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511-
as
related
activity
GEORGE WINDHOLZ*
Mental disorders were studied intensely by I. P. Pavlov during the last six years
of his life. He was greatly interested in the nature of, and therapy for, schizophrenia,
and saw at least 45 cases diagnosed as schizophrenic at the Psychiatric Clinic
located at the Balinskii Hospital in Leningrad. Pavlov did not perform experiments
in the Clinic, but observed schizophrenic behaviour in collaboration with
psychiatrists. He explained the behaviour of schizophrenics in terms of his theory
of higher nervous activity: that is, he focused on the function of the brain of
higher animals in their interaction with the external environment. He thought
that schizophrenia was the response of a weak genotype to traumatic
environmental events. The cortex of schizophrenics, with the exception of
catatonia, was overwhelmed by neural excitation which resulted in irrational or
non-adaptive activity. Pavlov proposed that therapy of schizophrenia should
consist of rest and prolonged sleep induced by soporific substances. His theory of
schizophrenia did not become widely known and may be considered to be mainly
of historical interest.
In
512
Pavlov wanted to explain the entire gamut of neuroses and psychoses, but
schizophrenia interested him most. From the perspective of the theory of
higher nervous activity, schizophrenia was a radical dysfunction of the higher
organisms adaptation to the external environment. However, it was found
that schizophrenia was potentially curable and therefore of interest to Pavlov.
In the last six years of his life, he did his best to understand schizophrenia
and to find therapy for it.
His conceptualization of schizophrenia will be presented with a brief
historical introduction and five subsequent parts. The first part describes his
laboratory and clinical methods in his study of schizophrenia; the second part
presents the most important aspects of his theory of higher nervous activity;
the third part describes his understanding of the nature and etiology of
schizophrenia; the fourth part describes its therapy, and finally, in the last
part, Pavlovs work is evaluated.
Pavlovs
513
that schizophrenia was the extreme weakness of the cortex. Then, during
the 20 November 1929 Wednesday Seminar, he made an important
announcement: he was observing two catatonic patients at the Balinskii
Hospital.7 If, up to now, Pavlov had observed psychotic patients only
occasionally, from that time on until his death in 1936 he participated with
psychiatrists in a more systematic study of psychoses in bi-weekly sessions.
These sessions, known as Clinical Wednesdays, were held at the Psychiatric
Clinic located on the premises of the Balinskii Hospital in Leningrad.
514
P. A. Ostankov. Pavlov
asked questions. Here is
thought of himself
one
instance of such
as a
an
deception.
Pavlov. But this is,
so to
say, the
content
of
paraphrenia?
Narbutovich. In the beginning, the delusion of
l
delusion of grandeur. 11
persecution
completely.2
Pavlov believed that the integration of knowledge from laboratory
experiments and from the clinical interviews would lead to a better
understanding of psychoses. Because he was first and foremost an
experimenter, it may have been expected that he would have performed
controlled experiments with schizophrenics as subjects, but he did not. When
during the 20 September 1933 Clinical Wednesday, Ivanov-Smolenskii
queried Pavlov as to whether the study of humans should be made only
through observation rather than experimentation, Pavlov replied that
conditioning experiments on dogs disclosed elemental laws that could be
generalized to human beings. This did not mean, however, that the nervous
system of dogs and humans are alike. After all, humans have language. The
method of conditioning is in itself insufficient to determine the characteristic
aspects of a specific disorder unless intricate experimental conditions are
used. Pavlov concluded that he did not have sufficient knowledge of such
experimental conditions.3
He continuously modified
his
515
material was presented at the Psychiatric Clinic and the ongoing research in
Pavlovs laboratory changed his conceptualization of psychiatric disorders.
He was thoroughly devoted to science and pursued knowledge with tenacity
and enthusiasm. His numerous disciples portray him as emotional and
compassionate.14 For instance, he was painfully affected by the fate of a 23year-old highly intelligent schizophrenic woman, a daughter of a physician
whom he knew personally. He saw her on the 12 December 1934 Clinical
Wednesday and after she had left told the participants that he would tell her
father that her condition was not hopeless. Then he, the scholar that he was,
proceeded in a dispassionate way to inquire into the cause of her condition. 15
To follow Pavlovs understanding of schizophrenia it is, however, necessary
to become acquainted with his theory of the higher nervous activity.
A brief description of Pavlovs
cortex.
516
more
adaptive, ones
The major difference between humans and other higher animals was that
the former were able to develop the second signal system, or language.
