A Brief Description of Treatments for Schizophrenia Throughout History
Paige Woolstenhulme
PSYCH 311-03
Brigham Young University of Idaho
Abstract
Throughout this paper, written due to requirements made by the Psychology department of Brigham Young University of Idaho, my main intent is to explore the initial discovery, categorization, and subsequent methods of treatments for the illness now termed schizophrenia. The next five facets of this subject, outlined in this text, will relate how this unique malady, throughout history, has affected countless lives and changed the way psychologists and therapists see the human brain. This paper will include a description of the modern understanding of schizophrenia and a brief description of such. It will also include the early recognition and classification of it and the subsequent treatments, including the primitive, magical and psycho-biological analysis. And it also will include descriptions of how advances in modern psychology, and its branches, have produced currently successful treatments for schizophrenia that include varied antipsychotics and therapies that enhance the daily lives of those affected. Lastly it will describe my hopes for the future of the field. This paper will include information found in the required class text titled An Introduction to the History of Psychology by B. R. Hergenhahn and various works found through the BYUI Library online resource.
Keywords: Schizophrenia, Psychology, Psychosis, Historical
Treatments of Schizophrenia Throughout History
Many advances have been made in the field of psychology throughout the brief history of modern science. Due to setbacks owing to religious and moral actions, awareness and subsequent treatment of psychological diseases has only recently been explored as a serious science. These actions have benefited countless people and allowed for the utilization of lives that would have otherwise been lost to false impressions and consequential isolation. Because of those basic sciences that originated in philosophy we now have advanced leaps and bounds in this field. One of the more perplexing diseases of the mind has been that of schizophrenia, a rare and equally mystifying illness categorized as a chemical imbalance between serotonin and dopamine, both of which are neurotransmitters highly important to the healthy functioning of the brain.
Modern Understanding of Schizophrenia
The National Institute of Mental Health (2007) describes this disease as:
a chronic, severe, and disabling brain disorder that has been recognized throughout recorded history. It affects about 1 percent of Americans. People with schizophrenia may hear voices other people don’t hear or they may believe that others are reading their minds, controlling their thoughts, or plotting to harm them. These experiences are terrifying and can cause fearfulness, withdrawal, or extreme agitation. People with schizophrenia may not make sense when they talk, may sit for hours without moving or talking much, or may seem perfectly fine until they talk about what they are really thinking. Because many people with schizophrenia have difficulty holding a job or caring for themselves, the burden on their families and society is significant as well. . . . Psychotic symptoms (such as hallucinations and delusions) usually emerge in men in their late teens and early 20s and in women in their mid-20s to early 30s. They seldom occur after age 45 and only rarely before puberty, although cases of schizophrenia in children as young as 5 have been reported.
Piotrowski, N. P., and Tischauser, L. P. (2015) maintain that:
Schizophrenia is a genetic disease. Individuals with the disease are very likely to have close relatives—mothers, fathers, brothers, sisters, cousins, grandmothers, or grandfathers—with the disorder. According to the National Institute of Mental Health in 2015, schizophrenia occurs in roughly 1 percent of the general population, but it occurs in roughly 10 percent of individuals with a first-degree relative (parent, sibling) who has the disorder. The risk increases when one has an identical twin with schizophrenia; that individual then has a 40–65 percent chance of developing the disorder.
Research has made it obvious that living day to day with the illness of schizophrenia is, in a word, difficult. It is also visible that those who are in positions of support for those with this disease struggle with the debilitations. Throughout writing this paper, though, I have been tasked with attempting to describe exactly what a schizophrenia patient experiences, and since I have never personally been affected, and have met only a few people that are, I hope that I will do it justice. Scientifically schizophrenia has empirically proven to be a mixture of genetics and brain chemistry, but socially and emotionally, this disease and it’s varieties are indescribable.
It is not surprising that those who have suffered in the previous centuries, before the advances of modern health care, have either attempted hiding, seeking to camouflage their differences from the perceived norm, or were persecuted by those with opposing views of their situation. When untreated or ignored, certain types of schizophrenia can escalate from suggestion to action. The thoughts caused by the disease can begin to alter the patient’s sense of reality. This can make the demands and accusations that a subject’s subconscious makes, which are oftimes based in the fictitious world, cause havoc in reality, both with the patient, and in some cases, innocent bystanders.
