ABSTRACT
Schizophrenia is a diagnosis usually given to individuals who present with seriously debilitating problems, as may be seen from the case study of Julian, a nineteen-year-old adolescent, presented in Box 18.1. Research on schizophrenia follows from two principal traditions, the first represented by Kraepelin (1896) and the second by Bleuler (1911). Whereas Kraepelin defined the presentation now called schizophrenia as principally characterized by a large constellation of observable symptoms (such as delusions, hallucinations and thought disorder), an underlying degenerative neurological cause and a chronic course, Bleuler proposed that schizophrenia was a circumscribed set of inferred psychological processes, which often led to the sorts of presentations to which Kraeplein had referred as ‘dementia praecox’. Bleuler speculated that the capacity to associate one thought with another, to associate thoughts with emotions and the self with reality, were impaired or split. Hence the term ‘schizophrenia’ (from the Greek words for split and mind). Bleuler argued that observable symptoms such as delusions and hallucinations were secondary to these central disrupted psychological processes and reflected the person’s attempt to cope with the world despite the disrupted psychological processes. Up until the late 1970s, Bleuler’s tradition, associated with a broad definition of schizophrenia, pre-dominated in the USA, whereas in the UK, Ireland and Europe, Kraepelin’s narrower definition held sway. Following the landmark US-UK diagnostic study (US-UK Team, 1974), which highlighted the extraordinary differences between the way schizophrenia was defined in the USA and Britain, there has been a gradual move towards developing an internationally acceptable set of diagnostic criteria, as can be seen from Table 18.1.