Whereas unconditioned reflexes allow adaptation through a direct contact
between the higher organisms receptors and the environment, and the
conditioned reflexes permitted adaptation by reaction to objects at a
distance, the second signal system allowed humans to react to words.&dquo; The
second signal system permitted the group to form a culture, and it permitted
some people to form an idiosyncratic delusion.
In the first decade of exploring the conditioned reflexes, Pavlov and his
disciples became aware of individual differences in the behaviour of dogs.
For example, some dogs were brave. They did not fear the experimenter.
Others were cowardly towards the experimenter. Pavlov noticed that the
brave dogs were easier to condition than the cowardly ones. Subsequently,
Pavlov determined that such individual differences were, to a large extent,
innately determined. In 1935, Pavlov proposed that three parameters
delineate the genotypes central nervous system with respect to its response
to the external environment: first, the strength of the excitation and
inhibition of neural processes; second, the balance between excitation and
inhibition; and last, the mobility or reactivity of the nervous system. The
permutation of these three variables gave a large number of genotypes.
Pavlov paid attention to four, but we shall consider only two: the ideal
strong type which has efficiently balanced nervous excitation and inhibition,
meaning that neither one nor the other neural process predominated over the
other, and the weak type which responded poorly to environmental stimuli.
The rapid reactivity of excitation and inhibition made it possible for the
strong type to deal with sudden and powerful environmental stimuli. In
short, a strong type could adapt even to very damaging environmental
conditions. In contrast, the weak type could not handle daily life situations
and, therefore, was prone to the development of neuroses or psychoses.
Under certain taxing conditions, the weak type succumbed to
schizophrenia.19
Schizophrenic cases observed by Pavlov
The stenographic record of the Clinical Wednesdays shows that from
December 1931 to February 1936, Pavlov observed at least 24 male and 211
female cases diagnosed as schizophrenic at the Psychiatric Clinic at the
Balinskii Hospital. The patients ranged in age from 18 to 60, with the modal
ages between 30 and 40. The psychiatric diagnoses were based upon
Kraepelins nosology of Dementia praecox. Although the participating
517
physicians
were not
identified 19 as
paranoid and the
we
to
be
518
at least to a considerable extent, have to be attributed to the clinical
illness Dementia praecox... It is possible that these [changes] were based on
inheritance, it may be that there are endogenous instances - this, of
course, a histologist cannot easily determine... The affected areas are
related to the higher verbal functions, to motor movement, etc... True, it
is necessary to be very careful, taking into consideration the existing
disputes in regard to the localization of higher functions.24
In
the
And three months before his death, during the 27 November 1935 Clinical
Wednesday Pavlov ruminated on the impact of taxing life events on the
development of schizophrenia:
For the last
two
years I often
saw
sick
people,
and I asked
myself many
519
times this question: what would have happened if all these schizophrenics,
of whom there are so many, just imagine this, if those schizophrenics
would be, at the first sign of illness, put in a greenhouse to keep them
away from the blows of life, of all the difficulties that life creates, well,
would they then become real schizophrenics? The more I see, and the
more I think about it, I come to the conclusion, that it is possible that
they would not become ill, but remain healthy.... This is my impression
after I merged the knowledge from the laboratory with the psychiatric and
neurologic material. 28
a general view of the etiology of
of explaining the different subtypes.
problem
schizophrenia,
Catatonia
520
after
catatonic who was in such condition 20 years and then became normal,
and were it not for starvation, he still would be among us.33
The view that catatonia consists of hypnotic mechanisms that protect the
brain from destruction was contained in Pavlovs major attempt to
summarize his theory in 1934. The catatonic process was inhibitory and,
therefore, protective of neural cells that the excitatory process was about to
damage. Therefore, Pavlov advised against treating catatonics so as not to
disturb the ongoing therapeutic process.34
Hebephrenia
In 1930, Pavlov compared the bizarre symptoms of hebephrenia to behaviour
resulting from the initial stages of intoxication or to children or whelps
shortly before falling asleep. The reason for the capricious or chaotic
behaviour is the progressive spread of inhibition in the cortex. Under normal
conditions the vigilant cortex controls the activity of sub-cortical regions,
regulating the persons behaviour into socially appropriate channels. But in
hebephrenia the spreading inhibition affected only certain cortical regions,
resulting in the mixture of the rational and irrational or in temporary
outbursts of anger. 31
During the 13 March 1935 Clinical Wednesday, psychiatrist G. V. Zenevich
described to Pavlov the behaviour of a 23-year-old female hebephrenic
patient. She sang, gesticulated, and took odd poses. Pavlov responded that in
hebephrenia the excitation was prominent in the motor areas of the brain
that were under the influence of emotions. 31
Paraphrenia
Pavlov had considerable difficulty in understanding and explaining paraphrenia.
