History of Psychiatry

http://hpy.sagepub.com

Problems with retrospective studies of the presence of schizophrenia

David Fraguas and C.S. Breathnach
History of Psychiatry 2009; 20; 61
DOI: 10.1177/0957154X08089453
The online version of this article can be found at:
http://hpy.sagepub.com/cgi/content/abstract/20/1/61

Published by:
http://www.sagepublications.com

Additional services and information for History of Psychiatry can be found at:
Email Alerts: http://hpy.sagepub.com/cgi/alerts
Subscriptions: http://hpy.sagepub.com/subscriptions
Reprints: http://www.sagepub.com/journalsReprints.nav
Permissions: http://www.sagepub.co.uk/journalsPermissions.nav
Citations http://hpy.sagepub.com/cgi/content/refs/20/1/61

Downloaded from http://hpy.sagepub.com by Daniel Martinez on October 2, 2009

History of Psychiatry, 20(1): 6171 Copyright 2009 SAGE Publications

(Los Angeles, London, New Delhi, Singapore and Washington DC) www.sagepublications.com
[200903] DOI: 10.1177/0957154X08089453

Problems with retrospective studies of

the presence of schizophrenia
DAVID FRAGUAS*
Hospital Infanta Sofa, San Sebastin de los Reyes, Madrid

Edited by

Professor C. S. BREATHNACH

Studies concerning the presence of schizophrenia in the distant past are controversial. Some authors maintain that schizophrenia-like illnesses existed in
antiquity, while others argue that this is quite doubtful. Imprecise definition of
schizophrenia, imposition of the current concept of schizophrenia onto the past,
difficulties in interpreting ancient texts describing schizophrenia-like conditions,
and cultural variables involved in the clinical defi nition of schizophrenia
underlie these controversies. This article reviews the methodological issues that
arise in such retrospective studies of schizophrenia.
Keywords: antiquity; history; methodology; presentism; schizophrenia

Introduction
The trend for labelling human experience with psychiatric diagnoses has been
a remarkable characteristic of modern culture since the nineteenth century
(Akerknecht, 1943). Ancient texts have been investigated from various perspectives in search of descriptions readily assimilated to schizophrenia (Bark,
1988; Ellard, 1987; Evans, McGrath and Milns, 2003; Freud-Loewenstein,
2004; Hare, 2002; Heinrichs, 2003; Jeste, del Carmen, Lohr and Wyatt,
1985; Simon, 1978; Vakili and Gorji, 2006; Youssef and Youssef, 1996).
Some authors maintain that ancient texts contain examples of schizophrenialike descriptions (Bark, 1988; Haldipur, 1984; Jeste et al., 1985; Otsuka and
* Address for correspondence: Department of Psychiatry, Hospital Infanta Sofa, Paseo Europa 34,
CP 28702, San Sebastin de los Reyes, Madrid, Spain. Email: david.fraguas@salud.madrid.org

Downloaded from http://hpy.sagepub.com by Daniel Martinez on October 2, 2009

62

HISTORY OF PSYCHIATRY 20(1)

