Schizophrenia Brief History

Opinion

Schizophrenic psychoses are considered serious mental illnesses characterized by personality dissociation. Nosographically, it has undergone different nomenclatures such as dementia praecox, intrapsychic discordance, autistic personality dissociation, and is currently called schizophrenia (Henri Ey, 1960, p.534). Individuals with schizophrenia may present symptoms such as inappropriate affect, mood may be dysphoric and take the form of depression or anxiety, disturbed sleep, audioverbal hallucinations, and delusions. Cognitive deficits are frequent and can cause professional and functional impairments (DSM5). Schizophrenia may present a disorganization of psychic functioning, compromising the individual’s perception, thought, language, and behaviour. This results in impairment of the patient’s social ties and daily life [1].

Around the years 1890 to 1907 E. Kraepelin, in his Treatise on Mental Diseases, unified the description of diseases with symptoms of dullness, numbness, incoherent reasoning, and psychomotor disorders under the nomenclature Dementia precox—Dementia praecox—a type of madness with characteristics of debilitating progression of the psychic state, which leads to profound disorders of affectivity such as indifference, apathy, and paradoxical feelings. Dementia praecox could present itself clinically in three versions: one of them and the simplest is hebephrenia; the other assuming a catatonic or hebephrenocatatonic form; and finally the paranoid form, each defined based on the degree of relevance of the delusional ideas and their complexities (Henri Ey, 1960, p.534).

Psychiatrists who were contemporary with Kraepelin agreed that dementia praecox was not a progressive and irreversible global intellectual weakness, but rather a ‘dissociation of psychic life’ that fragments into a kind of ‘disintegration of the personality’. In 1911, E. Bleuler proposed the concept of “schizophrenia” to designate ‘precociously demented’ patients. Bleuler considered that these patients were not demented, but rather “affected by a process of dislocation that disintegrates their ‘associative’ capacity, causing them to plunge into a state of autistic life, whose ideas and feelings are the symbolic expression of unconscious complexes”. He demonstrated the relevance of psychoanalysis in contributing to a better understanding of purely descriptive analyses. (Henri Ey, 1960, p.535). Schizophrenia is one of the most complex psychoses and has been debated throughout the history of psychiatry and psychoanalysis. For psychoanalysis, in Freud and Lacan, there is a rupture with the symbolic world in schizophrenia, which compromises the constitution of the subject. This occurs due to the manifestations of the unconscious; therefore, schizophrenia is considered not only as a set of symptoms described in psychopathology manuals, but it also considers the relationship that the subject has with language, desire, and the symbolic world [2].

However, the nosographic replacement of the term “dementia praecox” by “schizophrenia” allowed an abusive extension of the use of the term to describe clinical pictures of mental illnesses due to the loss of the progressive criterion. Since then, this scope in the definition of pictures of this nature has taken the lead in all schools of psychiatry, especially in Anglo- Saxon countries. Gradually, schizophrenic-type reactions have taken the place of diseases and syndromes, as if the picture of schizophrenia had become reduced to episodes of the subject’s rupture with reality or its definitive rupture, characterized by a simple introversion or a great autistic regression of the personality (Henri Ey, 1960, p.535).

There is a notable theoretical and therapeutic importance of the sociocultural approach to major psychoses, however, from this perspective one can incur in the dissolution of the pathological process or even characterize the disorder only in the pathology of communications, disintegrating the various aspects of schizophrenia, be it biological, psychological, individual or sociocultural. Therefore, it is necessary to characterize in these disorders their autistic evolution and the form of manifestation of delirium (Henri Ey, 1960, p.535). In this way, nosology must define schizophrenia as a chronic psychosis that leads to a profound alteration of the personality, imbued in the genre of chronic delusional psychoses, highlighting its characteristic of the rupture of the construction of communication with the other, introspection in autistic thoughts and imaginary chaos. The ‘intellectual’, ‘affective’ and ‘motor’ symptoms are part of this regressive process that becomes progressively more intense (Henri Ey,1960, p.536).

The clinical diagnosis of schizophrenic psychoses should encompass a group of disorders that tend to evolve into a deficit and dissociation of personality and that demonstrate “discordance, ideo-verbal incoherence, ambivalence, autism. Delusional ideas, poorly systematized hallucinations and profound affective disturbances in the sense of disinterest and strangeness of feelings” (Henri Ey, 1960, p.536) [3,4].

Acknowledgement

None.

Conflict of interest

None.

References

• Dalgalarrondo P (2019) Psychopathology and semiology of mental disorders. Medical Arts, Porto Alegre, Brazil.
• Roudinesco E, Plon M (1998) Dictionary of Psychoanalysis. Rio de Janeiro, Jorge Zahar.
• EY H Bernard P, Brisset C (1985) Manual of Psychiatry, São Paulo, Masson, Brazil.
• (2013) Diagnostic and Statistical Manual of Mental Disorders, 5^th