Early and Modern Recognition and Classification
According to Piotrowski and Tischauser (2015), Eugen Bleuler (1857–1939), a Swiss psychiatrist, was first to refer to the disease as Schizophrenia. That was in a 1908 paper authored by him titled “Dementia Praecox: Or, The Group of Schizophrenias”. This was following the previous classification of it “as a discrete mental illness by Emil Kraepelin in 1887, who had used the word dementia preacox to define it.” Kyziridis (n.d.)
According to Kyziridis (n.d.):
The word “schizophrenia” comes from the Greek roots schizo (split) and phrene (mind) to describe the fragmented thinking of people with the disorder. His term was not meant to convey the idea of split or multiple personality. Since Bleuler’s time, the definition of schizophrenia has continued to change, as scientists attempt to more accurately delineate the different types of mental diseases. Without knowing the exact causes of these diseases, scientists can only base their classifications on the observation that some symptoms tend to occur together.
This was a diagnosis based in the times of modern medicine, though, and rudimentary diagnosis has been around since ancient Egyptian and pre-biblical times. Basic understandings of the disease resulted in it being referred to as simply madness, or lunacy.
Also according to Kyziridis (n.d.):
“Ethnographic studies have demonstrated that schizophrenia is present in all existing cultures. Psychotic symptomatology and schizophrenic-like syndromes were clearly present in ancient civilizations. . . . Supernatural explanations remained the dominant theory behind mental illness for many years. Schizophrenia can be traced in written documents to the old Pharaonic Egypt, as far back as the second millennium before Christ. Depression, dementia, as well as thought disturbances found in schizophrenia are described in detail in the Book of Hearts, which is part of the Eber papyrus. Heart and mind seem to have been synonymous in ancient Egypt. The psychical illnesses were regarded as symptoms of the heart and the uterus and originating from the blood vessels or from purulence, faecal matter, a poison or demons. In most cases the Egyptians apparently looked upon the mental diseases as physical illnesses. . . . A Chinese text entitled The Yellow Emperor’s Classic of Internal Medicine, written around 1000 BC, described symptoms of insanity, dementia, and seizures. Demonic or supernatural possession was often implicated as the cause of psychotic behaviours.”
Centures later, thankfully, many lives were changed because of the actions of humanitarians that saw a solution to those with mental illness that were being sorely mistreated during their time. The team of Joseph Daquin (1733-1815) and Philippe Pinel (1745-1826,) American campaigner Dorothea Lynde Dix (1802-1887,) British Quaker William Tuke (1732-1822,) and Italian physician Vincenzo Chiarugi (1759-1820) were among the countless. These idealists were responsible for the philanthropic treatment of the mentally ill who otherwise would have been left in circumstances ill befitting of them. Hergenhahn (2009.)
Nineteenth century psychology brought with it Wilhelm Wundt (1832-1920), a founding father of the field, who furthered the investigation of schizophrenia by speculating in his time “that schizophrenia could be the result of a breakdown of the attentional processes. If a person lost the ability to apperceive, his or her thought would be disorganized and would appear meaningless, as in the case of schizophrenia.” Hergenhahn (2009.)
This was only an isolated view of the disease, though, and one of great speculation, and modern technology has brought with it the ability to view diseases such as schizophrenia through different lenses. One such lense is that of historical significance and cause and effect.
Modern classifications include five variations of the disease. These include Paranoid, Disorganized, Catatonic, Residual and Schizoaffective. All vary to different degrees and are specific to the individual patients. Schizophrenia. (n.d.)
According to the American Psychiatric Association:
Various subtypes of schizophrenia may be identified in diagnosis, depending on what symptoms predominate. They include paranoid schizophrenia, where delusions or hallucinations are prominent; disorganized schizophrenia, whose hallmark is disorganized speech and behavior along with flat or inappropriate affect; catatonic schizophrenia; undifferentiated schizophrenia; and residual schizophrenia, wherein prominent positive symptoms are currently absent.
Obviously current diagnosis of the disease has evolved greatly from that of the ancient Egyptians and Chinese methods. Therapy and medications have also become a predominant option. Still, though, primitive treatments and superstitions were still a large part of the stigma that has surrounded schizophrenia since prehistoric times and have shaped our view of the disease.
Primitive Treatments
The history of church and state has affected many facets of life for the predecessors of modern medicine. While it’s separation has been the cause for scientific evolvement it also cost many crimeless parties their freedom and resources needed in order for an individual sense of normality.
