When Was Schizophrenia Discovered? A Brief History Of The Disorder

Historically, schizophrenia was frequently viewed as one of the most mysterious and complex mental health conditions. Once believed to stem from spiritual or moral failings, this disorder later gained recognition as developing partially from structural brain abnormalities. 

As noted in an article from the American Psychiatric Association, "This modern picture of schizophrenia is the accumulation of innumerable clinical descriptions and extensive scientific research stretching from ancient history to the present—from King Saul to John Nash, Joan of Arc to Elyn Saks." While schizophrenia was originally called “dementia praecox,” it’s now referred to as “schizophrenia spectrum disorder.” Symptoms of this disorder can often be effectively managed with a combination of doctor-prescribed medication and therapy with a licensed mental health professional.

When was schizophrenia discovered?

To answer the question, “When was schizophrenia discovered?”, it may be necessary to look back in history before the disorder was formally identified. The history of schizophrenia may have started with observations of psychosis dating back to the Middle Ages, or earlier. In these times, signs of mental deterioration, bizarre behavior, or psychosis may have been attributed to evil spirits or demonic possession. Treatment options may have been nonexistent or limited.

Kraepelin and the introduction of dementia praecox  

Schizophrenia was officially identified as a mental illness by Emil Kraepelin in 1887. At this time, the term dementia praecox (also called premature dementia) was used to identify people experiencing symptoms of schizophrenia. Kraepelin believed the onset of early dementia praecox included persistent cognitive disturbances, which were then believed to be an important feature in charting the development of schizophrenia. 

Eugen Bleuler and the term schizophrenia 

At about the same time, in 1911, a Swiss psychiatrist named Eugen Bleuler coined the term “schizophrenia,” which meant “splitting of the mind.” 

Bleuler sought to "emphasize the loss of coherence between thought, emotion, and behavior" as distinctive features of the condition. Unlike Kraepelin, Bleuler attempted to distinguish schizophrenia from dementia, and instead focused on the aspect of splitting of psychic functioning as an essential feature of schizophrenia.

Bleuler also viewed the disorder as "schizophrenia," indicating a group of conditions rather than one disorder alone. This insight into the disease concept of schizophrenia may have contributed to the current understanding of the aspects of schizophrenia existing on a spectrum. 

The perception of mental illness

The APA also emphasizes that most people with schizophrenia are not more dangerous than those without the condition. Instead, they may often be more vulnerable to being targets of crimes. 

The evolution of the understanding of schizophrenia

As noted in Nature, since the designation by Emil Kraepelin, schizophrenia has been understood as "a chronic and deteriorating mental illness"  or a neurodegenerative disorder. During the early 20th century, early treatments included harsh methods such as electro-convulsive therapy, insulin coma, metrazol shock, and frontal leukotomy. Computed tomography and magnetic resonance imaging have indicated "structural and functional brain abnormalities in patients with schizophrenia."

More recently, ongoing medical research on schizophrenia has investigated whether brain abnormalities remain stationary or progress through different stages of the illness. 

In some studies, the age of onset and long-term exposure to antipsychotic medications have also been associated with symptom severity.

How has the understanding of the disorder changed

Scientists may have distinguished schizophrenia as a distinct mental health condition was first recognized in the late 19th century, though its understanding and diagnostic methods have significantly evolved over time.

Prior to the 1980s, more focus may have fallen on so-called “positive symptoms,” such as hallucinations and delusions; however, in the 1980’s, researcher Tim Crow suggested that people experiencing schizophrenia may have distinct symptoms clusters that also may include negative symptoms, such as apathy, lack of motivation (avolition), and lack of speech (alogia).

With the introduction of Tim Crow's model of schizophrenia as consisting of "two syndromes" — positive and negative symptoms — the diagnostic criteria changed. Crow also suggested that schizophrenia might be a "widespread genetic anomaly which arose quite recently in human evolution" and linked schizophrenia with the evolution of language. Psychotic symptoms, in Crow's view, were thought to be associated with "deviations in the subtle asymmetries of development of the cortex,” and he believed that “the symptoms arise as confusions between thought and speech and through the abnormal attachment of meaning to perceived speech."

Psychotic disorders and mental health in the DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the current version of the handbook used by mental health care professionals to guide the diagnostic process. The DSM-5 classifying criteria of mental health disorders, including primary psychotic disorders, now emphasize that these conditions exist along a spectrum, and are distinct from an intellectual disability and cannot be better explained by another condition.

