SCHIZOPHRENIA

This serious mental disorder is frequently confused with ‘split personality - an entirely different condition. In fact, schizophrenia encompasses a variety of unnerving symptoms, often mixed with normal behaviour.

Schizophrenia is one of the most serious mental disorders. It may include withdrawal from reality, disorders of thought processes, abnormal behaviour and a gross inability to communicate with other people. It is the most common type of psychosis and affects up to one person in every hundred. Modern treatment has meant a revolution in its outlook, although not too long ago about one third of those in mental hospitals suffered from this condition to some degree.

The symptoms and manifestations of schizophrenia are diverse; so much so that some clinicians prefer to talk about ‘the schizophrenias’ in the plural rather than if it were just one condition. A variety of treatments have enjoyed vogues, but as yet none has been found to be universally effective. The condition can sometimes gradually disappear even without treatment; but even if schizophrenic behaviour improves spontaneously, in some cases it may recur at a later stage and be serious enough to require specialist treatment.

SYMPTOMS

The common denominator in most forms of schizophrenia is irrationality in thought or behaviour, often, rather surprisingly, mix with other behaviour which is natural and reassuring. Thus, a person may reply easily and courteously to questions - yet assert that his mind is controlled by X-rays coming from the hospital radiators. In other cases it may be the patient’s emotions that are irrational, and he may begin to giggle foolishly at the sight of his hands, or burst into uncontrollable weeping because a window has been left open.

Someone suffering from schizophrenia may have delusions about ordinary happenings, and will say, for example. Because that woman put my shoes under the bed, I know I must go home to meet the Queen. Alternatively, he may have delusions of attack. The police are projecting rays that enter the back of my neck and stop me getting an erection. Or he may feel that thoughts are being implanted in his mind: I can’t think my own thoughts any more. I have to think thoughts my dead father is having.’

Some sufferer may have difficulty in concentrating. I can’t watch television because I can’t sort out what’s happening and understand the words at the same time. I just feel overwhelmed. Others may have delusions of hearing voices: ‘As soon as I think of something, this voice says it out loud a few seconds later. Or sometimes it contradicts what I say and argues with me.’

All the examples given so far are those of disorders of thought. Sometimes, however, there will be irrational behaviour; strange facial expressions, repeated gestures of a pointless yet complex nature, flailing of limbs and twitching. Alternatively, there will be a stranger immobility called catatonia, where the patient stays unmoving in an unusual position (to curl in a ball is quite common) often for several hours. In certain cases the patient will show what is called waxy flexibility. This is when his limbs can be moved into any position by another person, and will retain that position for a long time afterwards.

The patients suffering from schizophrenia may also show unusual emotional patterns, either exhibiting inappropriate emotion (giggling when told that a friend has died, flying into a rage because someone walked by past his shadow) or none at all.

As can be imagined, the diversity of schizophrenic symptoms sometimes make diagnosis of the condition difficult. Diagnosis is also not helped by the fact in some cases the behaviour is normal but inappropriate. This presents special difficulties when the person being examined comes from a different culture from that of his doctor. For example, in some societies it is normal for a religious person to talk out loud to God and to believe that God answers; yet the unthinking clinician could easily construe this as delusional thought and hallucination, and thus as incipient schizophrenia.

WHO DEVELOPS SCHIZOPHRENIA ?

Schizophrenia is no respecter of persons; young or old, male or female, rich or poor alike can become its victims. There is nevertheless powerful evidence that it runs in families, and careful research has established that this is not necessarily due solely to patterns of upbringing or to the way a schizophrenic parent behaves towards his or her offspring, but is due in part to genetic transmission.

CHILDHOOD SCHIZOPHRENIA

It is extremely important to realize that disturbed behaviour, imagined events, inappropriate emotion and bizarre thought patterns in childhood can occur without schizophrenia or indeed any mental disorder being present. However, schizophrenia can occur in children, but generally not before the child is three or four years old. It is marked by poor emotional relationships with others, and a lack of belief in his or her own identity. For example, when the schizophrenic child is asked if he wants to go out, he may say ‘Yes, he wants to put on his coat to go out, as if he were talking about someone else.

