Recovery From Schizophrenia: Psychiatry And Political Economy

4 BACKGROUNDor it will demonstrate a continuous but fluctuating course. Furthermore, althoughschizophrenia may be associated with depression, elation or agitation at times, it isoften free of these features and the mood is likely, instead, to be blunted, lackingin spontaneity or incongruous. Markedly illogical thinking is common inschizophrenia. Auditory hallucinations may occur in either bipolar disorder orschizophrenia, but in the latter they are more likely to be commenting on thepatient’s thoughts and actions or to be conversing one with another. Delusions,also, can occur in both conditions; in schizophrenia they may give the individualthe sense that he or she is being controlled by outside forces or that his or herthoughts are being broadcast or interfered with. Both bipolar disorder andschizophrenia are most likely to begin in late adolescence or in early adult life.Despite common features, different forms of schizophrenia can appear quitedissimilar. One person, for example, may be paranoid and hostile in certaincircumstances but show good judgment and high functioning in many areas oflife. Another may be bizarre in manner and appearance, preoccupied withdelusions of bodily disorder, passive and withdrawn. So marked are thesedifferences, in fact, that many psychiatrists believe that, when the underlyingneurophysiological and biochemical mechanisms of schizophrenia are workedout, the illness will prove to be a set of different but related conditions that lead, viaa final common pathway of biochemical interactions, to a similar series ofconsequences. This view of schizophrenia as a federation of states has beenpresent from the time of its earliest conception. To understand why theseconditions were united in the first instance we must look at the history of thedevelopment of the idea.EMIL KRAEPELINThe concept of schizophrenia was formulated by the German psychiatrist EmilKraepelin. Studying, over the course of years, patients admitted to the insaneasylums of the late nineteenth century, he observed that certain types of insanitywith an onset in early adult life and initially rather varied features seemed toprogress ultimately to a similar deteriorated condition. To accentuate theprogressive destruction of mental abilities, emotional responses and the integrityof the personality that he saw as central to this condition, Professor Kraepelintermed it dementia praecox—dementia of early life. Against considerableprofessional opposition, he took the position in 1887 that three conditions,previously considered separate, were in fact subtypes of this single disease entity.These conditions were hebephrenia, marked by aimless, disorganized andincongruous behavior; catatonia, in which the individual might be negativistic,motionless or even stuporose or, at other times, extremely agitated andincoherent; and finally, dementia paranoides, in which delusions of persecutionand grandeur were predominant.In defining dementia praecox, Kraepelin was particularly concerned to showhow it differed from other forms of insanity and from idiocy. Unlike cerebral