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Schizophrenia is quite the flag bearer for mental illness visibility. Everyone has heard of schizophrenia and almost everyone has watched a movie on schizophrenia. Despite this popularity, it is also one of the most misunderstood of the mental illnesses. Common representations in the media have led people to believe, schizophrenia may mean anything from having multiple personalities to being able to predict the future. Schizophrenia literally means “split-mind” but has nothing to do with multiple personalities. In reality, schizophrenia is a group of illnesses characterized by a loss of touch with reality, usually associated with a deterioration in social and occupational functioning.
A schizophrenia story
A 22-year-old unmarried white man presents to the clinic with his mother. He spends most of his time in the house and refuses to go out at night alone. He used to live independently and worked until a few months ago. The patient states he made an error on his taxes and is convinced the Internal Revenue Service (IRS) hired detectives to gather information about his whereabouts. He states that since his mistake he uncovered an essential flaw in the taxation algorithm, which may expose the underpinning of IRS, and is convinced they hired assassins disguised as bikers. After moving in with his mom, he did not see the bikers, but they are trying to trace his “mental activity”. Also, he hears them outside of his house talking about how they will kill him; he reported the problem to the police and FBI and is seeking my help “to defeat the IRS”. He appears suspicious, avoids eye contact, and his answers to questions are delayed, during which he appears internally preoccupied.
What is schizophrenia ?
Schizophrenia is a disorder of the brain, diagnosed when of the following features are present over the period of at least a month, along with a deterioration in social/occupational functioning.
Delusions – Which are false beliefs, held with conviction despite adequate evidence to the contrary. Cultural beliefs are excluded, from this definition.
For example, Ramesh has a constant belief that there is someone who is always following him around, and has been unable to leave home.
Krishna beleives that the government is conspiring to kill him, as he has come across some secret codes in the news papers.
Delusions need not always be suspicions, any belief can become a delusional one.
Hallucinations – Are false perceptions without stimuli. The process of receiving and processing information through our special senses (hearing, seeing, tasting, touching and smelling). Thus if one is able to hear something (speech or the door bell ringing )without an external sound, it is termed an auditory hallucination.
These are not imagined phenomena, the brain has the power to perceive/create stimuli even in the absence of a sense organ. To the sufferer, they are as real as real can get. For example, Charles Bonnet syndrome ( not schizophrenia ) is is a phenomenon wherein blind people have vivid hallucinations .
Disorganized speech and disorganized behavior – Speech that is difficult to comprehend and behavior which may be difficult to explain are often seen in those with schizophrenia. Wearing two shirts on a hot summer day, or saying something like “blue pigs eat grendels”.
Circuitry in the brain involved in perceiving, processing and communicating information are distorted, leading to a gross misrepresentation of the external world in a schizophrenic brain.
Negative symptoms – Poor social interaction, withdrawn behavior and decreased interest in self care, sometimes eventually replace the delusions, hallucinations and disorganized behavior.
What causes schizophrenia ?
Schizophrenia is currently conceptualized as a neurodevelopmental disorder with a genetic pre disposition. This roughly translates to a disorder caused due to improper brain development secondary to inheritable factors. These inheritable factors are often triggered by environmental factors such as a viral infection, birth trauma, malnutrition or other social factors.
Children of those with schizophrenia have a 13 fold increase in the risk of developing schizophrenia in their life time when compared to the general population.
This abnormal development leads to disturbances in
- Neural connections and circuitry.
- Complex, interrelated chemical reactions of the brain involving the neurotransmitters (substances that brain cells use to communicate with each other) dopamine and glutamate, , directly leading to observable symptoms such as delusions and hallucinations.
There are still a number of “grey areas” and “unknowns” in the exact etiology behind schizophrenia.
To summarize , schizophrenia is a mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. People with schizophrenia, require urgent medical attention. Longer the duration of untreated illness, worse the prognosis.