Some Aspects of the Schizophrenic Formal Disturbance of Thought

by Erwin Levy

[first published in: Psychiatry, 6 (1943), pp 55-69;
German translation 1997 by Gerhard Stemberger in Gestalt Theory, 19 (1), S. 27-50:
"Einige Aspekte der schizophrenen formalen Denkstörung"]
Siehe auch: G. Stemberger (Hrsg.), Psychische Störungen im Ich-Welt-Verhältnis. Gestalttheorie und psychotherapeutische Krankheitslehre.

Note: The topics of this article were discussed in depth in the seminars of Gestalt psychology founder Max WERTHEIMER at the New School for Social Research in the presence of Erwin LEVY. See the chapters 32, Understanding Psychotics' Speech, and 33, More on Psychotics' Speech, in A. S. LUCHINS & E. H. LUCHINS, 1978, .Revisiting Wertheimer's Seminars, Vol. II: Problems in Social Psychology. Lewisburg: Bucknell University Press; pp. 255-262)
(4th part)

If one is asked who Epaminondas was, it is tacitly assumed that he will see this question as a historical one, just as he learned it in school, and that he therefore will assume the 'objective' relationship to the problem. While this assumption would be valid in most normal cases one cannot take its validity for granted in the world and attitude of a schizophrenic. He may not be at all interested in the objective historical rôle of Epaminondas; for him Epaminondas may assume an entirely different situational meaning.

For these reasons the second tacit assumption of problem-centered objective thinking cannot be transferred from the study of certain normal thought processes to that of diseased ones.

BLEULER [17] uses a characteristic example. He had asked a schizophrenic patient: "Who was Epaminondas?" and the patient gave the following answer:

Epaminondas was one who was powerful, especially on land and on sea. He conducted great fleet manoeuvers and open sea battles against Pelopidas but was defeated in the second Punic war due to the foundering of an armored frigate. He wandered from Athens to the forest of Mamre in ships, there brought Caledonian grapes and pomegranates, and overcame Bedouins. He besieged the Acropolis with gun boats, and caused the Persian garrison to be burnt as living torches. The man who later became Pope Gregor VII - eh - Nero followed his example and due to him all Athenians, all Romanic-Germanic-Celtic clans who had not taken a stand favorable to the priests were burned by the Druid on Corpus-Christi day as a sacrifice to the sun god, Baal. This is the period of the stone age. Spear points of bronze.

BLEULERs question concerned a fact of ancient history. The answer was definitely prescribed by the facts themselves. There was apparently no place for any intrusion of the personal psychological situation of the patient. Therefore BLEULER assumed that the answer could be studied piecemeal, on its own intrinsic merits, simply by comparison with the right answer. This comparison, he assumed, would give a satisfactory list of the 'mistakes' which the patient had made.

The fact that schizophrenics live in a world of their own was, of course, known to BLEULER, and was described by him as autism. He also was aware that this influenced their thinking rendering it autistic or dereistic. However, this general knowledge did not enter into his chapters on the formal disturbance of thinking in any concrete manner. Here he proceded piece-meal, treating thinking as an isolated faculty.

With regard to the example BLEULER says: [17] "The thoughts are kept together by a sort of governing concept, but not by any idea of direction or goal. Thus it looks as if concepts of a certain category . . . . facts from ancient history - had been thrown into a pot and thoroughly mixed by shaking; and as if they had then been picked out one by one, just as chance would have it, and had been connected with each other by grammatical forms and some ideas."

Nothing is said about the patient's world, his life, his personality.

This approach is essentially that of classic associationism. For BLEULER, a thought normally consists of a number of heterogeneous, isolated, piecemeal items secondarily linked together by associations according to the blind experience of their past repeated coincidence. Whether or not there is any inner logical reason for the togetherness of just these items, whether objectively their contents fit together or not, does not even become a problem. Starting with this viewpoint, BLEULER does not stop to look at the whole-qualities of the answer except for his use of LIEPMANNs "governing concept." [18] He immediately breaks the answer into its pieces, focusses on the associative links between them, and finds them disturbed throughout. Not looking at the whole, he fails to see the positive factor which consistently determines the direction of this disturbance. He is therefore forced to the conclusion that it looks like a chance effect, and he can only see the negative side of the alteration.

Because of the limitations of space other approaches must be dealt with briefly. The various experimenters dealing with concept formation, for the most part treat the problem in isolation from the patient's life and personality. They do not investigate the psychological significance of the concrete experimental situation for the patient. One therefore learns what the situation meant to the experimenter, but one does not know what it meant to the patient. Probably the meanings are not the same. Yet, to know what it meant to the patient is most important in understanding the results. Similar problems arise in regard to related investigations of "concrete and abstract" behavior. [19] It may be indicated, however, that from the point of view of Gestalt theory, in large measure the results seem to be connected with the fact that the authors focus on the Aristotelian or the associationist idea of concept. Their finding that schizophrenics and children have trouble with the formation of this sort of concept may possibly, in the main, be due to the fact that it is a piecemeal and late artefact of culture which seems easily lost in psychoses and has not yet been forced upon sensibly thinking children. [20]

The psychobiological approach [21] contains some views which tend in a direction similar to that of this paper, particularly in regard to the stress laid upon the social situation between patient and interviewer. But it seems to this writer that the concrete features of the patient's field situation and inner tendencies are not taken into account sufficiently - so that in the end the thought disturbance is again considered only in its intellectual aspects. The result is a listing of mistakes, such as asyndesis, interpenetration, and others.