Sakai, 2004; Stone, 1997; Youssef and Youssef, 1996), while others argue that
this is quite doubtful (Dendle, 2005; Evans et al., 2003; Hare, 1988, 2002;
Torrey, 1980). Imprecise definition of schizophrenia, imposition of the current
concept of schizophrenia onto the past, a lack of consensus in interpreting
ancient texts, and cultural variables involved in the clinical definition of
schizophrenia underlie the controversies surrounding these studies. This article
addresses some of the methodological issues involved.
Retrospective assessment of descriptions of schizophrenia
Descriptions of illnesses are highly dependent on the definition of the object
of inquiry (Berrios and Porter, 1999). The word schizophrenia derives from
the Greek and roughly means split mind. Eugene Bleuler introduced this
term in 1908 to rename the group of mental disorders that Emil Kraepelin had
called dementia praecox (Bleuler, 1908, 1950; Hoenig, 1983). At the close of
the nineteenth century, Kraepelin grouped catatonia, dementia paranoides,
dementia simplex and hebephrenia under a new description, dementia praecox,
defined according to a pattern of symptoms (a peculiar destruction of the
internal connections of the psychic personality, often accompanied by delusions
and hallucinations) running a chronic course with poor prognosis (progressive
deteriorating course of both emotional and cognitive processes) (Berrios,
2002; Kraepelin, 1919). However, since it was first named, schizophrenia has
been characterized according to many different definitions (Berrios, 1999;
Berrios and Hauser, 1988; Dutta, Greene, Addington, McKenzie, Phillips
and Murray, 2007; Jablensky, 1999; Mellergard, 1987; Peralta and Cuesta,
2005). In fact, when Jablensky applied the criteria of the ninth edition of the
International Classification of Diseases (ICD-9) to clinical descriptions of
patients diagnosed by Kraepelin as having dementia praecox, only 67.9% were
found to have schizophrenia (Jablensky, 1999). In this sense, it is problematic
to assume that when a patient is currently diagnosed with schizophrenia, it is
the same condition as that referred to by Kraepelin or Bleuler. Furthermore,
there is still no universally accepted definition of schizophrenia (Berrios, Luque
and Villagrn, 2003; Cooper, 2004; Dutta et al., 2007; Galatzer-Levy and
Galatzer-Levy, 2007; Ghaemi, 2006; Kendler, 2005; Zachar and Kendler,
2007). Without a current consensus on what is specifically referred to by the
term schizophrenia, conclusions reached in scholarly studies into the past will
vary widely.
In this sense, searching for schizophrenia in the past may involve either
searching for a well-defined picture of schizophrenia, as with current rulebased diagnostic criteria for schizophrenia, such as ICD-9, ICD-10, DSM-III
or DSM-IV (i.e., a splitting approach to schizophrenia), or, conversely,
searching for a general sense of madness, including irrational, delusional-like,
hallucination-like, incomprehensible or uncontrolled ideas or behaviours (i.e.,
a lumping approach to schizophrenia). Interestingly, although both ICD-10

Downloaded from http://hpy.sagepub.com by Daniel Martinez on October 2, 2009

D. FRAGUAS: SCHIZOPHRENIA IN RETROSPECT

63

and DSM-IV diagnostic criteria are based on lists of specific symptoms

(splitting approach), both classifications use a lumping approach to introduce
the definition of schizophrenia. DSM-IV asserts that schizophrenia is
characterized by profound disruption in cognition and emotion, affecting the
most fundamental human attributes: language, thought, perception, affect and
sense of self (American Psychiatric Association, 2000). The ICD-10 introduces the concept of schizophrenia as follows: The schizophrenic disorders
are characterized in general by fundamental and characteristic distortions of
thinking and perception, and by inappropriate or blunted affect (World Health
Organization, 1992). It is generally accepted that the use of criteria-based
assessments, such as the ICD-10 or DSM-IV, increases diagnostic reliability,
but this does not guarantee conceptual validity (Berrios, 1999; Kendell and
Jablensky, 2003).
Studies using a splitting approach have resulted in different conclusions compared with studies using a lumping approach. A systematic study of the presence
of schizophrenia in ancient Greek and Roman literature based on a splitting
approach (DSM-IV criteria) shows no evidence of descriptions of individuals
fitting the current rule-based diagnostic criteria of schizophrenia (Evans et al.,
2003). But studies using a lumping approach conclude that schizophrenialike descriptions existed in ancient Greece and Rome (Drabkin, 1955; Fabrega,
1990; Jeste et al., 1985).
Conflicting results depending on the use of a splitting or a lumping approach
are in keeping with both the paucity of schizophrenia-like descriptions in antiquity (Jeste et al., 1985) and the profusion of ancient accounts of behaviour
and verbal manifestations readily assimilated to the current concept of madness
(Dodds, 1951; Harrison, 1960; Mumford, 1996; Simon, 1978).
The lack of descriptions of schizophrenia (in a splitting sense) in ancient times
does not necessarily imply that schizophrenia did not exist in those times. Dilip
V. Jeste et al. (1985) proposed that several factors may contribute to a false
perception of lack of schizophrenic cases in ancient times, for example: recent
origin of syndrome-based approaches to illness, lack of interest in chronic incurable conditions in antiquity, considering mental symptoms as the domain
of religion rather than medicine, confusing terminology to describe symptoms
of mental dysfunction, non-seeking of medical care by mentally ill subjects and
their relatives, and a possible change in the clinical manifestation of schizophrenia over the centuries. In fact, studies using a lumping approach have found
evidence of schizophrenia-like descriptions in first-century India (Haldipur,
1984), ancient Greece and Rome (Drabkin, 1955; Fabrega, 1990; Jeste et al.,
1985), medieval Persia (Vakili and Gorji, 2006), medieval Europe (Fabrega,
1990; Heinrichs, 2003; Jeste et al., 1985), medieval Islamic society (Youssef
and Youssef, 1996), Shakespeares tragedies (Andreasen, 1976; Bark, 1985),
Cervantes Don Quijote (Bailn Blancas, 2006; Gracia Guilln, 2005; Lpez
Muoz, Rubio, lamo and Garca-Garca, 2006), seventeenth-century England
(Hill and Shepherd, 1976), seventeenth- and eighteenth-century Germany

