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History of Psychiatry and Medical Psychology pp 461–483Cite as

Constructing Schizophrenia as a Category of Mental Illness

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Abstract

How can we define the illness we label schizophrenia? As there seems to be no clear and definite answer to this question, I will assume the existence of a nosological category called “schizophrenia” and will also assume that this category was constructed historically.1 Thus our present diagnostic criteria for schizophrenia evolve out of a constant analysis and restructuring of other concepts, which are formed to create the category of schizophrenia. Unlike most other disease entities in psychiatry, schizophrenia is still a label in search of a structure; it is a category applied to a rather large group of symptoms with an almost equal number of etiologies proposed for it.

Keywords

  • Mental Illness
  • Nineteenth Century
  • Disease Entity
  • Late Nineteenth Century
  • Eighth Edition

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Notes and References

  1. There have been many attempts to sketch the history of the concept of schizophrenia, either independently or within broader contexts, all of which are helpful, but only one of which provides any synthetic history of the concept: John G. Howells, ed., The Concept of Schizophrenia: Historical Perspectives (Washington DC: American Psychiatric Press, 1991), the essays in which are a useful adjunct to this paper. From 1928 to 1941 see Adolf Meyer, “The Evolution of the Dementia Praecox Concept,” in Charles L. Dana et. al., eds., Schizophrenia [Dementia Praecox] (New York: Paul Hoeber, 1928), 3–15; H. W. Gruhle, “Die Schizophrenie. Geschichtliches,” in O. Bumke, ed., Handbuch der Geisteskranken, IX, Spezieller Teil V (Berlin: Springer, 1932), 1–30; Gregory Zilboorg, A History of Medical Psychology (New York: Norton, 1941; revised edition, 1954). From 1956 to 1970 see J. Wyrsch, Zur Geschichte und Deutung der endogenen Psychosen (Stuttgart: Thieme, 1956); Erwin Ackerknecht, Kurze Geschichte der Psychiatrie (Stuttgart: Enke, 1957); Manfred Bleuler, “The Conception of Schizophrenia Within the Last Fifty Years and Today,” International Journal of Psychiatry 1 (1965), 501–523; Franz Alexander and Sheldon Selesnick, The History of Psychiatry (New York: Harper & Row, 1966); Dieter Wyss, Depth Psychology: A Critical History, Development, Problems (New York: W.W. Norton, 1966); N. D. Lewis, “The History of the Nosology and the Evolution of the Concepts of Schizophrenia,” Proceedings of the American Psychopathological Association 54 (1966),1–18; G. Tourney, “A History of Therapeutic Fashions in Psychiatry, 1800–1966,” American Journal of Psychiatry 124 (1967), 784–796. From 1970 to 1975 see Robert Cancro and Paul W. Pruyser, “A Historical Review of the Development of the Concept of Schizophrenia,” in Robert Cancro, ed., The Schizophrenic Reactions (New York: Brunner/Mazel, 1970), 3–12; Henri F. Ellenberger, The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry (New York: Basic Books, 1970); Silvano Arieti, Interpretation of Schizophrenia (New York: Basic Books, 1974), 9–29; Werner Janzarik, Themen und Tendenzen der deutschsprachigen Psychiatrie (Berlin: Springer, 1974); A. D. Forrest, “Concepts of Schizophrenia: Historical Review,” in A. D. Forrest and J. Affleck, eds., New Perspectives in Schizophrenia (Edinburgh: Churchill Livingstone, 1975), 1–15. From 1976 to 1979 see M. D. Altschule, “Historical Perspective—Evolution of the Concept of Schizophrenia,” in Stewart Wolf and Beatrice Bishop Berle, eds., The Biology of the Schizophrenic Process (New York: Plenum Press, 1976), 1–13; J. Ramano, “On the Nature of Schizophrenia: Changes in the Observer as Well as the Observed,” Schizophrenia Bulletin 3 (1977), 532–559; Henry Werlinder, Psychopathy: A History of the Concepts/Analysis of the Origin and Development of a Family of Concepts in Psychopathology (Stockholm: Almqvist & Wiksell, 1978), 100–127; Hannah S. Decker, “The Historical Evolution of Dementia Praecox,” in William E. Fann et al., eds., Phenomenology and Treatment of Schizophrenia (New York: Spectrum, 1978), 301–309; Manfred Bleuler, “On Schizophrenic Psychoses,” American Journal of Psychiatry 136 (1979), 1403–1409. From 1980 to 1983 see Peter Berner, “Schizophrenie: Oberblick und Geschichte,” in U. H. Peters, ed., Psychiatrie 1 (Zurich: Kindler, 1980), 353–370; John M. Neale and Thomas F. Oltmanns, Schizophrenia (New York: John Wiley & Sons, 1980), 2–16; Seymour S. Kety, “The Syndrome of Schizophrenia: Unresolved Questions and Opportunities for Research,” British Journal of Psychiatry 136 (1980), 421–436; Sue A. Shapiro, Contemporary Theories of Schizophrenia: Review and Synthesis (New York: McGraw-Hill, 1981), 7–23; Kenneth Kendler and Ming T. Tsuang, “The Nosology of Paranoid Schizophrenia and Other Paranoid Psychoses,” Schizophrenia Bulletin 7 (1981), 594–610; S. P. Fullinwider, Technicians of the Finite: The Rise and Decline of the Schizophrenic in American Thought, 1840–1960 (Westport, CT: Greenwood Press, 1982); Ph. Van Meerbeck, “D’ou nous viennent la demence précoce et la schizophrénie?” Acta Psychiatrica Belgica 82 (1982), 243–276; R. D. Chandresna, “Phenomenology and Nosology of Schizophrenia: Historical Review,” Psychiatric Journal of the University of Ottawa 8 (1983), 17–24; William N. Goldstein, “DSM-III and the Diagnosis of Schizophrenia,” American Journal of Psychotherapy 37 (1983), 168–181.

