History of schizophrenia (A brief guide)

In this guide, we will discuss the history of schizophrenia and how the term has evolved.

History of schizophrenia

The term Schizophrenia is relatively new,  compared with other terms such as melancholia, mania or generic “insanity”, all terms that have been around for a very long time.

In the 19th century, some European psychiatrists started to describe disorders of “unknown causes” which seemed to manifest specifically in young people and resulted in chronic deterioration. 

Bénédict Augustin Morel (1809 – 1873)  was a French psychiatrist who referred to schizophrenia as “ démence précoce”.

Then, in Scotland, Sir Thomas Clouston (1840 – 1915) a Scottish psychiatrist, referred to it with the term “adolescent insanity”.

In Germany, Karl Ludwig Khalbaum (1828-1899) started to refer to schizophrenia as a catatonic syndrome and his disciple Ewald Hecker (1843-1909) hebephrenia, both known until recently as subtypes of schizophrenia.

It wasn’t until Emil Kraepelin (1856-1926) that the terms used by the other psychiatrists to describe the same condition were unified under the name “dementia praecox”.

In his textbooks, Kraepelin kept elaborating on the description of the disorder acknowledging the diversity of the manifestations of this disease and described nine different clinical forms.

The clinical forms were termed as follows:

•  The first clinical form was named as “dementia praecox simplex”.
• The second clinical form was known as hebephrenia.
• The third was depressive dementia praecox (simple delusional form).
• The fourth was a circular dementia praecox.
• The fifth was agitated dementia praecox.
• The sixth was periodic dementia praecox.
• The seventh was catatonia.
• The eight-term was paranoid dementia with a mild and a severe form.
• The ninth was coined as schizophasia (confusional speech dementia praecox). 

However, these weren’t the first reported cases of people with mental illnesses, we have knowledge regarding specific periods in the History of Humankind where there are references to mental illnesses understood through different approaches.

Early references to mental disorders

Schizophrenia, as we discussed is a term that started to be introduced and used in the mental health field not so long ago (around 100 years).

Then, is it because it is a fairly recent mental disease?

Not really, the term has been adapted and changed a few times but it refers to the same group of observed symptoms. 

Was schizophrenia reported in the bible?

Reportedly,  references about people behaving atypically or abnormally are as old as the bible.

For example, in Mark 5 we can read the story of the healing of the Gadarene Demoniac.

“He lived among the tombs. And no one could constrain him, not even with chains, because he had often been bound with shackles and chains. But he had pulled the chains apart and broken the shackles to pieces. And no one could subdue him. Always, night and day, he was in the mountains and in the tombs, crying out and cutting himself with stones”. 

For some, the Gadarene was possessed by a Legion of demons, but some believe he was mentally disturbed or ill.

Mental illnesses have been reported throughout our history, however, at the time the only available explanations were religion or magic.   

Ancient origins of mental illnesses 

Ethnography is the in-depth study of a culture or a facet of the culture and comes from the discipline of anthropology. 

Studies using this in-depth cultural approach and description of human behavior through their customs, habits, and differences have suggested that schizophrenia is present in all existing cultures. 

For instance, It is believed that schizophrenia can be even traced far back into the Egyptian civilization.

In Ebers Papyrus of 1550 B.C, an Egyptian medical papyrus of herbal knowledge, there is a chapter called “the book of hearts” where there is detail about mental disorders such as depression and dementia. 

The Egyptians believed that “psychological symptoms were thought to emanate from the heart and uterus, and were associated with blood vessels, purulent or fecal matter, poisons or demons” (Martin Korn, Medscape).

In China, there are records of a text entitled “The Yellow Emperor’s Classic of Internal Medicine” said to have been written around 1000 BC were symptoms of insanity, dementia and seizures are reported.

Psychotic behavior was often explained through demonic or supernatural possessions.   

In contrast, the Greeks began to rationalize the conception of madness starting with Plato who started to introduce the dichotomy of the mind-body relationship suggesting that curing the head alone and not taking care of the body as well would not help the person suffering from madness, instead, it was also required to cure the soul.

