Schizophrenia is a mental disorder characterized by many symptoms that in different combinations involve feelings, thoughts, actions, and relations with the surrounding world. As a consequence of these symptoms, the schizophrenic adopts a way of living that differs from that prevailing in the society of which he is a part. He seems to confuse fantasy with reality and to live in a private world, at least where certain areas of living are concerned. The schizophrenic often entertains false beliefs, or delusions. He may, for example, think that he is the victim of persecutors. He may also have perceptual experiences without appropriate external stimulations. For instance, he has hallucinations of hearing voices although nobody is talking to him, or he perceives apparitions without a corresponding external object. Although etymologically the term "schizophrenia" means a division or splitting between the different parts of the psyche, the term as used by psychiatrists does not mean split personality.
History of Schizophrenia
Unlike other mental diseases that were well recognized as clinical entities in ancient times, schizophrenia was differentiated and considered as a separate entity only toward the end of the 19th century, predominantly by the German psychiatrist Emil Kraepelin, who named the disorder dementia praecox. The Swiss psychiatrist Eugen Bleuler coined the term "schizophrenia", after convincing himself that a dementia state is by no means the ineluctable outcome of the disorder, as Kraepelin had believed.
Schizophrenia is the most common of those serious mental illnesses called psychoses. The disorder affects a little less than 1% of the general population. In the United States more hospital beds are occupied by schizophrenics than by patients affected by any other disease. Every year schizophrenics constitute from 20% to 25% of first admission to public psychiatric hospitals. Because of the relative youth of most patients at admission and their long stay, schizophrenics make up 55% of the resident population of these hospitals.
Schizophrenia may occur at any time from puberty to the age of 40. After the age of 45 the risk of developing the illness is sharply decreased. Childhood schizophrenia has been described by many psychiatrists, but not all psychiatrists agree that such cases belong in the same clinical category as adult schizophrenia.
Types of Schizophrenia
There are four major types of schizophrenia: simple, paranoid, hebephrenic, and catatonic. The simple type is characterized by an impoverishment of the personality. The onset is insidious and often unnoticed. The patient isolates himself and seems to lose interest in his surroundings. His thinking processes are superficial and refer only to concrete things or situations. His emotions lack depth, and his judgment is inadequate.
The paranoid type is characterized by delusions, often of persecution but occasionally grandiose in content. For instance, the patient may consider himself a great inventor or believe that he is a great historical figure of the present or of the past. Hallucinatory experiences and special ways of thinking tend to support these false beliefs, or delusions.
The hebephrenic type has many characteristics similar to those of the paranoid type, but the disintegration of the personality is more pronounced. The patient's behavior is obviously inappropriate, silly, and bizarre, and his affective reactions to situations and people appear either shallow or incongruous.
The catatonic type is characterized by unusual motor behavior. The patient may be in a state of immobility and assume statuesque positions. He often presents the symptom known as waxy flexibility. He maintains positions of the body in which he is put, even if these positions are uncomfortable, and remains in these positions for long periods of time. He may be mute and comply with others' wishes to an extreme degree, or he may become negativistic and resist any attempt to direct him. Occasionally, states of immobility are interrupted by unpredictable periods of excitement.
Some psychiatrists distinguish three other types of schizophrenia: the schizo affective type, characterized by additional symptoms and by moods of elation or depression; the undifferentiated type, characterized by severe but not sufficiently specific behavior and thinking disorder; and the pseudoneurotic type, presenting predominantly neurotic symptoms with psychotic episodes of brief duration.
Symptoms of Schizophrenia
Some symptoms occur in all types of schizophrenia. The patient seems to have changed his relation to the world. He often hallucinates or has special referential attitudes. He thinks that facts or events in the world around him have a special meaning or a purpose connected with his own life. One symptom, either overt or hidden, that seems to be present in all types of schizophrenia is a thinking disorder. Abstract concepts are represented in a concrete frame of reference. This type of cognition is similar to the one found in the dreams of normal people. Freud attributed this type of thinking to what he called the primary process, the system that rules the unconscious more than the other parts of the psyche.