The DSM-5 now views psychosis or psychotic illness "as only one of several dimensions of neuropsychiatric disturbance in these disorders." Psychosis is usually seen in terms of how it may accompany other dimensions of neuropsychiatric disturbance, such as cognitive impairments and emotional disturbances during a psychotic episode. Previously, psychosis was broadly described as a “gross impairment in reality testing” or “loss of ego boundaries” that interfered with functioning and the ability to meet the demands of one's life.  

By recognizing psychotic disorders along a spectrum, the DSM-5 also highlights the importance of a more holistic approach to mental health in understanding these conditions. Hallucinations, delusions, thought disorders, and movement disorders may now be seen as consisting of psychotic symptoms to the extent that they affect the way a person thinks, behaves, and experiences their reality. 

Clinical symptoms, such as the negative symptoms of schizophrenia

According to the American Psychiatric Association, schizophrenia may now be characterized "by episodes in which the person is unable to distinguish between real and unreal experiences." The severity, duration of episodes, and frequency of symptoms tend to vary among individuals. Often, severe psychotic symptoms decrease with age. 

Clinical symptoms may be defined in the following terms:

• Positive symptoms: Hallucinations, such as hearing voices, delusions, exaggerated or distorted perceptions, and associated behaviors
• Negative symptoms: Reduced emotional expression, impaired speech, reduced interest in engaging in social activities, reduced motivation to undertake and finish projects, and loss of ability to experience pleasure (anhedonia)
• Disorganized symptoms: Confused and disorganized thinking and speech, difficulty with logical thinking, displaying behavior and/or gestures that may be considered unusual
• Cognitive symptoms: Challenges related to attention, concentration, and memory

A diagnosis for those at risk of developing schizophrenia may usually include a medical examination to screen for substance use and other illnesses that may present similar symptoms.

How are people with schizophrenia diagnosed?

A Psychiatric diagnoses of schizophrenia may be made using various tests and scales. Many scales and instruments have been developed and used to screen for schizophrenia, reflecting the current understanding of how to define and classify its symptoms. 

The negative symptom scale is generally considered the main mode of assessment, which may have a high diagnostic validity and may be used by clinicians and researchers alike. This type of scale can be used to monitor the severity of positive and negative symptoms associated with schizophrenia, as well as a person’s response to treatment. Older scales have largely been replaced by newer scales that consider the evolving scientific evidence and research on negative symptoms. Other potential scales that schizophrenia patients may have administered include the Brief Psychiatric Rating Scale, which can help assess the severity and occurrence of symptoms, which may be linked to occupational functioning skills in daily life. 

Treating schizophrenia

Currently, the main treatment approaches for schizophrenia in modern psychiatry may include antipsychotic medications and psychotherapy. One evidence-based psychotherapeutic approach to help manage symptoms may be cognitive behavioral therapy (CBT). Other potentially helpful approaches can include art therapy, stress-reducing techniques, support groups, and other therapies aimed at reducing symptoms and improving function. 

Related psychotic and mood disorders

People living with schizophrenia may experience overlapping disorders. Schizophrenia may occur in conjunction with other psychotic disorders or mood disorders, including:

• Manic depressive disorder
• Bipolar disorder
• Major depression 
• Brief psychotic disorder

Additionally, there may be many disorders with symptoms that overlap with schizophrenia or that are considered related psychotic disorders. Some related disorders may include: 

• Delusional disorder
• Schizophreniform disorder
• Schizoaffective disorder

Modern research into schizophrenia

In the past, a large portion of the effort and focus on schizophrenia centered on diagnosis and treatment after symptoms occurred. Modern research, on the other hand, may focus on genetic research, implementing artificial intelligence models, and developing targeted treatments. Through earlier detection and support, it may be possible for people living with schizophrenia to reduce symptoms and their impacts over time. Additionally, modern research may also focus on dispelling negative stigmas about schizophrenia. 

Therapy to support mental health

Many people with schizophrenia can find ways to cope with symptoms and improve their quality of life and social function. A licensed therapist can offer support and guidance throughout this process. If you are interested in exploring therapy from the comfort of your own home, a platform like BetterHelp can enable you to have sessions by phone, video, or online chat. Many therapists employ CBT, a therapeutic approach that can be helpful in managing challenging symptoms. You may also find art therapists who can adapt their approaches to an online format. 

A review that combined findings of various studies noted that online interventions may be "both feasible and acceptable to individuals with psychotic disorders" and may be associated with improving auditory hallucinations, depressive symptoms, motivation, and functioning. However, please note that individuals currently experiencing psychosis may need to seek in-person care.