Recovery From Schizophrenia: Psychiatry And Political Economy

198 THE INCIDENCE OF SCHIZOPHRENIARome distinguished conditions like schizophrenia from those resembling mania,depression, catatonic stupor and delirium. 8 It is an open question, however,whether schizophrenia was less common before the eighteenth century.The records of Richard Napier, an English mediaeval physician whospecialized in the care of the mentally ill, suggest that the condition closest to ourmodern category of schizophrenia, “mopishness,” was not common in his day. 9British psychiatrist Edward Hare argues that there was a real increase in theoccurrence of schizophrenia during the nineteenth century. Not only did thetotal number of the insane occupying the asylums increase throughout theVictorian era, but so did admission and first-admission rates. First admissions morethan tripled between 1869 and 1900. 10 As an editorial in the London Times of1877 quipped,“if lunacy continues to increase as at present, the insane will be in themajority, and, freeing themselves, will put the sane in asylums.” 11Many of the Victorian asylum superintendents, caught, as it seemed, in an upwardspiral of lunacy, were at pains to point out that this trend was an artifact of increasingrecognition of those in need of treatment, and not an indictment of their attemptsat prevention. Others, like Daniel Hack Tuke, believed that there was an actualincrease in mental disorder brought about by the spread of poverty. 12 Dr Hare,like Dr Tuke before him, argues that increased recognition of insanity cannotexplain a sustained growth rate on such a scale over several decades. If increasingnumbers of mild cases were being admitted to the asylums, he contends, one wouldexpect to find decreasing death rates and increasing recovery rates, and this wasnot the case. Hare points out, moreover, that the greatest increase was in“melancholia,” the nineteenth century condition that most closely matches themodern diagnosis of schizophrenia. 13Dr Hare argues that it was primarily the early-onset type of schizophrenia thatincreased during the nineteenth century. He suggests that some new biologicalfactor, such as the mutation of a virus or a change in the immunological defensesof the general population, occurred and caused an increase in schizophreniaaround 1800. 14Even at the end of the nineteenth century, schizophrenia appears to have beenrelatively rare. Psychiatrist Assen Jablensky reports that only nine per cent of menand seven per cent of women first admitted to the University Psychiatric Clinic inMunich in 1908 were diagnosed as suffering from dementia praecox (thecontemporary term for schizophrenia). Since Emil Kraepelin himself (thepsychiatrist who defined dementia praecox) evaluated some of these cases, it isunlikely that missed diagnosis accounts for the low prevalence of the disorderamong the admissions. The occurrence rate for the diagnostic categories most likelyto have included schizophrenia was low among other nineteenth century asylumpopulations, also. The greatest increase in institutionalized cases of schizophrenia,Dr Jablensky suggests, may well have occurred in the twentieth century. 15