But they TOLD me I was Bipolar: It seems the twain CAN meet, Part I

Posted on September 23, 2013 by

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Although there’s no reason to doubt that schizophrenia is as old as mankind, the name didn’t come into existence until 1910, when the Swiss psychiatrist Paul Eugen Bleuler termed the illness such, with the Greek words schizo (split) and phren (mind) referring to the dissociation that is common in the illness.

Bleuler was merely adding the ‘finishing touches,’ so to speak, on the ‘definitive’ work done by the German psychiatrist Dr. Emil Kraeplin.  Kraeplin didn’t just add much to our understanding of schizophrenia; he developed a system for mental illnesses that impacted later classifications, and thus, indirectly, affects how we view diseases of the mind to this very day.

Most importantly for this post, Kraeplin was the first to identify schizophrenia as a distinct illness, in 1895,  making definitive distinctions between schizophrenia and what was then termed manic-depressive psychosis that held until . . .well, I was about to use the trite “this very day,” except that I think we may very well have a problem.

In the 19th century, before Kraepelin began his work, psychosis was just considered to be one single condition.  You lost contact with reality, talked to people who weren’t there, believed the maid had a contract on your life, were so excited about a guest–who wasn’t coming (and didn’t even exist)–that you stayed up nights on end? Good–you were psychotic.

Kraepelin, who earned the name “the father of biological psychiatry,” was the first doctor to notice that, if such psychotic patients were followed closely over long periods of time, they actually exhibited one of two courses, despite the external similarities.

This first description isn’t pretty, and it may have negatively influenced thinking  about schizophrenics to this day.  Kraepelin found that this group developed psychosis early in life, had serious cognitive deficits (a “general decay of mental efficiency”), difficulty with executive dysfunction (“loss of mastery over volitional action”), and, fundamentally, had little chance of remission.  Due to the mental decline that went hand-in-hand with this disease, he termed it dementia praecox, meaning, literally a “premature dementia” or a “precocious madness.” In short, it was bad news.

On the other hand, however, there were people who tended to develop their psychotic symptoms later in life, had intermittent periods of acute illness punctuated by symptom-free intervals, and, instead of demonstrating an ongoing decline, as in the former, these people circulated in and out of madness.  Because patients were either elated or severely depressed when they ‘stepped out’ of reality, he named this illness manic-depression.

Let me guess–which one would you pick, if you had the choice?

 

It’s a dire sentence for schizophrenics–and one you might think researchers would have adapted over time. Aside from a ‘thank you’ to Dr. Bleuler for changing the name (very few people indeed feel good about being called demented), very little has changed in the view of schizophrenia for decades.

In fact, the view of manic-depression–which came to be called bipolar disorder (BD)–lightened further, while hopes for schizophrenia remained devastatingly low– with the FDA’s approval of lithium for BD in 1970. It turned out that lithium was somewhat of a “miracle drug” for those with BD–and a real dud for those with schizophrenia. This truth from the world of pharmacology years later served to further prove Kraepelin’s theories.  (Lithium went on to be “the little psychotropic that could,” used to help prevent suicide, avoid cluster headaches, potentially manage epilepsy, and, experimentally, to treat Graves’ disease.)

All of the diagnostic manuals have kept the two illnesses separate.  For example, in the recent publication of the latest Diagnostic and Statistical Manual of Mental Disorders (the DSM-5), schizophrenia is in a section entitled “Schizophrenia Spectrum and Other Psychotic Disorders,” where it gets to be the lucky host of such illnesses as Delusion Disorder, Catatonia, and Substance/Medicine-Induced Psychotic Disorder.

Well beyond such sturm and drang, the next chapter is “Bipolar and Related Disorders,” which really has nothing to write home about.

So there you have it: Two separate illnesses, if you’ve got to get stuck with one, pick the disease behind door number 2, because your alternative is a life sentence.

And that’s the way it was–until we started to get a peek at people’s brains and found. . .that just may not be the way it is at all.

Think schizophrenia and BD are fundamentally different?  You may very well be fundamentally wrong.