Schizophrenia
Imagine how drastically different your life would be if you were unable to distinguish between reality and your own perception of what is real. Envision friends, family, or even co-workers that you come in contact with daily, might just be a figment of your imagination. To think, how living in a world where your life wasn’t what it seemed and the memories you made never existed outside of your mind is reality for some is hard to grasp. Unfortunately, for individuals who suffer from schizophrenia, this is their reality. Some people require care in state institutions, while others are gainfully employed and can maintain an active family life. However, the majority of patients are at neither of these extremes. As depicted in the movie A Beautiful Mind, John Nash was a brilliant man, proficient in Mathematics who graduated from Princeton. He was always a bit socially awkward but no one knew he suffered from this disease since graduate school. Many individuals who were a big part of John Nash’s life all eventually turned out to be hallucinations, a lot and John soon found out that a lot of his experiences did not really occur, and he was later diagnosed with paranoid schizophrenia.
History of Schizophrenia
Schizophrenia is defined as a chronic mental illness characterized by disturbances in perceptions, thoughts, emotions, motor and other behavior. In 1887, German physician, Emile Kraepelin was one of the first people to classify mental disorders into different categories. Dr. Kraepelin created the term “dementia praecox” for individuals who displayed symptoms that are associated with schizophrenia today. Although progress was being made on the classification of these disorders, the treatment was very inhumane. People who suffered from mental disorders were often tied up and locked away in insane asylums that were usually dark, cold and filthy. Flogging was often used as treatment, and people were allowed to pay to come into these institutions and view these patients. It was not until 1911 that Swiss psychiatrist, Eugen Bleuler, coined the term, “Schizophrenia”. Bleuler believed that patients suffering from this disorder were “split off” from reality, which brought forth the term “Schizophrenia”. The meaning comes from the Greek roots “schizo” meaning split and “phrene” meaning mind, to describe the fragmented thinking of people with the disorder. Dr. Bleuler changed the name to Schizophrenia due to Krapelin’s term being misleading, as the illness was not Dementia. Schizophrenia differs from Dementia because it does not always lead to mental deterioration and can occur late, as well as early in life. Dr. Bleuler also was responsible for classifying schizophrenic symptoms as “positive” or “negative.” As time passed, conditions of mental institutions slowly improved but they were still far from ideal. Electro-shock therapy (ECT) and lobotomies (where they remove a portion of the brain) were considered as treatment for Schizophrenia and other severe psychiatric disorders. Sadly, electro-shock therapy is still used today even though there is a lot of controversy surrounding its use as a treatment option. The definition of Schizophrenia has continued to change over time as well, as scientists attempt to more accurately define various types of mental diseases. Since a specific cause for Schizophrenia is unknown, physicians must observe a patient’s symptoms in order to gain more insight on the disorder (Lane, n.d.).
Symptoms
There are three categories in which symptoms of Schizophrenia are recognized: cognitive, positive and negative (Comer, 2015).
Cognitive Symptoms
Cognitive symptoms refer to deficits in processing speed, attention, working memory, verbal learning, reasoning and social cognition. For some patients, the cognitive symptoms of Schizophrenia are subtle, but for others, they are more severe and patients may notice changes in their memory or other aspects of thinking (Comer, 2015).
Positive Symptoms
Positive symptoms are defined as psychotic behaviors that are not generally seen in healthy people (NIMH, n.d.). People with positive symptoms may “lose touch” with some aspects of reality and include pathological excesses like: hallucinations, delusions, loose associations, neologisms, perseverations, clang and inappropriate affect (Comer, 2015). In John Nash’s case, his college roommate, someone who he thought he known for years and even introduced him to his niece, was just a hallucination. He also believed he had a whole career working for a secret agent named William, which was also a delusion and ended up making him very paranoid and resulted in his admittance to a mental institution. A common misconception regarding schizophrenia is that the person suffering from it has multiple personalities when it is really their detachment from reality and their symptoms that cause the person to seem as though their behavior deviates from what is considered “the norm” and comes across as dysfunctional (NIMH, n.d.).
Negative Symptoms
Negative symptoms involve disruptions to normal emotions and behaviors. These symptoms include pathological deficits such as: alogia, social withdrawal, neglect of personal hygiene and avolition (Comer, 2015). In John Nash’s case he exhibited a lot of negative symptoms which include: social withdrawal, neglect of personal hygiene, and emotionless and it was not until his behavior started affecting people around him that anyone noticed that he had a problem.
Causes
Causes of Schizophrenia have been linked to brain abnormalities, genetic inheritance, and sociocultural effects (Comer, 2015).
