 2022).

History

The term démence précoce (premature dementia) was first used in 1860 by Vienna psychiatrist Bénédict Augustin Morel to describe the symptoms of a fourteen year old boy suffering from mental deterioration and loss of memory (2014).

Karl Kahlbaum (1828–1899) and his protégé Ewald Hecker (1843–1909) became key figures in the development of formal diagnosis criteria for mental disorders. In 1863, Kahlbaum described what eventually would be called dementia praecox as a mental disease that did not appear until the time of puberty and rapidly terminated into dementia, he called this disease 'hebephrenia.'

In 1871 Heckler, one of Kahlbaum's pupils, published the first detailed symptoms of the disease, creating a clinical framework for hebephrenia. He wrote that "hebephrenia is a mental affection which makes its appearance at the age of puberty, manifesting itself by alternate or successive fits of mania and both melancholia, and progressing rapidly towards dementia (Christian, et al. 1901).

Symptoms

Since dementia praecox is an outdated term, there is no precise list of symptoms. Common threads of the disease was recognized and categorized prior to the more detailed and generally accepted symptoms listed in the DSM. Doctors and medical institutions debated over the criteria and treatments, not agreeing over which cases should be included and or excluded from a diagnosis of dementia praecox. Slowly, overtime more practitioners agreed upon some general symptoms of the disease.

Today, many of the debated symptoms of dementia praecox may be found in DSM symptomology for schizophrenia.

In 1901, Dr. Justin Christian encapsulated dementia praecox with these four elements:

A constant appearance at the age of puberty
Various delirious symptoms at beginning
Constant sudden impulses
A rapid termination in a dementia which is more or less complete (p. 218).

A common theme to dementia praecox was the development of dementia during adolescence. Most early references to the disease believed that the condition was biologically tied to heredity.

Most early diagnosis of dementia praecox were made because some form of hallucinations or paranoid ideations were present.

Causes

Dr. Pompeo Milici suggested that although early symptoms of dementia praecox were often overlooked, he believed that those to later develop the dementia praecox in adolescents exhibited a certain type of personality.

Milici wrote that "almost from the start, such personalities are seen to be odd, peculiar, queer, 'different.' As a rule," he continued, " they are uncommonly seclusive, shy, retiring, docile in the extreme."

Swiss Psychiatrist Adolf Meyer (1866-1950) believed that dementia praecox developed from "a special constitution and personality likely to break down in specific manners" (Milici, 1931). Meyer explained a process similar to what is now known as the diathesis stress model was instrumental in the development of the disease. In the diathesis stress model "predispositions interact with stressful experiences. When life stresses disrupt our psychological equilibrium (or homeostasis), the stressful event may catalyze development of predispositioned disorders" (Murphy, 2021).

Meyer stated that "the general principle is that many individuals cannot afford to count on unlimited elasticity in the habitual use of certain habits of adjustment." Meyer concluded that "the types of adolescent deterioration can very largely be traced to disharmonies of thoughts, of habits and of interests, which bring about a stunting in one direction or another" (Milici, 1931).

Dr. L. S. London wrote that from his twenty years of experience that two conditions always accompanied dementia praecox. One the individuals were "highly moral and sensitive, and second, they were subject to sexual conflict." London explains further that an event creates a "conflict with the instinctive impulses which are unconscious. As a result of these repressed forces and conscious forces a compromise takes place and symptoms are formed."

London emphatically states that any investigation into dementia praecox will reveal that a "moral shock" has taken place (1930). Dr. London, obviously, has built his opinions around Sigmund Freud's theoretical framework.

Time has disproven many of these early theories of the development of dementia praecox. Data strongly supports a biological cause (heredity) for later development of schizophrenia. Although, there is more at play than DNA since in studies of identical twins one twin may contract the disease while the other does not.

Diagnosis

Dementia praecox is no longer diagnosed. Many early case studies of dementia praecox refer to a symptomology that likely would be diagnosed as schizophrenia today.

A complete list of schizophrenic symptoms.

A Few Final Thoughts

While schizophrenia diagnoses recently development within the last hundred years, the disease has been around much longer. Science is making headway in understanding and treating schizophrenia. While treatments have been to alleviate some of the symptoms, a cure still evades the reaches of science.

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References:

Christian, Justin, Wm. Rush Dunton, Clarence B. Farrar (1901). DEMENTIA PRAECOX. American Journal of Psychiatry.

Katzenelbogen, Solomon (2014). Dementia Praecox. Psychiatric Quarterly 16.3: 439-453. Originally published in 1942.

London, L.S. (1930) Treatment of dementia praecox. Psychiatric Quarterly 4, 631–641.

Milici, Pompeo (1931). Dementia praecox: Preventable. Psychiatric Quarterly, 11(4), 552-560.

Milici, Pompeo (1943). Psychology of dementia praecox. Psychiatric Quarterly 17, 87–111.

Murphy, T. Franklin (2021) Diathesis-Stress Model. Flourishing Life Society. Published 9-7-2021. Accessed 6-25-2022.

Pumptre, Elizabeth, (2022) What is Dementia Praecox? Verywellmind. Published 2-13-2022. Accessed 6-23-2022

Whitehead, Duncan (1937). Prognosis in dementia praecox. Psychiatric Quarterly 11, 383–390.