What comes to mind when the word schizophrenia is spoken? Likely images of a bedraggled man or woman, with wild hair and tattered clothing, chatting away with someone that you can’t see, as they amble down a city street. You might actually cross the street to avoid him or her, so as not to get caught up in their delusion.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) describes the condition as “characterized by delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction. For a diagnosis, symptoms must have been present for six months and include at least one month of active symptoms.” These are merely words on a page that allow treating professionals to determine clinical interventions such as psychotherapy, inpatient hospitalization if symptoms warrant, and medication.
Although there is no clear-cut answer, it is known that schizophrenia is considered a brain disease that has genetic components. A cautionary note to consider is that DNA is not a defining factor, since in identical twins, one may present with the symptoms, while the other may not. According to ongoing scientific research, brain development in utero may offer a key to unlock the mystery. Another theory relates to a viral component, which may exacerbate developmental conditions. In short, schizophrenia appears to be a complex condition caused by no single factor by itself.
In men, schizophrenia symptoms generally are noted in the early to mid-20s. In women, symptoms typically begin in the late 20s. It’s uncommon for children to be diagnosed with schizophrenia and rare for those older than 45.
The American Psychiatric Association‘s “Guideline for The Treatment of Patients with Schizophrenia” states that “Antipsychotic medications are indicated for nearly all acute psychotic episodes in patients with schizophrenia.” These include antipsychotic medications such as Haldol, Clozapine, Geodon, Seroquel, Risperdal, Zyprexa and Abilify. They are meant to treat the symptoms, but are not considered curative.
The term ‘positive symptoms’ is used to describe what will follow. It does not indicate that these are desirable, but rather in excess of what people without the disease experience:
- Delusions: Beliefs not based in commonly held collective reality. Examples include false perception that one is being talked about or harassed when another is merely having a private conversation or physical limitations that are not actually occurring.
- Hallucinations: Visual, auditory, tactile, gustatory (taste) and olfactory (smell) are the most common. The term ‘responding to internal stimuli’ is often used in psychiatric settings to describe this component of the condition. A 20/20 episode several years ago highlighted technology that allows people to experience in virtual reality what those with schizophrenia live with. Overlapping sounds, voices and imagery that are all temporary distractions to a person who doesn’t have them in his or her daily life can be terrifying to another who does.
- Disorganized thinking- It leads to speech that makes no sense to the typical listener. Referred to as ‘word salad,’ it may sound like this: “I went to the store because the trash can is on top of the refrigerator, leering at me. It said I had two purple teeth and no belly button.” To the person uttering these sentences, it is in synchrony with their current mindset.
- Abnormal motor behavior: This may appear as twitching, spontaneous posturing, agitation, frozen, statue-like positions or excessive movement.
The term ‘negative symptoms’ relates to the inability to function in ways that would be considered the societal norm:
- Limited or lacking eye contact.
- Frozen facial expression.
- Monotone speech, without inflection or animation.
- No emotional component of speech, so that the listener may not grasp what the speaker is attempting to communicate.
- Poor personal hygiene.
- Depressive symptoms, such as lack of interest or enthusiasm about life.
- Social isolation.
- Limited ability to feel pleasure.
From the Therapist’s Office
- A client seen in a therapist’s office presented with the erroneous belief that he was nearly bald when he had a full head of hair. It took a great deal of repetition and affirming his concerns, as well as discovering that a family history of hair loss and the ways in which his father and grandfather viewed themselves that may have been at the root of his delusion.
- A young woman admitted to an inpatient unit in an acute care psychiatric hospital expressed her belief that she was an angel whose deceased father told her to come there so that she could assist the other patients. She was in extreme distress upon admission as she cried and said she wanted to harm herself. After the therapist confirmed with her that being an angel didn’t mean she was invincible, she questioned whether her father’s message was meant to get her the help she needed and perhaps he knew that she wouldn’t admit herself otherwise.
- A man whose mother was diagnosed with schizophrenia shared his story of riding as a passenger in a car with her and needing to take the wheel when she saw what she thought were demons around them and began screaming. She had stopped taking her medications a few weeks earlier.
- Another patient on the unit said that he could hear his father’s voice in his head instructing him to “Get off cocaine and be nice to your brother.” He decided to do both.
Stigma attached to the disease
As is the case in most mental health diagnoses, schizophrenia carries with it the burden of stigma, by which the person is viewed as dangerous and a poor fit into society. What treating clinicians and those themselves with the condition have determined is that with proper and consistent intervention, the symptoms can be managed and the individual can be productive and high-functioning. National Alliance on Mental Illness (NAMI) is an educational and advocacy organization that provides support those living with mental illness, as well as for their families and friends. This is an important resource.
How can family and friends be of support?
- Take care of your own needs, since you can’t fill another’s cup if yours is empty.
- Seek support from extended circles, such as therapists, self-help groups and clergy.
- Assist with teaching and reinforcing ADLs (Activities of Daily Living) such as bathing, dressing and grooming.
- Encourage consistent sleep. It is not uncommon for symptoms to become more severe when someone is sleep-deprived.
Have them avoid mood-altering substances such as drugs and alcohol.
- Socialization rather than isolation at their comfort level will enhance stability.
- Know that the presentation will fluctuate throughout a lifetime and that riding the waves will be necessary, so self-care is essential (see No. 1).
- Take note of potential triggers. Does your loved one exhibit symptoms at certain times of the year or when particular people are around?
- Consistent med management is essential. See that they keep appointments with therapist and psychiatrist.
- There are times when you will need to validate their experience, rather than offer reality orientation, unless you or that person is in immediate danger. It may encourage a sense of trust.
- There are books available to assist in understanding the disease and act as ongoing support for someone you love, so that neither of you face it alone.
Dream image available from Shutterstock