Downloaded from http://hpy.sagepub.com by Daniel Martinez on October 2, 2009

64

HISTORY OF PSYCHIATRY 20(1)

(Heinrichs, 2003; Jeste et al., 1985; Otsuka and Sakai, 2004), seventeenth- and
eighteenth-century Mexico (Bartra, 2004), seventeenth- and eighteenth-century
New England (Goodheart, 2002; Jimenez, 1986), and progressively worldwide
since the nineteenth century (Altschuler, 2001; Berrios, 2002; Crighton, 1996;
Jablensky, 1999; Turner, 1992).
These accounts suggest that there were ancient verbal and behavioural
manifestations quite similar to clinical components of the current notion of
schizophrenia. However, schizophrenia is a recent term that cannot be found
in ancient texts. Moreover, schizophrenia does not refer to an unquestionable
real, recognizable, unitary and stable (RRUS) construct (Berrios et al., 2003).
In fact, classifications of mental disorders are rooted in cultural issues and
do not represent natural distinctions (Berrios, 1999). A factor analysis of 23
different contemporary diagnostic schemes of schizophrenia (all from the
twentieth century) suggests that diagnostic criteria for schizophrenia may be
arbitrary and not reflective of a natural discontinuity between schizophrenic
and non-schizophrenic individuals (Peralta and Cuesta, 2005). Hence, studies
regarding the presence of schizophrenia in the past should clearly specify what
is meant by the term schizophrenia.
Presentism in studies regarding the presence of schizophrenia in
the past
Historical research involves the risk of presentism the risk of imposing current concepts into the past (Akerknecht, 1943; Heinrichs, 2003; Thuilleaux,
1980). In studies regarding schizophrenia this risk is compounded when nonpathological experiences of individuals from the past (as judged by their contemporaries) are judged as pathological by current research (Evans et al., 2003;
Jeste et al., 1985). Unfortunately, reading into the past what we like to think is
true in the present is an ever-present risk in historical research (Dodds, 1951;
Kaufman, 1966). Looking back we see through a glass darkly.
Studying the past involves investigating the present. This is the epistemological
root of presentism. What is known is always in terms of what is presupposed
(Thornton, 1969). In this sense, the position of contemporary scholars
introduces an inescapable relativism into the question of presentism. The
Heisenberg uncertainty principle affirms that observation of an object implies
the modification of the observed object (Lewis and Mayer, 1929), and it is conceivable that the study of antiquity involves such a change; the original source
is modified by the observational process itself.
Research is regularly focused on those things that can be directly or indirectly linked with known features (historical or current) (Ekstein, 1975).
This bias, restricting knowledge of the past within present conceptions,
imposes a presentistic classification of the past, including the use of modern
psychopathological labels for ancient descriptions (Akerknecht, 1943).

