Concepts of schizophrenia
Each account of the concept of ‘schizophrenia’ reaches into the past from a viewpoint in a contemporary present. Berrios and Hauser (1988) commented that such accounts were unhistorical because we still lived in a Kraepelinian world. That was fair comment at the time and could be applied to many emerging disciplines whose concepts became temporarily stuck.
It is also true that most people who have been concerned with such concepts over a professional lifetime find that the accumulation of new knowledge requires them to take a critical look back along several progressively different sightlines. This section is limited to the past two centuries, but a comment by John Locke over 300 years ago illustrates the confusion arising from terms used to describe severe deviations from mental health.
Locke was ‘astonished at the Obstinacy of a worthy man,
who yields not to the Evidence of reason, though laid before
him as clear as Day-light . . . I shall be pardoned for calling it
by so harsh a name as Madness, when it is considered that
opposition to Reason deserves that Name and is really
Madness; and there is scarce a man so free from it, but that if
he should always on all occasions argue or do as in some
cases he constantly does, would not be thought fitter for
Bedlam, than for Civil Conversation. I do not here mean
when he is under the power of an unruly Passion, but in the
calm steady course of his Life.’ (Locke 1959)
Locke carefully distinguished ‘madness’ in the sense of unreasonableness, which was as common in his time as in ours, and the effects of being overpowered by ‘an unruly passion’, which was rare. His terminology is upside down to current readers but his distinction is clear and surprisingly modern.
Nevertheless, Michel Foucault would have none of it. To him, madness was always a form of opposition to ‘established’ reason. He thought that the way people react to it was a function of the historical epoch in which they lived (Foucault 1967).
Such issues have not gone away, but one of the strongest tendencies in modern psychiatry is towards accepting Locke’s basic differentiation between ‘unreasonableness’, which is common, and illness, which is rare. The international acceptance of specified definitions for mental disorders, with ‘schizophrenia’ as perhaps the outstanding example, may, however, have created an undue confidence in the durability of the global concepts. It is less likely that definitions of the constituent ‘symptoms’, about which people understandably complain and which are the most obvious and accessible phenomena, will change much in the foreseeable future. However, there is a gradual acceptance that standardized definitions of symptoms, plus new means of investigating brain functions, might eventually lead to the combination, break-up or abandonment of some current disease concepts, schizophrenia conceivably among them.
Even to the sceptical eye of the present authors, there has been sufficient advance in knowledge during the past decade to make another retrospective worthwhile, both for its own sake and because of the possible implications for future development.
J.K. Wing and N. Agrawal
Steven R. Hirsch
MD FRCP FRCPsych
Professor of Psychiatry Emeritus, Division of Neuroscience and Psychological Medicine Imperial College Faculty of Medicine and Director of Teaching Governance, West London Mental Health NHS Trust
Daniel R. Weinberger MD
Chief, Clinical Brain Disorders Branch
Intramural Research Program
National Institute of Mental Health
MD 20982, USA
- American Psychiatric Association (1993) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. APA, Washington, DC.
- Andreasen, N.C. & Carpenter, W.T. (1993) Diagnosis and classification of schizophrenia. Schizophrenia Bulletin 19, 199 - 211.
- Asperger, H. (1944/1991) Autistic psychopathy in childhood. In: Autism and Asperger Syndrome. Cambridge University Press, Cambridge. Translated and annotated by U. Frith, from: Die 'Autistischen Psychopathen' im Kindesalter. Archiv fur Psychiatrie und Nervenkrankheiten 117, 76 - 136.
- Bentall, R.P., Jackson, H.F. & Pilgrim, D. (1988) Abandoning the concept of schizophrenia. British Journal of Psychology 27, 303 - 324.
- Berrios, G.E. & Hauser, R. (1988) The early development of Kraepelin's ideas on classification: a conceptual history. Psychological Medicine 18, 813 - 821.
