The History of Schizophrenia

Abstract

This paper reports the history of schizophrenia. It indicates the transition from an ancient perception that the disorder was a direct result of demonic possession to the medical model that is now prevalent. Ethnographic reviews have shown that schizophrenia is available in every current culture, from the pre-proficient to the most profoundly progressed. Psychotic symptomatology, as well as schizophrenic-like disorders, were obviously present in antiquated human advancements. Recorded portrayals of the illness showed up before 2000 BC in the old Book of Hearts in Egypt, which is a piece of the Ebers papyrus. By then, mental illnesses were thought to exude from the uterus and the uterus and were related to fecal matter, toxins, blood vessels, or devils. Hindu portrayals go back to around 1400 BC and can be found in the Atharva Veda, one of the 4 Vedas, which are essential writings of Hinduism. It has argued that well-being came about because of a harmony between 5 components (Buthas) and 3 humors (Dosas) and that an irregularity between these different components may bring about madness. A Chinese writing called The Yellow Emperor's Classic of Internal Medicine, composed around 1000 BC, portrayed manifestations of seizures, dementia, and insanity.Demonic possession was regularly implicated as the reason for psychotic disorders.

The theories of demonic influence were also prevalent in Greek perceptions of madness. However, the inception of rationalist theories in ancient Greece such as those of Plato in the 4th and 4th centuries BC began to change this perception. Hippocrates (460-377 BC), generated the idea that madness was a result of an imbalance among four humors of the body and that its cure would be achieved through the restoration of the imbalance through such methods as blood-lettings, purgatives, and special diets. This perception became a scientific model to the study of madness, that would later become schizophrenia. The present idea of schizophrenia is viewed as the result of a straight advance from various definitions deducing in the present. As indicated by the "progression theory" schizophrenia has dependably existed and 19th and 20th century alienists have cleaned away its flaws and polluting influences, coming full circle in the definition now offered by the DSM-IV, which can therefore be considered as a paragon of a genuine, conspicuous, unitary and stable object of inquiry. This paper uses the paradigm of continuity and discontinuity to report the conceptual history of schizophrenia. It reports that Before the 17th century, dementia was used in referring to psychological incompetence states, whether acquired or inborn; irreversibility and age were not a part of its semantics. Other terms, have been developed out of refining dementia until the invention of schizophrenia in 1908. 

Introduction

It is undisputable that identifying the exact etiology of schizophrenia is not an easy task. The quest to find out the etiology of schizophrenia can be traced to 2000 BC. Since then, attempt to discover the real etiology of schizophrenia has been ongoing. By reviewing historical documentations on etiology of schizophrenia, the paper intends to demonstrate how schizophrenia was understood in the past as opposed to how it is seen today. Therefore, the thesis of this paper is that even though schizophrenia is a common clinical term in psychiatry, its origin is mysterious and its history is not sufficient to prove. 

Ancient perception of schizophrenia

Ethnographic researchers have shown that schizophrenia is available in every current culture, from the pre-proficient to the most profoundly advanced. Psychotic symptomatology, as well as schizophrenic-like disorders, were obviously present in antiquated human advancements. Recorded portrayals of the illness showed up before 2000 BC in the old Book of Hearts in Egypt, which is a piece of the Ebers papyrus (Korn, n.d). By then, mental illnesses were thought to exude from the uterus and the uterus and were related to the fecal matter, toxins, blood vessels, or devils. Hindu portrayals go back to around 1400 BC and can be found in the Atharva Veda, one of the 4 Vedas, which are essential writings of Hinduism. It has argued that well-being came about because of a harmony between 5 components (Buthas) and 3 senses of humor (Dosas) and that an irregularity between these different components may bring about madness. A Chinese writing called The Yellow Emperor's Classic of Internal Medicine, composed around 1000 BC, portrayed manifestations of seizures, dementia, and insanity.Demonic possession was regularly implicated as the reason for psychotic disorders (Korn, n.d). 

Plato’s perception of schizophrenia

Despite the fact that hypotheses of demonic impacts additionally held influence in Greek perceptions of madness, realist speculations started to be more influential. Plato, in his works of the 4th and 5th centuries BC, upheld an extremely present day integrative conceptualization of the connection between the brain and body. In the Dialogues, he composed that "...to consider healing the head alone and leaving the rest of the body, is the height of folly... and in this way, if the head and body are to be cured, you should start by curing the spirit."( Korn, n.d). He propelled the possibility of illogical and unconscious mental processes, proposing that all individuals had a limit with respect to nonsensical thought.

