Where Did the Term “Schizophrenia” Come From?

4/4/2020

Ty Colbert, Ph.D.

Until the end of the 19th century, the different forms of what we now call psychosis were generally considered to be the result of a single disease. But after studying hundreds of subjects and their seemingly unlimited behaviors and/or symptoms, Emil Kraepelin proposed the concept that there were three separate psychoses representing three separate disease entities: dementia praecox, paranoia, and manic depressive psychosis. In reference to the condition of dementia praecox, Kraepelin believed that this illness normally began in adolescence and that it involved irreversible mental deterioration.

Within a few years after Kraepelin’s dementia classification, many researchers, including Eugen Bleuler, began to realize that Kraepelin was wrong on both accounts; that indeed some individuals contracted this so-called disease later in life, and that many individuals recovered. Quoting directly from Bleuler,

"There is hardly a single psychiatrist who has not heard the argument that the whole concept of dementia praecox must be false because there are many catatonics and other types who, symptomatologically, should be included in Kraepelin’s dementia praecox, and who do not go on to complete deterioration. Similarly, the entire question seems to be disposed of with the demonstration that in a particular case deterioration has not set in precociously but only in later life."¹

Bleuler then proposed the adoption of a new term. Again, quoting directly from his writings,

"We are left with no alternative but to give the disease a new name, less apt to be misunderstood. I am well aware of the disadvantages of the proposed name but I know of no better one. I call the dementia praecox 'schizophrenia' [from the Greek words schizein, meaning “to split,” and phren, meaning “mind”] because the “splitting” of the different psychic functions is one of its most important characteristics.²

Because of the dissatisfaction of Kraepelin’s term dementia praecox, Bleuler began to search for a better understanding of this condition. To do so, he enlisted help from some bright young physicians. To begin this investigation, in 1900 he sent Franz Riklin to Heidelberg to learn about the association testing that Kraepelin was using in his laboratory.

It was also at about this same time that right after graduating from medical school, Carl Jung arrived at the clinic Bleuler was directing, to help him with his research. When Riklin returned from Heidelberg, he and Jung began developing their own word association tests. Quoting from an article by Moskowitz,

"They set about their task, which Bleuler hoped would inform his developing theory, systematically—first recording the associations of non-psychiatric subjects under a range of conditions before moving on to psychiatric subjects. Their studies formed the basis for a series of publications in the early 1900s, ultimately released in book form under the title of 'Diagnostic Association Studies'. During the course of these studies, which diverged from prior associational research by focusing not only on the time delay between the stimulus word and its response, but also on the personal meaning of the response and whether the subject could recall their response on subsequent trials, Jung developed the concept of a feeling-toned or emotionally-charged complex. This important concept… was to become central to Bleuler’s developing concept of schizophrenia."³

In the application of word association tests, a subject is given a word, and then the investigator records such data as the time delay between when the word is given and the person’s response, as well as the possible personal meaning of the response. Here is a perfect example that I also used in my book Healing Runaway Minds.

A father once brought his psychotic 23-year-old son, Mark, to me for an evaluation. Mark had been living on the streets of Hollywood for several years and had prostituted himself as a way of supporting himself and his drug habit. Although he had been free of street drugs for several months, his previous drug use complicated the attempt to isolate the origin of his psychotic symptoms. As I talked with Mark, he continually switched from a state of coherency to a state of extreme delusion, euphorically describing his extraordinary relationship with Jesus.

He shared that, at certain times, a glorious light beam would appear from the sky and envelop him. Within this beam, Jesus would then appear to purify him. Initially, it appeared that his psychotic behavior came out of nowhere, perhaps as a result of his use of street drugs. As I continued to listen to and observe Mark, paying close attention to his body language and the specifics of the conversation, I discovered a very precise link between his emotional pain and his psychotic behavior. If I directed the conversation to topics devoid of any strong emotional content (foods, music, etc.), he remained relatively free of any psychotic symptoms. But the moment I approached certain areas of his painful life (e.g., “Was it hard to support yourself on the street?”), he immediately escaped into a religious delusional monologue.

“Hollywood” would obviously not be a term Jung would use, but it can represent a fairly neutral word for one individual and obviously, a trigger word for this young man. So if I presented that word to a person who had lived his entire life in New York and had no strong emotional connection to Hollywood, he may respond with, “Oh, a place where movie stars live.” In addition, he may take a quick moment or two to think how he may want to respond, since he had no strong emotional connection to the place. But when I mentioned the word “Hollywood” to my client, Mark, he almost instantly began to talk about the “light of Jesus.”

Along the same lines, when I ask a person in therapy an emotionally-charged question, and that person is not ready or able to give me a truthful “feeling” response, I will usually receive one of three responses. The person will (a) give me a very quick, superficial response, (b) just not answer me, or (c) change the subject. In such a situation, the person is not deliberately acting dishonestly. The unconscious part of his or her mind quickly takes over before any painful feelings can surface, resulting in a response that helps push the feelings back down before they can fully surface. These kinds of behaviors are what Jung referred to as a “feeling-toned or emotionally-charged complex.” Thus, to me, what Bleuler identified as the “splitting of the different psychic functions” was no more than the person’s mind deliberately running off or hiding from the powerful and terrifying feelings locked up or dissociated off from the person.

Consequently, as Bleuler and Jung used a non-medical, non-biological test to notice that certain words triggered an emotionally reactive response resulting in an abnormal, often bizarre behavior, Bleuler searched diligently for the proper term to describe such behavior and came up with the term “schizophrenia.” Thus, the origin of the term was based on an emotional-dissociative model, not a disease or biological model.

¹ E. Bleuler, Dementia Praecox or the Group of Schizophrenias (1911), J. Zinkin, Trans. (New York: International University Press, 1950), p. 8.

² Ibid., p.6.

³ A. Moskowitz and G. Heim, “Eugen Bleuler’s Dementia Praecox or the Group of Schizophrenias (1911): A Centenary Appreciation and Reconsideration,” Schizophrenia Bulletin, Vol. 37, No. 3 (May 2011), retrieved July 21, 2014, from www.ncbi.nlm.nih.gov/pmc/articles/PMC3080676.