By: Bart Maracewicz



First Reported Cases

Philippe_Pinel.jpg
Phillipe Pinel: First to report a schizophrenia-like syndrome in 1797.

Prior to the 19th century, records of a schizophrenia-like pathology are rare. Although records of individuals with uncontrolled, irrational, and unintelligible behaviour were common,
they did not necessarily fulfill the modern requirements for a diagnosis of Schizophrenia. Reports in ancient times were not directly implicative of schizophrenia, and it has been argued that these authors greatly exaggerated and obscured their reports[1] . This has led to controversy as to whether Schizophrenia is a modern phenomenon. The earliest case of the schizophrenia-like illness in psychiatric literature was of James Tilly Matthews in 1797, as outlined in a report written by Phillipe Pinel[2] .

The first description of schizophrenia as a distinct syndrome was by Benedict Morel, who termed the condition démence précox, or dementia precox, in young adults and teenagers. In 1893, Emil Kraepline further developed classification of mental disorders, noting the distinction between dementia precox and mood disorders. Kraeprelin attributed dementia precox as a pathology in the brain[3] that occurred earlier in life and differed from other, later-appearing dementias, like Alzheimer’s disease[4]


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Eugen Bleuler. The first person to coin the term "schizophrenia".

Coinage of the Term


The term schizophrenia is derived from the Greek roots schizein (to split) and phren- (the mind)[5] and was coined by Eugen Bleuler in 1908. At the time, the term was misunderstood – it was thought to mean that affected individuals had a “split personality”. The first notable misuse occurred in 1933 in an article written by T.S. Eliot [6] . Bleuler’s intention for the term was that it describe a separation of functions localized in the brain, mainly memory, thinking, personality, and perception. Blueler observed that some individuals' condition actually improved, rather than deteriorated, and thus concluded that the condition could not be a dementia[7] .


Controverises

During the early 1970s, the diagnostic criteria for schizophrenia were a topic of controversy, leading up to the modern operational criteria. The controversy arose after 1971 when a US-UK diagnostic study demonstrated that schizophrenia was diagnosed more liberally in the U.S.A. compared to Europe[8] , likely due to the less strict criteria of the DSM-II used in America, compared to those found in the ICD-9 used in Europe . This ultimately led to revisions in the diagnostic criteria not only for schizophrenia, but of the entire DSM. These revisions were published in 1980 as part of the new manual, the DSM-III. Despite there being over 40 diagnostic criteria suggested and evaluated for the illness since the 1970s, those set out by the DSM-III remain to be the modern criteria for diagnosis[9] , which have made diagnosis more consistent and reliable. These same criteria for the diagnosis of schizophrenia are currently found in the DSM-IV and ICD-10.
  1. ^ Evans, K. McGrath, J., & Milns, R. Searching for schizophrenia in ancient Greek and Roman literature: a systematic review. Acta Psychiatrica Scandinavica, 107(5), 323-330 (2003).
  2. ^ Heinrichs, R. W. Historical origins of schizophrenia: two early madment and their illness. Journal of the History of the Behavioral Sciences, 39(4), 349-363 (2003).
  3. ^ Kraepelin, E. & Diefendorf, A. R. Text Book Psychiatry (7th Ed.). London: Macmillion (1907).
  4. ^ Hansen, R.A. & Achison, B. Conditions in Occupational Therapy: Effect on Occupational Performance. Hagerstown: Lippincott Williams & Wilkins (2000).
  5. ^
    Kuhn, R. Eugen Bleuler's concepts of psychopathology. History of Psychiatry, 15(3), 361-366 (2004).
  6. ^ Berrios, G. E. & Porter, R. A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders. London: Athlone Press (1995).
  7. ^ Turner, T. Chlorpromazine: unlocking psychosis. British Medical Journal, 7, 334 (2007).
  8. ^
    Wing, J. K. International comparisons in the study of the functional psychoses. British Medical Bulletin, 27(1), 77-81 (1971).
  9. ^
    Jansson, L. B. & Parnas, J. Competing definitions of schizophrenia: what can be learned fro polydiagnostic studies? Schizophr Bull., 33(5), 1178-1200 (2007).