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History of Psychiatry

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Pavlov's concept of schizophrenia as related to the theory of higher nervous


activity
George Windholz
History of Psychiatry 1993; 4; 511
DOI: 10.1177/0957154X9300401604
The online version of this article can be found at:
http://hpy.sagepub.com/cgi/content/abstract/4/16/511

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511-

Pavlovs concept of schizophrenia


to the theory of higher nervous

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

the early 1930s, after thirty years of intensive laboratory research on


conditioned reflexes, I. P. Pavlov moved to the clinic for exploration of
psychiatric and neuropathologic disorders. For Pavlov, the quintessential
experimenter, the step from the laboratory to the clinic was dramatic but not
surprising in view of the fact that he had a longstanding interest in
psychopathology. For the previous three decades he and his disciples had
been constructing a theory of higher nervous activity that was to explain the
function of the brain in higher organisms (such as apes, dogs and humans) as
they interacted with the external environment. His goal was to have his
theory encompass both normal and abnormal activities. By the end of the
1920s, after numerous laboratory experiments, using primarily dogs as
.I wish to thank J. R. Kuppers and P. A. Lamal for their suggestions and editorial assistance and
the inter-library loan librarians A. D. Cobb and B. J. Lisenby for their help in providing source
material. Address for correspondence: George Windholz, Ph.D., Professor, Department of
Psychology, University of North Carolina at Charlotte, Charlotte, NC 28223, USA.

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512

subjects, he had formulated the basic principles regarding the organisms


interaction with the environment. Inspired by the positivist ideals of his
generation, Pavlov wanted to apply that knowledge for the benefit of
humanity. Sometime in the 1920s, he expressed this view to his disciple E.
M. Kreps in the following words:
My belief is

that the progress in science will bring happiness to humans. I


believe that human intellect and its highest manifestation - science - will
free the human species of disease, hunger, hostility, and [that it will]
reduce human suffering. This belief has given and continues to give me
strength and helps me to continue my work.

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

early interest in psychiatry


Pavlovs interest in psychiatric disorders began early in life when his mother
suffered a nervous condition which, many years later, one of his
biographers, P. K. Anokhin, diagnosed as of organic nature.2In the 1870s,
Pavlov took courses in psychiatry at the University of St. Petersburg.3 His
interest in psychiatric disorders continued in the next decades as seen from
the following statement made on the 15 February 1933 Clinical Wednesday:
already for a long time wished to become acquainted with
psychiatry. I remember, 18 years ago, I was living not far from the
Udelninskii Hospital, and would visit there. Vera Petrovna [Golovina]
4
was my guide who showed me the patients.4
I had

In 1919, Pavlov gave a speech before the Psychiatric Society of Petrograd


suggesting that catatonic immobility was the consequence of the inactivity of
the cortical motor area which in healthy people allows voluntary
movements. Subsequently, in a lecture to surgeons in 1927, he proposed

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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.

Pavlovs research methods in

laboratory and in clinic


During the nineteenth century physiologists, such as F. Goltz, attempted to
determine the functions of the brain by the method of extirpation. Pavlov
objected to extirpation on the grounds that it was too crude a method for the
study of the brains delicate processes of adaptation. Instead, he advocated
the conditioned salivary reflex as a method preferable to extirpation. He and
his disciples determined that if an indifferent stimulus, such as light or
sound, preceded, or was concomitant with, the evocation of a salivary reflex,
then, after a few repetitions, that stimulus would become a conditioned
stimulus as it evoked salivation, i.e., the conditioned response. In the
laboratory, different conditioned stimuli under the experimenters control
evoked quantitative changes in the production of saliva. Pavlov maintained
that the different rates of salivary flow in response to the controlled stimuli
were
precise indicators of neural changes in the animals cortical
hemispheres. Using the conditioned reflex method, he developed the
principles of cortical functions without the use of extirpation.
Although Pavlov took courses in psychiatry at the University of St.
Petersburg in the 1870s, in 1930 he confessed that he had forgotten the little
he knew about mental disorders. 10 He therefore had to relearn psychiatry. He
used three approaches to further his knowledge of schizophrenia: reading
literature on psychiatry, interacting with schizophrenic patients, and
conversing with psychiatrists.
The records of Clinical Wednesdays show that Pavlov read the texts of E.
Bleuler, E. Kraepelin and E. Kretschmer as well as journal articles dealing
with schizophrenia. The seminars began with the psychiatrist, who was
responsible for the care of the patient being presented to Pavlov, reading the
patients history. The presentation ended with a diagnosis. Sometimes Pavlov
requested more information about the patient and his family. The
schizophrenic patient was then brought from the hospital ward and
introduced to Pavlov, who asked him questions pertaining to his previous
and present condition. After the patient had left, the psychiatrists elaborated
on symptoms, etiology, prognosis and medical treatment. Some of the most
prominent psychiatrists who participated in the Clinical Wednesdayss
were A. G. Ivanov-Smolenskii, F. P. Maiorov, 1. 0. Narbutovich, and

