There’s an episode of Futurama in which Fry accuses Bender of blackmail and Bender replies:
“I prefer the word ‘extortion’. The X makes it sound cool.”
This made me laugh, but also made me think a bit about how the ‘shape’ of words can sometimes affect how we view the subject they are describing. Hence the title of this post.
Schizophrenia is a much-misunderstood mental illness. I myself knew very little about it until I started the Mental Health Studies course I’m on now. Because of this, I thought it might be interesting to write a blogpost about schizophrenia, which would serve the dual purpose of informing others about it whilst acting as a kind of revision aid for me.
There have been many celebrities – and indeed, many ordinary people – who have spoken out about their own mental health problems. Some of these issues include: depression, anxiety, bipolar disorder, drug addiction, alcoholism, self-harm etc. But schizophrenia is rarely, if ever, talked about. This is particularly unfortunate as it has suffered from inaccurate – and in some cases frankly insensitive – portrayals in the media.
I believe the main problem with this illness is the fact that the predominant symptom is usually some form of psychosis. The idea of someone suffering from delusions and hallucinations is one that is both upsetting and very difficult to understand. It is so far outside the realms of most people’s experience that it is hard to empathise with those who suffer from it. So-called “neurotic” (as opposed to psychotic) disorders such as depression and anxiety are much easier for people to identify with, because even if we have never suffered from a full-blown major depressive episode, we all know what it is to feel overwhelming sadness, guilt, fear and low self-esteem on occasion. Relatively few people, on the other hand, have suffered from terrifying delusions or bizarre hallucinations, although some may have experienced these effects after using illicit substances.
Before I go into a deeper explanation of what psychosis actually is, I will first mention some of the basic facts about schizophrenia. I should also point out that having psychotic symptoms is not the same as being schizophrenic (and vice versa), but psychosis is definitely a big part of schizophrenia. The two words are not interchangeable, but they are very closely linked.
Schizophrenia affects around 1% of the population and people are usually diagnosed with it around their early twenties. The relatively young age of onset is reflected in Emil Kraepelin’s original term for the illness, which was “dementia praecox”, meaning “precocious madness”. Eugen Bleuler later coined the term ‘schizophrenia’, or ‘split mind’ to describe “the loosening of associations between different functions of the mind” associated with the course of the illness.
The causes of schizophrenia are still not clear. It was once put down to poor parenting – the “schizophrenogenic mother” was one of the phrases used by psychiatrists to describe this. Thankfully for both the sufferers and their families, this immensely harmful viewpoint has since been abandoned by professionals. There is now something of a divide between those who believe schizophrenia is mainly caused by genetic abnormalities and those who think that the illness has a more social cause. Those who argue for genetics will point out that twin studies have shown if one twin has schizophrenia, there is a 10% likelihood that the other twin will also have it. This probability increases to 50% with identical twins, who of course share the same DNA. A recent meta-analysis has shown that genes are the largest risk factor for schizophrenia. Having said this, environmental factors will also determine whether someone develops the illness. The argument for a social cause has strengthened recently following research which has shown that the rate of schizophrenia is higher in immigrant populations (this is found in almost every country) and also in urban areas. Smoking cannabis during adolescence may also increase the risk of developing the illness later on.
Having mentioned some of the possible causes, I will now move on to mention some of the symptoms of the illness. In the early twentieth century a psychiatrist called Karl Schneider made a list of what he considered to be the first-rank symptoms of schizophrenia. These included: hearing thoughts spoken aloud, auditory hallucinations, thought withdrawal or insertion, thought broadcasting and delusional perception. These symptoms are not in fact necessary for a diagnosis of schizophrenia, but they are common enough to be termed “first-rank” and they are the most obvious and flamboyant signs of the illness.
