Understanding Schizophrenia Helps to Select Treatment
Schizophrenia as a medical condition is not well understood in our society. As a result, there are many misconceptions regarding
If you or someone you know has been diagnosed with schizophrenia, learning more about the condition will help you to make decisions regarding treatment.
To raise your awareness and knowledge about schizophrenia, we have made an excerpt from Dr. Warner’s book, The Environment of Schizophrenia, available as a downloadable file.
What is schizophrenia?
In our own popular culture, there may be more widespread ignorance about schizophrenia than any other common illness. Ask a classroom of American college students ? in engineering or English literature what they know about AIDS or cancer and they will probably have a lot to say. But ask about schizophrenia and the silence will be embarrassing. Although schizophrenia is more common than AIDS/HIV, most people know far less about it. "Isn't it like multiple personality disorder?" people ask. "Is it caused by child abuse?" "Are they mentally retarded?" The answer to all these questions is "No."
What is it about this condition that stifles discussion and learning? AIDS, cancer and schizophrenia are all perceived as contaminating and incurable, but somehow people with schizophrenia are seen as more mysterious, alien and violent. Centuries of fear have promulgated many myths about schizophrenia. What are the facts?
Schizophrenia is a psychosis. That is to say, it is a severe mental disorder in which the person's emotions, thinking, judgment, and grasp of reality are so disturbed that his or her functioning is seriously impaired.
The symptoms of schizophrenia are often divided into "positive" and "negative." Positive symptoms are abnormal experiences and perceptions like delusions, hallucinations, illogical and disorganized thinking and inappropriate behavior. Negative symptoms are the absence of normal thoughts, emotions and behavior; such as blunted emotions, loss of drive, poverty of thought, and social withdrawal.
Problems abound in defining schizophrenia. The two most common functional psychoses are schizophrenia and bipolar disorder (also known as manic-depressive illness). The distinction between the two is not easy to make and psychiatrists in different parts of the world at different times have drawn the boundaries in different ways. Bipolar disorder is an episodic disorder in which psychotic symptoms are associated with severe alterations in mood ? at times elated, agitated episodes of mania, at other times depression, with physical and mental slowing, despair, guilt and low self-esteem.
On the other hand, the course of schizophrenia, though fluctuating, tends to be more continuous, and the person's display of emotion is likely to be incongruous or lacking in spontaneity. Markedly illogical thinking is common in schizophrenia. Auditory hallucinations may occur in either manic-depressive illness or schizophrenia, but in schizophrenia they are more likely to be commenting on the person's actions or to be conversing one with another. Delusions, also, can occur in both conditions; in schizophrenia they may give the individual the sense that he or she is being controlled by outside forces or that his or her thoughts are being broadcast or interfered with.
Despite common features, different forms of schizophrenia are quite dissimilar. One person, for example, may be paranoid but show good judgment and high functioning in many areas of life. Another may be bizarre in manner and appearance, preoccupied with delusions of bodily disorder, passive and withdrawn. So marked are the differences, in fact, that many experts believe that, when the causes of schizophrenia are worked out, the illness will prove to be a set of different conditions which lead, via a final common pathway of biochemical interactions, to similar consequences.
It is not at all clear what is schizophrenia and what is not. Scandinavian psychiatrists have tended to use a narrow definition of the illness with an emphasis on poor outcome. Russian psychiatrists have adhered to a broad definition with an emphasis on social adjustment. In the United States the diagnostic approach to schizophrenia used to be very broad. With the publication, in 1980, of the third edition of the American Psychiatric Association Diagnostic and Statistical Manual, however, American psychiatry switched from one of the broadest concepts of schizophrenia in the world to one of the narrowest.
Why is the diagnosis so susceptible to fashion? The underlying problem is that schizophrenia and manic-depressive illness share many common symptoms. During an acute episode it is often not possible to tell them apart without knowing the prior history of the illness. The records of people with manic-depressive illness, however, should reveal prior episodes of depression and mania with interludes of normal functioning.
Schizophrenia is universal
We should not let confusion about differentiating schizophrenia from other psychoses detract from the fact that schizophrenia is a universal condition and an ancient one. Typical cases may be distinguished in the medical writings of ancient Greece and Rome, and the condition occurs today in every human society. While the content of delusions and hallucinations varies from culture to culture, the form of the illness is similar everywhere. Two World Health Organization studies, applying a standardized diagnostic approach, have identified characteristic cases of schizophrenia in developed and developing world countries from many parts of the globe.
More surprisingly, one of these studies demonstrated that the rate of occurrence of new cases (the incidence) of the condition is similar in every country studied from India to Ireland. However, since both death and recovery rates for people with psychosis are higher in the Third World, the point prevalence of schizophrenia (the number of cases to be found at any time) is lower in the Third World - around 3 per 1,000 of the population compared to 6 per 1,000 in the developed world. The risk of developing the illness at some time in one's life (the lifetime prevalence) is a little higher - around one percent of the population in the developed world.
People recover from schizophrenia
The popular and professional view that schizophrenia has a progressive, downhill course with universally poor outcome is a myth. Over the course of months or years, about 20 to 25 percent of people with schizophrenia recover completely from the illness - all their psychotic symptoms disappear and they return to their previous level of functioning. Another 20 percent continue to have some symptoms, but they are able to lead satisfying and productive lives.
In the developing countries, recovery rates are even better. The two World Health Organization studies mentioned above have shown that good outcome occurs in about twice as many patients diagnosed with schizophrenia in the developing world as in the developed world. The reason for the better outcome in the Third World is not completely understood, but it may be that many people with mental illness in developing world villages are better accepted, less stigmatized, and more likely to find work in a subsistence agricultural economy.