Psychopharmacology and the Classification of Functional Psychoses 

By Thomas A. Ban and Bertalan Pethö

Four-Dimensional Classification

Affective Psychoses

Melancholia and Depressions

Separation of Vital Depression

The most important contribution to the clarification of the confounding situation created by the all-embracing concept of manic-depressive psychosis (which includes all depressions) was made by Schneider (1920, 1959). By distinguishing between "vital depression" which he considered a medical illness, and other ("non-psychotic") depressive disorders, Schneider opened the path to our present system of classification of depressions.

The crucial step in the separation of depressive illness from other depressive disorders was the recognition of "depressive personality." Distinct from "vital depression" which is the result of a disease process, depressive personality is a developmental abnormality. As such, it is ill defined in psychopathological terms (Chodoff, 1972). In general, however, people with a depressive personality lack self-confidence, are susceptible to fatigue and dread the unknown. Unlike those with specific illness (unipolar or bipolar), they have been feeling sad, experiencing guilt and complaining of concentration difficulties for a long time.

Vital depression is an endogenous affective illness which embraces all three psychopathological structures: (1) the perceptual-cognitive, (2) the relational-affective and (3) the motor-adaptive.

It is characterized by "passive-unmotivated" dysphoria and disturbance of vital feelings with the explicit experience of displeasure and discontent leading to a disturbed time sense, poverty of thought, reduced emotional susceptibility and retardation. There are also vegetative symptoms, accompanied by hypochondriasis, corporization and feelings of motor and sensory disturbances. This concept of vital depression, or depressive disease described by Schneider in 1920 differs considerably from Kraepelin's (1921) concept of "depressive states" which are characterized by the triad of sad or anxious mood, thought retardation and decreased drive.

The concept of "psychogenic depressive reaction" was perceived at first as reactions of abnormal personalities to moderate or mild stress, or reactions of normal personalities to severe stress (corresponding to Schneider's concept of neurosis). By this definition "psychogenic depressive reaction" was positioned between "developmental anomalies" and sui generis "depressive illnesses."

More recently, with the contributions of Strömgren (1958, 1968), it has been recognized that psychogenic depressive reactions are illnesses that may occur in psychotic and non-psychotic forms. Common characteristics of both states are a clearly identifiable precipitating factor, thematic continuity between the trauma and the content of the illness, lack of depressive evaluation and preoccupation with the traumatic life events. Other common characteristics include reactive mood changes and feelings of passivity (Jaspers, 1963, 1974). Within this new frame of reference "psychogenic depressive reactions" are perceived as disorders (illnesses) whether psychotic or not and are distinct from personality disorders in that activation of an endogenous factor depends on a precipitating life event and not on personality development.