Understanding the history of schizophrenia

From diagnosis to treatment, understanding the history of schizophrenia can help us understand how this condition is viewed today.

In 1900, Swiss psychiatrist Paul Eugen Bleuler coined the term “schizophrenia”. Derived from Greek roots, the word contains “schizo” which means “divided” and “phren”, which means “spirit”.

According to the National Alliance on Mental Illness and World Health Organization, an estimated 1.5 million people could be living with schizophrenia in the United States and 20 millions worldwide.

Schizophrenia is frequently stigmatized and misunderstood, often more so than other mental health problems. A 2010 study found that it may be common for people with schizophrenia to be perceived as dangerous, although other research suggests that most people living with the condition are generally non-violent.

Examining the origins of the disease can be an important starting point in changing the current stigma and public perception of schizophrenia.

The history of schizophrenia is loaded with ideas about spiritual causes and treatments that some may consider unethical or inhumane.

This story may be a major contributor to the current stigma surrounding schizophrenia and people living with the disease.

According to Tracy McDonough PhD, professor of psychology and chair of the Schizophrenia Oral History Project, a nonprofit organization dedicated to archiving the life stories of people with schizophrenia, “[the stigma of schizophrenia] is linked to historical beliefs about people with schizophrenia.

Schizophrenia in Antiquity

Theories about the causes and possible treatments of schizophrenia-like mental health problems date back to ancient times.

Ancient spirits frequently perceived the cause of mental illnesses such as schizophrenia as a punishment from the gods, or perhaps as a possession by evil spirits and demons. References to schizophrenia-like “madness” go back to the Old Testament, and even further.

Ancient egypt

A condition similar to schizophrenia is described in “The Book of Hearts”, a chapter devoted to mental health disorders in “The Ebers Papyrus”, an ancient Egyptian medical manuscript dating from 1550 BC.

According to Esme Wejin Wang, a best-selling author living with schizoaffective disorder, the ancient Egyptians attributed “psychosis to the dangerous influence of poison in the heart and uterus.”

Ancient Greece

Similar to the Egyptians, Hippocrates, “father of medicine” from ancient Greek, believed that conditions such as schizophrenia were rooted in biology, rather than spiritual or metaphysical causes.

According to Hippocrates, mental health disorders were caused by imbalances in the “four bodily humors” and could be treated with:

Middle Ages

Symptoms associated with schizophrenia – such as psychosis and hallucinations – were generally considered evidence of demonic possession and sin throughout Europe during the Middle Ages.

However, some medieval sources indicate that these mental health problems are caused by:

  • imbalances in the body
  • diet and alcohol consumption
  • overwork
  • mourning and loss

The institutionalization of people with mental disorders like schizophrenia in asylums or “mad towers” officially began in medieval Europe.

Common treatments for mental illness in the Middle Ages included trepanation, an early surgical procedure that involved making holes in the skull, either to relieve pressure or to free demons and spirits.

Enlightenment and modern era

Schizophrenia continued to be considered “madness” for hundreds of years. Until the mid-20th century, the treatment of schizophrenia was often experimental at best and cruel and inhuman at worst.

McDonough told Psych Central: “In the beginning, people [with schizophrenia] were considered incurable. They were often locked up in asylums. In Europe, people visited asylums as if they were going to the zoo.

McDonough continued, “Basically, [schizophrenia’s] the story is about not seeing human beings as human beings.

Philippe Pinel

At the end of the 18th century, the French physician Phillip Pinel helped pave the way for humane psychiatric treatment.

Pinel refused to chain his patients in a Parisian insane asylum and began practicing “moral therapy” in 1798, which included:

  • respect the person under psychiatric care
  • establish doctor-patient relationships based on trust and confidentiality
  • decrease in stressful stimuli or triggers
  • encourage routine activity and exercise

In treating people with mental disorders like schizophrenia with humanity, Pinel emphasized the need to:

  • hygiene
  • exercise
  • keep detailed history and records for each person

Kraepelin’s “precocious dementia”

In 1893, German psychiatrist Emil Kraepelin coined the term “dementia praecox”, which means “premature dementia”, to describe schizophrenia.

