1 - Childhood psychosis and schizophrenia: a historical review

Summary

Introduction

For over 100 years, the onset of schizophrenia during adolescence has been accepted, but its onset in childhood, the question of its equivalence with the adult disorder, and the possibility of childhood antecedents of the adult form have been controversial clinical and research issues. Until 20 to 30 years ago, child psychiatrists were reluctant to acknowledge or diagnose psychoses in children and adolescents, and various euphemistic terms tended to be used. Even at present, there may be a disinclination to do so because of fears about the potentially adverse consequences of diagnostic labeling. Many factors have contributed to this, principally infrequency of presentation and uncertainty about diagnosis and classification, since formerly, the term schizophrenia has been used to refer to a remarkable range of severe, chronic disorders arising in children, with little or no differentiation. Furthermore, there has been a lack of research-based therapeutic guidelines. Recent years, however, have witnessed a rebirth of interest in schizophrenia in children, especially in identifying continuities and discontinuities with the condition presenting in adolescents and adults. In this context, the general aim of this chapter is to review the literature relating to schizophrenia in children and adolescents up to the 1970s, setting in historical perspective some of the issues presented and discussed in subsequent chapters, particularly in relation to diagnosis and classification.

Historiography of schizophrenia

Historical consideration of the concept of schizophrenia in children has to be located in the wider context of historical research on the functional psychoses as a whole, particularly schizophrenia (Howells, 1991; Berrios & Porter, 1995, pp. 261–430).