What is Schizophrenia ?
Common beliefs about Schizophrenia
Schizophrenia is a term just about everyone has heard. However, most people do not know what schizophrenia really is, or what causes schizophrenia, or what can be done for individuals who have this illness.
So what is Schizophrenia?
Schizophrenia is a major mental illness that affects people in all countries of the world. About one person in every hundred is likely to develop this disorder. The number of hospital beds filled by people with schizophrenia is much greater than the number of beds filled by people with any other single illness.
We describe schizophrenia as a major mental illness because schizophrenia has a great effect on nearly every aspect of a person's life. Everything that is important in life may be affected by schizophrenia.
Although the symptoms of schizophrenia are not the same for every person, the symptoms often cause problems in everyday living at some stage of the illness. People with schizophrenia may have difficulty handling problems because their thinking may be jumbled and unclear. It may become difficult for people to work as well as they did before because they may have trouble concentrating or thinking quickly and clearly. There may also be similar difficulties with leisure activities. In addition, relationships with other people may become troubled because of difficulties in conversations, or because of problems with their feelings. At times individuals may be so preoccupied with their thoughts and feelings that they cannot take care of even the most basic needs (for example, sleeping and eating).
Not everyone who has schizophrenia will display exactly the same symptoms.
Many people have the wrong idea about schizophrenia. First, there is the common belief that schizophrenia means you have more than one personality, like Dr Jekyll and Mr Hyde! This is NOT the case. People with schizophrenia have only one personality, although their personality may be disturbed in some way. Schizophrenia refers to personality problems where the individual may have difficulty deciding what is real and what is not real. Schizophrenia is a bit like having a dream when you are wide awake - you are unsure whether the events in the dream are really happening to you or not.
Schizophrenia does not mean you have more than one personality.
Another confusion is that many people think schizophrenia means you are 'mad'. While it is true that individuals with schizophrenia will sometimes act in strange or irrational ways, more often they will behave quite normally most of the time.
Another common belief is that people with mental illness are violent and dangerous. Some individuals with schizophrenia may have violent outbursts if they become very frustrated or angry, but they are more likely to be quiet, timid and fearful. In fact, some people who do NOT have schizophrenia have violent outbursts when they are frustrated or angry.
People with schizophrenia are no more violent than people without schizophrenia.
How do we know when a person has Schizophrenia ?
Schizophrenia is diagnosed when a person displays a specific group of symptoms. These symptoms involve unusual changes in a person's thoughts, feelings, and behaviours. There are no special x-rays or blood tests that tell the doctor that you have schizophrenia. Your doctor will depend almost entirely on what you say you have been experiencing over the past weeks. It is important to tell your doctor exactly what has been going on. Psychiatrists cannot read people's minds even though popular belief suggests that they can! Doctors can only make a diagnosis from what you tell them.
The main symptoms of schizophrenia include:
Disturbances of thinking
You may have difficulty organising your thoughts or difficulty concentrating. Your thoughts may seem jumbled and unusual. People may comment that you are not making sense. They may also say that you drift off the topic of conversation and talk about irrelevant things.
You may also feel as if thoughts are being put into your head and they are not your own thoughts. The thoughts may seem to come from other people or may seem to be put there as a result of telepathy, radio-waves, or laser beams. Thoughts may seem to disappear from your head, as if they are being taken out by somebody. Your mind may go quite blank and you may feel that you are unable to think about anything.
Thoughts may seem to be spoken out loud as if somebody close by could hear them. Sometimes it may feel as if your thoughts are being broadcast from your head so that everybody knows what you are thinking and none of your thoughts seem to be private anymore.
• Schizophrenia leads to jumbled thinking.
• People may comment that your conversation does not make sense.
• Your may feel as if thoughts are put into or taken out of your head, or are being broadcast to the world.
Delusions
Another difficulty in your thinking is called a 'delusion'. A delusion is a false belief that may seem quite real to you but does not seem real to other people. Delusions can be very frightening at times. Some examples of these delusions are:
• The belief that some other person or force is controlling your thoughts or your actions. You may feel like a zombie with no free will whose body and brain has been taken over by another person.
