Has Schizophrenia Evolved Into Less Serious Illness?

Is the schizophrenia typically seen by clinicians today milder than the disease described by Emil Kraepelin in the 19th century or even that commonly seen by clinicians in the middle of the 20th?

And might natural selection be at work, progressively thinning the population of the most sorely affected patients while allowing a less-severe form of disease to survive into our day?

That's the intriguing idea floated by Thomas McGlashan, M.D., in an editorial in the July Schizophrenia Bulletin.

In an interview with Psychiatric News, McGlashan acknowledged that the notion hardly occurs to clinicians busy treating a disease no one would describe as mild. And credible research comparing the disease as it presented 100 years ago with today's malady is nonexistent.

But McGlashan suggests it may be reasonable for contemporary researchers and clinicians to look up, so to speak, from their work and ponder why it is that “recovery” is advanced as an expectable goal for many patients today, when 60 years ago such a notion would never have been considered.

He noted that the subjective experience of clinicians whose careers have spanned several decades seems to confirm that the severity of schizophrenia has ameliorated over the years.

“The question occasionally comes up with older colleagues about how many catatonic patients they've seen recently,” McGlashan said.“ And the answer is that we haven't seen any, or any of the really deteriorating cases that as a medical student I can recall seeing in the early 1960s. I can remember some of us had a trip to a state hospital then and went to the infamous building where they had the worst cases. They were really vegetative and scary, and even though they were medicated—this was in the early days of antipsychotic medication, and all of them were on Thorazine—they were often mute.”