- Berze, J. (1914/1987) Primary insufficiency of mental activity. In: The Clinical Roots of the Schizophrenia Concept (eds J. Cutting & M. Shepherd), pp. 51 - 58. Translated from Chapter 4 of Die primare Insuffizienz der psychischen Aktivitat. Deuticke, Leipzig.
- Bleuler, E. (1911/1950) Dementia praecox or the group of schizophrenias. New York: International Universities Press. Translated by J.Zinkin from Dementia Praecox oder der Gruppe der Schizophrenien. In: Handbuch der Geisteskrankheiten (ed. G. Aschaffenburg). Deuticke, Leipzig.
- Bleuler, E. (1919) Das Autistisch-Indisziplinierte Denken in der Medizin und Seine Uberwindung. Springer, Berlin.
- Bush, G., Fink, M., Petrides, G. et al. (1996) Catatonia. I. Rating scale and standardised examination. Acta Psychiatrica Scandinavica 93, 129 - 136.
- Cohen, H. (1961) The evolution of the concept of disease. In: Concepts of Medicine (ed. B. Lush), pp. 159 - 169. Pergamon, Oxford.
- Creer, C. & Wing, J.K. (1974) Schizophrenia at Home. National Schizophrenia Fellowship, London. [Reprinted with a new preface, 1988.]
- Crow, T.J. (1985) The two syndrome concept: origns and current status. Schizophrenia Bulletin 11, 471 - 486.
- Crow, T.J. (1998) Nuclear schizophrenic symptoms as a window on the relationship between thought and speech. Schizophrenia Research 28, 127 - 141.
- Diem, O. (1903/1987) The simple dementing form of dementia praecox. In: The Clinical Roots of the Schizophrenia Concept (eds J. Cutting & M. Shepherd), pp. 25 - 34. Translated from Die einfach demente Form der Dementia Praecox. Archiv fur Psychiatrie und Nervenkrankheiten 37, 81 - 87.
- Endicott, J. & Spitzer, R.L. (1978) A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry 35, 837 - 844.
- Falret, J. (1854) Lecons Cliniques de Medicine Mentale. Bailliere, Paris.
- Fish, F.J. (1958) Leonhard's classification of schizophrenia. Journal of Mental Science 104, 103.
- Fisher, C.M. (1983) Abulia minor versus agitated behavior. Clinical Neurosurgery 31, 9 - 31.
- Flaum, M. & Andreason, N.C. (1991) Diagnostic criteria for schizophrenia and related disorders: options for DSM-IV. Schizophrenia Bulletin 17, 143 - 156.
- Foucault, M. (1967) Madness and Civilisation. Tavistock, London.
- Foulds, G.A. (1965) Personality and Personal Illness. Tavistock, London.
- Frith, C.D. & Frith, U. (1991) Elective affinities in schizophrenia and childhood autism. In: Social Psychiatry. Theory, Methodology and Practice (ed. P.E. Bebbington), pp. 65 - 88. Transaction, New Brunswick.
- Frith, U. (1989) Autism: Explaining the Enigma. Blackwell, Oxford.
- Frith, U. & Happe, F. (1994) Autism: beyond theory of mind. Cognition 50, 115 - 132.
- Gillberg, C. (2002) A Guide to Asperger Syndrome. Cambridge University Press, Cambridge.
- Goffman, E. (1961) Asylums. Essays on the Social Situation of Mental Patients and Other Inmates. Penguin, Harmonsworth.
- Griesinger, W. (1861) Die Pathologie und Therapie der Psychischen Krankheiten. Krabbe, Stuttgart.
- Gruhle, H.W. (1929) Psychologie der Schizophrenie. In: Psychologie der Schizophrenie (eds J. Berze & H.W. Gruhle). Springer, Berlin.
- Jackson, J.H. (1869/1932) Certain points in the study and classification of diseases of the nervous system. Reprinted in: Selected Writings of
- John Hughlings Jackson, Vol. 2. (ed. J. Taylor). Hodder and Stoughton, London.
