The Delusions of the Non-Remitting Schizophrenias: Parallels with Childhood Phantasies

M. Bleuler's (1978) follow-up studies have confirmed the clinical observation that the course of the illness in non-remitting schizophrenias is towards the establishment of relatively stable ‘end states’. The term ‘end state’ as used by M. Bleuler (1978) does not mean that the process of illness has come to an end, is incapable of further development for good or ill, or that further changes may not affect the personality. Only when the illness has continued in this relatively steady condition for five years can it be designated an ‘end state’. Although acute attacks may occur during ‘end states’ they are ephemeral and there is a return to the quiescent condition. M. Bleuler distinguishes three types of ‘end state’: severe, moderately severe and mild. Dementia and defect state were the terms used in past times to describe the first two. The third type consists of those patients whose illness is not immediately obvious, who can conduct a rational conversation without the intrusion of delusional and hallucinatory experiences and can undertake useful work.

The delusions which occur during the initial, acute attack of a schizophrenic psychosis are inclined to disappear along with other acute manifestations (E. Bleuler, 1911). In contrast the delusions which make their appearance when the illness follows a chronic course (non-remitting) tend to persist unchanged over many years (E. Bleuler, 1911). The introduction of drug therapy has not altered this apart from causing a transient disappearance of the delusions. The long-term observation of schizophrenic patients, whose illnesses have reached ‘end states’, suggests that the content of the delusions is different from that present during the initial attack.

The delusions to be described here are drawn from twelve cases, four of which had reached a severe ‘end state’ (three women and one man); six had reached a moderately severe ‘end state’ (four women and two men); and two, a mild ‘end state’ (one man and one woman). The ret