SCHIZOPHRENIA

TheHistoryofSchizophrenia
LaithMasarweh
ChapmanUniversity

Definition

Schizophreniaisaseverementaldisordercharacterizedbysome,butnotnecessarilyall,

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ofthefollowingfeatures:emotionalblunting,intellectualdeterioration,socialisolation,
disorganizedspeech,behaviordelusions,andhallucinations.Delusionsarebeliefsthatarenot
true,likepeoplearetryingtohurtthem,believingotherpeoplecanreadtheirmind,ortheyhave
specialabilitiesorpowers.Hallucinationsarehearingvoicesthatarenotthere.Peoplewith
schizophreniamayalsosee,smell,taste,andfeelthingsthatarenotthere.Disorganizedspeech
iswhentheindividualspeaksinwaysthatarehardtounderstandorusessentencesthatmight
notmakesense.Sometimesthespeechiscompletelyincomprehensible.
Causes

Schizophreniaisquitepossiblethemostdreadedpsychologicaldisorderthereis.Itisalso
oneofthemostheavilyresearched(Myers,1998).Unfortunatelythereisnoconcreteevidenceto
pointtowardonesimplecause.However,thereareseveralfactorsthathavebeenresearched,and
havebeenproventoincreasevulnerabilitytothisdisorder.Geneticpredisposition,brain
abnormalities,prenatalandperinatalhavebeendiscussedasanarrayofcontributingcauses.
Thereisnodoubtthatgeneticpredispositionenhancestheprobabilityofschizophrenia.Achild
whohasabiologicalparentthathasbeendiagnosedwithschizophreniahasapproximatelyaone
ineightchanceofdevelopingthisdreadeddisorder(Berger,2010).Beingatwinalsoincreases
therisk,monozygotictwinsconcordanceraterangesfrom3050%,whileadizygotictwinrate
decreasestoabout15%.Whilethereisaconsiderabledrop,theseratesarestillconsiderably
higherthata1%ratewhichisfoundinthegeneralpopulation(McCance&Huether).Whilethe
geneticcontributionisunquestionable,thegeneticroleisnotquitesostraightforward.An
individualmaycarrythegenesforschizophrenia,butnotnecessarily
manifesttheillness.In1983behaviorgeneticistsSusanNicolandIrvingGottesmandetermined
thatsomepeople:
havethegeneticpredispositiontothedisorderbutthatthispredispositionbyitselfisnot
sufficientforthedevelopmentofschizophrenia(Myers,1998).

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Schizophreniamaybecarried,andthusareactiontoaparticularsituationorexperiences
wouldbethedevelopmentofthedisorder.Asourtextsuggestsstressmayalsobeacontributing
factor.ConsideringyoungadultswhoimmigratedtoAmerica,thosethathavenofamily
memberstoeasetheirstressfulsituationsarethreetimesaslikelytosufferfromschizophrenia
(Berger,2010).
Brainabnormalities,bywayofimbalancesinbrainchemistryhavealsobeenlabeledasa
linkinthecausesofschizophrenia.Onekeytounderstandingschizophreniainvolvesthe
neurotransmitterdopamine.Afterdeathbrainautopsiesofpatientsshowedasixfoldexcessof
dopaminereceptors.Atthisratedopaminecouldintensifybrainsignals,creatingpositive
symptomsofschizophrenia.Onesupportingfactorinthistheory,isthatwhendiagnosed
individualsusedrugssuchasamphetaminesandcocaineknowntoincreasedopaminelevels,
thesedrugssometimesintensifyschizophrenicsymptoms.Suchactivitymaybewhatmakes
victimsoverreacttoirrelevantinternalandexternalstimuli(Myers,1998).
Anotherleadingtheoryisprenatalandperinatalfactors,braindevelopmentdefectsthat
occurinfetallife.Environmentalinfluencesinterferewithgeneticallyprogrammedbrain
development,whichleadstovariationsinneuraldevelopment(McCanceandHuether).Onelink
thathasbeenreportedisbetweenschizophreniaandviralinfectionsduringpregnancy.These
resultscomefromaFinnishstudyofpregnantwomenwhowereexposedduringtheirsecond
trimestertotheA2influenzavirus.Diagnosisoftheiroffspringindicatedanincreasein
thedisorder.Womenwhowereexposedduringtheirfirstandthirdtrimestersshowedtheir
childrenwerenotaffectedanymorethanthecontrolgroup.Thistheorywouldsupportthatthe
fetusweresubjectedtothevirus,whichisateratogenduringasensitiveperiodofdevelopment
(Berger,2010).Itisduringthesecondtrimesterthatcorticalneuronsaredevelopingandswiftly

