Schizophrenia is among the most serious of all unsolved diseases.
This was the opinion expressed 60 years ago in Medical Research:
A Mid-Century Survey, sponsored by the American Foundation.
Because of a worldwide lifetime prevalence of approximately 0.85
percent and particularly because of its onset early in life, its
chronicity, and the associated social, vocational, and personal
disabilities, the same conclusion is justified today (see Carpenter
Neurologists and psychiatrists currently accept the idea that
schizophrenia comprises a group of closely related disorders characterized
by a particular type of disordered thinking, affect, and behavior.
The syndrome by which these disorders manifest themselves differs
from those of delirium, confusional states, dementia, and depression
in ways that will become clear in the following pages. Unfortunately,
the diagnosis of schizophrenia depends on the recognition of characteristic psychologic
disturbances largely unsupported by physical findings and laboratory
data. This inevitably results in a certain degree of diagnostic
imprecision. In other words, any group classified as schizophrenic
will include patients with diseases that only resemble schizophrenia,
whereas variant or incomplete cases of schizophrenia may not have
been included. Moreover, there is not full agreement as to whether
all the conditions that are called schizophrenic are the expression
of a single disease process. In the United States, for example, paranoid
schizophrenia is usually considered to be a subtype of
the common syndrome, whereas in some parts of Europe it is thought
to be a separate disease.
Present views of the disease now called schizophrenia originated
with Emil Kraepelin, a Munich psychiatrist, who first clearly separated
it from bipolar psychosis. He called it dementia praecox (adopting
the term introduced earlier by Morel) to refer to a deterioration
of mental function at an early age, from a previous level of normalcy.
At first, Kraepelin believed that “catatonia” and “hebephrenia,” which
had previously been described by Kahlbaum and by Hecker, respectively, as
well as the paranoid form of schizophrenia, were separate diseases,
but later, by 1898, he had concluded that several subtypes were
a single disease. He emphasized an onset in adolescence or early
adult life and a chronic course, often ending in marked deterioration
of personality as the defining attributes of all forms of the disease.
Early in the twentieth century, the Swiss psychiatrist Eugen Bleuler
substituted the term schizophrenia for dementia
praecox. This was an improvement insofar as the term dementia was
already being used to specify the clinical effects of another category
of disease; unfortunately, however, the new name implied a “split
personality” or “split mind.” By the “splitting” of psychic
functions, Bleuler meant the lack of correspondence between ideation
and emotional display—the inappropriateness of the patient’s
affect in relation to his thoughts and behavior. In contrast, in
bipolar disease, the patient’s mood and affect accurately
express his morbid thoughts. Bleuler also introduced the term autism (“thinking
divorced from reality”) as an aspect of the thought disorder.