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The History of Schizophrenia

The definition and diagnostic criteria of schizophrenia have undergone many revisions since the 19th century. Overtime, the diagnosis of schizophrenia has become more specific, with more clearly defined symptoms.

Early Descriptions of Schizophrenia: Kraepelin and Bleuler

In 1898, Emil Kraepelin, a German physician, used the term “dementia praecox” to describe the symptoms that are now associated with Schizophrenia. The term “dementia” was used to describe the global disruption of perceptual and cognitive processes, while “praecox" referred to the onset of the disorder in early adulthood. Kraepelin characterized the disorder as progressive with no return to premorbid levels of functioning.

A Swiss psychiatrist, Eugen Bleuler, reformulated dementia praecox. In 1911, Bleuler coined the term "schizophrenia“. The word schizophrenia is derived from the Greek roots schizo (split) and phrene (mind). Schizophrenia is often misconceived as multiple personality disorder. However, schizophrenia was intended to describe the fragmented thinking characteristic of people with the disorder.

Bleuler identified four fundamental symptoms of schizophrenia, reflecting the breakdown of normally integrated functions that coordinate thought, affect and behavior: Symptoms. However, Bleuler did not emphasize delusions and hallucinations as necessary characteristics for the diagnosis of schizophrenia.

Mid-20th Century Research and Theory

Influenced by the psychoanalytic theory of Freud and others, many researchers of the mid-20th century focused on the relationship between family dynamics and the onset of schizophrenia. Specifically, researchers emphasized the quality of the mother-child relationship as crucial to the development of schizophrenia. The type of parent thought to induce schizophrenia was termed a schizophenogenic mother. Characteristics of schizophrenogenic mothers.

Another view, called the Double-Bind Theory, was proposed by Bateson in the mid 1950s. So-called double-bind situations were thought to be an important contributing factor to the development of schizophrenic thought disorder. Characteristics of a double-bind situation include:

An intense relationship with another individual, to the extent that it is especially important to be able to understand communication from that person accurately in order to respond appropriately.

The other person expresses two messages when making a statement, one which
denies the other.

The individual is not able to explain the mutually contradictory messages and cannot withdraw from the situation or ignore the messages.

Influenced by Bleuler's theory, and in the face of a body of data suggesting that schizophrenia was heritable, Meehl discussed the interaction of genetics and environment in etiology of schizophrenia. Meehl emphasized the symptoms of thought disorder, interpersonal aversiveness, anhedonia, and ambivalence. Schizotaxia, or a neural integrative deficit, was the only inherited factor emphasized by Meehl. Schizotaxia interacts with what an individual has learned from the environment, and results in a personality organization called schizotype. Thought disorder, interpersonal aversiveness, anhedonia, and ambivalence are learned by schizotaxic individuals. Only a small number of schizotaxic individuals were thought to develop schizophrenia. Meehl proposed that the mother-child relationship played a role in the ultimate development of schizophrenia However, contemporary research has not implicated the mother-child relationship, nor double bind situations as causal factors in shcizophrenia.

The Direction of Research and Diagnosis of Schizophrenia:

How Far Have we Come?

The Diagnostic and Statistical Manual for Mental Disorders (DSM):

Kreapelin's and Beuler's observations have contributed to the formulation of modern diagnostic criteria for Schizophrenia. The first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I) retained the idea that environmental influences factor into the onset of schizophrenia. The diagnosis of schizophrenia included the term "reaction," implying an environmental influence. Problems with the diagnosis of schizophrenia at the time included vague definitions, lack of precise operational criteria, and lack of a discussion about differential diagnosis. At the time, schizophrenia actually became a widely used diagnosis for biologically unexplainable psychoses.

The DSM-II did not include the term "reaction" in its description of schizophrenia, although brief information about differential diagnosis was included. However, vague descriptions, and a lack of operational criteria remained a problem. The DSM-II did include a category titled "schizophrenia, latent type," which described people who presented clear symptoms of schizophrenia without a history of psychotic episodes. However, it is important to note, that the term "latent" implies that there is a underlying psychosis that is yet to present itself.

The production of the DSM-III was influenced by the neo-Kraepelinian movement in the 1960s and 1970s, and by an emphasis on empirical validations of psychiatric conditions. Included in the DSM-III were tests of diagnostic reliability, multiaxial diagnosis, and a focus on the description of syndromes and course of the disorder, rather than inferences about etiology. These changes made the diagnosis of schizophrenia more reliable and consistent, while narrowing the construct of schizophrenia. Psychosis was maintained as a fundamental feature of the disorder. For more on the DSM-III diagnostic criteria: DSM-III Classification of Schizophrenia

Alternative Conceptualizations of Schizophrenia:

Positive-Negative Symptom Dichotomy

The DSM is not the only conceptualization of schizophrenia available. For instance, the DSM does not emphasize the difference between positive and negative symptoms of schizophrenia. Crow (1980) proposed that the symptoms of schizophrenia can be divided into those that are positive (delusions, hallucinations, and thought disorder), and those that are negative (blunted or flat affect, anhedonia, avolition, alogia). According to Crow, schizophrenia can be classified as two distinct syndromes: Type I and Type II. Type I schizophrenia is a more acute disorder, characterized by the presence of positive symptoms, while type II is a more chronic disorder, characterized by the presence of negative symptoms.

Three-Factor System

Yet another conceptualization of Schizophrenia was proposed by Liddle (1987), who re-assessed Crow's positive-negative dichotomy. Liddle asserts that psychomotor poverty, disorganization, and reality distortion are the core symptoms of Schizophrenia.

Where are we Now?

Currently, researchers are working vigorously to uncover the etiology of schizophrenia. We have acquired much descriptive detail about how the disorder presents in a variety of patients. Now, the need for effective therapies, have made it necessary to search deeper for the root of the disorder. For more on the etiology of schizophrenia: Theories
There is mounting evidence that schizophrenia does have both a genetic and physiological basis. For more on the genetic and physiological basis of schizophrenia: Theories.
Over the years, the diagnosis of schizophrenia as become more consistent and reliable. Read on for more information.
The course of schizophrenia is now thought to be characterized by deterioration of functioning with no return to premorbid level of functioning. For more see DSM-III.

SM-IV de-emphasizes psychosis by allowing for the diagnosis of schizophrenia without the presence of delusions or