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KeywordsEysenck Body Type Normal Mental Status Psychotic Continuum Manic-depressive Insanity
The schizothymia-cyclothymia dimension was proposed by Ernst Kretschmer to explain the associations among personality components characteristic of schizophrenia at one extreme of the dimension, and manic-depressive insanity at the other, as well as normal-range “schizoid” and “cycloid” expressions of personality.
The term schizothymia, or schizothyme, derives from Ernst Kretschmer’s (1921, 1936) body type psychodiagnostic scheme proposing that the schizophrenic and manic-depressive forms of psychosis are each associated with unique qualities of temperament, which are engendered by common patterns of physical constitution factors characteristic of discernable body types. Kretschmer proposed that discernable body types existed and that three particular types conveyed specific likelihood to develop particular personality patterns. The thin (leptosomatic), muscular (athleticosomatic), and obese (pyknosomatic) body types were believed to be associated with schizothymic, cyclothymic, and epileptic temperaments respectively, and therefore personality groups with characteristics congruent with those temperaments (Eysenck 1950; Kretschmer 1937; Millon et al. 2004). Furthermore, the leptosomatic/schizothymic type was considered to be especially vulnerable to develop the schizophrenia form of psychosis, and the pyknosomatic/cyclothymic type was considered to be more vulnerable to manic-depressive psychosis. Eysenck observed that Kretschmer considered the athleticosomatic/epileptic type to be unrelated to the other two, considering schizothymia and cyclothymia to constitute a bipolar dimension of personality, with schizophrenic psychosis and manic-depressive psychosis being the most extreme expressions of the two poles, and related, but nonpsychotic schizoid and cycloid personality forms in the normal range. In Cattell’s (1944) Factor A, which was influenced by Kretschmer’s work, the schizothymic side of the dimension comprised a range of normal to psychotic personality features characterized as antisocial, schizoid, surly, superstitious, rigid, unhappy, and dour, for example. The cyclothymic side of Factor A was characterized by terms such as outgoing, idealistic, cheerful, witty, friendly, open, adaptable, trustful, and cooperative.
The proposed body types, and associated temperaments and personalities were the products of clinical observation, but, as reported in a review by Eysenck (1950), Kretschmer and his contemporary adherents did pursue systematic study of the body type psychodiagnostic scheme. However, the methods employed, or reporting of findings, were often inadequate to support firm conclusions. The studies were typically observational, with no a priori hypotheses, often reporting differences between groups on medically relevant physiological functions, or in one case, observing large differences in percentages of body types within groups of patients diagnosed with either schizophrenic or manic-depressive psychosis (Eysenck 1950). While interesting, such findings do not lend construct validity to Kretschmer’s body type psychodiagnostic scheme, as apparently, they were neither experimental nor longitudinal, and it is unlikely that the potential for investigator bias was controlled.
In the second part of his paper, Eysenck (1952) undertakes a systematic study, with a priori hypotheses central to Kretschmer’s schizothymia-cyclothymia model, to test: (a) whether the functional psychoses, schizophrenia, and manic-depressive insanity were on a continuum with normal mental states, rather than qualitatively different from them; and (b) whether the proposed bipolar dimension, with normal to extreme schizothymia on one side and normal to extreme cyclothymia on the other, was a valid psychodiagnostic construct. Eysenck did not attempt to test relationships between the body types and the personality constructs. Eysenck used a variety of psychological and neuropsychological measures, such as verbal fluency, word connection (a word association test), mathematical addition, color-form matching, mirror drawing, social attitudes, memory for strings of numbers/digits, reading speed, writing speed, and others. He concluded that the functional psychoses were on a continuum with normal mental states, but with the scores of schizophrenia patients tending to fall between those of the normal and manic-depressive samples. Therefore, the dimensional nature of the normal to psychotic continuum was supported, but the proposed bipolar structure, with schizophrenia at one extreme end, manic-depressive psychosis at the other extreme, and normal range schizoid and cycloid personality expressions in between, was not supported (Eysenck 1952).
Influence of the Concept
The literature linking psychological disorders to superficially observed body characteristics did affect the thinking of some influential personality theorists including Hans Eysenck (1950, 1952), Raymond Cattell (e.g., Cattell 1944; Cattell et al. 1955), and Theodore Millon (Millon et al. 2004). The body type psychodiagnostic model was contemporary with, and related to the genetic etiological model of psychopathology, still relatively in its infancy. Sadly, both models were used to justify and guide the actions of the eugenics movement (e.g., see Kretschmer 1937; Rees 1945), resulting in the forced sterilization of thousands of people presumed to carry psychological/psychiatric disorders genetically. Though interest in the proposed relationships between body characteristics and personality patterns began to wane in the 1950s, schizothymia as a personality construct motivated research into the 1970s (e.g., Van Kampen 1978), and the modern concept of schizotypy clearly has roots in schizothymia (Mason 2014).
Schizothymia and the body type psychodiagnostic theory are primarily of historical interest, as there is little empirical support for the notion that thin people are more likely to develop schizophrenia, or that obese people are more likely to develop a form of bipolar disorder. Kretschmer’s body type psychodiagnostic model was becoming influential at about the same time that genetic theories positing hereditary factors as causes of psychopathology were emerging and driving research. Although the theory relating body types to characteristic forms of psychopathology was quite popular in its time, as evidenced by the literature devoted to the subject during the early 1900s, the support found in that literature is likely inflated by preconceptions and clinician bias. Though interesting correlations may yet be observed, no modern rigorous study has indisputably established the existence of taxonic body types, beyond those defined by biological sex, much less a causal relationship where a body type at time point A predicts a psychopathology type at time point B. That said, the term cyclothymia has survived as part of the modern nomenclature referring to bipolar mood disturbance, and the term schizotypy persists to describe personality characteristics indicative of a predilection for thoughts and behaviors associated with schizophrenia spectrum disorders. Unlike the body type models, genetic etiological models have proven to be valid and useful. Unfortunately, both models were used to justify the eugenics movement and the forced sterilization of thousands of people.
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