History of behaviours

During the 1980s, and encouraged by the assumption that schizophrenia was a recognizable, real, unitary, and stable 'brain disease', questions were asked about the fact that clear descriptions of the disease seem hard to find before 1800.

Did schizophrenia exist before the eighteenth century?

This question remains 'unresolved'/37' Based on an 'epidemiological' claim, for which there is no historical evidence, supporters of the so-called 'recency hypothesis' suggested that 'some change of a biological kind occurred about 1800 such that a particular type of schizophrenia thereafter became much commoner'. (38> (Gruhle(26> and Cranefield(39> have reviewed 'possible' earlier cases of schizophrenia.) In the wake of this claim, efforts were made to rediagnose earlier 'cases of schizophrenia' as something else/S Interestingly, the 'recency hypothesis' seemed also to be supported by those who believed that the emergence of 'schizophrenia' coincides with the birth of some 'modern episteme' (which Foucault identified with the Kantian revolution). (4!> Foucault defined 'episteme' as the set of discursive practices that make possible the emergence of scientific disciplines. Constituted towards the end of the eighteenth century, 'modern episteme' included a view of man as an 'autonomous being' and is responsible for the development of the so-called human sciences.

However, others believed that schizophrenia 'had existed as long as mankind',(42) and cases were rediagnosed in the relevant direction. For example, Macalpine and Hunter(43) suggested that the seventeenth-century painter Christoph Haitzmann (diagnosed by Freud as a 'demoniacal neurosis' in 1923) (44) was suffering from 'schizophrenia'. Likewise, after re-reporting the case of James Tilly Matthews as 'the earliest clear description of schizophrenia', Carpenter (45) explained that the absence of earlier cases resulted from a 'different selection and description of cases for publication'. Jeste et al.(46> ferreted out, although not as successfully as Gruhle,(26) 'a substantial number of clinical descriptions resembling modern conceptions of schizophrenia'.

A pseudo-problem

Looking back, it seems clear that, in terms of the conceptual parameters accepted by the participants, the debate could not have been resolved. Firstly, there were the issues of what counted as evidence, how many cases would falsify 'the recency hypothesis', (47) or what level of diagnostic clarity was required for a case to qualify as evidence? Secondly, both sides were making unprovable claims; for example, 'schizophrenia has always existed' and 'there was a biological change that brought schizophrenia into life during the nineteenth century'.

The issues here are at the same time simpler and harder than anything that the participants in the debate seem to have envisaged. Some issues concern the clinical focus, i.e. what controls the perception and description of mental symptoms and diseases, others the ontology itself of the RRUS, i.e. what claims are being made about the existence of the entities in question, and yet others the rules of the epistemiological game, i.e. what counts as evidence etc. In the actual debate these issues appeared in various combinations and permutations. In this chapter, there is only space for one example.

Let us say that, because of their biological basis, the units of analysis (mental symptoms) have always existed. The current definition of schizophrenia is, at best, the result of the belief that some of these mental symptoms occur more frequently together. The way in which research is carried out today makes it very difficult to decide how often such mental symptoms affect individuals who are not considered as suffering from 'schizophrenia'. Let us now take both extremes—that no case or that thousands of cases of schizophrenia can be found before the nineteenth century. Would these lead to the conclusion that schizophrenia did not, or did, exist before the nineteenth century? In fact, neither inference follows; absence of reports can be explained away by using arguments taken from 'clinical focus' or 'rules of the epistemological game' issues (as mentioned above). However, multiple reports create a problem: Why was the disease not recognized and named before if it has such a frequent and stereotyped presentation?

Therefore it can be concluded that it is not possible to write a sensible history of 'behaviours redolent of schizophrenia' for the period before the nineteenth century. ty,8 This is because both the current concept of mental symptoms and disease and that of schizophrenia are nineteenth-century constructions. Hence clinical reports before this period will always lack epistemological 'distinctness' (from our perspective). However, such reports make a great deal of sense if assessed in terms of categories such as madness, insanity, lunacy, vesania, melancholia, and mania.

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