Schizophrenia : History, Symptoms and Causes

Schizophrenia occurs in people from all cultures and from all walks of life. The disorder is characterized by an array of diverse symptoms, including extreme oddities in perception, thinking, action, sense of self, and manner of relating to others.

History of Schizophrenia

In Observations on Madness and Melancholy, published in 1809, John Haslam portrayed what he called “a form of insanity.” About the same time Haslam was writing his description in England, the French physician Philippe Pinel was writing about people we would describe as having schizophrenia (Pinel, 1801/1962, 1809). Some 50 years later, another physician, Benedict Morel, used the French term démence (loss of mind) précoce (early, premature) because the onset of the disorder is often during adolescence.

Toward the end of the 19th century, the German psychiatrist Emil Kraepelin (1899) built on the writings of Haslam, Pinel, and Morel (among others) to give us what stands today as the most enduring description and categorization of schizophrenia. Two of Kraepelin’s accomplishments are especially important.

First, he combined several symptoms of insanity that had usually been viewed as reflecting separate and distinct disorders: catatonia (alternating immobility and excited agitation), hebephrenia (silly and immature emotionality), and paranoia (delusions of grandeur or persecution). Kraepelin thought these symptoms shared similar underlying features and included them under the Latin term dementia praecox.

In a second important contribution, Kraepelin (1898) distinguished dementia praecox from manic-depressive illness (now called bipolar disorder). For people with dementia praecox, early age of onset and a poor outcome were characteristic; in contrast, these patterns were not essential to manic depression (Lewis, Escalona, & Keith, 2009). Kraepelin also noted the numerous symptoms in people with dementia praecox, including hallucinations, delusions, negativism, and stereotyped behavior.

A second major figure in the history of schizophrenia was Kraepelin’s contemporary, Eugen Bleuler (1908), a Swiss psychiatrist who introduced the term schizophrenia (Berrios, 2011; Fusar-Poli & Politi, 2008).

The label was significant because it signaled Bleuler’s departure from Kraepelin on what he thought was the core problem. Schizophrenia, which comes from the combination of the Greek words for “split” (skhizein) and “mind” (phren), reflected Bleuler’s belief that underlying all the unusual behaviors shown by people with this disorder was an associative splitting of the basic functions of personality. This concept emphasized the “breaking of associative threads,” or the destruction of the forces that connect one function to the next.

Furthermore, Bleuler believed that a difficulty keeping a consistent train of thought characteristic of all people with this disorder led to the many and diverse symptoms they displayed. Whereas Kraepelin focused on early-onset and poor outcomes, Bleuler highlighted what he believed to be the universal underlying problem. Unfortunately, the concept of “split mind” inspired the common but incorrect use of the term schizophrenia to mean split or multiple personalities.

 

Definition of Schizophrenia and Researches

The broad category of schizophrenia includes a set of disorders in which individuals experience the distorted perception of reality and impairment in the content of thought, a form of thought, perception, sense of self, interpersonal functioning, thinking, behavior, affect, and motivation.

Schizophrenia is a serious mental illness, given its potentially broad impact on an individual’s ability to live a productive and fulfilling life. Although a significant number of people with schizophrenia eventually manage to live symptom-free lives, in some ways, all must adapt their lives to the reality of the illness. In economic terms, schizophrenia also exacts a heavy burden, with an estimated annual cost in health care alone of $12,000 to $20,000 per person per year in the United States, third only to heart disease and cancer (Chapel, Ritchey, Zhang, & Wang, 2017).

  Schizophrenia is a severe form of abnormal behavior that encompasses what most of us have come to know as “madness.” Psychosis (If you are unable to tell the difference between what is real and what is unreal, you are experiencing psychosis) can take many forms. One of the most severe and puzzling psychotic disorders is schizophrenia.

At times, people with schizophrenia think and communicate clearly, have an accurate view of reality, and function well in daily life. At other times, during the active phase of their illness, their thinking and speech are disorganized, they lose touch with reality, and they have difficulty caring for themselves. Most people who develop psychotic disorders do so in their late teenage or early adult years, when they are ready to begin contributing to society. Then the disorder strikes. Instead of pursuing their education, a career, or a family, they may need continual services, including residential care, rehabilitative therapy, subsidized income, and the help of social workers to obtain needed resources—and they may need these services for the rest of their lives, because schizophrenia tends to be chronic.

Fuller Torrey (2013) compiled data from several sources to estimate where people with schizophrenia are living. Torrey determined that the majority of people with schizophrenia live independently or with their family.

He also reported that there are almost as many people with schizophrenia in jails, prisons, and homeless shelters and on the street as there are in hospitals and nursing homes. The criminal justice system and shelters often are repositories for people with schizophrenia who do not have a family to support them or the resources to receive psychiatric help.

            Schizophrenia, a startling disorder characterized by a broad spectrum of cognitive and emotional dysfunctions including delusions and hallucinations, disorganized speech and behavior, and inappropriate emotions.

