For many years the word “schizophrenia” has provoked enormous discomfort. Invested with meaning at once surreal and feared, it is still used as an instrument of ridicule in ordinary conversation, in the media, and even among professionals themselves. The word itself is ominous and evokes visions of madness and asylums. It is a discordant and cruel term, just like the disease signifies. “Schizophrenia continues to be an illness about which the public at large remains unaware even though, along with other psychiatric disorders, it has become more susceptible to modern scientific investigation yielding information that has clarified the origin, progress, and outcome of the disorder” (Orey). Brilliant advances in brain and behavioral research over the last couple of decades have armed scientists and clinicians to such a degree that both diagnosis and therapeutics now rest on more solid ground than ever before.
“Schizophrenia is a complex disorder characterized by a constellation of distinctive and predictable symptoms that are most commonly associated with the disease. It is one of the most disabling and emotionally devastating illnesses known to man” (Orey). It is a relatively common disease with an estimated one percent to one and a half percent of the United States population being diagnosed with it over the course of their lives (Torrey 6). Schizophrenia usually begins with the individual having a “psychotic episode”, which is a serious onset of symptoms. The symptoms are divided into two main categories, positive and negative. Positive because these are new experiences and negative because these are everyday parts of life, at a reduced level. These may occur together, separately or alternately. The positive symptoms are hallucinations, delusions, disorganized speech.
Most commonly a person with schizophrenia will “hear” his own thoughts, for example, as if they have been spoken aloud within his head. The thoughts can appear to be so loud that the person may believe that people nearby will also be able to hear them. The mind usually adjusts to this very rapidly and as a result the thoughts then appear to come from some external source. These spoken thoughts are then called voices or, more technically, hallucinations. There can also be other kinds of hallucinations such as visual, smell or taste. A person who experiences hallucination will naturally attempt to find an explanation for what is happening. Which kind of explanation they decide on depends very much on the person involved and the culture in which he lives. These are attempts to make sense of experiences that most people do not have. To the outside world, these explanations are regarded as delusions.
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Delusions can take many forms: persecutory, telepathic, grandiose, religious, sci-fi, or paranormal. Another common symptom of schizophrenia is disorganized speech. This means they leap from one idea to another even though the two ideas are not connected in any logical way. Negative symptoms include profound apathy and loss of interest, marked withdrawal, reduction in spoken communication, lack of drive and interest in work, friends, family, or career, a fall in self-esteem leading to personal neglect, and a loss in enjoyment in activities that were previously a source of pleasure. In extreme cases, people with schizophrenia may become almost totally unresponsive and will not move, speak or respond, a condition known as catatonia. This is most common in people with chronic schizophrenia.
There is no objective way to diagnose schizophrenia, such as there are no chemicals in the blood, the brain, or the spinal fluid. X-rays and examinations of cells do not show it, either. Psychiatrists rely on symptoms, but many diseased may have similar symptoms. The requirements for diagnosis are found in the third edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM III), which is the official diagnostic system of the American Psychiatric Association. At least one of the symptoms from the list of symptoms must be present for six months or more to be a schizophrenic symptom (Torrey 86). If a person does not meet DSM III criteria, he or she does not have schizophrenia. During the last half of the nineteenth century different subtypes of what we now call schizophrenia were described as separate diseases.
Thus paranoid psychosis was characterized in 1868, hebephrenic in 1871, and catatonic in 1874. In 1896 a German psychiatrist, Emil Kraepelin, recognized these three sub-groups from patients in asylums who developed their illness in early adult life, had initially rather varied symptoms, and who shared a tendency for their condition to deteriorate over time. He termed it “dementia of early life”, and in 1919 published a set of clinical characteristics for it that remain largely valid today. Renamed schizophrenia by Eugen Bleuler in 1908, it is more common than people realize (Keefe-Harvey 97). Not all people with schizophrenia have the same symptoms. With this illness, there are often very different groups of symptoms. For that reason, schizophrenia is subdivided into types, based on particular clusters of symptoms that appear together. The disorganized type is based on confusion, disorganized speech, and blunted or inappropriate affect. The catatonic type is where the person is completely unaware of and unable to respond to the outer world.