A child suffering from schizophrenia may show acute, excessive and illogical anxiety, loss of speech, distortions in the way he sees or hears things, bizarre movements and a determined resistance to change in his environment.

CAUSES

There are many theories about what causes schizophrenia. Factors cited have included genetic, chemical, family upbringing and later social pressures. The psychiatrist Laing, for example, has argued that schizophrenia is not an illness at all, but occurs as a defence against intolerable pressures produced by society. He thus maintains that schizophrenia is a label for a certain sort of behaviour that a person invents in order to live in an unlivable position. He cannot make a move without being beset by contradictory pressures both internally, from himself, and externally, from those around him.

Laing’s theory is ingenious, and he produces examples of patients for whom his ideas may well be true. However, there is little other evidence to support the view that environment is a major cause for schizophrenia; it is probably more accurate to say that it may well precipitate an attack in someone who was already predisposed to schizophrenia for reasons other than environment.

HEREDITY

This is probably the most powerful influence on the development of schizophrenia. Numerous studies indicate that the condition tends to run in families - but it should be stressed that this is not necessarily proof that schizophrenia is hereditary, since a poor heredity and an unfavorable environment usually go together. In addition, most psychiatrists and psychologists agree that what can be inherited is a predisposition to schizophrenia; under severe pressure a predisposed individual is more likely to develop the condition than others.

The presence of schizophrenia tendencies among relative of schizophrenia is so striking that the term schizoid has been coined to refer to those who resemble the schizophrenic in many ways, but whose pathology is not severe enough to warrant the diagnosis of some form of schizophrenia.

However, the hypothesis that schizophrenia is hereditary gets strong support from the fact that identical twins, who come from the same egg, show more tendency to schizophrenia than fraternal twins, who come from different eggs produced at the same time. In addition, the child of a schizophrenic person has virtually a 50/50 chance of being either schizophrenic or schizoid; if both parents are schizophrenic, it is obvious that the chances are even higher.

But environmental factors cannot be discounted entirely. The schizophrenic parent may transmit the disorder to his offspring by means of faulty child-rearing rather than faulty genes. And two parents suffering from the condition would surely provide a more abnormal environment than jut one!

PHYSICAL CONSTITUTION

A theory proposed over 50 years ago postulated that physical constitution may contribute to the development of schizophrenia. It was suggested that people suffering from the condition were more often slim and wiry than very muscular and plump. Research has shown this theory to have some basis: the narrower the physique, the more marked the thought disorder and the earlier the onset of the condition will be. This, however, may be the genetic influence in another form, since genes control body build.

Body chemicals are also important in schizophrenia. Research with drugs that produce schizophrenic symptoms artificially have suggested that chemicals present in the bodies of some people render the person liable to the development of schizophrenia. Unfortunately, if such chemicals do exist, they have yet to be identified, and there is some doubt whether it is the chemical that produces the condition-or the condition that produces the chemical. And where does the instruction to produce the chemical come from? This, too, may be genetic.

TREATMENT

The primary treatment for schizophrenia is drug therapy. Electro convulsive therapy (ECT) - electric shock delivered to certain brain areas in such a manner as to produce a controlled brain convulsion while the patient is under an anaesthetic - is occasionally used in the treatment of schizophrenia, especially when the conditions is allied to severe depression. Medically authorities are nevertheless divided about its effectiveness, and as a result it is seldom favoured when other methods of treatment have a chance of being effective.

Drugs are generally prescribed for several months. As and when the symptoms abate, social and psychological treatment can begin, involving ‘talk out’ sessions, work therapy, social involvement practice and occupational therapy. These activities are important both in promoting recovery and, in severe cases, in preventing deterioration.

OUTLOOK

It should be pointed out that schizophrenia is a serious disorder, and although many people who suffer from it will recover completely, there are others for whom recovery is only partial or even minimal. Hospital studies show that a substantial proportion of patients make a good recovery, although some may show defects in personality, and a small proportion show a continuing severe defect. The outlook may even be better than these figures imply, for many who may in the end deteriorate seriously have long periods when they can return to the outside world with success, even though they may have to be looked after by the people around them. In addition, there are many cases of schizophrenic behaviour which never reach the stage of hospital admission, and for those people total and permanent recovery is very probable.