Schizophrenia: The Mind Is in the Works
Author: Emily Gardner
November 22, 2014
Schizophrenia is understood today as a disabling disorder characterized by perceptual,
emotional, and intellectual deficits; loss of contact with reality, and inability
to function in life (Garrett, 2011; p. 429). Symptoms of schizophrenia include conflicting
emotions occurring simultaneously (e.g. crying and laughing), delusions, illusions
of memory, negativism, illogical thoughts or behavior, etc. The Diagnostic and Statistical
Manual of Medical Disorders (DSM-IV) gives certain criteria for diagnosing schizophrenia
as a mental disorder. For example, two or more symptoms must be present for a significant
portion of time during a one-month period or only one if that symptom is exceptionally
bizarre (e.g. hearing voices). In addition, the symptoms must interfere with aspects
of everyday living; substances (i.e. drugs and alcohol) must not be used since this
could account for certain symptoms, and previously-existing medical conditions must
be accounted for (e.g. mood disorders, autism). Other criteria also apply.
It is generally thought that the way in which schizophrenia is understood today can
be traced back to the detailed clinical descriptions of Kraeplin and Bleuler (Henrichs,
349); Though the term schizophrenia was coined by Eugen Bleuler in 1911, some historical
psychologists would argue that characteristics of schizophrenia, both as it is understood
today and when the term was first coined, can be seen in literary sources and autobiographies
tracing back to the 13th century, in the guise of words like madness (Henrichs, 2003).
Although there seem to be well-established norms in clinical psychology today for
the diagnosis and treatment of schizophrenia, it may be useful to explore schizophrenia
within a historical psychological framework. Schizophrenia has been understood in
different ways throughout history and has been taken up differently by societies according
to the societal norms of each time period.
In this paper, I will explore the changing nature of schizophrenia throughout history,
drawing from previous historical psychological articles ones that reveal the way
in which schizophrenia was understood in the first 45 years that the term was coined,
as well as articles that explore the same psychological construct today. In addition
to looking at the historical construction of the term, I will use two different approaches
to guide my research. I will firstly draw on the ideas of Ignace Meyerson (1948) who
believed in the historical constitution of psychological functions (Pizarroso, 2013).
He believed that the way in which concepts are understood is reflective of society
(with all its norms and biases) in a given moment and that the way to study how they
are understood is to see how they are taken up by society at that specific time in
history (Pizarroso, 2013). He believed that the mind is in the works, so to speak.
Closely related to this is another approach I will employ briefly near the end of
my paper that of Ian Hacking. He believed in dynamic nominalism- the idea that a
kind of person (e.g. the schizophrenic person) comes into being at the same time that
the kind itself (e.g. schizophrenia) is being invented (Hacking, 1999).
In his 1930 article, The Physiogenic and Psychogenic in Schizophrenia, Bleuler discusses
both the physiological and psychological origins of schizophrenia as a mental illness
in the context of treating patients. He named as the main characteristic of schizophrenia
the lack of association between ideas; in other words, the lack of continuous feelings,
streams of thought, and behavior (Bleuler, 1930). He believed that nearly all [other]
psychogenic symptoms [could] be derived from it (Bleuler, 1930; p.206), including
all sudden changes in behavior, which are complex in the schizophrenic person. However,
he believed that psychic mechanisms were insufficient in explaining the whole disorder
and that the ultimate cause of the disorder was physical, while the psychogenic symptoms simply revealed the hidden complexities (Bleuler, 1930). In this way, he followed in Freuds footsteps, regarding much of the symptomatology
of schizophrenia...as a psychic reaction to its physical origins (Bleuler, 1930; p.
203). This is an example of understanding a concept in a way that is reflective of
society in Europe in a given time period. Freud heavily influenced the understanding
of schizophrenia by not only Bleuler but other European psychologists in the first
45 years following the introduction of schizophrenia to clinical psychology.
Freuds influence can still be seen some 25 years after Bleulers article. In his 1955
article, Childhood schizophrenia: Schizophrenia as a reaction to extreme situations,
Austrian psychologist Bruno Bettelheim alludes to Freudian theory, alleging that childhood
schizophrenia is a psychological reaction to extreme experiences (Bettelheim, 1955).
He used some of the same verbiage that Freud had invented in referring to the affects
of extreme situations on the schizophrenic person: As a consequence, the egos of persons
living under such conditions become so divested of energy that they can no longer
exercise influence and control over the other institutions of the mind, id and superego
(Bettelheim, 1955; p. 512). The popularity of Freuds ideas in Europe at this time
influenced how schizophrenia was normally understood as a mental disorder.
Though the consensus in Bleuler and Bettelheims time period was that schizophrenia
was partly a reaction to situational factors, it was less clear as to whether or not
the disorder had a physiological origin as Bleuler believed. By Bleulers time, autopsies
of deceased schizophrenic persons had revealed that there was brain swelling similar
to that of other deceased patients suffering from delirium, psychosis, and meningitis
(Belueler, 1930). Doctors had found inflammation of the meninges caused by viral or
bacterial infection that can lead to
delirium and convulsions, which are symptoms of schizophrenia (Bleuler, 1930). However,
several decades later, Bettelheim claimed that the question of whether or not schizophrenia
was organic in origin was still up in the air and that he did not feel comfortable
with or competent in discussing something that could not be proven (Bettelheim, 1955;
It would seem that Bleulers theory was correct, given what former autopsies had revealed.
However, the way in which Bleuler and Bettelheim went about actually treating their
patients show that Bettelheims concerns were well-founded. Though there was some evidence
for the physiological basis of schizophrenia, technology and research techniques were
not yet developed enough to prove the validity of this theory or develop physiological
treatments for the disorder (Garrett, 2011). Because of this, both Bleuler and Bettelheim
employed psychoanalysis and psychotherapy in the treatment of their patients, focusing
on the management of their psychological symptoms. This is another example of how
societal factors (i.e. technology) played a role in the way in which schizophrenia
was understood and taken up by psychologists in their treatment of the disorder.
