From diagnosis to treatment, understanding schizophrenia’s history may help us understand how this condition is perceived today.
In 1900, Swiss psychiatrist Paul Eugen Bleuler coined the term “schizophrenia.” Derived from Greek roots, the word contains “schizo” meaning “split” and “phrene,” which means “mind.”
Schizophrenia is frequently stigmatized and misunderstood, often far more than other mental health conditions. A 2010 study found that it can be common for those with schizophrenia to be perceived as dangerous, even though other research suggests most people living with this condition are generally nonviolent.
Looking at the condition’s origins can be an important starting point in changing the current stigma and public perception of schizophrenia.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), two of the following symptoms must be present for a schizophrenia diagnosis:
- catatonic or disorganized behavior
- disorganized speech (derailment or incoherence)
- negative symptoms, such as avolition, flat affect, and alogia
Additionally, these symptoms must be present the majority of the time for 6 months and be significant enough to impact:
- ability to care for yourself
- performance at work
Schizophrenia‘s history is fraught with ideas about spiritual causes and treatments that some may view as unethical or inhumane.
This history may be a main contributor to current stigmas around schizophrenia and those living with the disorder.
According to Tracy McDonough PhD, psychology professor and president of the Schizophrenia Oral History Project, a nonprofit dedicated to archiving the life stories of people with schizophrenia, “[the stigma of schizophrenia] is connected to historical beliefs about individuals with schizophrenia.”
Schizophrenia in antiquity
Theories about the possible causes and treatments for mental health conditions resembling schizophrenia date far back to antiquity.
Ancient minds frequently perceived the cause of mental illnesses like schizophrenia as a punishment from gods, or possibly as possession from evil spirits and demons. References to “madness” resembling schizophrenia date to the Old Testament, and even further.
A condition similar to schizophrenia is described in “The Book of Hearts,” a chapter dedicated to mental health disorders in “The Ebers Papyrus,” an ancient Egyptian medical manuscript dating to 1550 BC.
Similar to the Egyptians, ancient Greek “father of medicine” Hippocrates believed conditions like schizophrenia were rooted in biology, rather than spiritual or metaphysical causes.
According to Hippocrates, mental health disorders were caused by imbalances in the “four bodily humors,” and could be treated with:
- special diets
- purgatives, like laxatives
- blood letting
Symptoms associated with schizophrenia — like psychosis and hallucinations — were commonly viewed as proof of demonic possession and sin throughout Europe in the Middle Ages.
However, some medieval sources indicate that these mental health conditions were thought to be caused by:
- imbalances in the body
- diet and alcohol intake
- grief and loss
Institutionalizing those with mental disorders like schizophrenia in asylums or “fools towers” formally began in medieval Europe.
Common treatments for mental illness in the middle ages included trepanning, an early surgical procedure involved drilling holes in the skull, either to relieve pressure or to release demons and spirits.
Enlightenment and the modern era
Schizophrenia continued to be viewed as “madness” for hundreds of years. Until the mid-20th century, treatment for schizophrenia was often experimental at best and cruel and inhumane at worst.
McDonough told Psych Central, “Early on, people [with schizophrenia] were believed to be untreatable. They often were locked away in asylums. In Europe, people would visit the asylums like they were going to the zoo.”
McDonough continued, “At its core, [schizophrenia’s] history is one of not seeing human beings as human beings.”
In the late 18th century, French Physician Phillip Pinel helped pave the way for humane psychiatric treatment.
Pinel refused to chain his patients in a Parisian insane asylum and began practicing “moral therapy” in 1798, which included:
- respecting the person under psychiatric care
- establishing doctor-patient relationships based on trust and confidentiality
- decreasing stressful or triggering stimuli
- encouraging routine activity and exercise
In humanely treating people with mental health conditions like schizophrenia, Pinel emphasized the need for:
- keeping detailed case histories and records for each person
Kraepelin’s ‘dementia praecox’
In 1893, German psychiatrist Emil Kraepelin coined the term “dementia praecox,” meaning “premature dementia,” to describe schizophrenia.
Kraepelin was one of the first to
Schizophrenia in the 20th century
Swiss psychiatrist Eugene Bleuler coined the term “schizophrenia” in 1900, replacing the term “dementia praecox”. Bleuler also coined the famous “four As” of schizophrenia describing negative symptoms of schizophrenia, which were later changed to the 5 As.