Genetic Inheritance
Some scientists believe that schizophrenia is genetically inherited. According to Nasar, John Nash’s eldest son, John David Stier, suffered from episodic Schizophrenia in his adult years (Suellentrop, 2001). However, there has been controversy with this theory, due to some individuals with the disease not having any family members with the disorder, or individuals with one or more family members with the disorder who do not develop it themselves. If genetics alone were responsible for the development of Schizophrenia then the chance of both of identical twins developing the disorder would be 100% and not 50%, because identical twins have the same genetic makeup (Coon, 2011). They also believe that various genes may increase the risk of Schizophrenia, but that no single gene causes the disorder by itself and that genetic information should not be used to predict who will develop the disorder. Another genetic possibility that scientists predict is that interactions between genes and the aspects of the individual’s environment contribute to the development of Schizophrenia. These environmental factors include: virus exposures, malnutrition before birth, birth complications, or psychosocial factors (NIMH, n.d.).
Brain Abnormalities
As far as brain abnormalities, scientists believe that an imbalance in the complex, and interrelated chemical reactions of the brain involving the neurotransmitters dopamine and glutamate plays a role in Schizophrenia. These neurotransmitters allow nerve cells in the brain to send messages to each other and the imbalance of these chemicals affects the way a person’s brain reacts to stimuli. This explains why a person with Schizophrenia may be overwhelmed by sensory information, like loud music or bright lights that normally would not bother individuals who do not have the disorder (MHA, 2016). This problem in processing different sounds, sights, smells and tastes can also lead to hallucinations or delusions. Problems during brain development due to viruses or other complications while in utero may lead to structural abnormalities in the brain (Coon, 2011). The brain also undergoes major changes during puberty, and these changes could trigger psychotic symptoms in people who are vulnerable due to genetics or brain differences. (NIMH, n.d.).
Sociocultural Aspects
Sociocultural theorists believe that multicultural factors, social labeling and family dysfunction contribute to Schizophrenia. Regarding gender aspects, an equal amount of men and women suffer from Schizophrenia. According to Comer, Schizophrenia is reportedly higher in lower income areas and is higher in African American and Hispanics than in Caucasians. As far as social labeling, theorists believe that features of Schizophrenia are influenced by the diagnosis itself. They believe that society has a tendency to label people who deviate from the “norm” and these labels can become a self-fulfilling prophecy to people who are mentally ill (Comer, 2015). Instead of being treated properly and supported by loved ones, a lot of people are labeled as “crazy” and do not receive treatment for their symptoms. Theorists also believe that family dysfunction is a possible contributing factor to this disease. Family dysfunction includes those who are high in “expressed emotion” and hostility, or who have an intrusive parent. They believe that this family stress where parents engage in more conflict, have difficulties with communication or who display more critical or overinvolved behavior has a significant effect on the development of schizophrenia (Comer, 2015).
Types
Paranoid Subtype
Paranoid subtype, also known as paranoid schizophrenia, is the most common subtype and involves the presence of auditory hallucinations or prominent delusional thoughts about persecution or conspiracy. People with this subtype may appear to lead fairly normal lives because they are more functional in their ability to work and engage in relationships than people with other subtypes of Schizophrenia due to the successful management of their disorder. John Nash was diagnosed as a Paranoid Schizophrenic due to his outlandish beliefs that he was a secret agent working for government, that he betrayed them and as a result, that they were trying to kill him. In reality, he was a college professor who appeared normal to his peers until his symptoms spiraled out of control and caused him to be late for work and act erratically. People diagnosed with the paranoid subtype may not appear odd or unusual and may not readily discuss the symptoms of their illness. Since there may be no observable features, the evaluation requires sufferers to be somewhat open to discussing their thoughts. If there is a significant degree of suspiciousness or paranoia present, people may be very reluctant to discuss these issues with a stranger (Bengsten, 2016).
Disorganized Subtype
The disorganized subtype involves disorganization of the thought processes. Hallucinations and delusions are possible but not likely. These individuals struggle with completing tasks in their everyday lives. Routine tasks, such as dressing, bathing or brushing teeth, can be significantly impaired or lost. Often, there is impairment in the emotional processes of the individual, which results in blunted or flat affect. These people may appear emotionally unstable, or their emotions may not seem appropriate to the context of the situation, like laughing at a funeral or crying during a joyous event. These people also have difficulties with communicating effectively. Sometimes their speech can become virtually incomprehensible, due to disorganized thinking. The speech problems are associated with the ordering of words in conversational sentences, rather than with difficulties of enunciation or articulation. In the past, the term hebephrenic has been used to describe this subtype (Bengsten, 2016).
Catatonic Subtype
The Catatonic Subtype involves disturbances in movement. Affected individuals exhibit catatonic stupor, which is a dramatic reduction in activity, sometimes to the point that voluntary movement stops. Activity can also dramatically increase, a state known as catatonic excitement. Another disturbance of movement that is present in this subtype is stereotypic behavior, which is an action that appears relatively purposeless but is repetitively performed. Patients may exhibit waxy flexibility, where they maintain a fixed pose in which someone places them, sometimes for extended periods of time. Some patients show considerable physical strength in resistance to someone attempting to reposition them. Some people may exhibit unusual body positions, or make unusual facial contortions or limb movements. This set of symptoms sometimes is confused with another disorder called tardive dyskinesia, which mimics some of these same, odd behaviors. Other symptoms associated with the catatonic subtype, which is also seen in Tourette’s syndrome, include echolalia, which is an almost parrot-like repeating of what another person is saying and echopraxia, which is the mimicking of the movements of another person (Bengsten, 2016).