Orthodox psychoanalysts claim to have gone farther. According to them, such thinking cannot be taken in isolation, at face value, but must be analyzed in the light of the underlying emotional situation. But this similarity with Gestalt psychology is only apparent. For while psychoanalysts state that thinking must be dealt with in relation to the psychological situation of the 'whole personality,' adherents to its classical form, at least, seek this situation exclusively in an S2, which has always one and the same characteristic nature. Essentially it consists of variations on one type of problem, the various states of the unconscious libidinous development and the unconscious libidinous wishes. At bottom, despite all variations, the world is centered in the same way for everybody: it is an aggregate of situations and objects of essentially libidinous meaning.

But Gestalt theory makes no assumptions as to the nature of the material contents of either S1 or S2. It stresses the fact that the formal dynamics of both are whole-dynamics which in different cases may concern different basic issues. The emphasis is laid on the fact that the disturbance is primarily due to the change in the structure of the patient's world and field situation. The Epaminondas example itself contains strong evidence for this.

If one reads the production as a whole without making the two tacit assumptions and without definite expectation of what the answer should be like, and without prejudice, as if it were a new and strange poem, one feels - yes, this is 'sick.' It contains things which are clearly disturbed, illogical, inconsistent. But there is something besides these negative features. Seen as a whole the answer is pervaded by a powerful, strange, unsound mood, an unexpected atmospheric whole-quality. There is a breathless piling up of big events, a trend towards the violent and grandiose. One senses an urgency in the patient to get at something gigantic, a fury which explodes the objective structures intended by the question, distorting them to the point of becoming grotesque. But despite the bizarre result one feels the consistency of the underlying frenzy throughout the whole.

This grandiosity is qualitatively very different from the quiet grandeur which pervades the historic story of Epaminondes. There one finds an unassuming glory, the attainment of which was not the motive of his actions; he is not pictured as a vainglorious raging hero, but as a quiet citizen doing his duty. The patient's grandiosity is very different; it is violent, hectic, distinctly distorted.

There is method in this madness. This new trend imposes upon the whole a law of its own, impresses its own character and whole-dynamics. At the outset a simple question-answer system is intended. The question clearly states the topic, and, making the two tacit assumptions, sets the direction: it requires an objective historical report. In response to this requirement the patient starts as if he were going to give just this: "Epaminondas was . . . . " But something happens. The mood just described seems to have the nature of a second powerful vector which interferes with the intention of the question. Under the pressure of this second vector the answer deviates in a new direction. Instead of just telling who Epaminondas was the patient drives in the direction of showing that he was involved in tremendous events. Epaminondas becomes a figure of exaggerated might and grandeur. As the statement goes on the second vector becomes stronger and more dominant until towards the end it alone determines what has to be said, until even the original topic is abandoned since it is too small to carry the burden of what the patient is driven to convey. New horizons open which, to his feeling, are more essential, although they have no longer anything to do with Epaminondas and with the intentions of the question. But whatever is said is pervaded by this new whole-quality, the mood. As the statement proceeds the mood builds an internal crescendo until at the end the patient no longer forms complete sentences but just flings fragments of sentences in its direction. Fig. 6 may clarify what is meant: the original vector of the question-answer system and the second vector are entered as the two axes of a system of coordinates. The statement then appears to assume the shape of a curve rapidly approximating the direction of the second vector.

Fig. 6.

This new mood appears to originate in the characteristic features of the behavioral world of the patient. It is clearly not the same as that of man's common 'reality.' WhiIe not much is known about the patient one feels that his view of these things is centered differently. It is for some reason centered on and around this trend toward the grandiose of which everything becomes bearer and function. The question flung into this new situation assumes a different functional meaning [22] from that which the questioner, in his situation, intended. [23]

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[17] Reference footnote 11; p. 11. My translation. [-> Back to text.]

[18] LIEPMANN, Hugo, Über Ideenflucht. Sammlg. zwangl. Abhandlg. a. d. Gebiet d. Nerven- und Geisteskrkh. (1904) 4 (Heft 8):1-84. -> Back to text.

[19] Quotations from Eugenia HANFMANN, reference footnote 13; item 2.
BOLLES, Marjorie, and GOLDSTEIN, Kurt, A Study of the Impairrnent of "Abstract Behavior" in Schizophrenic Patients. Psychiatric Quart. (1938) 12:42-65.
GOLDSTEIN, Kurt, and SCHEERER, Martin, Abstract and Concrete Behavior: An Experimental study with Special Tests. Psychol. Monogr. (1941) 53 [2]:1-151. -> Back to text.

[20] WERTHEIMER, Max. über das Denken der Naturvölker. Zahlen und Zahlgebilde. Zeitschr. f. Psychol. (1912) 60:321-378. Refer to the English abstract in Ellis, Willis D., reference footnote 3, pp. 265-273. -> Back to text.

[21] CAMERON, Norman. Reasoning, Regression and Communication In Schizophrenia. Psychol. Monogr.1938) 50:1-34.
CAMERON, Norman, Schlzophrenic Thinking in a Problem Solving Situation. J. Mental Science (1939) 85:1012-1035. -> Back to text.

[22] fq(S2) -> Back to text.

[23] fq(S1) -> Back to text.

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