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A Mechanism in Schizophrenia: A Theoretical Formulation

A Mechanism in Schizophrenia: A Theoretical Formulation Abstract Ever since dementia praecox was first described by Kraepelin numerous theories have been proposed to explain its pathogenic mechanisms. These theories have varied widely in their conceptions and approach, but as yet no completely satisfactory solution to the problem has been found. Certainly the often-repeated and too-often-taught formulation, that schizophrenia represents a defensive withdrawal from reality in order to avoid the anxiety arising from the patient's neurotic conflicts, leaves something to be desired. For to consider schizophrenia as akin to severe neurosis fails to convey what every psychiatrist must at some time have perceived in his patients: their feelings of chaotic experience, of utter helplessness, of being unable to control their reactions or carry out intention, the feeling of having undergone some terrible, indescribable alteration which reaches somehow into the depths of the personality. The impression that schizophrenics experience an inner dissolution of their integrative capacities leads one naturally to References 1. References 5, 11, 24, and 28. 2. References 10 and 19. 3. References 26 and 27. 4. The hippocampal gyrus is an archipallial structure and forms a part of what Broca described as the "limbic lobe" because of its distribution around the medial surface of the cerebral hemispheres. The structures included by Broca were the cortex adjacent to the olfactory striae; the pyriform area; the hippocampal gyrus and hippocampus, and the parasplenial, cingulate, and subcallosal gyri. Because of the olfactory functions of some of these structures, the entire area was renamed the "rhinencephalon" by Turner, and it was long assumed to be the "smell center" of the brain. The limbic lobe can now be defined cytoarchitecturally as archipallium and mesopallium. It would include, in addition to the structures grouped by Broca, the architecturally similar insula and temporal polar gyrus. Yakovlev includes the cortex of the orbitomesial surface of the frontal lobe as well. Nuclear structures associated with the limbic system include the amygdala, septal nuclei, hypothalamus, epithalamus, anterior thalamic nuclei, and parts of the basal ganglia. 5. Bellak, L.: Dementia Praecox , New York, Grune & Stratton, Inc., 1948. 6. Bleuler, E.: Dementia Praecox or the Group of Schizophrenias , translated by Joseph Zinkin, New York, International Universities Press, 1950. 7. Bowman, K. M., and others: Thyroid Function in Mental Disease , J. Nerv. & Ment. Dis. 112: 4-24, 1950. 8. Brickner, R. M.: The Intellectual Functions of the Frontal Lobes , New York, The Macmillan Company, 1936. 9. Freeman, H., and Elmadjian, F.: Carbohydrate and Lymphoid Studies in Schizophrenia , Am. J. Psychiat. 106:660-667, 1950. 10. Friedlander, J. H., and others: Adrenocortical Response to Physiologic Stress in Schizophrenia , Psychosom. Med. 12:86-88, 1950. 11. Halstead, W. C.: Specialization of Behavioral Functions and the Frontal Lobes , A. Res. Nerv. & Ment. Dis., Proc. (1947) 27:59-66, 1948. 12. Halstead, W. C.: Brain and Intelligence , Chicago, University of Chicago Press, 1947. 13. Herrick, C. J.: The Functions of the Olfactory Parts of the Cerebral Cortex , Proc. Nat. Acad. Sc. 19:7-14, 1933. 14. Hill, D., and others: A Central Homeostatic Mechanism in Schizophrenia , J. Ment. Sc. 97:111-131, 1951. 15. Hope, J. M., and others: Intravenous Pervitin and the Psychopathology of Schizophrenia , Dis. Nerv. System 12:67-73, 1951. 16. Hoskins, R. G.: The Biology of Schizophrenia , New York, W. W. Norton & Company, Inc., 1946. 17. Jasper, H., and Ajmone Marsan, C.: Thalamocortical Integrating Mechanism , A. Res. Nerv. & Ment. Dis., Proc. 30:480-492, 1950. 18. Kubie, L.: Instincts and Homeostasis , in Lorand, S., Editor: Yearbook of Psychoanalysis, 1949 , New York, International Universities Press, Vol. V, 1950. 19. Lehmann, H. E., and Kral, V. A.: Studies on the Iron Content of Cerebrospinal Fluid in Different Psychotic Conditions , A. M. A. Arch. Neurol. & Psychiat. 65:326-336, 1951. 20. Lindsay, J. S. B.: Periodic Catatonia , J. Ment. Sc. 94:590-602, 1948. 21. MacLean, P. D.: Some Psychiatric Implications of Physiological Studies on Fronto-Temporal Portion of Limbic System (Visceral Brain) , Electroencephalograph. & Clin. Neurophysiol 4:407-418, 1952. 22. Magoun, H. W.: The Ascending Reticular Activating System , A. Res. Nerv. & Ment. Dis., Proc. 30:480-492, 1950. 23. Malmo, R. B., and Shagass, C.: Physiologic Studies of Reaction to Stress in Anxiety and Early Schizophrenia , Psychosom. Med. 11:9-24, 1949. 24. Papez, J. W.: A Proposed Mechanism of Emotion , Arch. Neurol. & Psychiat. 38:725-743, 1937. 25. Penfield, W.: Epileptic Automatism and the Centrencephalic Integrating System , A. Res. Nerv. & Ment. Dis., Proc. 30:513-528, 1950. 26. Penfield, W., and Jasper, H.: Epilepsy and the Functional Anatomy of the Human Brain , Boston, Little, Brown & Co., 1954. 27. Piaget, J.: The Origins of Intelligence in Children , translated by Margaret Cook, New York, International Universities Press, 1952. 28. Pincus, G., and Hoagland, H.: Adrenal Cortical Responses to Stress in Normal Men and Those with Personality Disorders , Am. J. Psychiat. 106: 641-659, 1950. 29. Rose, J. E.: Cortical Connections of the Reticular Complex of the Thalamus , A. Res. Nerv. & Ment. Dis., Proc. 30:454-479, 1950. 30. Sackler, A. M., and others: On the Pathogenesis of Certain Psychiatric Disorders , J. Clin. & Exper. Psychopath. 12:30-34, 1951. 31. Sackler, M. D., and others: Some Physiologic Common Denominators of Histamine, Sex Steroids, Insulin and Electro-Convulsive Therapies , Psychiat. Quart. 25:213-236, 1951. 32. Sands, S. L., and Rednick, E. H.: Concept and Experimental Design in the Study of Stress and Personality , Am. J. Psychiat. 106:673-679, 1950. 33. Wiener, N.: Cybernetics , New York, John Wiley & Sons, Inc., 1948. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Neurology & Psychiatry American Medical Association