Madnesses was comparatively considered as a discipline from God or the divine beings in Greek Homerian legends and mythology. However, a Greek physician, Hippocrates (460-377 BC), generated the idea madness was a result of an imbalance among four senses of humor of the body and that its cure would be achieved through the restoration of the imbalance through such methods as blood-lettings, purgatives, and special diets (Korn, n.d). This perception became a scientific model to the study of madness, that would later become schizophrenia. To present day researchers, Hippocrates' thoughts may appear to be fantastical, maybe even on the perilous side of capricious, yet in the fourth century BC, they spoke to a huge progress on the possibility of mental sickness as a discipline from God. Aristotle (384-322 BC) and later the Galen (129-216) developed Hippocrates' humoral hypotheses and assumed a vital part in building them us as Europe's predominant medicinal model. The origin of the term schizophrenia has a long and complicated history as depicted in the subsequent parts of this paper.

Modern perception of schizophrenia

It could be reasonable to presume that schizophrenia is the the perfect example of the the theory of research because of the consideration that it is a psychiatric problem better than others. In addition, it is also conceivable to presume that because of the enduring quality of the mental problem, it has a straightforward account since its initial depiction could be perceived as synonymous to its finding. To state it otherwise, it fails to add substance to the purpose itself that has undiscovered for years. Nevertheless, from its inception, there has been an advancement of many descriptive terms for schizophrenia, and it still remains unclear which one of them should be preferred to the rest (Nalplas and Brockington, 1993; Boyle, 1990; Rieder, 1974; Sarbin, 1972; McCulloch and Meduna, 1945). On the traditions of high-usage and recency, some people might desire to adopt the description that the DSM-IV promoted. However, the DSM-IV manual can only inform concerning the medical perceptions of the TFAPA (Taskforce of the American Psychiatric Association) as well as the social and political context of schizophrenia in antiquity. 

Writing the history of schizophrenia from the DSM-IV manual cannot tell anything concerning the manner in which some behaviors, concepts, and words interacted in the nineteenth century in France and Germany to generate the idea of dementia praecox. However, before this could be acceptable, an evidence-based medicine rule, which pivots assertions to be supported empirically should be applied. In this line of thought, it would imply that there has not been a crucial experiment done in the demonstration that high usage is adequate evidence for the validity of terms or that latest implies truest (Berrios, 2003). In fact, this paper explores the only support for the assumption of recency, and it calls it the continuity hypothesis. Medico-legal and peer pressures could also be a better explanation to support the assumption of high usage over truth value if the two are judged from the same token (Berrios, 2003). Really, no impartial or experiential method in existence is adequate to solve the problem concerning the referent of the mental illness that needs to be termed as the descriptive research. 

The History of Words Describing Schizophrenia

Terms are considered to be handles of convergences in psychiatry because regardless of whether they are coined afresh like in schizophrenia or recycled like the case of melancholia and mania, they are seldom informative (Berrios, 2003). Their history etymology continues to be important, but their initial meanings might linger on and influence the manner of their usage in future. 

Dementia Praecox

Dementia is a term, which has participated in about three convergences in the early eras. Before the 17th century, dementia was used in referring to psychological incompetence states, whether acquired or inborn; irreversibility and age were not a part of its semantics (McNally, 2016). Dementia was entered novel convergence by 1700s. A clinical meaning is added to the old meaning (that is still a legal term) to refer to acquired intellectual deficit states at any etiology and age (McNally, 2016). A third merging, the one present today, was negotiated towards the completion of the 1800s and it was named the cognitive hypothesis. This later denotation of dementia is used to define reasoning as memory, and further describes principles for evolution, etiology, and age. Therefore, children that have reasoning discrepancies or adults that develop them following the trauma of the head are not referred to as demented. In addition, those that improve after several days or develop them overnight are also not considered demented: i.e. dementia refers to a permanent state, which affects cognition, especially memory in the elderly persons (Berrios, 1987). Other forms of dementia were described gradually as the century wore off (Berrios, 1990; 1991). 

It would be impossible to comprehend what Morel meant by the term demence precoce without understanding these transformations in meaning. First, there is a need to establish a number of historical facts. It is not factual as Salesnick and Alexander (1966) have argued, that Benedict Morel coined the term in 1850. In fact, the term is absent from his Etudes Cliniques , but appeared in his Traite only ten years later. The later publication was a mere description and not an official clinical category . He stated: Deafness, congenital weakness of the faculties, early dementia (p. 516). A kind of stupor near stupidity replaced the former activity, and when I saw it again, I judged that the fatal transition to the state of early dementia was on the way to be effected (p. 566) (Morel, 1860). The views held by Morel were still under the control of the earlier connotation of dementia he desired to set apart a patient group with stupor that was considered a motility disorder at that time and which had a correlation with melancholia (Berrios, 1981). In his works of 1925 and 1927, Minkowski stated that Demene precoce was not a precursor to schizophrenia. He further posited that an abyss marked the boundary between Kraepelin’s definition Morel’s demence precoce (Minkowski, 1925). 

