Through a critical analysis of the peer-reviewed scholarly literature and reliance on primary and secondary historical sources, the current chapter will critically investigate three key aspects of the schizophrenia syndrome as they relate to outcome: 1. the emergence and metamorphosis of the diagnostic category over time beginning with Kraepelin’s and Bleuler’s seminal definitions at the turn of the twentieth century to DSM-5 formulations; 2. an analysis of large-scale, systematic, group studies of outcome beginning with the Iowa 500 study in the 1970s (Tsuang et al., 1979), through contemporary work, and how these findings have influenced thinking about patterns of recovery and disability in the disorder over recent history; and 3. the emergence and metamorphosis of psychosocial treatments for the disorder beginning in the 1890s through current practices. The chapter will seek to illuminate how changes in the ascendancy of conceptual models of schizophrenia in different historical epochs have influenced diagnostic formulations, treatment approaches, and understanding of outcome in the disorder.