Downloaded from http://hpy.sagepub.com by Daniel Martinez on October 2, 2009

D. FRAGUAS: SCHIZOPHRENIA IN RETROSPECT

65

The meaning of madness in past times is unclear and comprises a wide range
of current psychiatric and non-psychiatric conditions (Crighton, 1996; Fabrega,
1990). Indeed, schizophrenia is a modern term referring to a modern construct
(Berrios et al., 2003) that is not simply out there, waiting to be described and
theorized by researchers and clinicians (Borch-Jacobsen, 2001). Essentially, the
very existence of schizophrenia is rooted in historical and social factors (Berrios,
1999; Berrios et al., 2003). There is no schizophrenia as an invariant and natural
phenomenon, but schizophrenia or schizophrenias as medical and social
conventions (Waxler, 1974). Thus, any study of the presence of schizophrenia
in the past unavoidably implies some degree of presentism.
It is generally accepted that madness in a broad sense is not new, and is
possibly as old as the first human societies (Alexander and Selesnick, 1995;
Berrios and Porter, 1999; Jeste et al., 1985). However, the existence of madness
in antiquity does not guarantee that schizophrenia was one of those conditions.
Searching for schizophrenia means searching for ancient descriptions of
individuals having equivalent symptomatology to that suffered by patients
currently diagnosed with schizophrenia. Hence, it should not be inferred
from restrictive presentistic impositions that the search for such accounts is
methodologically unacceptable.
Some authors argue that, although defined under other names or grouped
into different categories, descriptions from antiquity show cases of individuals
with symptoms equivalent to what are nowadays grouped under schizophrenia
(Andreasen, 1976; Bark, 1985; Jeste et al., 1985; Otsuka and Sakai, 2004;
Turner, 1992; Youssef and Youssef, 1996). Others claim that schizophrenia,
as a clinical condition, did not exist before the nineteenth century (Hare, 1983,
1988; Torrey, 1980).
Schizophrenia as a recent disease vs. schizophrenia as a permanent
problem
The hypothesis that schizophrenia arose as a new form of mental illness in the
nineteenth century was first proposed by Torrey (1980), and then outlined by
Edward Hare in the 1982 Maudsley lecture, Was insanity on the increase?
(Hare, 1983, 1988, 2002). This position was named the recency hypothesis
(Dualde Beltrn and Rey Gonzlez, 2003; Hare, 1983, 1988). It is based on
several presupposed features, such as the lack of descriptions of behaviours
similar to schizophrenia before the nineteenth century, the apparent increase
of madness in Western societies during the nineteenth-century industrial
revolution, and the persistence of schizophrenia despite the low fertility rate
among schizophrenic patients (Hare, 2002). A viral infection as an aetiological
factor of schizophrenia is in the forefront of Hares statements.
When the basis for the recency hypothesis was systematically reviewed, the
supporting evidence was weak (Turner, 1992). Those who quarrel with the
hypothesis assert that there are texts predating 1800 which contain descriptions

Downloaded from http://hpy.sagepub.com by Daniel Martinez on October 2, 2009

66

HISTORY OF PSYCHIATRY 20(1)

conforming readily with current concept of schizophrenia (Bark, 1985, 1988;

Jeste et al., 1985; Turner, 1992). Nevertheless, it is true that schizophrenia-like
descriptions before the nineteenth century are uncommon in comparison with
references to other conditions, such as epilepsy (Jeste et al., 1985). However,
although scarcity of schizophrenia-like descriptions may reflect a real lack
of schizophrenia-like illnesses, this dearth may also be due to other factors,
including the lack of an adequate description of schizophrenia-like accounts
before the nineteenth century, a difference in the method of grouping clinical
features of what is currently grouped into schizophrenia, or the possibility
that schizophrenia-like processes were described under other names, such as
mania or melancholia (Berrios, 2002; Crighton, 1996; Jeste et al., 1985). In fact,
unlike other medical conditions that can be retrospectively traced in skeletons
or in well-preserved mummies, the diagnosis of schizophrenia in antiquity
is solely dependent on written texts and cannot be established objectively
(Crighton, 1996).
Interpreting ancient texts containing schizophrenia-like
descriptions
Diagnosis of schizophrenia-like descriptions in antiquity is exclusively
dependent on medical, philosophical, historical and literary texts (Akerknecht,
1943; Evans, McGrath and Milns, 2003; Jeste et al., 1985; Simon, 1978).
However, ancient texts concerning mental illness should be interpreted with
caution. Multiple ancient terms may refer to the same condition (Evans et al.,
2003), and many ancient expressions may have similar but not the same
meaning as today (Harrison, 1960). Hence, some apparently abnormal ideas, as
currently viewed, may have been normal expressions in ancient daily life
(Heinrichs, 2003).
Ancient texts are not free from ambiguity. The Greek word thumos, usually
translated as heart, appears 433 times in Homers Iliad. However, its use
varies, sometimes referring to the heart as a physical organ, but more frequently
as the seat of emotion, including impulsive emotions of anger, desire and
courage, or even the site of the faculty of thinking, memory or decision-making
(Harrison, 1960; Mumford, 1996). Furthermore, other Homeric Greek words,
such as phren (usually translated as breast, chest or diaphragm, but also as perception, knowledge, judgement, grief or fear) and kephale (usually translated
as head, but sometimes as a persons life) did not have a uniform meaning
(Harrison, 1960; Mumford, 1996). These terms illustrate the difficulty of
translating words from different times and languages into modern meanings
(Gonzalez de Pablo and Evans, 1994; Harrison, 1960; Mumford, 1996; Simon,
1978; Vakili and Gorji, 2006; Youssef and Youssef, 1996). Additionally,
abstract concepts, such as anger, fear, sorrow, grief, sadness or even psyche,
were not clearly developed in antiquity (Harrison, 1960; Simon, 1978).

