February 17, 2011

Schizophrenia: Causes and Consequences

Introduction

In our country, diseases of the mind are often stigmatized. To have any sort of mental defect is a character flaw that one should be able to work away through an effort of the will. If you cannot work through this, you are less of a person and are often left on the outside of normal working society. This bias seeps into the apparatus of medical care in America also. Until very recently, it was common for medical insurance plans to lack compensation for mental disorders at the level they compensated for physical ‘organic’ illnesses and accidents. The irony in such an unbalanced healthcare system is that mental disorders themselves are organic diseases. People who suffer from conditions as varying as bi-polar disorder, anxiety attacks, and anorexia nervosa do not just suffer; they often suffer in silence and suffer alone.


Figure 1: Mental Illness is often suffered alone

A personal connection
I write this because I do not want those who suffer to have to suffer in silence. We as a society have begun to normalize conditions such as depression and ADHD. I personally feel that this is because pharmaceutical companies have found particular chemicals that are able to treat those conditions and on some level ‘normalize’ the victims so that they can participate in society and not be defined by their disease.
I write this because I have been touched and my own life has been affected by mental illness. I have been fortunate in that I personally have not suffered but I have been affected. I have had friends, colleagues, coworkers, and family members suffer. I would not know though if those people had not been comfortable enough to discuss with me their situations. Everyone is in the same boat whether he or she is aware of it or not. In fact, the only things more shocking than the prevalence of mental illness are the silence that surrounds those who suffer and the stigma of having a disease.
I write this for my friend Steve . Steve was diagnosed in 2005 with schizophrenia. He is an honest and loving man, but as long as I have known him both before and after his diagnosis, he has been in a continual process of piecing his life together after his disease broke it apart. He has lost friends, jobs, and even access to his own children due to his disease. His diagnosis helped explained and give reasons for his behavior. His diagnosis also helped to show a path to recovery and treatment that was not there for him before. He has had his vicissitudes; his disease is now largely controlled through medication and therapy. Steve’s self-awareness helps both him and everyone around him. When he was first diagnosed, I taught myself as much as I could about his condition so I could understand him better. I hope that I can do the same for my readers here, so we can help the process of walking mental illness from the shadows.

What is Schizophrenia?
As a result of the too-common silence on mental disorders, many are poorly understood. They are often depicted in the media in a poor or untrue light, to be demonized when someone acts poorly as a result of the condition. This is not to excuse people of their acts, such as the shooters at Virginia Tech, Northern Illinois University and the recent tragedy in Arizona. People are ultimately responsible for their actions, but lack of treatment and silence on the issues creates situations where tragedies happen when early intervention would have helped. Before we can come to an understanding of any disease, we have to look at the broad definition what the disease is. Schizophrenia is defined as: “Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions and disordered thinking and behavior. The ability of people with schizophrenia to function normally and to care for themselves tends to deteriorate over time.
“Contrary to some popular belief, schizophrenia isn't split personality or multiple personality. The word "schizophrenia" does mean "split mind," but it refers to a disruption of the usual balance of emotions and thinking
“Schizophrenia is a chronic condition, requiring lifelong treatment” (Definition). The important thing to note here is that there is no one schizophrenia but we see that it is a cluster of related disorders that are often defined through the symptoms that occur.
Symptoms
The symptoms that characterize schizophrenia are varied. They include the stereotypical ‘voices in the head’ but such auditory hallucinations are not always present. WebMD describes the symptoms well: “Typically with schizophrenia, the victim’s inner world and behavior change notably. Behavior changes might include the following: social withdrawal, depersonalization (intense anxiety and a feeling of being unreal), loss of appetite, loss of hygiene, delusions, hallucinations (hearing or seeing things that aren't there), and the sense of being controlled by outside forces.
“Oftentimes, a person with schizophrenia may not have any outward appearance of being ill. In other cases, it may be more apparent, causing bizarre behaviors. For example, a person with schizophrenia may wear aluminum foil in the belief that it will stop one's thoughts from being broadcast and protect against malicious waves entering the brain.
“People with schizophrenia vary widely in their behavior as they struggle with an illness beyond their control. In active stages, those affected may ramble in illogical sentences or react with uncontrolled anger or violence to a perceived threat. People with schizophrenia may also experience relatively passive phases of the illness in which they seem to lack personality, movement, and emotion (also called a flat affect). People with schizophrenia may alternate in these extremes. Their behavior may or may not be predictable” (Types and Symptoms).Schizophrenia touches every aspect of the victim’s life. The symptoms are not just delusions and hallucinations, but all the symptoms negatively affect the potential for living a ‘normal’ life.
Types
The symptoms of schizophrenia cluster around different elements of a sufferer’s personality. This aspect of the disease has led to the development and diagnosis of several different types of schizophrenia, including aspects of behavior that would surprise most people as being lumped under schizophrenia. The various types of schizophrenia are defined here and on WebMD as: “Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations but relatively normal intellectual functioning and expression of affect. The delusions can often be about being persecuted unfairly or being some other person who is famous. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and argumentativeness.
“Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh at the changing color of a traffic light or at something not closely related to what they are saying or doing. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
“Catatonic-type schizophrenia is characterized by disturbances of movement. People with catatonic-type schizophrenia may keep themselves completely immobile or move all over the place. They may not say anything for hours, or they may repeat anything you say or do senselessly. Either way, the behavior is putting these people at high risk because it impairs their ability to take care of themselves.
“Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types but not enough of any one of them to define it as another particular type of schizophrenia.
“Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no positive symptoms (delusions, hallucinations, disorganized speech or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes” (Types and Symptoms). As you see, there is a surprisingly wide range and a very open definition of just what it means to be schizophrenic. The intensity of the disease varies and how people cope with their symptoms vary. You can learn to live with it or you can try to drown it out with alcohol, but ultimately the need is for victims to seek treatment.

