About Schizophrenia

What Is Schizophrenia?

Schizophrenia is a mental illness which can be a devastating experience.  About one in a hundred people world-wide experience an episode at some time during their lives, although the highest incidence is in the late teens and early 20s.  In about one quarter of cases there is eventually a full recovery.  The majority continue to have problems but usually they also have long periods of good functioning.  The recent discovery of new forms of treatment may lead to further improvement in rates of recovery, particularly if everyone involved, i.e both the person with the schizophrenia and the family, learns to understand how to cope.

In schizophrenia the activity of chemical messengers at certain nerve endings in the brain is unusual and this may be a clue to the causes of the disorder.  During what is commonly referred to as ‘an acute psychotic episode’ the mental processes of experiencing and thinking become distorted.  When severe, this can lead to intense panic, anger, depression, elation or over activity, perhaps punctuated by periods of withdrawal.  It is not surprising that other people, particularly family and friends, find the changes incomprehensible and are themselves devastated.

One common misconception is that schizophrenia is the result of a ‘split personality’.  In fact, ‘multiple personality’ (the correct term) is very rare and has nothing to do with schizophrenia.  The mistake comes from the fact that the name ‘schizophrenia’ was coined from two Greek words meaning ‘split’ and ‘mind’.  It was intended however to represent the fact that processes of thought, feeling and intention no longer interact to form a coherent whole guiding the person's actions.

The symptoms of schizophrenia are conveniently divided into two groups, called ‘positive’ (e.g hallucinations and delusions) and ‘negative’ (e.g slowness to move, think, speak or react).  These may occur together, separately or alternately.  Your relative may also experience secondary symptoms such as depression, as a result of the difficulties he may experience in learning to cope with day-to-day living.

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Positive Symptoms: Hallucinations

The positive symptoms are often based on new and rare experiences that most people who do not have schizophrenia never, or only in exceptional circumstances, have.  Most commonly a person with schizophrenia will ’hear’ his own thoughts, for example, as if they have been spoken aloud within his head.  The thoughts can appear to be so loud that your relative may believe that people nearby will also be able to hear them.  Your relative's mind usually adjusts to this very rapidly and as a result the thoughts then appear to come from some external source.  These spoken thoughts are then called ‘voices’ or, technically, ‘hallucinations’.  Your relative may also experience sounds other than voices.  It is possible, using an imaging technique, to see changes in the speech area of the brain at the time when a person says that he is hearing the ‘voices’.  This is a real experience.  It is not imaginary.  There can also be other kinds of hallucinations, visual or olfactory (smell) or sensory (taste) for example.

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Positive Symptoms: Delusions

A person who experiences hallucinations will naturally attempt to find an explanation for what is happening.  What kind of explanation depends very much on the individual person involved and the culture in which he lives.  The voices may, for example, be thought to come from the television.  In a different culture, however, they may be put down to ‘black magic’.  These are attempts to make sense of experiences that most people do not have.  To the outside world, however, these explanations are regarded as ‘delusions’.  Delusions can take many forms: persecutory, telepathic, grandiose, religious, sci-fi or paranormal.  Your relative may try  to keep them secret, knowing that others would not understand.  Other individuals are gradually overwhelmed and begin to act strangely according to the content of the delusional explanations.

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Negative Symptoms

In some cases, especially with hindsight, families may realise that their relative's behaviour has, over a period of time, been changing in subtle ways.  He may for instance, have  become slower to think, talk and move and may have become indifferent to social contacts; his sleeping patterns may have changed so that he is happy to remain up all night and sleep all day.  Body language may also be affected.  These are the so-called ‘negative symptoms’; they will affect your relative in a different way from the positive symptoms.  The overall result is a diminution of motivation, the effect of which varies from minor to severe.  Negative symptoms are much less dramatic than positive but they tend to be more persistent.  Recognising these changes can be particularly difficult if the illness develops during teenage years when it is quite acceptable for changes in behaviour to occur, particularly where the young person is experimenting with new freedoms and lifestyles.

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Secondary Symptoms

Fortunately, most people do not have both types of symptom to a severe extent.  However, it is important to remember that the secondary symptoms accompanying schizophrenia,  such as depression and demoralisation may in themselves be disabling.  The extent to which your relative is affected by secondary symptoms depends in part on what kind of person your relative was before the onset of schizophrenia.  There is an interaction with earlier personality, education, intelligence and achievement.  In addition, the reaction of the family members and friends will also have some impact, if through misunderstanding, they think that their relative is fantasising, seeking attention or simply lying.  Losing a job and possibly social contacts at work as a result of schizophrenia adds further problems.

