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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, 2003; p. 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; p. 507).
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; p. 1).
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, 2011).
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 human 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.
Bleuler, E. P. (1930). The physiogenic and psychogenic in schizophrenia. The American Journal of Psychitary, 10, 203-211.
Bettelheim, B. (1956). Childhood schizophrenia: Symposium, 1955: 3. Schizophrenia as a reaction to extreme situations. American Journal of Orthopsychiatry, 26(3), 507-518.
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: SAGE.
Hacking, I. (1999). Making up people. In M. Biagioli (Ed.), The science studies reader (pp. 161-171). New York: Routledge.
Heinrichs, R. (2003). Historical Origins of Schizophrenia: Two Early Madmen and Their Illness. Journal Of The History Of The Behavioral Sciences, 39(4), 349-363. doi: 10.1002/jhbs.10152
Mueser, K. T., & VandenBos, G. R. (2011). Schizophrenia. In J. C. Norcross, G. R. VandenBos, D. K. Freedheim (Eds.), History of psychotherapy: Continuity and change (2nd ed.) (pp. 601-611). Washington, DC US: American Psychological Association. doi: 10.1037/12353-038
Pizarroso, N. (2013). Mind's historicity: Its hidden history. History of Psychology, 16(1), 72-90. doi:10.1037/a0030533
Ruiz, S., Birbaumer, N., and Sitaram, R. (2013). Abnormal neural connectivity in schizophrenia and fMRI brain-computer interface as a potential therapeutic approach. Frontiers in Psychiatry, 4, 1-14.
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