The Schizophrenias:
There is a coming and a going, a parting and often—no returning
Charles Lachenmeyer was raised under the beliefs of Christian Science. His relationship with his mother was severed drastically due to her beliefs in Christian Science and being raised primarily by his aunt. However, despite childhood trauma, Charles Lachenmeyer aged to take an interest in Sociology. Charles ultimately became a prestigious Sociology major and had some of his work published before he even graduated. His life was an array of endless possibilities. He had a loving wife, an adventurous son, an esteemed career, and even a family dog. Yet, all that changed when Charles developed paranoid schizophrenia. His wife believed that he was a hazard to his son, Nathaniel; Charles and his wife divorced. Over the remainder of Charles’ existence, his symptoms slowly escalated and his condition worsened. He began to believe a conspiracy he referred to as Thought Control was following him, sending him encrypted messages, and that he did not have a mental condition, but that Thought Control wanted him to believe he did. Therefore, Charles refused medication. Charles lived on the street surviving bitter cold temperatures, frost bite, starvation, and Thought Control. When put on trial for stealing food from various restaurants, Charles claimed that he was Commander-in-Chief and President of the United States…he was then again institutionalized (Lachenmeyer 2000).
Describe
Schizophrenia is a perplexing psychological disorder. Schizophrenia effects thought, perception, and mood. “The thought problems involved with the disease encompass difficulty with concentration, abstract thinking, and basic logic” (Seligman 415). Only 1% of the population world-wide suffers from schizophrenia. There is an estimated 2.5 million in the
Measured in economic terms, the disorder costs the U.S. 32.5 billion dollars annually in direct treatment and support costs, loss of productivity, and caregiver and related services. The majority of individuals with Schizophrenia do not marry, and most have relatively limited social contacts (Lachenmeyer 16).
“Patients with schizophrenia have been called lunatics, madmen, [and] raving maniacs, unhinged, deranged, and demented” (Seligman 416). Misconceptions are that a person with schizophrenia is dangerous, out of control, unpredictable, has a split personality, and that their condition is life long when in fact the truth is that a person with schizophrenia is usually withdrawn, shy, preoccupied, doesn’t have a split personality, and that their condition can be temporary or with permanent remission (Boehm 2006). The Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) states that the characteristic symptoms are:
Two (or more) of the following, each present for a significant portion of time during a one month period (or less if successfully treated): (1) delusion; (2) hallucinations; disorganized speech (e.g., frequent derailment or incoherence); (4) grossly disorganized or catatonic behavior; (5) negative symptoms, i.e., affective flattening [dull feeling], alogia [inability to speak] or avolation [inability to make decision] (Seligman 418).
The positive symptoms of schizophrenia include the following: delusions, hallucinations, and disorganized speech (Boehm 2006).
Delusions are false beliefs that are held even without evidence to the contrary. Delusions are also a disorder of thought content. Types of delusions are delusions of grandeur, control, persecution, reference, and somatic. Schizophrenics believing that they are kings or Jesus Christ are suffering from delusions of grandeur. A schizophrenic suffering from control might believe that aliens are controlling him. Persecution sufferers usually believe that people are out to get them; they are paranoid. Reference delusion sufferers believe that everyone is talking to them or about them; they are very narcissistic. Somatic delusions make the sufferer believe that something is rotting inside them (Boehm 2006).
Hallucinations are perceptions of visual, auditory, tactile, olfactory, or gustatory experiences without an external stimulus and with a compelling sense of their reality. The five types of hallucinations are auditory, visual, smell, taste, and touch (Boehm 2006). Auditory hallucination is hearing voices that can be pleasant or harmful. Auditory hallucinations are more common than visual hallucinations. Visual hallucinations are seeing things or people that are not really there. Smell, taste, and touch, are smelling, tasting, or feeling something that is not there (Boehm 2006).