Morel’s efforts vanished when Kraepelin chose to coin his dementia praecox because Morel failed to suggest that his demence precoce be used as an authorized medical category. Other reasons also existed as to why Morel’s description vanished. For example, the meaning of dementia had changed (Gross, 1904). In addition, the classificatory and clinical challenges of stupor had already been dealt with.There is a lack of evidence to indicate that Kraepelin recognized that Morel’s descriptive term was in existence before he coined his own (Hoff, 1994). The description first appeared in his 1896 textbook under Verblödungsprocesse where he listed three independent conditions; dementia paranoides, catatonia and dementia praecox (severe and mild forms and hebephrenia). The text fails to mention Morel, but it appeared in three latter editions. The term dementia had already transformed in meaning by the time Kraepelin was composing this edition. Therefore, he realized the need to add praecox to qualify his term and it meant early or better still, not at the expected age. Because Kraepelin (1919) acknowledged Morel in his latter edition indicates that somebody might have indicated to him that a French form of the word was already in existence. It is reported that such attention from a Latinized form of the term used by Arnold Pick in 1891 (Pick, 1891). Therefore, there is little point in attempting to determine a continuity between Kraepelin and Morel as Wender (1963) did. 

Schizophrenia 

Bleuler 

According to Bleuler (1908), Schizophrenia appears to have been first invented in 1907 and is still a misleading neologism. Bleuler introduced a fundamental distinction between basic (obligatory) and accessory (supplementary) symptoms of the disorder. While the accessory symptoms comprised the delusions and hallucinations that today are commonly classified as “positive” symptoms,then they are also negative symptoms ...” (Jablensky, 2010 p. 274). The reasons that Bleuler put forward in explaining why he coined the term are not convincing. For example, he states that he chose to call dementia praecox schizophrenia for the fact that as he hoped to indicate, the splitting of the various functions of the psychic was among the most critical features (Bleuler, 1911). This appears straightforward, but to believe so would be misleading. The meaning he accorded splitting and psychic function is considered ambiguous and requires clarification. Bleuler gave credence to the ideology of splitting of psychic functions because it was in existence and the splitting happened vertically, which implies that it was used in separating mental functions from one another (Bleuler, 1911). This splitting constitutes the mind’s functional model; therefore, there was a clear differentiation between schizophrenia and dementia praecox (Bleuler, 1911). Stated otherwise, the change was another form of convergence and not just a transformation of the name like stated in this paper. 

Jung

This is the manner in which Jung seems to to have comprehended it: as per his depiction (Bleuler's), some sort of breaking down is included, in light of the fact that the affiliations appear to be unconventionally damaged and incoherent. He (Bleuler) declines to acknowledge Wernicke's idea of "sejunction" in view of its anatomical ramifications. He favors the expression "schizophrenia" clearly thoughtful by this a useful unsettling influence' (Jung, 1972, p. 234). Such perspective of schizophrenia made an issue of the differential finding of madness and different states putatively because of dissociative systems (Guraud, 1985). Jung was oriented to think that the separation in schizophrenia is significantly more genuine, as well as frequently it is irreversible. The separation stopped being fluid and alterable like the case of depressions such as the neuroses; it is more similar to a glass broken into fragments. The solidarity of the identity that, in hysteria case, loans a humanly reasonable character to its own particular auxiliary identities is unquestionably broken into pieces (Jung, 1972, p. 2350). What is more, in regards to the change of name itself: from the mental perspective, the transformation in nomenclature is irrelevant, since it has less incentive to the name of a thing than to comprehend what it is' (Jung, 1972, p. 155).

The Metaphor of Splitting

When all is said and done, what was the function of the component of "splitting" relating to German psychiatry then? Beginning at the onset the 1800s, Romantic Psychology research and the works of Scharfetter documented in 1975, the analogy of isolating, apportioning, breaking, separating or partitioning of psychological functionalities ended up plainly prevalent to clarify erratic and odd human conduct (McNally, 2016). The illustration was utilized as a part of well-known folk and literature and scientific psychology. For instance, it was as of then present, in the state of a functional theory in the two-brains hypothesis of Wigan (McNally, 2016). Starting the 1850s and beyond, it swarmed writings. For instance, the writings were prevalent in philosophy (Hartmann's theory of the oblivious), neurophilosophy (Jackson’s various-leveled hypothesis of the brain), consciousness (mental automatism, Azam's separation; different identities, and so forth.), and neurology (such as Charcot's thought of hysteria). Such writings, at the completion of the century, went ahead to motivate both Freud ( the idea of partitioning the Ego) and Wernicke ('sejunction') (Compi, 1980). 

Subsequently, it is little pondering that Bleuler's utilization seemed well and good to most scholars. In its lengthy antiquity, the splitting of "splitting" was caused to happen both on a level plane and perpendicularly, and both between and inside functions or structures. Various contrasting options to dementia praecox, in light of a form of the separating system, were accessible at the time: intrapsychic ataxia, dementia sejuctiva , dementia dessecans , and discordance among others. Its illustrative power was, accordingly, practically unending.