Downloaded from http://hpy.sagepub.com by Daniel Martinez on October 2, 2009

D. FRAGUAS: SCHIZOPHRENIA IN RETROSPECT

67

Translation of texts in ancient languages involves the risk of falsely assuming

that ancient terms and modern translations have equivalent meanings (Harrison,
1960). Many problems in the study of Greek philosophy come from confusing
grammar, logic and metaphysics, distinctions that did not exist in antiquity
(Guthrie, 1960). Current meanings of numerous modern words cannot be
directly inferred from their original derivation, and current usage often disguises the rich semantic field of ancient terms (Bremmer, 2002). Thus, the
interpretation of ancient texts must consider the historical context in which
each text originated.
In this sense, the rationale for including or excluding characteristics of what
is currently grouped under the concept of schizophrenia is dependent on
historical context (Berrios, 1999; Kirmayer, 2005). Different issues, such as
lack of interest in chronic and incurable conditions, comprehension of schizophrenia-like accounts as religious issues rather than medical illness, confusion in
terminology regarding madness, social conception of madness, or predominant
theoretical psychiatric paradigm, may underlie historical differences in constructing the concept of schizophrenia (Berrios, 2002; Huertas, 2004; Jeste
et al., 1985; Lantri-Laura, 2000).
Above all, when reading and interpreting ancient texts it is crucial to remember that these descriptions were not case-reports written to inform the
reader about the presence of schizophrenia in those times.
Cultural aspects of studies on the presence of schizophrenia in the past
Understanding written descriptions from the past demands an understanding of
their cultural context (Ackerknecht, 1942; Beiser, 2003; Skinner, 1969; Tosh,
2003). An appraisal of the cultural variables underlying the clinical definition of
schizophrenia is crucial to understanding its real significance (al-Issa, 1995;
Fabrega, 1990; Haghighat, 1994; Thuilleaux, 1980; Waxler, 1974; Waynik,
1985). Indeed, accounts of psychotic experiences are highly dependent on the
cultural context of the narrative, and may differ across different cultures
(Fabrega, 2005; Haghighat, 1994; Kirmayer, 2005; Thuilleaux, 1980).
Although schizophrenia patients have been reported everywhere, culture dictates
whether and how experiences and behaviours are defined: as schizophrenia-like
illness, other type of illness, or non-illness phenomena (Beiser, 2003).
As expected, the use of rule-based diagnostic criteria increases diagnostic
reliability across different cultures. However, diagnosis is ethnicity-mediated,
even when standardized diagnostic criteria (such as the DSM-IV or ICD-10) are
used (Minsky, Vega, Miskimen, Gara and Escobar, 2003). Schizophrenia was
conceived in Western culture, so searching for schizophrenia-like descriptions
in non-Western cultures implies a risk of imposing Western concepts of schizophrenia in non-Western cultural settings. This risk, which can be called cultural
ethnocentrism, may underlie discrepancies in diagnostic decisions between
Western and non-Western societies (Jenkins and Barret, 2004). Texts should

Downloaded from http://hpy.sagepub.com by Daniel Martinez on October 2, 2009

68

HISTORY OF PSYCHIATRY 20(1)

be studied within their precise cultural frame. In searching for schizophrenia

in ancient texts there can be no equivalent of the clinical encounter which
narrows down the diagnostic decision (Berrios and Chen, 1993). Accordingly,
cultural context might be looked upon as a substitute to serve for the clinical
encounter.
Conclusions
Results of studies on the presence of schizophrenia in past times are methodology-dependent. They depend mainly on the definition of schizophrenia
(Berrios and Porter, 1999). Schizophrenia is a modern term that refers to a nonunambiguous psychiatric condition (Berrios et al., 2003; Cooper, 2004; Zachar
and Kendler, 2007). However, searching retrospectively for schizophrenia does
not mean looking for an abstraction, but searching for ancient descriptions of
cases of individuals who suffered from symptoms in some way comparable to
those suffered by patients currently diagnosed with schizophrenia. Therefore,
studies on the presence of schizophrenia in the past should clearly define the
term schizophrenia.
This investigation implies interpreting written texts in search of descriptions
readily assimilated to the modern concept of schizophrenia (Akerknecht, 1943;
Evans et al., 2003; Jeste et al., 1985). However, interpreting texts from antiquity
involves two methodological concerns. Firstly, there is the risk of missing
schizophrenic-like behaviours due to various unclear ancient expressions.
Secondly, interpreting ancient texts may entail a risk of imposing the current
concept of schizophrenia on the past (Akerknecht, 1943; Heinrichs, 2003).
This risk of historic presentism goes hand-in-hand with the risk of Westernculture ethnocentric imposition. Schizophrenia is a modern as well as a Western
psychiatric concept. Thus, searching for schizophrenia in past times involves a
certain inescapable degree of both presentism and cultural ethnocentrism.
References
Ackerknecht, E. H. (1942) Primitive medicine and culture pattern. Bulletin of the History of
Medicine, 12, 54574.
Akerknecht, E. H. (1943) Psychopathology, primitive medicine and primitive culture. Bulletin
of the History of Medicine, 14, 3067.
al-Issa, I. (1995) The illusion of reality or the reality of illusion. Hallucinations and culture.
British Journal of Psychiatry, 166 (3), 36873.
Alexander, F. G. and Selesnick, S. T. (1995) The History of Psychiatry (London: Jason
Aronson Inc.).
Altschuler, E. L. (2001) One of the oldest cases of schizophrenia in Gogols Diary of a Madman.
British Medical Journal, 323 (7327), 14757.
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders
DSM-IV-TR (Washington DC: American Psychiatric Association).
Andreasen, N. J. (1976) The artist as scientist. Psychiatric diagnosis in Shakespeares tragedies.
Journal of the American Medical Association, 235(17), 186872.

