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Schizophrenia throughout the history - The prehistoric times
The word schizophrenia is less than 100
years old, but the illness has probably accompanied mankind through its history.
Schizophrenia can be traced in written documents to the old Pharaonic Egypt, as
far back as the
second
millennium before Christ. Depression, dementia, as well as thought disturbances
found in schizophrenia are described in detail in the Book of Hearts. This book
is part of the Eber papyrus, named after the German Egyptologist Georg Ebers,
who bought and published the papyrus in the 19th century. Heart and mind seem to
have been synonymous in ancient Egypt. The psychical illnesses were regarded as
symptoms of the heart and the uterus and originating from the blood vessels or
from purulence, fecal matter, a poison or demons. In most cases the Egyptians
apparently looked upon the mental diseases as physical illnesses.
Temple sleep therapy
The treatment comprised temple sleep, also called incubation. The ill persons spent the night in a holy place. Before falling asleep they were influenced by suggestions, in the hope of provoking dreams sent by the gods. The dreams were interpreted by priests and priestesses, who used them to get knowledge about the illnesses and curing of these. Incantations and prayers were uttered to bring forth the healing powers of the gods. The incantations included remedies of medical herbs and substances that were part of the therapy.
The
tradition of temple sleep goes back to Imhotep, an Egyptian vizier, architect
and highly esteemed physician who lived around 2600 BC. Imhotep built the step
pyramid, which is the first pyramid. He was worshipped, and sleep therapy was
practiced in the temples built to his honor. In Greece the god of healing,
Asclepios, took over the role of Imhotep. Sleep therapy survived in the temples
of Asclepios, which were constructed by the Greeks in the 5th and 4th centuries
BC.
Brain science of ancient times
The word brain is used already in the Smith papyrus, a papyrus written about 1700 BC but based upon texts from around 3000 BC. As far as our knowledge the Smith papyrus is the first medical document in the history of mankind. It is named after Edwin Smith, an American Egyptologist who bought the papyrus in the 19th century. In the Smith papyrus the brain anatomy, the meninges of the brain, the bone marrow and the cerebrospinal fluid of the brain and the bone marrow, are described for the first time. The papyrus comprehends 48 cases written down by an Egyptian surgeon many thousands of years ago. The patients were probably injured by falls or during battle. One of the descriptions indicates that the surgeon may have known that brain controls movement. Another case tells us of a patient unable to speak because of a fracture of the temporal bone. Here aphasia is described thousands of years before Paul Broca discovered the connection between aphasia and brain injury in 1861. The Smith papyrus is written in a rational and scientific spirit, and the diagnoses and treatments are for the most part free of magic and superstition.
Already
at an early stage the Greek natural philosophers took an interest in the human
brain and nervous system. The physicist Alcmaion who lived in the beginning of
the 5th century BC meant that the brain was the center of thoughts and
perceptions. During the two following centuries the physicians Herophilus and
Erasistratus carried out dissections on humans. They made several observations
of the function and structure of the brain nerves. Herophilus thought that the
brain was the seat of the intellect, and together with Erasistratus he founded
neuroscience.
Long period of stagnation
Herophilus and Erasistratus were the only known Greeks who dissected humans in antiquity. Nearly 1800 years passed before Leonardo da Vinci and Andreas Vesalius resumed the study of the human anatomy. Several factors may have contributed to the prolonged stagnation in this area. Wars, unfavorable economic circumstances, and a negative attitude towards the intelligentia in Alexandria during the period after Herophilus and Erastistratus have probably played a role. Moreover, the works of the two physicians may have been destroyed in the fire that devastated the library of Alexandria 391 AD.
The divine madness
The
ancient Greeks took a great interest in the human psyche and especially in
madness. Plato who lived in the 5th and 4th centuries BC speaks about two kinds
of madness, one with a divine origin and another with a physical origin. The
divine madness may create prophets, relieve the generation of impurity, inspire
poets, or provoke an intense desire for beauty, according to Plato. The idea of
the divine madness was firmly rooted in the Greek culture even before Plato. It
also appears in the Greek tragedies, for instance in Heracles by Euripidos, from
the 5th century BC. But in that tragedy madness ends in catastrophe.
The platonic ideas of a connection between madness and prophecy recur in the ancient Israel. The highly esteemed religious prophets were often regarded as mad because of their odd utterances and deviant clothes and behavior. The same conceptions later appear in the Koran in the Islamic countries. The Koran uses the word majnoon to describe mad persons as well as prophets.
Even in Greece the relation between madness and genius survived. The written collection Problemata is usually attributed to Aristoteles who lived in the 4th century BC. One of the written documents begins with the question:
"How come that all men distinguished in philosophy, statesmanship, poetry or art are melancholics and some of them to such an extent that they are affected by the illnesses originating from the black bile (melaines choles), of which the story of Heracles tells us?"
