schizophrenia

Abstract
This paper describes and discusses schizophrenia. It looks at the disorder from the standpoint of history, etiology, treatment, prevention, culture and the Bible to explore its many facets. It shows that in spite of there being no known cause of the disorder, treating it is possible. It highlights the need to reduce the taboo and stigma associate with schizophrenia as a step in preventing it or at least in treating it before it worsens. It notes that from the Biblical standpoint faith can be a factor in prevention.
Keywords: schizophrenia, biblical worldview, history of schizophrenia
Introduction
Schizophrenia literally means “split mind,” and the symptoms of schizophrenia have been observed throughout all history and have been treated differently in different cultures in different eras (Kinter, 2009). The DSM (2013) classifies schizophrenia as a mental disorder that causes the patient to experience hallucinations, delusions, irrational speech patterns, anti-social behavior, a loss of willpower or motivation, and a possible catatonic state at times. This broad spectrum of symptoms should be demonstrated actively for at least a month, with behavior being monitored and observed in a continuous manner for up to six months after the initial signs. While there is no known cause of schizophrenia, and therefore no known way to prevent it, researchers are still examining a variety of different factors, both genetic and environmental, that may impact mental health disorders like schizophrenia. This paper will discuss the history of schizophrenia, what is known or theorized as the cause of the illness, how it is treated today, possible avenues of prevention, cross-cultural issues pertaining to the topic, and the disease from Biblical worldview.
Historical
From the earliest historical records, schizophrenia has been viewed as both a physical and spiritual malady, depending on the culture and the times. The ancient Egyptians saw it as a physical disease, while the Chinese and the ancient Greeks viewed it as spiritual problem (Vazquez & Santone, 2011). In ancient India, Hindus believed it to be a combination of both spiritual and physical disorders, and throughout the Middle Ages the different approaches to treating schizophrenia indicated that the people of Europe viewed it as having mental, physical and spiritual roots (McNally, 2016).
It was not until modern times that a better understanding of schizophrenia began to develop. That began in 1893 when Dr. Kraepelin referred to the disorder as premature dementia. The disorder was renamed schizophrenia by Eugen Bleuler in 1911. While Kraepelin drew attention to the topic of auditory hallucinations, Bleuler highlighted the effect of the patient having a split personality (Maatz, Hoff & Angst, 2015). Treatments throughout the 20th century have ranged from electroshock therapy to the humanistic approach of Carl Rogers (Styliandis, 2016).
Today, the primary methods used to treat schizophrenia typically include a combination of pharmacological and therapeutic approaches. Neuroleptics, mood stabilizers and anti-depressants may be used depending on the patient’s receptivity. Psychosocial therapy may also be used (Villeneuve, Potvin, Lesage & Nicole, 2010) or cognitive behavioral therapy. As Saks (2009) points out, schizophrenia is very treatable, but a patient will need a strong support system and a firm will to be committed to the treatment process. It is also important that taboos about schizophrenia be eliminated from the patient’s psyche, because these can be roadblocks to treatment that will cause the patient to resist the diagnosis (Saks, 2009).
Cause of the Illness
The etiology of schizophrenia is unknown. It is believed that there may be genetic factors, environmental factors or a combination of both that cause a person to become schizophrenic. Freud believed it came about as a result of a problem in the family dynamic (McNally, 2016). However, today, some researchers are focusing on finding a genetic link to schizophrenia, while others look for a physiological explanation, as a result of the idea that auditory hallucinations are caused by neurotransmitters failing to act in a precise manner (Dhindsa & Goldstein, 2016). Still other research has focused on the environmental factors that might lead to schizophrenia, such as stress, drug usage, viral infection, or over-exposure to toxins (McNally, 2016). The fact is that there is no evidence to indicate that any one factor serves as a cause of schizophrenia. It may be a combination of any one of these issues, and it may be something else completely. Some believe that it is at root a spiritual problem, as are all other mental problems (Ho et al., 2016).
Not knowing the cause of schizophrenia does not mean it cannot be treated effectively, however. Cognitive behavioral therapy, for example, does not depend upon understanding the causes of a patient’s problems but rather on identifying the triggers that lead to the negative outcomes and developing a behavioral plan that will. Pharmacological treatment also does not depend upon understanding the cause of schizophrenia but rather on recognizing the types of drugs that can be used to reduce psychotic episodes, depression, manias and so on.
Treatment
Treatment of schizophrenia has ranged throughout history and culture. The ancient Greeks and Romans believed that music could be used to help heal the soul (and it was their view that schizophrenia was a spiritual malady), while Eastern cultures believed diet could be altered to help remedy the physiological ailment (Stylianidis, 2016). Today, treatment typically focuses on the use of neuroleptics, therapy, and peer support systems.
Pharmacological interventions have the best rate of success followed by therapeutic interventions, when accompanied by pharmacological treatment. Dietary adjustments can be a supplementary aid (Leucht et al., 2013). Commonly, more than one drug will be used to treat a person with schizophrenia, and as Leucht et al. (2013) showed, there are dozens of effective anti-psychotics, mood stabilizers and anti-depressants on the market today. However, because each individual is different, there is no one drug or combination of drugs that works effectively universally. Rather, because everyone has a unique biology, personality, and set of sensitivities, there is basically a trial and error period in which the patient undergoing pharmacological treatment finds the right drug or combination of drugs that produce the necessary effects without exacerbating side effects.
