Year : 2017 | Volume
: 1 | Issue : 2 | Page : 133--135
The divine madness: A history of schizophrenia
Amey Yeshwant Angane
Department of Psychiatry, KEM Hospital and Seth GS Medical College, Mumbai, Maharashtra, India
Amey Yeshwant Angane
Department of Psychiatry, KEM Hospital and Seth GS Medical College, Acharya Donde Marg, Parel, Mumbai, Maharashtra
The nonspecific concept of “madness” has been there for thousands of years. In antiquity, people thought of “madness” in terms of divine punishment or demonic possession. It was only during early Renaissance that people took this phenomenon seriously and termed it as an illness. It is due to the efforts of a cluster of scientists and psychiatrists that has led to unraveling of schizophrenia as a mental illness characterised by delusions and hallucinations. As postgraduates, it is important to know how the mystery unfolded and how it has overcome infinite obstacles. This article throws light on how we can learn from history and not deceive ourselves when we selectively take evidence from the past to justify our beliefs. The knowledge of history helps us to understand the disease itself as well as help us understand the chronology of the events leading to the evolution of the enigmatic disorder and its elusive treatment strategies.
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Angane AY. The divine madness: A history of schizophrenia.Ann Indian Psychiatry 2017;1:133-135
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Angane AY. The divine madness: A history of schizophrenia. Ann Indian Psychiatry [serial online] 2017 [cited 2019 Aug 20 ];1:133-135
Available from: http://www.anip.co.in/text.asp?2017/1/2/133/220251
When it comes to the possibilities of “learning from history,” there are doubtless many things we as postgraduates could aspire to learn. Some of those would be more practically useful, in terms of contributing to the normal and decent functioning of well-meaning societies than others. As it is rightly said those who cannot learn from history are doomed to repeat it. A person without the knowledge of their history, origin, and culture is like a tree without roots. Similarly, schizophrenia has travelled a long way and has undergone plenty of metamorphosis before it evolved into what we know of it as today-an illness characterized by delusions and hallucinations. Hence, let us understand the events chronologically.
Old is gold (1500 BC) – References to schizophrenia appear in classical writings and the Bible. One such example is Gerasene Demoniac in Mark V who would, “howl all day in the tombs and the mountains and gash himself with stones.” In fact, the oldest recorded description of an illness such as schizophrenia dates back to the Ebers Papyrus of 1550 BC from Egypt. Among diabetes and dracunculiasis, madness was also one of the only five threats to human health mentioned in the Egyptian archives. As a resident, I feel it still stands true as the emergency rooms in tertiary care hospital are always marred with violence of the inflowing psychotic patients.
The divine madness (1000 BC) - In antiquity, around 1000 BC people did not think of “madness” in terms of mental illness, but in terms of divine punishment or demonic possession. Evidence for this comes from the Old Testament and most notably from the First Book of Samuel, according to which King Saul became “mad” after neglecting his religious duties and angering God. The fact that David used to play on his harp to make Saul better suggests that people believed psychotic illnesses could be successfully treated. This should teach us to hope the best for our patients instead of giving up on refractory cases. There is no tough a nut that mind cannot crack!
Madness is illness (400 BC) - Cornelius Celsus continued the belief that “madness” evolved through having angered the Gods but it was Greek philosopher Socrates (470-339 BC) who inked in Plato's Phaedrus “madness is a nobler thing than sober sense … madness comes from God, whereas sober sense is merely human.”
Hippocrates (460-377 BC) thought that madness was an illness due to an imbalance of four bodily humors and that it could be cured by rebalancing these humors with treatments such as special diets, purgatives, and blood-lettings. Today, we as postgraduates may think of Hippocratic ideas as farfetched and easy to be laughed on, but it draws a sharp line between knowledge and belief. It clearly criticized the methods of magicians and quacks even in the treatment of mental diseases, which then was considered to be biologically rooted.
Middle ages-demonic affliction (1500 AD) - In the 15th century Europe, delusions and hallucinations continued to be seen as proof of demonic possession shared almost by all cultures. The word Majnun, for the possessed and Junun Mufrit, distinguished the severe madness from other forms such as mania and rabies. However, the Medieval era saw the beginning of formal detention and institutionalization of those deemed mentally ill. Some towns had “fools towers” (Narretnurm in Vienna, Bedlam in England) which housed madmen. It was during this era that fever therapy (by injecting sulfur oil and causing abscess) and trepanning (creating holes in the skull to let the evil spirits out) became common methods to treat the mentally ill.
Change of beliefs (1700 AD) - Phillip Pinel (1745–1826) started “moral treatment” which included respect for the person, a trusting and confiding doctor–patient relationship, decreased stimuli, routine activity, and the abandonment of old-fashioned Hippocratic treatments. He emphasized the need of hygiene, physical exercise, and preservation of detailed case histories for research. In 1798, Pinel cut chains from the limbs of patients called “madmen” at the Bicêtre Hospital, a Parisian insane asylum giving birth to a nonviolent approach toward care of mentally ill. A student of Pinel, Jean Etienne Esquirol during the same time defined “hallucinations” in a way that is similar to current terminology and “monomania,” a clinical syndrome similar to modern descriptions of paranoid schizophrenia.