Family and friends can provide a vital lifeline.  It is essential to seek assistance for your relative as soon as symptoms appear.  Treatment is most effective when it is given early and in the context of consistent and informed support from the family, who have also learned to understand schizophrenia. 

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Experiencing Schizophrenia?

Schizophrenia is experienced in different ways.  But what seems to be characteristic of all those experiencing the condition is an inability to manage anxiety.  During an acute psychotic episode your relative may experience a fragmentation of his world which will seem unbearably confusing and frightening.
For example, your relative may seem preoccupied with baseless fears that people are pursuing or persecuting him.  He may attribute hostile intentions to people who are really behaving normally towards him and he may feel powerless to stop these ‘bad’ things happening.  This is called paranoid reaction.  If your relative is experiencing delusions, his actions may be dictated by what the voices require him to do rather than by what is actually said.  Fear of the voices may lead him to take unusual action to defend himself against what are seen as real threats or attacks.  This ‘defence’ may involve attempts at self-harm or aggression against others including the informal carer.  It is important to remember how overwhelmed your relative is feeling and how much he may feel threatened by this loss of control over what he feels is happening to him and those around him.
He may be so anxious about his relationships with others that he will try too hard to control his feelings and as a result lose the ability to feel and communicate.  He may not be able to give or respond to affection.  This can be very hard for informal carers to take and some may even withdraw as they no longer feel they can cope.  Your relative may not understand why he needs to eat regularly or to dress appropriately and this can cause both anxiety and embarrassment.  It is vitally important to remember that your relative may not be able to control these thoughts, moods and actions.  He is not being lazy or deliberately uncooperative.  Normal communication will be much more difficult because of his inability to concentrate.  He can still receive information but may not always be able to act upon it correctly.  People experiencing schizophrenia may be unable to tell the difference between what is real and what is unreal.  They often refuse to accept that they are ill, believing that the problems lie with others.  The psychiatrists call this ‘loss of insight’.
When your relative has recovered from an acute episode, he may remember with a sense of shame, some of what has happened.  He may then feel both frightened and confused about the consequences.  This is a difficult time for all those involved.  At best, he may be very grateful to family and friends.  But sometimes the sense of fear and shame can show itself in anger towards his informal carer.  Continued warmth, reassurance and confidence-building will help on the way to recovery.

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What Causes Schizophrenia?

It seems that no one factor alone causes schizophrenia.  Research has established that a person's genetic make-up is crucially important in that it may produce a predisposition to develop schizophrenia.  This makes a person more vulnerable to stress in life than is usual.

What seems clear now is that despite early theories to the contrary, families do not cause schizophrenia.  Some informal carers worry that they may not have loved the person enough or that they have loved too much.  Often they feel both alternately!  They can find themselves lying awake at night worrying about how things have turned out and wondering how things would have been if a different action had been taken.  They may feel guilty about arguments between family members and believe these contributed to the schizophrenia.  But arguments are a normal part of life, and while they may be upsetting, they do not cause schizophrenia.  Research has not provided any scientific proof to support out-of-date theories that families are to blame and these ideas have been rejected by psychiatric professionals.  Informal carers should not feel any sense of guilt or blame, instead they need to devote their energies to find out ways of helping their relative to cope.  Unfounded feelings of guilt or blame may get in the way of this process.

The renowned mathematician John Forbes Nash was diagnosed with schizophrenia in the 1950s, before the idea that families cause the condition had arisen.  In his case, it was suggested that his illness had been caused by ‘repressed homosexuality’ or ‘foetus envy’ since his wife was pregnant when the diagnosis was made!

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Will Treatment Cure Schizophrenia?

As yet, no approach to these illnesses has yielded a cure.  Treatments have been developed to promote recovery and by controlling the symptoms, they can be very effective.  Although people with a diagnosis of schizophrenia remain vulnerable to recurrences of the illness, a good proportion recover well enough to lead full lives again.

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Recovery Statistics

In round numbers the statistics on recovery from schizophrenia are: 
Up to 25% - Recover completely within five years, with no further need of anti-psychotic treatment.

50% - Have symptoms which continue to fluctuate over decades, but with good periods of remission.  Much depends on the quality of the care provided.

15% - Have severe persistent problems

10% - Suffer permanent lifelong incapacity
(Wing J. - 1992)

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Further Information
For more information contact SANELINE on 0845 767 8000 (1pm to 11pm every day) or click here to visit the SANE web site.

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