Introduction
Mental health refers to the state of human cognitive and emotional condition. This refers to the feelings and behaviour of individuals. Mental health can also refer to the absence of a mental illness. Mental health is a concept that was clearly defined during the 19th century by William Sweetzer. He was the first to define mental hygiene that laid the ground for advances in mental health. Eugen Bleuler is credited for having come up with the term “Schizophrenia” during the second decade of the 20th century (Kyziridis, 2005).
Nonetheless, it has to be remarked that Emil Kraepelin came up with various categories of mental disorders. There is no doubt that schizophrenia is not a new disease. This is because symptoms that are associated with schizophrenia were witnessed in the formative years of human history.
In the early years, signs related to the disease were said to be resulting from possession of evil spirits. There has been debate on whether schizophrenia is a biological or social condition (Jablensky, 2010). This paper strives to give a critical analysis of schizophrenia and provide a position on whether the condition is biological or social.
Historical analysis of Schizophrenia
The term “Schizophrenia” is relative new in medical circles. Notably, the word was coined by Eugen Bleuler in 1911. In this regard, it can be observed that the term has only been in existence for barely a century now. In the first description of schizophrenia, Emile Kraepelin categorised the condition as “dementia praecox” in the year 1878.
Nonetheless, schizophrenia has been associated with humans since the ancient times. There is evidence indicating that schizophrenia was recorded in ancient Egypt since the year 2000 BC. Notably, psychotic symptomatology and symptoms related to schizophrenia characterised the ancient communities.
This is evidenced by the skulls belonging to the Stone Age humans that have holes drilled in the skulls. Research has indicated that the holes in skulls were drilled while the individual was alive to give a throughway for the evil spirits to leave the head. This mode of treating schizophrenia has become to be known as trepanning. In the ancient communities, schizophrenia was explained through supernatural understanding (Kyziridis, 2005).
Incidents of schizophrenia are clearly described in the Book of Hearts. In ancient Egypt, the heart and mind were seen as being similar. Psychical illnesses were considered to be symptoms resulting from blood vessels, faecal matter, poison or evil spirits. In most instances, the people of ancient Egypt regarded the mental disorders as being physical illnesses. Among the Hindu community, mental disorder descriptions can be traced to the year 1400 BC.
It was believed that health was derived from the balancing act of the Buthas and the Dosas. An imbalance resulting from the two elements was argued to lead to madness. Among the Chinese, symptoms related to schizophrenia were described in an ancient text about 1000 BC. It was believed that psychotic behaviours were caused by an individual being possessed by evil spirits (Kyziridis, 2005).
The history of development in respect to mental health can be traced to antiquity. Nonetheless, there are those individuals who stood out in defining the term schizophrenia. Notably, in the early 18th century, there was an emphasis on accurately detailing and describing mental abnormality. Philippe Pinel, who is regarded as one of the pioneers of modern psychiatry, emphasized on the need to incorporate medico-philosophical approach in understanding psychological disorders.
He went further to distinguish a worsening psychosomatic “dementia” from other conditions such as idiocy, mania, and melancholia. The other individual who contributed to the development of psychiatry is Jean Etienne Esquirol. He offered the definition of hallucination that is relatively similar to the modern definition.
During the 1860s, Benedict Augustin Morel used the term “dementia praecox” for the first time in his “Treatise on Mental Illness”. There are other individuals whose contribution to the field of psychiatry cannot be ignored. Such individuals include Kahlbaum who referred to the pattern of abnormal motor tension as “katatonia” or “catatonia” (Kyziridis, 2005).
During the nineteenth century, there were major developments related to the aspect of body and mind. There were indications that mental disorders were caused by an illness in the brain. This was after it was discovered that syphilis and insanity were closely related. During this time, organic aetiologies related to mental disorders were approved, and different illnesses were approved. This period was characterised by numerous descriptions defining what is now referred to as schizophrenia.
Emil Kraepelin came up with the various categories of mental disorders in 1878. Notably, he referred to the disorders with symptoms similar to those observed in schizophrenia as “dementia praecox” (Klosterkötter, Schultze-Lutter and Ruhrmann, 2008). On the contrary, during the early years of the 20th century, Eugen Bleuler coined the term “schizophrenia” for the first time in the history of mental disorders.
Bleuler was critical of the term “dementia praecox” arguing that there was the lack of evidence to support a worldwide dementing process. The term schizophrenia is derived from a Greek words “schizo” and “phone”. In Greek, schizo means “split” while “phone” is the “mind” (Kyziridis, 2005).