- Janzarik, W. (1984) Jaspers, Kurt Schneider und die Heidelberger Psychopathologie. Nervenarzt 55, 18 - 24.
- Janzarik, W. (1987) The concept of schizophrenia: history and problems. In: Search for the Causes of Schizophrenia (eds H. Hafner, W.F. Gattaz & W. Janzarik). Springer-Verlag, Heidelberg.
- Jaspers, K. (1946/1963) General Psychopathology. Manchester University Press, Manchester. Translated by J. Hoenig & M. Hamilton from Allgemeine Psychopathologie. Springer Verlag, Heidelberg.
- Joseph, A.B. (1992) Catatonia. In: Movement Disorders in Neurology and Neuropsychiatry (eds A.B. Joseph & R.R. Young), pp. 335 - 342. Blackwell Scientific, Boston.
- Kahlbaum, K. (1874/1973) Catatonia. Johns Hopkins University Press, Baltimore. Translated by Y. Levij & T. Priden from Die Katatonie oder das Spannungs-Irresein. Hirschwald, Berlin.
- Kanner, L. (1943) Autistic disturbances of affective contact. Nervous Child 2, 217 - 250.
- Kendell, R.E. (1987) Diagnosis and classification of functional psychoses. British Medical Bulletin 43, 499 - 513.
- Kendell, R.E. (1989) Clinical validity. Psychological Medicine 19, 45 - 55.
- Kendell, R.E. & Brockington, I.F. (1980) The identification of disease entities and the relationship between schizophrenic and affective psychoses. British Journal of Psychiatry 137, 324 - 331.
- Kendell, R.E., Cooper, J.E., Gourlay, A.J. et al. (1971) Diagnostic criteria of American and British psychiatrists. Archives of General Psychiatry 25 (2), 123 - 130.
- Kendler, K.S. (1985) Diagnostic approaches to schizotypal personality disorder: a historical perspective. Schizophrenia Bulletin 11, 538 - 553.
- Kleist, K. (1960) Schizophrenic symptoms and cerebral pathology.Journal of Mental Science 106, 246 - 255.
- Kraepelin, E. (1896/1987) Dementia praecox. In: The Clinical Roots of the Schizophrenia Syndrome (eds J. Cutting & M. Shepherd), pp. 15 - 24. Cambridge University Press, Cambridge. Translated from Lehrbuch der Psychiatrie, 5th edn, pp. 426 - 441. Barth, Leipzig.
- Kraepelin, E. (1920) Die Erscheinungsformen des Irreseins. Zeitschrift fur Neurologie und Psychiatrie 62, 1 - 29.
- Kretschmer, E. (1966/1974) The sensitive delusion of reference. In: Themes and Variations in European Psychiatry (eds S.R. Hirsch & M.Shepherd). Wright, Bristol. Translated from Der sensitiver Beziehungswahn. Springer, Heidelberg.
- Laing, R.D. & Esterson, A. (1964) Sanity: Madness and the Family. Tavistock, London.
- Leekam, S.R., Libby, S.J., Wing, L. et al. (2002) The diagnostic interview for social and communication disorders. Algorithms for ICD 10 childhood autism and autistic spectrum disorders. Journal of Child Psychology and Psychiatry 43, 325 - 327.
- Leonhard, K. (1957) Aufteilung der Endogenen Psychosen. Akademie Verlag, Berlin.
- Locke, J. (1959) Essay Concerning Human Understanding, Vol. 1, 2nd edn (ed. A.C. Fraser ). Dover, New York.
- Lorr, M. (1966) Explorations in Typing Psychotics. Pergamon, London.
- McKenna, P.J., Lund, C.E., Mortimer, A.M. & Biggins, C.A. (1991)
- Motor, volitional and behavioural disorders in schizophrenia. II. The 'conflict of paradigms' hypothesis. British Journal of Psychiatry 158, 328 - 336.