Hippocrates, a Greek physician considered the father of modern medicine approached mental illnesses in a different way, suggesting that mental illnesses originated entirely from our brain and an imbalance between body “humors” such as blood, phledge, and yellow and black bile. 

Basically, these ancient cultures tried to conceive a “rational” explanation of mental illnesses through magic, religion or the spiritual world unlike how we perceive them now through modern science. 

Bleuler’s Schizophrenia

Later on in our history, around the 17th century, there was a change of mentality in how mental disorders were understood and explained.

After Kraepelin used the term “dementia praecox”, in the early stages of the identification of schizophrenia, Eugen Bleuler significantly modified the concept by changing the perception of schizophrenia as one illness.

Instead, he stated that it appeared to be a group of diseases. 

Bleuler’s term “schizophrenia” is derived from the Greek words for “split” and “mind”, but it is not the same as the term split personality.

He referred to a splitting of the psychic functions not a split in personality or multiple personalities for that matter. 

Unlike Kraepelin’s dementia praecox, Bleuler’s term considered that the illness was not a disease subject to a deteriorating course and early onset as Kraepelin suggested was the hallmark of the disease, instead, he suggested schizophrenia should be understood as being the composed of several different entities rather than one disease

Additionally,  Bleuler also introduced an important distinction between basic/obligatory and accessory/supplementary symptoms of the disorder (Jablensky, 2010).

Current symptoms such as delusions and hallucinations that are currently classified as “positive symptoms” were included within the accessory symptoms and the basic symptoms included thought and speech derailment, volitional indeterminacy, affective incongruence and withdrawn from reality. 

20th Century schizophrenia

Kurt Schneider in 1959, also supported Bleuler’s hierarchical system of symptom classification.

Alternatively, according to Martin Korn, MD from Medscape, Schneider termed the core features “first-rank” symptoms and they included:

• Hearing one’s thoughts spoken aloud  
• Auditory hallucinations commenting on one’s own behavior  
• Thought withdrawal, insertion, and broadcasting  
• Somatic hallucinations, or the experience of one’s thoughts as being controlled or influenced from the outside

For someone to get the diagnosis of schizophrenia, the manifestation of these “first-rank” symptoms needed to have a differential diagnosis and couldn’t be explained by any other disease or organic illness, persistent affective disorder or drug intoxication. 

Additionally, he also stated there was another group of symptoms he termed “second-rank symptoms” that included other forms of hallucinations, depressive or euphoric mood changes, emotional blunting, perplexity, and sudden delusional ideas.

If the first-rank symptoms were not present, schizophrenia might still be diagnosed if there were a sufficient number of second-rank symptoms (Martin Korn, Medscape). 

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Schizophrenia subtypes vs Schizophrenia spectrum disorders

According to Bleuler, the presence of the basic symptoms were considered the core symptoms of the disease.

Additionally, Jablensky (2010) mentions that he acknowledged that the clinical subgroups of paranoid schizophrenia, catatonia, hebephrenia, and simple schizophrenia couldn’t be limited by the attenuated forms or presentations of the same disease. 

He instead, argued that schizophrenia needed to be understood and acknowledged as a much broader concept, where he added other mental illnesses into the mix, considered them as part of what we conceive as schizophrenia spectrum disorders.  

Negative vs Positive vs Mixed schizophrenia

A study published by researches in the Archives of General Psychiatry in 1982, developed criteria that allowed them to categorize schizophrenia according to the symptoms in three subtypes: 

• Positive schizophrenia: characterized by prominent delusions, hallucinations, positive formal thought disorder, and persistently bizarre behavior.
• Negative schizophrenia: characterized by affective flattening, alogia, avolition, anhedonia, and attentional impairment.
• Mixed schizophrenia: characterized by not having a prominent presentation of symptoms of any of the two other subtypes. 

From Bleuler to DSM-V

The American Psychiatric Association and the New York Academy of Medicine, began their initiative in 1949 to standardize the diagnostic system of mental diseases throughout the United States.

As a result, in 1952 the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I) was published. 

This classification of mental disease was highly influenced by the theories of Adolf Meyer where psychiatric disorders were conceived as the reactions of the personality to factors such as psychological, social and biological. 

