Schizophrenia

Schizophrenia is one of the most misunderstood mental illnesses, leading to is association with a great deal of negative stigma.   I’ve worked for the past four years as a counselor and case manager for the moderately to severely mentally ill and have seen an unbelievable amount of ignorance and intolerance.  Stigmatizing of schizophrenic people is done not only by people who are uneducated about the illness, but by their families, peers and treatment teams. 

Schizophrenia can be traced back to 2000 years B.C.E., however the illness was not identified as more than just “madness” until 1887.   Emil Kraepelin was a psychiatrist who is likely best known for identifying and naming dementia praecox, the precursor to what we now call schizophrenia.[1]  The name was later changed to "schizophrenia" by Eugen Bleuler.[2] 

There are some common misconceptions about schizophrenia that contribute to the stigma.  It is not Disassociative Identity Disorder (or Multiple Personality Disorder as it is more commonly known).  The term "schizophrenia" comes from the Greek roots schizo (split) and phrene (mind).[3]  However, this term was never meant to imply that sufferers had a “split personality”; it was meant to describe the fragmented thinking of people with the illness.  Unfortunately, this translation could have led to the belief that people with schizophrenia are people who have “split personalities”.  The majority of people with schizophrenia are not violent, nor are they a danger to society.  In fact, they tend to be more of a danger to themselves.  Although the cause of schizophrenia is unknown, we do know that it is not caused by lack of willpower.

People with schizophrenia suffer from two different types of symptoms.  There are “positive” symptoms (symptoms that are added to a person’s personality) and “negative” symptoms (symptoms that are taken away from a person’s personality).  Some examples of positive symptoms are hallucinations, delusions and disorganized thoughts and speech.  Examples of negative symptoms include social withdrawal, emotional unresponsiveness and lack of empathy.   

            There are six different types of schizophrenia.  They are paranoid type, catatonic type, undifferentiated type, disorganized type, residual type and schizoaffective disorder.  Each type has symptoms of its own, as well as symptoms that are common with other types.  

            Paranoid schizophrenia is characterized by symptoms such as suspicion of others or persecution ideation.  A worst case scenario of a person suffering from paranoid schizophrenia could be someone who is barricading their door with furniture because the voices tell them that a murderer is coming after them.  Catatonic schizophrenia is characterized by symptoms such as bizarre body positions, blunted affect or inability to speak.  Not all people with this diagnosis are catatonic in the traditional sense of the word.  Some simple fit that diagnosis due to their symptoms.  However, there are many people with this disorder require hospitalization due to the care that is required of a severely catatonic person.  Residual type schizophrenia is the diagnosis used for a person with chronic schizophrenia.  This person may not be suffering from positive symptoms any longer, but still experiences the negative symptoms of schizophrenia. Schizoaffective disorder is diagnosed when a person fulfills the criteria for schizophrenia and another mental illness, such as major depression or bipolar disorder.  Interestingly, many people with this disorder don’t consider themselves to be schizophrenic.  I’ve heard many people say “I don’t have schizophrenia-I only have schizoaffective disorder.”  This is just one example of the stigmatization between people with mental illness.  Undifferentiated schizophrenia is diagnosed when there is not a specific type to define the person’s schizophrenia.  The person suffers from positive and/or negative symptoms, but does not fit the criteria for another type.  Disorganized schizophrenia is characterized by purposeless, uninhibited and possibly agitated behaviors.

            Due to the unpredictable nature of this illness, as well as the severity of the symptoms that accompany it, it is easy to see how people could be skeptical of schizophrenic people.  Factor in ignorance to the skepticism, media attention to the actions of people who are acutely psychotic and untreated and institutional behavior in those that leave long hospitalizations without proper aftercare, and suddenly skepticism turns into all out fear. 

            As I mentioned in the previous paragraph, the media often portrays schizophrenia in a negative light.  When a delusional mother kills her children, it is on every channel-making sure to point out that she suffers from schizophrenia.  A schizophrenic person who does something violent is generally not receiving treatment.  However, the media doesn’t mention that appropriate treatment could have prevented the incident.  On the other hand, I have yet to see a news report about a schizophrenic person who regains control of their life with proper treatment and lives successfully in the community. 

In movies, mentally ill people are portrayed as villains.  “Psycho”, for example, presents a murderer, who the viewers later learn is mentally unstable.  I remember being afraid of mentally ill people when I was a teenager.  Just about every horror movie I watched opened with a radio broadcast about an escaped mental patient who later kills all of the characters.   

            This passage from an article on stigma brings into focus the reality of stigmatizations.  “I witnessed this first hand many years ago, when my brother was diagnosed with schizophrenia. The majority of his friends deserted him; they weren't able to comprehend or cope with his altered personality and erratic behaviour. Within months he went from being a popular, vivacious and outgoing young man to a shattered, isolated loner. Over the following months, I watched my brother sink deeper into debilitating depression, which ultimately became so unbearable that he took his own life.”[4]

Recently, I attended a family meeting for one of my clients.  She had been hospitalized due to an increase in symptoms, and the doctors were ready to discharge her back to our program.  This particular client has a family who does not understand the nature of their daughter’s illness and is not willing to accept her diagnosis.  At one point during the meeting, her father asked if she would ever be “normal” again.  After listening to his negative comments for almost an hour, I had to speak up.  I told him that his daughter is normal and that she is simply suffering from an illness.  I equated her schizophrenia to cancer.  I explained to him her illness was in her brain, but that doesn’t make it any different from any other illness.  He looked at me with a blank stare, as if I had just introduced a completely foreign concept.  Imagine how difficult is it to explain this concept to people who are not affected by mental illness. 

That being said, the only solution to this issue is education.  As difficult as it may be to break through the barriers of stereotyping and prejudice, we have to try.  Over the years, many injustices have occurred due to ignorance.  Women were seen as less than human, African-Americans were seen as second-class citizens and people suffering from mental illness are feared.    

The Anti Stigma Project[5] is a group that travels around the state teaching people about the effects of stigma.  Their focus is on mental illness; however, they involve the audience by speaking of other types of stigma as well.  In fact, one of their most successful tools is an interactive portion of the training in which audience members talk about a time they felt stigmatized.

Schizophrenia is a highly misunderstood illness that is surrounded by a great deal of stigma.  The only way to stop the cycle of stigmatization is through education.  There are many resources available for people to learn about this illness.  There are also many groups with the mission of educating the public about this and other mental illnesses.  The sooner we all begin to learn about schizophrenia and stop allowing the myths to become the truth, the sooner this problem will be remedied.