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It was casual conversation about Psychosis during a lunch with my colleague and there came a sudden remark by a psychologist ‘ If I were to be a close associate of Sri Ramakrishna Paramahamasa I would have treated him for psychosis’..  This is a classic piece of example to start our discussion on history of Schizophrenia, as this show the cultural implications of understanding the schizophrenia and recording the same.

This gets complicated when we try to trace the history of Schizophrenia. Adding to this is the debate about whether this disease is a recent intrusion into mankind’s mind or its been there for a long time but not recorded properly which is famously debated and quoted as ‘recency VS persistency’ .

It’s very sure to the medical science and historians that there existed mental Illness and mental illnesses are not of a recent origin. Mental Illness appears in most of the scriptures, texts and recordings of the history along with physical health issues.

The debate or problem is whether schizophrenia as we describe now existed or not. Is it right to be searching for the same in history when it was not as it is discussed and recorded today. Nevertheless to trace the history we might have to be liberal and accommodative as there is nothing to lose and if at all it is only history.

Indian Context:

Indian system of medicine dating back to second and third millennium BC has description of mental illness. The theory is based on the 3 humors of which the imbalance is supposed to cause the mental illness as well when specific channels in the mind gets blocked.

The treatment methodologies are also very Indian in nature ranging from medicine to worshipping and most interesting is the inclusion of spirituality as part of treatment. In specific context of schizophrenia there is a hint to it where there is description of demonic possession, which was held to be incurable if chronic and inherited.

Greece, Egyptian and Roman context:

In second millennium BC this civilization, like the Indian context, believed in four Humor theory causing the illnesses. The problems of mental illness were regarded as due to problems with either the heart or the uterus.

Most of the available resources show that mental illness as being an outcome of sin committed or due to a curse. The condition mentioned in some of the scriptures does indicate an illness similar to schizophrenia.

It is documented that the Great Socrates contemporary of Hippocrates had apparently experienced auditory hallucinations in midlife, along with trance states in which he would remain standing motionless for hours.

Though this cannot in itself be stated as symptom of schizophrenia considering the examples of Sri Ramakrishna Paramahamsa for us and also for the fact that he was lucid and well functioning.

Hippocrates also recognised hysteria and paranoia. These were considered to be due to the disturbance in the humors in the body  a step further to understanding the illness as more biological rather than it being considered as a consequence of sin or curse.

Islamic or Arabian Context:

The understanding of the mental illness in this era was much influenced by the thoughts of Hippocrates and Aristotle. There is description of mental illness resembling schizophrenia. There appear some 30 types of mental illnesses under 9 different categories.

Europe During and After Renaissance context:

It is mentioned that Charles VI of France was making silly remarks and acting in an undignified manner. There are reports of him getting violent and killing innocent people. He used to call himself as George sometimes and with episodes of relapse. His grandson Henry VI of England is reported with memory problem, hearing voices and seeing visions. He is also reported to have had catatonic stupor.

One of the major revolutions of this period is the better documentation of the problems and transition of thinking from humors to demons to biological aspects. Though no drastic treatment methodologies are seen but at least the diseases were identified much more scientifically and with the understanding of the body/anatomy.

Emil Kraepelin and further:

Mr Emil Kraepelin is generally considered as the father of schizophrenia for describing it though he did not name it. It was named as Schizophrenia by Eugen Bleuler. Even today these two giants continue to have their impact on psychiatry especially with regard to schizophrenia and related psychosis in both clinical and research practice.

Schizophrenia Today:

As we have gone through the history of the illness it seems apparent that it is not an illness of recent origin and there are marks of the illness even before industrialisation. Today though our understanding of the illness is much better when we look back at it there remains a lot of gray areas.  There are many aspects of the illness still being explored and trying to be understood.

Today we understand that schizophrenia has 5 different symptom complex or dimensions. They are

  • Positive Symptoms: Presence of hallucinations and/or delusions
  • Negative Symptoms: Reduced speech, social interaction, perception of pleasure and motivation.
  • Aggressive Symptoms: Abusive, assaultive and frank violence
  • Affective Symptoms:  Depression,  anxious mood, irritability
  • Cognitive Symptoms: Problems with executive functions, impaired attention and verbal fluency.

We have done a long journey, a journey with so much to learn but little to take back or to expect a paradigm shift in the treatment when we compare this illness to many other physical illnesses or to infectious illnesses. It is needless to say that with the new findings and trends in medicines and therapies there is hope for a better quality of life and greater outcomes.

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