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?

Schizophrenia was identified as a mental illness by Emil Kraepelin in 1887. The name given to the disorder at that time was “dementia praecox.” Kraepelin emphasized the early onset of persistent cognitive disturbances in the disorder, which were then believed to be an important feature in charting the development of schizophrenia.  

In 1911, a Swiss psychiatrist named Eugen Bleuler coined the word “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 did not associate schizophrenia with dementia, and instead focused on the aspect of "splitting of psychic functioning" as an essential feature of schizophrenia.

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

The perception of mental disorders

Historically, mental disorders like schizophrenia have been misconstrued and maligned. According to the American Psychiatric Association (APA), "the complexity of schizophrenia may help explain why there are misconceptions about the disease. Despite the origin of the word, from the Latin meaning 'split mind,' schizophrenia does not mean split personality or multiple personality."

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. Computed tomography and magnetic resonance imaging have indicated "structural and functional brain abnormalities in patients with schizophrenia." 

More recently, schizophrenia research 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 the symptom severity.

Psychiatric diagnoses 

A diagnosis 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 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 research of negative symptoms.

According to researchers, prior to the 1980s, more focus fell on so-called “positive symptoms,” such as hallucinations and delusions. Negative symptoms, such as apathy, lack of motivation (avolition), and lack of speech (alogia), were usually given less attention. 

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 in the DSM-V

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) is the current version of the handbook used by healthcare professionals to guide the diagnostic process. The DSM-V classifying criteria of primary psychotic disorders now emphasizes that these conditions exist along a spectrum. 

The DSM-V now views psychosis "as only one of several dimensions of neuropsychiatric disturbance in these disorders." It's usually seen in terms of how it may accompany other dimensions of neuropsychiatric disturbance, such as cognitive impairments and emotional disturbances. 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. 

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 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 disordered 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 usually includes a medical examination to screen for substance use and other illnesses that may present similar symptoms.

Treating schizophrenia

Currently, the main treatment approaches for schizophrenia 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. 

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.

Takeaway

Schizophrenia was identified as a mental illness named dementia praecox by Emil Kraepelin in 1887. Later, a Swiss psychiatrist named Eugen Bleuler coined the word “schizophrenia” (splitting of the mind) in 1911. Historically, schizophrenia has often been misunderstood, which may be attributed to its complexity. Despite the origin of the word, schizophrenia does not mean “split personality” or “multiple personality.” Today, schizophrenia is seen as a spectrum disorder that may present differently depending on the individual. Current approaches to treat schizophrenia generally include antipsychotic medications and cognitive behavioral therapy (CBT), which can be completed online or in person.