Professor Eugene Bleuler has immensely contributed to the study and research of schizophrenia. According to him, schizophrenia is a severe disorder which directly affects how an individual thinks, acts, relates to others or even perceives reality. Schizophrenia is the most severe and chronic of all the mental illnesses and hence affects the lifestyles of those who have it. Schizophrenia has long-term recurrent effects which often leave the victims frightened and withdrawn. However, although various researches, studies, and experiments have been conducted on schizophrenia, no cure has been found. Schizophrenia and its effects can, however, be controlled and managed to the extent of enabling its victims to live in normal societies without difficulty. Eugene Bleuler’s contribution to psychology has made it possible to define, identify the symptoms, epidemiology, and causes of schizophrenia through a theoretical approach.
Historical Perspective of Schizophrenia
Historically, the term schizophrenia traces its origin from its founder Eugene Bleuler who was inspired to dwell deeper into research after Kraepelin’s principle of nosology was declined. Bleuler had a strong belief that what Kraepelin had described was dementia and hence strived to identify scientific features and patterns which would help him categorize and later classify schizophrenia. Bleuler (1991) further went ahead to demystify the psychosocial and social factors that played along the neurobiological aspect of schizophrenia to later lead to a deeper understanding of the bio-psycho-social understanding of the concept of mental illness (Ashworth " Chung, 2007). Bleuler’s research on mental illnesses further demystified key concepts such as essentialism, stigma, and naturalism among others.
Kraepelin was the original founder and researcher on schizophrenia. Bleuler, however, took over from Kraepelin’s research and changed the main area of conflict by refuting the Kraepelin’s assertion that schizophrenia is dementia. Bleuler went ahead and further categorized the symptoms of schizophrenia into positive and negative. Bleuler just like Kraepelin further subdivided schizophrenia into multiple categories. Bleuler (1991) ended up with 5 categories which include paranoid, residual, catatonic, undifferentiated and disorganized among others. Bleuler further made different tests of patients so as to narrow down the symptoms and severity of the effects of schizophrenia.
Schizophrenia often varies from one person to another as while people may experience multiple attacks or only a single psychotic episode that might last for long or for a short while (Ashworth " Chung, 2007). In some instances, the schizophrenic episodes tend to worsen and increase through episodes known as remissions and episodes.
Case Study 1
In his case study on the origin and authenticity of schizophrenia, Bleuler (1991) approaches the disease from a nosological perspective leaving a debate on whether schizophrenia is a distinct disease. He equally adds the concept of the “self” and “person” to further demystify the roots of the disease. Just like in the case of the contemporary researchers, Bleuler categorized and studied individuals on the basis of their personalities to ascertain the concept of the “person” and “self.” The concept of the “self” and “person” are directly correlated to the concept of schizophrenia. It follows that, Bleuler’s nosological concept of schizophrenia is directly correlated with the contemporary groups and categories that various researchers try to pool the symptoms and conditions that pertain to schizophrenia (Bleuler, 1991).
The Symptoms of Schizophrenia
People suffering from schizophrenia often exhibit various symptoms which result in changes in symptoms, perceptions, and functions that make them display a certain type of behavior at different times. Being a long-term mental illness, schizophrenia often begins to show its symptoms in men during teenagehood and when they near 20 years (Bernier " Gerdts, 2010). In women, it often manifests itself after 20 years but before 30. Since there is often no specific trigger of the schizophrenic psychosis, the prodromal period might take from a few days to years to become a full psychosis (Bleuler, 1991). The symptoms of schizophrenia can be grouped into positive, negative and cognitive.
The positive symptoms are not as good as the name might imply. Instead, they are symptoms that are often added to one’s experience and hence result in a form of exaggerated thinking. People with schizophrenia tend to be delusional in the sense that they perceive things which are not true but are psychotic (Mason " Overdrive Inc, 2011). Although the victims of this condition are presented with facts, they tend to stick to their original thoughts and shut out other reasons. Hallucinations are also part of the positive symptoms of people with schizophrenia. People experiencing hallucinations see and perceive things that are not true and practical. Hallucination often takes charge of a victim’s brain and instills a form of fear and or experience which is not real (Bleuler, 1991). Positive symptoms of schizophrenia include catatonia which often prompts a person to remain in a single position or state for a long time. Some disorganized symptoms sometimes accompany the positive symptoms (Dyck " Project Muse, 2008).