• The belief that somebody is trying to harm you or perhaps actually trying to kill you.
• The belief that things you see or hear have a special message for you. For example, seeing a red car may mean the world is about to end.
• The belief that you are a special person or have special abilities. For example, that you are a king or a queen, or that you can cause earthquakes, floods or other natural disasters.
A delusion is a false belief which may seem real to you but does not seem real to other people These ideas often come on suddenly and are quite unusual. Because the ideas are so unusual your family and friends are able to realise that you are not well. When you are a bit better you may be surprised about what you believed when you were ill. Some people say it is a bit like waking up from a dream.
Hallucinations
An hallucination is the experience of hearing things, seeing things, or smelling things that are not seen, heard, or smelt by other people. Hearing voices when nobody is in the room is a very common symptom of schizophrenia. The voices seem quite real and may appear to come from outside your head or from the next room. Sometimes the voices may seem to come from inside a person's head or, more rarely, from a part of the body.
An hallucination is hearing, seeing or smelling things that are not seen, heard, or smelt by other people
Unusual speech
Sometimes people with schizophrenia will talk in a way that is difficult to follow. Occasionally people will make up unusual words or use unusual expressions. Sometimes they may speak very little and be almost impossible to communicate with.
Strange behaviour
Some people with schizophrenia may hold their arms and legs in unusual positions and may not move their arms and legs for long periods of time. However, this behaviour is quite rare with modern treatments. It is more likely that you may have unusual facial expressions or that your body movements may be a bit restless or repetitive. These movements are often a side effect of antipsychotic medications.
Changed feelings
The experience that your feelings or emotions have disappeared, or are much less intense, is a common symptom of schizophrenia. Both happy and sad feelings may be affected. Sometimes you may feel quite depressed and at other times you may feel quite excited. You may also find that your feelings are unusual at times so that you may laugh or cry when you are not feeling happy or sad.
Lack of energy or motivation
Things that you used to do very easily may now seem to require much more effort. Perhaps you may find it difficult to complete tasks or to start the tasks at all. Making conversation with people may also take a lot of effort. It is possible that you may feel the need to withdraw from other people and spend time alone.
Lack of insight
Although your behaviour may seem very unusual to other people, it is possible that you do not believe there is anything wrong with you. This denial of your illness may lead you to refuse treatment. People who care about you may be very distressed by your lack of insight. They would prefer to see you accept treatment and get better. Sometimes you may need to trust the judgement of those who care about you.
What causes Schizophrenia?
Schizophrenia is probably caused by a combination of life stress and problems with brain functioning. The brain works by using special chemicals called neurotransmitters. Although it is not exactly clear what goes wrong when a person develops schizophrenia, it seems that these chemicals in the brain are affected. This chemical change usually occurs at times in people's lives when they are experiencing a great deal of stress. The chemicals in the brain do not seem to be properly balanced which results in the symptoms of hallucinations, delusions and thinking difficulties.
Schizophrenia is a disturbance of the brain chemicals, which may be brought on by stress.
It has also been noted that certain types of medication which act like the special chemicals in the brain can help to correct this chemical problem and decrease the symptoms of schizophrenia. These medicines are called antipsychotics.
Many scientists have been trying to find the cause of schizophrenia but have not reached any general agreement. New theories appear every few months and it is easy to become confused. At present we still do not know what causes schizophrenia, nor do we have a total cure. We do, however, have treatment that can reduce many of the symptoms of schizophrenia and help you to live a more fulfilling life.
Although schizophrenia cannot be cured, many of the unpleasant symptoms can be reduced with medication.
Does Schizophrenia run in families?
Yes, schizophrenia does tend to run in families. However, this does not mean that if somebody in your family has schizophrenia then everybody else will get schizophrenia. Nor does it mean that an individual who has schizophrenia should not marry and have children. We mentioned before that people in the general population have a chance of about 1 in 100 of developing schizophrenia. Well, if a close relative like a mother, father, brother or sister has experienced schizophrenia then your chances of developing schizophrenia are now about 1 in 10. If both your parents have schizophrenia, or if you have an identical twin who has schizophrenia, your chances are even greater - something like 1 in 2.
