Infantile Schizophrenia

views updated

INFANTILE SCHIZOPHRENIA

The French classification of childhood and adolescent mental disorders describes two psychoses under two rubrics: childhood-onset psychoses of the schizophrenic type and adolescence-onset psychoses of the schizophrenic type.

Nineteenth-century child psychiatry, it can be assumed, followed the models proposed by adult psychiatry. Valentin Magnan applied the adult psychiatric theory of degeneration to children. In the same vein, Ernest Dupré applied the theory of constitutions to children. Later, various authors described clinical cases of children that showed obvious adult forms of schizophrenia. Thus, in 1905 Sancte de Sanctis described dementia præcocissima on analogy with dementia præcox. In 1888 Jacques-Joseph Moreau de Tours wrote the first treatise on child psychiatry, La folie chez l 'enfant (Madness in children). A year earlier, Hermann Emminghaus demonstrated that the description of mental illness in children should be separated from descriptions of adult mental illness.

In 1908 Theodore Heller described dementia infantilis, a clinical group of several illnesses generally of neurological origin with various components. At the First International Congress on Child Psychiatry, held in Paris in 1937, Lutz was the first to use the notion of infantile schizophrenia, of which he made a critical study. According to him, there are very few such cases. His presentation was supported by Georges Heuyer. Already English-speaking authors had extended the concept of infantile schizophrenia to cover everything in current practice conventionally referred to as "childhood psychoses." In 1943 Leo Kanner proposed isolating a particular morbid illness under the term "infantile autism." This particular psychosis does not evolve toward schizophrenia. As a matter of practice, institutions that treat children do not admit the notion of schizophrenia, while the concept of autism is very widespread.

French psychiatry has described prepsychotic and parapsychotic states that evolve toward a state of disintegration accompanied by mental retardation and that can appear analogous to certain schizophrenic states in adults. In English-speaking countries, especially in institutions following the American classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM -IV), the notion of psychosis has disappeared and been replaced by the concepts of autism and of pervasive developmental disorders. Some of the latter disorders may develop into schizophrenia. In German psychiatry, which long maintained its influence over the Soviet and Eastern Bloc countries, childhood autism has long been described as an initial form of schizophrenia, with development into schizophrenia more or less inevitable.

Schizophrenia that begins during adolescence will not be treated here, for it is generally at this age that symptoms of schizophrenia are first manifested. Many authors believe that schizophrenic adolescents, who are often extremely intelligent, already had bizarre behavioral problems in childhood. Most authors, however, believe that schizophrenia appears in the young adult out of the clear blue sky. In conformity with this view, the World Health Organization's International Classification of Diseases (ICD -10), "Classification of Mental and Behavioral Disorders" lists autism and childhood disintegrative disorder, but not infantile schizophrenia. Lastly, Roger Misès has described childhood borderline pathologies, within which he included states that may develop into schizophrenia. He sees this as a failure of the development of narcissism. Although it is possible to invoke some cases of infantile autism that have unquestionably evolved in the direction of schizophrenic states, the onset of schizophrenia during the latency period is altogether exceptional.

Psychiatric morbidity in children whose parents suffer from mental disorders is significant. However, these disorders are usually neuroses. When one parent is schizophrenic, the child has a 20 percent chance of being schizophrenic, whereas the rate is only 3 percent when neither parent is schizophrenic. Children adopted by parents listed on the schizophrenic register are more likely to be psychotic than those who are apparently the children of schizophrenics. These studies, carried out in Chicago and in the Scandinavian countries, seem to be more probing than research involving identical twins.

Some serious neurotic states, especially obsessive-compulsive disorders, may be a neuroticization of certain childhood and adult psychoses. This is what Joyce McDougall and Serge Lebovici described in Un cas de psychose infantile (A case of infantile psychosis; 1960). They describe the case of a child whose analysis was stopped by his parents. The parents wanted to place the boy in the care of Bruno Bettelheim. The mother of this boy said the boy was suicidal, and the boy, according to his father, became a "homosexual schizophrenic" who was among "the wealthiest Americans." At the end of his analysis, the boy would make sure that the subway had indeed stopped in each station and would go down to check its exact position. The neuroticization of his "schizophrenia" thus led to an obsession with checking that impeded subway trains from leaving the station.

It is legitimate to wonder whether true obsessional neuroses that appear from the latency period on are not preschizophrenic. Generally, very bizarre obsessions are involved, as in the case of a boy who wanted to make certain that falling snow made no sound. These obsessional neuroses are not mild schizophrenias that have already led to a degree of defensive obsessive behavior. In adulthood, schizophrenic decompensations can emerge, as in one case of traumatic schizophrenia in a preadolescent girl who saw her sister, caught in the eddying currents of the Loire River, drown. She first blamed herself, in the manner of a delusional melancholic, then became schizophrenic.

Clearly, as these few cases show, infantile schizophrenia is rare.

Serge Lebovici

See also: Autism; Deprivation; Double bind; Infantile psychosis; Lack of differentiation.