As we have seen, at the 11January 1933 Clinical Wednesday Pavlov asked the
attending psychiatrists what paraphrenia was and Narbutovich replied: In
the beginning the delusion of persecution, and then the delusion of grandeur. 31
Another problem facing Pavlov was to determine the relation of paraphrenia
to schizophrenia and to paranoia. During the 12 December 1934 Clinical
Wednesday, Ivanov-Smolenskii told Pavlov that Kraepelins nosology considered
paraphrenia a disease unrelated to schizophrenia, whereas Bleuler placed it
among the subtypes of schizophrenia. Paraphrenia differed from paranoia in
that with the former there was a poorly systematized delusion and progressive
imbecility.38
Paranoid schizophrenia
During the
Wednesday Pavlov
was
shown
521
stranger.39
During the 13 March 1935 Clinical Wednesday, psychiatrist P. Ia.
Iapontsev described the case of a 37-year-old woman who was diagnosed as
paranoid schizophrenic. She was 25 years old when she married but refused
to have sexual relations with her husband, claiming that such acts were
disgusting. At the same time she was very jealous when her husband was
friendly with other women. She was under the delusion of being poisoned.
Pavlov responded that this was a case of genuine schizophrenia as the history
of her disease showed that her condition was slowly deteriorating. That
deterioration began with parasthesia, then spread to sexual feeling and finally
encompassed other sensory areas, such as the auditory, gustatory, olfactory,
tactile, etc. After a long interview with the patient Pavlov suggested that, as
the result of a sexual deficiency, she experienced parasthesia which in turn
led to delusions of persecution. Originally, the sensory, peripheral receptors
worked normally but the nerve impulses were processed defectively on the
cortical level. The result was delusion. As the cortical processing of the nerve
impulses was distorted, so was the gustatory experience suggesting poisoning
that, in turn, led to the delusion of persecution. This delusion of persecution
led to the attempt to understand who were the enemies and why one was
persecuted, and so on. At the end Pavlov suggested that the cause of her
schizophrenic condition was endocrine, mainly a deficiency in sexual
hormones. To which one of the participants, D. S. Svetlov, responded that in
the past there were unsuccessful attempts to cure schizophrenia by surgery
on the sexual glands. Pavlov replied that the possibility existed that the
transfer of healthy sexual glands to an ill person usually ended with the
atrophy of the healthy glands. Svetlov pointed out that organ therapies had
no effect on schizophrenia. Pavlov replied that the reason for such failures
was the inability of the transplanted organs to function normally.4o
522
Cloettal.43
Meanwhile in the 6 March 1935 Wednesday Seminar44 and in the 13 March
1935 Clinical Wednesday,45 Pavlov said that he had received a letter from
the Moscow psychiatrist M. Ia. Sereiskii describing his sleep therapy with
schizophrenics. Sereiskii shared Pavlovs view that through prolonged sleep
the nervous system of a schizophrenic patient rests and recovers. Sereiskii
induced a 10-day-long sleep in a hallucinatory-paranoid male by
administering Cloetta Mixture. Here is Pavlovs description of Sereiskiis
therapy on the Wednesday Seminar:
He [the patient] was subjected to soporific therapy according to the
initiative of the Swiss scholar Maier, a psychiatrist, Bleulers heir, and the
Swiss pharmacologist Cloetta. Cloetta combined experimentally a mixture
of soporific substances. But he did not limit himself to soporific substances
because he wanted simultaneously to strengthen other organs of the body,
such as the heart and kidneys. The mixture was administered to the patient
on 23 December [1934]. The effect occurred in one hour. It [Cloetta
Mixture] was introduced rectally in 4 to 6 hour intervals. Sleeps ensued
within an hour and the patient slept a few hours. During the next two days
his condition was periodically soporific or awake. From the 3rd day on, for
five days, he slept without interruption. In the last three days, sleep became
intermittent, interrupted by motoric excitement.46
523
In March 1935, Pavlov received another letter from Sereiskii. The letter
informed him about the progress of the patients recovery. He was somewhat
sceptical of the patients progress because of earlier reports by Maier and
Cloetta which were not so optimistic. Nevertheless, he advised the local
psychiatrists to use this method. It was also necessary, he warned, to prevent
the patient from coming in contact with taxing situations. To emphasize the
need of rest, Pavlov revealed that a 23-year-old schizophrenic woman who was
given a furlough from the Balinskii Hospital for six days had failed to return for
over a month. Staying at home to write a review of a book on physical
chemistry, she had a relapse as a consequence of this difficult intellectual
endeavour. She returned to the hospital in a catatonic state that was followed
by hebephrenia. Ivanov-Smolenskii assured Pavlov that as soon as they could
obtain the Cloetta Mixture, they would administer it to the woman.&dquo;
On 9 October 1935, during the Clinical Wednesday, Pavlov stated that he
had received a letter from Sereiskii saying that the patient previously given
sleep therapy in January was healthy and held a job. Sereiskii also wrote that
three additional cases given the same therapy had recovered. Pavlov then said
that he expected a more thorough description of the recovered patients, to
which Ivanov-Smolenskii responded that he had received information about
Sereiskiis treatment from a third person. It was reported that 12-13 people
in Sereiskiis hospital were treated by the sleep therapy and of them 3
recovered and 3 died, one of nose bleed and the other two of pneumonia.