The risk of developing schizophrenia is greater if you have a parent, brother, sister or identical twin who has schizophrenia.
It does not seem to be schizophrenia itself that is inherited but merely the tendency to develop schizophrenia. People who inherit this tendency possibly lack some chemical in the brain which makes it more likely that they will develop schizophrenia. However, schizophrenia probably only develops when the person who has this tendency experiences a major period of stress.
Environmental stress and Schizophrenia
It has been noted that schizophrenia is most likely to develop when people are under a lot of stress. One of the most stressful periods of life is early adult life. At this time individuals are striving to get a good job, to develop close friendships, and to establish independence. This period of life is the most common time for schizophrenia to begin in men. In women, the period of major life stress is usually around the time of childbirth and child-rearing. We find that the age at which schizophrenia starts in women is generally later.
Schizophrenia often develops following periods of stress.
Several studies show that major stressful events such as a death in the family, loss of a job, or break-up of a relationship tend to make schizophrenia worse. Other studies show that once a person has schizophrenia, the environment in which he or she lives (that is, family, work, etc.) can help the individual get better if people in that environment provide plenty of support and encourage the individual to gradually regain former skills. If family and friends tend to push, nag, or criticize, these behaviours may make things worse. On the other hand, allowing the individual to lie around all day doing nothing may also make things worse.
It is impossible to totally avoid stress, but family members are most helpful when they assist one another to cope with difficulties in their lives. Your family will need to help you aim for realistic goals step-by-step.
It is clear that family members can be very helpful but that occasionally they can also make things more stressful. However, there is no evidence that families can actually cause schizophrenia. A few years ago it was believed that schizophrenia was caused entirely by the way parents communicated their thoughts and feelings to their children. While we all know how important it is for parents to communicate their thoughts and feelings clearly, there is NO scientific evidence that child-rearing techniques, or family communication patterns cause schizophrenia.
Families do not CAUSE schizophrenia.
Will I get better?
Schizophrenia usually begins in early adult life but may occur at any time in an individual's life. Individuals who develop schizophrenia at a very early age do not tend to do as well as those individuals whose illness begins in middle or old age. However, many people experience only one episode of the illness and never have a further episode. Generally, 25% of people recover completely, 40% have further episodes of psychosis with some degree of social disability, and 35% may have more severe long-term disability. There is a tendency for schizophrenia to gradually get better over the years, however, for many people schizophrenia will be a life-long concern.
Schizophrenia is often a recurring illness.
Sources of further information
National Schizophrenia Fellowship 020 8974 6814 (Advice line. 10.30-3 pm)
National Schizophrenia Fellowship Scotland. 0131 557 8969
National Schizophrenia Fellowship Northern Ireland 02890 402 323.
SANEline 0345 678 000 (7 nights 2 pm-midnight)
Living With Schizophrenia: A Holistic Approach To Understanding, Preventing and Recovering From Negative Symptoms by John Watkins, Hill of Content, 1996
Working with Voices by Coleman R and Smith M, Handsell, 1997 (workbook to help voice hearers manage their voices).
Brief summary of Schizophrenia
• Schizophrenia is a major illness that affects 1 in 100 people.
• The symptoms include: disturbances in thinking; delusions (false ideas); hallucinations (false sensations which are usually in the form of voices); problems with feelings, behaviours, motivation, and speech.
• The exact cause is not known but appears to have something to do with the balance of chemicals in the brain.
• Stress makes the symptoms worse and possibly triggers the illness.
• Your chance of developing schizophrenia is greater if you have close relatives who have schizophrenia.
• Some people may recover completely from schizophrenia while others will have symptoms which occur from time to time or which are present all the time.
• Relapses can often be prevented and life difficulties overcome.
• Family members and friends can be most helpful by encouraging the individual to gradually regain former skills and to cope with stress more effectively.
Adapted with permission from Falloon, I., McGill, C.and Boyd, J. (1980). What Is Schizophrenia? LA: Family Aftercare Program, University of Southern California, quoted in Andrews G and Jenkins R, eds, Management of Mental Disorders (UK Edition). Sydney: World Health Organisation Collaborating Centre for Mental Health and Substance Abuse.