- Magnan, V. (1893) Lecons Cliniques Sur les Maladies Mentales. Battaille, Paris.
- Robins, L.N., Wing, J., Wittchen, H.U. et al. (1988) The Composite International Diagnostic Interview: an epidemiological instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 45, 1069 - 1077.
- Rogers, D. (1992) Motor Disorder in Psychiatry: Towards a Neurological Psychiatry. Wiley, New York.
- Scheff, T.J. (1966) Being Mentally Ill. Aldine, Chicago.
- Schneider, K. (1959) Clinical Psychopathology. Translated by M.W.Hamilton. Grune & Stratton, New York.
- Schneider, K. (1976) Klinische Psychopathologie, 11th edn. Thieme, Stuttgart.
- Spitzer, R.L., Endicott, J. & Robins, E. (1975) Research Diagnostic Criteria: Rationale and Reliability. Hodder and Stoughton, London.
- Sturt, E. (1981) Hierarchical patterns in the distribution of psychiatric symptoms. Psychological Medicine 11, 783 - 794.
- Szasz, T. (1971) The Manufacture of Madness. Routledge, London. Tantam, D. (1988) Asperger's syndrome. Journal of Child Psychology and Psychiatry 29, 245 - 255.
- Wing, J.K. (1961) A simple and reliable subclassification of chronic schizophrenia. Journal of Mental Science 107, 862 - 875.
- Wing, J.K., ed. (1975) Schizophrenia from Within. National Schizophrenia Fellowship, London.
- Wing, J.K. (1978) Reasoning About Madness. Oxford University Press, London.
- Wing, J.K. (1991) Social psychiatry. In: Social Psychiatry: Theory, Methodology and Practice (ed. P.E. Bebbington), pp. 3 - 22. Transaction, New Brunswick.
- Wing, J.K. & Brown, G.W. (1961) Social treatment of chronic schizophrenia: a comparative survey of three mental hospitals. Journal of Mental Science 107, 847 - 861.
- Wing, J.K. & Brown, G.W. (1970). Institutionalism and Schizophrenia.Cambridge University Press, London.
- Wing, J.K., Cooper, J.E. & Sartorius, N. (1974) The Description and Classification of Psychiatric Symptoms: an Instruction Manual for the PSE and CATEGO System. Cambridge University Press, London.
- Wing, J.K., Sartorius, N. & Ustun, T.B. (1998) Diagnosis and Clinical Measurement in Psychiatry: the SCAN System. Cambridge University Press, Cambridge.
- Wing, L. (1981) Asperger's syndrome. Psychological Medicine 11, 115 - 129.
- Wing, L. (1982) Development of concepts, classification and relationship to mental retardation. In: Psychoses of Uncertain Aetiology (eds
- J.K. Wing & L.G. Wing), pp. 185 - 190. Cambridge University Press, Cambridge.
- Wing, L. (2000) Past and future research on Asperger Syndrome. In: Asperger Syndrome (eds A. Klin, F. Volkmar & S. Sparrow). Guildford Press, New York.
- Wing, L. & Gould, J. (1979) Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification. Journal of Autism and Developmental Disorder 9, 11 - 29.
- Wing, L. & Shah, A. (2000) Catatonia in autistic spectrum disorders. British Journal of Psychiatry 176, 357 - 362.
- Wing, L., Leekam, S.R., Libby, S.J. et al. (2002) The diagnostic interview for social and communication disorders. Journal of Child Psychology and Psychiatry 43, 307 - 325.
- Wolff, S. (1995) Loners: The Life Path of Unusual Children. Routledge, London.
- World Health Organization (1973) The International Pilot Study of Schizophrenia. WHO, Geneva.
- World Health Organization (1993) The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. WHO, Geneva.
- World Health Organization (1999) Schedules for Clinical Assessment in Neuropsychiatry. World Health Organization, Geneva.
Provided by ArmMed Media