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Schizophrenia, a Splitting of the Mind

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Schizophrenia, A splitting of the mind

Dementia Praecox, the early term for schizophrenia was presented by Emil Kraepelin in 1898. Dementia Praecox included - dementia paranoids, catatonia and hebephrenia. Whilst these different entities are symptomatically very diverse, Kraepelin believed they shared a common core. Kraepelin noted several major symptoms in his patients, these included hallucinations, delusions, negativism, attentional difficulties, stereotyped behaviour and emotional dysfunction. Kraepelin focused on describing schizophrenia and made no attempt to categorise and explain what he saw.

Eugen Bleuler however tried to define the core of the disorder. Bleuler disagreed with Kraepelin on two points. Bleuler believed that the disorder didn't necessary have an early onset and that the disorder didn't necessarily lead to total dementia. Since he believed that the disorder didn't lead to total dementia the term dementia praecox was no longer valid, so in 1908 Bleuler suggested a new term for the condition Schizophrenia. Bleuler had a great influence over the American concept of Schizophrenia. Whilst the European view of Schizophrenia remained relatively narrow.

The American view of schizophrenia broadened significantly during the 20th century, with 80% of patients in the New York State Psychiatric Institute being diagnosed with Schizophrenia in 1952. Adolf Myer argued that diagnostic categories where often to stringent and believed that a more flexible approach to defining Schizophrenia was necessary. Kansnin then found that some patients showed signs schizophrenia combined with symptoms from other disorders. The concept of schizophrenia was also broadened by Hoch who believed that schizophrenia often disguises itself has other disorders. As a result a lot of people who would normally have been diagnosed with personality disorders or neurosis, where diagnosed has having schizophrenia. After the publication of DSM III the American definition moved away from the very broad definition of schizophrenia, to a more controlled approach that meant that less people are now wrongly diagnosed with schizophrenia.

The symptoms of schizophrenia cause suffers problems in several major areas these include: thought, perception, attention, motor behaviour and emotion. Many patients, who are diagnosed with schizophrenia, only have some of the symptoms. Unlike most disorders schizophrenia doesn't have an essential symptom, which must be present for schizophrenia to be present. The symptoms of schizophrenia can be divided into two categories, positive and negative symptoms.

Positive symptoms include disorganised speech, hallucinations, delusions and bizarre behaviour. Disorganised speech also known has formal thought disorder. It refers to the problems that a patient has in organising speech in a manner the listener can understand. A patients speech can be made difficult because they are incoherent and whilst the patient makes repeated references to central ideas, the images and fragments of thought are not connected. Speech can also become disorganised through loose association or derailment, in which case the patient may have more success communicating to the listener but they have difficulty sticking to one subject. The disorganisation of thought seems more central to schizophrenia than the disorganisation of speech. Many schizophrenics are subject to delusions, holding a belief that the rest of society would simply deem as false. Delusions generally take one of eight forms.

1. Somatic passivity - The patient believes they are the unwilling recipient of bodily sensations administered by an external force.

2. Thought insertion - The patient believes that thoughts that are not their own have been inserted to their head.

3. Thought broadcast - The patient believes their thoughts are being broadcast to others around them.

4. Thought withdrawal - The patient believes that some external force is stealing their thoughts.

5. Made feelings - They believe that some external force is making them feel a certain way, for example unhappy, when the patient believes they are not in fact unhappy.

6. Made volitional acts - When the patient makes a particular action for example pick up a cup, they believe they have no control over their movements.

7. Made impulses- Is when the patient believes they certain impulses are placed in their head by some external force.

8. Persecutory delusions - The patient believes they are the victim of a great plot against them.

Schizophrenics also often report that the world seems unreal in some way. The most dramatic distortions of perception are called hallucinations. There are many different types of hallucinations. Below there's a brief description of some types of auditory hallucinations.

1. Audible thoughts - The patient may hear a voice from above their head repeating some of their thoughts.

2. Voices arguing - The patient hears voices arguing, often about the patient themselves.

3. Voices commenting - The patient hears voices commenting on their actions, often in a negative way.

Negative symptoms consist of behavioural malfunctions such as avolition, alogia, anhedonia, and flat effect. Avolition is when the patient has a lack of interest or energy when it comes to routine activities such has personal hygiene. They spend a lot of time sitting around doing nothing. Alogia has several components, these include a reduction in the amount of speech, a degrading of the content of the speech and whilst the person is coherent they convey very little information when speaking. Anhedonia is the inability to experience pleasure. Flat affect is when virtually no stimulus can get an emotional response.

There are other symptoms of schizophrenia that do not fit into either positive to negative symptoms. One of these is catatonia, which is when the patient adopts strange seemly uncomfortable poses for long periods of time. Some schizophrenics report a sudden increase in their overall level of activity. Some also have inappropriate affect. This is when the emotional response of the sufferer is out of context. For example they laugh upon hearing their father died.

We know people suffering from schizophrenia differ from normal people in the way they think, perceive, speak and imagine. But we don't know why some people become schizophrenic. Below I'm going to outline some of research people have done



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