Prehistoric Biological Treatments. Many archeological explorations have provided evidence of ancient procedures that were thought to heal victims of mental illnesses, most likely including that of schizophrenia. These attempts included extreme prehistoric procedures such as that of trepanation. Found as evidenced by a large group of prehistoric human skulls, they have been described by Hergenhahn (2009) as “found throughout the world with man-made openings in them. These skulls display an opening made by chipping away at it with a sharp stone, a procedure known as Trepanation.” (pg. 491).
Ancient Greek Biological Approaches. These attempts at curing mental illness, schizophrenia included, trickled down history to the Greeks, where Hippocrates (ca. 460-377 B.C.) “was among the first to liberate medicine and psychiatry from their magico-religious background.” (pg. 491) Hergenhahn (2009). Here, during the reign of Greek and Roman communities as a cultural haven, is a short time period in history where mental illness, at least to the Ancient Greeks, became a possibilities of educational enlightenment. This was the time period when philosophy, the predecessor to psychology and its branches, was born. Mental illness, including schizophrenia, were studied and attempts at natural remedies were made. These included the “prescribing (of) treatments such as baths, fresh air, and proper diet,” (pg. 492) Hergenhahn (2009).
Magical and Supernatural Treatments. The era of humane treatment did not survive long, as the Roman empire fell and the Middle Ages replaced the need for understanding with fear and superstition. Hergenhahn (2009) cites (Alexander and Selesnick, 1966, pp. 50, 52) in this brief explanation of the cause of supernatural and magical treatments of mental illnesses:
The collapse of the Roman security system produced a general regression to belief in the magic, mysticism, and demonology from which, seven centuries before, men had been liberated through Greek genius. . . . The psychiatry of the Middle Ages can be scarcely distinguished from prescientific demonology, and mental treatment was synonymous with exorcism. . . . In medieval exorcism Christian mythology and prehistoric demonology found a quaint union. (p. 493)
Witch hunts, which were an extremist form of persecution of the time, were prevalent. Maltreatment of those who did not conform to strict religious and social guidelines were, no doubt, a large cause of the scientific and psychological regression of the Middle Ages. Thankfully, not all mentally ill were persecuted to such an extent with punishments such as witch trials as they were isolated and unique incidents until the Reformation and Renaissance. Still, though, preferred treatment from a religious point of view was exorcism. (pg. 493) Hergenhahn (2009).
This gave way to hundreds of years of superstition until the 17th century which became a mixed century for inhumane treatment and the beginnings of modern diagnosis. According to Kyziridis (n.d.):
The 17th century saw the beginnings of psychiatric hospitals in Europe. With these hospitals came attendants and medical supervisors and the birth of psychiatry. But the ideas of early psychiatrists made no more sense than those who had tried to cure the mentally ill before them. It was widely believed in the asylums that the way to cure someone was to shock them. Early shock methods 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.
Modern Scientific Treatments and Diagnosis
Radical ideas and forms of treatment, thankfully, have become a thing of the past in first world countries and we now have groups dedicated to protecting those who cannot speak for themselves. Early diagnosis and education on symptoms and treatment options are now widely spoke of across every country with access to modern health care.
According to the American Psychiatric Association:
“. . . a diagnosis of schizophrenia requires that at least two of the following five types of symptoms show up for a significant portion of a one-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. It is also required that the person show impaired functioning in a major area such as work, school, or interpersonal relations; that some signs of the disturbance continue for at least half a year; and that such other potential causes of the disturbance as drug abuse, a medical condition, and certain mental disorders are ruled out.”
It’s easy for anyone with access to the internet to be able to find help and basic knowledge of the disease, such as this basic description of schizophrenia in Funk & Wagnalls New World Encyclopedia:
Medical studies suggest that schizophrenia may be as many as eight distinct mental disorders, with the variation in symptoms resulting from underlying genetic variation among people with the disease. Schizophrenia almost always develops before middle age. Typically, the first episode takes place during adolescence or young adulthood and tends to be followed by others. The onset of symptoms may be abrupt but more often occurs slowly and gradually. Some people with schizophrenia may experience periods of remission, while in others the illness takes on a chronic character; it may follow a stable course or gradually worsen. Once it develops, schizophrenia tends to be lifelong. In some people symptoms seem to ease with age, but complete recovery appears to occur in only a fraction of cases. Generally only some of the symptoms of schizophrenia are present in any one individual. Schizophrenia (2016).
