When speaking about the history of schizophrenia, one must consider a specific question first. It is difficult for us to retrospectively diagnose people who have passed on simply by reading biographies and accounts of their behavior. So the question remains… has schizophrenia always existed, or is it a relatively new disease or psychological condition related to our time, culture, and the state of our environments? It is not an answerable question, but offers a valuable insight if held in the back of the mind while pursuing information on the history of this mental illness.
So did schizophrenia develop in the early 20th century or was it discovered and labeled at this time? Let’s go back further in time and perhaps you can come to your own conclusions. But before we start, there are also other considerations that are important to take into account, just as the cultural relativity of this diagnosis. To those in the Western world, schizophrenia is an illness that should be suppressed in order to return to full functioning in society.
In other cultures, there is a sense of reverence for the schizophrenic. They can be considered prophets, healers, holy men, shamans, and god-intoxicated. The process should be allowed to unfold fully without intervention, only support. When this person emerges on the other side of the experience, they should be more healthy than when they began and will have gained insight and skills that will place them beyond the rest of society and well-respected within the community.
This preamble is just a reminder that schizophrenia has been a dynamic label for a cluster of symptoms, and the label has moved, changed names, and covered different areas over time. With that being said, the history is not clear, but we can make an attempt.
The Earliest Eras of Schizophrenia
Before the 19th century there were many reports of individual acting in peculiar fashions. None of them were specifically labeled as schizophrenia particularly because the term itself along with the identifiable constellation of symptoms had not been delineated just yet. There are reports that go so far back in history that they were written on papyrus by Egyptians. Greeks and Romans in ancient times wrote of psychotic episodes that somewhat resemble those of the schizophrenic.
In the Middle Ages, conditions more closely related to the modern day idea of schizophrenia were reported in the medical literature of the Arabic community. Early apothecaries and physicians who were studying the mind and behavior of erratic individuals began to notice a type of “severe madness” that was different than the common types of mania being observed. Although some historians of the psychological world would believe that this lack of evidence means schizophrenia is an isolated condition of the modern world, it is quite obvious to multi-disciplinarians that there are some obvious incidences of schizophrenia in tribal cultures that still survive today, although they are not regarded as illnesses so much as blessings. The Indian ayurvedic literature describes a cluster of symptoms that very closely resemble schizophrenia, for instance.
Of course, the ideas that were considered religious or spiritual aren’t examined in the perusal of psychological history. Shamans and possession cases weren’t thought of as mental illnesses, but cases of some form of transcendental intervention. In shamanic and witch doctor cases, these people were allowed to work through this episode in order to become leaders and healers for the community. In the Middle Ages, the possession cases were sadly burned, drowned, and otherwise mistreated by practices of bloodletting or drilling holes in the skull to allow the spirit beings to escape the brain.
The First Specific Cases in Modern Medicine
In 1853, Benedict Morel coined a term called “early dementia” which occurred, rather than in the elderly, in young adults and even teenagers. The largest influence in the separation of this “new” type of disease from mood disorders such as manic depression was made by Emil Kraepelin in 1893. He specifically distinguished it from mood disorders and other types of dementia, like Alzheimer’s, which is found in the later stages of human life. It also was known as developmental insanity, meaning it occurred in adolescents in a particular stage of development, from around the ages of 18 to 25.
In 1871, Ewald Hecker began using the term “hebephrenia” to label those who had the silliness of cognitive disorganization. This term is alive today in order to help comprehend certain subtypes of disorganized schizophrenia.
The Invention of the Term Schizophrenia
In 1908 a man named Eugen Bleuler spent much time focused on this peculiar psychological condition and set about attempting to describe the difficulty in unified functioning. That is, he noticed there was some “split” between the personality, the cognitive abilities of reasoning, the recall of memories, and the perception of the incoming stimuli, whether external or internal. Bleuler was inspired by the Greek root words referring to “mind” (phren) and “to split” (schizein). Thus, the coined the term “schizophrenia” to mean “the splitting of the mind.”
He identified four main symptoms related to this condition as the Four A’s of Schizophrenia: Affect, Austim, Association, and Ambivalence, all referring to impairments of the feeling and thinking mind. Bleuler did it! He outlined the symptoms and coined the modern label, and for that we are grateful, because it is responsible for the forward movement in the medical community.
Unfortunately, even after this progress was made, there remained some mistreatment of people living with schizophrenia, such as sterilization and eugenic “cleansing.” The use of insane asylums became prevalent around this time as well, where people were bound, locked in a cell, and even flogged. People could pay money to wander through like they were visiting a human zoo. But there have also been those who have risen to the cause and defended schizophrenics, saying, rather than classifying them as subordinate people with illnesses, that schizophrenics are highly intelligent and emotionally sensitive people who have problems dealing with the reality of the sick world we now live in. Confrontation with a sick society and broken field of study that labels and deals with those labels rather than each individual case can cause anyone to appear to be behaving madly. This is just another angle and approach to attempting to comprehend the condition of schizophrenia, and it is appreciated.
Moving Towards the Present and The Future
While the standards of mental institutions continued to slowly improve, treatments were still being developed and misused. Our schizophrenic brothers and sisters were being exposed to ECT, or electro-shock therapy, which sent a surge of electrical activity through the brain, thought to “reset” the brain. This simply left the patients docile, but not necessarily improved. It seems to be more of a management motive than a recovery treatment. The same goes with lobotomies.
Fortunately, in the 1950’s, antipsychotic medications began appearing on the market, such as Thorazine, which has been successfully used but is depreciated in preference for antipsychotics that cause lesser and less side effects. They are not perfect by any means, but are our most progressive and compassionate forms of therapy at the moment and have contributed to the fulfillment of happy and productive lives for those who are continuing to struggle with schizophrenia.
At the time of this writing, in the autumn of the year 2012, there is no current cure for schizophrenia. We continue to learn more of the condition which will continue to improve the treatment modalities offered. The ultimate goal then is either a cure or a total prevention of the occurrence of schizophrenia.