Jürgen Zielasek & Roland Weierstall & Wolfgang Gaebel - On the use of frame theory for the analysis of mental disorders: the term "schizophrenia"

Over the course of the history of psychiatry, psychiatric diagnosis was mainly guided by the observation of clinical phenomena like hallucinations or delusions. For the purpose of psychiatric classification, additional factors like the course of the disease were usually considered. Currently, revisions of the operationalized diagnostic systems like the International Classification of Disorders (ICD) of the World Health Organisation (WHO) and the American Diagnostic and Statistical Manual (DSM) are being developed and new diagnostic categories based on genetic findings are being considered. This has brought the classical distinction between affective and schizophrenic disorders (“dementia praecox”) first introduced by the German psychiatrist Emil Kraepelin under attack since some genetic risk factors appear to predispose individuals to a psychotic phenotype, which may occur in the diagnostic classificatory group of either schizophrenic or affective disorders.
   In this project, we investigated whether Frame Theory can be applied for clinical phenomena in mental disorders and may provide a framework for classification in psychiatry. For this purpose, we focused on the term “schizophrenia”, as it is a central term for the description of a whole class of severe mental disorders.
   First, we applied the concepts of Frame Theory to analyse Kraepelin´s “dementia praecox” as a predecessor of the term “schizophrenia”. Then, we analysed Bleuler´s introduction of the term “schizophrenia” and applied Frame Theory to see in how far Kraepelin´s frame of “dementia praecox” was still included in Bleuler´s terminology. In a third part, we analysed the frame structure of the current version of the ICD-classification (10th revision, ICD-10), which is an assembly of operationalized criteria.
   By investigating the frame structures of the term “schizophrenia” in these original sources over a time period of approximately 100 years, we found that the frames have undergone significant changes. We will discuss whether this was due to scientific progress or the need to formalize the term for classification purposes.