Though Bleuler was the first to coin the term schizophrenia, the term has undergone numerous changes to suit the definition of certain mental disorders. It is worth noting that Bleuler and Kraepelin divided schizophrenia into various categories relying on the elaborate signs and diagnosis. Individuals in the modern times have continued to categorise schizophrenia into various types. In this classification, there are five categories defined in the DSM-III. They include the “disorganised, catatonic, paranoid, residual, and undifferentiated” schizophrenia (Kyziridis, 2005, p. 45).
In defining schizophrenia, Bleuler noted that the disorder was characterised by positive and negative symptoms. According to Bleuler, the positive symptoms of schizophrenia are those that are regarded as additional to the normal human behaviour. Such symptoms include hallucinations and delusions (Moskowitz and Heim, 2011).
Hallucinations can be described as sensations that occur in without the individual experiencing a stimulus. The perceptions may seem to be realistic; however, they are just a creation of the brain. On the other hand, delusions refer to unfounded beliefs indicating abnormality in the thought process. The negative symptoms of schizophrenia are those that relate to loss of normal behaviour. Such symptoms include social withdrawal and apathy or lack of interest for certain things (Kyziridis, 2005).
It has been found that schizophrenia develops during early adulthood in most instances. In essence, most individuals begin showing signs of schizophrenia during their early twenties. It has also been observed that women take between five and ten years to peak more than men. During the initial stages, an individual appears not to be having any goals in life. The individuals thus become weird and lack motivation in life. Depression has strongly been associated with schizophrenia.
In this regard, depression is closely witnessed in patients suffering from schizophrenia. Kraepelin used the affective symptoms in differentiated praecox from manic-depressive illnesses. Kraepelin recognised the significance of depression in schizophrenia and came up with various subtypes of the disease (Mulholland and Cooper, 2000).
There has been a major debate on whether schizophrenia is a biological or a social disorder. Most people assume that the social causes of schizophrenia have been rendered ineffective due to the development of biological theories. Nonetheless, it can be asserted that both these aspects can be considered in the analysis of mental illnesses such as schizophrenia. Notably, it has been noted that biological factors may be critical in the development of schizophrenia; however, social factors also are critical in the development of schizophrenia.
Biological Construct of Schizophrenia
Biological and genetic aspects play a critical role in the development of schizophrenia. In this respect, numerous theories have been put forth to provide a biological explanation of schizophrenia. Among these theories include the dopamine hypothesis; glutamate hypothesis; genetics; and substance/drug/alcohol abuse.
In respect to the dopamine hypothesis, it is argued that schizophrenia is caused by the excess dopamine in the brain. This is because patients suffering from schizophrenia are having more dopamine in the brain than normal individuals. The increased level of dopamine causes symptoms related to schizophrenia (Moghaddam, 2003).
In regard to the glutamate hypothesis, it is argued that schizophrenic patients have a deficiency in a receptor found in the brain. In essence, it has been established that glutamate, which also serves as a transmitter, is a chemical found in the brain. This chemical is secreted into synapses and enhances the propagation of nerve impulse.
It is noted that, when the receptors in question are compromised, an individual becomes schizophrenic. The receptors, N-methyl-D-aspartate (NMDA) receptors are argued to be the main subtype of glutamate receptors facilitating slow excitatory postsynaptic potentials. This is important for the expression of complicated behavioural observations that get distorted in schizophrenic patients (Moghaddam, 2003).
The genetics hypothesis notes that schizophrenia is caused by the prenatal environment in the DNA of the child before it is born. In this regard, schizophrenia is considered to be a hereditary disease in which schizophrenic genes are passed from the parents to the child. It has been asserted that individuals inherit genes from the parents, which are critical in brain development.
If an allele of a gene that is critical in the brain development of the child is subjected to mutation, then the child stands a high chance of being born with a mental disorder. Notably, somatic mutation is common at the time of intense cell division and thus the chance of a child developing schizophrenia is limited to critical moments during neurodevelopment (Guidry and Kent, 1999).
There has been an association between schizophrenia and abuse of substances (Kosten, and Ziedords, 1997). Several studies have demonstrated that schizophrenics tend to indicate high rates of drug and alcohol abuse. Notably, individuals suffering from schizophrenia are said to be susceptible to negative consequences of drug abuse. It has also been indicated that use of drugs and alcohol leads to developmental issues in the brain. This has been noted to cause schizophrenia (Smith and Hucker, 1994).
