"Non-specific specificity" in schizophrenia

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It is clinically important to recognize that the patient’s initial complaints are often in the nature of vague or nonspecific clichés that may be a shorthand for more specific complaints. Blankenburg termed this phenomenon the “non-specific specificity.”37,47 Often, only when the patient is asked for a concretely lived example of his (nonspecific) complaint does a more characteristic (and specific) configuration of anomalous experience emerge. For example, a patient complaining of “fatigue” may, upon prompting, report the constant, oppressive burden of a reflective, energy-consuming effort to decode and understand the meanings of ordinary, everyday conversations (in this case “fatigue” covers anomalous self-experiences, including loss of common sense, perplexity, and hyper-reflection). Another patient, complaining about “concentration difficulties,” may, upon request, describe these difficulties as rooted in several thematically unrelated and chaotic trains of thought that occur at the same time and that he can neither stop nor control, thus making it almost impossible to concentrate on something else. The psychiatrist’s acquaintance with the phenomenon of “non-specific specificity”37,47 is, in our view, extremely important in the context of early diagnostic assessment, especially of patients presenting with a vague, unelaborated picture of maladjustment, underperformance, chronic malaise and dysphoria, negative symptoms, or hypochondriac preoccupations.