Of all the psychoses and neuroses listed in the psychiatric definitions, probably none carries more fear and dread than schizophrenia. I guess I was a child when I first heard about this mental disorder. When I went into nurses' training, I learned more about this disease that affects about 1.3 percent of the population. Onset usually occurs in young adults, the mid-twenties for men and late twenties for women. Attention was drawn to this disorder by a recent movie, A Beautiful Mind, the story of a brilliant mathematician who developed the disorder. The movie was based on the book A Beautiful Mind: The Life of Mathematical Genius and Nobel Laureate John Nash which is a true story.

Many families have had the heartache of having a loved one diagnosed as being schizophrenic. It is a madness that tortures and torments its victims. There are several types of schizophrenic having different symptoms. In general these symptoms are:

Positive Symptoms Hallucinations are thought to be a result of over-sharpening of the senses and of the brain's inability to interpret and respond appropriately to incoming messages. A person with schizophrenia may hear voices or see visions that are not there, or experience unusual sensations on or in his or her body. Auditory hallucinations, the most common form, involve hearing voices that are perceived to be inside or outside of the person's body. Sometimes the voices are complimentary, reassuring, neutral. Sometimes they are threatening, punitive, frightening, and may command the individual to do things that may be harmful. Delusions are strange and steadfast beliefs that are held only by the observer and that remain despite obvious evidence to the contrary. For example, red and green traffic signals may be interpreted by someone with schizophrenia as instructions from space aliens. Many people with schizophrenia who suffer from persecution delusions are termed "paranoid." They believe that they are being watched, spied upon, or plotted against. A common delusion is that one's thoughts are being broadcast over the radio or television, or that other people are controlling the ill person's thoughts. Delusions are resistant to reason. It is of no use to argue that the delusion is not "real." Thought disorder refers to problems in the way that a person with schizophrenia processes and organizes thoughts. For example, the person may be unable to connect thoughts into logical sequences. "Racing thoughts" come and go so rapidly that it is not possible to "catch them." Because thinking is disorganized and fragmented, the ill person's speech is often incoherent and illogical. Thought disorder is frequently accompanied by inappropriate emotional responses: words and mood do not appear in tune with each other. The result may be something like laughing when speaking of sombre or frightening events. Altered sense of self is a term describing a blurring of the ill person's feeling of who he or she is. It may be a sensation of being bodiless, or non-existent as a person. The ill individual may not be able to tell where his or her body stops and the rest of the world begins. It may be as if the body is separated from the person. Negative Symptoms Lack of motivation or apathy is a lack of energy or interest in life that is often confused with laziness. Because the ill person has very little energy, he or she may not be able to do much more than sleep and pick at meals. Life for the person with schizophrenia can be experienced as devoid of interest. Blunted feelings or blunted affect refers to a flattening of the emotions. Because facial expressions and hand gestures may be limited or nonexistent, the ill individual seems unable to feel or show any emotion at all. This does not mean that the individual does not feel emotions and is not receptive to kindness and consideration. He or she may be feeling very emotional but cannot express it outwardly. Blunted affect may become a stronger symptom as the disease progresses. Depression involves feelings of helplessness and hopelessness, and may stem in part from realizing that schizophrenia has changed one's life, from realizing that the "special feeling" experienced in the psychotic state is an illusion and that the future looks bleak. Often the person believes that he or she has behaved badly, has destroyed relationships, and is unlovable. Depressed feelings are very painful and may lead to talk of, or attempts at, suicide. Biological changes in the brain may also contribute to depression. Social withdrawal may occur as a result of depression, as a result of a feeling of relative safety in being alone, or as a result of being so caught up in one's own feelings and fearing that one cannot manage the company of others. People with schizophrenia frequently lack the resources needed to show interest in socializing. It is most common for schizophrenia to attack young people for the first time between 15 and 30 years of age, but the illness may develop as late as age 40. It occurs in all races, in all cultures, in all social classes, and in both sexes. The risk for anyone in the population becoming schizophrenic is generally accepted as one percent. This means that about 250,000 Canadians will suffer from this illness at some point in their lives. Schizophrenia is not now curable, but through the use of anti-psychotic medication and psychotherapy, the positive symptoms of schizophrenia can usually be controlled. Full recovery may occur, but it cannot be predicted. In some cases people get better on their own. Remission usually comes within the first two years and is rare after having the disease for five years. With advancing age, particularly after 40, life for the person with schizophrenia often becomes less difficult: positive symptoms tend to diminish and medication can often be taken at a low dose or less frequently.

quote: Schizophrenia: A Handbook For Families

There seems to be a genetic predisposition for the disease. Those who are afflicted with schizophrenia and their families need sympathy, love, understanding and compassion. There is, even in this enlightened age, a great stigma attached to mental illnesses. It can be very difficult for many people to open up about how it has affected them. They have a real fear of being shunned by friends and coworkers who still picture the mentally ill as "lunatics."

The families of the afflicted suffer much heartache and pain as they watch their loved one change into someone they don't know, a person tormented by voices and visions, by irrational fears, unable to cope with even their own personal needs. Hopefully, medication will help, but sometimes it doesn't. Sometimes the only medications that work carry awful side effects. Another problem is that once the medicine takes effect, some of the afflicted persons will stop taking the medicine because they feel fine, only to sink back into the symptoms of the disease.

A good source of information online can be found at Internet Mental Health.

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Spelling correction only.

[ June 10, 2002, 10:42 AM: Message edited by: Daryl Fawcett ]

The definative work for the diagnosis, or listing of the conditions of a mental disease, (in the United States) is THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS-IV. (NOTE: I am including the revision in that catagory.) Good libraries ought to have a copy. I suggest that any interested in this refer to it. Once you have a good understanding, there are other works that will be helpful in treatment and prognosis.

Linda's reference gives a good statement of the differences in understanding that is reflected by the DSM-IV, and the ICD-10 (INTERNATIONAL CLASSIFICATION OF DISEASES, which is used both in the U. S. and in other countries.)

[ June 10, 2002, 10:47 AM: Message edited by: Gregory ]

I sadly have seen what Linda quoted firsthand as my brother is a victim of this since his teens.

He has heard voices, etc.

He had also stopped taking his medication thinking he was OK now, as well as on account of the side-effects.