History of Schizophenia and Its Treatment

HISTORIC OVERVIEW OF SCHIZOPHRENIA AND ITS TREATMENT

ABSTRACT

This paper provides an overview of the history of schizophrenia and its treatment. The paper begins by first providing some basic facts about the condition such as its nature, its probable causes, and its symptoms. This brief description is followed by a historical overview which discusses how schizophrenia came to be identified as a unique illness. The views of psychiatrists pivotal to making this identification are described. The paper then goes on to discuss how these views affected what was considered to be effective treatment for schizophrenia (e.g., sedation) and delineates how the notion of what should constitute effective treatment changed over the years. The paper also explores various medications that were used to treat the condition.

Introduction

Butcher, Mineka and Hooley (2003) define schizophrenia as a brain disorder in which there is a failure of the brain's chemical or electrical systems to function properly, resulting in a variety of unusual neural twists, such as disjointed ideas, confused or disconnected thoughts, and sounds or other sensations experienced as real when they exist only in the person's mind. The prevalence of the disorder is estimated to be about one percent of the population in most countries including the United States. Butcher, Mineka and Hooley also note that there are no sex-related difference for the prevalence of schizophrenia among men and women with the exception of a slight difference in the average age of onset with men showing symptoms a few years earlier than women.

According to Foster (2003), it is currently believed that schizophrenia is caused by multiple factors but scientists are still unsure of the exact cause. Some of the factors believed to be involved in the development of schizophrenia but which are still being researched are: an imbalance of the brain's neurotransmitters (naturally existing chemicals that assist in cellular communication); genetics (schizophrenia is more likely to occur in families with a history of the disorder); (an abnormality in brain structure (the structure of schizophrenic brains are different from those of non-schizophrenics); and developmental factors such as a viral infection that occurs in the womb.

Finally, Comer (2000) points out that symptoms of schizophrenia can vary somewhat from person to person but, typically, those diagnosed with the disorder will show some combination of the following symptoms:

1. Delusions of oneself and/or one's surroundings (e.g., one believes that he has special powers that nobody else has).

2. Hallucinations. Typically (but not always) the schizophrenic will suffer from audio hallucinations in which he or she hears voices that talk negatively about self or give dangerous commands.

3. Disrupted thoughts and behavior making for concentration difficulties.

4. Negative symptoms such as an absence of normal characteristics. There can be lack of interest in previously enjoyable activities, not taking care of oneself, social withdrawal, and blunted affect (restricted facial expressions and emotions).

While today much is known about schizophrenia and its treatment, this has not always been the case, despite the fact that behavior and symptoms of schizophrenia have been reported in physician records since ancient times (Cormer, 2000). To provide a historic foundation to what is currently known about schizophrenia, this paper presents an overview of the history of schizophrenia and its treatment.

History and Treatment

Andreasen (1997) states that schizophrenic behavior has been noted in almost all cultures in history and that early views of the disorder tended to ascribe it to either demonic assaults or punishment by the gods for immoral behavior. Treatment is believed to have often taken the form of making holes in a person's skull to allow evil spirits to escape (Tallis, 1998). Indeed, Tallis (1998) reports that for centuries some form of supernatural explanation was the dominant theory for not only schizophrenia but also most mental illnesses.

Healy (1997) states that it was the Greeks who first began to view schizophrenia as having a biological cause. In the Greek view, the delusions and other symptoms of the disorder occurred as the result of an imbalance of bodily humours. For example, Hippocrates believed that all insanity was due to problems with liver functioning.

It was not until the 18th century that the central nervous system began to be viewed as contributive to schizophrenia and other mental illnesses. Andreasen (1997) reports that as this view grew, so did the number of institutions designed to treat mental illness. However, it should not be thought that institutions did not exist prior to those built in the 18th century. Indeed, Porter (1991) states that institutions existed prior to the new medical notions of the 19th century but these provided very little treatment and were essentially used for confinement. Chains and stocks were used to quell violent behavior. However, with the growth of a new understanding of schizophrenia as biologically based, the institutions now being built were psychiatric hospitals. In these European institutions, the first ideas of psychiatry were being used to provide treatment to people with a variety of mental illnesses including schizophrenia.

However, Porter (1991) argues that the early notions of psychiatry were, in reality, little better than the views held in the early institutions where confinement was the order of the day and stocks and chains were used on the violent. This is because the psychiatrists in these early institutions relied heavily on shock as a means of remediating the condition. Methods of treatment included pinning patients down and pouring cold water on their faces until they were nearly drowned, or strapping patients to chairs so that they lost sensation and became calm.

Still, knowledge about mental illness in general and schizophrenia in particular began to grow as did the idea that mental illness could be connected to the neurobiology of the brain and with this, Porter (1991) states that psychiatry found its true place in the medical world. Indeed, Healy (1997) reports that it was during this period that organic explanations of a variety of mental illnesses began to be seriously investigated; moreover, the various conditions were classified, and distinguished from one another. Still there was as yet no real strong connections made between biology and the differences in symptoms. In other words, schizophrenia as a unique condition