The contraposition between the two concepts of schizophrenia and Dementia Praecox is usually considered as the result of a shift in perspective operated by Eugen Bleuler: Emil Kraepelin focuses on the outcome of cognitive deterioration, whereas Bleuler emphasizes the primary disintegration of the self as a nuclear feature of the disorder. The hypothesis that such a process could reside in deep alterations of the psychic structure was also often opposed to Kraepelin’s conceptualization routed in an organic aetiology of the disorder. However, analysing carefully the fundamental texts of both authors, comes to light that the chronic alteration of the relationship with reality constitutes the core of the disorder, and both authors use this core to formulate their diagnosis. The alteration underlined by the two authors does not appear to coincide with the distortion of reality proposed by contemporary nosography, distortion that is strongly associated to the concepts of delusion and hallucination. It is in fact known that these symptoms do not constitute a necessary criteria for the diagnosis, nor do they always occur in most patients. This article proposes a shift in perspective - from psychotic symptoms to the stable permanence of a pathological alteration in the contact with reality - and discusses the practical and theoretical results of such a shift.
Keywords: Schizophrenia, Dementia Praecox, reality, delusion, nosography, pathogenesis.