Psychology › Mental health & disorders › Mental disorders: what they are and how common
Schizophrenia and psychosis
Named 1908 (Bleuler)· Condition or disorder
Well replicatedStrong, repeated evidence.
A serious condition involving psychosis, losing touch with reality through hallucinations and delusions, plus problems with motivation and thinking.
See it on the Psychology map →What it says
Kraepelin called it 'dementia praecox'; Swiss psychiatrist Eugen Bleuler renamed it schizophrenia, 'split mind', in 1908, meaning fractured mental functions, not split personality. Symptoms include hearing voices, fixed false beliefs, disorganized speech, flat emotion and withdrawal, usually starting between the late teens and early thirties. About 1 in 300 people worldwide are affected. Antipsychotics, starting with chlorpromazine in 1952, ease hallucinations and delusions; early coordinated care, family support and work programs improve outcomes.
Why it matters
It is among the most disabling conditions and shortens life by about 15 years on average, yet many people recover substantially. People with schizophrenia are more often victims than perpetrators of violence.
The evidence
WHO estimates, twin studies putting heritability near 80 percent, a 2014 genome study finding 108 risk regions, and decades of drug trials.
Open questions
The causes are still unclear: the dopamine theory explains only part, and how genes, heavy teenage cannabis use and early-life adversity interact is debated.
Connections (3)
▸Rosenhan's 'On Being Sane in Insane Places' claimed sane people were labeled with Schizophrenia and psychosisWeak or failed to replicate
The connection
Rosenhan said that in all but one of 12 admissions his pseudopatients, who reported a single hallucination and then acted normally, were diagnosed with schizophrenia and discharged 'in remission', arguing the label stuck no matter how they behaved.
Who showed it and when
Twelve US psychiatric hospitals, from Rosenhan's own 1969 stay into the early 1970s; reported in Science in 1973.
How solid is it?
Doubts are serious: Cahalan found Rosenhan's own records described more symptoms than he reported, and she could trace only one of his seven reported companions, plus one whose positive stay he left out.
Open questions
Spitzer noted 'in remission' was a rare discharge label, suggesting staff saw little illness; critics say a reported voice reasonably suggests psychosis.
▸Schizophrenia and psychosis are among the most disabling Mental disorders: what they are and how commonWell replicated
The connection
Though it affects only about 1 in 300 people, schizophrenia ranks high among causes of disability because it usually starts in young adulthood, often persists, and affects work, relationships and independence. People with it die about 15 years earlier on average, mostly from heart disease and other physical illnesses.
Who showed it and when
Global Burden of Disease studies and large Nordic registry studies of life expectancy, such as Thomas Munk Laursen's in Denmark.
The evidence
Disability weights in the Global Burden of Disease put acute schizophrenia at the top of all health states; registry data on early death are robust.
Open questions
Outcomes vary widely between people and possibly between countries; WHO studies suggesting better outcomes in poorer countries are debated.
▸Antipsychotic medications reduce psychosis in Schizophrenia and psychosisWell replicated
The connection
Antipsychotics are the main medical treatment for schizophrenia. They reduce 'positive' symptoms such as hallucinations and delusions within days to weeks, and staying on them lowers relapse risk. They help much less with 'negative' symptoms, such as low motivation and flat emotion, or with problems in memory and concentration.
Who showed it and when
First seen in 1952 at Sainte-Anne Hospital in Paris, where Jean Delay and Pierre Deniker gave chlorpromazine to patients with psychosis.
The evidence
Stefan Leucht's 2012 meta-analysis of maintenance trials: about 27 percent relapsed within a year on medication versus about 64 percent on placebo.
Open questions
Roughly a third of patients respond poorly; whether everyone needs long-term medication, or some can taper safely after recovery, is actively studied.