Treatment of Schizophrenia
Individuals suffering from schizophrenia cannot experience a comprehensive remission of symptoms. Nonetheless, schizophrenia can be managed by combining medication and psychosocial therapies. The treatment of this condition can be directed by a psychiatric who manages the biological and medical needs of the patient.
The mental health professionals and social workers develop a strategy that is geared towards helping the schizophrenic patient integrate into the society. It can be noted that drugs are effective especially in the control of the positive symptoms. Such drugs enable the schizophrenic patients to live outside institutional care centres normally (Cheadle, Freeman and Korer, 1978).
Schizophrenia can be described as a condition that brings together thought, mood, and anxiety disorders. Also, the use of drugs is critical in the management of positive symptoms associated with schizophrenia. These drugs enable schizophrenic individuals to lead a relatively normal life outside the institutional care. The treatment of schizophrenia demands a combined effort from various medications. Such medication includes antipsychotics, antidepressants, and antianxiety drugs (Plasky, 1991).
Though these medications have proved to be helpful, most individuals on drugs do not continue using the drug prescribed after some time. This is especially when the side effects are intolerable. It has been indicated that about three quarters schizophrenic patients stop taking medication once they leave the institutional centers.
To ensure that patients adhere to the prescription, it is important to have follow-up programs in place that will monitor the progress of the patients in taking medication. Apart from the side effects that are associated with the medication, it has been realised that some schizophrenic patients do not respond to the drugs positively. Approximately, 30% of the patients do not respond to medication (Kramer, et al, 1989).
Several drugs are used in treating schizophrenia. These drugs include Clozapine, Seroquel, Risperdal and Zyprexa. The antipsychotic drugs assist in the normalisation of the biochemical imbalances that lead to schizophrenia. The traditional antipsychotic drugs include haloperidol, chlorpromazine, and fluphenazine, which help in the treatment of positive symptoms.
Also, there are the new antipsychotic drugs such as the Seroquel, Risperdal, Zyprexa and Clozoaril used in treating both positive and negative symptoms of schizophrenia. The new antipsychotic drugs also do not have numerous side effects as the old antipsychotic drugs (Carpenter and Koenig, 2008).
Social construct
Apart from the drug therapy, there are the psychological therapies used in treating schizophrenia. For instance, there is the cognitive behaviour therapy that is used in the management of schizophrenia. It is believed that the social environment in which an individual live can affect Cognitive behaviour therapy identifying what triggers and sustains schizophrenia and how strategies can be developed in managing the symptoms related to schizophrenia (Turkington, Dudley, Warman and Beck, 2006).
Notably, family intervention is one of the strategies used in enforcing the cognitive behaviour therapy. Family interventions are meant to change interaction patterns within family groups. This is aimed at stopping a relapse of schizophrenia symptoms among the patients who leave the institutional care centers (Carpenter and Koenig, 2008).
Training in social skills is also critical in helping schizophrenic patients cope with normal life. In social skills training, interpersonal skills are taught by breaking the complex behaviours into individual elements. These skills are demonstrated in role play where the schizophrenic patients are given a role to play while practising the skills.
Social skills training is rooted in conditioned reflex therapy, psychotherapy, and social learning theory. Social skills training help schizophrenic individuals to learn new skills, which they can maintain for quite some time. It also helps in improving social functioning, as well as quality of social life of patients. Social skills are critical in enhancing social functioning, quality of life, and adjustment of the patient to normal, community life (Mueser and Bellack, 2007).
Schizophrenia and Culture
Schizophrenia cuts across all cultures across the globe. In this regard, ethnographic studies have indicated that schizophrenia is found in virtually all communities around the world (Kyziridis, 2005). Therefore, it has to be noted that the various world communities devised different ways of dealing with this mental condition. In essence, some societies used to drill holes in the skull of individuals who were schizophrenic. It was believed that the individuals were possessed by evil spirits and thus drilling a hole provided a way through which these spirits left the brain (Insel, 2010).
Various cultural beliefs have developed over centuries aimed at the treatment of schizophrenia. Such cultural aspects include hydro baths, electroshock, and lobotomy. In hydrotherapy, there were various treatments in which water was used in treating schizophrenic patients. This required a doctor’s prescription and an attendant was assigned the duty of ensuring that the patient underwent all the necessary procedures in hydrotherapy.
