History of schizophrenia

The history of schizophrenia is akin to that of madness. Madness has been observed and recorded for centuries. There are accounts from Hippocrates in 400BC, as well as from Egypt in the days of the Pharaoh.

The first detailed account in literature of a case of paranoid schizophrenia is thought to be that of James Matthews in the 1790s. He was admitted to the Bethlem (Bedlam) psychiatric hospital after he accused the government of trying to kill him.

The first distinct syndrome resembling schizophrenia was described by Benedict Morel (1809-1873), a French psychiatrist, in 1853 when he described early adults suffering from what he termed ‘demence precoce’ which meant early dementia. Arnold Pick first used the term ‘dementia preacox’ in 1891 in a case report of a psychotic disorder.

In 1887 Emile Kraeplin (1856-1926) began classifying mental illness into diagnostic categories. He believed that dementia praecox was a biological illness of the brain, and a form of early dementia, distinguishing it from later dementias like Alzheimers. He distinguished dementia praecox with a long-term deteriorating process from manic depression, which had distinct episodes of illness alternating with periods of normal functioning, and from the insanity of syphilis.

The word ‘schizophrenia’ was first used by Eugen Bleuler in 1911, and he also started the classification of positive and negative symptoms. The name schizophrenia stems from Greek, ‘schizo’ meaning split and ‘phrene’ meaning mind. This has unfortunately not helped in dispelling the myth that schizophrenia is a form of multiple or split personality. Split personality is classified as a dissociative disorder, which differs completely from schizophrenia. Bleuler chose the term 'schizophrenia' to express the schisms between thought, emotion and behaviour in patients with the disorder.

Bleuer identified specific fundamental symptoms of schizophrenia. These symptoms are summarised in the four As: flattened Affect, Autism, Association of ideas and Ambivalence. He also included accessory symptoms which included those which Kraeplin saw as major indicators of praecox dementia: hallucinations and dementia.

Schizophrenia was later seen as a hereditary defect, and people with the disorder were subjected to eugenics. Eugenics is the practice of improving the genetic composition of a population. In the case of humans this meant that people were subjected to sterilization, mainly in the United States, Nazi Germany and the Scandinavian countries. They were also murdered in Nazi concentration camps.