Dementia Praecox, Schizophrenia, Dissociation, Multiple Personality: Implications for Joanne Greenberg’s “I Never Promised You a Rose Garden”

“The Kraepelinian dichotomy is the division of the major endogenous psychoses into the disease concepts of dementia praecox, which was reformulated as schizophrenia by Eugen Bleuler by 1908, and manic-depressive psychosis, which has now been reconceived as bipolar disorder. This division was formally introduced in the sixth edition of Emil Kraepelin's psychiatric textbook…in 1899…

“…psychogenic theories of dementia praecox dominated the American scene by 1911. In 1925 Bleuler's schizophrenia rose in prominence as an alternative to Kraepelin's dementia praecox. When Freudian perspectives became influential in American psychiatry in the 1920s schizophrenia became an attractive alternative concept. Bleuler corresponded with Freud and was connected to Freud's psychoanalytic movement, and the inclusion of Freudian interpretations of the symptoms of schizophrenia in his publications on the subject, as well as those of C.G. Jung, eased the adoption of his broader version of dementia praecox (schizophrenia) in America over Kraepelin's narrower and prognostically more negative one….

“The term ‘schizophrenia’ was first applied by American alienists and neurologists in private practice by 1909 and officially in institutional settings in 1913, but it took many years to catch on. It is first mentioned in The New York Times in 1925. Until 1952 the terms dementia praecox and schizophrenia were used interchangeably in American psychiatry, with occasional use of the hybrid terms ‘dementia praecox (schizophrenia)’ or ‘schizophrenia (dementia praecox)’…” (Wikipedia).

However, beginning in the 1970s, although the name “schizophrenia” has been retained, it has been more rigorously defined, back to the kind of cases connoted by “dementia praecox”; that is, cases with a young adult onset (praecox) that involve a biologically-based (endogenous) deterioration in coherent thinking (dementia).

What, then, has happened with the cases no longer considered schizophrenia; cases whose delusional and hallucinatory symptoms seem more psychological, even imaginative; cases in which the person has complex thoughts rather than dementia; cases that may do better with psychotherapy than medication as the main treatment modality? These cases have increasingly come to be seen as psychotic-like presentations of dissociative defenses rooted in childhood trauma: complex cases of dissociative identity disorder (multiple personality).

For an historical review of schizophrenia and dissociation, including Joanne Greenberg’s I Never Promised You a Rose Garden, please read the following brief article:

Karen Gainer. “Dissociation and Schizophrenia: An Historical Review of Conceptual Development and Relevant Treatment Approaches.” Dissociation, December 1994, pp. 261-271.

http://www.empty-memories.nl/dis_94/Gainer_94.pdf