Characteristics of Schizophrenia
Because it is such a severe disorder, schizophrenia is sometimes called the cancer of mental disorders. Like cancer, it can take many different forms. Indeed, some psychologists question whether it is really a single disorder or a family of related disorders. People who suffer from schizophrenia may exhibit “negative symptoms” (a reduction or loss of a normal trait or ability) such as impoverished speech, emotional flatness, and especially social withdrawal, and/or “positive symptoms” (additions to normal behavior) such as delusions (ie, bizarre beliefs about the self and others), hallucinations, and disorganized and innapropriate patterns of thinking, feeling, and behaving. Approximately 1 to 1½ percent of the population suffers from schizophrenia. Schizophrenia is found at similar rates in all cultures and, evidence suggests, has been present at that rate throughout recorded history.
Onset and Causes of Schizophrenia
One of the many puzzles about schizophrenia is why it strikes at the ages when it does. Schizophrenia usually first manifests itself during young adulthood, that is, between the late teen years and early 30s. Children do not develop schizophrenia, and very few people with schizophrenia develop the disorder after age 35.
Slow onset. In some cases the disorder emerges quite suddenly in a severe episode called a “psychotic break.” More commonly, however, the disorder develops somewhat slowly over the course of a couple of years. A rather typical scenario (to the extent that anything is “typical” when discussing schizophrenia) is that friends and family members of an individual in his or her late teens will notice the person beginning to behave oddly, think oddly, and withdraw from normal patterns of social interaction. That period may end (much to the relief of family members who may chalk it up to “a stage she was going through”) but then some months later the individual will begin to think and behave oddly again-and probably more oddly than had been the case before. At that point, or perhaps during a third episode some months later, it will become clear that something is seriously wrong; and friends or loved ones or perhaps the individual himself will seek a diagnosis and treatment.
Strong genetic component. The fact that schizophrenia develops during early adulthood is made particularly puzzling by the fact that there is a strong genetic contribution to the disorder. As is the case with bipolar disorder and depression, twin studies and adoptions studies suggest that some people are genetically more likely to develop the disorder than are others. Twin studies have found, for example, that the concordance rate for fraternal twins is approximately 15 percent but for identical twins is about 50 percent. It is now thought that some people are genetically vulnerable to developing the disorder, and that in the absence of such vulnerability, the likelihood of developing the disorder is very small.
Effect of early problems. However, there must be more to the development of the disorder than genetics, because the concordance rate for identical twins is only 50 percent. Why might one identical twin develop the disorder while the other does not? At one time it was thought that general life stresses played a role in the development of the disorder, but today much of the research is focusing on the effects of prenatal problems and birth complications as somehow combining with genetic vulnerability to produce the pattern of brain development that causes the disorder to emerge during early adulthood.
Treatments of Schizophrenia
Because schizophrenia is such a severe and bizarre disorder, living with, and caring for, someone suffering from schizophrenia is a difficult task. Sixty years ago, an individual diagnosed with schizophrenia was likely to be admitted to a large mental institution, where the individual was likely to live for the remainder of his or her life. The care that patients received in these institutions was often very poor, and no true treatments were available that were successful in reducing the severity of the symptoms.
Prefrontal lobotomies. One attempt at a treatment that was used beginning in the late 1930s and continuing through the early 1950s involved a form of psychosurgery called a prefrontal lobotomy. This surgical procedure involved severing the connections between the frontal parts of the frontal lobes and the rest of the brain. The initial reports regarding the procedure were very positive. The procedure did not, however, cure schizophrenia, nor did it enable patients to behave and think in a normal manner. The procedure did tend to make patients more manageable within the institutions.
Antipsychotic medications. Lobotomies stopped being performed in the 1950s. Two factors were involved in the demise of its use. First, it was becoming increasingly apparent by that time that the procedure was not effective. Second, in the 1950s the first antipsychotic medications were discovered. These drugs definitely did reduce the severity of many of the positive symptoms of schizophrenia (e.g., hallucinations and delusions) for many patients. The drugs did not, however, cure the disorder. If patients stopped taking the medication, the symptoms would recur. In addition, the drugs did not help all patients, and had less of an effect on the negative symptoms of the disorder.
Indeed, because the drugs were major tranquilizers, they tended to contribute to the difficulty patients had concentrating and interacting in a normal way. During the past fifty years several new kinds of antipsychotic medications have been discovered, and the drugs used today are both more effective, and have fewer side effects, than those first used in the 1950s. However, it remains the case today that the drugs manage symptoms but do not cure; and even with the medications, most people with schizophrenia are not able to care for themselves or lead a life with normal kinds of social relationships.
Deinstitutionalization. The initial discovery of the medications contributed significantly to a major policy change that began in the 1960s regarding the treatment of patients with schizophrenia. The term for this policy is deinstitutionalization. The essense of the policy is to keep patients in mental institutions for the least amount of time possible. In theory, the idea was that patients would be treated in mental institutions or in the mental disorders section of a hospital for a limited period of time, during which they would receive quality care and begin a regimen of medication. Once the medication had brought the positive symptoms under control, patients would be released to the care of their family, and would receive support through community mental health centers.
This policy has had a dramatic effect on the number of individuals receiving treatment for mental disorders in hospitals or other institutions. During the past 50 years, the population of the US has doubled. As a result, the number of people suffering from schizophrenia has also doubled. The number of individuals receiving treatment for schizophrenia in a mental institution or hospital on any given day has, however, declined to 10 percent of what it was 50 years ago!
Some in the mental health community feel this policy has gone too far. Families are not always capable of caring for family members with schizophrenia, and it is common for patients to stop taking their medications after they are released from institutional care.
