by Otto Gross
In a previous paper I proposed that the term 'dementia sejunctiva'
be introduced to replace the term 'dementia praecox'. Stransky
has since criticised my proposal, and the purpose of the present
paper is to present my own counter arguments.
The meaning of the term 'dementia' has changed
in current psychiatric usage. We have grown accustomed to employing
it to denote not only an end state but also a developing state,
a process. As the term is used today, therefore, we have to understand
it, according to circumstances, sometimes as 'imbecility' or
'feeblemindedness' and sometimes as 'becoming imbecilic', 'dementing'.
When Kraepelin established this terminology he gave the name
'dementia' to certain clinical pictures and described them collectively
as 'processes of dementing'. I have retained this usage and would
like the word 'dementia' to be understood in my proposed nomenclature
as a 'process of dementing' in the widest sense.
In designating clinical illnesses one usually
tries to find a name which implies an aetiology or, if this is
not possible, a name which indicates a markedly conspicuous symptom.
Sejunction is a universal and cardinal psychopathological
symptom that occurs prominently in most acute psychoses, far
more so in fact than in chronic or subacute phases or forms of
the dementia praecox group of illnesses. 'Dementia sejunctiva',
however, is a double-barrelled term and means that the factor
of sejunction is regarded as particularly conspicuous in one
group only among the many forms of dementia. This means only
that sejunction has more significance for the dementia praecox
group than for the other groups of illnesses that we call the
'dementias'. I would also claim not only that sejunction plays
a greater part in dementia praecox than in all the other dementing
processes, but also that it is the most striking and dominant
of all the phenomena of that condition. In other words, the symtomatology
of dementia praecox, in contrast to all other forms of dementia,
is dominated by sejunction.
Sejunction, in my sense, means a breakdown of
consciousness of a particular type. It is the simultaneous collapse
of several functionally separate series of associations. The
most important component of the concept is that the activity
of consciousness always has to be seen as the product of many
simultaneously ongoing psychophysical processes. The unity of
consciousness is never apparent to us in its entirety, but is
produced by the synthesis of simultaneous processes. This synthesising
activity can be suspended by functional disturbances of an unknown
kind, and that is what I mean by the sejunction mechanism.
My views on sejunction were derived from those
of Wernicke, but there are some differences in our two concepts,
which I should like to emphasise. Wernicke treats the activity
of consciousness as a succession of events in time, never as
the co-existence and intertwining of simultaneous processes,
as I do. Whereas in Wernicke's scheme, the sejunction mechanism
is a 'closed circuit' of associative ties, in mine it is the
work of synthesis which is affected. Wernicke's explanation of
sejunction involves the loss of certain associations caused by
an interruption in pathways. I invoke a general decline in some
higher cerebral function. Wernicke's sejunction factors are theoretically
localisable, whereas mine are diffuse. In summary, Wernicke is
more concerned with a breakdown in the contents of consciousness,
whereas my formulation emphasises the processes involved.
When Stransky made his own valuable contribution
to the understanding of dementia praecox, in which he emphasised
the 'striking disparity between affective and intellectual life',
he maintained that such dissociation was incompatible with Wernicke's
concept of sejunction. I can only say that I agree with him,
and congratulate him for pointing out yet a further form of sejunction,
which differs both from my formulation and from Wernicke's original
* This article was
published originally in Neurologisches Centralblatt 23
this translation is from The Clinical Roots of the
Schizophrenia Concept, John Cutting, M. Shepherd, eds.,
Cambridge University Press, 1987, preceded by this
Otto Gross (1877-1920)
Otto Gross was born in Graz in Austria and died in Berlin at
the age of 33. He was an eccentric person, an alcoholic and a
drug addict who consulted Freud, Jung and Gruhle. Jung regarded
him as a schizophrenic. He was an anarchist in the years before
the First World War, took part in the socialist revolutions which
convulsed Germany and Austria after the war, and was friendly
with Max Brod and Franz Kafka in Prague.
Despite his own psychiatric illness, he wrote extensively
and sensibly on a variety of aspects of organic and functional
psychoses. The following extract is a comment on the idea, current
at the time, that schizophrenia was a disorder of consciousness.