A Psychoanalytic Approach to the Diagnosis of Paranoia

In 1917 Freud wrote: "The form of disease known as paranoia, chronic systematic insanity, occupies an unsettled position in the attempts at classification made by present-day psychiatry. There is, however, no doubt of its close affinity to dementia praecox. I once ventured to suggest that paranoia and dementia praecox should be brought together under the common designation of 'paraphrenia'" (1916-1917, p. 423f.).

Indeed, paraphrenia would have been a much more fitting name than Bleuler's term of schizophrenia, which is now the commonly accepted designation. This term suggests that a splitting of the personality is the most characteristic symptom of the illness, which is certainly not true (Freud, 1911, p. 76). It is a pity that, to my knowledge, no deep analytic evaluation has been made of those symptoms which clinically seem to demonstrate the phenomenon of splitting in the psychotic personality.

In the United States not much attention has been paid to attempts at differentiating between paranoia and schizophrenia, nor does this problem seem to have been settled among German psychiatrists. In this respect, I want only to comment that the prominent psychiatrist Kretschmer developed a picture of paranoia which deviates considerably from the picture as it is usually understood. Strictly speaking, Kretschmer (1950) does not think that paranoia exists; however, there are paranoiacs. He sees the personality of the paranoiac as resulting from a process of long standing. The endogenous