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Schizophrenia throughout
the history - The prehistoric times
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by Lena
U Carlsson
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. Lūkartidningen 1997, 94, 1-2, 33-6
Sjstrand L: Platon - den frste psykiatern. Lūkartidningen 1995,
92, 25, 2587-90
Wills A: Herophilus, Erasistratus, and the birth of neuroscience.
The Lancet 1999, 354, 1719-20
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