The negative symptoms of schizophrenia mean that the victim of schizophrenia loses interest in many things. It could also refer to the absence of normal or ordinary behavior that is often exhibited in people who do not have schizophrenia (Ashworth " Chung 2007). People with negative effects of schizophrenia tend to emotionless and hence when they speak their voice lacks conviction. Emotionless people often lose interest and refuse to think beyond the ordinary. In some instances, people exhibiting the negative effects of schizophrenia tend to withdraw themselves from society. They often tend to lay back and shut themselves out from the rest of the world (Maatz " Angst, 2015). Having a conversation with such people is often difficult as they tend to keep quiet most of the time. People with schizophrenia tend to have a constant struggle with their daily lives as they often fail to keep track of their activities and interests. Schizophrenic people, hence, develop thinking problems and overthink most of the time thereby deliberately alienating themselves from the activities that take place around them (Maatz " Angst, 2015).
The patients suffering from schizophrenia often encounter negative symptoms which often take the short to long term effects and could be easily identified even prior to the diagnosis of the condition (Keefe, Richard, " McEvo, 2001). The cognitive symptoms of schizophrenia often range from mild to severe and hence include the impairment of the executive functions, working memory, verbal learning, and the attention span. Although these symptoms predate the onset of the psychosis, they tend to be stable and constant throughout the course of the illness in most patients (Keefe, Richard, " McEvo, 2001). Over the years, however, researchers and medical specialists have continually dwelled on these symptoms and have used them as the main reference points to diagnose people with schizophrenia.
Epidemiology
In an attempt to explain his neural model of schizophrenia, Bleuler devised an example from the clinical neurology. In the case study, he found that the abducens muscle creates a paralysis of the lateral eye movement alongside a wrong localization of movements due to the tension of the lesion (Mason " Overdrive Inc, 2011). In the concept of schizophrenia, Bleuler claims that the primary symptoms of schizophrenia are much closer to the neural substrate. The secondary symptoms are comparable to the distant polymorph features of schizophrenia. It follows that while the secondary features of the illness are open to a dynamic interpretation, the primary features are closer to the neural substrate (Lieberman, Stroup, " Perkins, 2006). Bleuler, however, did not further elaborate on the abducens lesion muscle but instead left the field open for other researchers to build on and further explore.
Statistically, 1 in every 10,000 adults aged between 12 years to 60 years is often diagnosed with schizophrenia (Grant, 2011). Using standard assessment methods alongside a precise definition of the diagnosis, the incident rates of schizophrenia are constant across countries and cultures over the past 50 years (Lieberman, Stroup, " Perkins, 2006).). The main age range for schizophrenia is 20-35 years (Mason " Overdrive Inc, 2011). Grant (2011) affirms that the schizophrenic incidences that occur after the age of 60 have not been clearly defined as either etiological or psychopathological. In over 75% of the schizophrenic cases, the first 5 years after diagnosis are mainly characterized by the prodromal phase which is usually accompanied by a year’s psychotic phase (Ashworth " Chung, 2007). The late onset schizophrenic incidences are more common among women in comparison to men. Most of the women who encounter these effects in their later stages often experience the symptoms 3-4 years after men. The period around menopause equally triggers the symptoms and later diagnosis of schizophrenia (Ashworth " Chung, 2007). The core symptoms and type of onset of schizophrenia do not differ among the sexes.
Causes of Schizophrenia
There are several causal factors to schizophrenia and they include genetics, the structure of the brain and viral infections among others. One of the most common causes of schizophrenia is genetics as most of people with relatives who have schizophrenia tend to acquire the condition themselves (Ashworth " Chung, 2007). However, this is not always the case as there are some people with schizophrenia whose families are not affected and vice versa. Research shows that several different genes are responsible for schizophrenia although no individual gene has been established to cause schizophrenia (Ashworth " Chung, 2007). It is, therefore, not entirely correct to state that genetics is a strong causal factor for schizophrenia (Bleuler, 1991). It is possible to come to the conclusion that even though genes are required to cause schizophrenia, they need to come in contact with several other factors which could range from environmental to psychosocial factors.
