history
The History of Schizophrenia
The disease known as schizophrenia was first described as a unique illness, one distinguishable from other mental illnesses, by the German psychiatrist, Dr. Emile Kraepelin (1856-1926).
In his Encyclopedia of Psychology, H.J. Eysenck referred to Kraepelin as the founder of modern scientific psychiatry, psychopharmacology, and psychiatric genetics.
Kraepelin first described the illness in 1887, but as “dementia praecox”, not schizophrenia. This term implied that the disease represented a precocious, or premature, dementia. He believed that it involved cognitive problems (such as memory), that it began early in life, and that it was a disease that always demonstrated a chronic and deteriorating course.
Kraepelin was at odds with Sigmund Freud, who maintained that psychiatric illnesses were caused by psychological factors. Instead, Kraepelin favored genetics and other biological factors as the causes for mental illnesses, including schizophrenia. He postulated that there were toxic effects on the brain that could be traced back to increasing levels of hormones during and after puberty.
He was known to develop detailed clinical histories from his observations of patients with this disease and believed that the course (how the disease manifest itself over time) was important. Modern descriptions of the disease, such as those from the DSM-IV (TR)1, continue to emphasize the importance of the course of this illness.
Kraepelin also introduced the notions of two types of psychosis, one that involved mood, major depression (which now includes bipolar disorder) and one that involved cognition, dementia praecox (now referred to as schizophrenia. This was to become an important distinction that would ultimately influence diagnosis and ultimately the choices for treatments, particularly medications.
He also determined that this disease seemed to afflict people equally, no matter where in the world they lived. Unfortunately, he was convinced that the prognosis for this illness was universally poor. He described three subtypes of schizophrenia: catatonic, hebephrenic and paranoid types.
The French physician Benedict Augustin Morel was the first to consider the illness a psychotic disorder in his textbook, Traite des Maladies Mentales, but continued to use the term “dementia praecox”.
Paul Eugen Bleuler finally renamed the illness schizophrenia, primarily because he believed that the disease was neither a dementia, nor that it always occurred in young people. He chose the word schizophrenia from the Greek roots: “schizo”--split and “phrene”--mind.
Sadly, to this day, many people think of the disease as involving “split personality”. It is better thought of as an illness that results in a split from reality.
In contrast to Kraepelin’s pessimistic view, Bleuler saw the prognosis for this illness as potentially variable and more optimistic. He also added “demential simplex” (simple schizophrenia) to the list of subtypes.
After 1980, DSM-III totally reshaped thinking about the diagnosis of schizophrenia and helped to bring America and Europe together with respect to how they viewed this illness. In 1952, the first Diagnostic and Statistical Manual of Mental Disorders, DSM-I, was still using terms like “reactions” and “psychogenic” to describe schizophrenia, implying that the illness resulted from a response to stress or other factors.
In 1968, the DSM-II continued to use the term “psychologically self protected” to refer to the symptoms of schizophrenia and included diagnoses that no longer exist or are now categorized as personality disorders, under the heading of schizophrenia.
DSM-IV 1 included paranoid, catatonic, disorganized, undifferentiated and residual types.
Disorganized schizophrenia is still referred to as hebephrenic schizophrenia in the ICD-10 2.
While the term schizophrenia has only been used in the last century, early Greeks, Romans and Egyptians described the symptoms of this illness. Resources that include references to these descriptions from the middle ages and prehistoric times, and from the Muslim world can be found at: http://www.hubin.org/facts/history/index_en.html.
1 The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (Text Revision), © APA (The American Psychiatric Association).
2 The International Classification of Diseases, WHO (World Health Organization), 1990.
(Sources: The author’s knowledge base, unless otherwise noted.)
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