Therapy that can be used to assist includes group therapy, psychosocial therapy and cognitive behavioral therapy. Psychosocial therapy helps the patient suffering from schizophrenia to deal with the social struggle, which can be quite daunting when dealing with schizophrenia (Saks, 2009). Cognitive behavioral therapy can be useful for augmenting the patient’s habits of thinking, behaving and feeling whenever a particular trigger is come across. Group therapy can be useful in developing a support network or finding sympathy among others who share the same experiences.
Prevention
The best prevention in the case of schizophrenia is early detection and treatment. Since it is not known what actually causes schizophrenia to occur, prevention is basically impossible. However, education and the raising of health literacy regarding schizophrenia is not. With a little education, schizophrenia can be detected early and treated before it becomes a majorly disruptive life-long disorder that destroys the life of the patient and hurts many around him or her. As Saks (2009) points out, education helps to reduce the stigma of having schizophrenia. When that stigma exists in the minds of people, they do not want to admit that a diagnosis of schizophrenia is possible. Schizophrenia is still such a taboo topic in society that people are afraid of it because they do not know much about it. They fear it and feel that if they are around someone with schizophrenia they may become schizophrenic too.
Thus, the best way to prevent schizophrenia in the sense of catching it before it totally destroys lives is to educate people about what schizophrenia is, how it can be treated, why it is not contagious, why it is not something people should fear if it appears in their family, and how people can help someone who suffers from schizophrenia. Reducing the stigma of having schizophrenia is the best thing that someone can do with respect to this particular disorder. However, if the stigma of schizophrenia is not eliminated, even the person who suffers from it may refuse diagnosis and treatment because he or she will not want to be seen as someone who is “crazy” or who cannot control his own thoughts or feelings. The stigma of having a split personality is one that can ruin careers, relationships and dreams (Saks, 2009).
Cross-Cultural
As McNally (2016) shows, schizophrenia has been in existence throughout history and across cultures. Every culture has had its own way of dealing with schizophrenia, depending on their own cultural inputs. As Hofstede has shown with his theory of cultural dimensions, there is no one universal way to look at schizophrenia outside of the medical approach as provided by in the DSM. Another important point to make about cross-cultural issues in schizophrenia is that every culture has its own views, stressors, and relationship with schizophrenia (Lee et al., 2018).
The study by Schwartz & Blankenship (2014) showed that ethnic minorities are more likely to be diagnosed with schizophrenia that whites in Europe and in North America. This could be a cultural issue in which the ethnic minority group suffers from psychological stress from being a minority and trying to cope with that situation, which aggravates a predisposition for schizophrenia. Or it could be a matter of the ethnic majority misinterpreting the issues suffered by the ethnic minority and labeling them as a psychological disorder when in reality they are actually the signs and symptoms of a social issue.
Understanding the different cultural dimensions as pointed out by Hofstede can help to address cross-cultural issues in relation to schizophrenia. Another important point to consider, however, is that in third worlds where there is a great deal of poverty and lack of access to appropriate health care, prevalence of schizophrenia may actually be higher than in the developed world. On the other hand, incidence of schizophrenia in the industrialized world appears to be on the rise as more and more diagnoses appear (Dhindsa & Goldstein, 2016).
Biblical Worldview
From a Christian perspective, the “split mind” personality could be said to be caused by the self being divided into two selves—i.e., pulled in two directions at once, which results in a kind of madness. Or it could be said to be caused by demonic possession, as was commonly believed in the middle Ages. However, as Scripcaru, Iliescu, Furnica, Scripcaru and Nistor (2017) point out, there is no clear line between a mental disorder and a demonic possession in the Bible—for sometimes it is one and sometimes it is the other: “Although diseases, possession and exorcism are considered to be the results of sins, the Bible describes each of them separately. Jesus Christ has the demiurgic capacity to distinguish between disease and demonic possession” (p. 213). The point is, nonetheless, the best prevention of schizophrenia, according to the Bible is a life spent following Christ. When one deviates into a life of habitual sin, one risks becoming a “split mind” personality, especially if one knows that one should be following Christ rather than following Satan.
The best treatment for this kind of suffering is through prayer and fasting, which doubles as a preventive measure. However, in some cases, spiritual intervention may be required, as in an exorcism. Because the nature of the disease is viewed differently by modern scientists, this type of intervention would be disputed today. However, as Scripcaru et al. (2017) note, it is not so much a matter of denying a spiritual capacity to people’s lives as it is discerning that exact nature or character of the disorder from which the patient is suffering. James 1:5-8 states, “If any of you lacks wisdom, let him ask God, who gives generously to all without reproach, and it will be given him. But let him ask in faith, with no doubting, for the one who doubts is like a wave of the sea that is driven and tossed by the wind. For that person must not suppose that he will receive anything from the Lord; he is a double-minded man, unstable in all his ways.” In other words, faith is the key to preventing the “split mind” personality from developing.
Conclusion
The etiology of schizophrenia is unknown; however, modern medicine does have ways of treating it, which include pharmacological intervention and therapeutic intervention. Throughout history, every culture has described a disorder that resembles schizophrenia and each culture and age has treated it differently—some by trying to soothe the soul through music, others by treating the physiology through food; others through prayer, and others through electroshock. From the standpoint of the Bible, faith, prayer and fasting can put one on the straight and narrow so that the “split mind” personality is avoided. Future research on the topic should focus on identifying the relationship between faith and schizophrenia to test the idea of whether there is any correlation between those who follow Christ and those who develop schizophrenia.
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