Why do people experience delusions and hallucinations? They may be more common than you think – quite apart from hypnagogic and hypnopompic hallucinations (which occur just when you are either waking up or falling asleep), studies have shown that the experience of such phenomena seems to be on a spectrum. Some people never have any, others may occasionally hear voices which they can’t explain without it affecting their lives in any adverse way and still others may develop full-blown schizophrenia. Hallucinations can be auditory (the most common), visual, olfactory or tactile.
Delusions are usually either grandiose (when the person believes they are someone special or important i.e. God or Elvis Presley) or paranoid – thinking that MI5 have secret cameras hidden in your house or that people from the government are trying to kill you etc. They are thought to be caused by increased levels of dopamine in the brain – dopamine is a neurotransmitter which regulates how much attention we pay to external stimuli. If there is too much of it, then we begin to pay attention to details which we would usually consider to be relatively insignificant – the colour of that person’s jumper, the way someone looks at you, three red cars in a row going past etc. It is hypothesised that because the brain is noticing so many of these tiny details, it needs to provide some sort of explanation, thus giving rise to the paranoid or grandiose delusions mentioned above.
Whilst this type of psychosis is usually associated with schizophrenia, it can also occur during episodes of mania in people with bipolar disorder and sometimes even in people suffering from depression. Psychotic depression is relatively rare and can be difficult to treat – Alan Bennett describes with heart-breaking honesty how his mother suffered from it for many years in his book “A Life Like Other People’s”.
Other symptoms of schizophrenia include social withdrawal, reduced volition (lack of drive/initiative), emotional apathy and thought disorder. These are usually known as negative symptoms and are more commonly associated with the chronic type of schizophrenia. This is often a progression from the acute type, which is more likely to feature delusions and hallucinations. These are called positive symptoms because something has been added to the person’s usual experiences – in contrast to negative symptoms which involve something being removed from the person’s experiences – hence words such as withdrawal, reduction, lack, apathy.
So what is it actually like to suffer from schizophrenia? There have not been anywhere near as many books written by sufferers of schizophrenia as there have been by people suffering from depression, bipolar disorder etc. In part, this is because the illness has such a devastating effect on a person’s ability to function. As I mentioned before, the portrayal of this type of mental illness in films and TV programmes has also been somewhat lacking in authenticity and sensitivity, usually resulting in people with schizophrenia being portrayed either as dangerous psychopaths or having rare intellectual gifts – as in “A Beautiful Mind”, which is about the brilliant mathematician John Nash, who experienced auditory hallucinations caused by schizophrenia. Whilst these storylines have undeniable dramatic potential, they do not truly represent the lives of most people who have the illness. Such misrepresentation can also be found in films about people with autism – “Rain Man” is a good example. Having said this, at least “A Beautiful Mind” demonstrated that mental illness does not necessarily prevent people from having a successful career, even if that illness involves symptoms of psychosis.
Below are some historical accounts written by people who had suffered from schizophrenia.
The first is from a Reverend George Trosse, who wrote these words around the year 1690. He appeared to have suffered this episode in his early twenties, but recovered and later became a respected member of his local community in Exeter.
“I was haunted with a great many terrifying and disquieting Visions and Voices; which tho’ (I believe) they had no Reality in themselves, yet they seem’d to be such to me, and had the same Effect upon me, as if they had been reallywhat they appear’dto be.
I heard a Voice, as I fancy’d, as it were just behind me, saying, Yet more humble; Yet more humble; with some continuance…In Compliance with it I proceeded to pluck down my Stockings, and then my Hose, and my Doublet; and as I was thus uncloathing my self, I had a strong internal Impression, that all was well done, and a full Compliance with the design of the Voice.
At length, standing up before the Window, I either heard a Voice, which bid me, or had a strong Impulse, which excited me, to cut off my Hair; to which I reply’d, I have no Scissors. It was then hinted, that a Knife would do it; but I answer’d, I have none. Had I had one, I verily believe, this Voice would have gone from my Hair to my Throat, and commanded me to cut it.”