Kraepelin was one of the first to describe schizophrenia as a progressive and irreversible biological condition with potential toxic causes. His contributions to the study of schizophrenia were much more intentionally scientific and naturalistic than many of his predecessors.

Schizophrenia in the 20th century

Swiss psychiatrist Eugène Bleuler coined the term “schizophrenia” in 1900, replacing the term “dementia precocious”. Bleuler also invented the famous “four A’s” of schizophrenia describing the negative symptoms of schizophrenia, which were later replaced by the 5 A’s.

Institutionalizing people with schizophrenia was still common practice until the 20th century.

Common 20th century treatments for schizophrenia included:

  • insulin therapy for coma: repeatedly injecting large amounts of insulin to induce daily comas over a period of several weeks
  • Metrazol shock: a life-threatening form of shock therapy involving injections of Metrazol (pentylenetetrazole) to trigger seizures and coma
  • electroconvulsive therapy: stimulate or shock the brain with electricity to cause seizures
  • operation: including frontal lobotomy

Eugenics also played a dark role in treatments for schizophrenia in the 20th century. At the time, schizophrenia was considered a largely hereditary disease. Due to persistent stigma and misunderstanding, many people with schizophrenia have been sterilized, often without consent.

The first antipsychotics, such as Chlorpromazine, were developed and marketed in the 1950s. The availability of these drugs and similar drugs led to widespread deinstitutionalization in the 1960s. These drugs are still prescribed today and are considered to be “typical antipsychotics”.

The 1990s saw the development of more sophisticated antipsychotic drugs – atypical antipsychotics – to treat schizophrenia.

When diagnosing schizophrenia, psychiatrists generally use the DSM-5 criteria. Other diagnostic tools, such as self-report forms, are also used alongside qualitative clinical assessments, such as:

  • Communication disorders index
  • The Positive and Negative Symptom Scale (PANSS)
  • BPRS (Brief Psychiatric Rating Scale)
  • The mini mental state examination (“the mini”)

Schizophrenia is a treatable disease. Doctors and therapists now have a number of tools at their disposal to help people with this disorder find the best possible treatment plans for them. Many people with schizophrenia are able to manage their symptoms and lead well-balanced, fulfilling lives.

Medication

Antipsychotic drugs are often used on an ongoing basis in schizophrenia treatment plans to manage psychosis. Two classes of antipsychotic drugs are prescribed today for schizophrenia: typical and atypical antipsychotics.

Therapy

In addition to medication, there are many forms of psychotherapy that can help people with schizophrenia cope with symptoms and improve their quality of life.

Types of psychotherapy that can help schizophrenia include:

Comprehensive care

Comprehensive care programs are designed to integrate therapeutic approaches at several levels, such as:

  • individual
  • family
  • use
  • education
  • community participation

A 2016 study have found that comprehensive care programs may lead to greater success for schizophrenia than other treatments.

While many medical beliefs about schizophrenia have changed over time, cultural representations and attitudes have not caught up.

A huge stigma around schizophrenia still exists today, rooted in historical misconceptions and media representations.

The word “schizophrenic” could be used casually to describe the weather or the stock market. Worse yet, it can be used to define a person with the disease.

The pervasive myths often mistakenly associate schizophrenia with:

  • violence
  • a “childish” spirit
  • a “weak” character

Schizophrenia is often confused with “split personality” or “multiple personality disorder,” a separate condition now known as dissociative identity disorder.

For some people, the stigma surrounding schizophrenia can make the diagnosis uncomfortable. But as psychiatrist and author Elyn R. Saks wrote in her 2007 seminal book, “A diagnosis of mental illness does not automatically condemn you to a dark and painful life, devoid of pleasure, joy or fulfillment.

Mental health problems of the schizophrenic type have been recorded and treated since ancient times. Over the centuries, theories about the causes of disease have evolved from the spiritual realm to physiological means.

Treatments for schizophrenia have often included inhuman and cruel “remedies”, even as recently as the 20th century.

But thanks to evidence-based research and medical science, modern doctors and therapists have a plethora of effective tools to help treat schizophrenia.

If you live with schizophrenia, you are not alone. And if someone you love is affected by the illness, it can be helpful to learn how to support your loved one.

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