I am seeking information on the history and understanding of schizophrenia and its treatment during around the times 1900 to 1930 for a novel that I am interested in writing any help would be greatly appreciated.

-- Trevor Xamin (trevorx75@hotmail.com), September 07, 2002

Answers

I'd start with the following books:

The Concept of schizophrenia: historical perspectives Howells, John G.Washington, DC : American Psychiatric Press, 1991

Interpretation of schizophrenia.Arieti, Silvano.New York: R. Brunner, 1955

You might also see if you can find any abnormal psychology textbooks from that period, or see what you can find in the Journal of Abnormal and Social Psychology, which would have been the premier professional journal at that time.

-- Hendrika Vande Kemp (hendrika@earthlink.net), September 08, 2002.

Hi Trevor, Hendrika's suggestion to read Howells is a great place to start. Unfortunately, the book is very difficult to find (it has since gone out of print) and demands a high price in the used book market. Also, very few libraries actually carry it and there are very few articles within it that deal with aspects of treatment for schizophrenia. The book is mainly concerned with the recency hypothesis and identifying early cases of schizophrenia. A thorough examination of pre- neuroleptic treatment of schizophrenia is obtainable by reading Robert Whitaker’s (2002) “Mad in America: Bad Science, Bad Medicine, And the Enduring Mistreatment of the Mentally Ill. Cambridge, MA: Perseus. However, identifying schizophrenia from 1900 to 1930 is just as important as understanding the treatments utilized during this period. For example, in 1896 Emil Kraepelin organized the symptoms of dementia praecox (schizophrenia) into three major psychopathological forms: paranoid, catatonic and hebephrenic. They measured the patients illness from the least severe (paranoid) to the most severe (hebephrenic) and presented a “clinical picture” of disintegration or disconnection of emotion, intellectual thought and motivation (loss of inner unity), which followed a chronic course and deteriorative outcome. However, Kraepelin noted the great variability in the speed and extent of different individuals’ declines and pointed out that there might even be remissions, or periods when the disease was no longer obvious. For example, he noted that 13 percent of the catatonic and 8 percent of the hebephrenic forms recovered and indicated that improvements in clinical forms were associated with their general prognosis. As a result, the clinical picture of dementia praecox was divided into good (recovery) and poor (chronic) prognosis and necessitated different treatments. Furthermore, according to Eugen Bleuler (1950 [1911]) the concept of dementia praecox was misunderstood because it was only identified with that of a certain psychosis in young people (poor prognosis) despite the recognition of individuals with late onset dementia praecox who were not victims of early deterioration in life and whose course was not necessarily chronic with “complete deterioration” (good prognosis). Therefore, he chose to de-emphasize the “praecox” (premature onset) aspect of “dementia praecox” by renaming it “schizophrenia” and emphasizing the “splitting of the different psychic functions (emotion and cognition) as the most important characteristic” of the disease (p.8). As a result, some researchers have suggested that there are two diagnostic concepts of schizophrenia: one “Kraepelinian” (narrow) and the other “Bleulerian” (broad) that although they have fallen out of diagnostic favor had tremendous bearing between the years 1900 - 1950. For example, evidence indicates, that at least in Europe, the diagnosis of schizophrenia (narrow) was usually made along fairly restrictive lines, and the concept of schizophrenia remained consistent over time. For example, Bleuler’s broad concept of schizophrenia was very popular in the United States. American- trained clinicians diagnosed many people as schizophrenic, even if they only exhibited some of the characteristics of Bleuler’s fundamental symptoms (e.g., looseness of associations, flat or inappropriate affect, autism and ambivalence). There wasn’t any emphasis in differential diagnosis that discriminated between affective disorders (especially manic depression) and schizophrenia. The amount of people being labeled schizophrenic increased tremendously. For example, in the 1930’s about 20% of patients at the New York Psychiatric Institute were diagnosed as schizophrenic. By the 1950’s, the figure had reached 80%. In contrast, the proportion of patients diagnosed as schizophrenic at Maudsley Hospital in London, where a Kraepelin-derived concept of schizophrenia continued to be used, remained at 20% over the same period. As a result, it was often erroneously claimed that European treatments for schizophrenia were more effective and led to greater recovery rates among schizophrenics. This is definitely something you should think about before writing your book. Below are some references most relevant to your writing endeavors. Trust me, this is the short list -

Beveridge, A. (1995a). Madness in Victorian Edinburgh: a study of patients admitted to the royal Edinburgh asylum under Thomas Clouston, 1873 – 1908. Part 1. History of Psychiatry, 6, 21 – 54.