Disorganized speech is random speech patterns that show lack of structure. Hallucinations are when a person with schizophrenia experiences sensory events without any input from the surrounding environment (Boehm 2006). There are six types of disorganized speech that include: derailment, tangential, loose association, clang association, incoherent, and neologism (Boehm 2006). Derailment is no connection to anything that has been previously said or completely and randomly picking a topic to switch to. Tangential is going off on a tangent and / or having no relation to the question asked. Loose association is making a connection based loosely on what was just said, but not stating the connection out loud making the transition sound random. Clang association is a part of disorganized speech in which the schizophrenic chooses his or her next train of thought by words that rhyme with other words that were said. Incoherent disorganized speech is like a “word salad,” all are jumbled together and make little or no sense to the listener (Boehm 2006). And lastly, “neologism is the term used to describe the creation of words which only have meaning to the person who uses them. It is considered normal in children but a symptom of altered thought content and indicative of a mental illness (likely in the psychotic spectrum such as schizophrenia) in adults” (Wyden 87).
Negative symptoms of schizophrenia include withdrawal (emotions and social), apathy or avolation (a lack of will), affective flattening, poverty of speech (“agolia”) or thought, and disorganized or catatonic behavior (Boehm 2006).
The subtypes of schizophrenia include: paranoid, disorganized, catatonic, undifferentiated, and residual (Boehm 2006).
Paranoid schizophrenia is the most common type of schizophrenia. Paranoid schizophrenics have relatively intact cognitive skills and generally no disorganized speech or catatonic symptoms. Symptoms include: delusions of persecution, control, and grandeur. They also have auditory hallucinations that are threatening and / or commanding (Boehm 2006).
Those with disorganized schizophrenia are usually shy and diagnosed between fifteen and twenty-five years of age. They have empty and purposeless behavior with no drive, determination, and no passion to meet goals. They have disorganized ramblings and incoherent thoughts. Their moods are shallow and inappropriate. They also have superficial preoccupation with religion, philosophy, or abstract themes and usually have poor hygiene (Boehm 2006).
Catatonic schizophrenia is relatively rare. They can assume inappropriate and bizarre frozen posture with motionless resistance. Catatonic schizophrenics often exhibit echolalia and echopraxia (Boehm 2006).
Undifferentiated schizophrenia meets the general diagnostic criteria but does not conform to any specific subtype. The patient can exhibit multiple subtypes but not more one that the others.
Explain
Many of those who suffer from schizophrenia have no idea they are sick (Lachenmeyer 16). “[A] common misconception about Schizophrenia is that it involves a split personality of the Dr. Jekyll and Mr. Hyde sort” (Seligman 416). Some often mistake multiple personality disorder with schizophrenia (Boehm 2006). Despite misconception, one way of explaining schizophrenia is by analyzing genetics.
Most experts refer to “the schizophrenias” as believing that it is not just on single disorder. This new change has been brought about because the symptoms between patients very greatly. Schizophrenics with the same symptoms will respond differently to the same medication (Boehm 2006). Eugen Bleuler (1857-1939) coined the term schizophrenia which literally means “split mind” (Boehm 2006). Bleuler also viewed schizophrenia for the first time in terms of the possibility of a biological explanation (Boehm 2006).
There is strong evidence that schizophrenia might be inheritable. The degree of genetic information shared with a relative with schizophrenia is correlated with an individual's risk for developing the life-impairing disorder. This means that, for example, there is an elevated risk for developing the disorder if one's father is affected than if one's uncle has been diagnosed with schizophrenia. Nowadays, the biological explanation is currently dominant (Boehm 2006). Studies have found that the concordance rate for schizophrenia is also twice as high for monozygotic twins than dizygotic twins, and if an individual is reared away from his or her biological parents, the likelihood of developing the disorder is associated with the appearance of schizophrenia in the biological parents, not the adoptive parents (Wyden 54).
Scientists have conducted a great deal of research to determine whether there is an inherited vulnerability to schizophrenia. Twin studies, family studies, and adoption studies have proved strong evidence for the role of genes in schizophrenia (Seligman).
Then, Adolf Meyer (1866-1950) looked beyond the biological explanation to a psychological explanation (Boehm 2006). Another theory of Schizophrenia from the psychological theory is that of the schizophrenogenic mother.
This theory states that the mothers of schizophrenic individuals tend to be cold, rejecting, and yet controlling. Throughout childhood, the mother engages in double-binding communication with the child, creating a relationship characterized by constant contradictions between verbal and non-verbal information. The child is left in a confused state and must choose to obey either the verbal or the non- verbal messages. This leads to a weakening of the child's understanding of reality wherein the child must develop his or her own creative explanation of events (Wyden 34).
