John S. Strauss and schizophrenia: Early discovery, lasting impact

ABSTRACT Early in his career, John S. Strauss conducted a remarkable series of studies that challenged contemporary views of schizophrenia. He challenged the disease entity view, deconstructed the clinical syndrome into separate domains of psychopathology, made a compelling case for viewing psychopathology on a continuum that extended into normal behavior, showed that areas of dysfunction had their own developmental trajectories and were not accounted for by psychotic symptoms. He provided evidence that narrow definitions of schizophrenia, based on special symptoms such as Schneiderian symptoms of first rank, did not capture Kraepelin's concept of dementia praecox and that these symptoms lacked prognostic validity and were not unique to persons with a schizophrenia diagnosis. These studies, hotly debated at that time, have been validated and are now common knowledge. Strauss' concepts are represented in today's emphasis on symptom dimensions, the explicit recognition of clinical syndromes with porous diagnostic boundaries, and the prevalence of psychotic-like experience in non-ill persons. His 1974 assertion that schizophrenia was a poor target for research and that etiological, pathophysiological, and therapeutic discovery required syndrome deconstruction is finally becoming the dominant paradigm—for example, the NIMH Research Domains Criteria [RDoC] initiative.