Schizophrenia is the most disabling and serious of all mental disorders. It is what is usually associated with insanity. All societies describe some variant of schizophrenia-like “madness.” In fact, the rate of occurrence is more or less similar throughout the world.
Most of us have an experiential awareness of one variant of schizophrenia, as a portion of the homeless are schizophrenic. We have all seen individuals dressed not just sloppily but oddly, with bodies rigid and contorted, shouting bizarre statements in an angry, wired fashion. Even a small child can pick up that there is something very basically wrong with their psychological functioning—and that it is tragic. There is so much suffering in schizophrenia.
Schizophrenia means “split mind.” Unfortunately, in popular culture this has been erroneously equated with “split personality,” but this has nothing to do with schizophrenia. With multiple or “split” personality, the idea is that at least two or more distinct personalities inside the person’s head are vying for control. Despite its popularity in the media, true multiple personality disorder is actually quite rare.
In contrast, the “split mind” in schizophrenia means that the mind of one personality is not functioning normally. It is not intact, but “split” or malfunctioning because the actual workings of the mind are so disjointed, disorganized or broken down. Mental processes seem to be fragmented, distorted or chaotic. The result is that thoughts, speech, emotions, and behavior are nonsensical and often chillingly bizarre.
Perhaps, one reason that so little is known about schizophrenia is that it is so disconcerting. We don’t want to deal with it. Schizophrenia affects those fundamental psychological processes that most of us take for granted. Try to imagine yourself unable to think in an organized fashion or to be able to trust your perceptions as real. Think of what it would be like to have terrifying nightmarish images that you are unable to turn off or to hear commanding voices inside your head. What would happen if you “knew” characters on television were controlling your mind or reading all your thoughts? What if you tried to communicate with others, but were unable to use basic, agreed-upon patterns of language?
This is a horrific scenario, but it gets worse. You would likely behave in ways that were entirely misunderstood and ridiculed. You would probably feel isolated and trapped within a mental cage of misperception, miscommunication, and confusion. In fact, you would most likely be perceived as threatening by others.
Being with a schizophrenic individual or truly understanding what happens in schizophrenia can be unnerving and almost always raises existential and philosophical issues because the disorder reminds us of the fragility of normal mental functioning. Schizophrenia also raises moral issues because it is a societal responsibility as well as an individual tragedy. It has been said that the true caliber of a society is revealed in how it treats its disabled members. Many people with schizophrenia clearly fall into this group.
Schizophrenic symptoms vary from person to person, and the more bizarre elements of the disorder are generally not present all the time, even if the condition goes untreated. There are also different types of schizophrenia. For example, in paranoid schizophrenia the bizarre disorganization is not evident on the surface, but underlying are disturbing delusions, which can be acted upon as though real.
Who is affected by schizophrenia? Most studies have found men and women are equally affected, although some research has suggested the disorder is more severe and possibly more common in men. Schizophrenia also appears in all races and social classes. In the United States, schizophrenia affects most cultural groups about equally.
These days most researchers feel that schizophrenia is primarily a biological disorder. The one factor that appreciably seems to bias the odds of getting schizophrenia is genetics. At the same time, it is equally clear that the disorder is not entirely genetically caused. The environment is also thought to play a part by some theorists. In this view, it is felt that the underlying biological disorder causes a predisposition for schizophrenia, which later becomes manifest because of stress.
Some people show marked improvement over time and some even recover from schizophrenia. On the other hand, all too often the disorder is very long-term, if not chronic, and can involve serious problems in basic functioning that require extensive management and ongoing care. The treatment of schizophrenia changed drastically in the 1950s with the introduction of anti-psychotic drugs. These medications reduce the bizarre symptoms—such as hallucinations, delusions, and some of the disorganized thinking. Still, anti-psychotic medications, which work on brain chemistry, are not a cure and do not work for everyone. Even with medication, there can be periodic relapses or residual problems, and there are significant dangers and side effects, which can make life very uncomfortable physically for the schizophrenic person.
The reality of schizophrenia is disturbing and confronts us with the vulnerability, interdependence, and inherent responsibility of all human beings. Schizophrenia is one of the most puzzling and unsettling aspects of the human condition. Schizophrenia forces us, both individually and as a society, beyond rhetoric and abstract attitudes. It is a call for action and true compassion. Whether we heed the call, perhaps like nothing else, demonstrates what our basic values really are. Even the fact that we are so ignorant of what schizophrenia actually involves in our politically correct “Information Age” speaks to a denial and stigma of staggering proportions.
Dr. Judy Marshall received her doctorate in clinical psychology from the University of North Carolina at Chapel Hill. In thirty years of clinical practice in New York and Los Angeles, she has worked with many different groups, from children to the frail elderly, with particular interests including self-esteem, depression, sensitivity, and creativity.
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