Schizophrenia is a very serious psychosis, usually of a chronic type, that manifests in some young patients and is clinically characterized by signs of mental dissociation, affective dissonance and an incoherent, raving activity. It generally leads to losing contact with the exterior world and to bringing the individual to a state of degradation, both from a social point of view, as well as from a psychological and biological one, even more so if specialized treatment is not being applied.
According to Beck, Rector, Stolar & Grant (2009), the condition has a long standing history, with manifestations of a schizophrenic nature being noted by James Tilly Matthews and accounts being given by Philipe Pinel in the publications of 1809. However, the recognition of schizophrenia as a psychological disorder that affects young adults and late adolescents has been made in 1853 by Benedict Morel, the one who also deemed it with the term “early dementia”. Arnold Pick and Emil Kraepelin have used the term dementia praecox in describing a psychological disorder that affects the brain, is a form of dementia, yet in the same time is completely different from the one that occurs with Alzheimer’s disease (usually specific to the old age).
The term “schizophrenia” (translated as “splitting out the mind”) was first used by Eugen Bleuler. Bleuler was a Swiss psychiatrist, who intensely studied the problem of this psychosis and has come to characterize it through the four A’s: Affect, Autism, impaired Association of ideas and Ambivalence.
Ever since the ’50s and up to the present day, with the discovery of new drugs and new types of psychotherapy designed to help the patient with regaining balance after delirium episodes, schizophrenia has slowly but surely become a much better tolerated condition from a social point of view, even though it still bears a stigma that affects the people diagnosed with it. Socially reintegrating people who suffer from this chronic condition and improving their life quality with the latest medication are factors that give the patient the hope that his/her condition is not the end of the world for him/her or for his/her loved ones.
Today, real examples show that it’s possible to live with schizophrenia and even perform at the highest levels despite it (for instance, the case of John Nash, the famous mathematician awarded with a Nobel prize, who also suffered from schizophrenia).
Causes and diagnostics
The causes for this condition vary greatly and there is always a myriad of factors contributing to its development. The first and most spoken of cause is genetic, the risks of developing schizophrenia for someone who has first degree relatives diagnosed with it being greater than for someone who has no family history with the disease. Researchers also speak of environmental factors, such as life conditions (social adversity, racial discrimination, family dysfunctions, unemployment and poor housing conditions (Selten, Cantor-Graae & Kahn, 2007)), drug use (cannabis, cocaine, alcohol and amphetamines (Picchioni & Murray, 2007)) or prenatal stressors (infections, hypoxia, malnutrition of the mother during pregnancy (van Os & Kapur, 2009)).
The diagnosis is usually made considering the DSM-IV (2000) criteria:
- Characteristic symptoms: Two or more of the following, each present for much of the time during a one-month period (or less, if symptoms remitted with treatment).
- Disorganized speech, which is a manifestation of formal thought disorder
- Grossly disorganized behavior (e.g. dressing inappropriately, crying frequently) or catatonic behavior
- Negative symptoms: Blunted affect (lack or decline in emotional response), alogia (lack or decline in speech), or avolition (lack or decline in motivation)
If the delusions are judged to be bizarre, or hallucinations consist of hearing one voice participating in a running commentary of the patient’s actions or of hearing two or more voices conversing with each other, only that symptom is required above. The speech disorganization criterion is only met if it is severe enough to substantially impair communication.
- Social or occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care, are markedly below the level achieved prior to the onset.
- Significant duration: Continuous signs of the disturbance persist for at least six months. This six-month period must include at least one month of symptoms (or less, if symptoms remitted with treatment).
Currently, the diagnosis for schizophrenia automatically includes the prescription of specific, anti-psychotic medication. Gradually, psychotherapy methods have been implemented alongside the medication (Lynch, Laws, McKenna, 2010): cognitive behavioral therapy (for the purpose of reducing the symptoms and preventing a relapse into delirium), social therapy (for the purpose of social reintegration), family therapy (addressing the patient, as well as the patient’s family for gaining a better and more accurate understanding of his/her condition), occupational therapy (for the purpose of reintegrating into the work-place), as well as drama therapy and art therapy.
The curative approach involves medication, but also psychological stabilization through psychotherapy as well as social integration. In the present day, hospitalization is being kept to a minimum and the individual can live in society under normal conditions.
Reducing the social stigma of this condition through social campaigns meant to raise awareness and understanding what the people who are diagnosed with it are going through are also ways of helping them and of providing them with a normal life experience.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author
Beck, A. T., Rector, N. A., Stolar, N., Grant, P. (2009) Schizophrenia: Cognitive Theory, Research and Therapy. New York, NY: Guilford Press.
Lynch, D., Laws, K.R., McKenna, P.J. (2010). Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials. Psychol Med., 40(1), p. 9–24. doi:10.1017/S003329170900590X
Picchioni, M.M. & Murray, R.M (2007). Schizophrenia. British Medicine Journal, 335(7610), p. 91–95. doi:10.1136/bmj.39227.616447.BE
Stotz-Ingenlath, G. (2000). Epistemological aspects of Eugen Bleuler’s conception of schizophrenia in 1911. Medicine, Health Care and Philosophy, 3(2), p. 153–9. doi:10.1023/A:1009919309015
Selten, J.P., Cantor-Graae, E., Kahn, R.S. (2007). Migration and schizophrenia. Current Opinion in Psychiatry, 20(2), p.111–115. doi:10.1097/YCO.0b013e328017f68e
van Os ,J., Kapur. S (2009). Schizophrenia. Lancet, 374 (9690), p. 635–45. doi:10.1016/S0140-6736(09)60995-8