Modern times have brought forth modern ways of treating mental illness. With Schizophrenia it is no less. Health care now offers assistance for anyone suffering from the effects caused by schizophrenia and most care facilities try their best to never refuse helping a patient in need. Psychosocial Rehabilitation Programs help people re-adjust to new situations pertaining to their illnesses. Self help groups are constantly welcoming of newcomers. 24-hour hotlines, drop in centers, and immediate therapy sessions are most always an option when dealing with persistent and extreme cases. New age antipsychotics now cause less side effects and more greatly deter the symptoms of the disease such as hallucinations and confusion, and the byproducts of the pills themselves. These byproducts include a myriad of discomforts including dizziness, blurred vision, and drowsiness, which could also likely impair the subject's ability to drive and thus their dependability upon others. These lesser side effects could also in turn evolve into more serious symptoms such as lack of muscle control, facial ticks and pacing. Schizophrenia. (n.d.).
Differences in therapy techniques have also evolved, such as with a style referred to as Naming. These techniques build a groundwork for psychologists, and those suffering from schizophrenia, seeing as it is often difficult for patients to describe their emotions. According to Lotterman (2016):
The technique of Naming consists of a persistent, determined effort to help the patient identify sensations, perceptions, and body experiences which may embody essential thoughts and emotions. By paying vigilant attention to the details of the patient’s experience, and by translating the details of that experience into words, the patient’s inner life may be clarified and shared. What begins as concrete perception may be transformed into emotion, thought and meaning. If this is successful, it may pave the way to a more traditional form of psychodynamic therapy based on word and concept use. (p. 75-76)
Hopes for the Future and Conclusion
“How then, should we approach work with patients who have schizophrenia? Our long-term goal may be symptom reduction and better psychosocial adaptation” said Lotterman (2016).
In the conclusion of his paper on the different techniques for diagnosing those with schizophrenia, Lotterman (2016) states what I believe to perfectly encapsulate the positive effects of therapy on schizophrenics by shedding light on his experiences as a psychotherapist:
Work with these patients can be very difficult, very taxing, and, at times, very discouraging. But it is certainly possible to establish relationships in depth with patients with psychosis which can have all kinds of useful results. On the more modest side, the relationship can help a patient to follow his treatment plan more consistently and to take his medication, if indicated, more regularly. In some cases, it can help patients not only reduce psychiatric symptoms, but also to come out from profound social isolation, and resume work, schooling, and even romantic relationships. The path is never easy or straight, but, it can often be deeply rewarding. (77)
At the end of this paper it is evident to myself, as a student historian, and hopefully to you, as the reader, that modern medicine and psychology has paved the way to brighter futures for those suffering from schizophrenia. The historical lense has proven to be an interesting lens through which to view the more perplexing mental illnesses of schizophrenia. It has shown that sufferers dependance upon the willingness of others to accept and understand their situation is just as important as their own personal acceptance of the disease. Hopefully we will only advance from this stage of science and psychology and see even brighter futures for those afflicted and their loved ones.
References
Hergenhahn, B. R. (2009). An Introduction to the History of Psychology (6th ed.). Australia: Wadsworth Cengage Learning.
Kyziridis, T. C. (n.d.). Notes on the History of Schizophrenia. German Journal of Psychiatry, 1-48. Retrieved July 19, 2016, from http://www.psychodyssey.net/wp-content/uploads/2012/05/Notes-on-the-History-of-Schizophrenia.pdf
Lotterman, A. C. (2016). Psychotherapy Techniques for Patients Diagnosed with Schizophrenia. American Journal Of Psychotherapy, 70(1), 63.
Piotrowski, N. P., and Tischauser, L. P. (2015). Schizophrenia. Magill’S Medical Guide (Online Edition),
Schizophrenia. [electronic resource] with addendum schizophrenia January 2007. (2007). [Bethesda, Md.] : U.S. Dept. of Health and Human Services, National Institutes of Health, [2007].
Schizophrenia. (2016). Funk & Wagnalls New World Encyclopedia, 1p. 1.
Schizophrenia. (n.d.). Retrieved July 20, 2016, from http://www.mentalhealthamerica.net/conditions/schizophrenia © Copyright Mental Health America