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  2. Quoted from the students’ edition of Alfred M. Freedman, Harold I. Kaplan, and Benjamin J. Sadock, eds., Modern Synopsis of Comprehensive Textbook of Psychiatry (Baltimore: Williams & Wilkins, 1976), p. 418.

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  3. On historical changes in the appearance of schizophrenia see B. Mahendra, “Where Have All the Catatonics Gone?” Psychological Medicine 1 (1981), 669–671. Compare J. R. Morrison, “Changes in Sub-Type Diagnosis in Schizophrenia: 1920–1966,” American Journal of Psychiatry 131 (1974), 674–677. I am relying in this study on the accepted distinction between an “illness” as a social state created by human evaluation of problematic experiences and a “disease” as a variety of biological events existing independently of human knowledge and evaluation; see D. Locker, Symptoms and Illness: The Cognitive Organization of Disorder (London: Tavistock, 1981). The research in the area of schizophrenia is, in general, operating without a specific definition of the concept of schizophrenia. The standard American periodical dealing with this area, the Schizophrenia Bulletin (funded by the National Institutes of Mental Health), ran a series of guest columns under the title “What is Schizophrenia?” Such openness about the difficulty of definition is rare in any medical subspecialty. See John S. Strauss and Thomas E. Gift, “Choosing an Approach for Diagnosing Schizophrenia,” Archives of General Psychiatry 34 (1977), 1248–1253.

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  4. Quoted in Richard Hunter and Ida Macalpine, eds., Three Hundred Years of Psychiatry 1535–1860 (London: Oxford University Press, 1963), p. 987.

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  5. Bleuler provides his own discussion of the history of the concept of schizophrenia, which is discussed in detail later (see note 26). See Eugen Bleuler, Dementia Praecox oder Gruppe der Schizophrenien (Leipzig/Wien: Franz Deuticke, 1911), pp. 1–5. (For the English translation from which all quotations are taken see note 10.)

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  6. On the problems of interpreting “signs” and symptoms historically see Joel Wilbush, “Clinical Information: Signs, Semeions and Symptoms,” Journal of the Royal Society of Medicine 77 (1984), 766–773.