People with schizophrenia may withdraw from other people and from everyday reality, often into a life of odd beliefs (delusions) and hallucinations. They may hear voices that aren’t there or make comments that are difficult, if not impossible, to understand. Their behavior may be guided by absurd ideas and beliefs.

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For example, a person might believe that spaceships from another planet are beaming thoughts into his brain and controlling his behavior. Some people with schizophrenia recover fairly quickly, whereas others deteriorate progressively after the initial onset of symptoms. It is a disorder with “many different faces” (Andreasen, 2001) Because of the diversity of symptoms and outcomes shown by these patients, many clinicians believe that schizophrenia, or “the group of schizophrenias,” may actually include several forms of disorder that have different causes. Others contend that schizophrenia is a single pathological process and that variations from one patient to the next in symptoms and course of the disorder reflect differences in the expression or severity of this process.

Given that schizophrenia is associated with such widespread disruptions in a person’s life, it has been difficult to uncover the causes of the disorder and develop effective methods to treat it. We still have a long way to go before we fully understand the multiple factors that trigger schizophrenia and develop treatments that are both effective and free of unpleasant side effects. The symptoms of schizophrenia invade every aspect of a person: the way someone thinks,  feels, and behaves. Not surprisingly then, these symptoms can interfere with maintaining a job, living independently, and having close relationships with other people. They can also provoke ridicule and persecution.

Substance use rates are high (Blanchard, Brown, et al., 2000), perhaps reflecting an attempt to achieve some relief from the symptoms (Blanchard, Squires, et al., 1999). Moreover, the suicide rate among people with schizophrenia is high. Indeed, they are 12 times more likely to die of suicide than people in the general population. People with schizophrenia are also more likely to die from any cause than people in the general population (Laursen, Nordentoft, & Mortensen, 2014; Olfson, Gerhard, et al., 2015; Saha, Chant, & McGrath, 2007), and their mortality rates are as high as or higher than the rates for people who smoke (Chesney, Goodwin, & Fazel, 2014).

The lifetime prevalence of schizophrenia is around 1 percent, and it affects men slightly more often than women (Kirkbride, Fearon, et al., 2006; Walker, Kestler, et al., 2004). Schizophrenia is diagnosed more frequently among some groups, such as African Americans, though this likely reflects a bias among clinicians (Kirkbride et al., 2006).

Schizophrenia rarely begins in childhood; it usually appears in late adolescence or early adulthood, and usually somewhat earlier in men than in women. People with schizophrenia typically have several acute episodes of their symptoms and less severe but still debilitating symptoms between episodes.

Schizophrenia typically develops in late adolescence or early adulthood, at the very time that young people are making their way from the family into the outside world (Dobbs, 2010; Tandon, Nasrallah, & Keshavan, 2009).

The range of symptoms in the diagnosis of schizophrenia is extensive, although people with the disorder typically have only some of these symptoms at any given time (see the DSM-5 criteria).

DSM-5

Criteria for Schizophrenia

  1. For 1 month, individual displays two or more of the following symptoms much of the time:

(a) Delusions

(b) Hallucinations

(c) Disorganized speech

(d) Very abnormal motor activity, including catatonia

(e) Negative symptoms

  1. At least one of the individual’s symptoms must be delusions, hallucinations, or disorganized speech.
  2. Individual functions much more poorly in various life spheres than was the case prior to the symptoms.
  3. Beyond this 1 month of intense symptomology, the individual continues to display some degree of impaired functioning for at least 5 additional months. (Information from APA, 2013.)

References

Nevid, J. S., Rathus, S. A., & Greene, B. S. (2017). Abnormal psychology in a changing world (10th ed.). Pearson.

COMER, R. J. (2015). Abnormal psychology. New York, Worth Publishers.

Butcher, J. N., Mineka, S., & Hooley, J. M., Nock,M.K. (2017). Abnormal psychology. England: Pearson.

Whitbourne, S. K. (2020). Abnormal psychology: Clinical perspectives on psychological disorders. New York, NY: McGraw-Hill.

Nolen-Hoeksema, S. (2020). Abnormal psychology. New York: McGraw-Hill.

Barlow, D. H., & Durand, V. M., Hofmann,S.G. (2019). Essentials of abnormal psychology (8th ed.). USA: CENGAGE Learning.

Dozois, D. J. (2019). Abnormal psychology: Perspectives (6th ed.). Ontario, Canada: Pearson Canada.

Oltmanns, T. F., & Emery, R. E. (2019). Abnormal psychology. Hoboken : Pearson,

Kring, A. M.,Johnson,S.L. (2014). Abnormal psychology: The Science and Treatment of Psychological Disorders. John Wiley & Sons.

American Psychiatric Association. (2013).Diagnostic And Statistical Manual of Mental Disorders(5th ed.)

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