Sante de Sanctis, “On Some Varieties of Dementia Praecox,” in Clinical Studies in Childhood Psychoses: 25 Years in Collaborative Treatment and Research, The Langley Porter Children’s Service, edited by Stanislaus Zurek and Andrew Berlin (New York: Brunner/Mazel, 1973), 31-47. Originally published in 1906 as “Sopra alcune varieta della demenza precoce,” Revista Sperimentale de Freniatria 32 (1906):141-65.
Complete original source available here.
Sante de Sanctis was an Italian physician and founder of neuropsychiatry in his country. Like his Swiss contemporary, Eugen Bleuler, who coined the terms autism and schizophrenia, de Sanctis observed autistic-like disturbances in young children. Here, he described six cases of “dementia praecocissima,” or precocious insanity. He considered these cases important for two reasons: because they suggested that not all severe behavioral disorders in children were the result of mental defect and because their similarities to adult symptoms might be accurate early indicators of the onset of adult mental illness.
The first problem which has particularly interested me is the relation between dementia praecox and mental deficiency…. [R]ecently I had the occasion to observe another interesting fact, namely, that among the mentally deficient children one could find some with a type of mentality truly insane (that is with a dementia praecox mentality). I could not, however, state at that time whether in these cases one dealt with individual psychopathic varieties or with true dementia praecox, which given the age of the patient, I called dementia praecocissima…
[I]n a few months and in a restricted field of observation (that is, outside of a mental hospital), six cases have come to me, each of which I have studied closely over a long period. I am now convinced that in the prognosis of mentally deficient educable children, dementia praecox must be considered as a serious possibility…. The symptoms with which the dementia praecox announced itself in my six cases were, in order of frequency, the following: strangeness of character and capriciousness; apathy; depressed mood; scruples; negativism; hallucinations; and agitations. In only one of the six cases were there marked catatonia….
Typical Case—S.A. Age 17
…Periodically, she is very agitated, she breaks things and threatens to commit suicide, wants to run away, and does not stop smiling and grimacing. In periods of calm, she either laughs or cries, or keeps an obstinate silence, or expresses absurd ideas, or speaks words without sense, or assumes statuesque postures and grotesque affected poses. At certain times her negativism becomes extreme. For many days she refuses food, becomes mute, and even refuses to urinate, so that several times she was catheterized.
In the patient’s speech I noted frequent association of assonance, rhyme, foulness of speech, neologisms, echolalia, verbigerations, confusion of words without sense—symptoms that have their counterparts in her writings….
One must admit with much caution that in infancy and in childhood there are other causes of true intellectual deficit apart from those which determine mental deficiency….
I used to believe that all forms and varieties of dementia praecox were incurable. Now I believe that some children regarded as mentally deficient, who present clearly insane mentality, not only have improved but can be cured. This suggests that these are not cases of mental deficiency with insanity (psychosis), but true cases of dementia praecox, because, apart from symptomatology, it is more reasonable to believe in recovery from an attack of dementia praecox than to believe in recovery from mental deficiency…..
Typical case—D. Flavio, Aged 10 (observed in 1899)
….He began to walk at three years. He was delayed in the development of articulate speech. He began to pronounce words well only at five years….
His attention is prompt and of sufficient duration, except when he is occupied in play. Often be becomes fixated in contemplating objects and asks many questions in regard to them. Memory fair, musical memory is very good; his father says that “he has a good ear.” He can add and subtract numbers up to 1000…. He does not feel affection for anyone…. He doesn’t like to play games with other children, flees from company, and prefers to remain in idleness and make grimaces alone. His sense of imitation is much developed, he imitates the physiognomy and gestures of others…. His father adds that often in the house he repeats for many minutes the same word; and sometimes this repetition of the same word is accompanied by stereotyped head and hand movements (stereotypes with verbigerations)….
Has dementia praecox, in general, premonitory signs in the early years of life?
According to my experience I should reply: very often….