Paranoid type is an organized system of delusions and auditory hallucinations that often guide a person’s behavior. Residual type is symptoms of schizophrenia are less significant in intensity and number but are still present. The undifferentiated type describes those who do not fall neatly into any other categories (Friedman 17). Sometimes people have symptoms of a mood disorder in addition to symptoms of schizophrenia. A mood disorder is a disorder that affects a person’s emotions. The Diagnostic and Statistic Manual of Mental Illness defines the schizoaffective disorder as “the occurrence of symptoms of major depression or mania concurrent with the symptoms of schizophrenia (Torrey 90). The course of schizophrenia varied tremendously between different people. Two individuals with the same symptoms at the onset of the illness may have completely different outcomes. About twenty-five percent of those with schizophrenia respond very well to treatment and can return to their lives they led before (Friedman 21). Most people with schizophrenia, however, continue to experience symptoms throughout their lifetime.
Scientists have developed dozens of theories to explain what causes this disease, but researchers are focusing on four leading theories. They are the Genetic Theory, the Environmental Theory, the Biochemical Theory, and the Bio-Psycho-Social Theory. The Genetic Theory argues that schizophrenia is caused by traits in a person’s genetic makeup. As we all know, a person has twenty-three pairs of chromosomes. Each pair contains one chromosome from each parent. In corresponding locations, called loci, of each chromosome, the genes for specific traits are located. Some researchers believe that problems with these genes can cause schizophrenia. We inherit our genes from our parents but this does not mean that the parents of a schizophrenic are mentally ill. Problems in a person’s genetic makeup could come from mutated chromosomes or recessive genes. In an attempt to prove this theory scientists study identical twins. Due to the fact that identical twins have the exact same genetic makeup, researchers will be able to determine if heredity is the main cause of schizophrenia. However, the evidence seems to disprove this theory.
This is because on some occasions both identical twins are schizophrenics and other times only one is inflicted. To defend the theory, it should be noted that this research is difficult and complicated. Identical twins are relatively rare, especially twins who are both diagnosed with schizophrenia. Further defending the theory, studies have shown that children with one parent diagnosed with schizophrenia have a ten percent chance of suffering from schizophrenia (Keefe-Harvey 82). When both parents are schizophrenic their risk raises to about forty percent (Keefe-Harvey 82). Very little is known about Environmental Theory. It is built mainly on the effects stress has on human behavior, however, most researchers agree that stress alone cannot be the main cause of schizophrenia. Most researchers agree that stress can trigger or worsen the symptoms when the illness is already present. Other researchers focus on drug abuse. Like stress, certain drugs such as amphetamines can make psychotic symptoms worse if a person already has schizophrenia. Furthermore, these drugs can create schizophrenia-like symptoms in normal persons when the dosage is large.
Other researchers that support the Environmental Theory believe that “slow viruses” may be to blame. Slow viruses are viral infections that go undetected for long periods of time therefore signs and symptoms are delayed and may occur many years after the first infection. The Bio-Chemical Theory suggests that schizophrenia is caused by mixed-up signals to the brain. When something acts upon one of our senses, electrical impulses are sent to the brain. These impulses allow us to feel pain, smell, and they also manage our thought processes. In our body, we have a complex nervous system. For example, there is no single nerve that travels from our feet to our brain. Therefore, in order for information to be sent to the brain, the nerves must interact with each other. Because the system is so complex it is possible for the signal to get mixed up. When this happens our brain may misinterpret the signal or may not receive it at all. If the signal does get mixed up on the way to the brain the make-up of the impulse can undergo a chemical change resulting in abnormal thought processes and abnormal behavior.
They believe that schizophrenics have higher levels of this chemical than a mentally sound person. To experiment, researchers have injected animals and humans with amphetamines, this increases the amount of dopamine reaching the brain. Following the injection, the animals exhibit the same behavior as humans who have been diagnosed with schizophrenia, such as standing still for long periods of time or continuously pacing. In humans, research has shown that when given small doses of amphetamines the amount of dopamine in the brain slightly increases. Although the increase is small it still causes delusions and hallucinations. In conclusion, researchers believe that an increased amount of dopamine to the brain causes abnormal behavior, however, they cannot safely say that this is the sole cause of schizophrenia (Smith). The Bio-Psycho-Social Theory combines all of the previous theories. Some researchers believe that bio-chemical abnormalities are a contributing factor but that other event must also occur.