Undifferentiated Subtype
The undifferentiated subtype is diagnosed when people have symptoms of schizophrenia that are not sufficiently formed or specific enough to permit classification of the illness into one of the other subtypes. The symptoms can fluctuate at different points in time, which results in uncertainty as to the correct subtype classification. Some people will exhibit symptoms that are stable over time but still may not fit one of the typical subtype explanations (Bengsten, 2016).
Residual Subtype
The Residual Subtype is diagnosed when the patient no longer displays noticeable symptoms or their severe symptoms have decreased. Some characteristics of certain behaviors may still be present, but their manifestations are significantly diminished compared to the acute phase of the illness (Bengsten, 2016).
Treatment
The cause of schizophrenia is still unknown, so physicians mainly focus on eliminating the symptoms of the disease. Treatments include antipsychotic medications, psychosocial treatments, and coordinated specialty care.
Antipsychotic Medications
Antipsychotic medications can be taken in pill or liquid form and are taken on a daily basis. There are two major types of antipsychotic medication: typical and atypical. Typical, also known as “conventional”, antipsychotics effectively control positive symptoms, such as hallucinations, delusions, and confusion. Some typical antipsychotics include: Chlorpromazine (Thorazine), Fluphenazine (Proxlixin), and Trifluoperazine (Stelazine). Atypical, or “New Generation”, antipsychotics treat both the positive and negative symptoms of schizophrenia, often with fewer side effects. Some atypical antipsychotics are: Aripiprazole (Abilify, Aristada), Olanzapine (Zyprexa), and Risperidone (Risperdal). A third, smaller category of drugs used to treat schizophrenia is known as “miscellaneous antipsychotic agents,” which function differently than typical or atypical antipsychotic medications. Loxapine (Adasuve, Loxitane) is an example of a miscellaneous antipsychotic and is used to treat agitation in people with Schizophrenia (MHA, 2016). Some antipsychotics are given once or twice a month by injection. Insulin Coma Therapy was injected patients with insulin in order to reduce anxiety, nervousness, tremors, vomiting, weight loss, and agitation of patients undergoing opiate withdrawal. The treatment calmed patients, and them much more cooperative and less argumentative, hostile, and aggressive. At times, when the dose of insulin was high, the patient went into stupor. Physicians believed that the benefits of insulin, reporting that when the patients developed stupor or coma, they lost their psychotic thoughts (Fink, n.d.). When John Nash entered Trenton State Hospital in 1961, doctors recommended insulin coma therapy. After six weeks of treatment, Nash was moved to a rehabilitation ward. The symptoms appeared to have initially dissipated but a real recovery was elusive. Afterwards, Nash continuously took medication but still suffered with Schizophrenia for decades before slowly recovering. Every disease and the reactions caused by various medications may vary, so it’s important that doctors and patients work together to find the best medication or medication combination, and the right dosage in order to properly treat the patient.
Psychosocial Treatment
Psychosocial treatments are usually introduced after patients and their doctor find a medication that properly treats their symptoms. These treatments involve learning and using coping skills to address the everyday challenges of Schizophrenia. It helps people to pursue their everyday tasks, such as attending school or work. Individuals who participate in regular psychosocial treatment are less likely to relapse or be hospitalized (MHA, 2016).
Coordinated Specialty Care
Coordinated specialty care is a treatment model that involves medication, psychosocial therapies, case management, family involvement, and supported education and employment services. These are all aimed at reducing symptoms and improving quality of life (NIMH, n.d.). Different kinds of impairment affect each patient’s life differently. Most will stay display symptoms over a period of time, marked with some hospitalizations and some assistance from outside support sources. People with a higher level of functioning before the start of their illness typically have a better outcome. In general, better outcomes are linked with brief episodes of symptoms worsening followed by a return to normal functioning. Women have a better prognosis for higher functioning than men, as well as patients with no apparent structural abnormalities of the brain. A poorer prognosis is indicated by a gradual or insidious onset, beginning in childhood or adolescence; structural brain abnormalities, detected on imaging studies; and failure to return to prior levels of functioning after acute episodes (Bengsten, 2016).
In conclusion, Schizophrenia is truly a misunderstood disease. Individuals who suffer from this disease have been labeled as “crazy”, stereotyped that they all either belong in mental institutions or are homeless, and have been thought to have multiple personalities controlling them, which is all far from the truth. Schizophrenia is actually far more complex and the people suffering from this disorder deserve empathy and understanding, not ridicule. A Beautiful Mind actually does a great job clearing up misconceptions that people may have regarding Schizophrenia and its symptoms. It also showed that with proper treatment that people can have this disease and still function as a regular member of society and excel to any heights that they wish.