Institutionalizing people with schizophrenia was still a common practice well into the 20th century.
Common 20th century treatments for schizophrenia included:
- insulin coma therapy: repeatedly injecting large amounts of insulin to induce daily comas over a period of weeks
- Metrazol shock: a potentially fatal form of shock therapy involving injections of Metrazol (pentylenetetrazol) to trigger convulsions and coma
- electroconvulsive therapy: stimulating or shocking the brain with electricity to induce seizures
- surgery: including frontal lobotomy
Eugenics also played a dark role in 20th century schizophrenia treatments. At the time, schizophrenia was feared as a largely genetically inherited condition. Due to persistent stigma and misunderstanding, many people with schizophrenia were sterilized, often without consent.
The first antipsychotics, like Chlorpromazine, were developed and released in the 1950s. The availability of these and similar drugs led to widespread deinstitutionalization in the 1960s. These medications are still prescribed today and are considered “typical antipsychotics.”
The 1990s saw the development of more sophisticated antipsychotic medications — atypical antipsychotics — to treat schizophrenia.
When diagnosing schizophrenia, psychiatrists typically use the DSM-5 criteria. Other diagnostic tools, like self-reporting forms, are also used alongside qualitative clinical assessments, such as:
- Communication Disturbances Index
- The Positive and Negative Symptom Scale (PANSS)
- BPRS (Brief Psychiatric Rating Scale)
- The Mini Mental Status Exam (“The Mini”)
Schizophrenia is a treatable condition. Doctors and therapists now have a number of tools to help people with this disorder find the best treatment plans possible for them. Many people with schizophrenia are able to manage their symptoms and live well-balanced, fulfilling lives.
Antipsychotic medication is often used continuously in schizophrenia treatment plans to manage psychosis. Two classes of antipsychotic medications are prescribed today for schizophrenia: typical and atypical antipsychotics.
In addition to medication, many forms of psychotherapy may help people with schizophrenia cope with symptoms and improve quality of life.
Types of psychotherapy that can help schizophrenia include:
- cognitive behavioral therapy (CBT)
- cognitive enhancement therapy (CET)
- family therapy
- group therapy and peer support
- acceptance and commitment therapy
- mindfulness training
Comprehensive care programs are designed to incorporate therapeutic approaches on multiple levels, such as:
- community participation
While many medical beliefs about schizophrenia have changed over time, cultural depictions and attitudes haven’t caught up.
Immense stigma around schizophrenia still exists today, rooted in historical misconceptions and media depictions.
The word “schizophrenic” might be used casually to describe the weather or stock market. Worse yet, it may be used to define a person with the condition.
Pervasive myths often falsely associate schizophrenia with:
- a “childlike” mind
- a “weak” character
Schizophrenia is commonly confused with “split” or “multiple personality disorder,” a separate condition now known as dissociative identity disorder.
For some people, the stigma around schizophrenia can lead to discomfort with a diagnosis. But as psychiatrist and author Elyn R. Saks wrote in her seminal 2007 book, “A mental illness diagnosis does not automatically sentence you to a bleak and painful life, devoid of pleasure or joy or accomplishment.”
Fighting schizophrenia stigma
Schizophrenia is not a life sentence, nor is it something to fear in others. Learning about the condition, as well as the experience of living with schizophrenia, can be a powerful first step in fighting stigma.
Listening to the voices of people with the condition, past and present, can also help. Some narratives from people with schizophrenia include:
- Schizophrenia Oral History Project
- “The Center Cannot Hold: My Journey through Madness,” by Dr. Elyn R. Saks
- “The Collected Schizophrenias: Essays,” by Esmé Wejin Wang
Schizophrenia-like mental health conditions have been recorded and treated since antiquity. Over centuries, theories about the condition’s causes evolved from the spiritual realm to physiological means.
Treatments for schizophrenia have often included inhumane and cruel “cures,” even as recently as the 20th century.
But thanks to evidence-based research and medical science, modern physicians and therapists have a wealth of effective tools to help treat schizophrenia.
If you are living with schizophrenia, you are not alone. And if someone you love is impacted by the condition, it may be helpful to learn about how to support your loved one.