The second account is from a man called John Perceval and was written in 1838. He first experienced such symptoms at the age of 27 and was kept in asylums for three years before he finally recovered.
“Only a short time before I was confined to my bed I began to hear voices, at first only close to my ear, afterwards in my head, or as if one was whispering in my ear, – or in various parts of the room. These voices I obeyed, or endeavoured to obey, and believed almost implicitly…Those voices commanded me to do, and made me believe a number of false and terrible things.
I recollect that even at the height of my delusions I refused to obey these voices on several occasions, when by obeying them I was afraid of taking away the life of my attendants – for instance I was often desired to push a man named Hobbs backwards into an empty bath, but I was afraid to do it, lest I should injure him.”
The last account was written by an 18 year old boy and quoted by Sir Aubrey Lewis (an eminent psychiatrist) in 1967. It describes the terrifying cognitive deterioration associated with the chronic type of schizophrenia.
“I am more and more losing contact with my environment and with myself. Instead of taking an interest in what goes on and caring about what happens with my illness, I am all the time losing my emotional contact with everything including myself. What remains is only an abstract knowledge of what goes on around me and of the internal happenings in myself…Even this illness which pierces to the centre of my whole life I can regard only objectively. But, on rare occasions, I am overwhelmed with the sudden realisation of the ghastly destruction that is caused by this creeping uncanny disease that I have fallen victim to…My despair sometimes floods over me. But after each outburst I become more indifferent, I lose myself more in the disease, I sink into an almost oblivious existence. My fate when I reflect on it is the most horrible one can conceive of. I cannot picture anything more frightful than for a well-endowed cultivated human being to live through his own gradual deterioration fully aware of it the whole time. But that is what is happening to me.”
I feel I should point out that although these accounts all come from men, schizophrenia also affects women. The more chronic and debilitating form of the illness is more often seen in men, however, and there is also a later stage of onset in some female cases (around the fifties).
Medication is the usual method of treatment, usually in the form of antipsychotics. Some forms of psychological therapy are also starting to be used, as studies have shown that they can be effective and they provide a valuable alternative to medication, which can have unwanted side effects. The acute form of the condition has a sudden onset, but a better chance of recovery. The chronic form, as the name suggests, is much harder to treat successfully and may eventually result in the gradual deterioration described by the last account quoted above. Having said this, community psychiatry now offers patients the chance to receive treatment for their illness whilst remaining at home, thus maintaining vital social links with friends, family and colleagues. This also means, however, that they are more likely to be exposed to stigma and discrimination from other members of their local community. In order to target this, there have been a couple of media campaigns, most notably one by Time to Change, which was based around a short film called Schizo. The link for it is here, should you wish to watch it: http://www.youtube.com/watch?v=5kh2SpZP4Cg
It has been suggested that such campaigns may give the public the wrong idea about people with schizophrenia and perhaps make them feel that those who suffer from it aren’t really that ill at all, however I personally feel that anything which helps to reduce stigma and promote understanding and sympathy for people who have mental illness should be encouraged. I hope that this post has gone some way to encouraging a positive and accepting attitude towards mental illness – any questions or comments which you may have will be greatly appreciated, as always.
UPDATE: I have just discovered this video on YouTube which is intended to give some idea of what it’s like to experience auditory hallucinations. Listen to it with headphones on for the full effect – but be warned, you may find it upsetting and/or disturbing. Bearing in mind that this is what some people with schizophrenia/psychosis experience every day of their lives, such apparently counter-intuitive behaviour as self-harm and even suicide suddenly becomes easier to understand. http://www.youtube.com/watch?v=0vvU-Ajwbok
Frith, C. & Johnstone, E. (2003). “Schizophrenia: A Very Short Introduction”.
Gelder, M., Harrison, P. & Cowen, P. (2006). “Shorter Oxford Textbook of Psychiatry”.
Champion, L. & Power, M. (2000). “Adult Psychological Problems: An Introduction”.