Gray Areas Between the Schizophrenias and the Depressions*

The schizophrenias and depressions, in their most typical quality, can be considered polar opposites, the former most classically involving thought disorders, the latter almost synonymous with pathologic mood variations. Between these syndromes there is actually a limbo of what might be called a “gray area” of symptoms and phenomena that have enough similarity at times to make for clinical confusion.

In the one patient is encountered convergence of symptoms of both depressive and schizophrenic syndromes, whether overlapping or, at times, sequential; that is, whether in parallel, as it were, or in tandem. This issue is often experienced as the therapist's problem in diagnostic acumen, a flaw in the eye of the beholder. Often the still familiar issue was which of the two diagnoses could plausibly be defended and be socially less stigmatizing to the patient, which, of course, turned out to be depression rather than schizophrenia. Fortunately now in a receding era, the diagnosis of schizophrenia carried the psychiatrist's prognostic hopelessness, which was reflected in this therapeutic nihilism, while the diagnosis of depression offered more resources and attitudes of hope for the patient.†