Fifty years later, technology had finally caught up to Bleulers theory. Advanced brain
monitoring systems that can pinpoint the location of brain areas and brain functions
involved in schizophrenia have changed the way that the disorder is understood and
treated today. Neurobiological researchers, Ruiz, Birbaumer, and Sitaram (2013), discuss
the abnormal neural connectivity hypothesis, which speculates that the impairments
associated with [schizophrenia] arise from a failure to integrate the activity of
local and distributed neural circuits (p. 1). While psychologists like Bleuler and
Bettelheim would have regarded
schizophrenia as a physiological and psychological disorder due to former autopsies,
Freuds influence, and, most importantly, their observations of patients, nowadays,
it is postulated that cognitive symptoms are related to a failure to integrate the
activity of local and distributed neural circuits (Ruiz, Birbaume, & Sitaram, 2013;
In contrast to Bleuler and Bettelheims time, therapy is now more centered on the brain.
Re-wiring of neural circuits is a way to produce results that does not require giving
attention to the mind as a means to relieve psychological symptoms. Neurobiology is
privileged in psychology today, and this will change how schizophrenia is treated
as a disorder:
"fMRI-BCI offers a novel and promising possibility to enhance brain connectivity,
without adverse effects. Schizophrenia patients are able to learn self-regulation
of single brain areas using this technology, leading to behavioral modifications and
brain network modulation" (Ruiz, Birbaume, & Sitaram, 2013; p. 11)
Employing Meyersons approach, one can see how the development of technology in todays
society has influenced how schizophrenia is understood and also how it is treated.
Psychology has shifted from a combination of physiological and psychological theory
to a science that is more narrowly focused on the material (e.g. brain functions).
This can be seen in the prevalence of brain-focused and pharmacological research articles
in psychological research today as opposed to the 1960s when research studies were
conducted using a combination of pharmacotherapy and psychotherapy (Mueser & VandenBos,
In addition to Meyerson, Ian Hacking (1999) proposes an approach to historical psychology
that deals with human kinds, which are categories created by humans as opposed to
natural kinds, which exist in nature (Hacking, 1999). The term schizophrenia is a
invention meant to attribute to a person a certain set of characteristics. It was
invented and developed in the context of the treatment of mental disorders.
According to Hackings theory of dynamic nominalism, which postulates that people are
created at the same time that the category is invented (Hacking, 1999), the schizophrenic
person did not exist before Bleuler coined the term. Before his time, there were categories
of madness that some would argue had certain characteristics that fit into the framework
of how schizophrenia is understood diagnostically today (Henrichs, 2003). However,
those people would have been considered mad, not schizophrenic. In a way, the schizophrenic
person was made up (Hacking, 1999) by Bleuler, and this tradition was continued by
his contemporaries and has been taken up by psychologists today.
For Bleuler, the schizophrenic had a disorder with physiological and psychological
origins that entailed a disconnect from reality and lack of proper association between
ways of thinking and behavior (1930). Thus, the schizophrenic required both physical
and psychological treatment, but due to the technological limitations of the time,
Bleuler offered psychotherapy and focused on the psychological symptoms.
Today, the schizophrenic has a brain disorder due to lack of proper connectivity between
neurons of different areas of the brain (Ruiz, Birbaume, & Sitaram, 2013). Thus, the
schizophrenic requires physical treatment, and the psychological symptoms are seen
as a consequence of incorrect brain functioning. If brain functioning is fixed, then
the psychological symptoms should go away.
One can see how Hackings approach can be useful when viewing schizophrenia within
a historical psychological framework. According to Hacking, the schizophrenic is a
made-up person. However, the amount of time and resources devoted to knowledge and treatment
of schizophrenia treats the disorder like a naturally-occurring phenomenon in the
world that researchers have always struggled with. In reality, it is a fairly new
psychological construct, and it is a dynamic one, as Hacking points out. The schizophrenic
of Bleulers time is not the same schizophrenic as today. This has implications for
how schizophrenia is understood and also how it is treated.
Combining both theories, Meyerson and Hacking offer an insightful way of looking at
schizophrenia within a historical psychological framework. The development of schizophrenia
since the early 20th century has been reflective of society, and this has influenced
the way in which psychologists have understood the disorder and also how they have
treated their patients. In addition, the invention of the category schizophrenia sheds
light on what psychologists are actually treating, which is a category invented by
a man. This certainly has implications for the diagnostic definition of schizophrenia,
which cannot be delimited to what is commonly accepted by society at a given time.
Needless to say, schizophrenia is a dynamic disorder with a dynamic history. It will
be interesting to see how it is taken up in the future, and if neuroscience will replace
neuropsychology in the treatment of mental disorders all together.
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Journal of Psychitary, 10, 203-211.
Bettelheim, B. (1956). Childhood schizophrenia: Symposium, 1955: 3. Schizophrenia
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DSM-IV Criteria for Schizophrenia :: DNA Learning Center. (n.d.). DNALC Blogs. Retrieved May 10, 2014, from http://www.dnalc.org/view/899-DSM-IV-Criteria-for- Schizophrenia.html
Garrett, B. (2011). Psychological disorders. In V. Knight (Ed.), Brain & behavior:
An introduction to biological psychology (pp. 428-462). Thousand Oaks, California:
Hacking, I. (1999). Making up people. In M. Biagioli (Ed.), The science studies reader
(pp. 161-171). New York: Routledge.
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Ruiz, S., Birbaumer, N., and Sitaram, R. (2013). Abnormal neural connectivity in schizophrenia
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