ABSTRACT
Kraepelin first defined dementia praecox-which we now call schizophrenia-in 1890. At that time neuropathologists were achieving remarkable success in relating abnormal behaviour to brain pathology. Alzheimer was observing the plaques and tangles that are found in the brains of many patients with dementia and published his results in 1907. These biological markers could then be used to define the type of dementia that now bears his name. It was therefore possible to distinguish between different syndromes that had already been defined on the basis of gross signs of intellectual decline (e.g. Alzheimer’s disease, general paresis of the insane) in terms of independent neuropathological signs. In Kraepelin’s time no such characteristic abnormalities had been observed in the brains of patients with dementia praecox or manic-depressive psychosis. Nevertheless, it was believed that brain abnormalities would soon be found. This has proved to be more difficult than expected. Neuropathologists searched diligently and abnormalities were frequently reported, but they were never replicated. Indeed, schizophrenia eventually became to be known as “the graveyard of neuropathology” (Plum, 1972). I have known neuropathologists to remark facetiously that it is easy to recognise the brains from schizophrenic patients because they are the ones which look normal.