Ivanov-Smolenskii also informed Pavlov that the hospital received the
Cloetta Mixture. Pavlov suggested that the therapy should be used but with
care because of fatalities. A therapist should continuously observe the
patients condition to apply, if necessary, proper counter-measures to any
life-threatening signs. A cure should be attempted with the 23-year-old
schizophrenic woman, as her father requested the therapy.48
At the 12 February 1936 Clinical Wednesday, Pavlov inquired about the
schizophrenic patients who went through the sleep therapy.49 At the 19
February 1936 Clinical Wednesday, he heard a report concerning the condition
of five schizophrenics who received sleep therapy in January and were living at
home but visited by their psychiatrists. The report indicated that the mental
state of most patients had improved in the aftermath of the therapy.5 About
their subsequent mental state Pavlov never heard; he died a week later.
Kraepelin
wrote
that the
cause
of Dementia praecox
was
wrapped in
524
impenetrable darkness.51
psychoanalysis. 12
Pavlov did not, however, ignore the views and findings derived from the
various specific theories of schizophrenia. In the 1920s there was much
interest in schizophrenia, which can be seen from the impressive 1930 review
articles on contemporary schizophrenia research by Gottfried Ewald and
James V. May.53 There is little doubt that Pavlov was familiar with the state
of contemporary research on schizophrenia; that can be seen from his
statement that he had read Devines address.54 Furthermore, some of the
psychiatrists who attended the Clinical Wednesday, such as Ivanov-Smolenskii
and Narbutovich, were following the newest developments of research on
schizophrenia. Hence, Pavlov, like Devine, incorporated the existing research
findings into his theory. This can be best seen from his insistence that
prolonged sleep therapy would cure schizophrenia.
To begin with, Pavlov derived the proposal to treat schizophrenia by
prolonged sleep from his theory of higher nervous activity. According to the
theory, in schizophrenia neural excitation overwhelms the weak genotypes
cortical cells. It follows that a reverse process, namely, an induced inhibition
of the high levels of excitation, would restore the brain to its normal
function. Moreover, prolonged sleep therapy was one of the several
approaches used by contemporary psychiatrists in the treatment of
schizophrenia.55 Manfred Bleuler stated that in the 1920s sleep was induced
in schizophrenics at the Burgholzli with scopolamine morphine, a derivative
of barbituric acid, and sodium phenobarbital. 56 Pavlov was aware that the
Cloetta Mixture was administered by Maier at Burgholzli. The use of Cloetta
Mixture in clinics supported, on the one hand, his theory of schizophrenia
and, on the other hand, may have brought about some release from the
schizophrenic condition.
Over five decades has passed since Pavlov attempted to understand the
nature of schizophrenia and formulate an effective therapy for it. Time has
not been kind to his theory of schizophrenia; it did not become widely known
and therefore was not subjected to extensive experimental tests. Possibly this
omission was the consequence of Pavlovs failure to describe his theory of
525
11.
12.
SSSR, 1951).
Bykov (1954), 454.
K. M. Bykov (ed.), Pavlovskie Klinicheskie Sredy: Stenogrammy Zasedanu υ Nervnoi i
Psikhiatricheskoi Klinikakh (Moscow, Leningrad: Izdatelstvo Akademii Nauk SSSR, 1955),
520.
13.
14.
15.
16.
17.
18.
19.
20.
Bykov (1954).
George Windholz, Pavlov and the Pavlovians in the laboratory, Journal of the History of the
Behavioral Sciences, xxvi (1990), 64-74.