Moreover, the manual has gone through a series of changes and adjustments.

The DSM-II was published in 1968 but didn’t differ much from the previous version. Other revisions followed with the DSM-III were published in 1980, the DSM-IV in 1994 and the DSM-IV-TR in 2000. 

Major changes in the classification of the diseases were evidenced in the third edition of the DSM where they attempted to “make the manual theoretically neutral and based on descriptive lists or clusters of symptoms” (Martin Korn, Medscape). 

It wasn’t until the DSM-IV were schizophrenia was divided into 5 subtypes that included paranoid, disorganized, catatonic, undifferentiated and residual.

However, the most recent version, the DSM-V, removed the subtypes and conceives schizophrenia as a spectrum. 

How was schizophrenia treated?

The 14th century is considered the “era of asylums” and they were scattered through Europe establishing facilities in Florence, Spain, Belgium, and England.

One of the most iconic was St. Mary of Bethlehem, located outside London also known as “Bedlam”. 

However, the treatment was qualified as brutal and inhumane towards the mentally insane.

For instance, in the 18th century, the asylum in Newcastle, England, where patients from both sexes were housed together and were used to be chained in a place that resembled a dungeon. 

Moreover, in 1845, Esquirol reported how the inhumane treatment towards patients that were considered violent, were being fastened onto their beds and they were put on a straitjacket to control their movements for too long resulting in them being paralyzed.

Drug treatment was administered by the use of Lachryma papaveris or camphor mixed with vinegar.

Physical interventions included leeches, induction of emesis to eliminate poisons from the body and trepanation.

Some treatments such as spinning the patient until loss of consciousness were also used believing that it would be helpful “rearranging” their brains, as well as insulin shock, frontal lobotomy, and other invasive surgical procedures.

It wasn’t until the 19th century where the mentally ill started to receive a more compassionate and humane treatment approach, releasing them from their chains and stopping abusive treatments. 

Psychopharmacological treatment 

A group of French Scientists discovered the antipsychotic drug named chlorpromazine in the early 1950s.

They were proven to be effective alleviating some of the positive symptoms of psychotic patients, which helped set the neurobiological processes of the disorders. 

Additional drugs termed “typical” such as thioridazine, trifluoperazine, and haloperidol had similar mechanisms of action but had serious side effects, which led to the discovery of other drugs termed “atypical” such as clozapine, but had a life-threatening side effect so its use was limited. 

Finally, scientists introduced newer atypical drugs such as Risperdal, olanzapine, quetiapine and ziprasidone that had fewer side effects compared to the other drugs used initially. 

Why is this blog about the history of schizophrenia important?

We discussed how since the beginning of the history of humankind and across many cultures, there has been a necessity to understand and classify mental illnesses. 

Explanations have gone through a series of changes from demonic possessions to witchcraft and the supernatural to our modern understanding of diseases as being a result of certain imbalances in the brain and other social and environmental factors. 

It is important to raise awareness of this condition and how originally it was perceived as “hopeless cases” where the deterioration of the person was inevitable and it ultimately could only result in death.

We have a better understanding of this mental illness now and we know that it can certainly be treated with medicines and other therapeutic approaches.

Please feel free to comment on the content of the history of schizophrenia in the comments section below. 

What we recommend for Schizophrenia

Professional counselling

If you have schizophrenia then ongoing professional counselling could be your ideal first point of call. Counselling will allow you to practice various habits that improve your overall quality of life.

Frequently Asked Questions (FAQs) about History of Schizophrenia

Recommended books

1. The Schizophrenia Spectrum 2017 (Advances in Psychotherapy: Evidence-Based Practice)
2. The Heartland: finding and losing schizophrenia 
3. Schizophrenia: Understanding Symptoms Diagnosis & Treatment
4. SURVIVING SCHIZOPHRENIA, 7TH EDITION: A Family Manual 
5. Schizophrenia: Understanding Schizophrenia, and how it can be managed, treated, and improved

References

Jablensky, A. (2010) The diagnostic concept of schizophrenia: its history, evolution, and future prospects. Dialogues Clin Neurosci.

Bible Gateway

Medscape: Martin Korn, MD.