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Our psychodynamic concepts about the prognosis of schizophrenia have undergone considerable change in their historical evolution. In 1869 Kraeplin1 connected three apparently dissimilar syndromes — hebephrenia, catatonia, and paranoia to dementia praecox. These three syndromes had previously been considered completely different illnesses; but he classified them together because, according to him, they were all characterized by “progressive decay.” He felt that this disease was caused by either a metabolic disturbance, or a degenerative brain.2
Fifteen years later, Bleuler3 added a fourth syndrome to Kraeplin's classification, namely the simple or acute form. Believing that the disorder could best be characterized as a splitting of the basic functions of the personality, he renamed the illness Schizophrenia. He postulated that the fundamental cause of the syndrome was some yet unknown faulty organic process, and therefore no one could ever become cured of the disease. Even though some acute cases could achieve a socially accepted “recovery,” the basic causes of the disease could never be removed.
At about the same time Adolf Meyer advanced an even more daring view.4 Emphasizing the importance of psychological factors, he claimed that schizophrenia was not a disease entity, “but rather a maladaptation determined by life experiences.” He also felt that the patient's lifetime should be analyzed so that contributing factors could be unconvered as to the origins of the disease.
Bleuler and Meyer both divided schizophrenia into chronic and acute forms.
In general the chronic schizophrenic was described as becoming disturbed early in life, and showed the typical “four A” symptoms — affect disturbance, autism, ambivalence and associative disorder. In addition, the secondary symptoms such as hallucinations and delusions, confusion, fluctuation of mood, stupor or catatonic rigidity, were quite strong. In contrast, the acute schizophrenic is disturbed for a smaller amount of time,