The term ‘Accessory Symptoms’ enters the depth-psychological corpus principally through Eugen Bleuler’s 1911 monograph on schizophrenia, where it performs a critical taxonomic function. Bleuler distinguishes accessory symptoms — hallucinations, delusions, catatonic phenomena, somatic disturbances, speech pathologies, and automatisms — from the fundamental symptoms (disturbances of association, affectivity, ambivalence, autism) that he regards as the disease’s irreducible core. The distinction is not merely classificatory; it carries explanatory weight. Accessory symptoms are characterized as non-essential in the sense that they may appear and disappear without altering the essence of the disease, yet clinically they are often what forces hospitalization and governs the patient’s behavior at any given moment. Bleuler insists they arise from a predisposition furnished by the primary disease process, but that psychic mechanisms — complexes, affective constellations — shape their specific content. This produces a productive tension between organic substrate and psychological elaboration that anticipates later depth-psychological integrations. The accessory/fundamental distinction also implicitly invites the Freudian-influenced reading of symptom content that Bleuler himself partially endorses. No other major theorist in this corpus appropriates the term directly, leaving it as definitively Bleulerian — a monument to early twentieth-century psychiatric nosology from which depth psychology drew heavily.
Those of the symptoms which are designated as accessory are unessential in that they may appear or disappear without altering the essence of the disease.
Bleuler provides his canonical theoretical definition: accessory symptoms are non-constitutive of schizophrenia’s essence, distinguishable from the fundamental symptoms that define the disease entity.
, Dementia Praecox or the Group of Schizophrenias, 1911thesis
Should accessory symptoms come to the fore at any stage of the disease, it is they which determine actions and behavior.
Despite their theoretical inessentiality, Bleuler establishes that accessory symptoms are the primary clinical determinants of conduct whenever they predominate, underscoring the paradox of their practical dominance.
, Dementia Praecox or the Group of Schizophrenias, 1911thesis
The latter provides only the predisposition, on the basis of which psychic processes develop the symptoms.
Bleuler argues that the primary disease process furnishes only a substrate, and that psychic processes — including unconscious complexes — are responsible for elaborating the specific content of accessory symptoms.
, Dementia Praecox or the Group of Schizophrenias, 1911thesis
CHAPTER II—THE ACCESSORY SYMPTOMS … a. Hallucinations, Delusions, and Illusions … c. The Accessory Affective Phenomena … g. The Catatonic Symptoms
The table of contents formally delineates the scope of accessory symptoms, cataloguing hallucinations, delusions, affective phenomena, speech and writing disturbances, and catatonic symptoms as the chapter’s subject matter.
, Dementia Praecox or the Group of Schizophrenias, 1911supporting
In schizophrenia we find a number of somatic symptoms, most of which, however, are not very pronounced and in some cases cannot be detected at all.
Bleuler extends the category of accessory symptoms to include somatic manifestations, arguing they suggest a more fundamental cerebral alteration without being diagnostically definitive.
, Dementia Praecox or the Group of Schizophrenias, 1911supporting
The compulsive thinking is the most common of all the automatic phenomena. It has its counterpart in the compulsive cessation of thinking.
In the accessory symptoms chapter, Bleuler identifies automatisms — including compulsive thinking and thought withdrawal — as characteristic accessory phenomena arising from unconsciously operating processes.
, Dementia Praecox or the Group of Schizophrenias, 1911supporting
My own observations do not permit, as do Kraepelin’s, the separation of acataphasic from agrammatic disturbances. Provisionally, I would designate all these distortions of grammar as paragrammatisms.
Within the accessory symptoms framework, Bleuler discusses language pathology — paragrammatisms and distorted word construction — as characteristic accessory manifestations of schizophrenic thought disorder.
, Dementia Praecox or the Group of Schizophrenias, 1911supporting
The schizophrenic hallucinations of taste and smell have no special characteristics. The patients taste sperm, blood, feces, and all sorts of poison in their food.
Bleuler catalogues gustatory and olfactory hallucinations as accessory symptoms, noting their lack of distinguishing characteristics relative to other sensory modalities.
, Dementia Praecox or the Group of Schizophrenias, 1911supporting
Elevations of temperature are usually explicable by some complication (gastro-intestinal disturbance, constipation, contusions, etc.).
In the accessory symptoms section, Bleuler discusses thermoregulatory disturbances as part of the somatic dimension, distinguishing those intrinsic to schizophrenia from those secondary to complications.
, Dementia Praecox or the Group of Schizophrenias, 1911supporting
The most common attacks, which may at once be considered as the type-form of the schizophrenic fit, appear to us to be organically conditioned attacks of paralysis and irritability in which particularly the intrapsychic associations are altered.
Bleuler classifies schizophrenic fits within the accessory symptoms chapter, attributing their organic character to alterations in intrapsychic associations rather than to purely psychogenic mechanisms.
, Dementia Praecox or the Group of Schizophrenias, 1911supporting
A really or imaginarily gravid patient will hear her child or children speaking inside her womb.
Bleuler’s detailed phenomenology of voice localization illustrates how complex-determined content shapes the specific form taken by hallucinatory accessory symptoms.
, Dementia Praecox or the Group of Schizophrenias, 1911supporting
If delusions or fallacious concepts are the causes of the ‘negation,’ then we are not dealing with negativism but rather with normal behavior under abnormal circumstances.
In distinguishing true negativism from delusionally motivated refusal, Bleuler draws a boundary between authentic catatonic accessory symptoms and secondary behavioral consequences of other accessory symptoms such as delusions.
, Dementia Praecox or the Group of Schizophrenias, 1911supporting
During the period of manifest disease this symptom is found in the greatest variety of forms: as pressure in the entire head, behind the forehead, and especially frequently in the occipital region.
Bleuler enumerates headache and paresthetic phenomena as part of the somatic dimension of accessory symptoms, noting their resemblance to neurasthenic presentations.
, Dementia Praecox or the Group of Schizophrenias, 1911aside
A part of these edemas appear to be directly conditioned by the disease process itself.
Bleuler tentatively assigns certain vasomotor anomalies and edemas to direct organic causation, further elaborating the somatic register of accessory symptoms beyond psychogenic explanation.
, Dementia Praecox or the Group of Schizophrenias, 1911aside
Janet understood ‘common stigmata’ to be related to a lowering of the mental level; these symptoms included lapses of all the mental functions, the lack of feeling and of will (abulia), and the inability to begin and end activities.
Nijenhuis’s exposition of Janet’s stigmata/accidents distinction provides a parallel taxonomic framework from the hysteria tradition that resonates structurally with Bleuler’s fundamental/accessory dichotomy.
, Somatoform Dissociation: Phenomena, Measurement, and Theoretical Issues, 2004aside