Secondly, the structure of the brain is also another factor as people with schizophrenia often experience an abnormal secretion of the brain’s chemicals. The chemicals, in turn, affect the different paths and circuits of neuro-receptors that affect the process of thinking as well as people’s behavior (Bernier " Gerdts, 2010). The different circuits in the brain often form communication patterns that occur throughout the brain. The problem that is experienced in the circuits of the brain is likely to emanate from the trouble that occurs in certain receptors that are located on the nerve cells that are responsible for providing the nerve cells with the brain circuits. In some instances, people with schizophrenia have also been reported to have an abnormal brain structure (Ashworth " Chung, 2007). This, however, does not occur in the brains of all people as some people without the schizophrenia syndrome also have an abnormal brain structure.
Environmental factors also play a crucial role as causal factors for schizophrenia. An exposure to a highly stressful environment or toxins may trigger schizophrenia. A combination of one or more trigger factors could further cause schizophrenia among people who have a high affinity for developing the disorder. Teenagers and adults are more susceptible to get schizophrenia as their bodies undergo hormonal changes that could come in contact with some trigger factors and result in schizophrenia.
Diagnosis of Schizophrenia
Schizophrenia does not have a specific way of diagnosis. The doctor can, however, either have a physical check or even go through the patient’s medical history. There are no specific tests that the doctor needs to undertake on a patient with schizophrenia (Bernier " Gerdts, 2010). The doctor can use brain imaging studies so as to rule out the possibility of any other illnesses. The doctor could equally run a blood test that will help identify if the patient has schizophrenia. In the case where doctors cannot identify any physical symptoms, it is advisable that they send the patient to a psychiatrist or psychologist. Psychiatrists and the psychologists often use special equipment and techniques such as interviews which will then help them decide whether the patient has schizophrenia or not (Bleuler, 1991). The psychologist or psychiatrist might then make a decision basing on the family history of the patient and the general observation of the patient’s behavior.
Treatment
The treatment of schizophrenia does not necessarily aim at eradicating all the symptoms of the condition but to reduce most of the adverse effects. Medication is one of the common methods of treating schizophrenia. Antipsychotics are some of the medicines that are used to reduce the effects of schizophrenia (Dyck " Project Muse, 2008). Although the antipsychotic drugs are effective, they do not cure schizophrenia but rather reduce its adverse effects. Some common drugs include fluphenazine, chlorpromazine, and loxapine among others. The second generation of drugs for treating schizophrenia includes risperidone, lurasidone, iloperidone, and quetiapine among others. There are some newer atypical antipsychotic drugs which include cariprazine, brexpriprazole (Dyck " Project Muse, 2008). The medication of schizophrenia is not a smooth process as it is still a trial and error process. Psychiatrists and psychologists still find it a challenge to administer the right dosage in each patient.
Another strategy that could be used to reduce the effects of schizophrenia is the coordinated specialty Care (CSC) (Hopper, Harrison, Janca, " Sartorius, 2007). The coordinated specialty care often strives to treat schizophrenia when the first symptoms occur or are visible (Bleuler, 1991). This type of treatment is an intervention strategy that is used to curb the effects of schizophrenia so as to stop it from becoming severe. The CSC is often applied to social services, education interventions, and employment. In most instances, the family is encouraged to take part in the treatment process as it has a psychological healing effect towards the patient (Hopper, Harrison, Janca, " Sartorius, 2007). If this type of treatment is properly executed, it could help the patient lead a better life and recover gradually from the adverse effects of schizophrenia.
Psychosocial therapy just like other forms of treatment often helps the patient adjust and recover from the adverse effects of schizophrenia. Psychosocial therapies could help the patient deal with occupational problems, psychological problems, and social issues among others (Lieberman, Stroup, " Perkins, 2006). The psychosocial therapies are effective as they help patients manage their conditions as well as prevent them from relapsing into severe schizophrenic attacks. Some examples of psychosocial therapies include rehabilitation which helps the victims to deal with their social aspects. Individual psychotherapy is also another issue which helps schizophrenic people understand themselves better (Lieberman, Stroup, " Perkins, 2006). The cognitive remediation often helps schizophrenic people to improve their cognitive abilities. The family and group therapies are also effective as they help the patients deal with their schizophrenic conditions with the aid of their families.
