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While all mental illnesses continue to carry some sort of stigma, perhaps no mental illness is more widely misunderstood than schizophrenia. In fact, prior to the introduction of some of the more modern medications, it was virtually impossible to live a normal life if one had a diagnosis of schizophrenia. The complex interplay of symptoms experienced by most schizophrenics lent those patients the classic air of madness. Moreover, the combination of hallucinations, delusions, and disorganized thought contributed to the air of dangerousness (see APA, 2000). While the mentally ill, as a whole, are no more dangerous to themselves or others than the general population, the reality is that an individual with schizophrenia could be much more dangerous than the population as a whole. Moreover, there was no standard treatment of the patient with schizophrenia. Schizophrenia crosses all races and cultures, so that a wide variety of cultural treatments contributed to the traditional treatment of a person with schizophrenia. Furthermore, schizophrenia is not as rare as one might think. Schizophrenia impacts one percent of the general population.
While that figure certainly indicates a certain level of rarity, what that figure means is that, during a lifetime, almost every person is going to know at least one person with schizophrenia. However, knowing a person with schizophrenia and accepting the disease are two wildly different propositions. People with mental illness continue to face widespread discrimination. For example, in the United States, the only group of people who can be deprived of liberty without an underlying criminal act is the mentally ill. In addition, people use pejorative terms to describe the mentally ill, and often equate mental illness with evil or bad intent. This criticism from society makes people with schizophrenia think that they are not accepted by society. In fact, some suggest that schizophrenia's most significant impact on patients is its negative symptoms, and how they contribute to the perception of dysfunction in a schizophrenic's life. Although one percent of the population lives with schizophrenia, there are highly effective treatments available to help those people live normal lives.
While it would be naive to suggest that society now embraces people with schizophrenia, the fortunate reality is that society has grown more tolerant of mental illness in general, and schizophrenia in particular. In fact, schizophrenia is more acceptable in modern society than it has been in the past. This may be due to the fact that people are beginning to understand much more about schizophrenia. In the past, schizophrenia was classified as madness. However, madness was a catch-all diagnosis, which could include mental illness, mental retardation, or physical deformity. A diagnosis of madness did not lead to effective treatment for the individual. Instead, people with madness were segregated from society, generally locked in asylums and given virtually no treatment. This isolation from society created two forms of discrimination: it lessened the presence of the mentally ill in general society, giving people the impression that mental illness was rarer than it actually is; and it gave the impression that mental illness is something to be feared, and that mentally ill people are dangerous and must be segregated from society.
Today, some facts are known about schizophrenia, which make it easier to treat the schizophrenic, and easier to understand people suffering from the disease. At its heart, schizophrenia indicates a major breakdown in the patients reality testing. In turn, this breakdown in reality testing leads patients to engage in reasoning and thinking that, to an outsider, seems bizarre and illogical. Not all schizophrenics suffer the same range of symptoms or effects. In fact, some patients may have what is considered a mild form of the disease, with limited impairment of their functioning or reason. However, for the vast majority of schizophrenics, the disease is critically disruptive of normal functioning. To understand this, one must look at some of the symptoms of schizophrenia.
One of the trademarks of schizophrenia, which is probably what has led to its confusion with multiple personality disorder, is that the patient may experience auditory hallucinations. Another symptom of schizophrenia is delusions; these delusions may manifest as paranoia, which can make the patient possibly dangerous as he responds to perceived risks, or simply as bizarre behavior that does not reflect the external reality. A third symptom of schizophrenia is a breakdown in the patient's intellectual processing, which can manifest itself in disorganized speech or thought. A fourth hallmark of schizophrenia is one that may be a cause or an effect of the disease; schizophrenics suffer from abnormally high levels of dopamine, specifically in the mesolimbic pathway of the brain. Given that dopamine and dopamine reception can play critical roles in other mental illnesses, it is no surprise that treating the disease often involves dopamine suppression. Perhaps the most critical symptom of schizophrenia is that it renders the patient socially dysfunctional, though this effect is obviously a secondary one, as it is the above three symptoms that lead to the patient's inability to socialize in an effective manner.
In fact, when one looks at the diagnosis of schizophrenia, it becomes clear that social dysfunction remains a critical part of diagnosing the disease, and, perhaps, a critical part of how society continues to treat schizophrenics. Though modern society has become more multi-cultural, discrimination certainly exists. The diagnosis of schizophrenia in the United States certainly reveals latent discrimination. However, that does not mean that it treated as a universal disease.
According to Niehas and others (2004), the term cultural bound syndrome, refers to any one of a number of recurrent, locality-specific patterns of aberrant behavior and experiences that appear to fall outside conventional Western psychiatric diagnostic categories. In other words, cultural bound syndromes are psycho-social constructs that reveal the interplay between society and the occurrence of mental illness. Schizophrenia appears to be impacted by culture; at least, the diagnosis of schizophrenia does. Although schizophrenia has been shown to affect all ethnic groups at the same rate, the scientist found that blacks in the United States were more than four times as likely to be diagnosed with the disorder as whites. Hispanics were more than three times as likely to be diagnosed as whites. When one considers that blacks and Hispanics are already marginalized in a white-dominant society, this differential diagnosis highlights the disparate treatment of those with schizophrenia.
This differential treatment is especially telling when one considers the prevalence of schizophrenia in society. The misperception is that schizophrenia is a rare disorder. While it certainly is not a prevalent disorder, like depression, it is actually one of the more common mental illnesses. Schizophrenia is one of the most common mental illnesses. About 1 of every 100 people (1% of the population) is affected by schizophrenia. This disorder is found throughout the world and in all races and cultures. What this means is that, unless a person leads a relatively isolated life, he is going to encounter someone with schizophrenia during his lifetime.
Moreover, while schizophrenia crosses cultures, it is important to realize that the diagnosis of schizophrenia is linked to culture. For example, one hallmark of schizophrenia is that the patient is socially dysfunctional. However, social dysfunction cannot be defined without looking at the norms of the surrounding society. For example, the auditory hallucinations and delusions of schizophrenia might not be considered aberrant behavior in a community that believes in direct revelations from God. In addition, one of the major symptoms of schizophrenia is a breakdown in intellectual processing, which is evidenced by disorganized speech and/or behavior. Without knowing culturally normative behavior, it is impossible to see whether speech or behavior is disorganized.
While schizophrenia may impact people of all races and cultures, it is important to note that not all people are at equal risk of having the disease. Schizophrenia tends to onset in early teens to early adulthood, with most patients beginning to experience true symptoms in their early twenties. Schizophrenia can impact both men and women, though males tend to develop the disease earlier; 40% of schizophrenic males had adolescent onset compared to 23% of females (Cullen et al., 2008). There are several risk factors that enhance one's likelihood of experiencing schizophrenia, which is why most people consider it a biopsychosocial disease. Genetics seems to play a critical role in the disease; twin and adoption studies have found that, even when environment is controlled as a factor, schizophrenia appears to run in families. However, genetics do seem to be impacted by environmental factors. For example, prenatal exposure to infection, being born in the winter or spring, living in an urban environment, poverty, childhood abuse, and substance abuse all increase the risk of developing schizophrenia.
There is no doubt that people with mental illness face tremendous social challenges. People with mental health problems have greater rates of poverty, homelessness, and unemployment than members of the general population. Schizophrenia is one of the more visibly noticeable mental illnesses, and people with schizophrenia are particularly vulnerable to the disparate impact of discrimination. This…[continue]
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