There is also a socio-cultural explanation to explaining schizophrenia.
There are two main hypotheses concerning the sociological causes of schizophrenia: the downward drift hypothesis and the social selection hypothesis. The downward drift hypothesis says that, given the level of functional impairment that occurs and is a necessary aspect for diagnosis, impairment will also occur in functional and occupational areas of life and lead to a downward drift in socioeconomic status (SES). Empirical studies that support this theory show that schizophrenic victims, differing from normal patterns, have a lower SES than their parents. The social selection hypothesis states that individuals who have a lower SES exist in environments that are more stressful--including aspects of life such as more crime, poverty, hunger, less education, and less nutrition--and are therefore more vulnerable to developing schizophrenia. Both of these hypotheses indicate that the development of schizophrenia is highly correlated with the level of stress in the individual's environment. Proof for this can be found in empirical evidence indicating that when the economic condition of a country is bad, a higher number of cases of schizophrenia is reported (Wyden 44).
The three explanations for schizophrenia consist of biological, psychological, and socio-cultural. All three present possibilities for explaining this perplexing ailment…but what about treatments for this disease?
Treatments
Treatments range including such practices as drug therapy treatments, psychological treatments, and interpersonal training. A variety of new approaches have been tried over the past five decades. The results have been mixed, although generally encouraging (Seligman 461).
Drug Therapy
Until the 1950s, the treatment of schizophrenia was primarily custodial. Patients were hospitalized for long periods of time in institutions that were sometimes boring and hopeless. Often their disorder and hospital environment interacted to being about behavior that required physical constraint (Seligman 456).
Then, in 1952, chance changed this dreary situation and put into motion the drug treatment approach to schizophrenia. While working with fresh combinations of drugs called antihistamines which were originally intended to aid asthmatics and allergy sufferers, the drugs were noticed eliciting soothing effects (Seligman 456).
In fact, one of the drugs, promethazine, was so tranquilizing that the French surgeon Henri Laborit gave it to his patients as a prelude to anesthesia. Using a close relative of promethazine with even stronger sedatives effects, French psychiatrists Jean Delay and Pierre Deniker treated mentally disordered patients with varying results (Seligman 456-457).
A diagnosis of schizophrenia was used to label patients who’s conditioned improved. Chlorpromazine was the drug given to those suffering; this new drug revolutionized treatment. Antipsychotic made an incredible improvement in the world of the mentally ill (Seligman 457).
Since the introduction of antipsychotic, drugs, the number of psychiatric inpatients has decreased dramatically. In 1955, there were about 560,000 patients in American psychiatric hospitals. By 1968, that number had declined further to 161,000 patients, of whom fewer than half were diagnosed with schizophrenia (Seligman 457).
Psychological Treatments
Early psychological approaches to the treatment of schizophrenia used psychodynamic techniques with the patient and family members. There was little evidence that this was beneficial to patients. Contemporary psychological treatments for schizophrenia focus on the cognitive problems and social adjustment problems associated with the illness.
Also, many believe that cognitive rehabilitation has great potential in aiding those dealing with schizophrenia (Seligman 462). Then, interpersonal training is also a treatment that shows great promise in helping schizophrenics. Penn and Muser state:
Social skills training is used in many treatment programs for schizophrenia. Training in social skills usually includes discussions about patients’ social experiences, structured role playing of social interactions, and various didactics procedures intended to improve social problem solving. Most studies have shown this type of intervention to be beneficial (Seligman 464).
Family therapy educates relatives about schizophrenia and improves their skills in communicating with the patient has proven to be effective in reducing relapse (Seligman 464).
“However, the ideal treatment for schizophrenia involves carefully monitored psychopharmacological intervention, combined with psychological intervention that is implemented within the framework of a community program” (Seligman 464).
Boehm, T. (2006, April 27). Schizophrenia [Lecture]. In Psychology 230: Abnormal
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Kafka, F. (1998). The Castle.
Lachenmeyer, N. (2000). The Outsider: A Journey into My Father’s Struggle with Madness.
Seligman, M. (2001). Abnormal Psychology ( 4th ed.).
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Wyden, P. (1997). Conquering Schizophrenia.
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