Schizophrenia historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Irfan Dotani
Overview
Schizophrenia the name comes from the Greek roots schizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-, "mind"). Studies suggest that genetics, early environment, neurobiology and psychological and social processes are important contributory factors. Historically there was debate as to whether schizophrenia was in fact a single disorder or a combination of separate discrete psychiatric disorders. For this reason, Eugen Bleuler termed the disease the schizophrenias (plural) when he coined the name.
Historical Perspective
- Descriptions of schizophrenia-like symptoms date to 2000 BC in the Book of Hearts—part of the ancient Ebers papyrus.
- However, the study of the ancient Greek and Roman literature shows that although the general population probably had an awareness of psychotic disorders, there was no recorded condition that would meet the modern criteria for schizophrenia.[1]
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- Although a broad concept of madness has existed for thousands of years, schizophrenia was only classified as a distinct mental disorder by Emil Kraepelin in 1893.
- He was the first to make a distinction in the psychotic disorders between what he called dementia praecox (early dementia—a term first used by the psychiatrist Bénédict Morel [1809–1873]) and manic depression.
- Kraepelin believed that dementia praecox was primarily a disease of the brain,[2] and particularly a form of dementia, distinguished from other forms of dementia, such as Alzheimer's disease, which typically occur later in life.[3]
- The word schizophrenia—which translates roughly as "splitting of the mind" and comes from the Greek roots schizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-, "mind")—was coined by Eugen Bleuler in 1908 and was intended to describe the separation of function between personality, thinking, memory, and perception.[4]
- Bleuler described the main symptoms as 4 A's:[5]
- Flattened Affect
- Autism
- Impaired Association of ideas
- Ambivalence
- Bleuler realized that the illness was not a dementia as some of his patients improved rather than deteriorated and hence proposed the term schizophrenia instead.
- The term schizophrenia is commonly misunderstood to mean that affected persons have a "split personality".
- Although some people diagnosed with schizophrenia may hear voices and may experience the voices as distinct personalities, schizophrenia does not involve a person changing among distinct multiple personalities.
- The confusion arises in part due to the meaning of Bleuler's term schizophrenia (literally "split" or "shattered mind").
- The first known misuse of the term to mean "split personality" was in an article by the poet T. S. Eliot in 1933.[6]
- In the first half of the twentieth-century schizophrenia was considered to be a hereditary defect, and sufferers were subject to eugenics in many countries. *Hundreds of thousands were sterilized, with or without consent—the majority in Nazi Germany, the United States, and Scandinavian countries.[7][8] Along with other people labeled "mentally unfit", many diagnosed with schizophrenia were murdered in the Nazi "Action T4" program.[9]
- The diagnostic description of schizophrenia has changed over time.
- It became clear after the 1971 US-UK Diagnostic Study that schizophrenia was diagnosed to a far greater extent in America than in Europe.[10]
- This was partly due to looser diagnostic criteria in the US, which used the DSM-II manual, contrasting with Europe and its ICD-9.
- This was one of the factors in leading to the revision not only of the diagnosis of schizophrenia, but the revision of the whole DSM manual, resulting in the publication of the DSM-III.[11]
Schneiderian Classification
- The psychiatrist Kurt Schneider (1887–1967) listed the forms of psychotic symptoms that he thought distinguished schizophrenia from other psychotic disorders. *These are called first-rank symptoms or Schneider's first-rank symptoms, and they include delusions of being controlled by an external force; the belief that thoughts are being inserted into or withdrawn from one's conscious mind; the belief that one's thoughts are being broadcast to other people; and hearing hallucinatory voices that comment on one's thoughts or actions or that have a conversation with other hallucinated voices.[12] The reliability of first-rank symptoms has been questioned,[13] although they have contributed to the current diagnostic criteria.
Cultural references
- The book and film A Beautiful Mind chronicled the life of John Forbes Nash, a Nobel-Prize-winning mathematician who was diagnosed with schizophrenia. The Marathi film Devrai (Featuring Atul Kulkarni) is a presentation of a patient with schizophrenia. The film, set in the Konkan region of Maharashtra in Western India, shows the behavior, mentality, and struggle of the patient as well as his loved ones' struggle.
- It also portrays the treatment of this mental illness using medication, dedication and lots of patience of the close relatives of the patient.
- Other factual books have been written by relatives on family members; Australian journalist Anne Deveson told the story of her son's battle with schizophrenia in Tell me I'm Here, later made into a movie.[14]
- In Mikhail Bulgakov's Master and Margarita the poet Ivan Bezdomnyj is institutionalized and diagnosed with schizophrenia after witnessing the devil (Woland) predict Berlioz's death.
- The book The Eden Express by Mark Vonnegut accounts his struggle into schizophrenia and his journey back to sanity.
References
- ↑ Evans K, McGrath J, Milns R. (2003). Searching for schizophrenia in ancient Greek and Roman literature: a systematic review. Acta Psychiatrica Scandanavica, 107(5), 323–330. PMID 12752027
- ↑ Kraepelin E. (1907) Textbook of psychiatry (7th ed) (trans. A.R. Diefendorf). London: Macmillan.
- ↑ "Conditions in Occupational Therapy: effect on occupational performance." ed. Ruth A. Hansen and Ben Atchison (Baltimore: Lippincott, Williams & Williams, 2000), 54–74. ISBN 0-683-30417-8
- ↑ Kuhn R; tr. Cahn CH (2004). "Eugen Bleuler's concepts of psychopathology". Hist Psychiatry. 15 (3): 361–6. doi:10.1177/0957154X04044603. PMID 15386868.
- ↑ Stotz-Ingenlath G. (2000). Epistemological aspects of Eugen Bleuler's conception of schizophrenia in 1911. Medicine, Health Care, and Philosophy, 3(2), 153–9. PMID 11079343
- ↑ Turner T. (1999) 'Schizophrenia'. In G. E. Berrios and R. Porter (eds) A History of Clinical Psychiatry. London: Athlone Press. ISBN 0-485-24211-7
- ↑ Allen GE. (1997). The social and economic origins of genetic determinism: a case history of the American Eugenics Movement, 1900–1940 and its lessons for today. Genetica, 99, 77–88. PMID 9463076
- ↑ Read J, Masson J. (2004) Genetics, eugenics and mass murder. In J. Read, L.R. Mosher, R.P. Bentall (eds) Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. ISBN 1-58391-906-6
- ↑ Lifton RJ. (2000) The Nazi Doctors: Medical Killing and the Psychology of Genocide. Basic Books. ISBN 0465049052
- ↑ Wing JK (1971) International comparisons in the study of the functional psychoses. British Medical Bulletin, 27 (1), 77–81. PMID 4926366
- ↑ Wilson M. (1993) DSM-III and the transformation of American psychiatry: a history. American Journal of Psychiatry, 150 (3), 399–410. PMID 8434655
- ↑ Schneider, K. (1959) Clinical Psychopathology. New York: Grune and Stratton.
- ↑ Bertelsen, A. (2002). Schizophrenia and Related Disorders: Experience with Current Diagnostic Systems. Psychopathology, 35, 89–93. PMID 12145490
- ↑ Deveson, Anne (1991). Tell Me I'm Here. Penguin. ISBN 0-14-027257-7.