Schizophrenia

What isn’t Schizophrenia?

This may seem like an odd place to start but before you start to learn a little more about Schizophrenia it’s important to get any wrong impressions out of the way. For some reason there are a few popular misconceptions about Schizophrenia.

Schizophrenia isn’t having multiple personalities nor is it having a ‘split personality’. These are separate mental disorders which are often used wrongly to describe Schizophrenia.

This misconception may have occurred due to the origins of the term Schizophrenia. The term originates from two Greek words, ‘Schizo’ meaning ‘split’ and ‘phren’ meaning ‘mind’. Literally translated then Schizophrenia is ‘split mind’, which would probably account for the confusion.

So what is Schizophrenia?

Schizophrenia is an extremely serious mental disorder, it is rated as the most serious mental disorder in both the DSM and the ICD (lists which are used to diagnose mental disorders).

Since Schizophrenia is such a varied disorder, affecting no two people in the same way, it is extremely difficult to describe. Simplistically it is a disorder which impairs its sufferers, leaving them unable to cope with day to day life and with an extremely distorted grasp of reality. Anything that can go wrong with a person’s mental life can go wrong with Schizophrenia.

When learning about mental disorders it’s sometimes easy to relate to the symptoms of each disorder, and diagnose yourself as a sufferer. However with schizophrenia even the ability to do this would imply that you don’t have the disorder. Schizophrenics have a complete loss of reality, and have a tendency of assuming that there is absolutely nothing wrong with them but that there’s something wrong with everybody else.

Who is vulnerable to Schizophrenia?

The disorder is higher for University students and the urban poor. In men, it usually first occurs before they are 25. In women it usually occurs between the ages of 25-45. Schizophrenia affects roughly 1% of the population – that’s 1 in 100 people.

What are the Symptoms?

Since schizophrenia is so varied, there are many different symptoms for the disorder. Typically though, Schizophrenia involves problems with attention, thinking, relationships, motivation and emotion.

Symptoms can be divided into two categories – those which can be observed, and those which can’t be observed. Symptoms sound horrific enough to read, but living with such symptoms can be crippling.

Symptoms which cannot be observed:

- Thought Disturbances

Schizophrenics often suffer with disturbances to their thoughts. These can vary from thought insertion – the belief that thoughts are being inserted into the mind from outside the person, thought withdrawal – the belief that thoughts are being removed from their mind through external forces and perhaps most disturbingly thought broadcasting – the belief that their thoughts are being ‘broadcast’ or made known to others.

External forces may be described as ‘Martians’, ‘The Government’ and so on and they often believe their thoughts are being broadcast through radio transmitters or a ‘special ray’. This leads to the belief that their thoughts aren’t their own, and often leads to paranoia.

Sufferers may believe that they have wires attached to their heads and may blame radio or television for this control and avoid it.

- Hallucinations

Hallucinations are perceptions of stimuli that are not actually present. This can occur in any of the senses but the most common is auditory. Voices are often heard coming from outside the individual’s head, sometimes offering a ‘running commentary’ of their behaviour. Often the voices insult the sufferer’s personality and can give commands in a demanding way.

Depersonalisation can occur when sufferers describe feeling as if they have been separated from their body. Sometimes they may not even recognise themselves in the mirror.

- Primary Delusions

Delusions are false beliefs that persist despite evidence showing that the belief is wrong. Many schizophrenics hold beliefs that the rest of society would disagree with. There are a variety of different delusions which schizophrenics may suffer with.

Some may suffer from delusions of grandeur – the belief that they are somebody who was or is important - often historically or religiously important people for example Jesus or Napoleon. Others may suffer from a delusion of persecution – the belief that others are planning to kill them or are plotting against them. They may believe they are being watched, followed or talked about.

A delusion of reference is the belief that objects, events etc have a personal significant to them – they may believe that a song is referring specifically to them.

A delusion of Nihilism is the belief that nothing really exists – they may believe they have been dead for years or are simply an observer of the world.

Symptoms that can be observed:

- Thought Process Disorder

In our day to day lives our senses are overloaded with information, however normally we are able to filter out irrelevant inputs and select those which are most relevant. In schizophrenics this ability is lost and leads to them feeling overwhelmed, the result of which is poor attention and the inability to concentrate. Schizophrenics can be distracted by anything and everything and this often translates in their use of language.

Disjointed thoughts may lead an individual to shift from one topic to another – this is often referred to as a ’schizophrenic slip’ where parts of conversation make sense, but as a whole their speech is meaningless.

The person fails to form coherent and logical thoughts, and language is often rambling and disjointed. This incoherent speech is called a ‘word salad’.

Sometimes they may use ‘clang associations’ where words are used together simply because of a similar sound and the meaning of these words are disregarded. Often schizophrenics may invent new words or combine common words in a unique fashion– referred to as ‘neologisms’.

- Disturbances of Affect

‘Affect’ is the term used to describe mood in psychology. There are three types of emotional disturbances – blunting, flattened effect and inappropriate effect. Blunting refers to a lack of emotional sensitivity leading an individual to remain impassive, even in situations which would normally yield a very emotional response e.g. in the event of a death of a relative.

Flattened effect refers to a general absence of emotional expressions where the sufferer appears not to have any emotions.
Inappropriate effect is the display of emotion which does not fit in with its context for example giggling upon receiving bad news.

- Psychomotor Disturbances

Motor in this context simply refers to movement of the schizophrenic. Some schizophrenic’s movement can be affected. Sometimes they may develop bizarre motor movements such as waving their hands erratically, pulling strange faces, displaying immobility etc. Sometimes an individual may assume an unusual posture which is maintained for hours or even days – this is referred to as catatonia. Other times an individual may engage in repetitive movements such as rocking back and forth – this is known as ‘stereotypy’.

- Lack of Volition

Volition means the ability to act or do something. When schizophrenics lack volition they may lose interest in their environment and lose their drive. In extreme cases individuals may seem oblivious to the presence of others and behave unresponsively when contact is attempted. This is sometimes because sufferers have become self-obsessed – concerned only with their inner thoughts and fantasies.

What causes schizophrenia?

This is a hotly debated area in psychology and many differing ideas have been put forward. Typically theories can be divided into two approaches – the psychological approach which focuses upon upbringing, personal events, learning etc and the biological approach which focuses on biology as a cause for a disorder through genes, brain biochemistry etc.

Some argue that schizophrenia is inherited through our genes, and this is supported through studies finding an increase in the likelihood of schizophrenia when it is also present in relatives. Some studies have even found that schizophrenia is related to the occurrence of flu during pregnancy, and that schizophrenia has correlated with flu epidemics.

However it seems that the best explanation involves both biological and psychological cues. The diathesis-stress model suggests that a biological predisposition combined with the correct life events will result in schizophrenia.

Is it curable?

There is no definite cure for schizophrenia however there are drug treatments and therapies which allow schizophrenics to better cope with day to day life. Schizophrenia has often ‘cured’ itself naturally, and can be defeated. Around 1/3 of patients have one or a few brief episodes and then recover fully. Another 1/3 have occasional episodes of the disorder throughout their lives but function relatively well in between these periods. Unfortunately the remaining 1/3 deteriorate through reoccurring episodes which progressively become more incapacitating.