The Psychology of Dementia Praecox by Dr. Carl G. Jung— Summarized by Miguel A. Faria, MD

Published in its original German in Zurich, Switzerland, The Psychology of Dementia Praecox (1906) is strictly a psychiatric study with essentially no mythological underpinnings, as Jung’s more famous works later evolved in reference to the unconscious.

As he admitted, Jung frankly became bored with conventional psychiatry and looked for a wider perspective, diverging from the conventional views held by older colleagues and instead at first following the footsteps of his elder colleague, Dr. Sigmund Freud. In time, Jung’s views conflicted with Freud’s, and he developed his own psychoanalytic work finding underpinnings in both the unconscious psyche of the individual and the collective mind of humanity as reflected in mythology—namely, the celebrated Jungian psychoanalysis.

Introduction

Some terms need to be defined for the modern reader and general readership. Dementia praecox (“Precocious dementia”) is today recognized as schizophrenia. However, at the time of Jung’s writings, the two conditions were considered separate and not completely understood. In fact, in 1893, the German psychiatrist Emil Kraepelin had separated two types of psychoses with which the disorder had been confused—that is, dementia praecox and manic depression. Dementia praecox was renamed schizophrenia by Jung’s mentor, the Swiss psychiatrist Eugen Bleuler in 1908, only two years after Jung’s treatise was published. In Latin, the term meant “split mind or split personality.” It was not until the mid-20th century that true schizophrenia (a major psychosis) was further separated from split (or multiple) personality hysteria—the latter, subsequently categorized as either a conversion reaction or a dissociative, identity disorder.

Still believing that both conditions stemmed from repressed psychological (sexual) conflicts and ego-complexes, Freud recommended psychotherapy for both schizophrenia and psychoneurosis (hysteria), a treatment which was almost always unsuccessful and unfeasible in severely mentally ill patients. In contrast, Kraepelin preferred more aggressive intervention, including electroconvulsive therapy (ECT) that was often ineffective. Thus, psychosurgery came into vogue; fortunately, it was soon supplanted by psychotherapy, which proved to be safer and the most efficacious treatment in Schizophrenia, at least in 75% of patients. ECT can still be used in recalcitrant patients, and sometimes it is quite beneficial with modern refinements not previously available to Kraepelin.

The four fundamental signs of schizophrenia, originally described by Dr. Bleuler are the four “As” of schizophrenia:

1. looseness of associations, or disordered associations with a loss of contact with reality;
2. autism, a disordered conception of the world with a preference for fantasy rather than reality;
3. a disorder of affect, or an abnormal emotional state or mood;
4. ambivalence, a mixed feeling about a subject matter and contradictory attitudes that may be indirectly expressed. Schizophrenia is also characterized by cognitive impairments, delusions, and hallucinations that are most frequently auditory.

Neurotransmission and biochemical defects and impairments of neurotransmitters production, transport, reuptake, blockage, and degradation have provided the best theories for explaining the good to excellent response in schizophrenic patients to a variety of neuropharmacological agents. In addition, defects in working memory associated with disconnection of the hippocampal formation with the prefrontal cortex and in neurotransmission in the dorsolateral prefrontal cortex and frontotemporal disconnection have implicated both the frontal and temporal lobes in the neuropathology of schizophrenia.

But none of these biological, neural, and biochemical substrates were known to Dr. Jung at the time of his 1906 classic, The Psychology of Dementia Praecox. At the time, he was essentially working in the dark and only just beginning to follow the lead of Freud. Even the psychoneuroses were all classified as hysterias, and therefore were all mentioned in this treatise either as catatonia (actually a psychosis), somnambulism, or hysteria. The term “complex” was first used by Freud to denote a series of accentuated ideas in a repressed state affecting the mental health of the individual, but the term was also used by Jung, as in ego-complex, to refer to the part of the psyche that possesses consciousness, preserves identity, and deals with the conflicts of reality.

The Psychology of Dementia Praecox—A Summary

While schizophrenia is a psychosis as previously characterized, hysteria is a neurosis, characterized by mental (emotional) problems, including lack of control over acts and emotions, anxiety, and complex conversion and dissociative disorders. Hysteria is also frequently accompanied by physical complaints and symptomatology for which there is a lack of biological evidence. As a neurosis, hysteria can be alleviated by psychotherapy and is not as severe a mental illness as schizophrenia, a psychosis in which the ego complex is out of touch with reality and psychotherapy is usually of no use.