Downloaded from http://hpy.sagepub.com by Daniel Martinez on October 2, 2009

D. FRAGUAS: SCHIZOPHRENIA IN RETROSPECT

69

Bailn Blancas, J. M. (2006) La psiquiatra en El Quijote (Barcelona: Ars XXI).

Bark, N. M. (1985) Did Shakespeare know schizophrenia? The case of Poor Mad Tom in
King Lear. British Journal of Psychiatry, 146, 4368.
Bark, N. M. (1988) On the history of schizophrenia. Evidence of its existence before 1800.
New York State Journal of Medicine, 88 (7), 37483.
Bartra, R. (2004) Doce historias de melancola en la Nueva Espaa. Frenia, 4 (1), 3152.
Beiser, M. (2003) Why should researchers care about culture? Canadian Journal of Psychiatry,
48 (3), 15460.
Berrios, G. E. (1999) Classifications in psychiatry: a conceptual history. Australian and New
Zealand Journal of Psychiatry, 33 (2), 14560.
Berrios, G. E. (2002) The History of Mental Symptoms (Cambridge: Cambridge University
Press).
Berrios, G. E. and Chen, E. Y. (1993) Recognising psychiatric symptoms. Relevance to the
diagnostic process. British Journal of Psychiatry, 163, 30814.
Berrios, G. E. and Hauser, R. (1988) The early development of Kraepelins ideas on
classification: a conceptual history. Psychological Medicine, 18 (4), 81321.
Berrios, G. E., Luque, R. and Villagrn, J. M. (2003) Schizophrenia: a conceptual history.
International Journal of Psychology and Psychological Therapy, 3 (2), 11140.
Berrios, G. E. and Porter, R. (1999) A History of Clinical Psychiatry (London: Athlone Press).
Bleuler, E. (1908) Die Prognose der Dementia Praecox-Schizophreniegruppe. Allgemeine
Zeitschrift fr Psychiatrie, 65, 43664.
Bleuler, E. (1950) Dementia Praecox or the Group of Schizophrenias (New York: International
Universities Press); originally published in German in 1911.
Borch-Jacobsen, M. (2001) Making psychiatric history: madness as folie a plusieurs. History
of Human Sciences, 14 (2), 1938.
Bremmer, J. N. (2002) El concepto del alma en la antigua Grecia (Madrid: Ediciones Siruela).
Cooper, R. (2004) What is wrong with the DSM? History of Psychiatry, 15 (1), 525.
Crighton, J. (1996) Some descriptions of schizophrenia-like illness in the German literature
of the early nineteenth century. History of Psychiatry, 7, 3154.
Dendle, P. (2005) Schizophrenia in the early Middle Ages: some negative evidence. Australian
and New Zealand Journal of Psychiatry, 39 (6), 522.
Dodds, E. R. (1951) The Greeks and the Irrational (Los Angeles: University of California Press).
Drabkin, I. E. (1955) Remarks on ancient psychopathology. Isis, 46, 22334.
Dualde Beltrn , F. and Rey Gonzlez, A. (2003) A propsito de Hare: una revisin sobre la
hiptesis de la recency. Archivos de Psiquiatra, 66 (4), 25568.
Dutta, R., Greene, T., Addington, J., McKenzie, K., Phillips, M. and Murray, R. M. (2007)
Biological, life course, and cross-cultural studies all point toward the value of dimensional
and developmental ratings in the classification of psychosis. Schizophrenia Bulletin, 33
(4), 86876.
Ekstein, R. (1975) Psychoanalytic precursors in Greek antiquity. Bulletin of the Menninger
Clinic, 39 (1), 24667.
Ellard, J. (1987) Did schizophrenia exist before the eighteenth century? Australian and New
Zealand Journal of Psychiatry, 21 (3), 30618.
Evans, K., McGrath, J. and Milns, R. (2003) Searching for schizophrenia in ancient Greek
and Roman literature: a systematic review. Acta Psychiatrica Scandinavica, 107 (5),
32330.
Fabrega, H., Jr (1990) Psychiatric stigma in the classical and medieval period: a review of the
literature. Comprehensive Psychiatry, 31 (4), 289306.
Fabrega, H., Jr (2005) Psychiatric conditions and the social sciences. Psychopathology, 38
(4), 2237.

