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GAZETTE
SEPTEMBER 1990
S c h i z o p h r e n ia a n d t h e L aw
Part I
Schizophrenia is the term applied to a group of disorders with a
number of basic symptoms in common. One should probably speak
of "the schizophrenias" or "the group of schizophrenias" rather
than "schizophrenia" in the singular. However, that is rather cum-
bersome and I will use the term schizophrenia in this paper.
The disorder séems to occur in all ancient Indian, Greek and Roman
cultures with a strikingly consistent writings which are strongly sug-
incidence of 0.8 to 1% of the pop-
ulation. It occurs with equal fre-
quency in both sexes but there is
a slight tendency for it to first
manifest itself in females at a
slightly later age. It is predom-
inantly a disease of young people,
the onset in 70% or more occurring
between the ages of 15 and 25
years.
The contention that it occurs in all
cultures has been borne out by a
study conducted under the auspices
of WHO and reported on in 1974.
Psychiatrists from such diverse
countries as the United Kingdom,
the U.S.A., the U.S.S.R., India, China,
Nigeria, Czechoslovakia and
Colombia were trained in a standard-
ised system of clinical examination
known as the Present State
Examination. This ensured that the
trained psychiatrists achieved a very
considerable degree of agreement as
to what symptoms were present
irrespective of the culture or lan-
guage which they shared with the
patient. Their findings could be
incorporated in a computer pro-
gramme. It was found that in each
of the countries surveyed syndromes
of acute and chronic schizophrenia
were clearly described.
The concept of Schizophrenia
The concept of schizophrenia is a
relatively recent one and it has
been suggested that it may be a
disorder of recent origin linked to
the spread of modern civilization
with a suggestion that it might be,
say, of viral origin. However, in a
recent paper from the National
Institute of Mental Health in
Washington, a group of psy-
chiatrists quoted descriptions from
gestive of cases of schizophrenia.
There is a good deal of evidence to
By
S. Desmond McGrath*
FRCPI., FRC.Psych.,
DPM,
suggest that Henry VI, King of
England in the 15th century, suf-
fered from schizophrenia.
Recognition of what we nowcall
schizophrenia came at the end of
the 19th century. Until that timeall
psychosis or madness had been
regarded as a common disorder
with varying manifestations. A
German psychiatrist named
Kraepelin distinguished two major
groups of disorders, one character-
ised by marked variations in mood
from depression on the one hand to
excitement or elation on the other,
carrying a good prognosis, at least
for the individual attacks (manic
depressive psychosis), and another
with anearlier onset and oftenwith
a tendency to progressive deter-
ioration. He gave the name
dementia praecox to this group in
his text book of psychiatry pub-
lished in 1893. Kraepelin consider-
ed the following symptoms
characteristic of dementia praecox:
hallucinations, a decrease in at-
tention towards the outside world,
lack of curiosity, disorder of
thought, lack of insight and
judgement, delusions, emotional
blunting, negativism and streo-
types. He stressed the importance
of these symptoms being present
in a setting of clear consciousness
and unimpaired perception with
normal memory. He recognised
three major sub types of the dis-
order: hebephrenic, in which the
most prominent symptom was
thought disorder; catatonic, which
was characterised by physical
symptoms, such as stupor and
muscular rigidity; and paranoid, in
which the predominant symptom
was systematised delusions, either
of persecution, grandiosity or of a
fantastical religious nature.
Despite the title that he gave it,
Kraepelin recognised that the con-
dition did not always have a bad
"Recognition of what we now
call schizophrenia came at the
end of the 19th century."
prognosis and that true dementia,
that is deterioration of intellectual
functioning, did not occur. The
patient's withdrawal into a private
world of delusions and loss of
initiative and drive gave the
impression of dementia.
The Swiss psychiatrist, Eugene
Bleuler, introduced the term "the
schizophrenias" commenting "the
disconnection of splitting of the
S. Desmond McGrath.
273