Schizophrenia: 4 a’s and ABCD
The term Schizophrenia , as many of the readers will recall, was coined by Eugen Bleuler, a Swiss psychiatrist , who intended the ‘split personality’ to reflect the fact that there was an underlying dissociation between various functions like memory, cognition, emotion that are normally integrated in normal people.
He also gave the famous 4 a’s that he presumed lied at the core of the schizophrenia and were fundamental aspects of the disorder.
‘affect’: Inappropriate or flattened affect-emotions in-congruent to circumstances/situation.
‘autism’: social withdrawal- preferring to live in a fantasy world rather than interact with social world appropriately.
‘ambivalence’ : holding of conflicting attitudes and emotions towards others and self; lack of motivation and depersonalization.
‘associations’ : loosening of thought associations leading to word salad/ flight of ideas/ thought disorder.
Bleuler maintained that these distinctive and fundamental features identified and formed the core of Schizophrenia while the manifest symptoms like hallucinations and delusions (first rank symptoms as per Schneider) were peripheral and not that important).
The readers of this blog will also be familiar with the ABCD model of psychology where Affect, Behavior (social aspects), Cognition and Desire (motivation/ dynamics) are the four fundamental domains; it is easy to see how the four a’s of Bleuler map to the 4 domains of psychology and it seems that schizophrenics have major troubles in each domain:
affect: this directly maps to Affect dimension and inappropriate affect is a major core part of the syndrome.
autism: though named somewhat incorrectly the intent of autism was to catch the behavioral and social impediments of the schizophrenics.
ambivalence: here there are conflicts and ambiguities regarding what one desires; for self and for others; lack of motivation/conflicted motivation is significant at this dimension.
associations: here the cognitive underpinnings are all too evident- the thought disorganization and flight of ideas is all too cognitive in nature.
It is amazing how the insights of Bleuler from a century before lend themselves so easily to fit the ABCD framework. What do you think, a bit stretched? or have I started making loose associations myself ?
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