The Psychology of Dementia Praecox is a classic monograph, and despite its title, it is an excellent treatise on the mental processes and the psychology of normal people, who have developed mental conflicts in the course of their lives, and patients with neuroses (hysteria included), and to a lesser degree as in passing, some aspects of catatonia (or catalepsy), and somnambulism.

Jung came to believe at the time of his treatise and following Freud’s lead, that the traumatized ego of a normal person could lead to hysteria via repression of a forbidden secret or a hidden desire (usually sexual), thereby becoming a tenacious unconscious hysterical complex, which by psychological displacement could be substituted by a more acceptable social behavior, e.g., prudery and altruistic work in women, and intense professional activity in men.

Both Freud and Jung held that a more traumatizing ego event in a predisposed person could also result in catatonia and dementia praecox. It was a matter of degrees, even though Jung, at least, recognized that in dealing with hysteria and dementia praecox, he was dealing with two different disorders. In the case of the latter, the ego damage may have been so severe as to be irretrievable, perhaps because of a metabolic toxin had caused permanent damage to the psyche.

Additionally, there are two great and lasting contributions contained in this classic monograph. The first is Jung’s support for Freud’s summation of the psychological and mental processes taking place in normal people and neurotic patients when the ego-complex has sustained severe psychological trauma in earlier life, trauma that has become subconscious or has been repressed totally by ego-defense mechanisms because the person has difficulty coping with the reality of the traumatic incident. Thus, a new personality has emerged, a traumatized or overly sensitive normal person, or a frankly mentally ill person with a psychoneurosis, most notably in this case with a hysterical conversion reaction. The second contribution in the treatise is Jung’s magnificent analysis of the schizophrenic patient in the last chapter, which we will touch briefly on later.

In the Author’s Preface, Jung stated that this book is an eclectic work attempting to investigate and understand dementia praecox (DP), and he paid tribute to Sigmund Freud’s “ingenious conception” of the human mind.

Jung’s work may be seen as a “confession of faith rather than a scientific book” because he has not offered anything conclusive in terms of psychotherapy for DP. [p. iii]

In Chapter 1, “ Critical Presentation of Theoretical Views on the Psychology of Dementia Praecox,” Jung stated that although the literature on DP is extensive, “all the statements of older authors are of limited value.” [p. 1] One problem is that many conditions described in DP also occur in the normal person as well as in a variety of mental conditions like catatonia and hysteria, and this includes such symptomatology as “pathological whims,” “falsification of memory” (often seen in organic dementia’s such as Korsakov’s syndrome), disturbances of associations, perseverations, emotional apathy, delusions, suggestibility and automations, distractibility, lack of attention, “flight of ideas” (typical of manias), et cetera.

Lack of attention and diminished apperception, defined as the process by which “a psychic process is brought to clear perception” [p. 9] were postulated to cause shallow associations, poverty of emotional reactions, and disturbances of motor-speech coordination seen in DP. Incongruity between the formation of ideas (thought) and affect (emotional reaction and mood) is also marked in DP, but Jung insisted that incongruity and inappropriate affect—noting that the “la belle indifférence,” in which the hysterical patient shows a lack of concern despite experiencing significant physical symptoms during conversion reactions—were also seen in hysteria. Moreover, disorders of ideation and affect in DP resulted sometimes in “a stream of thought resembling flight of ideas.” [p. 17]

“The disintegration of ideas in DP is so marked that they cannot be compared to reveries of the normal state, but rather to dreams.” [p. 11] Freud, Kraepelin, and Jung “were struck by the resemblance between dreams and DP.” In fact, in dreams researchers have noted the blending of situations, pictures, elements of speech, symbolism (false perceptions), and dissociations, the splitting of one or more of ideas from the ego and developing their own independence of existence. [p. 23]

Dissociations and incongruity between the content of consciousness (ideation) and emotional tone (affect) are repressed complexes found not only in hysteria but also in normal persons. [p, 29] But Freud included paranoid DP patients as well, asserting that their paranoid symptoms appeared “in consequence of their disagreeable feeling tone,” which also precipitated the behavior, the nature of their delusions, and hallucinations. For Freud, the same mechanism uncovered for a bad experience, repression, and conversion was at play in hysteria (neuroses) and DP. [p. 30, 32] Jung qualified the statement by admitting that the manifestations of hysteria are different and not as pronounced as in DP. [p. 31]

In summarizing the first chapter, Jung noted that culling from various researchers, DP pointed to a central disturbance, described by various names but that likely resulted from an unknown factor, perhaps a toxin, the ego complex was irretrievably injured and became fixated in the psychic functions of the individual.

