How Schizophrenia S Definition Has Evolved A Timeline

Less than 200 years ago schizophrenia emerged from a tangle of mental disorders known simply as madness. In the upcoming fifth edition of psychiatry’s primary guidebook, the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, schizophrenia will finally shed the outdated, 19th-century descriptions that have characterized it to this day. Yet the disorder remains poorly understood. “There is substantial dissatisfaction with schizophrenia treated as a disease entity; its symptoms are like a fever—something is wrong, but we don’t know what,” says William Carpenter, a psychiatrist at the University of Maryland and chair of the manual’s Psychotic Disorders Work Group. Psychiatrists may discover that this disorder is not a single syndrome after all but a bundle of related conditions.

Madness, Demons and Delusions

circa 1550 B.C. The Book of Hearts from ancient Egypt records how poison, demons, fecal matter or blood trouble may be at the root of madness.

ca. 1400 B.C. The ancient Hindu Vedas describe illnesses characterized by bizarre behavior, lack of self-control, filth and nudity brought on by devils.

ca. 400 B.C. Another early text, The Yellow Emperor’s Classic of Internal Medicine from China, describes how insanity, dementia and seizures arose from demonic possession and other supernatural forces.

1334 A.D. Opicinus de Canistris, an Italian scribe, is struck by a strange illness in which he believes he sees the Virgin Mary. Afterward, he becomes socially withdrawn and devotes his time to creating fantastical maps. The case may describe either a stroke or an early example of schizophrenia.

Early Dementia

1809 French and English physicians Philippe Pinel and John Haslam independently describe young patients who show signs of “premature dementia.” These cases are commonly referred to as the first thorough portraits of schizophrenia.

1834 Ukrainian writer Nikolay Gogol’s Diary of a Madman follows Poprishchin, whose delusions of grandeur accompany his slide into insanity. The story is considered one of the earliest descriptions of schizophrenia in literature.

1871 German psychiatrists Karl Ludwig Kahlbaum and Ewald Hecker are among the first to categorize forms of “madness.” Kahlbaum describes catatonia—characterized by alternating immobility and frenzy—and paranoia, in which an individual is overwhelmed by fear. Hecker iden-tifies hebephrenia, which involves erratic behavior and incoherent speech.

1896 Emil Kraepelin, a German psychiatrist, describes dementia praecox as a lifelong disease that worsens with time. He later incorporates Hecker and Kahlbaum’s disorders as syndromes of dementia praecox.

1906 Swiss psychiatrist Adolf Meyer rejects Kraepelin’s concept of dementia praecox as a biological disease. Instead he favors a psychoanalytic approach, in which mental illness is triggered by life experiences, such as stress or a difficult childhood. Meyer’s ideas will influence the DSM-I and DSM-II descriptions of schizophrenia.

“Schizophrenia”

1908 Swiss psychiatrist Eugen Bleuler, who did not believe that the disorder known as dementia praecox always involved deterioration and only struck adolescents, coins the term “schizophrenia,” referring to a split mind.

1914 First use of term “schizophrenic” in a Scientific American publication, in an article entitled “The Psychanalytic Movement.”

1930 Roaring 20s icon Zelda Fitzgerald is diagnosed with schizophrenia. She spends the rest of her life in mental hospitals. Her husband, F. Scott Fitzgerald, is inspired to write the novel Tender Is the Night about a woman’s mental illness.

1958 Premiere of Suddenly Last Summer, by Tennessee Williams. Williams is said to have based his troubled heroine, Catharine Holly, on his sister, Rose Williams, who was diagnosed with schizophrenia and underwent a lobotomy.

1959 German psychiatrist Kurt Schneider identifies core symptoms of schizophrenia, such as auditory hallucinations and delusions, that distinguish it from other forms of psychosis. His criteria end up informing the DSM-III.

Biological Mystery

1972 Neurologist Fred Plum calls the disorder a “graveyard of neuropathologists,” a reference to the apparent lack of a brain-based explanation for schizophrenia.

1976 A study of CT scans suggests differences in the size of cerebral ventricles in patients with schizophrenia. This is the first of many studies to identify brain anomalies associated with schizophrenia.

1980 Building on Kraepelin’s definition, the DSM-III recognizes five subtypes of schizophrenia: disorganized (hebephrenic), catatonic, paranoid, residual and undifferentiated.

1986 German psychiatrist Karl Leonhard suggests schizophrenia is a group of psychoses—including hallucinations and cognitive dysfunction—rather than a single disorder.

1994 Mathematician John Forbes Nash, Jr., receives a Nobel Prize. His struggles with schizophrenia are the subject of A Beautiful Mind, a biography by Sylvia Nasar and an eponymous Oscar-winning film.

1994 The DSM-IV is published. It includes subtypes of schizophrenia but notes their limited utility in diagnosis.

Contemporary Questions

2002 The Japanese Society of Psychiatry and Neurology changed the name of schizophrenia from seishin bunretsu byo, or “mind-split disease,” to togo shitcho sho, or “integration disorder.” The change has reduced stigma and confusion about the nature of the disease.

2009 In what New York Times reporter Nicholas Wade dubs “a Pearl Harbor of schizophrenia research,” three studies in Nature journals implicate between tens and thousands of possible gene variants.

2013 The DSM-5 will remove the subtypes of schizophrenia. To receive a diagnosis of schizophrenia, patients must now exhibit delusions, hallucinations or disorganized speech. They may also experience motor difficulties, such as catatonia, and negative symptoms, such as social withdrawal or lack of emotional responsiveness.