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migratingtotakeupposition,orientation,andconnections.Interferenceofthisprocessmaylead
tobrainabnormalities,whichhavebeenobservedinschizophrenicpatients.
EarlyHistory

Thebeginningsofschizophreniaarehardtopinpointinhistorybecauseanypersonwho

hadmentalillness,mentalretardationorphysicaldeformitieswerelargelytreatedthesame
(TheHistory,n.d.).Itisbelievedthattheearliestwrittenhistoryofadiseasewith
schizophrenialikesymptomswasasearlyas1400B.CinancientEgyptianmanuscripts(Beer,
2001).Otherevidencepointingtoahistoryofmentalillnesssuchasschizophreniaisthe
archaeologicaldiscoveryofStoneAgeskullswithburrholesdrilledintotheminordertoallow
spiritstoescape(Burton,2012).
Theearliesttheoriesofmentalillnesseswerethetheorythatevilhadpossessedabody.
Thiscouldhappenthroughthepossessionbyorinvolvementwiththedevilorotherevilspirit.
Inthefourteenthandfifteenthcenturies,itwascommonforpeoplewhowerebelievedtobe
possessedtobeburnedtodeath.Peopleofthedaybelievedthatmentalillnesswasapunishment
fromGod.By1563,JohannWeyerwroteDepraestigiisdaemonum,whichofferedtheopinion
thatmentallyillpeoplewerenotpossessedorbeingpunished,butratherthatitwasanatural
state.TheChurchdidnotapproveofthemessage,forbadethebook,andcalledWeyerasorcerer
(Beer,2001).Thiseffectivelystoppedanyscientificadvancementformentalillnessatthetime.
Bythelate1700's,physiciansbegantotreatanddiagnosementalillnessesdifferently.
PhysicianPhillippePinelhypothesizedthatmentalillnesscouldbearesultofbeingexposedto
psychologicalandsocialstressors,andcalledforamoraltreatmentforthosewhowere
mentallyill.DuringthistimethefirstinsaneinstitutionwasopenedintheBritishIsles
(Burton,2012).Inthelastpartofthe1800'smentalillnesseswerestartingtobecome
differentiatedbyscientistsanddoctors.In1871,EwaldHeckerdescribedthesymptomsof

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cognitivedisorganizationandsilliness,adescriptionthatisstillusedinmoderndiagnosisof
disorganizedschizophrenia(Historyof,n.d.).Schizophreniawasfirstdescribedandidentified
asit'sownmentalillnessin1887byDr.EmileKraepelin,althoughitisnotcalledschizophrenia
atthetime(Beer,2001).
NamingofSchizophrenia

ThefirstpersontoclassifymentaldisorderswasDr.EmileKraepelin.Thenamehegives
toschizophrenicsymptomsisdemetiapraecox,whichliterallymeansearlydementia.He
namesitthistodistinguishitfromdementia,suchasAlzheimers,thatheobservesinhisolder
patients,sincethesymptomsappearinapatient'slateadolescencetomidtwenties(Historyof,
n.d.).Kraepelinalsodescribedthefirstthreetypesofschizophrenia:disorganized,catatonicand
paranoid.Bothresidualandundifferentiatedhavebeenaddedastypesofschizophrenia;
however,theclassificationsdonothelptopredicttheoutcomeofthedisorder,andare
thereforenotusefulinthediagnosis.
SwisspsychiatristEugenBleulerusedthetermschizophreniain1911.Bleulernotedthat
patientswithdemetiapraecoxoftendidnothavethesymptomsofmentaldeteriorationthatwere
hallmarksofdementia.Healsorecognizedthatitwaslikelyforittooccurearlyinlifeaswellas
later.Becauseofthesereasons,hearguedthatitwasnotaformofdementia,andshouldbegiven
itsownname:schizophrenia.Thenameschizophreniameanssplitmind,andwasusedto
describethefragmentedthinkingofpeoplewiththedisorder(Berger,2010).Bleuleralso
believedthatschizophrenialedtoheightenedconsciousnessofmemoriesandexperiences
(Burton,2012).In1957,KurtSchneidercreatedthecurrentdefinitionofschizophrenia(History
of,n.d).
HistoryofTreatment