Electroshocks were also used in the treatment of schizophrenia. In this respect, electric shocks are used to generate nerve-wracking convulsions in the treatment of schizophrenia. This treatment began in the 18th century and took root during the 19th century. Lobotomy treatment of schizophrenia entails the drilling of holes in the human skull. This is an ancient method of treatment, which has been revamped to minimise the dangers associated with it in the modern days.
Initially, lobotomy was thought to be only effective in treating patients with depression, as opposed to those with acute schizophrenia. However, this assertion has been disapproved, and numerous lobotomies have been carried out around the world. During the second decade of the 20th century, the Nazi advocated for the extermination of the schizophrenic individuals.
They advocated for euthanasia in which the unfortunate individuals were viewed as being a burden to the society. It can be remarked that the T4 program that was occasioned during the holocaust saw thousands of mentally challenged individuals being killed. The society has moved away from the archaic methods of treating schizophrenia to embrace humane means of treatment.
Schizophrenia is also associated with religious aspects. In the ancient societies such as Mesopotamia, any form of sickness was associated with spirits. Many religious groups handled schizophrenia in various ways. Plato, a Greek philosopher who lived during the 4th and 5th centuries, categorised madness into two. The first category had a divine origin whereas the other one had a physical origin. Among the Christians, exorcism was conducted to remove the evil spirits or demons from the individual.
It was believed that schizophrenia resulted from an individual being possessed by demons. During the 16th century, witchcraft was practiced among some societies to cure schizophrenia. Individuals suffering from schizophrenia were believed to be bearing the wrath of the gods. Therefore, a witch doctor was called to intervene and heal the patient (Jablensky, 2010).
Conclusion
Schizophrenia is a condition that has characterised the human society for many years. From the onset, individuals have struggled with ways to deal with the condition. However, development that has been realised in the medical field has seen the discovery of new and advanced medication to treat this condition. Notably, it can be asserted that schizophrenia is a biological condition since it concerns the composition of the chemicals in the brain. Nonetheless, social aspects also play a role in the development of schizophrenia.
Reference List
Carpenter, W. and Koenig, J. (2008). The evolution of drug development in schizophrenia: past issues and future opportunities. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, 33(9), 2061-2079.
Cheadle, A. J., Freeman, H. L. and Korer, J. (1978). Chronic schizophrenic patients in the community. British Journal of Psychiatry, 133, 221–227.
Guidry, J. and Kent, T.A. (1999). New genetic hypothesis of schizophrenia. Med Hypotheses, 52(1):69-75.
Insel, T. (2010). Rethinking schizophrenia. Nature, 468(7321), 187-193.
Jablensky, A. (2010). The diagnostic concept of schizophrenia: its history, evolution, and prospects. Dialogues In Clinical Neuroscience, 12(3), 271-287.
Klosterkötter, J., Schultze-Lutter, F., and Ruhrmann, S. (2008). Kraepelin and psychotic prodromal conditions. European Archives Of Psychiatry And Clinical Neuroscience, 258 Suppl 274-84.
Kosten, T. R. and Ziedords, D. M. (1997). Substance Abuse and Schizophrenia: Editors’ Introduction. Schizophrenia Bulletin, 23(2):181-186.
Kramer, M. S., et al. (1989). Antidepressants in ‘depressed’ schizophrenic inpatients. A controlled trial. Arch Gen Psychiatry, 46: 922.
Kyziridis, T. C. (2005). Notes on the History of Schizophrenia. German J Psychiatry, 8: 42-48.
Moghaddam, B. (2003). Bringing order to the glutamate chaos in schizophrenia. Neuron, 40(5): 881-4.
Moskowitz, A. and Heim, G. (2011). Eugen Bleuler’s Dementia praecox or the group of schizophrenias (1911): a centenary appreciation and reconsideration. Schizophrenia Bulletin, 37(3), 471-479.
Mueser, K. T. and Bellack, A. S. (2007). Social skills training: Alive and well? Journal of Mental Health, 16(5): 549 – 552.
Mulholland, C. and Cooper, S. (2000). The symptom of depression in schizophrenia and its management. Advances in Psychiatric Treatment, 6: 169-177.
Plasky, P. (1991). Antidepressant usage in schizophrenia. Schizophrenia Bulletin, 17, 649–657.
Smith, J. and Hucker, S. (1994). Schizophrenia and substance abuse. Br J Psychiatry, 165(6): 836-7.
Turkington, D., Dudley, R., Warman, D. M. and Beck, A.T. (2006). Cognitive-Behavioural Therapy for Schizophrenia: a review. Focus, 4(2), 1-11.