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514
P. A. Ostankov. Pavlov
asked questions. Here is

thought of himself
one

instance of such

pupil of psychiatrists and


interaction:

as a
an

Pavlov. How do you characterize paraphrenia? What is it?


Narbutovich.
As a rule, paraphrenia begins with hallucinations....
Paraphrenics hear non-existing voices, fall under the influence of such
non-existing voices and trust them more than the normal stimuli that
come from the environment. When he hears something, and others do
not confirm it, then he [the patient] anyway trusts his voice. In
consequence, there occurs an estrangement from the environment, and
he fails rather early to communicate with the environment and loses
contact.... Such ill people experience continuously some kinds of sense-

deception.
Pavlov. But this is,

so to

say, the

genesis, but what is the usual

content

of

paraphrenia?
Narbutovich. In the beginning, the delusion of
l
delusion of grandeur. 11

persecution

and then the

Usually Pavlov attempted to explain the psychiatric cases within the


framework of his theory of higher nervous activity. Here is an example of
such an explanation while referring to a 33-year-old schizophrenic male:
Obviously, he is now in the period of excitation, not a destructive one, but
an extraordinary excitation, that is, before the destructive period, but this
is only the first stage. Here everything manifests itself in terms of an
extraordinary excitatory process, that changes all relations. Our normal
thought involves the continuous alternation of the inhibitory and
excitatory processes, but in that man the excitatory process prevails

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

understanding of schizophrenia. New

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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

theory of higher nervous activity


Pavlov attempted to explain the interaction of higher organisms and the
environment within the concept of the Darwinian struggle for existence.
Although, in 1904, he received the Nobel Prize for his work on digestion,
from 1901 on he explored the functions of the nervous system. He thought
that the nervous system had a two-fold function: the lower nervous activity
integrated the diverse systems within the body, while the higher nervous
activity regulated the interaction of the organism with the changing external
environment.16

higher organisms functioned on three neural levels. The subcortical


regions of the brain produced chains of innate unconditioned reflexes, or
instincts: the alimentary, sexual, aggressive, social, etc. The instincts
prompted the organism to action. However, survival (under the control of
subcortical regions) was unlikely as observed in a decorticated dog. In higher
organisms, the cerebral cortex helped the organism to survive by allowing
flexible adaptation. Therefore Pavlov focused on the neural processes in the
The

cortex.

He thought that the acquired conditioned reflexes were advantageous to


survival. The conditioned reflexes made it possible for the organism to
approach or avoid external objects or situations without coming into direct
contact with them. A repeated approach-activity and its life-enhancing
consequences were reflected on the cortical level. There the spreading
excitation formed a neural connection (association) between the objects
perception and the stimuli that evoked behaviour. In contrast, a repeated
avoidance of a dangerous situation - which also had life enhancing
consequences - was also reflected on the cortical level. There the spread of
neural inhibition interrupted the connections between the objects perception
and the stimuli that evoked the avoidance behaviour. The daily-life
adaptation of the organism was, therefore, a chain of approach or avoidance
behaviours under the control of the brain. The conditioned reflex was thus a

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516

marvellous instrument of adaptation; it was relatively easily established and


yet so sensitive that it could be as easily extinguished. As the environment
was continuously changing, old associations were discarded and replaced by
new,

