History of schizophrenia

It might seem unnecessary to need to prove that schizophrenia is an old disease because “every town had a fool.” However, the only case of schizophrenia that possibly meets the diagnostic criteria for the disease (see box) much before 1800 is that of Edgar or Poor Tom in Shakespeare's King Lear.3-5 This has led to the tentative suggestion that some factor—a virus, environmental toxin, or perhaps “modernity itself”—in play since 1800 has greatly increased the incidence of schizophrenia.3 As the signs of schizophrenia can be noticed without any laboratory test or even specialised training, the extreme dearth of old cases of schizophrenia cannot trivially be due to lack of advanced diagnostic equipment or medical education in days of yore. The “mad” ravings of a local town “fool” could have been secondary to mania, temporal lobe epilepsy,6 substance misuse or withdrawal, vitamin deficiencies, or heavy metal poisoning.