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Paraphrenia

PARAPHRENIA

German psychiatrists in the 19th century employed the term paraphrenia, derived from the Greek para (beyond) and phrēn (mind), as a nonspecific term for madness. In 1863 Karl Ludwig Kahlbaum used paraphrenia hebetica to designate a degenerative malady of puberty, later known as hebephrenia.

Emil Kraepelin, in the eighth edition of Dementia Praecox and Paraphrenia (1919), which was published in four volumes beginning in 1908, proposed paraphrenia to designate chronic delirious psychoses unaccompanied by intellectual decline; he suggested four different clinical types: systematica, expansiva, confabulans, and phantasica.

Freud believed paraphrenia to be a more properly descriptive term than schizophrenia, the term Eugen Bleuler suggested to replace Kraepelin's dementia praecox. He used it for the first time in his "Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia (Dementia Paranoides)" (1911c). Although Bleuler's term became prevalent, Freud employed paraphrenia again in "The Disposition to Obsessional Neurosis: a Contribution to the Problem of Choice of Neurosis" (1913i) and in "On Narcissism, an Introduction" (1914c). Subsequently it came up again twice, first in the Introductory Lectures on Psycho-Analysis (1916-17a) and in the second published version of "The Disposition to Obsessional Neurosis." Strangely enough, the term did not surface at all in the long discussion of the mechanisms of schizophrenia in the metapsychological article on "The Unconscious" (1915e), nor in "A Case of Paranoia Running Counter to the Psycho-Analytic Theory of the Disease" (1915f). It was also missing from the two articles on "Neurosis and Psychosis" (1924b) and "The Loss of Reality in Neurosis and Psychosis" (1924e).

It is difficult to understand why Bleuler's term became preferred usage, although certainly this was due in part to the notion of "split" (schizo ). However, although paraphrenia did not gain currency, on a nosological level Freud's reasoning, as developed particularly in the Schreber case, was quite remarkable and in line with his earlier attempts at diagnostic precision concerning neurosis. Freud maintained in effect that paranoia must be viewed as a clinical type distinct from schizophrenia, even if the overall clinical picture is complicated by schizophrenic-like characteristics. The two conditions can be distinguished by the central obsession and by a different mechanism of symptom formation.

Nicolas Gougoulis

See also: Hypochondria; Introductory Lectures on Psychoanalysis ; Narcissism, secondary; "On Narcissism, An Introduction"; Paranoid psychosis; Psychoanalytic nosography; Psychoses, chronic and delusional; Schizophrenia.

Bibliography

Delrieu, Alain. (1997). Sigmund Freud. Index thématique. Paris: Anthropos.

Freud, Sigmund. (1911c). Psycho-analytic notes on an autobiographical account of a case of paranoia (dementia paranoides). SE, 12: 1-82.

. (1913i). The disposition to obsessional neurosis: a contribution to the problem of choice of neurosis. SE, 12: 311-326.

. (1914c). On narcissism: an introduction. SE, 14: 67-102.

. (1915e). The unconscious. SE, 14: 159-204.

. (1915f). A case of paranoia running counter to the psycho-analytic theory of the disease. SE, 14: 261-272.

. (1916-17a). Introductory lectures on psycho-analysis. Part I, SE, 15; Part II, SE, 16.

. (1924b). Neurosis and psychosis. SE, 19: 147-153.

. (1924e). The loss of reality in neurosis and psychosis. SE, 19: 180-187.

Kapsambelis, Vassilis. (1997). Termes psychiatriques français d'origine grecque. Paris: Masson.

Kraepelin, Emil. (1971[1919]). Dementia praecox and paraphrenia. New York: Robert E. Krieger.

Porot, Antoine. (1952). Manuel alphabétique de psychiatrie Paris: Presses Universitaires de France.

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paraphrenia

paraphrenia (pa-ră-free-niă) n. see late-onset schizophrenia.

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