Causes
Before we can treat a disease though, we have to know what causes a disease. That way we can disrupt the disease’s pathway and short-circuit the disease before it can act out. This is as true for bacterial infections as it is for mental disorders. When looking for an organic cause of schizophrenia though you will be disappointed: “It's not known what causes schizophrenia, but researchers believe that a combination of genetics and environment contributes to development of the disease.
“Problems with certain naturally occurring brain chemicals, including the neurotransmitters dopamine and glutamate, also may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they support evidence that schizophrenia is a brain disease (Causes).
Unfortunately, mental disorders are poorly understood, even though progress is being made every day. The national institute of mental health notes its obscure cause, but notes the genetic aspect of the disease: “Scientists have long known that schizophrenia runs in families. The illness occurs in 1 percent of the general population, but it occurs in 10 percent of people who have a first-degree relative with the disorder, such as a parent, brother, or sister. People who have second-degree relatives (aunts, uncles, grandparents, or cousins) with the disease also develop schizophrenia more often than the general population. The risk is highest for an identical twin of a person with schizophrenia. He or she has a 40 to 65 percent chance of developing the disorder” (What causes schizophrenia?).
Treatment
Luckily, for the sufferers of the disease, there are treatments for schizophrenia, even though the cause is unknown. In treating schizophrenia, the attack is like that of treating the common cold. You cannot fully treat the disease, but you can treat the symptoms. There is a variety of medicines available to treat the symptoms. For example, “Antipsychotic medications have been available since the mid-1950's. The older types are called conventional or "typical" antipsychotics. Some of the more commonly used typical medications include: Chlorpromazine (Thorazine); Haloperidol (Haldol), Perphenazine (Etrafon, Trilafon); Fluphenazine (Prolixin)” (How is schizophrenia treated?). There have been advances in the chemicals used to treat the disease, but they all exist to limit the psychotic symptoms, hallucinations, and breaks with reality that characterize the disease.
Unfortunately, the medicines used to treat schizophrenia have side effects that may make the victim discontinue use of the medicine, or perhaps they need a different drug or dosage for their medicine to be effective. For this reason, it is necessary that effective treatment of schizophrenia must include a trusting relationship between the doctor and the patient. Once psychotic episodes are controlled then the patient can move on to psychosocial treatments, which “can help people with schizophrenia who are already stabilized on antipsychotic medication. Psychosocial treatments help these patients deal with the everyday challenges of the illness, such as difficulty with communication, self-care, work, and forming and keeping relationships. Learning and using coping mechanisms to address these problems allow people with schizophrenia to socialize and attend school and work” (How is schizophrenia treated?).
Conclusion
By understanding and being aware about mental diseases, we as a culture can move past the stigmatization of those who suffer from the disease. Although the disease, such as schizophrenia, may be hard to define and poorly understood, we can at least make an attempt to understand that one percent that suffers with it. We can stop pointing fingers at the failings of those around us and instead point them towards a place of treatment so that they can steady their symptoms and rejoin society as productive members. My friend Steve did and we need to help everyone who suffers to be able to take the same path.

Works Cited
“Causes”. MayoClinic.com http://www.mayoclinic.com/health/schizophrenia/DS00196/DSECTION=causes Accessed February 13, 2011.

“Definition”. MayoClinic.com http://www.mayoclinic.com/health/schizophrenia/DS00196 accessed February 13, 2011.

“How is schizophrenia treated?” National Institute of Mental Health http://www.nimh.nih.gov/health/publications/schizophrenia/how-is-schizophrenia-treated.shtml Accessed February 13, 2011.

“Photograph”. Prison Advice and Care Trust http://www.prisonadvice.org.uk/?q=volunteerstory Accessed February 13, 2011.

“Schizophrenia Types and Symptoms”. WebMD.com. http://www.webmd.com/schizophrenia/guide/schizophrenia-symptoms Accessed February 13, 2011

“What causes schizophrenia”? National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/schizophrenia/what-causes-schizophrenia.shtml Accessed February 13, 2011.