A Contribution to the Study of Schizophrenia1

All of us, I imagine, have had more or less reason to suspect that, in psychiatry, the term schizophrenia is applied to morbid states differing in origin though characterized, as they develop, by the same or very similar clinical symptoms. Theoretically we admit that the disease may have various origins. Sometimes the cause may be organic, e.g. a hereditary defect or a microbic infection, while, in other cases, the origin is psychic and the disease is to be attributed to shocks received in childhood and affecting subsequent development or, it may be, to the influence of the family environment.

At the present time it is still by no means easy, when confronted with a case of schizophrenia, to know its exact cause; in order to pronounce upon the nature of the disease we now realize that a thorough study of the patient is essential. And it is in the hope of making some contribution to this particular study that I now propose to communicate to you certain interesting material which I have been collecting in the past two years, while treating a young girl suffering from schizophrenia.

The patient, whom I will call Odile, is now twenty-five. The following is, in brief, her history. The disease manifested itself when she was seventeen, first of all in an obsessional state with a germ-phobia (a need to be constantly washing) and in an exaggerated scrupulosity, etc. As time went on, Odile found it more and more difficult to speak. On one occasion she accused herself of having acted immodestly in allowing herself to chat with a young man. Next, she made her first attempt to commit suicide, whereupon she was immediately taken to a private mental hospital. There she remained for a year and was then sent to a similar institution where she stayed for about two years. Her condition grew worse, she became refractory, spoke less and less and made frequent attempts at suicide. At last the medical superintendent of the mental hospital informed the family that the case was a se