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

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517

physicians

certain as to the patients diagnoses in all cases, they


schizophrenic, 7 as catatonic, 111 as paraphrenic, 6 as
remaining 2 of mixed or undetermined type. 21

were not

identified 19 as
paranoid and the

Pavlovs theory of schizophrenia


have seen, Pavlov explored schizophrenia under the guidance of
psychiatrists who were mainly under the influence of Bleuler and Kraepelin.
By 1930, he was aware that schizophrenic symptoms involved apathy and
debility, negativism and immobility, stereotypic and bizarre behaviour. He
also knew that Kraepelins nosology recognized the catatonic, hebephrenic,
and attempted to specify
paranoid and paraphrenic subtypes of schizophrenia
1
the underlying features of each subtype. 21
In 1930 Pavlov related schizophrenia to hypnotic states induced in the
laboratory. He thought that hypnosis was a state of neural inhibition between
the extremes of vigilance and sleep. Whereas in sleep a large area of the brain
was inhibited, and in vigilance the entire brain was excited, in hypnosis
inhibition spread only over specific areas of the cortex. This chronic hypnotic
state in schizophrenia was the result of a weak nervous system. When weak
genotypes were subjected to taxing environmental conditions, the neural cells
were swamped by excitation. To protect themselves from destruction, the
inhibitory process spread over the cortical areas. In consequence, the cortical
cells are saved from self-destruction but the result is the schizophrenic state
which prevents the person from leading a normal life.22
During the 2 November 1932 Wednesday Seminar, Pavlov backtracked on
the role of hypnosis in schizophrenia, asserting that hypnosis does not cause
schizophrenia because the brain of the schizophrenic is destroyed, whereas
hypnosis is not destructive. Hypnosis was, however, a part of the
schizophrenic syndrome. At that time Pavlov could safely assert that
schizophrenia was related to the destruction of the brain cells. 21 On the same
day, at the 2 November 1932 Clinical Wednesday, Maiorov informed Pavlov
that the catatonic patient A., a 19-year-old male, died as a result of a fall
from a window. Then the histologist L. Ia. Pines reported that a postmortem examination of the patients brain was performed to determine
whether there were histological changes in the brain, and if such were found,
where they were located and whether these caused schizophrenia. In the
examination of the brain, Pines followed Brodmanns system of cortical
areas. In a detailed report, supported by visual material, Pines stated that he
had correlated the characteristics of the tissue with clinical data (body
temperature, eventual trauma or infection) collected during the patients stay
in the hospital. From this data, Pines concluded that changes found in the
cortical areas were related to schizophrenia:
As

we

Confronted with all the facts, it has

to

be

said, that the observed changes,

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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

ensuing debate, Pavlov stated that clinical observations


corresponded to the histological material and Ostankov remarked that
Piness conclusions were supported by other studies.
Pavlov was prone to accept the evidence that pathological changes in the
brain were related to schizophrenia, but insisted that the etiology of
schizophrenia involved the impact of traumatic events on the genetically
predisposed weak individuals central nervous system. Pavlov reiterated this
assertion in different contexts. When informed during the 24 October 1934
Clinical Wednesday that a 24-year-old schizophrenic male was fearful,
negativistic, disoriented, and cried often, he stated that withdrawal was a
characteristic of weak genotypes having to interact with the social environment.
Such weak types felt threatened because the powerful environmental stimuli
destroyed their ability to adapt.25 During the 12 December 1934 Clinical
Wednesday he observed a 23-year-old female engineer diagnosed as
schizophrenic. After the presentation of the case, Pavlov stated that somatically
she was abnormal because various organs were poorly developed. If these
organs were inadequate, then it may be presumed that so was her brain.
Strenuous intellectual work affected her brain and she became schizophrenic.26
In 1935, Pavlov summarized his theoretical position on the etiology of
schizophrenia after comparing it to the strong genotype in the following way:
In the second type, both processes [excitatory and inhibitory] are weak
and therefore individual and social life [of the person] become
unbearable, especially when harsh crises occur during their youth when
the organism is not as yet [fully] formed and strong. And this can lead,
and often leads, to the full destruction of the highest parts of the central
nervous system, provided that happier events in life, and even more the
protective function of the inhibitory process, fail to preserve [the person]
during this difficult period from the [consequences] of disastrous overexcitation. It is possible that weak types that become schizophrenic were
in some special situation such as inappropriate development or
continuous self-intoxication that brings about a fragility, a brittleness of
the nervous instrument.2

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

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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.