A Mechanism in Schizophrenia: A Theoretical Formulation

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Publisher
American Medical Association
Copyright
Copyright © 1955 American Medical Association. All Rights Reserved.
ISSN
0096-6886
DOI
10.1001/archneurpsyc.1955.02330170078014
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Abstract

Abstract Ever since dementia praecox was first described by Kraepelin numerous theories have been proposed to explain its pathogenic mechanisms. These theories have varied widely in their conceptions and approach, but as yet no completely satisfactory solution to the problem has been found. Certainly the often-repeated and too-often-taught formulation, that schizophrenia represents a defensive withdrawal from reality in order to avoid the anxiety arising from the patient's neurotic conflicts, leaves something to be desired. For to consider schizophrenia as akin to severe neurosis fails to convey what every psychiatrist must at some time have perceived in his patients: their feelings of chaotic experience, of utter helplessness, of being unable to control their reactions or carry out intention, the feeling of having undergone some terrible, indescribable alteration which reaches somehow into the depths of the personality. The impression that schizophrenics experience an inner dissolution of their integrative capacities leads one naturally to References 1. References 5, 11, 24, and 28. 2. References 10 and 19. 3. References 26 and 27. 4. The hippocampal gyrus is an archipallial structure and forms a part of what Broca described as the "limbic lobe" because of its distribution around the medial surface of the cerebral hemispheres. The structures included by Broca were the cortex adjacent to the olfactory striae; the pyriform area; the hippocampal gyrus and hippocampus, and the parasplenial, cingulate, and subcallosal gyri. Because of the olfactory functions of some of these structures, the entire area was renamed the "rhinencephalon" by Turner, and it was long assumed to be the "smell center" of the brain. The limbic lobe can now be defined cytoarchitecturally as archipallium and mesopallium. It would include, in addition to the structures grouped by Broca, the architecturally similar insula and temporal polar gyrus. Yakovlev includes the cortex of the orbitomesial surface of the frontal lobe as well. Nuclear structures associated with the limbic system include the amygdala, septal nuclei, hypothalamus, epithalamus, anterior thalamic nuclei, and parts of the basal ganglia. 5. Bellak, L.: Dementia Praecox , New York, Grune & Stratton, Inc., 1948. 6. Bleuler, E.: Dementia Praecox or the Group of Schizophrenias , translated by Joseph Zinkin, New York, International Universities Press, 1950. 7. Bowman, K. M., and others: Thyroid Function in Mental Disease , J. Nerv. & Ment. Dis. 112: 4-24, 1950. 8. Brickner, R. M.: The Intellectual Functions of the Frontal Lobes , New York, The Macmillan Company, 1936. 9. Freeman, H., and Elmadjian, F.: Carbohydrate and Lymphoid Studies in Schizophrenia , Am. J. Psychiat. 106:660-667, 1950. 