WrittendocumentsthatidentifySchizophreniacanbetracedtotheoldPharaonicEgypt,

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asfarbackasthesecondmillenniumbeforeChrist.Depression,dementia,aswellasthought
disturbancesthataretypicalinschizophreniaaredescribedindetailintheBookofHearts.The
HeartandthemindseemtohavebeensynonymousinancientEgypt.Thephysicalillnesseswere
regardedassymptomsoftheheartandtheuterusandoriginatingfromthebloodvesselsorfrom
purulence,fecalmatter,apoisonordemons.ArecentstudyintotheancientGreekandRoman
literatureshowedthatalthoughthegeneralpopulationprobablyhadanawarenessofpsychotic
disorders,therewasnoconditionthatwouldmeetthemoderndiagnosticcriteriafor
schizophreniainthesesocieties.
Treatmentsofschizophreniahavevariedovertheyearstocorrespondwithpeople's
beliefsinthecauseofthedisease.Whenpeoplebelievedthatmentalillnesswasdueto
possessionofevilspiritsthetreatmentwastodrillholesintoapatient'sskull(knownas
trephining)inordertoallowthespiritsinsideachancetoescape(Myers,1998).Ifthiswasnot
successful,peoplewereoftenexorcised,flogged,starvedorburnedatthestake.Hippocrates
hypothesizedthatmadnesswasaresultoftheimbalanceofthefourbodilyhumors,andthatit
couldbecuredbyrebalancingthehumors.Thiswasdonethroughspecialdiet,purgativesand
bloodletting(Burton,2012).Oftenbloodlettingwouldleadtothepatient'sdeath.
InthemiddleageswhenpeoplebelievedmentalillnesswasapunishmentfromGod,the
treatmentoftenincludedreligion,andpatientswereencouragedtoprayandgotoconfession.
Inthe1800's,manyschizophrenicswerelockedininsaneasylumswheretheconditions
wereterribleandthepatientswereoftenflogged.Theasylumswereoftenusedasentertainment
forthegeneralpublicwhocouldpayasmallfeetowalkthroughtheasylumsandgawkatthe
patients.Bytheearly1900'sfevertherapywasacommontreatmentforschizophrenia.Doctors
wouldinjecttheirpatientswithforeignsubstancesinanefforttoraisethebodytemperatureand
killthementalillnessaswell.Othertreatmentsincludedsleeptherapy,gastherapy,

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electroconvulsiveorelectroshocktreatmentandprefrontalleucotomy.Allofthesetreatments
wereusedtocontrolthebehaviorofthepatientratherthantocureoralleviatesufferingofthe
patient(Burton,2012).Inthe1900'sFreudinfluencedthethinkingthatschizophreniawasa
resultfromunconsciousconflictsthatoriginatedinchildhood.Inthe1950'sthefirst
medicationThorazinewasusedtosuccessfullytreatthesymptomsofschizophrenia.Sincethen,
manymoremedicationshavecomeonthemarket,andallowsufferersofschizophreniatolive
morenormalliveswhentakingtheirmedication(Berger,2010).
RecentHistory

Overthepastfewdecades,diagnosisandtreatmentofschizophreniahaveadvanced

significantly.Throughadvancedbrainimagingandmoleculargeneticstudieswehavebeen
abletoconfirmschizophreniaasabiologicaldiseaseofthebrain(Berger,2010).However,itis
alsounderstoodthatthereisapsychologicalbasisandthatsocialstressesplayapartintriggering
episodesoftheillness

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