Beveridge, A. (1995b). Madness in Victorian Edinburgh: a study of patients admitted to the royal Edinburgh asylum under Thomas Clouston, 1873 – 1908. Part 2. History of Psychiatry, 6, 133 - 156.

Bleuler, E. (1950 [1911]). Dementia praecox or the group of schizophrenias. J. Zinkin (trans.). New York: International Universities Press.

Gottesman, I. I. (1991). Schizophrenia genesis: The origins of madness. New York: Freeman.

Jablensky, A. (1997). The 100-year epidemiology of schizophrenia. Schizophrenia Research, 28, 111-125.

Jablensky, A. and Sartorius, N. (1979). Culture and schizophrenia. Psychologica l Medicine, 5, 113 – 124.

James, R. L., and May, P. R. A. (1981). Diagnosing schizophrenia: Professor Kraepelin and the research diagnostic criteria. American Journal of Psychiatry, 138, 501 – 504.

Jimenez, M. A. (1987). Changing faces of madness: early American attitudes and treatment of the insane. Hanover, NH: University Press of New England.

Keefe, R. S. C. et al. (1991). Diagnostic issues in chronic schizophrenia: Kraepelinian schizophrenia, undifferentiated schizophrenia and state independent negative symptoms. Schizophrenia Research, 4, 71 – 79.

Kraepelin, E. (1971 [1919]). Dementia praecox and paraphrenia. R.M. Barclay (trans.). Facsimile edition. Huntington, New York: Robert E. Kriegger. Kraepelin, E. (1987). Memoirs. Berlin: Springer-Verlag.

Moran, J. E. (1998). Insanity, the asylum and society in nineteenth- century Quebec and Ontario. Dissertation. Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Graduate Programme in History at York University, North York, Ontario. Printed by University Microfilms International; Ann Arbor, Michigan.

Murphy, H. B. M. (1984). Diseases of civilization? Psychological Medicine, 14, 487 – 490.

Palha, P. A. and Esteves, M. F. (1997). The origin of dementia praecox. Schizophrenia Research, 28, 99 – 103.

Robinson, D (1977). Significant contributions to the history of psychology 1750 – 1920: Series C,Medical psychology; (3) 1. Washington, D.C.: University Publications of America.

Porter, R. (1988). A social history of madness: the world through the eyes of the insane. New York: Weidenfield & Nicolson.

Sarason, I. G. and Sarason, B. R. (1989). Abnormal Psychology (6th ed.). New Jersey: Prentice Hall.

Scull, A. (1984). Was insanity increasing? A response to Edward Hare. British Journal of Psychiatry, 144, 432 – 436,

Shorter, E. (1997). A history of psychiatry. New York: Wiley.

Torrey, E. F. (1973a). Is schizophrenia universal? An open question. Schizophrenia Bulletin, 7, 53 – 59.

Torrey, E. F. (1980). Schizophrenia and civilisation. London: Aronson.

Torrey, E. F. (2001). Surviving Schizophrenia: A manual for families, consumers, and providers. (4th ed.). New York: Quill.

Torrey, E. F. and Miller, J. (2001). The invisible plague: the rise of mental illness from 1750 to the present. New Jersey: Rutgers University Press.

Turner, T. H. (1992). Schizophrenia as a permanent problem: Some aspects of historical evidence in the recency (new disease) hypothesis. History of Psychiatry, 3, 413 – 429.

Winchell, A.G. (1991). The era of prognosis and prophylaxis: The reception of dementia praecox in North America, 1896-1910. Thesis. Submitted in partial fulfillment of the requirements for the degree of Master of Arts in the Graduate Programme in Psychology at York University, North York, Ontario. Printed by University Microfilms International; Ann Arbor, Michigan.

All the best Trevor.

-- Pete Economou (Peteecon@yorku.ca), September 08, 2002.