Kurt Schneider

Kurt Schneider (7 January 1887 – 27 October 1967) was a German psychiatrist known largely for his writing on the diagnosis and understanding of schizophrenia, as well as personality disorders then known as psychopathic personalities.

Biography
Schneider was born in Crailsheim, Kingdom of Württemberg, and trained in medicine in Berlin and Tübingen. He was drafted for and completed military service in World War I and later obtained a postgraduate qualification in psychiatry. In 1931 he became director of the German Psychiatric Research Institute in Munich, which was previously founded by Emil Kraepelin.

Disgusted by the developing tide of psychiatric eugenics championed by the Nazi Party, Schneider left the institute (when?) and served as an army doctor (for who?) during World War II. After the war, anti-Nazi academics were appointed to serve in, and rebuild Germany's medical institutions and Schneider was given the post of Dean of the Medical School at Heidelberg University. Schneider kept this post until his retirement in 1955.

Heidelberg School of Psychiatry
Schneider and Karl Jaspers founded the Heidelberg School of Psychiatry.

Contributions to psychiatry
Schneider was concerned with improving the method of diagnosis in psychiatry. He contributed to diagnostic procedures and the definition of disorders in the following areas of psychiatry:

Mood disorders
Schneider coined the terms endogenous depression, derived from Emil Kraepelin's use of the adjective to mean biological in origin, and reactive depression, more usually seen in outpatients, in 1920.

Psychosis
Like Karl Jaspers, he particularly championed diagnoses based on the form, rather than the content of a sign or symptom. For example, he argued that a delusion should not be diagnosed by the content of the belief, but by the way in which a belief is held.

He was also concerned with differentiating schizophrenia from other forms of psychosis, by listing the psychotic symptoms that are particularly characteristic of schizophrenia. These have become known as Schneiderian First-Rank Symptoms or simply, first-rank symptoms.

First-rank symptoms in schizophrenia

 * Auditory hallucinations
 * Hearing voices referring to himself / herself (3rd person auditory hallucination)
 * Voices heard commenting on one's actions (hallucination of running commentary)
 * Thought echo (a form of auditory hallucination in which the patient hears his/her thoughts spoken aloud)
 * Somatic hallucinations
 * Passivity experiences e.g. made volition, made feeling & made impulse (delusions of control / of being controlled)
 * Thought withdrawal
 * Thought insertion (thoughts are ascribed to other people who are intruding into the patient's mind)
 * Thought broadcasting (also called thought diffusion)
 * Delusional perception (linking a normal sensory perception to a bizarre conclusion, e.g. seeing an aeroplane means the patient is the president)

The reliability of using first-rank symptoms for the diagnosis of schizophrenia has since been questioned, although the terms might still be used descriptively by mental health professionals who do not use them as diagnostic aids.

A memory device that is frequently used to remember the first rank symptoms is ABCD: Auditory hallucinations, Broadcasting of thought, Controlled thought (delusions of control), Delusional perception.

Individuals with dissociative identity disorder may experience first-rank symptoms more commonly than even patients with schizophrenia though patients with DID lack the negative symptoms of schizophrenia and normally do not mistake hallucinations for reality.

Psychopathic personalities
Schneider also played a key role in developing concepts of psychopathy, used in a broad sense to mean personality disorder or particularly antisocial personality disorder. He published the influential 'The Psychopathic Personalities' in 1923. This was based in part on his earlier 1921 work 'The Personality and Fate of Registered Prostitutes' where he outlined 12 character types.

Schneider sought to put psychopathy diagnoses on a morally neutral and scientific footing. He defined abnormal personality as a statistical deviation from the norm, vaguely conceptualised. He thought very creative or intelligent people had abnormal personalities by definition, but defined the psychopathic personality as those who suffered from their abnormal personality or caused suffering to society because of it. He did not see these as mental illnesses as such - thus adding to a divide, contrary to Eugene Bleuler for example, between those considered psychotic and those considered psychopathic.

Schneider's unsystematic typology was based on his clinical views. He proposed 10 psychopathic personalities: those showing abnormal mood/activity; the insecure sensitive and insecure anankastic (drifting, feckless); fanatics; self-assertive; emotionally unstable; explosive; callous; weak-willed; asthenic.

Schneider's work in this respect is said to have influenced all future descriptive typologies, including the current classifications of personality disorders in the DSM-IV and ICD-10. Nevertheless, Schneider is considered to not exactly have succeeded in his attempted and claimed production of a value-free non-judgemental diagnostic system. In fact, Schneider's mixing of the medical and the moral has been described as the most noteworthy aspect of this work, which has been linked back to German reception of Cesare Lombroso's theory of the 'born criminal', redefined by Emil Kraepelin and others (see also Koch) in to psychiatric terms as a 'moral defect'. After World War I it lived on in Schneider's 'gemutolos' (compassionless) psychopaths, or what Karl Birnbaum called 'amoral' psychopaths. It has been described as remarkable that Schneider criticized Kraepelin and others for basing their personality diagnoses on moral judgements, yet appeared to do so himself. For example, Schneider admitted that the 'suffering of society' was a 'totally subjective' and 'teleological’ criterion for defining psychopathic personalities, but said that in 'scientific studies' this could be avoided by operating by the broader statistical category of abnormal personalities, which he believed were always congenital and therefore largely hereditary. The attempt to finesse the problem of value judgments has been described as 'clearly unsatisfactory'.