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HISTORICAL ARTICLE Schizophrenia – from Devilry to Disease Ruaridh Owen1

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HISTORICAL ARTICLE Schizophrenia – from Devilry to Disease Ruaridh Owen1 Res Medica 2014, Volume 22, Issue 1 HISTORICAL ARTICLE Schizophrenia – From devilry to disease Ruaridh Owen1 1Medical Student, University of Sheffield Medical School Correspondence email: [email protected] Abstract Symptoms of psychotic diseases historically instilled fear and distrust in onlookers, who associated them with witchcraft, demonic spirits, and the devil. From Egyptian medicine to medieval witch hunts, psychotic diseases have been associated with the supernatural throughout history. Yet even with advancements in neuroscience and improvements in our understanding of mental illness, stigma surrounding mental health remains prevalent today. Schizophrenia is a psychiatric illness which has evaded a clinical definition until relatively recently; even now, the precise features that constitute a schizophrenic patient are open to dispute. This article explores the ancient history of mental health with a particular emphasis on psychosis, and also considers the changing attitudes and understanding of schizophrenia throughout the last century, leading to its clinical definition as a treatable condition. Copyright Royal Medical Society. All rights reserved. The copyright is retained by the author and the Royal Medical Society, except where explicitly otherwise stated. Scans have been produced by the Digital Imaging Unit at Edinburgh University Library. Res Medica is supported by the University of Edinburgh’s Journal Hosting Service: http://journals.ed.ac.uk ISSN: 2051-7580 (Online) ISBN: 0482-3206 (Print) Res Medica is published by the Royal Medical Society, 5/5 Bristo Square, Edinburgh, EH8 9AL Res Medica, 2014, 22(1): 126-132. doi:10.2218/resmedica.v22.i1.746. Owen, R. Schizophrenia – From devilry to disease, Res Medica 2014, 22(1): pp.126-132. doi:10.2218/resmedica.v22i1.746 Res Medica 2014, Volume 22, Issue 1 126 Schizophrenia – From devilry Papyrus Ebers, a scroll written around 1500 to disease BC, contains references to mental Introduction conditions with associated diagnoses. However, it appears that the academics of Schizophrenia is a neurological disorder that time assumed the heart and mind to be manifested by a variety of symptoms of the same entity: “When the Heart is including hallucinations, delusions, and miserable and is beside itself, behold it is the often disorder of speech. However, it is a Breath of the heb-xer Priest”.4 The Ancient condition which has evaded a clinical Egyptians therefore diagnosed most 1 definition until relatively recently. In the conditions as diseases of the heart, past, symptoms of psychosis have been occasionally attributing particular conditions attributed to the heart and paranormal on the invasion of demons, a theme that entities, and it has been only in the last 150 was common throughout many ancient years that the various forms of medical texts.3 Apart from containing schizophrenia have been characterised as a references to some mental disorders, such as single mental condition, by Dr Emil depression, the Papyrus Ebers do not to 2 Kraepelin. The symptoms of schizophrenia, contain any direct descriptions of particularly paranoid schizophrenia, have schizophrenia, contrary to what Theocharis been described for thousands of years, Kyziridis argues in his Notes on the History of including in Ancient Egyptian medicine, Schizophrenia.3 Nevertheless, it is worth citing Hindu culture, Ancient Greece and China, these ancient papyri as some of the first and have been the source of much recorded references to disorders of the persecution and adversity for those with the mind. disease.3 By highlighting possible references to schizophrenia in history, a clearer view of Mental illness and schizophrenia-like not only the changes in medical definitions conditions appear in ancient Hindu culture, of psychosis, but also the changes in public with symptoms being mentioned in many opinion of those considered psychotic, may texts of that time, including the Atharva 5 be formulated. Veda. It was believed that good health was maintained through the interactions of Ancient medicine “Buthas” and “Dosas”, and that if these two Some of the oldest medical texts originate entities were unbalanced, insanity may 3 from Ancient Egypt, and a closer analysis result. The Atharva Veda contains a provides an insight into the attitudes multitude of hymns to cure ill health, some towards mental diseases of that time. The of which were used to cure “possession by Owen, R. Schizophrenia – From devilry to disease, Res Medica 2014, 22(1): pp.126-132. doi:10.2218/resmedica.v22i1.746 Res Medica 2014, Volume 22, Issue 1 127 demons of disease”. One particular extract Ancient diagnoses of diseases were makes reference to someone who “has been summarized in a medical handbook, written maddened by the sin of the gods, or been by Aretaeus in the second century AD. robbed of sense by the Rakshas” – the Symptoms of schizophrenia were depicted stereotypes of madness are often as conditions of “mania” and “melancholy”, synonymous with the