In Chapter II, “The Emotional Complex and Its General Action on the Psyche,” Jung postulated that “the essential basis of our personality is affectivity,” as proposed by Bleuler. [p. 33] The affect (emotions, mood) directs the attention of the individual, and it is the affectivity of the person that propels him to thought, associations, and actions. As to the personality, “the ego complex in the normal person is the highest psychic force.” [p. 35]

The ego complex, though, can be affected by intruding acute emotional complexes that may become chronic, either because it continues to affect the ego for a long period of time after a single affect, or because the affect is always in a continuous state of irritation. [p. 37] “There are impressions that last a lifetime.” [p. 38] A person can become dominated by a complex so that he is unable to react appropriately to stimuli of daily life because the uncontrolled influences of the complex affect and disturb his daily life. His frame of mind and self-control “suffer in proportion to the strength of the complex.” Moreover, “the purposefulness of his actions is more and more replaced by unintentional lapses, errors, and unaccountabilities for which he can give no reason.” [p. 40]

Love is an obsessional complex, but the unattained love object may be displaced to satisfy the ego complex. In the case of women suffering from unreciprocated or hopeless love, a strong complex sensitiveness may occur, which may be manifested in prudery or altruistic concerns, such as nursing and other charitable work. In men, the love object may be displaced to professional activities, men’s clubs, et cetera. [p. 43-45] In both talented men and women, it may be sublimated into artistic or creative works.

Chronic emotional complexes may become stabilized, submerged in the unconscious, sublimated by the ego, at least superficially, but then “a single word, a gesture, striking his wound, shows the complex lurking from within the psyche” of a normal or hysterical individual, and surfacing, it may result in an emotional outburst, which is much worse and exaggerated in DP. [p. 45]

“The Influence of the Emotional Complex on Association” is expounded in Chapter III. “A strong complex, such as a tormenting grief, hinders concentration; we are unable to tear ourselves away from the grief and direct our activity and interest into other channels.” [p. 47] The conscious activity of the ego complex prevents the emotional complex from becoming manifest, as well as impedes recognition and awareness of our thought complexes. [p. 49] Dreams are symbolic expressions of repressed thoughts, situations therein hide under similarities of impressions and symbols which, we must remember, are actually false representations of repressed complexes. [p. 51]

Simultaneous existing complexes influence or reinforce each other, especially if they are related, so that they may become “fused,” having activity of content in each other. These complexes influence the conscious activity of thought, even automatically, outside ego control (automation). Freud referred to this strong influence of thought by autonomous, psychic, debilitating complexes, which are not under the direct control of the ego complex, as overdetermination. [p. 56]

In psychoneuroses, particularly hysteria, insignificant things may lead to strong emotional outbursts because affective (emotional) events stimulate and reinforce existing emotional complexes. Such impressions lead to sudden, strong outbursts because they pique directly or indirectly (symbolically) the repressed complexes. Jung referred to these episodes as complex-storms. Jung agreed with Freud at this stage, that “most complexes are of an erotic-sexual nature, as are also most dreams and hysterias…and may call forth hysterical symptoms to those predisposed.” [p. 60]

Jung offers advice for normal psychological development even as the ego is under assault by emotional trauma and serious disappointments:

 It is to the interest of the normal individual to free himself from any obsessive complex which impedes the proper development (adaptation to environment) of his personality [Jung’s italics]. Time generally takes care of this disburdening. Frequently however artificial aid must be invoked so as to help the individual rid himself of an obsessional complex [such as] displacement… But strong complex-sensitiveness has a marked tendency to recrudescence.[p. 61]

But as Jung noted in his footnote, “ hysteria makes use of all sorts of detailed measures in order to protect itself against the complex, such as conversion into bodily symptoms, dissociations (splitting) of consciousness, et cetera.” We referred to them as conversion reactions and multiple personality disorders. For Freud and Jung when the complex persisted because the ego was seriously damaged, as postulated by an unknown toxic, perhaps metabolic poisoning, DP (schizophrenia) was the result. [p. 61-62] Jung could only hope that in the future, better science could demonstrate the culprit responsible for the degeneration of personality as seen with DP and the psychoses.

