Le but de ce travail est d’explorer les multiples aspects du « Praecox Feeling » tels qu’il a été décrit par le psychiatre néerlandais H.C. Rümke et développé dans les suites par ses pairs.

Nous proposons une présentation historique sur ce sujet allant des premières descriptions aux études les plus récentes. Nous proposons d’y associer des notions voisines telles que les processus de typification et le jugement expert (Gut feeling) en y intégrant des aspects épistémologiques.

Le Praecox Feeling a été présenté par Rümke comme le moyen le plus sensible pour diagnostiquer une schizophrénie. Phénomène singulier de la rencontre clinique, il peut être décrit comme une expérience de bizarrerie ou d’étrangeté vécue par le clinicien au contact de son patient. Rümke conclut que le diagnostic de schizophrénie ne se fait pas strictement par une description précise des symptômes, mais en examinant son propre ressenti. De nombreux auteurs et chercheurs ont travaillé sur ce sujet et sont pour la plupart sensibles à une approche phénoménologique. Ainsi, Minkowski, Binswanger ou Tellenbach, parmi d’autres, ont permis d’affiner cette notion en parlant de « diagnostic par intuition », « diagnostic par pénétration » ou encore « diagnostic atmosphérique ». Malgré un abandon progressif de la subjectivité dans le processus diagnostique en psychiatrie, on retrouve dans la littérature contemporaine un regain d’intérêt de telles approches. On peut ainsi citer les processus de typifications ou encore le jugement expert (Gut feeling) qui proposent d’éclairer les mécanismes en jeu via une approche issue en partie des sciences cognitives et sociales. Ainsi, il apparaît que la question du diagnostic et de ses processus dépasse le strict champ psychiatrique pour rejoindre celui de la médecine au sens large.

The aim of this review is to explore the multiple aspects of the « Praecox Feeling » as introduced and developed by the Dutch Psychiatrist H.C Rümke in 1941 and re-assessed over the following years by its peers.

We present a historical review of this subject from the first description to the most recent research and proposed related notions like typification processes and gut feeling.

The Praecox Feeling, as presented by Rümke, may be considered as the most sensible tool in order to diagnose schizophrenia. This phenomenon appears in the in-between of the clinical encounter (i.e. the intersubjective space). It may be felt by the clinician as an experience of bizarreness during the interaction with a patient suffering from schizophrenia. Those feelings suggest fundamental aspects of schizophrenia that can be recognized as a peculiar form of embodiment. Rümke finally concludes that schizophrenia is not diagnosed by strictly examining patients’ symptoms, but psychiatrists’ own feelings. The recognition of such feelings remains hard to describe explicitly, since it takes place in a very basic (« pre reflexive ») state. However, numbers of researchers tried to explore praecox feeling more accurately. A phenomenological approach, with Minkowski, Binswanger or Tellenbach among others, developed several related terms: “Diagnostic by intuition”, “Diagnostic by penetration” or “Atmospheric diagnosis”. Although the precocity of the diagnosis is mentioned in Rümke's original paper, it does not precisely define the Praecox Feeling, contributing to the misunderstanding of the Rümke's original formulation. The very notion of Praecox Feeling in terms of psychiatric diagnoses fell into disuse with the development and the widespread diffusion of criteriological approaches, with the risk of an impoverishment of the clinical diagnosis. However, the study of specific subjective perspectives showed a renewed interest over the last decade, especially with the contribution of cognitive and social neurosciences. Furthermore, studies on psychiatrists’ daily-practice suggest that the Praecox Feeling is still relevant. Moreover, “the subjective tool” represented by the Praecox Feeling remains as used today as it was fifty years ago, in a pre-DSM III era. Temporal aspects have, nevertheless, lead to several studies suggesting that many clinical indices are identified during the first minutes of a clinical interview, especially for schizophrenia. In order to specify this very intuitive pathway, authors developed and worked on the typifications processes that lead to such feelings, involving diagnosis through prototypes. The passive synthesis of such subtle clinical clues may induce for the clinician a “pattern recognition” phenomenon that reminds a “gestaltic” diagnosis. This specific aspect of typification may not be specific of psychiatry. The “Guts Feeling” is a notion first developed by Dutchs physicians, particularly in General medicine but also among other medicals disciplines, theoretically very close from the notion of intuitive typification. It may allow benefits in term of diagnoses, reassurance or alarm sense. It suggests that clinical experience added to criteriology provides risks reductions. The crucial role of clinical experience in the diagnosis decision making tends to be underexplored, but still represents a crucial aspect of the evidence-based medicine as firstly described.