The Contemporary Perception of Schizophrenia Compared to Ancient Times 

While schizophrenia was thought to be caused by demonic possession in its early antiquity, its history indicates an evolution to the modern perception of the mental disorder. For instance, schizophrenia is currently considered as a severe disorder of the mind that affects the manner in which patients act, feel and think (Boyle, 2014). The efforts of scientific researchers in history have been the foundation for a better understanding of schizophrenia. For instance, it is reported that the American psychiatry adopted Bleuler and Adolph Meyer’s trajectory while European psychiatry chose to follow Kraepelin (McNally, 2016). This and the effect of psychoanalysis, as well as Adolph Mayer, resulted in the blur schizophrenia definitions that the DSM I and II offered (Raskin, 1975) (cited in Berios, 2003). Nevertheless, consistent empirical research picks up the differences between Europe and the US e.g. the US-UK study, the study by WHO among others. There is the discovery that Schneider and Kraepelin and the obscurantist era paved the way for a novel idea of genetic psychiatry. The DSM III is an initial expression of the novel science while the DSM-IV gives schizophrenia’s definition that, though not de jure, appears de facto to be considered the new model of explaining schizophrenia (Berrios, 2003). The DSM-IV gives the diagnostic criteria for schizophrenia, which means that the efforts to describe the disease in antiquity have now been transformed into clinical practice. 

For this reason, modern psychiatrists and other mental health practitioners had explored methods of treatment that include therapies and medications based on more advanced criteria of diagnosis offered by the DSM-V as opposed to the 17th century when little was done in terms of medication. However, the causes of schizophrenia are still unknown, which means that the mental problem remains mysterious. For example, the models explaining the causes of schizophrenia include immune disorders, possible viral attack, abnormalities in the structure and chemistry of the brain and genetic factors. Concerning heredity, modern scientists have the belief that schizophrenia appears to run through family generations and that people inherit the tendencies to develop the mental health disorder (Boyle, 2014). They believe that schizophrenia might occur when the body of individual experiences physical and hormonal changes such as those which happen in adolescence just as the rest of the illnesses related to heredity (Boyle, 2014). Modern scientists also appear to favor the conceptualization that persons suffering from the disorder have some imbalances in their brain chemicals as well as neurotransmitters such as serotonin, glutamate, and dopamine. They consider that such imbalances alter the way the individuals’ brains react to stimuli (Boyle, 2014). This perception is considered viable for explaining why people that suffer from schizophrenia could be unable to handle sensory information, which other people will have no problem handling. In addition, modern advances in research has led to the discovery of different subtypes of schizophrenia. For example, according to Bengston (2016), the following as the subtypes of schizophrenia: paranoid subtype, disorganized subtype, catonic subtype, undifferentiated subtype, and residual subtype. These subtypes of the mental health disorder are considered to affect approximately 1 per cent of the population worldwide and close to 1.2 per cent of Americans (Dombeck and Nemade, 2009). The cited authors posited that “About 1.5 million people will be diagnosed with schizophrenia this year (2009) around the world. In the United States, this means about 100,000 people will be diagnosed, which translates to 7.2 people per 1,000 or about 21,000 people within a city of 3 million who are likely to be suffering from schizophrenia” (p. 1). 

As much as the modern understanding of schizophrenia has led to medical and therapeutic forms of treatment of the disease, the theories that explain the causes of the problem have not led to a real cure for the disease. However, what has changed from antiquity is the fact that people that suffer from the mental health problem could lead normal reproductive lives when an appropriate intervention is sought. What is even more important is the emphasis on the need to seek early medical and psychiatric care when people experience symptoms likely to insinuate the problem (Boyle, 2014). 

The historical backdrop of schizophrenia can be best depicted as the historical backdrop of an arrangement of research projects that have attempted to explain the disease better. Authentic research demonstrates that there is minimal theoretical congruity among Schneider, Bleuler, Kraepelin and Morel in order of their contributions to tracing schizophrenia in antiquity. Two outcomes take after from this result. The first is that the possibility of a direct movement culminating in the present is mythological. The second that the present perspective of schizophrenia is not the consequence of one definition and a single piece of research. More research is expected to discover why schizophrenia in antiquity remains mysterious. It may just be the aftereffect of historical unawareness or the use of some uninspired operationalism. This issue is not a serious concern. What makes a difference is that the story of continuity among the works of researchers in antiquity be disallowed on the grounds that its primary function is to compliment and legitimize the present and not to lit it up. However, as this paper has demonstrated, the works of scientists as early as the 17th century have paved the way for the modernized perception of schizophrenia through the development of the DSM-IV and latter the DSM-V diagnostic manuals. 

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