It is possible to make certain a priori speculations as to prognostic
criteria based on classification and what that implies. We know that pure
paranoia is not a deteriorating psychosis--that it does not necessarily
preclude the possibility of considerable social usefulness--and that it
grades off almost imperceptibly into dementia praecox. The features
differentiating these two diseases should therefore supply us with data for
determining the prognosis. A case undoubtedly, praecox, which shows markedly
the differential features of paranoia, should have a proportionately better
outlook. In a vague way our common sense uses this standard when it makes us
"feel" that the case will have a long course which shows a relatively well
retained personality in conjunction with praecox symptoms. But "feelings"
are hardly objective criteria. What symptoms may we make use of? We may
say that the praecox patient as opposed to the paranoia has a poverty or
inappropriateness of affect, a scattering of thought and a lack of
systematization in his delusions. The weakness of will on which Kraepelin
lays so much stress may be included, though that can probably be derived
from the scattering of thought. What of these symptoms may be analyzed for
our purpose? Affect changes and dissociation in the stream of thought are
themselves signs of the deterioration we wish to predict; to make use of
them we should have at hand some theory as to the relation between their
quality and quantity, and that we have not. There remains the content of
the psychosis, a definitely objective material with which to work. This is
naturally a big problem--almost as wide as insanity itself--and one brief
communication cannot pretend to solve it. What we wish to do is merely to
put forward tentatively the claim of one type of delusion formation to
prognostic value.
Public-domain text, read in full here on John Shaqi.
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