Bykov (1955).
I. P. Pavlov, Kratkii ocherk vysshei nervnoi deiatelnosti, in I. P. Pavlov, Polnoe Sobranie
Sochinenii. Vol. 3. Part 2. 2nd enlarged edn (Moscow, Leningrad: Izdatelstvo Akademii Nauk
SSSR, 1951).
I. P. Pavlov, "Uslovny refleks, in I. P. Pavlov, Polnoe Sobranie Sochinenii. Vol. 3. Part 2. 2nd
enlarged ed. (Moscow, Leningrad: Izdatelstvo Akademii Nauk SSSR, 1951).
I. P. Pavlov, Fiziologiia vysshei nervnoi deiatelnosti, in I. P. Pavlov, Polnoe Sobranie
Sochinenii. Vol. 3. Part 2. 2nd enlarged edn (Moscow, Leningrad: Izdatelstvo Akademii Nauk
SSSR, 1951).
I. P. Pavlov, Obshchie tipy vysshei nervnoi deiatelnosti zhivotnykh i cheloveka, in I. P.
Pavlov, Polnoe Sobranie Sochinenii. Vol. 3. Part 2. 2nd enlarged edn (Moscow, Leningrad:
Izdatelstvo Akademii Nauk SSSR, 1951e).
Bykov (1954); Bykov (1955); K. M. Bykov (ed.), Pavlovskie Klanicheskie Sredy: Stenogrammy
Zasedanii υ Nervnoi i Psikhiatncheskoi Klinikakh (Moscow, Leningrad: Izdatelstvo Akademii
Nauk SSSR, 1957).
Pavlov, Probnaia ekskursiia.
21.
22. Ibzd.
23. Orbeli (1949a).
24. Bykov (1954), 414-415.
526
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
Bykov (1955).
Ibid.
Bykov (1954).
Ibid.
Bykov (1957).
Bykov (1954), 417.
Pavlov, Uslovnyi refleks.
Pavlov, Probnaia ekskursiia.
Bykov (1957).
Bykov (1954), 454.
Bykov (1955).
Ibid., 520.
Bykov (1957).
Jakob Kläsi, Einiges über die Schizophreniebehandlung, Zeitschrift für die gesamte Neurologie
und Psychiatrie, lxxviii (1922), 606-20; Jakob Kläsi, Über die therapeutische Anwendung der
Dauemarkose mittels Somnifens bei Schizophrenen, Zeatschrift für die gesamte Neurologie und
Psychiatrie, lxxiv (1922), 557-92; Jakob Kläsi, Über Somnifen, eine medikamentöse Therapie
schizophrener Aufregungszustände, Schweizer Archiv für Neurologie und Psychiatrie, viii (1921),
131-34.
42. M. Müller, Die Dauernarkose mit Somnifen in der Psychiatrie; Ein Überblick, Zeitschrift für
die gesamte Neurologie und Psychiatrie, xcvi (1925) 653-82.
43. M. Cloetta and Hans W. Maier, Über eine Verbesserung der psychiatrischen
Dauernarkosebehandlung, Zeitschrift für die gesamte Neurologie und Psychiatne, 1c (1934),
146-62.
44. L. A. Orbeli (ed.), Pavlovskie Sredy: Protokoly i Stenogrammy Fiziologacheskikh Besed. Vol. 3.
(Moscow, Leningrad: Izdatelstvo Akademii Nauk SSSR, 1949
).
b
45. Bykov (1957).
46. Orbeli (1949
), 121.
b
47. Bykov (1957).
48. Ibid.
49. Ibid.
50. Ibid.
51. Emil Kraepelin, Psychiatrie, ein Lehrbuch für Studierende und Arzte. Vol. 3, Part 2, 8th edn
(Leipzig: Johann Ambrosius Barth, 1913), 909.
52. H. Devine, The problem of schizophrenia, Proceedings of the Royal Society of Medicine, xxvi
(1932),111-20.
53. Gottfried Ewald, Schizophrenie, Fortschntte der Neurologie, Psychiatrie und Ihrer Grenzgebiete,
iv (1931), 198-228; James V. May, The Dementia praecox-schizophrenia problem, American
Journal of Psychiatry, xi (1931), 401-446.
54. Bykov (1954).
55. G. de M. Rudolf, Experimental treatments of schizophrenia, Journal of Mental Science, lxxvii
(1931), 767-91.
Bleuler, Schizophrenia; review of the
Neurology and Psychiatry, xxvi (1931), 610-28.
56. Manfred
work of Prof.