Maatz, Hoff and Angst (2015) state that people with schizophrenia often receive the outpatient type of treatment. However, in some cases, those with severe effect might be treated on the inpatient provision so as to offer them a closer care and prevent them from hurting themselves and others. In some instances, the Electroconvulsive Therapy (ECT) is applied to the patients with schizophrenia. The procedure is painful but it is often done through administering a certain dose of anesthesia before electrodes are attached to the scalp of the patient while sleeping. The dosage for the application of the electroconvulsive therapy lasts is between 2-3 times a week which might last for several weeks until the patient feels much better (Maatz, Hoff, " Angst 2015). The ECT method of treatment is much more effective when treating schizophrenia as opposed to other psychotic conditions such as bipolar disorder and acute depression. The electroconvulsive therapy is applied through repeatedly controlling the seizures released to the brain. This system of treatment is effective as it helps control the moods of schizophrenic people.
Case Study 2
In his case study on the difference between schizophrenia and dementia, Bleuler (1991) found that the psychic functions in the brain of the patient draw the difference between schizophrenia and dementia. He further asserts that both dementia and schizophrenia have a distinct structure of psychic functions. According to Bleuler (1991), dementia is not a usual feature of the dementia precox. He instead prescribes the term “schizophrenia” to carter for the aspect of the multiple disorder. As part of the schizophrenic symptoms that are currently in use, Bleuler ascribed the four most common schizophrenic features among his patients. The four features include abnormal affect, ambivalence, autistic behavior and abnormal associations. Hence, depending on the patient’s environment and adaptive capacity these features have the tendency to turn to secondary characteristics such as hallucination, social withdrawal and delusion among others (Bleuler, 1991).
Caring For People with Schizophrenia
It is important to care for people with schizophrenia so as to encourage the patients to take better care of themselves and recover faster (Maatz, Hoff, " Angst, 2015). Another strategy for caring for people with schizophrenia is to encourage them to develop self-help strategies. Schizophrenic people often thrive in areas where they have a predictable environment which encourages them to deal with their situation (Maatz, Hoff, " Angst, 2015). It is equally important for the caregivers to prepare for a crisis in advance so as to stop the patients with schizophrenia from relapsing.
Conclusion
Eugene Bleuler’s contribution to psychology has made it possible to define, identify the symptoms, epidemiology, and causes of schizophrenia through a theoretical approach. Schizophrenia often varies from one person to another as while some people experience multiple attacks, some experience only a single psychotic episode that might last for long or for a short while. The symptoms of schizophrenia can be positive, negative and cognitive.
There are several causal factors to schizophrenia and they include genetics, the structure of the brain and viral infections among others. Schizophrenia does not have a specific way of diagnosis. The doctor can, however, be required to either have a physical check or even go through the patient’s medical history. The treatment strategies for schizophrenia include medication, coordinated specialty care, and psychosocial therapy among others. Caring strategies include developing self-help and preparing for a crisis in advance.
References
Ashworth, P., " Chung, M. C. (2007). Phenomenology and psychological science: Historical and philosophical perspectives. Dordrecht: Springer.
Bernier, R., " Gerdts, J. (2010). Autism spectrum disorders: A reference handbook. Santa Barbara, Calif: ABC-CLIO.
Bleuler, E. (1991). Dementia praecox: Or the group of schizophrenias. American Institute for Psychological Research.
Dyck, E., " Project Muse. (2008). Psychedelic psychiatry: LSD from clinic to campus. Baltimore, Md: Johns Hopkins University Press.
Grant, P. (2011). Schizophrenia - Cognitive theory, research, and therapy. Guilford Publications.
Hopper, K. P., Harrison, G. M. D., Janca, A. M. D., " Sartorius, N. M. D. (2007). Recovery from schizophrenia: A report from the WHO collaborative project, the international study of schizophrenia. Oxford University Press.
Keefe, R.S.E. " McEvo, J.P. (2001). Negative symptom and cognitive deficit treatment response in schizophrenia. Washington, DC: American Psychiatric Press.
Lieberman, J.A, Stroup, T.S., " Perkins, D.O. (2006). The American psychiatric publishing textbook of schizophrenia. Washington, DC: American Psychiatric Pub.
Mason, S. E., " Overdrive Inc. (2011). Diagnosis schizophrenia. Columbia University Press.
Maatz, A., Hoff, P., " Angst, J. (2015). Eugen Bleuler’s schizophrenia - A modern perspective. Dialogues in Clinical Neuroscience, 17(1), 43–49.
