Drs Murray and Harvey's initial article in this issue brings to mind the history of schizophrenia over the past 100 years or so. Its relevance will be apparent in the fantastic labyrinthian quest for putative etiological factors to account for this puzzling mental disorder. Under the guise of various labels, the disorder's characteristic and bizarre signs and symptoms have been evident throughout all cultures and all ages. In historical perspective, one can trace its myriad routes. Given these many assumptions, distinctive labels have been applied, and treatments devised accordingly. Hopefully, with the advent of demonstrable, molecular, biological, irrefutable data, not only newer psychopharmacologic agents can be devised but also psychiatric taxonomy will be structured on a molecular periodic table.
To continue the history of this sorting process that has attempted to define and thereby classify the congeries of disorders that fall under the present-day rubric of schizophrenia, Murray and Harvey begin their account with Kraeplin's concept of dementia praecox, which was first described by DeSanctis as dementia praecissima. The term démence précoce originally was used by the Belgian psychiatrist Morel to describe a single patient whose deteriorating illness began at the age of 14. This denomination was used as an adjective, based on the prominent behavioral characteristics and consonant with the French school, which based its criteria on clinical descriptions.
In contrast, the German school opted for a designation that conoted organic psychopathology - a disease entity. By 1899 Kraeplin, who had observed these patients in the Munich Clinic, translated the French into Latin - naming it dementia praecox. This categorization was based on the clinical aspects of deterioration, akin to other entities such as dementia paralytica and dementia senilis. Inasmuch as the latter two dementias had demonstrable neuropathologic lesions, others who followed Kraeplin's reasoning turned their search to brain pathology. It should be noted that Kraeplin's reasoning was by analogy. He reasoned from the particular to the general.
In this historic perspective, it is obvious that various phenotypic characteristics were used to justify taxonomic labels. McDonald Critchley quotes Andre Maurois: "The members of the medical fraternity can, at least, classify by labels its compartments, and that, in itself, is reassuring. To be able to call a demon by its name is half-way to getting rid of him."
Eugene Bleuler, who coined the term schizophrenia in 1911, was influenced by Kantian ideas about mental functioning. He posited the common feature of a thought disorder and consequently coined the term schizophrenia - split mind. His was a paradigm shift in the search for cause, clearly separating the organic from the functional, characterized as it was by a loss of harmony. Strensky called this phenomenon "intrapsychic ataxia."
The ferreting out and sorting process then moved into its epidemiologic phase. Freud's anatomization of the psyche and its consequent attribution to childhood traumata, conditioned by the perduring family conflicts, focused its theories and practices on intrapsychic processes. Subsequently, Adolf Meyer modified this approach by his formulation of what he called psychobiology. In essence, Meyer concentrated attention on the consequences of a qualitative adaptation of an individual to his environment. Then too, there is a host of variants of what was posited as intrapsychic reactions, offshoots of the monumental Freudian oeuvre.
Treatments in earlier centuries were used as models for latter-day shock therapy. For example, instead of such barbaric practices as total immersion in water, being thrown from heights, enforced immobility in dark places, etc, later revivals attempted to accomplish the same result by the use of induced insulin coma, injections of metrazol, and electroconvulsive shock treatments. Rarely in bygone times did these various shock treatments produce desirable results. However, in more modern times, in special instances cautious use of convulsive therapy produced remission of symptoms.
The 1950s marked the beginning of the psychopharmacologic revolution. Chlorpromazine, its congeners, and its many derivative agents have had remarkable dramatic effects. They have made a large majority of schizophrenics able to participate in habilitation and rehabilitation programs. These latter have enlarged clinical psychiatry's repertoire. Our contributors, in their articles, have documented the vast variety of these proven medical, social, and vocational measures. The consequence is that inpatient psychiatric hospitals are no longer filled with Bedlam-like patients. The latest revolution awaits a new taxonomy and treatment based on its molecularly appropriate, specially designed, pharmaceutical agents.