10. Friedlander, J. H., and others: Adrenocortical Response to Physiologic Stress in Schizophrenia , Psychosom. Med. 12:86-88, 1950. 11. Halstead, W. C.: Specialization of Behavioral Functions and the Frontal Lobes , A. Res. Nerv. & Ment. Dis., Proc. (1947) 27:59-66, 1948. 12. Halstead, W. C.: Brain and Intelligence , Chicago, University of Chicago Press, 1947. 13. Herrick, C. J.: The Functions of the Olfactory Parts of the Cerebral Cortex , Proc. Nat. Acad. Sc. 19:7-14, 1933. 14. Hill, D., and others: A Central Homeostatic Mechanism in Schizophrenia , J. Ment. Sc. 97:111-131, 1951. 15. Hope, J. M., and others: Intravenous Pervitin and the Psychopathology of Schizophrenia , Dis. Nerv. System 12:67-73, 1951. 16. Hoskins, R. G.: The Biology of Schizophrenia , New York, W. W. Norton & Company, Inc., 1946. 17. Jasper, H., and Ajmone Marsan, C.: Thalamocortical Integrating Mechanism , A. Res. Nerv. & Ment. Dis., Proc. 30:480-492, 1950. 18. Kubie, L.: Instincts and Homeostasis , in Lorand, S., Editor: Yearbook of Psychoanalysis, 1949 , New York, International Universities Press, Vol. V, 1950. 19. Lehmann, H. E., and Kral, V. A.: Studies on the Iron Content of Cerebrospinal Fluid in Different Psychotic Conditions , A. M. A. Arch. Neurol. & Psychiat. 65:326-336, 1951. 20. Lindsay, J. S. B.: Periodic Catatonia , J. Ment. Sc. 94:590-602, 1948. 21. MacLean, P. D.: Some Psychiatric Implications of Physiological Studies on Fronto-Temporal Portion of Limbic System (Visceral Brain) , Electroencephalograph. & Clin. Neurophysiol 4:407-418, 1952. 22. Magoun, H. W.: The Ascending Reticular Activating System , A. Res. Nerv. & Ment. Dis., Proc. 30:480-492, 1950. 23. Malmo, R. B., and Shagass, C.: Physiologic Studies of Reaction to Stress in Anxiety and Early Schizophrenia , Psychosom. Med. 11:9-24, 1949. 24. Papez, J. W.: A Proposed Mechanism of Emotion , Arch. Neurol. & Psychiat. 38:725-743, 1937. 25. Penfield, W.: Epileptic Automatism and the Centrencephalic Integrating System , A. Res. Nerv. & Ment. Dis., Proc. 30:513-528, 1950. 26. Penfield, W., and Jasper, H.: Epilepsy and the Functional Anatomy of the Human Brain , Boston, Little, Brown & Co., 1954. 27. Piaget, J.: The Origins of Intelligence in Children , translated by Margaret Cook, New York, International Universities Press, 1952. 28. Pincus, G., and Hoagland, H.: Adrenal Cortical Responses to Stress in Normal Men and Those with Personality Disorders , Am. J. Psychiat. 106: 641-659, 1950. 29. Rose, J. E.: Cortical Connections of the Reticular Complex of the Thalamus , A. Res. Nerv. & Ment. Dis., Proc. 30:454-479, 1950. 30. Sackler, A. M., and others: On the Pathogenesis of Certain Psychiatric Disorders , J. Clin. & Exper. Psychopath. 12:30-34, 1951. 31. Sackler, M. D., and others: Some Physiologic Common Denominators of Histamine, Sex Steroids, Insulin and Electro-Convulsive Therapies , Psychiat. Quart. 25:213-236, 1951. 32. Sands, S. L., and Rednick, E. H.: Concept and Experimental Design in the Study of Stress and Personality , Am. J. Psychiat. 106:673-679, 1950. 33. Wiener, N.: Cybernetics , New York, John Wiley & Sons, Inc., 1948.

Journal

A.M.A. Archives of Neurology & PsychiatryAmerican Medical Association

Published: Nov 1, 1955

References