A Brief History of the Schizophrenic Diagnosis
Introduction
Schizophrenia is a heterogeneous disorder and can be characterized by any of the following symptoms: intellectual deterioration, emotional blunting, disorganized speech, disorganized behavior, social isolation, delusions, and/or hallucinations (American Psychiatric Association [APA], 2000). Schizophrenia is not a disorder of multiple personalities as it is often depicted in popular media (that disorder is dissociative identity disorder), but instead the term as was coined by Bleuler means “split mind.” This was depicted by Eugene Bleuler as a splitting of cognition from personality (Cohen, 2003).
Prevalence
Schizophrenia has a prevalence rate of approximately one in one hundred persons in the United States. It is one of the most crippling mental disorders and at the same time one of the least well understood. Schizophrenia is not a gender specific or culture specific disorder; it exists in all cultures. The ratio of overall cases favors neither men nor women. The disorder most often appears before the age of 20 in men and woman often have a later onset with more mood disturbance and a better prognosis. Schizophrenia accounts for nearly one third the homeless population in the United States, and costs the U.S. alone over 50 billion dollars a year (APA, 2000).
Brief History
Schizophrenia is a relatively modern disorder. There have been reports in the past and in mythology of conditions that appear to resemble schizophrenia, but these descriptions of madness, hallucinations, and delusional behaviors may not have been forms of schizophrenia. Such depictions may have been caused by a traumatic brain injury, a brain infection, stroke, another mental disorder such as bipolar disorder or depression or any other psychotic disorder (Cohen, 2003).
Some of the earliest descriptions of mental disorders believed to be genuine descriptions of schizophrenia are found in 1809 in reports from John Haslam at the Bethlem Royal Hospital in London, England and those from Philippe Pinel at the Salpêtrière asylum in Paris, France. These descriptions appear to reasonably meet the diagnostic criteria currently considered important in the diagnosis of schizophrenia even though during that time there was no standardized classification system of mental disorders. Of course at that time diagnoses could easily differ from place to place; however, even this situation was a radical improvement over the previous theories of mental illness. Well into the 19th century the predominant theory mental illness was a theory of imbalances in bodily fluids that had persisted since the time of the Greeks and Romans. Mental disorders and physical illnesses were believed to be caused an excess of one of the four humours: yellow bile, black bile, blood, or phlegm. Treatments such as bloodletting, purging, and the use laxatives were popular for all forms of illness under this paradigm (Cohen, 2003).
Up until the 1500’s the care for mentally ill or for the insane was the providence of priests, monks, and nuns. However, in the 17th century those with mental illnesses and the infirm began to receive care in more centralized facilities such as jails and hospitals. During this period physicians were put in charge of these institutions and began to study the patients. Such physicians were labeled as “mad-doctors” or “lunatic-doctors.” By late in 19th century they were called “alienists” which referred to the notion that someone with a form of madness had lost of a sense of himself and had been “alienated” from the self. Probably the most famous of these physicians was Emil Kraepelin, a German psychiatrist, who believed that a defining feature of the disorder he observed in some was the deterioration of the patient’s mental faculties over time. Kraepelin defined two classes of mental disorders: Dementia Praecox because it affected primarily the young and led to them aging or deteriorating mentally before their time, and Manic Depression (which included all forms of depression). Eventually Kraepelin’s diagnostic scheme would serve as a model for the DSM diagnostic format that is used in the United States today (Pinel, 2009).
However, as mentioned above it was Swiss psychiatrist Eugene Bleuler, who was a contemporary of Kraepelin, who refined diagnostic term and criteria for dementia praecox. Bleuler had personally treated patients who appeared to recover and function normally for brief periods of time. Therefore, Bleuler did not agree with Kraepelin’s term, dementia, as accurate as there was not always a decline in these patients. Bleuler’s clinical observations had led him to believe that these patients actually suffered from schizo (split) phrenia (minds). He conjectured the cause of schizophrenia to be a brain abnormality and not a degeneration of the brain as the term dementia praecox implied. Bleuler finally won out and his designation of schizophrenia was used commonly beginning in 1911 (Cohen, 2003; Sadock & Sadock, 2007).
Next: Part II Diagnostic Issues (To Read Part II Click here)
Rudy Hatfield - I am a clinical neuropsychologist with extensive experience in the assessment and treatment of neurological and psychiatric disorders. I ...
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