In Chapter IV, “Dementia Praecox and Hysteria,” Jung continued to elaborate on the psychological resemblances between hysteria and DP. He pointed out the similarities in the abnormal affect of hysterical as well as DP patients, so that explosive emotional outbursts and difficulty establishing rapport may occur in both. Nevertheless, in normal people and hysterics, the analyst can penetrate into the ego complex, identify obsessional complexes, and the patient may feel better and calmer after a therapeutic session, but not so with the DP afflicted, who remains the same with no improvement. [p. 65-67]

Similarities also exist with “characterological abnormalities,” but in hysteria no new character (personality) is created; the neurosis only exaggerates the already existing characteristics of the personality. DP creates a new pathological character out of touch with reality. “What really characterizes hysteria [and many other neuroses we may add] is the existence of powerful complexes, which are incompatible with the ego complex.” [p. 67] The peculiarities of hysterical patients, such as embellishment, pretension manifested in exaggerated manners (such as aristocratic manners, bombastic behavior, intellectual airs, et cetera) are also seen in DP with the added ingredients of delusions of grandeur and hallucinations, as in this disease, the affliction takes over the mechanisms of normality of the ego complex resulting in disorders of association and overt psychosis. Schizophrenics (and DP) also develop neologism with “word-salad” speech and characteristic (bizarre) writing style. [p. 67-69]

Intellectual disturbance is another feature where hysteria resembles DP, as for example, diminished clearness of ideas and associations occurs in both. Likewise, lucidity of consciousness fluctuates in both hysteria and DP, but in the latter, there is marked confusion, there are fixed delusions and hallucinations (frequently auditory), and suppression of intellectual faculties becomes an important factor, perhaps because of a lack of attention and too much distractibility. Hypnosis works in some hysterics because it suppresses the emotional complexes and permits the ego complex to emerge, but not so in psychoses. [p. 72] On the other hand, both hysteria and DP develop a negativism in the form of obstruction to the analyst’s questions, distraction, deflecting answers to banal incidents, evasions and outright refusal to answer questions because the patient’s wish to repress the complex. [p. 80-81]

Delusions, hallucinations, “pathological whims,” obsessive ideas—all “deal with psychological mechanisms universally formed, which are set free by the most variable injuries.” [p. 74] Most obsessive ideas represent sexual complexes that have been repressed. Jung went on to describe a woman patient, who had previously had a child out of wedlock and had concealed this from her family. She developed a severe complex from being constantly worried (severe anxiety) that the man who she wanted to marry would find out about her past. She developed a hysterical complex precipitated by the need for a hospitalization for teeth extraction, that rapidly advanced to catatonia requiring commitment to a mental institution. [p. 74-75]

A normal dream is a hallucinatory complex-delirium, many dreams express the need for wish-fulfilment. But the psychopathology of DP also sets in motion a mechanism which normally functions in dreams. [p. 82] Jung made an intriguing and elegant comparison for the state of dreaming and DP in actuality:

 In dreams we see how reality is spun with fanciful creations, how the pale memory pictures of the waking state assume tangible forms, and how the impression of the environment adapt themselves to the sense of the dream. The dreamer finds himself in a new and different world which he has projected out of himself. Let the dreamer walk about and act like one awakened and we have the clinical picture of dementia praecox. [p. 78-79]

In hysteria the ego-complex is suppressed by the morbid repressed complex. In DP the morbid-complex may be so entrenched and severe with delusions and abnormal associations and out of touch with reality that the ego-complex seems to have been totally obliterated. But as Jung pointed out, “That the normal ego-complex does not entirely perish, but is prevented from reproduction by the morbid complex, seems to me to be shown by the fact that during severe physical diseases or any other deep-going changes, the patient suddenly begins to react in a tolerably normal manner.” Jung then described such a DP patient who upon developing a serious attack of gastroenteritis developed a clearness of personality and a nice rapport with the doctor, but upon recovery lapsed into his own “scurrilous manner and inaccessibility.” [p. 82]

Next Jung discussed the similarities between hysteria and DP as far as “Stereotypy, the persistent and constant reproduction of certain activities,” which is based on the observation that personality rests on automatization. [p. 83] Complexes have a tendency toward autonomy and independent action from the ego, and this is expressed in the form of perseveration of thought and behavior. With strong complexes, the personality may be suspended and its efforts spent in covering up the repressed complex by symbolic action. [p. 84]

Fixation of the complex leads to monotony of symptomatology and the issuing of “tiring complaints” typical of some hysterics. Stereotypy in DP may be expressed more severely by the uttering of a string of words and accidental phrases or making new words (neologisms) and repeating them constantly. [p. 85] Jung summarizes the chapter with, “Hysteria contains in its innermost nature a complex which could never be totally overcome.” Likewise in DP obsessive complexes became tenaciously fixed. [p. 88-89] And yet, while in hysteria a predisposition to the condition is presupposed and there is a clear relation between the complex and the disease, he admitted that this was “not clear in DP.” He continued to argue in support of Freud’s hypothesis that while hysteria and DP were two different diseases, the same psychological mechanism and affectional components were responsible for both. Again, Jung postulated that a toxic mechanism (biochemical) component was responsible for the more severe damage in DP. Today, as discussed in the Introduction, we know a lot more about the neural and biochemical abnormalities in schizophrenia that are not present in the neuroses and hysteria.

