The Letter, Issue 40, Spring 2009, Pages 7 - 17
Schizophrenia in Freud and Lacan: No Return to pre-Kraepelinian Bewilderment
This article argues that while Freud accepted Kraepelin’s nosological divisions, he reversed the order of late nineteenth century conceptions of psychosis, objective-biological and subjective-biographical, without returning to early nineteenth century Romantic psychiatry or obviating the claims o f biological psychiatry on heredity. It demonstrates that neither the conceptions of Freud nor Lacan represent a return to the early Griesinger’s "unitary psychosis”or to pre-Kraepelinian classificatory confusion.
Keywords: Freud, Lacan, Kraepelin, Schizophrenia, Unitary Psychosis
"Schizophrenia” is the new name Eugen Bleuler gave to Emil Kraepelin’s "dementia praecox” in 1908. In a lecture to German psychiatrists that year, Bleuler questioned Kraepelin’s ominous prognosis and early onset. He came up with the new name, with its suggestion of tearing or splitting, because he believed that “splitting” of psychical functions was one of the most salient characteristics of the illness. And while he regularly used the term schizophrenia in the singular, he thought of it as a group of illnesses. As early as 1906, Bleuler had begun to apply to psychosis the mechanisms Freud had discovered in the field of neurosis, and his 1911 schizophrenia book expressed his indebtedness to Freud by placing him on a par with Kraepelin, the originator of dementia praecox. But Bleuler’s conception was less pessimistic than Kraepelin’s and, in terms of symptoms, his new conception offered patients hope, as Bleuler’s son, Manfred, used to put it, "hope of a cure”. Kraepelin, for his part, had managed to draw order and clarity out of the existing classificatory confusion by bringing various clinical pictures together into distinct illness unities. The fourth edition of his psychiatry text-book in 1893 grouped dementia praecox, catatonia and dementia paranoides together. And while Kraepelin had originally applied the term dementia praecox only to “hebephrenia”, the sixth edition of his text-book in 1899 united the whole group under the one name, dementia praecox. Back in 1878, Rinecker had helped Kraepelin obtain a position at the Bavarian district asylum of the brain-anatomist, Bernhard von Gudden, and his experience there was important for his project of classifying distinct illness unities such as dementia praecox. According to Kraepelin’s memoirs, his first impressions in the asylum were disheartening. He was not only unhappy with Gudden’s repeatedly answering questions about the nature of illnesses with “I don’t know”, but what he called the “bewildering horde” of countless mental patients, the helplessness of medical treatment and complete perplexity in the face of so many forms of illness bereft of scientific understanding, made his chosen career weigh heavily upon him.