Schizophrenia: Emil Kraepelin, Adolph Meyer, and beyond

Prior to 1800, insane persons often lived on the streets or were incarcerated in asylums, jails, or prisons. The 19th century witnessed progression in the understanding of psychosis, and the hospital management of psychotic patients began. While Kraepelin in Europe described the symptoms of what would later be called schizophrenia, Meyer developed humanistic treatment for the illness in the United States. The early 20th century treatments for schizophrenia included insulin coma, metrazol shock, electro-convulsive therapy, and frontal leukotomy. Neuroleptic medications were first used in the early 1950s. Deinstitutionalization, beginning in the 1960s, resulted in medicated, stable schizophrenics being released from state hospitals. However, lack of stable living arrangements, misuse of funds, poor medical follow-up, and drug use resulted in deterioration of a large segment of this outpatient schizophrenic population. The 1990s have seen the development of newer, more effective antipsychotic agents and managed care. Both have impacted the state of health of schizophrenics in our society.