History of schizophrenia

Schizophrenia has likely existed for centuries. Historically, it has been the mental illness most likely to be confused with ‘madness’ or ‘spiritual affliction or possession’.

However, the understanding and approach to the diagnosis and treatment of this mental health condition has developed significantly over the last century. Today, the condition is classified as a psychotic disorder, with some of the main signs and symptoms including hallucinations, delusions, and disorganized thinking, while effective treatment typically involves a combination of antipsychotic medication and therapy.

Early history of schizophrenia

One of the earliest records of schizophrenic behavior dates back to 1550 BC. However it wasn’t until the 17th century that medical literature started to regularly reference people with symptoms of schizophrenia: seeing visions, hearing voices and erratic behaviour. ^[1]

In the 19th century, this was taken a step further by a director of a psychiatric clinic in Estonia named Dr Emil Krapelin. Dr. Emil Krapelin was the first to come up with an evidence-based attempt to diagnose schizophrenia. He used the term Dementia Praecox, or premature dementia. He believed that this condition had a steady downward trajectory and little to no improvement could be expected ^[1].

Schizophrenia in the 21st century

The term ‘schizophrenia’ was first used by a swiss psychiatrist named Dr. Eigen Bleuler who expanded upon Dr Krapelin’s ideas. Crucially, Dr Bleuler believed that with treatment and given time patients could show distinct improvements. ^[2]

By the early 1900s, in the UK at least, almost all schizophrenic patients would have been treated at an asylum. These institutions were controlled by the local authorities and although it was later discovered that some were abusive, at the time of building, they were seen as a compassionate way to care for the vulnerable.

Aside from the reported abuse, the other main criticism of asylums was that many patients became ‘institutionalised’. Patients tended to live in these institutions for years. Even if their condition improved, they would be so dependent on the staff and environment of the asylums that they would be unable to reacclimate to life outside the facilities. Irrespective of improvement patients needed to stay indefinitely meaning that the asylums were essentially a life sentence albeit a compassionate one. ^[2]

Additionally, these institutions were often controlled by the state, which left them vulnerable to changing political strategies and opinions. Historically, there has been one group, the followers of eugenics, which has continuously sought to eradicate mental illness by forced sterilisation or euthanisa.

The most infamous period was the Nazi regime in Germany who undertook an ambitious campaign to eliminate all schizophrenics from their race. Initially, elimination was performed by lethal injection, but eventually via gas chambers. Before the end of the second world war over a quarter of a million disabled or mentally ill people were put to death under the Nazi regime. ^[2]

Evolution of treatments for schizophrenia

Early treatments for schizophrenia were barbaric, relying mainly on brain surgery, electric shock therapy, or drug-induced confinement.  It was not until antipsychotic drugs were discovered and developed in the mid twentieth century that any other options were considered. ^[3]

In the early 1950s, a naval surgeon called Laboret thought that a new drug called chlorpromazine would be beneficial in treating post-operative shock for his patients. While experimenting, he noted the intense relaxing effect it had on his patients and considered the benefits in psychiatry. Chlorpromazine was the first new drug in what would become known as antipsychotics. For schizophrenia patients, chlorpromazine acts differently to sedatives. Rather than blunting the effect of hallucinations, this drug reduces them altogether allowing a better quality of life for patients. ^[2]

Although the first generation of antipsychotics, including chlorpromazine, haloperidol and flupenthixol, were revolutionary in treating the symptoms of schizophrenia, they did come with many different side-effects. However, the benefits outweighed the drawbacks.

Before the use of antipsychotic drugs, up to 70% of people with schizophrenia were confined to mental institutions, often for a period of years. After drug therapy, it was approximately 5% of patients and the period confinement was measured in months. ^[2]

In the latter half of the 20th century, the second generation of antipsychotics medication was produced; these are called atypicals. They reduced the side-effects felt by patients while maintaining the positive effect on schizophrenia symptoms.

Around the same time that the atypical antipsychotic drugs were starting to be produced, psychologists were developing a new type of talk therapy called cognitive behaviour therapy or CBT. This therapy seemed to be effective in helping schizophrenia patients take responsibility for the management of their illness, allowing for greater independence and empowerment. This allowed more people to be cared for at home rather than requiring the expertise of hospital staff. Thus, reducing the likelihood of abuse by staff as well as removing the ‘institutionalised’ problem with long-term patients. ^[3]

Current outlook for people with schizophrenia

Currently in the U.S., treatment for schizophrenia patients is managed by a consultant psychiatrist, often in addition to a psychologist and a psychiatric nurse, with support by social workers. In-patient treatment is reserved for people in crisis or people whose illness may put themselves or others in danger. The clinical outcomes for people with schizophrenia have never been better with modern drug regimes, therapy, and community care. However, there is still much to be done to understand this mental illness and to systematically improve those people who suffer from schizophrenia.