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  10. Bleuler’s study was translated into English only after World War II: Dementia Praecox or The Group of Schizophrenias, trans. Joseph Zinkin (New York: International Universities Press, 1950). For a more detailed discussion of the literature on Bleuler see note 26.

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  11. Thomas Willis, De anima brutorum... exercitationes duae (London: Dring et al., 1683). On the tradition of a “mental ailment during the teen-age years” see Ernest Harms’s introduction to the reprint of Emil Kraepelin, Dementia Praecox and Paraphrenia (1919) (Huntington, New York: Robert E. Krieger, 1971), p. xiii. All references to Kraepelin are to this translation.

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  14. Patricia Meyer Spacks, The Adolescent Idea: Myths of Youth and the Adult Imagination (New York: Basic Books, 1981).

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  15. Bénédict August More1, Traite des maladies mentales (Paris: V. Masson, 1860), 565–566. Translation from Altschule, “Historical Perspective,” p. 7 (see note 1).

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  16. J._T. Dickson, The Science and Practice of Medicine in Relation to Mind (New York: D. Appleton, 1874), 290–292; G. C. Gaudier, De la démence précoce chez les jeunes aliénés héréditaires (Thesis: University of Paris (376), 1883).

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  17. Richard von Krafft-Ebing, Textbook of Insanity, trans. Charles Gilbert Chaddock (Philadelphia: F. A. Davis, 1904), p. 350. Translation (probably of the 1903 seventh revised edition) of Lehrbuch der Psychiatrie auf klinischer Grundlage, originally published in three volumes, Stuttgart, 1879–1880.

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  18. Alois Pick, “Über primäre chronische Demenz (sog. Dementia Praecox) im jugendlichen,” Prager medizinische Wochenschrift 16 (1891), 312–315.

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  19. See George Mora’s introduction to the translation of K. L. Kahlbaum, Catatonia (Baltimore: Johns Hopkins University Press, 1973), viii–xviii.

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  20. See the discussion in Werner Leibbrand and Annemarie Wettley, Der Wahnsinn:Geschichte der abendländischen Psychopathologie (Freiburg/Munich: Karl Alber, 1961), 582–586.

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  21. Uwe Henrik Peters, Wörterbuch der Psychiatrie und medizinische Psychologie (Munich: Urban & Schwarzenberg, 1984), 289.

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  22. Altschule, “Historical Perspective,” p. 10 (note 1).

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  23. See Albrecht Hirschmüller, Physiologie und Psychoanalyse in Leben und Werk Josef Breuers (Bern: Hans Huber, 1978), 207n.

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  24. On the destructive influence of this model see E. M. Butler, The Tyranny of Greece over Germany (Boston: Beacon Press, 1958). For the turn of the century see more specifically Wendelin Schmidt-Dengler, “Decadence and Antiquity: The Educational Preconditions of Jung-Wien,” in Erika Nielsen, ed., Focus on Vienna 1900: Change and Continuity in Literature, Music, Art and Intellectual History (Munich: Wilhelm Fink, 1982), 32–45.

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  25. Emil Kraepelin, Dementia Praecox and Paraphrenia [1919] (Huntington, New York: Robert E. Krieger, 1971), p. 243 (translation of the section on dementia praecox in the eighth edition of Psychiatrie). On the contemporary reception of Kraepelin see Louise Brink and Smith Ely Jelliffe, “Emil Kraepelin: Psychiatrist and Poet,” Journal of Nervous and Mental Diseases 77 (1933), 134–152. For a more general background see R. L. James and P. R. May, “Diagnosing Schizophrenia; Professor Kraepelin and the Research Diagnostic Criteria,” American Journal of Psychiatry 138 (1981), 50–54; H. Hippius et al., eds., Emil Kraepelin: Lebenserinnerungen (Berlin: Springer, 1983). The editions of Psychiatrie published during Kraepelin’s lifetime were as follows: first edition, Abel, Leipzig, 1883, 384 pp.; second edition, Abel, Leipzig, 1887, 540 pp.; third edition, Abel, Leipzig, 1889, 584 pp.; fourth edition, Meiner, Leipzig, 1893, 707 pp.; fifth edition, Barth, Leipzig, 1896, 825 pp.; sixth edition, Barth, Leipzig, 1899, 969 pp.; seventh edition, Barth, Leipzig, 1903–1904, 1,369 pp.; eighth edition, Barth, Leipzig, 1909–1913, 2,500 pp.