In Chapter V, Jung performs a systematic “Analysis of a Case of Paranoid Dementia as a Paradigm” for mental illness. The patient was a middle-aged seamstress with multiple delusional and obsessional complexes and institutionalized for paranoid dementia (paranoid schizophrenia). She was studied not only for analysis of her ideation and behavior but also for the use and timing of repetition of simple word and their association with other words in her speech. Suffice to say that she possessed typical delusions of grandeur, used neologisms, “words-salad,” pretentious speech, and “power-words” (stereotyped sentences with strong hidden content). And yet she had no insight into her mental illness, although she had no evidence of “imbecility” (mental retardation). She lacked emotions with a “displaced affect.” [p. 91-94]

Typically, she was also afflicted with a “persecutory-complex” and a more hidden “erotic-complex.” Jung noted that the patient was “a very sensitive person, possessing an exaggerated self-consciousness that will generally meet with many obstacles in life.” [p. 102]

As with the dreams of a normal person, the patient expressed sentiments of wish-fulfilment in both dreams and the waking state, at the same time that she also possessed seemingly contradictive thoughts of “self-admiration” and “self-glorification.” [p. 103,115] In short:

Her thoughts and desires express a striving to come out of this milieu and to attain a better social standing; it is therefore no wonder that her wish for money, et cetera, is specially accentuated. All strong wishes furnish themes for dreams, in which they are represented as fulfilled, not in concepts of reality, but in dreamlike obscure metaphors…The inhibiting ability of the ego-complex having been destroyed by the disease, the complex appears in the waking state and automatically spins its dreams on the surface in the same manner as it used to do under normal conditions, but then only in the dim depths of the uninhibited unconscious. [Jung’s italics; p. 115-116]

As for the sexual complex, which has also been established by her “words-salad” that contained delusions of grandeur, persecutory, religious, and sexual content, Jung affirmed, “Such a sublimation of the very worldly matrimonial desire has been a loving toy of woman’s dreams since the oldest Christian epochs. From the Christian interpretation of the Song of Songs to the secret rapture of St. Catherine of Siena…” [p. 125]

In summation, the patient presented a picture of a psychosis centered on “dream-thoughts,” also characterized by a speech with a senseless, stream of thought, incomprehensible, “with extensively elaborated fancies.” It was as if she was in a dream with monstrous and distorted metaphors, which are characteristic of the absurdities of dreams. [p. 135-136] The patient, according to Jung, had sustained a severe psychic injury in which dreams have permanently replaced the normal waking state with no adaptation to reality. Her dream state was a hallucinatory representation of repressed complexes. [p. 139]

It must be recalled that in conclusion, Jung asserted he “had not offered anything conclusive,” but only a personal study in the pursuit of attempting to understand dementia praecox. Moreover, to Jung, the last case presented seemed to confirm his ideas as presented in the preceding chapters, as well as to serve as a paradigm for the study of paranoid dementia.

Unbeknownst to him, perhaps, his book added a significant contribution to the study of the entire spectrum of psychological disorders that can afflict the normal person, as well as those suffering from hysteria, some neuroses, and some psychoses, including the gamut of schizophrenic disorders, which despite our advances in neurochemistry have yet to be completely understood. This is a classic monograph adding to the edifice of knowledge in the psychiatric literature.

Summarized by Dr. Miguel Faria

Miguel A. Faria, M.D., is Associate Editor in Chief in neuropsychiatry; history of medicine; and socioeconomics, politics, and world affairs of Surgical Neurology International (SNI). He is the author of numerous books, including Controversies in Medicine and Neuroscience: Through the Prism of History, Neurobiology, and Bioethics (2023). His most recent book is The Roman Republic, History, Myths, Politics, and Novelistic Historiography (2025) published by Cambridge Scholars Publishing, Newcastle upon Tyne, U.K.

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