On the Nomenclature „Dementia sejunctiva“

Dementia sejunctiva*
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 concept.

* This article was published originally in Neurologisches Centralblatt 23 (1904), 1144-6;
this translation is from The Clinical Roots of the Schizophrenia Concept, John Cutting, M. Shepherd, eds.,
Cambridge University Press, 1987, preceded by this biographical profile:

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.