They suggest that environmental and social problems have to be considered along with biological problems. Social scientists believe that no chemical factors are involved, instead, they believe “mental disorders are described as a consequence of human motivations, drives, and unconscious forces” (Smith). These scientists suggest that people become overloaded with stress, information, and stimulation. When this happens they lose their ability to cope with the anxiety which accompanies these stressors. Instead of dealing with their problems, they seek peace in their own world. Despite all these theories, it is quite evident that the cause of schizophrenia is still a mystery. It also seems clear that this disease is not caused by any one factor. As of now, researchers are leaning toward the Bio-Chemical theory. The brain is the most complex organ in the human body and an imbalance of the brain’s chemical system has been suspected as the main cause of schizophrenia for a long time. As previously mentioned, some researchers point to an excess of or lack of dopamine a chemical substance in the brain. Others suspect different neurotransmitters which are substances that allow communication between nerve cells.
The area of the brain thought to be affected in most cases of schizophrenia is the limbic system. This is the area of the brain that acts as a gate for incoming stimuli or messages. In any case, it appears that all schizophrenics have some sort of abnormal chemicals that are not found in healthy people. At this time, there is no cure for schizophrenia. Anti-psychotic medications are very effective in controlling the symptoms of schizophrenia. These medications first became available in the mid-1950s. They have greatly improved the lives of thousands of people. Before that time, people with schizophrenia spent most of their lives in crowded hospitals. With antipsychotic medication, however, many people with schizophrenia are able to live in the outside world. Because each person with schizophrenia has a unique mix of symptoms, no single medication works best for all people.
The ideal medication for one person may not be the best choice for another. Although antipsychotic medications do not cure the disease, they can reduce hallucinations and delusions and help people with schizophrenia regain their grip on reality. The medication also reduces the risk of the symptoms returning. If the person does have a relapse of symptoms, medications may make the symptoms less severe. People with schizophrenia can have a hard time communicating with other people and carrying out ordinary tasks. Counseling and rehabilitation can help people with schizophrenia build the skills they need to function outside the sheltered setting of a hospital. However, these treatments are not very helpful during acute attacks. Rehabilitation programs may help people with schizophrenia develop skills such as money management, cooking, and personal grooming, for example, needed for ordinary life.
They may also prepare the person to go or return to work. Individual psychotherapy may help a person with schizophrenia learn to sort out the real from the unreal. Group therapy may help them learn to get along with others. Self-help groups may help persons with schizophrenia feel that others share their problems. The best way to prevent relapses is to continue to take the prescribed medication. People with schizophrenia may stop taking their medications for several reasons. Side effects are one of the most important reasons that people with schizophrenia stop taking their medication. It is hard for people to put up with unpleasant side effects for months or years. It is especially hard when the person feels well. It is very important to find the medication that controls symptoms without causing side effects. Convenience is also important. Some medications need to be taken two, three, or even four times a day. Others may be taken just once a day. People are more likely to remember to take medication once a day than several times a day. Some people prefer to get injections every month of long-lasting medication. Taking medications regularly is the best way to prevent repeated illness and hospitalization.
Despite the considerable progress in our understanding and treatment of the disease, there is a long way to go before all the needs of people with schizophrenia can be met. Not all people with schizophrenia respond well to antipsychotic medicines and of those who do, most are still left with some of their symptoms and varying degrees of impairment of their social functions and thought processes. As a result, they tend to be vocationally disadvantaged. The long battle to develop better medicines has been as much a struggle to overcome their formidable side effects as to improve their effectiveness. This has resulted in the discovery of a new generation of antipsychotic medicines. Some of these will find broad use, while others will address particular problems such as drug resistance, improvements in reasoning and related thought processes, relapses, and quality of life issues. the prospects for a cure for schizophrenia, rather than the treatment of its symptoms, look distant. If schizophrenia is eventually traced to defective genes, then gene therapy may be the only route to a permanent cure. However, such approaches are still many years in the future and may never be a realistic option for most people.