What is Schizophrenia?
Many people think people with schizophrenia have a ‘split personality’. Perhaps this comes from Robert Louis Stevenson’s classic novel, ‘Dr Jekyll and Mr Hyde’, in which the sane and upright doctor, experimenting with mind-altering drugs, descends into the near-bestial Hyde with tragic results. But schizophrenia, which affects one in every 125 people worldwide, is not really like this.
It is true that ‘schizo’, from Ancient Greek, means split. The ‘phrenia’ part is harder to translate. ‘Phrenum’ originally meant ‘bit’ or ‘bridle’, something assisting a rider in controlling a horse. In human anatomy, the word came to refer both to the diaphragm, the membrane that rises and falls with our breathing, and to our minds, to what goes on inside our heads. Schizophrenia, then, can literally mean ‘split-mind’, renowned psychiatrist, Professor Nancy Andreasen’s phrase, ‘broken brain’, used in the title of one of her books.
Susceptible people usually develop schizophrenia in their teens or early twenties. Before that, their brains and minds seem to be working okay. Then something goes wrong. The brain gets broken. Mental functions go awry… But nobody has yet discovered precisely what is at the heart of the problem. Biological factors – including abnormal brain anatomy, alterations in brain chemistry, genetic influences, and/or the effects of toxic substances (including cannabis and other drugs) – are strong possibilities that have been investigated. Psychological factors – such as early losses and other forms of emotional trauma – must be considered too.
Any or all of these various factors, plus others perhaps, may combine to produce the mental illness (or group of related illnesses) we call schizophrenia. About one-third of people who get it later recover. About one-third have a fluctuating course, with variations in intensity and periods of partial or complete remission; and about one-third experience more or less permanent symptoms and associated disabilities.
Treatment with medication (‘anti-psychotics’) can help reduce symptom intensities, suppressing some or all symptoms, but the illness process continues, so that stopping medication results in the symptoms returning.
Working with people with schizophrenia for many years has taught me much. To me, they are always ‘people with schizophrenia’, never ‘schizophrenics’. The disease label is utterly insufficient to define everything that these individuals have been, are now, and might become. To use it that way is an insult.
A typical person will have been doing fine at home and school when something starts to go wrong. For many patients, it is as if the focus of consciousness starts blinking, switching rapidly on and off, occasionally at first, and then more consistently. There are mini-gaps in the flow of mental activity. Imagine watching a television programme, then the screen very briefly goes blank, and when the picture and sound return the set is tuned to another channel and another programme. You start watching that, and then it happens again. You try and get back to the first programme, but the harder you try, the more frequently the blank screen effect cuts in.
This may be the basic fault in schizophrenia. Most of the other symptoms can be attributed to this fundamental imperfection, a repeated interruption to the flow of thoughts and sensations. When this starts happening, there is a tendency to open up to the inner world of experiences, paying less attention to whatever is going on in the environment. There are strong suggestions that the basic fault is linked – whether as cause or effect – to a persistent overload of stimulation. Colors or sounds may, for example, seem exceptionally vivid or altered in character. This can all be very disconcerting.
It is wise to think of the young person with schizophrenia as having a healthy functioning mind trying to make sense of, and get under better control, the part of itself which is broken. Successful mental health professionals always try to work with this healthy part, even when the symptoms seem overwhelming.
When the mind blinks, so to speak, goes blank briefly and keeps switching channels, the person’s thoughts become vague, elliptical and obscure. He or she can no longer easily, therefore, master and follow a series of instructions, or plan and carry out a course of actions. Often feeling impotent and useless, they may respond badly when pressure is put on them to achieve in the way they had been able to before the onset of the disorder.
Irritability is common. The person naturally feels a deep sense of being invaded. Their thoughts, feelings and actions seem to be known to other people, as if perhaps inserted into or withdrawn from their minds by others. By way of explanation, they readily develop false beliefs about being targeted and persecuted. They mistrust people, including close family members, who are themselves having difficulty understanding what seems to be happening, and the person’s changed pattern of behavior. Affected people may, for instance, isolate themselves much of the time, as a way of coping with the sensations of outside interference, as well as the demands of well-meaning but misplaced encouragement. Another symptom, hallucinatory voices, that are often highly critical, may add to the person’s feelings of persecution.
In the early stages, a teenager or young adult, will only rarely consider (much less like the idea) that they have a mental illness and go for professional help. Usually, the person keeps quiet about it. With difficulty concentrating, in class for example, he or she may try harder at first, in an almost obsessional way. Eventually, though, unable to keep up, it is common for such a person to fall behind and, often, to drop out of school, or later to give up their employment. He or she may self-medicate with so-called ‘recreational’ drugs and/or alcohol, in unwise amounts, as another (ultimately self-defeating) way of trying to cope with the symptoms.
Much has been written about the emotional state of people with schizophrenia, and how their mood can often appear shallow, volatile or incongruous. Some forms of schizophrenia are thought to include a depressive component as part of the illness process. However, great care should be taken when interpreting a person’s emotional reaction to very challenging, often bizarre internal mental experiences and their consequences.
With the healthy part of their mind working alongside the broken elements, a person might naturally seek to minimize external stimuli and close down their emotional responsivity. Those who seem apathetic, dull and closed off, hard to reach and communicate with, are often super-sensitive, sometimes instinctively feeling the raw emotional state of other people better than those people do themselves. Social withdrawal is, for them, an important and understandable form of self-defence.
The healthy mind of the sufferer will also recognize that, unable to finish school, he or she will be unable to find decently paid employment, and will not be attractive to others, and so less likely to find a life-partner. With poor job and marriage prospects, and low income, they will miss out on many of the things that seem necessary for simple human happiness. They may well, in a natural and healthy way, feel unhappy about that, perhaps angry too, or ashamed. There is, in other words, even at a young age, a good deal of grieving to be done, and new, appropriate, reachable goals to be set, once optimal treatment and symptom control have been reached.