Schizophrenia: A Medical View of a Medical Concept

Abstract

The term schizophrenia was coined by the Swiss psychiatrist Eugen Bleuler in the early years or the 20th century. (Although his monograph Dementia Praecox of the Group of Schizophrenias was not published until 1911, the manuscript was completed in 1908.) As every schoolboy knows, the term means “split mind.” It refers to the dissociation, or loss of coordination, between different psychological functions. Bleuler regarded this as the fundamental abnormality underlying the strange subjective experiences and behavioral abnormalities of the disorder. But although the term was Bleuler’s, the original concept of an irreversible disease process with its onset in adolescence was Kraepelin’s, and can be traced back to the 4th edition of his Lehrbuch (1893), published shortly after he moved to Heidelberg from Dorpat. In that 4th edition he described a group of what he called “psychic degeneration processes” (Die Psychischen Entartungs Processe) which included Kahlbaum’s Katatonie and Hecker’s Hebephrenie and were characterized by the rapid development of a permanent state of “psychological weakness.” In the 5th edition (1986) the name was changed to dementia praecox, a term originally coined by the Frenchman, Morel. Three major pathological forms, (hebephrenic, catatonic and paranoid), were described. At that stage in his career, Kraepelin regarded dementia praecox as a disease process which invariably resulted in permanent damage to the personality, in contrast to the disorders subsumed under his other great rubric, manic depressive insanity, whose individual episodes always resolved completely.