PubMed1976
A survey of the literature on the primary personality of schizophrenics shows that the essential concepts derive from Kraepelin (1893), E. Bleuler (who also introduced the technical term "schizoid", 1911) and C.G. Jung introversion; 1913). E Kretschmer (1921) adopted these preliminary findings and integrated them into his system of "Constitution" which greatly stimulated research in this field. Most of the following investigations confirmed his hypotheses on the basis of clinical impressions. A few only criticised his teaching, particularly as a theoretical concept. The musculo-somatotonic type apart, Sheldon's (1940) research agrees with Kretschmer to a large degree. Later investigators, however, could not sufficiently support Sheldon's constitutional biology on empirical grounds. No further pre-morbid types were developed in the following years, if one discards the somewhat rare "stormy" character (Arieti, 1955). All attempts to discover differences between the pre-morbid development of personality and the subheadings of schizophrenia failed. Pre-morbid sexual development is not typical, but the disturbances of contact are in the foreground. Whether schizophrenics differ later in their intelligence is still undecided. But it appears certain that, even before the start of their illness, they achieve a lower social status than their siblings. There exists a large experimental psychologic literature on relationships between the original personality, symptoms and psychophysiologic correlates in which it is confirmed again and again that bad pre-morbid adaptation corresponds closely with the severity of symptoms and loss of achievement. There are no consonant result of investigations into the frequency of schizoid structures in schizophrenics, in psychiatric control groups and in the normal population. Psychometric techniques have been used only rarely, but existing publications confirm in principle that schizophrenics are markedly more schizoid than control groups. As with schizophrenia, there are contrasting ideas as to the cause and pathogenesis of the pre-morbid personality. Psycho- and socio-genetic, behavioral, genetic and neurochemical hypotheses have their adherents. According to recent studies of adoption the genetic factor appears to predominate. The clinician relies on pre-morbid development of the personality in his search for a "kink in the life line" or in his assessment of the quality of remissions. There is general agreement that a schizoid primary personality has an unfavorable influence on the long-term prognosis. This is still true today, in spite of modern possibilities of treatment and rehabilitation. Prophylactic aspects have been discussed for a long time but have remained unhelpful clinically. Often it may be difficult to distinguish between schizoids and mild hebephrenias. In spite of this the clinical concept "schizoid" should never be used for "mild schizophrenia"...