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  26. Hans Stierlin, “Bleuler’s Concept of Schizophrenia: A Confusing Legacy,” American Journal of Psychiatry 123 (1967), 996–1001; David E. Raskin, “Bleuler and Schizophrenia,” British Journal of Psychiatry 127 (1975), 231–234; David Rosenthal, “Eugen Bleuler’s Thoughts and Views about Heredity in Schizophrenia,” Schizophrenia Bulletin 4 (1978), 476–477; M. Menuck, “What Did Eugen Bleuler Really Say?” Canadian Journal of Psychiatry 24 (1979), 161–166; T. J. Crow and E. C. Johnstone, “Dementia Praecox and Schizophrenia: Was Bleuler Wrong?” Journal of the Royal College of Physicians (London) 14 (1980), 238–240; Mark Ast, “Kraepelin and Bleuler: A Comparison of Dementia Praecox and Schizophrenia,” Dissertation, Yeshiva University, 1984. On the World Health Organization’s International Pilot Study of Schizophrenia and its findings, which seem to contradict those of Bleuler, see Norman Sartorius, Robert Shapiro, and Assen Jablensky, “The International Pilot Study of Schizophrenia,” Schizophrenia Bulletin 11 (1974), 21–34; Assen Jablensky, “Multicultural Studies and the Nature of Schizophrenia: A Review,” Journal of the Royal College of Medicine 80 (1987), 162–167.

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  27. Freud’s works are cited in reference to The Standard Edition of the Complete Psychological Works of Sigmund Freud (London: Hogarth Press, 1953–1974), cited as SE, here “The Neuro-Psychoses of Defence” (1894), SE 3:41–68. On Freud’s understanding of the disease see B. L. Boyer and P. C. Giovacchini, Psychoanalytic Treatment of Characterological and Schizophrenic Disorders (New York: Science House, 1967); P.-N. Pao, “Notes on Freud’s Theory of Schizophrenia, International Journal of Psycho-Analysis 54 (1973), 469–476; T. Freeman, “On Freud’s Theory of Schizophrenia,” International Journal of Psycho-Analysis 58 (1977), 383–388.

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  28. “Further Remarks on the Defence Neuro-Psychosis” (1896), SE 3:157–185.

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  29. For example, the Dadaist and Expressionist Hugo Ball wrote a series of poems called “Sieben Schizophrene Sonette.” See Thomas Anz, ed., Phantasien tiber dem Wahnsinn: Expressionistische Texte (Munich: Carl Hanser, 1980), pp. 56–61, for the text, as well as Wolfgang Rothe, “Der Geisteskranke im Expressionismus,” Confinia Psychiatrica 15 (1972), 195–211, for the popular reception of the idea of schizophrenia.

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  40. “A Contribution to the Study of Psychological Types,” CW 6:499–509.

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  68. I am indebted to the overviews of Shapiro, Contemporary Theories (note 1), and Neale and Oltmanns, Schizophrenia (note 1), for this segment. I, however, do not always agree with their interpretation of the data.

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Authors and Affiliations

  1. Liberal Arts and Sciences, Emory University, USA

    Sander L. Gilman (Distinguished Professor)

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  1. University of South Carolina, Columbia, SC, USA

    Edwin R. Wallace IV MA, MD, MACPsych

  2. Randallstown, MD, USA

    John Gach

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Gilman, S.L. (2008). Constructing Schizophrenia as a Category of Mental Illness. In: Wallace, E.R., Gach, J. (eds) History of Psychiatry and Medical Psychology. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-34708-0_15

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