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A review is given of the concept 'deterioration' in schizophrenia. Quoted are the opinions of various authors: Kræpelin, Bleuler, Freud, Meyer, Jelliffe and others.
The author investigated 20 cases of schizophrenia, all males, 60 years of age or over. Cases of this type were selected because it could be anticipated that such patients would most probably prove the existence of deterioration if it really occurred in schizophrenia. From the study of these cases two facts emerge, namely, that deterioration is not inevitable in schizophrenia, and that the schizophrenic process is reversible. The author arrives at the opinion that the word 'deterioration', first used by Kræpelin, later by Meyer, cannot correctly be employed as a synonym for dementia præcox. In this he agrees with Bleuler, who stated the same opinion in 1911; also with various French authors. The deterioration observed in certain old cases is not a true one, but the result of lack of interest in external reality and lack of use of old assets, resulting in a profound loss of the utilization of the assets.
The word 'deterioration' should be applied only to organic disorders and the concept 'regression' (Freud) should be applied to schizophrenia. If deterioration should occur in a psychosis one has to assume that the process is of an organic etiology.