The author himself answers that the black bile may influence mood and behavior by among other things cold and heat. In favorable circumstances this may lead to great achievements, while otherwise the result may be madness. But contrary to Plato the author does not believe in any madness of a divine origin.
Hippocrates and humoral pathology
The
influence from Hippocrates is obvious in the citation from Problemata.
Hippocrates, the "father of medicine", was partly a contemporary with Plato. He
has given rise to the Hippocratic Collection, which consists of written
documents from the 5th century or somewhat later. Probably only a part of them
are written by Hippocrates. In one of the documents, "The Holy Disease", the
author objects to the opinion that illnesses like epilepsy, madness and
confusion are caused by the gods. Instead he argues that
"... only from the brain spring our pleasures, our feelings of happiness, laughter and jokes, our pain, our sorrows and tears. ... This same organ makes us mad or confused, inspire us with fear and anxiety..."
Then the author describes the famous humoral pathology, a model to explain the origin of the diseases as a disturbance of the balance of the humours, that is the body fluids. This model groups the humours into blood, phledge, yellow bile and black bile. According to the humoral pathology an imbalance of the body fluids may influence the brain and provoke madness. The disturbance is caused by a complex co-operation between the outer environment and interior physical factors, including inheritance. The humours are coupled to the four elements of air, water, fire and earth. The blood is warm and wet like the air, the phledge is wet and cold like water, the yellow bile is hot and dry like fire, and the black bile is dry and cold like earth. Moreover, the ages of man and the changes of the seasons play a role. (See figure) Diseases are cured through correcting the imbalance with the help of diet or lifestyle. For instance, if an illness is caused by too little blood the body shall be provided with wet and heat. Later the four humours were also related with temperament. Blood is connected with sanguine, phledge with phlegmatic, yellow bile with choleric and black bile with melancholic temperament. Different methods of emptying the body of ist fluids were also added, such as blood-letting, purgatives, vomiting and purulence.
Reason and magic
Hippocrates wanted to build his theories on a
rationalistic and empirical basis. In that he continued the tradition of the
ionic Greek philosophers who wanted to explain nature in a rational way.
Hippocratic medicine draws a sharp line between knowledge and belief. It clearly
criticizes the methods of magicians
and
quacks even in the treatment of mental diseases, which are considered to be
biologically rooted. However, no official view existed on the origin of diseases
in antiquity, and there were often other opinions among the laymen than among
the academics. The belief that mentally ill persons were possessed by devils was
widely spread. Humoral pathology competed with astrology, magic and occultism,
which played an important role in the popular tradition. Apart from the
academically educated physicians there were a lot of other persons, for instance
priests, who tried to cure the ill with an arsenal of different therapies, such
as medical herbs, gymnastics, magic and exorcism. In the holy temples academic
treatments were mixed with religious rites.
Handbook with diagnoses
The ancient view on the origin, symptoms, and treatment of diseases is summarized in a medical handbook written by the physician Aretaios in the 2nd century AD. This handbook contains a systematic classification of the psychical illnesses. The most important diagnoses are phrenitis, hysterical suffocation, melancholy and mania. Phrenitis corresponds to an acute and temporary state of febrile confusion. Hysterical suffocation implies anxiety diseases, while melancholy comprises depressions and schizophrenic states of withdrawal and chronic deterioration. Mania corresponds to modern mania in manic depressive illness, as well as schizophrenic states of excitement and agitation. The instructions for treatment followed the rules of humoral pathology.
The humoral pathology was taken over by the Greek physician Galenos in the 2nd century AD. Galenos exerted a great influence over Arabic as well as European medicine, and he was an important authority until the beginning of the 19th century. The theory of the four body fluids survived just as long.
References
Encyclopaedia
Britannica
Nationalencyklopedin
Neuroscience for kids - Ancient Brain
Fabrega H:
Psychiatric Stigma in the Classical and Medieval Period: A Review of the
Literature. Comp Psychiatry 1990, 31, 4, 289-306
Kotsopoulos
S: Aretaeus the Cappadocian on Mental Illness. Comp Psychiatry 1986, 27, 2,
171-9
Okasha A:
Mental Health in the Middle East: An Egyptian Perspective. Clin Psychol Rev
1999, 19, 8, 917-33
Sjstrand L:
Herakles' vansinne. Lþkartidningen 1997, 94, 1-2, 33-6
Sjstrand L:
Platon - den frste psykiatern. Lþkartidningen 1995, 92, 25, 2587-90
Wills A:
Herophilus, Erasistratus, and the birth of neuroscience. The Lancet 1999, 354,
1719-20
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