Downloaded from http://hpy.sagepub.com by Daniel Martinez on October 2, 2009

70

HISTORY OF PSYCHIATRY 20(1)

Freud-Loewenstein, A. (2004) In search of madness. American Journal of Psychotherapy, 58

(1), 11630.
Galatzer-Levy, I. R. and Galatzer-Levy, R. M. (2007) The revolution in psychiatric diagnosis:
problems at the foundations. Perspectives in Biology and Medicine, 50 (2), 16180.
Ghaemi, S. N. (2006) Paradigms of psychiatry: eclecticism and its discontents. Current Opinion
in Psychiatry, 19 (6), 61924.
Gonzalez de Pablo, A. and Evans, N. J. (1994) The medicine of the soul. The origin and
development of thought on the soul, diseases of the soul and their treatment, in medieval
and renaissance medicine. History of Psychiatry, 5 (4), 483516.
Goodheart, L. B. (2002) The distinction between witchcraft and madness in colonial
Connecticut. History of Psychiatry, 13, 43344.
Gracia Guilln, D. (2005) Discretas locuras. Variaciones en torno al tema de la locura de don
Quijote. Anales de la Real Academia Nacional de Medicina, 122 (2), 10521.
Guthrie, W. K. C. (1960) The Greek Philosophers from Thales to Aristotle (New York: Harper
Torchbooks).
Haghighat, R. (1994) Cultural sensitivity: ICD-10 versus DSM-III-R. International Journal
of Social Psychiatry, 40 (3), 18993.
Haldipur, C. V. (1984) Madness in ancient India: concept of insanity in Charaka Samhita
(1st century A.D.). Comprehensive Psychiatry, 25 (3), 33544.
Hare, E. H. (1983) Was insanity on the increase? British Journal of Psychiatry, 142, 43955.
Hare, E. H. (1988) Schizophrenia as a recent disease. British Journal of Psychiatry, 153,
52131.
Hare, E. H. (2002) El origen de las enfermedades mentales (Madrid: Triacastela).
Harrison, E. L. (1960) Notes on Homeric psychology. Phoenix, 14, 6380.
Heinrichs, R. W. (2003) Historical origins of schizophrenia: two early madmen and their
illness. Journal of the History of the Behavioral Sciences, 39 (4), 34963.
Hill, C. and Shepherd, M. (1976) The case of Arise Evans: a historico-psychiatric study.
Psychological Medicine, 6 (3), 3518.
Hoenig, J. (1983) The concept of schizophrenia. Kraepelin-Bleuler-Schneider. British Journal
of Psychiatry, 142, 54756.
Huertas, R. (2004) El siglo de la clnica (Madrid: Frenia).
Jablensky, A. (1999) The conflict of the nosologists: views on schizophrenia and manicdepressive illness in the early part of the 20th century. Schizophrenia Research, 39 (2),
95100, (discussion) 159.
Jenkins, J. J. and Barret, R. J. (2004) Schizophrenia, Culture and Subjectivity. The Edge of
Experience (Cambridge: Cambridge University Press).
Jeste, D. V., del Carmen, R., Lohr, J. B. and Wyatt, R. J. (1985) Did schizophrenia exist
before the eighteenth century? Comprehensive Psychiatry, 26 (6), 493503.
Jimenez, M. A. (1986) Madness in Early American history: insanity in Massachusetts from
1700 to 1830. Journal of Social History, 20 (1), 2544.
Kaufman, M. R. (1966) The Greeks had some words for it. Early Greek concepts on mind
and insanity. Psychiatric Quarterly, 40, 133.
Kendell, R. and Jablensky, A. (2003) Distinguishing between the validity and utility of
psychiatric diagnoses. American Journal of Psychiatry, 160 (1), 412.
Kendler, K. S. (2005) Toward a philosophical structure for psychiatry. American Journal of
Psychiatry, 162 (3), 43340.
Kirmayer, L. J. (2005) Culture, context and experience in psychiatric diagnosis. Psychopathology, 38 (4), 1926.
Kraepelin, E. (1919) Dementia Praecox and Paraphrenia. Translated by R. Mary Barclay
from the 8th edn of Psychiatrie. Ein Lehrbuch fr Studierende und rzte, III, ii, IX:

