Disorganization of speech and behavior have been central features of schizophrenia since the description of hebephrenia by Hecker (Hecker, 1871; Taylor et al., 2010; Tsuang & Winokur, 1974). Notwithstanding the changes that the concept of hebephrenia has gone through since its inception, all taxonomies are permeated by disorganized speech and behavior that ultimately lead to persistent socio-occupational failure in a few years (Bruijnzeel & Tandon, 2011; Kraepelin, 1919).

Although disorganization of speech and behavior usually go hand in hand, cases of severe disorganization of speech without disorganization of behavior were recognized by Kraepelin, who referred to them as “dementia with confused speech” or “schizophasia”:

A last very peculiar group of cases (…) is formed by the patients with confusion of speech. These are cases of disease the development and course of which correspond in general to those of dementia praecox (…) It consists in a terminal state, which is essentially characterized by an unusually striking disorder of expression in speech with relatively little impairment of the remaining psychic activities. If one will, one may therefore, relying on Bleuler’s nomenclature, speak of a “schizophasia” (Kraepelin, 1919 pp. 177-178).

As described by Kraepelin, schizophasia, which henceforth will be called “Kraepelin’s schizophasia”, has rarely been mentioned in the literature as such. Schiff and Courtois briefly commented on the paradoxical coexistence of delusional speech with coordinated and adjusted behavior:

The authors present a patient in whom mental disintegration is expressed above all by a pattern of language that is extremely dissociated and one that contains a number of transformed or newly formed words. In contrast to the utterly incoherent verbal activity, pragmatic activity remains almost intact (Schiff & Courtois, 1928 p. 154).

On the same occasion, Courbon (1928) noted that he also encountered patients whose retained professional skills coexisted with a profound incoherence of speech. In 1937, Sjödén reported on the case of Lundberg, a 68-year-old man who had been “speaking and writing a curious, distorted and incomprehensible language” for 30 years (Sjödén, 1937 p. 585). Lundberg had been “a gifted child, with a love and aptitude for reading, writing and music”, who “began a phase of short periods of liberty and ever-increasing stays behind the prison gates” after the age of seventeen; at this age, he was found guilty of his first offence of stealing (Sjödén, 1937 p. 585). Sjödén further stated that, concerning his behavior in the asylum, “Lundberg’s deportment is good and he is general factotum of his ward. It is he who apportions the food and keeps track of those who get extra food or a special diet. In the hospital he has done unsupervised painting jobs in which he has proved himself to be very efficient and to have good judgment in choosing colours (…)” (Sjödén, 1936 p. 586). Although Sjödén correctly employed the term schizophasia in his article, he did not give credit to Kraepelin as the first to recognize schizophasia as a distinct entity.

It may be somewhat surprising that Bleuler does not mention schizophasia in his classical oeuvre (Bleuler, 1911). Possibly, because Bleuler considered the thought disorder (in contrast to the language disorder) to be the central manifestation of schizophrenia, he devoted only a few paragraphs to speech and language in his account of schizophrenia.

Over the twentieth century clinicians and researchers have loosely applied the term schizophasia to the speech of patients with schizophrenia with little concern for the sparing of nonverbal cognition and instrumental behaviors (Coron et al., 2000; Covington et al., 2005; Galli, 1967; Gerson et al., 1977; Halpern & McClartin-Clarke, 1984; Kirov, 1990; Nestor et al., 1998; Oh et al., 2002). Even the few authors who came closer to Kraepelin’s concept equaled schizophasia with grossly disorganized speech, such as word salad, glossolalia, incoherence, and cataphasia, but overlooked the preserved ability to handle the instrumental activities of daily living (Rule, 2005). These points are illustrated in an oft-cited debate in which Lecours and Vanier-Clément define schizophasia as:

(…) a deviant linguistic behavior observed in certain―not in all, by far―people considered to be schizophrenics. It is, or at least, it can be, episodical. It is believed not to be the result of focal brain lesion (which does not mean that it is not the result of brain dysfunction). In phase d’état, schizophasia is characterized by [1] a normal or greater than normal speech flow, [2] a normal arthric and prosodic realization, [3] a production, in various amounts and combinations, of paraphasias and/or télescopages and/or neologisms, and [4] a more or less apparent component of glossomania (Lecours & Vanier-Clément, 1976 p. 524, italics in the original).

In his classification of the endogenous psychoses, Leonhard devoted a chapter to schizophasia, which he called “cataphasia”. After giving due credit to Kraepelin’s delimitation of the disorder, he goes on to criticize it as “too narrow” (Leonhard, 1999 p. 95). He then subtypes schizophasia in “excited” and “inhibited”. By giving weight to the phenomenology of subtypes, Leonhard seems to have lost sight of the importance of the sparing of the activities of daily living for the differential diagnosis. Moreover, his assumption that schizophasia reflects a formal thought disorder leaves no room for other possibilities; for example, that it may be a disorder of language or, most important, that thought itself may be intact. (Otherwise, how would these patients be able to carry out their everyday activities?). More recently, Case and Kelley stated that “some individuals with schizophrenia produce speech that is profoundly confused but are, none the less, able to carry out responsible work that does not involve the use of words” (Casey & Kelley, 2007 p. 50). Although their understanding of schizophasia could hardly be more accurate, the authors did not illustrate the concept of schizophasia with new cases, nor did they trace their description to Kraepelin’s original account.

The aim of the present article is to report on a case of Kraepelin’s schizophasia. No attempt will be made to provide a detailed psycholinguistic analysis of our patient’s speech or of the neural mechanisms of schizophasia. Our chief goal is to probe the validity of Kraepelin’s schizophasia and how it presents itself in clinical practice. The following report was presented in abstract form several years ago (Côrtes et al., 1998). The patient and her husband provided written informed consent for the publication of her case, including the supplementary audiovisual documentation, in its current form. No part of the study procedures was pre-registered, nor the study analyses were pre-registered prior to the research being conducted.