Pavlov, having proposed


faced

problem

schizophrenia,

Catatonia

1918, Pavlov observed hospitalized patients diagnosed as schizophrenic at


the Udelninskii Hospital. One of the patients was a woman in her early 20s
and the other was a 60-year-old male by the name of Kachalkin. Kachalkin
had been uncommunicative for 22 years, but when he had recovered he told
Pavlov that during the acute state he knew what was going on but lacked
strength to talk or move. Pavlov then suggested that, for a variety of reasons
toxicity, localized circulatory changes, or taxing environmental conditions the cortical motor areas that control voluntary motor behaviour had become
exhausted and failed to function. The result is the catatonic symptom. Other
areas of the cortex, such as cognition, are not affected. The subcortical
regions were not affected either, and tended to manifest themselves in
instinctive behaviour.29
During the 11 May 1932 Clinical Wednesday, Pavlov saw the catatonic
behaviour of a 32-year-old male. Given an order, the patient responded to it
but then returned to the catatonic state that was intermittently followed by
outbursts of aggression. Pavlov explained that this aggressive behaviour
resulted from a conflict between the inhibition of the cortical areas that
regulate speech and the psychiatrists attempt to make him talk. The patient
found himself in a difficult situation and reacted with anger. Anger was
followed by profanity, a response typical of the Russian people.o
A year later Pavlov reformulated his understanding of catatonia. At the 11I
October 1933 Clinical Wednesday, after observing a 40-year-old woman who
had recovered from catatonia, Pavlov stated that catatonia protects the
nervous system from over-excitation. During the catatonic state, the nervous
system rests and this explained her recovery.&dquo; Pavlov reiterated his position
on the nature of catatonia at the 13 March 1935 Clinical Wednesday holding
that catatonia brings about rest to the nervous system and thus prevents its
permanent destruction. 31
It follows that catatonia is a form of schizophrenia that can be cured.
Pavlov was very much encouraged by the case of Kachalkin who recovered
In

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520

after

22-year stupor. During the 2 November 1932 Clinical Wednesday,


Pavlov, having in mind the Kachalkin case, said:
Catatonia... also relates to Dementia praecox yet people recover. We had a
a

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

14 November 1934 Clinical

Wednesday Pavlov

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was

shown

521

33-year-old male engineer who was sexually impotent, who experienced


auditory and visual hallucinations, and who claimed that doctors wanted to
infect him with syphilis and poison him. Pavlov stated that in normal people
the excitatory and inhibitory process alternate, but in the case of the patient
the excitatory process was so powerful that reality - in regard to oneself and
the environment - was falsified, which explains hallucinations. Narbutovich
added that the patient claimed to have other peoples thoughts and that other
people could read his thoughts. Pavlov explained this phenomenon in the
following way:
Because the tonus of the great hemispheres has changed, he is no longer
the person that he was before. On the other hand, he still has a remainder
of self-concept left, and that he attributes to someone else. He [the
patient] is another [person] now, but in the same time the character of his
personality has not disappeared but is imagined as being that of a

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

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522

Treatment of schizophrenia by rest and prolonged sleep


We have already seen that Pavlov was very much interested in improving the
condition of human existence. Faced with the horrors of schizophrenia, he
attempted to treat it. Convinced that in the acute phase of schizophrenia the
neural cells of the cortex have been over-excited by the external
environment, he recommended rest and prolonged sleep as the therapy of
schizophrenia. To achieve rest during waking hours, he advised psychiatrists
to isolate the schizophrenic patients in wards which were off-limits to noisy
and disturbing patients. The psychiatrists at the Balinskii hospital assured
him that they were planning to follow his advice.
The prolonged sleep therapy as a treatment of schizophrenia was proposed
in the early 1920s by the Burgholzli psychiatrist Jakob Klasi. Klasi claimed
that sleep induced by Somnifen and lasting six or seven days reduces psychic
excitation and restores contact between therapist and the patient.41 It appears
that Somnifen was widely used, primarily by European psychiatrists, but in
1925 M. Muller, reviewing the relevant literature, concluded that although
the therapy was useful in some cases, it was dangerous too.42 Stunned by
mortality related to prolonged therapy with Somnifen, the Swiss pharmacologist M. Cloetta and Hans W. Maier, the Director of Burgholzli, decided
to combine known soporifics with pharmaceutics that counteracted
circulatory collapse. The product was known as either Cloetta Mixture or

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

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523

patient recovered. Hallucinations disappeared, and the patient talked


rationally with his family and physicians. He was active but tired quickly.
Pavlov considered the recovery of great importance, because it demonstrated
that even after two years of hallucinatory and paranoid condition, the large
hemispheres did not sustain permanent damage.
The

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.

