What Kurt Schneider Really Said and What the DSM Has Made of it in Its Different Editions: A Plea to Redefine Hallucinations in Schizophrenia

Kurt Schneider has played a leading role in shaping our current view of schizophrenia, placing certain manifestations of delusions and hallucinations at the center of the disorder, especially ideas of persecution and voice-hearing. The first part of this review summarizes Schneider's original ideas and then traces how the different editions of the DSM merged aspects of Kraepelin's, Bleuler's, and Schneider's historical concepts. Special attention is given to the transition from the DSM-IV to the DSM-5, which eliminated much of Schneider's original concept. In the second part of the article, we contrast the current definition of hallucination in the DSM-5 with that of Schneider. We present empirically derived arguments that favor a redefinition of hallucinations, much in accordance with Schneider's original ideas. We plea for a two-dimensional model of hallucinations that represents the degree of insight and perceptuality, ranging from thoughts with full "mineness" via perception-laden thoughts and intrusions (including "as if" experiences") to hallucinations. While we concur with the DSM-5 that cognitions that are indistinguishable from perceptions should be labeled as hallucinations, we suggest expanding the definition to internally generated sensory phenomena, including those with only partial resemblance to external perceptions, that the individual considers real and that may lie at the heart of a subsequent delusional superstructure.

[The notion of psychopathic personalities in Kurt Schneider's concept]

The understanding of psychopathic personalities in early works of Kurt Schneider making start from the traditional doctrine of temperament but straying from the degeneration theory and constitutional concepts of E. Kretschmer is analyzed. Under the notion of psychopathic personality K. Schneider means properly the variation of the character that according to his famous definition can cause by its 'deviations from the average' suffering for the society and can also suffers itself due to those deviations. The importance that K. Schneider attached to the differentiation of all personality anomalies from schizophrenic process is emphasized. The basic characteristics of 10 special types of psychopathic personalities according to K. Schneider's systematics are also analyzed. K. Schneider pursued the identification of one prominent psychological trait in the building of his systematics and definition of special psychopathic types. He strived to avoid sociological labels that had been used by his predecessors ('liars and cheaters', 'enemies of society' 'inborn prostitute' and so on). The great influence of E. Kretschmer on K. Schneider's characteristics of 'affective' and 'unsure of himself' psychopaths is noted although K. Schneider did not accepted the constitutional systems of E. Kretschmer and did not highlight 'schizoid' psychopathy. The growth of psychopathic personality groups compared with the last lifetime systematics of E. Kraepelin (from eight to ten) appears by K. Schneider only formal because E. Kraepelin placed some clinically detailed descriptions of personality disorders beyond the main heading.

Max Scheler's influence on Kurt Schneider

Kurt Schneider (1887-1967) met Max Scheler (1874-1928) in 1919 when he enrolled in the latter's philosophy seminars at the University of Cologne. Kurt Schneider was then a junior psychiatrist and Max Scheler a renowned philosophy professor and co-founder of the phenomenological movement in philosophy. We uncover the facts about their intellectual and personal relationship, summarize the main articles and books that they wrote and consider whether Max Scheler did influence the young Kurt Schneider. We conclude that Scheler's philosophy of emotion impressed Schneider, and that the latter's notion of 'vital depression' as the core element in melancholia was essentially applied Schelerian philosophy. Schneider's more celebrated contributions to psychiatry - his notion of first rank symptoms of schizophrenia - owed nothing to Scheler or any other philosopher.

Max Scheler's theory of the hierarchy of values and emotions and its relevance to current psychopathology

The philosopher Max Scheler (1874-1928) set out a hierarchical theory of values and emotions in the early twentieth century. This inspired Kurt Schneider to distinguish two sorts of depressive illness, each conforming to a Störung (disorder) in different levels of Scheler's hierarchy. No other psychopathologist, except Stanghellini, gave the matter much attention. I believe that Scheler's theory is a rich source of insight into psychopathology, general and neuropsychiatric. I therefore give an account of Scheler's scheme, review its extant applications (Schneider's, Stanghellini's), and present suggestions as to its continuing potential relevance in a wide range of psychopathological conditions.

First rank symptoms of schizophrenia: their nature and origin

Kurt Schneider's insight nearly 80 years ago that schizophrenia could be demarcated from other psychoses by a small set of particular delusions and hallucinations powerfully influenced diagnostic practice. The theoretical status of such 'first rank symptoms' as a whole, however, has rarely been addressed. But if they are sensitive and specific to the condition, it is about time that their essential nature and potential origin be considered. This is the purpose of the present paper. I argue that these psychopathological phenomena are indeed relatively sensitive and specific to the condition, that their nature can be formulated within a Schelerian model of what constitutes a human being, and that their origin fits anthropological and neuropsychological notions of the make-up of contemporary human beings.

Milestones in the history of personality disorders

This paper analyzes the major historical milestones in the study of normal and abnormal personality, from antiquity up until the 20th century. Special attention is paid to the interaction between dimensional and typological approaches, which was a major issue during the preparation of DSM-5. Theories of personality started with the humoral theory of Greek medicine. Pinel, and later Esquirol and Prichard, are credited with the first descriptions of abnormal personalities in textbooks of psychiatry. Between the late 19th and early 20th centuries, elaborate systems of normal and abnormal personality, associating to some degree types and dimensions, were devised by a succession of European psychologists, such as Ribot, Heymans, and Lazursky. Emil Kraepelin and Kurt Schneider proposed classifications of abnormal personality types. In parallel, psychoanalysts stressed the role of early life experiences. Towards the mid-20th century, statistical methods were applied to the scientific validation of personality dimensions with pioneers such as Cattell, anticipating the five-factor model.

Milestones in the history of personality disorders

This paper analyzes the major historical milestones in the study of normal and abnormal personality, from antiquity up until the 20th century. Special attention is paid to the interaction between dimensional and typological approaches, which was a major issue during the preparation of DSM-5. Theories of personality started with the humoral theory of Greek medicine. Pinel, and later Esquirol and Prichard, are credited with the first descriptions of abnormal personalities in textbooks of psychiatry. Between the late 19th and early 20th centuries, elaborate systems of normal and abnormal personality, associating to some degree types and dimensions, were devised by a succession of European psychologists, such as Ribot, Heymans, and Lazursky. Emil Kraepelin and Kurt Schneider proposed classifications of abnormal personality types. In parallel, psychoanalysts stressed the role of early life experiences. Towards the mid-20th century, statistical methods were applied to the scientific validation of personality dimensions with pioneers such as Cattell, anticipating the five-factor model.