Types of Schizophrenia and Treatment
Understanding the history and classification of schizophrenia is vital for the proper intervention, approach, and awareness.
The classical subtypes of schizophrenia include:
- paranoid
- hebephrenic
- undifferentiated
- residual
- catatonic, and
- straightforward.
Psychoanalysis, behavioral therapy, supportive therapy, and family interventions were the only available psychotherapies for a long time. The consensus was reached that psychoanalysis is not indicated in patients with schizophrenia. Conventional behavioral therapy made valuable contributions but was mainly aimed at compensating for behavioral deficits. Family therapy positively affects critical clinical outcomes like psychotic relapse, medication compliance, and rehospitalization. Cognitive-behavioral therapy (CBT) has been introduced not only for helping to compensate for specific deficits of schizophrenia but also to complement medication in treating positive, emotional, and negative symptoms.
History of Schizophrenia
The “first clinical description of a case of schizophrenia was described in the English physician John Haslam’s “Illustration of Madness,” although the term schizophrenia appeared up to a century later. It presented the case of James Tilly Mathews, a tea merchant, married, and the father of two children. France imprisoned him in 1793 because he claimed the existence of telepathic communications between France and the United Kingdom. He wrote to British ministers to denounce conspiracies against his country. According to him, a gang of villains in London, very skilled in “Pneumatic Chemistry,” assaulted him with a mind-control machine built by French Jacobin revolutionaries to lead England into a war disaster.
This group was able to control people’s minds, “forcing magnetic fluid so that facial muscles were forced to laugh or grimace,” and they were able to “speak in the brain” in a “silent transport of intelligence into the intellectual atmosphere” of the brain.
James Mathews’ story generates disputes between his family, the representatives of medicine, the government, and controversies within the medical group. He remained for almost two decades years in Bethlem Hospital. He had delusions and chronic hallucinations, dying a year after discharge from the hospital. This case is the first reliable example of that condition that, 100 years later, would be named schizophrenia.
Between 1868 and 1874, a German psychiatrist described a syndrome relevant to this history: catatonia.
“A state in which the patient sits, quietly or completely mute, immobile, without anything making him change position, with the appearance of being absorbed in the contemplation of an object, with his eyes fixed on a distant point and without any apparent volition, nor a reaction to sensory impressions.”
Some patients went on to intellectual deterioration, but others had remarkable recoveries. He emphasized the presence of “epileptiform seizures,” which suggested neurological causes in some patients. We know that viral and autoimmune encephalitis cause catatonia, seizures, and mental disorders. The evidence that schizophrenia is a biologically-based brain disease has accumulated rapidly during the past two decades. Recently, this evidence has been supported by dynamic brain imaging systems that precisely show the wave of tissue destruction in the brain suffering from schizophrenia.
In 1907, the Swiss psychiatrist Eugen Bleuler changed the name of dementia praecox by coining the neologism schizophrenia, which means “division (or splitting) of the mind.” He wrote to justify this etymological choice: “I call early dementia schizophrenia because the splitting of psychic functions is one of its most important characteristics.”
The metaphor of a division, separation, splitting, rupture or fragmentation of the mind was part of the romantic psychology of the 19th century. It became part of the literary culture, as seen in the stories of Robert Stevenson, Dr. Jekyl, and Mr. Hyde. This metaphor, whose supporters took it as a reality, also penetrated the fields of philosophy, psychoanalysis, and popular culture. This largely explains the almost immediate acceptance of clinical neologism; it was a point of convergence between biological psychiatry and psychoanalysis and academic and popular culture articulation.
Schizophrenia in American Literature
The novels by Thomas Pynchon and Don DeLillo grapple with the shift from modernism to postmodernism. Both present new ways of interpreting agency and identity through the postmodernist sensibility of schizophrenia while not wholly rejecting the modernist sensibility of paranoia. Pynchon, writing The Crying of Lot 49 early in postmodernity, is specifically grappling with how characters can transition from paranoid to schizophrenic modes of interpreting the world and how an individual’s agency and selfhood are affected by this shift. While writing in postmodernism two decades later, DeLillo rethinks in Libra the divide between the eras and their terms to construct an amalgamated interpretation of paranoia, agency, and identity regarding schizophrenia. There seems to be an alternative narrative of the world hiding within the accepted narrative in these books, which is just a façade for the “real” narrative. Schizophrenia is presented by its characters as a mode of knowledge that interprets the world as multiple narratives. The postmodernist thinkers who associate paranoia with modernism and schizophrenia with postmodernism believe that the former was a psychological response to the conditions of modernity. At the same time, the latter is the psychological response to the needs of postmodernity. The experience of postmodernity is too fragmented, multiple, and overloaded with information to be understood through paranoia, as well as it is understood through schizophrenia.
Decades after the publication of Dr. Jekyll and Mr. Hyde, the term schizophrenia was included in the psychiatric classifications of the World Health Organization and the American Psychiatric Association.
At La Jolla Recovery, clients diagnosed with this mental condition will be backed by our experience treating schizophrenia and schizoaffective with the most innovative evidence-based therapies with both inpatient and outpatient approaches. Contact us to learn about our approach to treating schizophrenia and other co-morbid addiction problems, including drugs and alcohol. During Covid-19, we are open and respect social distance procedures. Read more about our privacy practices here.