Observations and conclusions


In 1913,

Kraepelin

wrote

that the

cause

of Dementia praecox

was

wrapped in

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524

impenetrable darkness.51

In the next decades, two paradigms were advanced


solve this riddle. One paradigm attempted to explain the entire range of
human activity including schizophrenia, whereas the other focused on
schizophrenia without considering other human activities. One may ask
which of the two methodological approaches was consistent with Pavlovs
theory of schizophrenia.
Pavlovs understanding of schizophrenia derived from his theory of higher
nervous activity which attempted an explanation of the entire range of
activity of higher organisms. Such an approach was not unique. For instance,
H. Devine, in his 2 November 1932 presidential address to the Psychiatry
Section of the Royal Society of Medicine, after a general review of
contemporary research, described schizophrenia from the perspective of
to

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

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525

schizophrenia in a special article. Whether Pavlovs work will ever become a


working theory is an open question, yet it is now at best of historical interest.
REFERENCES
E. M. Kreps, Ivan Petrovich Pavlov i religiia, In I. P. Pavlov υ Vospominaniiakh
Sovremennikov. Kreps, E. M, (ed.) (Moscow, Leningrad: Izdatelstvo Nauka, 1967), 131.
2.
P. K. Anokhin, Ivan Petrovich Pavlov, Zhizn, Deiatelnost i Nauchnaia Shkola (Moscow,
Leningrad: Izdatelstvo Akademii Nauk SSSR, 1949).
3.
N. M. Gureeva, and N. A. Chebysheva, Letopis Zhizni i Deiatelnosti Akademika I. P. Pavlova,
Vol. 1. (Moscow, Leningrad: Izdatelstvo Nauka, 1969).
4.
K. M. Bykov (ed.), Pavlovskie Klinichiskie Sredy: Stenogrammy Zasedanii v Nervnoi
Psikhiatricheskoi Klinikakh (Moscow, Leningrad: Izdatelstvo Akademii Nauk SSSR, 1954),
490.
5.
I. P. Pavlov, Psikhiatriia kak posobnitsa fiziologii bolshikh polusharii, in I. P. Pavlov, Polnoe
Sobranie Sochinenii. Vol. 3. Part 1. 2nd enlarged edn (Moscow, Leningrad: Izdatelstvo
Akademii Nauk SSSR, 1951).
6.
I. P. Pavlov, Fiziologicheskoe uchenie o tipakh nervnoi sistemy, temperamentakh tozh in I
. P.
Pavlov, Polnoe Sobranie Sochinenu. Vol. 3. Part 2. 2nd enlarged edn (Moscow, Leningrad:
Izdatelstvo Akademii Nauk SSSR, 1951).
7.
L. A. Orbeli (ed.), Pavlovskie Sredy: Protokoly i Stenogrammy Fiziologicheskikh Besed. Vol. 1.
(Moscow, Leningrad: Izdatelstvo Akademii Nauk SSSR, 1949a).
8.
Friedrich Leopold Goltz, Ueber die verrichtungen des Grosshirns. (Bonn: Emil Strauss, 1881).
9.
I. P. Pavlov, Lektsii o rabote bolshikh polusharii golovnogo mozga, in I. P. Pavlov, Polnoe
Sobranie Sochinenii. Vol. 4. 2nd enlarged edn (Moscow, Leningrad: Izdatelstvo Akademii Nauk
SSSR, 1951). Nevertheless, Pavlov and his disciples performed extirpations to determine the
cerebral areas of sensory modalities.
10. I. P. Pavlov, Probnaia ekskursiia fiziologa v oblast psikhiatrii, in I. P. Pavlov, Polnoe Sobranie
Sochinenii. Vol. 3, Part 2. 2nd enlarged edn (Moscow, Leningrad: Izdatelstvo Akademii Nauk
1.

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.

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1993 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.

526
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.

Bykov (1955).
Ibid.

Pavlov, Obshchie tipy, 292-293.


Bykov (1957), 419.
Pavlov, Psikhatriia kak posobnitsa.

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.

Eugen Bleuler, Archives of

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