Somewhere down in France, physician Benedict-Augustin Morel coined the term “demence precoce” which characterized a previously asymptomatic adolescent boy who became progressively more withdrawn and “degenerated into a state of dementia.”
During the same time, psychosurgery paved into psychiatry by means of the much-dreaded lobotomy. American psychiatrist Walter Freeman, to make the procedure accessible to patients in asylums developed the transorbital lobotomy. For some who were lucky to escape the devastating effects of lobotomy on cognition and intelligence were subjected to barbiturates and chloral hydrate to relieve their anxiety but not psychotic symptoms.
Schizophrenia at last (1900 AD) - In 1868 German psychiatrist, Karl Kahlbaum gave the term “juvenile madness” and isolated a form of a movement disorder characterized by a mannequin-like muscle stiffness associated with unusual postures and a pervading fear to be later called as “katatonia.” Ewald Hecker another German psychiatrist did a series of studies on young psychotic patients at Kahlbaum's clinic in Görlitz, Prussia. Hecker coined the word “cyclothymia” and “hebephrenia” a disorder that began in adolescence with erratic behavior followed by a rapid decline of all mental functions; named after Hebe, Goddess of youth and frivolity (1871).
In 1878, German Psychiatrist, Emil Kraepelin combined these various “disorders” into a single disease and gave 4 subtypes, namely, paranoid, catatonic, hebephrenic, and simple. This entity that brings to a man early decline in cognitive function was then called “dementia praecox” to differentiate it from other forms of dementia. He also coined another term “manic-depressive psychosis” for those who showed affective symptoms during psychosis.
In 1900, Swiss psychiatrist Eugene Bleuler coined the term “Schizophrenia” meaning split mind replacing the previous terminology dementia praecox. He also gave the very famous 4 A's of schizophrenia along with other terms such as “Autism” and “Schizoid.”
Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas Meduna by inducing seizures first with camphor and then metrazol (cardiazol). Italian Professor of neuropsychiatry Ugo Cerletti had been using electric shocks to produce seizures in animal experiments during the same time. His colleague, Lucio Bini, however, developed the idea of using electricity as a substitute for metrazol in convulsive therapy and in 1938 experimented for the first time on a person after which it was and is still called today as “Electroconvulsive therapy.”
Schizophrenia and eugenics (1950 AD) - Schizophrenia and other mental illnesses were overshadowed by persistent stigma and misunderstanding of mental illness. Schizophrenia was thought to be an inheritable disorder and sufferers were subjected to Eugenics and sterilization. It was in this ocean of chaotic waves in 1959 that Kurt Schneider gave a list of “ first rank symptoms” of schizophrenia.
The first antipsychotic medication came on the market in the 1950s. Chlorpromazine was discovered by a surgeon looking to find an anesthetic which could control cardiorespiratory shock. In the next 10 years, over twenty other antipsychotic drugs were introduced. However numerous side effects, namely, tremors, restlessness, loss of muscle tone, and postural disorders were seen, due to which these drugs earned their name – neuroleptics. The pharmacological breakthrough came when new “atypical” antipsychotics deemed “cleaner” than the old neuroleptics, appeared on the scene of which Clozapine (1960) was one of the first.
Imaging the unseen (1970 AD) - Progress in the area of schizophrenia research came to a near standstill, and it was not until 1976, with the advent of computed tomography (CT) abnormally large lateral ventricles in schizophrenic patients were reported which renewed the interest.
After years of debate, research and field testing the current classificatory systems of ICD 10 and DSM 5 have given a standardized organization of the disorder called “madness”. The so-called “Bible of Psychiatry” DSM 5 put forth the idea of concentrating the symptoms into three dimensions: psychotic (hallucinations/delusions), negative (deficit), and disorganized. Although heavily criticized, it still improves the precision of identifying schizophrenia subtypes.
Thus, schizophrenia has progressed from God's blessings to demonic possessions to dopamine; from trepanning and flogging to exorcisms to depot preparations. I believe that imagination is stronger than knowledge. That myth is more potent than history. That dreams are more powerful than facts. That hopes always triumphs over experience. That laughter is the only cure for grief. And I believe that science is stronger than disease.
Today, schizophrenia is no more an impenetrable darkness and sufferers clearly stand a better chance than at any other time in history of leading a normal life. In history, a great volume is unrolled for our instruction, drawing the materials of future wisdom from the past errors and infirmities of humanity. Today as postgraduates, we no more fear the “divine madness” rather treat it with infinite kindness. Perhaps, I always feel that history is a gossip well told!
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Conflicts of interest
There are no conflicts of interest.
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