Causes of Schizophrenia
Many theories have been advocated to explain the cause of schizophrenia. Some psychiatrists believe that the disorder is caused by environmental psychological factors, while others think that it is due to organic causes, and still others find the cause in a combination of psychological and organic factors.
The American psychiatrist Adolph Meyer considered schizophrenia the result of what he called a longitudinal progressive maladaptation that resulted from faulty habits and disorganizations of habits. Although the Austrian physician and neurologist Sigmund Freud did not attempt to enunciate a total theory of schizophrenia, he added new partial understandings of the disorder. As a result of Freud's psychoanalytic studies, schizophrenic symptoms came to be interpreted as having a symbolic meaning. Actually, it was the Swiss psychologist Carl Jung who applied Freud's theory and interpretation of dreams to schizophrenia. According to Jung, a schizophrenic thinks and acts as a normal person does in his dreams. Jung believed that the disorder is caused by an unusual strength of what he called the collective unconscious, so that an abnormal number of atavistic tendencies hinder adjustment to present life.
Still another theory of schizophrenia was presented by the American psychiatrist Harry Stack Sullivan, who stressed the importance of a person's early interpersonal relations, especially to poor parent-child relationships. The individual in such a situation grows up with great anxiety and lack of self-esteem. If at adolescence or later, repeated traumas occur to his sense of self-regard, the patient may go through a sequence characterized by distortions, lack of consensual validation, and finally by a state of schizophrenic panic.
The present author believes that psychological environmental factors have a great, but not exclusive, importance in the causation of schizophrenia. If an individual responds to an unhealthy family environment in ways that distort and magnify the environmental abnormality, he may begin to deal with reality in an inappropriate manner.
Several authorities have stressed the importance of heredity as a cause of schizophrenia. Some have ascertained statistically that schizophrenia occurs more frequently in some families than in others, though not frequently enough to permit the recognition of a transmission that is in accord with the known laws of heredity. It seems probable that only a potentiality for schizophrenia is transmitted genetically and that certain environmental pressures tend to change this potentiality into a clinical problem in some individuals.
Still other investigators have tried to find a biochemical error that may be responsible for schizophrenia. One reported that he had isolated in the blood serum of patients a substance, taraxein, that might cause schizophrenic symptoms. Other researchers have attributed the condition to a deficiency of serotonin, a chemical present in the blood and brain. Still other investigators have carried out extensive histological investigations of brain tissue, but they have failed to find any anatomical abnormality in schizophrenics.
Most schizophrenic patients are treated by physical methods, a minority by psychotherapy. Drug therapy is the most common physical method. It consists of the administration of large doses of tranquilizers, the most common of which is chlorpromazine (Thorazine). Other methods of treatment include electric-shock therapy and insulin treatment. Psycho-surgery involving the separation of certain areas of the brain, especially in the frontal lobes, is now rarely used. Increasing numbers of patients are treated by a form of psychotherapy that represents a modification of traditional psychoanalysis.
The pessimism that used to prevail concerning the effects of treatment seems to be disappearing. Although statistics about the final results of treatment are unreliable, it appears that a large number of patients treated by physical therapy have a complete remission of symptoms, particularly if treatment is initiated at the onset of the illness. Other patients improve but have some residual defects. Only a hard core never recover. Psychotherapy, when successful, brings about not only a removal of symptoms of schizophrenia but also an integration of personality that is generally superior to that preceding the onset of the disorder.
Living with Schizophrenia
It is not fully understood why some people develop this illness. It appears there is a biochemical as well as a hereditary predisposition towards it. It is also apparent that the nature of the child's early relationship with the mother and the family enter into the aetiology of this condition.
About half the people afflicted with this illness recover spontaneously and can resume a more or less normal life, although they may always seem emotionally impoverished. About one quarter of people with the illness have recurrent attacks, with reasonable states of mind in the interval, while the remaining 25 per cent deteriorate despite treatment. The poorest outlook is for those in whom the illness began in a slow insidious way.