Downloaded from http://hpy.sagepub.com by Daniel Martinez on October 2, 2009

D. FRAGUAS: SCHIZOPHRENIA IN RETROSPECT

71

Die endogenen Verbldungen. Ed. George M. Robertson (Edinburgh: E. & S.

Livingstone; also Chicago: Chicago Medical Book Company).
Lantri-Laura, G. (2000) Ensayo sobre los paradigmas de la psiquiatra moderna (Madrid:
Triacastela).
Lewis, G. N. and Mayer, J. E. (1929) The quantum laws and the uncertainty principle of
Heisenberg. Proceedings of the National Academy of Sciences of the United States of America,
15, 12739.
Lpez Muoz, F., Rubio, G., lamo, C. and Garca-Garca, P. (2006) A propsito de la
locura del hidalgo Alonso Quijano en el marco de la medicina espaola tardorrenacentista.
Anales de Psiquiatra, 22 (3), 13345.
Mellergard, M. (1987) Psychiatric classification as a reflection of uncertainties. Acta
Psychiatrica Scandinavica, 76 (1), 106111.
Minsky, S., Vega, W., Miskimen, T., Gara, M. and Escobar, J. (2003) Diagnostic patterns
in Latino, African American, and European American psychiatric patients. Archives of
General Psychiatry, 60 (6), 63744.
Mumford, D. B. (1996) Somatic symptoms and psychological distress in the Iliad of Homer.
Journal of Psychosomatic Research, 41 (2), 13948.
Otsuka, K. and Sakai, A. (2004) Haizmanns madness: the concept of bizarreness and the
diagnosis of schizophrenia. History of Psychiatry, 15 (1), 7382.
Peralta, V. and Cuesta, M. J. (2005) The underlying structure of diagnostic systems of
schizophrenia: a comprehensive polydiagnostic approach. Schizophrenia Research, 79
(23), 21729.
Simon, B. (1978) Mind and Madness in Ancient Greece. The Classical Roots of Modern Psychiatry
(London: Cornell University Press).
Skinner, Q. (1969) Meaning and understanding in the history of ideas. History and Theory,
8 (1), 353.
Stone, M. H. (1997) Healing the Mind: A History of Psychiatry from Antiquity to the Present
(New York: W. W. Norton).
Thornton, H. (1969) Socrates and the history of psychology. Journal of the History of the
Behavioral Sciences, 5, 32639.
Thuilleaux, M. (1980) Conocimiento de la locura (Barcelona: Ediciones Pennsula).
Torrey, E. F. (1980) Schizophrenia and Civilization (London: Aronson).
Tosh, N. (2003) Anachronism and retrospective explanation: in defence of a present-centred
history of science. Studies in History and Philosophy of Science, 34, 64759.
Turner, T. H. (1985) Was insanity on the increase? British Journal of Psychiatry, 146, 325.
Turner, T. H. (1992) Schizophrenia as a permanent problem. Some aspects of historical
evidence in the recency (new disease) hypothesis. History of Psychiatry, 3, 41329.
Vakili, N. and Gorji, A. (2006) Psychiatry and psychology in medieval Persia. Journal of
Clinical Psychiatry, 67 (12), 18629.
Waxler, N. E. (1974) Culture and mental illness. A social labeling perspective. Journal of
Nervous and Mental Disease, 159 (6), 37995.
Waynik, M. (1985) Paranoia as a cultural phenomenon: treatment of an Indian physician.
American Journal of Psychotherapy, 39 (4), 58792.
World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural
Disorders (Geneva: WHO).
Youssef, H. A. and Youssef, F. A. (1996) Evidence for the existence of schizophrenia in
medieval Islamic society. History of Psychiatry, 7, 5562.
Zachar, P. and Kendler, K. S. (2007) Psychiatric disorders: a conceptual taxonomy. American
Journal of Psychiatry, 164 (4), 55765.

Downloaded from http://hpy.sagepub.com by Daniel Martinez on October 2, 2009