symptoms of with treatment methods revolving around a schizophrenia. Therefore, it could be argued theory of humoral pathology and a that the disease was present in this ancient rectification of imbalances of the body.3 population. This text also highlights the Humoral pathology was also practised by recurring attitude that such a condition must Galen, who attributed mental disorders to a be caused by devilry or a sinister entity.5 disease of the brain and welcomed the possible involvement of other organs, Much like the Ancient Egyptian medicine marking an improvement in the approach to 500 years before, Chinese medicine revolved mental disorders and setting the foundation around the concept that the heart was the for further advancements in the field that centre of the mind and spirit, as depicted in would later become psychiatry.8 The Yellow Emperor’s Classic of Internal Medicine: “The heart controls the spirit, the spleen The Middle Ages controls ideas”. Symptoms of insanity and The writings of Aretaeus and Galen madness were therefore associated with developed the notion of mind–body unity. diseases infecting the heart, with the cause However, the concept of Galenism that being “evil influences” or an imbalance predominated medical thinking throughout between “Yin” and “Yang”.6 the Middle Ages, brought to Europe In 400 BC, Hippocrates described mental through Arabic writings, was often at odds conditions as problems of the brain and was with cultural beliefs and myths of the time, one of the first to record these diseases as and instead religious superstition dominated tangible, medical conditions: “… from the the field of mental health.9,10 brain only, arise our pleasures, joys, laughter Despite the founding of Europe’s first and jests, as well as our sorrows, pains, “asylum” in the 15th century, the general griefs and tears. […] Madness comes from public viewed hallucinations and delusions its moistness.”7 Although ground breaking as justification of demonic possession and in his time, the work of Hippocrates was witchcraft.11 Upon confession, “witches” often met with scepticism and were made to recount their seduction by the misunderstanding from the public.7 devil, which often occurred at times when Owen, R. Schizophrenia – From devilry to disease, Res Medica 2014, 22(1): pp.126-132. doi:10.2218/resmedica.v22i1.746 Res Medica 2014, Volume 22, Issue 1 128 they were psychologically vulnerable. These paranoid form into one condition when he alleged conversations with Satan are similar described “dementia praecox”. In his text to auditory hallucinations experienced by Manic-Depressive Insanity and Paranoia, paranoid schizophrenics, making it possible Kraepelin describes many symptoms that many persecuted witches may have consistent with modern concepts of been sufferers of the disease.11,12 In the 15th schizophrenia.2,13,14 However, the term century, the practice of exorcism was “dementia praecox” was later considered developed as a treatment for demonic inaccurate by Bleuler, as the disease was possession. Although theories and based on an end stage of dementia, and explanations of mental disorders have suggested inappropriate treatment radically changed in the last 600 years, methods.15 As a result, in 1919, Dr Elmer exorcisms are still performed by various Ernest Southard proposed the term extremists and cults as a cure for what is “dementia praecox” to be dropped in favour now viewed as a treatable mental of Bleuler’s term “schizophrenia”, which he condition.12 had coined 8 years earlier.3,16 The word “schizophrenia” is derived from the Greek The 16th century was an age of reformation, words schizo and phren, to mean “split mind”. featuring radical cultural changes throughout Bleuler originally intended this to depict the Europe. None was more significant than the disjointed and often confused thoughts of unshackling of medical science from the sufferers of the disease, however, this has religious and cultural superstitions of the also been the source of many time. With the end of the Middle Ages also misconceptions surrounding schizophrenia, came the demise of an era of witch hunts such as its incorrect association with and exorcisms. However, the foundations of multiple personality disorder.17 Both fear towards mental disease had been laid Kraepelin and Bleuler defined the multitude and would prove more difficult to uproot.9 of different forms of schizophrenia, with 3 Emil Kraepelin and Eugen Bleuler of Kraepelin’s original definitions still in use today: hebephrenic (disorganized), catatonic, Two of the most notable psychiatrists of and paranoid schizophrenia. Little has 19th century Europe, Emil Kraepelin and changed in the definition of the disease in Eugen Bleuler, were instrumental in the the last century.17,18 development of modern definitions of schizophrenia. Kraepelin combined the previously defined disease entities of hebephrenia, catatonia, and his own Owen, R. Schizophrenia – From devilry to disease, Res Medica 2014, 22(1): pp.126-132. doi:10.2218/resmedica.v22i1.746 Res Medica 2014, Volume 22, Issue 1 129 Modern treatment and attitudes towards their usage less common over the last 40 schizophrenia years.
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